Maternity services are critical for the safe delivery of babies. Childbirth is not a very predictable exercise, and many people assume that giving birth in hospital is the safest way of handling it (Coyne, Timmins, & Neill, 2010). However, childbirth is not just a biological exercise. It is also a very emotional process for the mother and close relatives. There is a view amongst some medical professionals that unless there are complications during delivery, there is really no overwhelming need to send mothers to maternities to deliver because childbirth is a natural process (Coyne, Timmins, & Neill, 2010).
This case considers the case of Maria (not real name), who chose to deliver her baby from home with the assistance of her sister, who is a registered nurse. This case looks at the issues that came up regarding her decision and the benefits and risks that arose. If more women knew about this possibility, then it is likely that many of them might choose to deliver their children from home as opposed to hospitalization since pregnancy is not a medical condition. Therefore, looking at it as a case that may affect the practice of medicine will provide insight on how to handle women who want to deliver from home. The story of Maria is inspiring as it is intriguing. It raises several possibilities and question regarding the choice of a location for childbirth and the role of formal institutions.
Maria attended prenatal clinic in the regional health center, which is located in a rural area. The health center serves about fifty outpatients daily on average, and has a ten bed maternity wing. On average, the health center delivers three babies daily. The staff at the hospital all along assumed that Maria would come to the health center to deliver because of her strong relationships with many of the workers. Her own sister was a nurse at that health center. Maria volunteered her time at the hospital every weekend. She normally came in on Sunday afternoon to help care for pregnant mothers and in-patients who did not have any visitors. The members of staff at the health center knew Maria very well because of her volunteer work. There was a whiff of excitement in the health center when word went round that Maria was pregnant.
Maria had two children already. Their births were normal, without any incidents whatsoever. She was a strong woman, both physically and emotionally. Her last born was about seven years old. Maria’s pregnancy records did not show any anomalies. Her baby was growing normally, and she took her doctor’s advice seriously. It helped a lot that her sister, who she accommodated, was a nurse at the health center. Maria had the reputation of being resolute in her decisions.
In fact, she represented the fruit farm workers where she worked as a fruit packer. She was also a very keen woman. People that knew her personally found her to be strict but understanding. She went the extra mile to gather facts about any issues she faced. As a result, her colleagues, neighbors, and workers at the fruit farm trusted her decisions. She had such clarity of mind on issues, which earned her the nickname, “Super Maria”. This is why it took everyone by surprise when Maria broke the news that she would have her third baby in her own house.
Two years earlier, Maria attended a seminar conducted by a visiting midwife, which focused on the needs of pregnant women. The midwife must have had a huge impression on Maria. From that time, Maria debated severally with the nurses and doctors about the benefits of giving birth in a familiar, non-medical surrounding. Her key argument was that pregnancy was not a medical condition, but a natural biological process. She argued that while it made sense to prepare for any eventualities by giving birth in hospital where it would be possible to deal with any complication, it was possible to make those arrangements without having to book a hospital bed. There were other issues to consider, such as the emotional well-being of the mother, support from familiar people, and being around an emotionally meaningful surrounding. The nurses and doctors saw her point but did not imagine this was a view that anyone could act on. After all, Maria volunteered at the maternity. Surely, they thought, she believed in the benefits of delivering in the hospital.
Maria insisted that she would prepare a room in her house for her third delivery. No one could talk her out of it. She understood the risks, and was prepared to seek the benefits of a home delivery at all costs. When her doctor realized that Maria would not change her mind, he prepared to handle Maria under her own terms. Since she had not had a complication earlier, and her pregnancy seemed to progress well, he did not feel the pressure to insist on a change to Maria’s plans. The doctor called Maria for one more meeting to discuss his professional opinion and to discuss the risks that Maria was taking.
In a sense, the doctor wanted to free himself of any liabilities relating to professional negligence if anything went wrong. However, he did not expect any problems with Maria’s delivery. The doctor imposed a few conditions on Maria as his terms in accepting Maria’s desire to deliver from home. Maria agreed to have a midwife and a nurse from the health center to assist her in the delivery. The doctor offered to come to her house when she went into labor to check her vitals, and to ensure that the baby was fine. In addition, the doctor made Maria promise to go to the hospital to allow for a full examination of the baby within six hours of delivery. The doctor also arranged with the health center ambulance to be on standby in case there was a complication during childbirth.
Maria’s sister, together with a midwife attached to the health center went to care for Maria when she went into labor. There was no incident, with Maria delivering a healthy baby boy. The doctor chose to visit her as soon as he heard she had delivered. As he walked into the room Maria and her baby were, he could not help but notice its natural warmth. A pair of candles burnt silently on the dressing table. Beside Maria, there was a huge cup of cocoa, steaming away.
Everyone who knew Maria personally also knew that she loved a cup of hot cocoa. The carpet in the room had seen better days. It vaguely matched the cream-colored duvet that covered Maria. Maria was wearing a warm smile. She looked exhausted, but very relaxed. Her eyes shone with the joy of motherhood. Maria’s husband and their two older children were taking turns to rock the newborn in his straw cot. It was clear to the doctor why Maria had chosen to deliver in her own house. The room spoke of love and comfort. The mood was very uplifting devoid of the smell of medical supplies and disinfectants that fill every hospital ward.
It seemed to him that the risk was well worth it. No hospital could provide that kind of atmosphere. Just then, the baby let out a cough. It was a little dry, and unexpected. He looked at Maria and saw the surprised concern in her eyes. He called the ambulance immediately. The last time he heard that type of cough, it was the beginning of a long battle with lung infection. The baby never made it. Luckily, after examination at the health center, the Maria’s baby seemed fine. The cough was just a chance occurrence. There was no reason to worry.
The story of Maria illustrates the risks that many doctors face on a daily basis. They struggle to make decisions that are in the best interest of their patients (Miller & Webb, 2011). In addition, they must look at their legal liabilities as they make these decisions. In the area of maternal health, there are benefits such as those that Maria’s story illustrates. A mother can get emotional support from the immediate family, friends, and relatives if she chooses to deliver from home.
In addition, it gives the mother and her support group the chance to create an environment that supports the delivery process. The mother in this case is the only person of interest, compared to a maternity full of mothers in various stages of labor. In hospitals, mothers get medical attention with no emotional support (Miller & Webb, 2011). The medical professionals approach childbirth from a medical angle to the exclusion of the psychological and emotional aspects of the childbearing experience.
Replicating home delivery is a tall order. Maria had the support of the health center when she decided to deliver from home. If the precautions taken by the health center for Maria are unavailable, then delivering from home can be a dangerous thing. A complication that a doctor can solve easily in a hospital maternity may put the life of the mother and child in danger if there is no doctor at hand.
Maria’s doctor felt that home delivery is a viable option for mothers who choose to deliver from the comfort of their homes. However in an administrative meeting, the health center ruled that they would only support home delivery if there was a doctor on call, a nurse and a midwife to support the mother, and the delivery cannot be more than five minutes driving distance from the hospital in case of the need for ambulatory services. Since then, two more mothers have opted for home deliveries, and Maria volunteered to support them through the process.
References
Coyne, I., Timmins, F., & Neill, F. (2010). Clinical Skills for Children’s Nursing. Oxford: Oxford University Press.
Miller, E., & Webb, L. (2011). Active Listening and Attending: Communication Skills and the Healthcare Environement. In L. Webb, Nursing: Communication Skills for Practice (pp. 52-72). Oxford: Oxford University Press.