What to Do During an Out-of-Hospital Birth

18 September, 2020
In this article, you'll learn more about out-of-hospital births, health recommendations, and requirements to carry it out.

As its name entails, out-of-hospital birth refers to a birth that takes place outside of a hospital. Moreover, there are many circumstances that lead to an out-of-hospital birth; such as a mother’s decision to give birth at home, or a sudden development that prevents the mother from reaching the hospital on time.

In many countries and regions around the world, out-of-hospital births taking place in homes is an option covered by the public health system. Thus, if a pregnant woman meets the necessary criteria and wants that type of delivery, she can request it.

If a woman wants a home birth, she can also hire the services of independent midwives who, within the legal framework of each country, can attend to it with all the safety measures.

Requirements for an out-of-hospital birth

“Normal childbirth is when a woman starts, continues, and completes her pregnancy in a physiological way. Physiological delivery is a safe option for mothers that offers health and social benefits, both in the short and long term for mothers, their children, families, and society in general.”

– RCM 2007 –

There are multiple action guidelines prepared by health agencies around the world. They include essential requirements to be able to recommend a home birth.

What to Do During an Out-of-Hospital Birth

It’s essential that any planned home birth be attended by a qualified, registered health professional who works within the legal framework. This qualified professional is a midwife.

These are some of the fundamental requirements to carry it out:

  • The spontaneous delivery starts between 37 and 42 weeks of gestation.
  • The fetus is in a cephalic presentation.
  • Control tests performed during the pregnancy had normal hemoglobin values (Hb≥10g/dl).
  • Body mass index (BMI)≤30 when pregnant.
  • Single gestation. 
  • Maternal medical history is without relevant complications.
  • Maternal obstetric history doesn’t have complications. 
  • Absence of relevant signs or symptoms related to pregnancy complications. These include preeclampsia, intrauterine growth restriction (IUGR), cholestasis…
  • Proper hygiene control during pregnancy (performing ultrasound analytics)

Contraindications for an out-of-hospital birth at home

Any deviation from normality would be a contraindication to request assistance for a home birth due to the possible increase in risk it would entail. These are just some of the contraindications studied to this day:

Health problems or maternal diseases

  • Cardiovascular diseases or problems (hypertension…).
  • Respiratory problems.
  • Hematological diseases.
  • Increased risk of infection. 
  • Immune, endocrine or renal diseases.
  • Neurological problems.
  • Gastrointestinal or liver diseases.
  • Psychiatric disorders.

Obstetric history with factors that suggest a higher risk

  • Complications in pregnancies or previous deliveries: preeclampsia, eclampsia, cesarean section, postpartum hemorrhage, previous uterine surgery, shoulder dystocia…
  • Deviations from normality in a current pregnancy. This includes multiple gestations, placenta previa, preeclampsia, preterm birth, abnormal presentation (buttocks or transverse)…
  • Fetal indications: small fetus according to gestational age, abnormal fetal heart rate or altered Doppler ultrasound, large fetus according to gestational age, presence of malformations…
  • Previous gynecological history: myomectomy (removal of uterine fibroids), hysterotomy (previous uterine incision, for example, a cesarean section).

Keep in mind that each woman and each pregnancy are unique. Thus, each situation is studied individually to guarantee the safety of the mother and the baby at all times.

Unplanned out-of-hospital birth

On many occasions, a woman’s water unexpectedly breaks in a place that’s not a hospital. It can take place in a health center, her own home (without planning), the street…

When an unexpected birth occurs, the most common causes are usually:

  • Multiparous women (those who have previously given birth).
  • Small fetuses or premature births.
  • Excessive distance to the hospital, usually in big cities.
  • Being in peripheral or rural areas away from your reference hospital.
  • Teenage pregnant women.
  • Unwanted pregnancies that are hidden until the birthing process begins.

What to do in an unplanned out-of-hospital birth

If you witness an out-of-hospital delivery or if it’s you who will unexpectedly give birth in a place you didn’t plan on, you can follow these recommendations:

  • Firstly, request health assistance by dialing the emergency number in your region.
  • Stay calm and ask for help from people around you.
  • Try to locate a place as quiet and safe as possible that encourages privacy.
  • Request clean and dry towels or clothes.
  • If it’s your birth, let your instincts guide you. They will surely tell you what position to adopt and what to do. If you accompany another woman during childbirth, tell her to trust her instincts and stay by her side.
  • Emotional support at that time is essential, don’t separate from her and also let her know that you are there.
  • If the baby is born, it must go directly to the arms of the mother for skin-to-skin contact.
  • Check that the baby is breathing correctly and also that the nose and mouth are clear. Cover the baby with clean and dry clothes, especially the head. Subsequently, dry the baby well.
What to Do During an Out-of-Hospital Birth

Other recommendations

  • You don’t need to do anything with the umbilical cord. Moreover, it’s not necessary to cut it if sterile tools aren’t available.
  • If the placenta is expelled (afterbirth), put it in a plastic bag to have it checked later in the hospital. It’s ok if the baby and the placenta are still connected by the umbilical cord.
  • Gently massage the mother’s abdomen to help the uterus contract and reduce bleeding.

In the majority of unplanned out-of-hospital births, emergency health professionals arrive before the baby is born; they’re the ones who assist with the expulsion and delivery. They assess the need to carry out more advanced measures, such as administering medication.

Regarding out-of-hospital birth, remember…

An out-of-hospital birth that is planned at home is a delivery option that’s safe for the mother and the baby. Just make sure a healthcare professional (midwife) fulfills and performs the criteria set forth above. 

As with any birth, complications may arise. It’s undoubtedly essential for you to consult a midwife if you consider this alternative for your delivery. Also, solve all your questions and concerns, and request scientific facts and information.

  • Vázquez Lara J.M., Mora Morillo J.M., Rodríguez Díaz, L. (2012). Etapas del montaje de una guía audiovisual de asistencia al parto urgente, destinado a personal sanitario de urgencias y emergencias. Matronas Prof. 2012; 13(1): 29-32
  • Vázquez Lara J.M., Rodríguez Díaz L., Palomo Gómez R. Manual de atención al parto en el ámbito extrahospitalario. Instituto Nacional de Gestión Sanitaria (INGESA). Ministerio de Sanidad, Servicios Sociales e Igualdad. Disponible en: http://www.ingesa.mscbs.gob.es/estadEstudios/documPublica/internet/pdf/Parto_extrahospitalario.pdf
  • Alcaraz Vidal L., Casadevall Castañé L., Díaz-Maroto S., Domínguez Cano P., et al. (2018).Guía de asistencia al parto en casa. Associació Catalana de Llevadores. Disponible en: http://www.llevadores.cat/docs/publicacions/Guia_PartoCasa_2018.pdf