Home births vs the hospital – what you need to know

If you’re expecting a baby then you’ll probably know that you’ll have a choice between a home or hospital birth. If a home birth is something you’re considering it’s important that you weigh up the relative pros and cons. A home birth means you’ll be giving birth at home as opposed to the hospital, and if this is something that you are considering it is important that you discuss it with your doctor.

What are the benefits of a home birth?

The first pro of a home birth is that you are at home, in a familiar environment with familiar people or trusted friends. It is only recently that hospital births have become so common, and prior to half way through the 20th century, most births did happen at home .

Another reason why some moms choose to deliver at home is the fact that allows them to give birth with a lesser degree of medical intervention and they have more freedom in the birthing process. After giving birth you are able to be in the comfort of your own home with your new baby and family, another reason why home birth would be chosen over a hospital by moms.

If you think this may be an option for you, you’ll need to find a midwife who has experience with home births so that if any issues should arise, she has a contingency plan to deal with the situation.

The risk depends on your situation. If you are only carrying one baby, don’t have diabetes or high blood pressure, haven’t had a previous c-section and live around 15 mins away from the nearest hospital (in case of emergency) you are a more ideal candidate for a home birth. It’s important to weigh in on the possible risks  before deciding if a home birth method is right for you and your baby.

When would the hospital be a better option?

Generally speaking, hospital births are safer because there are always doctors available in the case of an emergency, for instance if the baby becomes blocked in the birthing canal or the mom starts hemorrhaging.

During your home birth, you may need to be transported to the hospital if your labour or birthing process doesn’t go to plan (that’s why it’s important to live close by to one if you choose this option). If your labour is slow, you need pain relief, the baby shows signs of distress or isn’t head first it’s best to be transported to the hospital for medical assistance.

What do you need to prepare for a home birth?

If you are seriously considering a home birth make sure you’ve consulted with your doctor to make sure this is a good option for you and your baby. If it’s something you want to consider, you’ll probably be wondering what you need to prepare for a home birth.

Before getting to the details, you’ll need to choose a midwife or health care professional to assist, create a birthing plan, a well as a plan to prepare for a hospital transfer, should this become needed.

If you still have questions, Home Birth South Africa, which is a website dedicated to home births in South Africa, has many resources you can browse through.

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What is HELLP?

Pregnancy and the arrival of a new baby is a time of great excitement and joy for expectant parents.  However, occasionally there can be complications, which is why pregnant moms should have regular health checks and be aware of any unusual symptoms that may develop.

Over the past few years, there has been discussion around a condition known as HELLP Syndrome. It’s a life-threatening complication in pregnancy that can be difficult to diagnose. We reached out to Dr Morgan Mkhatshwa, Head of Operations at Bonitas Medical Fund and his clinical team, to get some answers and advice about HELLP.

What is HELLP Syndrome?

HELLP (Haemolysis, Elevated Liver enzymes, Low Platelet count) Syndrome usually develops before the 37th week of pregnancy but can occur shortly after delivery.  It’s a serious complication that affects the blood and liver.

H = Haemolysis is the breakdown of red blood cells that carry oxygen from lungs to the rest of the body.

EL= Elevated liver enzymes.  High levels of these chemicals in the blood can be a sign of liver problems.

LP = Low platelet count.  Platelets are little fragments of blood cells that help with blood clotting.  A low platelet count can lead to serious bleeding.

What causes HELLP?

‘We don’t know what causes HELLP syndrome,’ says Dr Mkhatshwa, ‘however, you are at risk if you have pre-eclampsia or eclampsia.’  About 1 to 2 in 10 pregnant women (10 to 20 percent) with pre-eclampsia or eclampsia develop HELLP. 

Pre-eclampsia is caused by high blood pressure. It usually starts after the 20th week of pregnancy or giving birth. Eclampsia is when pre-eclampsia is uncontrolled and causes seizures. Many women are diagnosed with pre-eclampsia before they have HELLP which is a more severe form of pre-eclampsia.

What are the symptoms / signs of HELLP? 

You may feel tired, have pain in the upper right part of the belly, bad headaches and nausea or vomiting. You may also experience swelling, especially of the face and hands and blurry vision. Some women develop HELLP suddenly, without having any signs or symptoms. 

If you have any signs of HELLP Syndrome, call your medical practitioner, emergency services or go to a hospital emergency room for medical care right away.

How is HELLP diagnosed?

To find out if you have HELLP Syndrome, your healthcare provider will do a physical exam to check  for:

  • Belly pain or soreness, especially in the upper right side
  • An enlarged liver
  • High blood pressure
  • Swelling in your legs

Other tests could include:

  • Blood tests to check your liver enzyme levels, lactate dehydrogenase and full blood and platelet count with a peripheral smear
  • Urinalysis to check for protein in the urine
  • A CT scan to see if there’s bleeding in your liver
  • Non-stress test or ultrasound to check your baby’s health. A non-stress test checks your baby’s heart rate, in the womb, to see how the heart rate changes when your baby moves. This test is to make sure your baby’s getting enough oxygen. Ultrasound uses sound waves and a computer screen to show a picture of your baby inside the womb

Is HELLP painful?

