Childbirth in residence

Presentation

The modern childbirth with residence has nothing to do with those practiced before the appearance of the Pénicilline, the Ocytocique S and the modern techniques obstétricales. The latter were much riskier: the conditions of Hygiène were summary. The pregnancies many, were supervised little, badly respected. The doctor or the midwife (when they were present) did not have effective means of monitoring before and during work. The absence of recourse to the echography made more random the diagnoses of twin Grossesse, of dystocic presentation, Procidence of the cord or Placenta praevia. In addition, the hospital was a long time a high-risk place because them infections which could touch the Parturient are and the new-born babies.

From the years 1960, the vast majority of the women of the developed countries are encouraged to be confined at the hospital. Working comfort of the professionals in residence, bad conditions of displacement in the event of urgent transfer to the hospital, current of modernization of the pieces of housework and feminist current, support of advantage this movement that medical reasons. The Netherlands, nevertheless, perpetuate the practice of the AAD with a rate which borders 33 % of the births. Then Great Britain (continuation, in particular, with the report/ratio Changing Childbirth of the permanent Parliamentary commission on maternity, in 1993) registered in the center of its health-care system the freedom of choice of a AAD and the legal requirement for the hospitals provide for their accompaniment by midwives with their services.

The childbirth in residence remains minority in the countries of the South of Europe, of which France. However, in spite of the difficulties encountered by the French midwives, the number of those/those which accompany by the AAD continues to grow. Moreover, Belgian or German midwives practice in all legality on the French soil in the border regions.

The motivations of the couples which choose the modern AAD are multiple. Among them, one can quote:

will of réapproprier birth of their child, to be respected as responsible parents.
the need for the women to feel in confidence and in the intimacy for " travailler" in peace, of being able to be driven, feed and choose the position of childbirth which is appropriate to them, possibly in water.
the absence quasi-systematic of interventions of repeated vaginal the examinations type, drilling of the pocket of water, episiotomy, perfusion the oxytocic ones, Monitoring uninterrupted or intermittent but too long and frequent, or abdominal expression. Each gesture being discussed before the childbirth (advantages, disadvantages). During the childbirth, the gestures suggested are justified according to the circumstances and approvals by the woman.
a non-violent birth for the child, according to the criteria establish by the parents: the light is filtered, the cord is cut when it does not beat any more, the child is maintained against his mother in skin with skin, it immediately is not washed nor not aspired, it is put at the center at will.
a follow-up postpartum in residence in family supporting the rest, the wellbeing of the other children, the participation of the father, and a weaker occurrence of the postnatal Depression, the bond mother-child having been preserved and encouraged to the maximum.

The AAD is accompanied mainly by midwives, sometimes by Médecin S. the expert brings a kit of Réanimation for the mother and the child, of the products of Perfusion making it possible to face in the majority of the complications. It has a portable monitoring allowing of the recordings of the cardiac activity of the Fœtus.

Some statistics

In 1989,33.4% of the 190079 births in the Netherlands took place in residence. The midwives had the responsibility for 45.7% of the women, general doctors 11.3% and obstetricians 43.0%.

Safety

The childbirth in residence can be carried out only under certain conditions: the pregnancy must be “physiological”: no the Twin birth , not of presentation in seat, not of Placenta praevia, not of counter-indications of the type Hypertension. An inscription in a close maternity is often carried out in the event of possible transfer. In Belgium, the midwife (known as also obstretician) " authorized to follow in Belgium the occupation of obstretician or to achieve there services in the capacity as obstretician, is entitled to assume under its responsibility the monitoring for expectant mothers for whom a high-risk pregnancy was excluded, to practice the childbirth whose evolution will be most probably Eutocique and to look after and accompany the mother and the child during the normal Post-partum. The normal pregnancy and the childbirth eutocic are the whole of the physiological, mechanical and psychological phenomena which lead to spontaneous expulsion, in the long term, initially of the fetus in presentation of the top and then of the placenta." (http://users.swing.be/carrefour.naissance/Sage-Femme/loibelgeprofsf.htm)

The epidemiological studies showed that the perinatal results (especially concerning death rates) were comparable, subject to medical good conditions, whatever the place chosen for the childbirth, in the case of pregnancy at the weak risk followed by a personnel médicalement qualified. Beyond these general observations, no prospective study randomized (the best level of scientific proof) can be planned to compare the perinatal results between the various modes of assumption of responsibility of the childbirth. Indeed, for reasons of ethics, the parents must profit from a whole freedom of choice apart from any emergency obstétricale, which prohibits any experimental protocol based on a drawing lot.

In the absence of scientific evidence, the colleges of gynecologists-obstétriciens of several industrialized countries continue to condemn with very practical firmness of the childbirth out of the hospital framework (what as well excludes the Maisons from Birth).

One can quote three publications based on retrospective studies representative of the practice of the AAD in France and in the countries bordering:

Results compared of births planned with residence and the hospital for pregnancies at the weak risk: exploratory study of the practices of the midwives in the Netherlands (T has Wiegers, MR. J NR C Keirse, J van der Zee, & G HAS H Berghs). British Medical Journal, 1996; 313:1309 - 1313. (See original version) does
Childbirth in residence, risk or model? (Cathy-Anne PIREYN-PIETTE). Memory of end of studies for the diploma of state of midwife, School of midwives of Strasbourg, 2005.
total Accompaniment with childbirth in residence in France of 1997 to 2001 (Mathilde MUNIER). Memory of end of studies for the diploma of state of midwife, School of midwives, UFR of medicine Cochin Port-Royal, University Paris V, 2005.

Window of the Collective " To be born At Soi"
Gate Birth
Collective Interassociatif Around the French-speaking Birth
Alliance for Acouchement Respected
http://accoucherautrement.free.fr/
http://perinatalite.chez-alice.fr/

Recommendations of WHO

http://www.who.int/reproductive-health/publications/French_MSM_96_24/MSM_96_24_chapter6.fr.html
http://www.who.int/reproductive-health/publications/msm_98_3/fr/index.htm

Charter of the childbirth in residence

http://www.ansl.org/Pages/charteansfl.htm

Repertory of the experts in residence in France

Approximately 60 midwives or general doctors practice AAD in France in 2006. See the repertory of experts of the total accompaniment: http://perinatalite.chez-alice.fr/repertoire-praticiens.pdf
Another repertory resulting from the site of the National association of the Liberal Midwives: http://www.ansl.org/images/Accoucheuses.pdf

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