Following the presentations that different European specialists and user associations recently made in Madrid at the ENCA conference, I now refer to the one in which we talked about the “delivery houses”Or“ birth houses ”in Germany. The conference was given by Elizabeth Geisel, coordinator of ENCA and member of the German Society for Childbirth Preparation.
The delivery houses in Germany independent places where women can give birth in a physiological way, by themselves, without more provocation than those of their own hormones and accompanied by the person of their choice. There, parturients receive assistance only from midwives or midwives. There is a midwife per parturient, and it does not change during the active period of childbirth.
A delivery house It is part of the so-called "Network of birth houses" and all have common minimum criteria, which can evolve with the experience of midwives. But there is also a list of exclusion criteria. And also only pregnant women who attend prenatal control in the delivery house can give birth there, since midwives know them well.
Before 1950 in Germany Most babies were born in their homes. But after the Second World War there were health problems and. For that reason and for economic reasons, women began to go to the hospital to give birth. Approximately from that date the births in the hospital began to be in charge of Social Security. And it coincided that from that same time both maternal and perinatal mortality was reduced. Consequently, it was deduced that the hospital was much safer than a house as a place of delivery. This deduction was very satisfactory for the medical assistance system and was accepted without contradiction by the majority of the population.
However, this deduction, analyzed with modern statistical methods and in the light of epidemiology, concludes that there are other factors that have improved since the end of the Second World War, such as a more balanced diet, family planning, the health of mothers and the best hygienic conditions. In other words, since the 1950s, maternal and perinatal mortality, in the hospital or at home, decreased in all industrialized countries due to the improvement of living conditions.
In the mid-eighties in Germany There were only a few midwives left who dared to attend the women in their homes. Most midwives were part of the hospital obstetric teams headed by a chief doctor and performed many administrative tasks, spending less time and less personalized with mothers. The midwives were less and less satisfied with their work and the parturients were not happy with their midwives either. Childbirth was a disease.
For these reasons, at the end of the eighties a growing group of young midwives decided to start exercising their profession independently to be able to better care for pregnant women and parturients. The best solution, to combine the work of several of them organizing their time and improving their training, considered that they were delivery houses. In 1987 the first two birthing homes in Berlin were founded in Germany.
German law states that each birth must be assisted by a midwife, even gynecologists must have a midwife accompanying them, they cannot attend a birth alone.
The birth in childbirth homes It is also paid by Social Security, a fixed sum of € 550 per birth, which is less than what you pay for a birth in a hospital. Likewise, parents must pay € 200 if they wish to be entitled to the guard service of the delivery house, which allows them to call the midwife 24 hours a day from the thirty-seven week of pregnancy and during the four weeks postpartum. Before the 37th week of pregnancy, the birth should not take place in a nursing home but in a hospital to ensure the safety of the birth.
Surveys are carried out on the care in these delivery houses and the data reveal their safety and the satisfaction of the users.
For example, in Berlin there are ten houses, in one of them there were 200 births in 2007. 40% of women gave birth in the water. The maternal posture during the second phase of labor was: one in the supine position, the others in the position of their preference: vertical without or with a chair, on all fours, or lateral. Of those 200 women, 126 did not tear the perineum at all, and only one had an episiotomy. The others had first or second degree perineal tears without sutures.
According to a complete study conducted by the Gesellschaft für Qualität in der außerklinische Geburtshilfe, QUAG (Independent Society for the Quality of Outpatient Birth) of more than 40,000 births collected there was episotomy in 6% of cases and 4% of C-sections (women transferred to hospital). Approximately 10% to 13% of deliveries require transfer, according to the experience of midwives, the status of women or the condition of the baby. The vast majority of women transferred to a hospital were able to give birth without problems, being one of the decisive tasks of midwives just to recognize the onset of complications.
The delivery houses, an option that in Spain does not exist recognized as such, are an option whose validity and quality is demonstrated by the German experience, and that would be a formula that in our country could surely work perfectly, especially in places where a transfer in case Urgently can be guaranteed. They offer greater intimacy, a family atmosphere and a relationship of trust with professional midwives, in which physiological delivery can happen safely.
In Babies and more | Childbirth in Holland, Childbirth care in Europe
