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Safe Home Delivery

Introduction

Childbirth or delivery is the process that occurs at the end of pregnancy with the expulsion of a foetus, its membranes and placenta from the mother’s uterus. It usually starts with regular continuous contraction causing the opening of cervical os.

The process of normal childbirth is categorised into the three phases of labour, i.e., Phase 1, Phase 2 and Phase 3 as described below:

  • Phase 1
    • Begins with contraction of the uterus every 10 – 30 minutes and the intensity of the contraction increases to cause the progressive opening of the cervix until it becomes fully dilated at 10cm. This is followed by discharging of show and spontaneous rupture of the membrane.
  • Phase 2
    • Strong continuous regular contraction of the uterus that causes pushing and the delivery of a baby from the vagina.
    • After the delivery of the baby, the umbilical cord that connects the baby and placenta which is still attached to the mother will be clamped and cut.
  • Phase 3
    • During this stage, there will be a separation of the placenta from the uterus which occurs 15 to 30 minutes after delivery of the baby.

What is the meaning of safe delivery and its importance?

  • Safe delivery refers to the births attended and conducted by skilled health personnel, and it must be handled in a proper, suitable, safe and clean home environment.
  • Every stage of labour will have risks for the mother and baby. Monitoring, observation, and proper handling by skilled health personnel are mandatory to avoid or reduce any complication that may occur during delivery. Sometimes, assisted delivery by using instruments such as vacuum, forceps or caesarian section could be performed to prevent further complications.
  • It is important for a mother who wants to deliver at home, to get a proper antenatal check-up and book a skilled health personnel with midwifery qualifications and registered with the Midwifery Board Malaysia under the Ministry of Health (MOH).
  • It is the intention of MOH to ensure that every mother will undergo a safe delivery hence providing a better quality of life for the mother and her newborn.

Where to obtain the information about safe home delivery?

  • Government Health Clinic
  • Community Clinic
  • 1 Malaysia Clinic
  • Mobile Clinic
  • Government Hospital
  • University Hospital
  • Army Hospital
  • Private Clinic
  • Private Hospital

Who is eligible to deliver at home?

A suitable mother who has been identified as not having any risks after having undergone a proper antenatal check-up at the health facilities and after discussions with the healthcare providers regarding their preferred choice to deliver at home.

Based on the physical examination, the eligible criteria to allow mother to deliver at home are:

  • Mother in her 2nd to 5th pregnancy.
  • Mother’s height >145cm.
  • Mother’s age is more than 18 years old and less than 40 years old.
  • Married mother with good family support.
  • Period of gestation is more than 37 weeks or less than 41 weeks.
  • Estimated baby weight is between 2.5 kg to 3.5 kg.
  • NO past obstetric history that may recur and affect the current pregnancy such as a history of caesarean section, retain placenta, postpartum haemorrhage etc.
  • NO current obstetric problem such as placenta praevia (low lying placenta), multiple pregnancies, abnormal fetal lie/presentation (e.g., breech/transverse/oblique) etc.
  • NO past and current medical history such as Diabetes Mellitus, Hypertension, Heart Disease, Thyroid Disease, Psychiatric, Obesity, Anaemia and others.
  • The suitable home environment for delivery.

**Important Notes: If any complication occurs to yhe mother and baby that may arise during the process of delivery, the health staff who conducted the delivery will refer the patient as soon as possible to the nearest hospital.

Who is eligible to conduct home delivery?

Skilled health personnel with midwifery specialisation and registered with the Midwifery Board Malaysia under the Ministry of Health (MOH) (such as Community Health Nurse and Trained Staff Nurse).

When and how to discuss with the Health Staff to book the place for delivery?

  • The discussion on the preferred choice of place of delivery should be started during the first trimester and the final decision for the place of delivery should be decided during 36 weeks period of gestation. The discussion should be made together with health staff, husband and family members which include the risks of home delivery.
  • The role of health staff if the mother chooses to deliver at home:
    To identify the suitability for mother to deliver at home based on:

    • Risk Factors (depending on the risk of pregnancy according to colour coding as determined by MOH).
    • Suitable home environment (health staff will do home visit prior to delivery).

Is the mother allowed to be accompanied by husband, relatives or any individuals during delivery at home when conducted by health staff?

Yes, she can.

However, the husband, relatives or any related individuals who are not trained in midwifery and not registered under MOH are not allowed to handle or conduct the delivery.

What are the risks and complications of home delivery if unskilled health personnel conducts it?

Risks and complications could happen to both the mother and baby during the process of delivery. Risks are enhaced if the individual that conducts the delivery is not trained or is unable to give any help in a case of emergency due to lack of medical equipment.

  1. Risks and complications to the mother:-
    • Hypertension/Hypotension can occur during a delivery process that can lead to death if no treatment is given.
    • Prolong labour pain that may lead to the need for instrumental delivery or caesarian section.
    • Difficult delivery (obstructed labour) and can cause uterine rupture which may lead to persistent bleeding and death.
    • Retained placenta and product of conception which can cause postpartum haemorrhage and if not initiate early treatment, may result in death.
    • Extensive vaginal tear that may cause persistent bleeding and infection if not treated.
    • Infection can occur if not using sterile equipment.
  2. Risks and complications to baby:
    • Foetal distress due to abnormal lie/presentation such as breech, oblique or transverse. This may cause obstructed labour; cord prolapsed and foetal distress because no proper abdominal examination was performed.
    • Meconium stained liquor which may be aspirated into the baby’s respiratory tract causing airway obstruction and lung infection.
    • Infection may occur if sterile equipment is not used to cut the umbilical cord.
    • Low body temperature (hypothermia) which can reduce oxygen absorption which can lead to hypoxia and death if no treatment is given.
    • Congenital malformation and medical problems which may not be identified early because no thorough physical examination was performed to the baby.

References

  1. Perinatal Care Manual, National Technical Committee on Perinatal Health Coordinated by Family Health Development Division, Ministry of Health Malaysia, 3rd edition 2013.
  2. Garis Panduan Senarai Semak Bagi Penjagaan Kesihatan Ibu dan Anak mengikut Sistem Kod Warna Edisi 2013, Bahagian Pembangunan Kesihatan Keluarga, Kementerian Kesihatan Malaysia.
  3. Garis Panduan Pusat Bersalin Alternatif (ABC) di Klinik Kesihatan Edisi 2013, Bahagian Pembangunan Kesihatan Keluarga, Kementerian Kesihatan Malaysia.
Last Reviewed : 29 May 2017
Writer/Translator : Dr. Zul Azuin bt. Zulkifli
Accreditor : Dr. Hj. Mohamed Hatta b. Mohamed Tarmizi
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