For many parents-to-be the anomaly ultrasound, usually offered at 18-20weeks of pregnancy is the chance to be reassured that their baby is ‘perfect’, to have a glimpse of their unborn baby and to find out if they are having a son or daughter.
The World Health Organisation (WHO) estimates that worldwide 1 in 33 babies are born with a defect, with half of all major anomalies picked up by ultrasound and some will be picked up after the birth.
If you are planning a homebirth, any problem will give rise to the question ‘should I stay home?’ as well as all the questions as to the impact on your baby.
Each situation needs to be looked at individually but the main questions that need to be considered are:
- What can or will be done in hospital which can’t be done at home?
- Will my baby’s condition increase the chance of fetal distress in labour?
- Will my baby need intensive support immediately following birth?
The problems which can be picked up can be divided into three types – Minor, Major & Fatal.
These will involve conditions, such as club foot (talipes) where no immediate additional care is needed. While some people will suggest that these babies are born in hospital so a paediatrician can see them following birth, there is no real need for them to be born in hospital, and the midwife will transfer after the birth if there is any concern, for example, in the case of a baby with a cleft lip, a condition which may lead to feeding difficulties. Another example of a minor problem being treated at home includes the diagnosis of unilateral renal agenesis. This condition can be detected on an antenatal ultrasound, and while the baby requires antibiotic prophylaxis, ultrasounds and tests, paediatricians are happy to liase with the midwife to sort medication and for the baby to have scans on an outpatient basis within a week of the birth. Had the baby been born in hospital these scans would have been arranged prior to discharge.
These will often require surgery or intervention soon after birth, for example gastroschisis (where the intestines are outside the body) or spina bifida. For babies who require this you may be recommended to birth in a tertiary hospital, rather than locally, where the surgical facilities are based to prevent the baby being transferred soon after birth to keep mother and baby together. Some birth defects may cause a recommendation for the baby to be born by caesarean section, to prevent further damage. If you chose to birth at home, or your baby’s condition is discovered after birth you will be transferred immediately by ambulance.
Unfortunately, some conditions are not compatible with life outside the womb. Some women will choose to birth their babies at home, knowing they will either be stillborn or pass away shortly afterwards and you should be supported in this, if this is your wish. One mother’s story of her daughter’s homebirth after being diagnosed with Trisomy 18 is shared here.
More information on birth defects can be found here.
Written by Claire, Mum of 4 & midwife and who had her baby at home after a diagnosis of unilateral renal agenesis.