Home births have seen an increase in popularity in recent years in Malaysia, in keeping with birthing trends abroad.

A number of social media groups provide support and training on being able to birth at home.

Women often talk about how their birthing choices are not always available in our country: water birthing, gentle birthing, birthing without anaesthesia, and other interventions, such as episiotomy, vacuum, suction, forceps delivery, and of course, a caesarean.

There is also a perception (or one could say – misperception) that hospitals in Malaysia try to force birthing interventions to maximise profits and money-making.

Added to this is a discourse – harkening back to a golden past, where mothers gave birth to record numbers of babies with little, if any assistance, and always survived.

Unfortunately, this is a misrepresentation. The World Health Organisation says: “While most pregnancies and births are uneventful, all pregnancies are at risk. Around 15% of all pregnant women develop a potentially life-threatening complication that calls for skilled care and some will require a major obstetrical intervention to survive.”

Home births, self-deliveries and deliveries by those not trained to deliver babies carry immense risks.

Last week, a newborn is believed to have died in a home delivery in Johor Baru and in 2013, a 40-year-old woman suffered from excessive blood loss and lost her life after a natural home delivery.

An information brief on maternal deaths, by the family health development division of the Health Ministry (based on preliminary data analysis of the confidential inquiry into maternal deaths), puts home deliveries as associated with a much higher maternal mortality ratio (296.4), in comparison with deliveries in both private (18.6) or government (19.5) health facilities.

Both the life of the mother and the infant are at greater risk. Out of 420,000 deliveries per year, about 10,000 are home deliveries, said the ministry’s national head of obstetrics and gynaecological services and national head of maternal foetal medicine ervices Dr J. Ravichandran R. Jeganathan in 2014.

This is a significant number of women opting to give birth at home.

Unfortunately, most pregnant women will not know whether they will face complications or not till the delivery stage.

At that critical point, what is necessary is that the pregnant woman is attended by skilled attendants, who have access to early referral services to comprehensive emergency obstetric care. This usually ensures that both the mother and the baby survive.

A woman can die during delivery because of direct or indirect causes.

Among these are: haemorrhage, embolism, hypertensive disorders and sepsis. These are usually controlled by close monitoring during pregnancy, delivery and for the first 48 hours post-delivery.

As such, close care by trained personnel during the time is necessary. Women can also experience tears (fistula) and uterine ruptures if the delivery is not properly managed. Post-delivery care ensures that both mother and child thrive – both physically and psychologically.

A baby can die in-utero due to umbilical cord accidents or placenta disruptions. During delivery, if the birth is not well managed, this can also result in death.

Complications faced by the mother, such as hypertension and bleeding, also cause distress to the foetus. Technology and medicines are today at our disposal to reduce these risks and ensure a safe delivery for both mother and child.

While individual choices need to be respected, it is essential that these are “informed choices” which are being made. There needs be a concerted effort to educate both women and men on their full range of choices around pregnancy and child-birth and the risks these pose.

There needs be an enhanced understanding of who is the best trained health personnel that the individual or the couple can relate to, but at the same time, is able to deliver solutions in cases of complications and emergency.  

There is also a need to understand why women and men are opting for home births: are the reasons economic, socio-cultural, psychological or religious? And from that standpoint, a range of safe options for delivery and care needs to be made available.

There needs be a building of rapport and relationship between the health personnel – be it the midwife, doctor or ob-gyn, and the client. There also need be greater regulation of those who offer their services via social media, including unregistered midwives, by both the authorities and those seeking their services.

While this may not be the first such unfortunate death of a newborn or a mother in our country, it can definitely be the last, if proper steps are taken.

Birthing is a natural experience. Today, it is a safer experience due to advances in medicine and technology. It doesn’t have to be an either or. It can be both – for all women. – February 13, 2018.

* Sivananthi Thanenthiran is the executive director of the Asian-Pacific Resource and Research Centre for Women (ARROW). She co-authored Reclaiming & Redefining Rights: The Status of Sexual and Reproductive Health and Rights in Asia and the Pacific in 2009 and 2013.

* This is the opinion of the writer or publication and does not necessarily represent the views of The Malaysian Insight. Article may be edited for brevity and clarity.