Symptoms of HELLP include serious pain just below the ribs, or the upper right side of the chest area (where the liver is), shoulder pain or pain when breathing.

How is HELLP treated?

You may be given medication to control your blood pressure and prevent seizures or you may require a blood transfusion to treat anaemia and low platelet levels. 

Early birth may be necessary because HELLP complications can get worse and harm both you and your baby – either through an induced labour or by C-Section depending on the health assessment results of the baby. 

How does it impact the baby?

Infants born to mothers with HELLP Syndrome may have a variety of birth injuries: Intrauterine growth restriction (IUGR) or severe respiratory distress.

Are there long term effects of HELLP?

A history of HELLP Syndrome means you are at increased risk for recurrent pre-eclampsia and HELLP Syndrome as well as increased long-term morbidities, particularly depression and chronic hypertension.

Can HELLP develop after childbirth?

Yes, up to 30% of all patients who develop HELLP Syndrome do so after giving birth, typically within 48 hours. 

Can I have another baby after HELLP syndrome?

If you had HELLP in a previous pregnancy, regardless of the time of onset, you have a greater risk for developing it in future pregnancies.

‘The condition is serious but rare’, stresses Dr Mkhatshwa. ‘Throughout your pregnancy it’s important to understand the changes your body is going through and to discuss any unusual pain or symptoms with your medical practitioner. This will ensure you receive the right help especially if you develop a complication and make the pregnancy and birth the joyous event it should be!’ 

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Veganism and pregnancy

Veganism is becoming an increasingly popular lifestyle which abstains from the consumption and use of animal products, predominantly for health, and/or ethical reasons. If you’re vegan and are considering pregnancy, or are pregnant, you are probably wondering how to best provide nutrients for your growing baby, and if veganism is still the best option for both of you.

Can I stay vegan while pregnant?

Veganism is often criticised for its lack of certain vitamins and minerals that a typical ‘balanced’ diet contains. Luckily, it is still possible to stick to your vegan diet during pregnancy – you’ll just have to make sure that your growing baby receives the nutrients that she needs.

While pregnant, it’s important to eat foods that contain folic acid (a B vitamin), calcium, vitamin D, iron and protein – you can get this from the food you eat as well as supplements. If you’re wondering where you can find these important nutrients in a plant-based diet, read on.

Citrus fruits, dried beans and leafy green veggies are all foods that include folic acid. Typically dairy is a source of calcium, however, non dairy foods rich in calcium are broccoli and kale.  Vitamin D can be found in mushrooms and fortified products, such as rice milk and soy milk.  Although meat is often seen as a primary source of protein, beans, peas, nuts and seeds are all rich in protein. Potatoes and tofu are also good foods to eat when replacing meat protein, and iron can be found in spinach and beans.

What nutrients are typically lacking in a vegan diet?

As a vegan, there are certain nutrients that you can’t find in plants – during pregnancy it becomes even more important to supplement these. Vitamin B12 (which helps with proper brain development), vitamin D (which aids bone and teeth development), omega 3 fatty acids and iron (you’ll need about twice as much when pregnant) are vitamins and minerals you might need to supplement.

Even if you’re not vegan, making sure your baby gets all the correct nutrients is important and may mean adjusting your diet. If you are planning on sticking to a strict diet plan it’s a good idea to consult with someone knowledgeable first.

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Putting together your birth plan

As you enter your third trimester you’ll have probably done a fair bit of research on the birth process (if this is your first) and may have a good idea of what you want before, during and after delivery. There are many options and opinions, from whether or not you want pain medication to how many people you would like supporting you. However, trying to keep track of your choices during labour may be tricky, which is why you’d put together a birth plan. So what exactly is it and how do you put one together?

Why should I put together a birth plan? 

Your birth plan is your choices or preferences before, during and after labour and delivery. While things may not always go according to plan, having your preferences written down and communicated means you, your midwives and doctor have a more mutual understanding. However, if your pregnancy doesn’t go accordingly, you need to be prepared to make adjustments on the day.

What should be in my birth plan?

Your birth plan is how you’d like everything would go in the best-case scenario. Your birth plan will also have to take into consideration what is available at the hospital or place where you are giving birth.

Some birth plans are very basic, just outlining a simple overview, whereas others may be far more detailed and in-depth. The choice is yours.

Typically a birth plan will include before, during and after labour and birth preferences. Such as who you want to assist you during birth, whether or not you want any pain medication,  you birthing positions, and requests for newborn care, such as skin-to-skin time.

How can I learn more about the birth process? 

If you feel like you need to top up your birthing knowledge before putting together a plan they are a few ways you can go about this. Joining antenatal classes are a good way to learn more and to meet other women in your position. Chatting to friends or family who has been through the birthing process themselves is another good way to see what would work best for you. If you and your partner are having a baby together, keep them in the loop as well. Find out what they expect during labour and you can chat about what you want, and what role you see them playing in the process.

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