Editorial: Challenging home births

FILMMAKER Ara Chawdhury blogs while waiting for the baby, her first.

In her March 4 post on lordoftherinse.blogspot.com, Chawdhury writes about seeing her baby on his 32nd week and anticipating the things they’ll do together, like breastfeeding.

One activity, though, is out of bounds: a home birth.

Although her doctor said it would be possible if she supervised, Chawdhury has been consulting friends on Facebook and surfing the Net to learn more about a Department of Health (DOH) policy that’s interfering with what she calls her right.

The DOH implements a “no home birthing policy.” Requiring women to give birth in health centers, birthing centers and hospitals is intended to arrest the number of maternal and child deaths.

In 2011, the National Statistics Office reported maternal and infant deaths at 221 for every 100,000 live births. The country is one of 69 countries where 97 percent of global maternal and child deaths are recorded.

Not a solution

However, nongovernment organizations (NGOs), such as the Gabriela and the Council for Health and Development (CHD), oppose the ban on home births.

In a March 4 Manila Bulletin article, the CHD argued pregnancy-related deaths will continue because women in remote barangays have limited access to health centers and birthing stations. The CHD also highlighted the lack of medical personnel, supplies and facilities for safe childbirth in 41 percent of the country’s 41,000 barangays.

In a July 6, 2012 statement uploaded on www.gabrielaph.com, the NGO criticized the DOH requirement for women to give birth in public or private medical institutions as it burdens those who may not be able to afford the “P5,000 for supplies and use of the delivery room else they are refused admission.” Gabriela also protested the Aquino administration’s “corporatization of 26 public hospitals across the country.”

Less than ideal

When Sun.Star Cebu visited last February six health centers in Cebu City, with three serving sloping and upland communities, nearly all of the 26 mothers interviewed said that they visited the centers and availed themselves of medical services, from family planning and prenatal checks to birthing and infant immunization.

Much credit goes to barangay health workers (BHWs) who visit homes. With only six doctors serving Cebu City’s 86 health centers and a midwife catering to about 15,000 persons, BHWs are out in the field, assisting mothers breastfeed their babies, exhorting the pregnant, especially the teenaged and unmarried, to go for prenatal checks as soon as the pregnancy is detected or within the first trimester, or following up on women who give birth at home to have their infant registered to avoid steep penalty fines.

For although the Cebu City Health Office (CCHO) considers all health centers as birthing centers, some indigent women risk complications and death to give birth at home for lack of money.

According to the 26 mothers interviewed by Sun.Star Cebu, one spends P1,500-2,000 to give birth and stay for 24 hours at a center. This is less than the P5,000 required for the OB pack at government hospitals. Midwives explain that the fee they collect is not for services but to replace the supplies used in the birthing.

Since the OB packs given by CCHO are not sufficient and regular, a patient brings her own supplies, pays to replace supplies used, or midwives use their own money when the patient is poor.

Home birth advocates like Chawdhury criticize the DOH for banning home births. For instance, the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists support home births for women with uncomplicated pregnancies.

During Sun.Star Cebu’s February 2013 interviews at the health centers of Basak San Nicolas Brotherhood, Basak-Pardo, Labangon, Tisa,Busay and Babag, there was a shortage of OB packs, as well as no stocks of birth control pills, injectables and condoms.

Given the lack of doctors, midwives (one midwife assisted upland births but was not trained to perform episiotomy and vaginal repair) and supplies, the DOH should consider training traditional birth attendants (“hilot”) for those who prefer home births.