Out-of-hospital births a growing trend in S’pore

SINGAPORE — Most women in labour make a dash for the hospital, but not 34-year-old homemaker Diana Chen. In between contractions, she had climbed into an inflatable birthing water tub placed in her bedroom, where she ­delivered her second child in 2012.

Two years later, her third child was born on the tiled floor of her bathroom. Mdm Chen’s out-of-hospital births were no accident — she had meticulously planned them with the support of her husband, 50, who was also born at home.

Mdm Chen had delivered her first child in a hospital, but had felt uncomfortable with the clinical environment and its restrictions.

“A few people were surprised and completely unaware that a home birth was even an option in Singapore. Some might have thought we were ­irresponsible and crazy,” she said.

“But if you think about it, birthing is such a natural physiological process which shouldn’t need intervention, ­unless there is a medical situation. If animals can birth their babies in the wild without drama, why can’t I?”

Like Mdm Chen, a tiny but increasing number of women are having their babies outside a hospital.

Home births accounted for 107 of 42,263 live births — or 0.25 per cent — last year, according to provisional figures from the Immigration and Checkpoints Authority. In comparison, only 57 home births took place in 2006.

Dr Lai Fon-Min, the only known obstetrician here who attends home births, has handled a corresponding increase in home deliveries, including Mdm Chen’s.

From 4.3 per cent in 2011, home ­deliveries made up 9 per cent of the total he handled last year.

Dr Lai, who is also a gynaecologist, said his home birth patients are highly educated, knowledgeable and are supported by their husbands. Their ­average maternal age is about 34, and the majority already have at least one child.

“With easy access to the Internet and social media, women now realise they have options, and have also probably heard of celebrity mums such as Angelina Jolie and Cindy Crawford having home births in the United States,” said Dr Lai of A Company For Women at the Camden Medical Centre.

Ms Ginny Phang, chief doula at Four Trimesters, said more than a fifth of her clients last year underwent a planned home birth, the highest number encountered in the last 
10 years. From just under five home births a year about 10 years ago, Ms Phang now assists in an average of two per month.

The typical motivation behind a home birth is the desire for a “gentle and compassionate” childbirth, she said.

Doctors warn of possible unexpected complications

Other doctors were quick to point out the added risks of a home birth, and said a hospital delivery need not involve significantly more medical 
intervention. The American College of Obstetricians and Gynaecologists respects a woman’s right to make a medically-informed decision about delivery, but maintains that hospitals and birthing centres are the safest settings for births.

It also advised that women planning to have a home birth be informed of the two- to three-fold increase in risk of neonatal death, compared with a planned hospital birth.

Planned home births may pose a risk to both mother and child, even in a low-risk pregnancy, according to the College of Obstetricians and Gynaecologists, Singapore. The ­Obstetrical and Gynaecological Society of Singapore shares the same view, said its president, Associate Professor Tan Lay Kok.

“The possibility of unexpected complications in low-risk pregnancies without any known obstetric risk factors must be taken into consideration,” said Associate Prof Tan, who is also a senior consultant at Singapore General Hospital’s Department of ­Obstetrics and Gynaecology.

For example, urgent C-sections cannot be done at home. Some ­unexpected obstetric emergencies such as postpartum haemorrhage (significant bleeding after delivery) and shoulder dystocia (where the b­aby’s head has delivered but shoulders are stuck in the mother’s pelvis) would require an immediate and ­coordinated team effort, which can be easily summoned in a hospital setting, said Associate Prof Tan.

“Let’s not forget that when the baby is born in a poor condition, a neonatologist is essential for resuscitation (and) can be called upon in a hospital setting,” he added.

Dr Christopher Ng of GynaeMD Women’s and Rejuvenation Clinic, who has received a few home birth requests, usually advises his ­patients not to take the unnecessary risks ­involved, in line with the official stance of various colleges of obstetricians and gynaecologists worldwide.

“In view of the overwhelming ­evidence, I usually advise them not to take the unnecessary risks of home birth, as giving birth takes one day but if things go horribly wrong, which can happen unexpectedly, even in low-risk pregnancies, they have to live with the consequences for the rest of their lives,” he said.

Women who request home births prefer to give birth “in the most natural way in the familiar surroundings of their home”, and see hospitals as “cold” and “unwelcoming”, said Dr Ng. “And they mistakenly think that if they were to deliver in the hospital, there would be a lot of unnecessary medical intervention, which is really not true.”

Women who wish to have natural drug-free births with little medical ­intervention can work with their doctor to achieve it in a hospital, he added.

“The whole birth experience really boils down to the obstetrician one chooses and not the location. At the end of the day, safety should be the No. 1 priority.”

Allowing mothers to make informed decisions

Dr Lai said his goal is to support mothers to make informed decisions about their choice of delivery. Women who wish to have a home birth should have an uncomplicated pregnancy, deliver at full-term and preferably have had a previous vaginal delivery, he added.

“Most people think a home birth is an unmonitored birth, but that is not true. In this instance, the father is entrusted with the responsibility to check the foetal heart rate regularly (using a Doppler, which is a portable heart rate monitor), just like how midwives used to do in the old days before the advent of continuous monitoring. While nothing can be guaranteed in medicine, I try to make sure that the antenatal assessment is thorough prior to the onset of labour to avoid unexpected problems,” he said.

Ms Phang, whose clients must ­engage an obstetrician to attend the home birth, said it is important for parents to do their homework and ­assess the risks beforehand.

“Ultimately, a home birth is a calculated risk. In most of the cases I’ve seen, the home births go fine, but there are instances whereby the mother has had to go to the hospital because labour was not progressing or she changed her mind,” she said.

Mdm Chen took natural birthing classes to prepare for her home births and ­engaged a doula, an obstetrician and a paediatrician to be present. Before her delivery, she and her obstetrician also discussed what to expect and when to go to the hospital.

Unlike the hospital delivery for her first child, her home birth experiences were “relaxing” and “beautiful” and “non-intrusive”, she said.

“My older children, husband and best friends were with me, and we spoke and laughed in between my contractions,” said Mdm Chen.

“I could labour in familiar positions and places in my home, and I could eat whatever I wanted. I enjoyed each and every moment of my home birth. If I’m going to have more babies, I would do it again.”