For a majority of mothers-to-be, giving birth involves a hospital stay. But a growing number of women are choosing to have babies in the comfort of their homes or at birthing pools, surrounded by loved ones, a midwife and a doula.
When Faith Wanjiku was planning for the birth of her first-born child, a posh hospital is not what came to mind. And it’s not that she did not have the money. Instead, she was not comfortable with the hospital environment; the glaring bright lights, the white dull walls, and the prying eyes.
She is among pregnant women who are shunning hospital stays, opting for birthing centres, water pools or cosy bedrooms, where they have a more private and relaxed experience to bring their children into the world.
“The hospital environment is cold and sterile to me. I was terrified of childbirth and was very apprehensive about it,” she says.
She said she did a lot of research and after hearing stories about mistreatment in hospitals, home birth came to mind.
Her home in Nairobi’s Karen estate was her first choice but it was too far if she needed a hospital transfer in case of complications. So, after further research, she settled for a birthing centre on Ngong’ Road – Eve’s Mama.
“The birthing centre provided a home-like environment and I even listened to music as I laboured,” she says.
Ms Wanjiru had a midwife by her side throughout the 13-hour labour.
She ushered her newborn baby to the world through a water birth at the birthing centre, which can be mistaken for someone’s home. The quaint house is complete with a living room, lounge, dining room, three bedrooms and a yard.
“It is meant to give labouring mothers a feel like a home away from home,” says Lucy Muchiri, a midwife who runs Eve’s Mama birthing centre.
It is a midwife’s undivided attention, and a warm, calm, safe place that the women want to ensure the body is relaxed for the birthing process. The women want calming interiors in rooms, a birth pool, labour aids like birth balls and seats and padded floors. They also want accommodation for their families or friends.
Home births are common in the West where some women prefer to allow the process to unfold naturally from the comfort of their homes without epidural pain medications during labour.
It was a practice common among the royals in the 1970s.
Queen Elizabeth had four home births. In the days of yore, delivering a baby was a spectator sport, and the practice is slowly returning; women giving birth at home surrounded by their husbands, mothers or friends.
But how safe are home births? The practice has sparked a heated debate globally on risks at a time that low-income countries like Kenya are pushing for hospital births to cut high child mortality rates associated with delivery at home.
But adherents argue that poorer women doing home births are more likely to encounter tragedy. With a well-trained midwife and doula at one’s beck and call, the risk factors are lower.
Ms Muchiri says for those mothers-to-be opting to give birth at private homes, they have to first get authorisation from their doctors. Ms Wanjiru says her obstetrician okayed the home birth beforehand.
In preparation for labour, Ms Muchiri says she offers pre-natal care for the mothers-to-be before sending them to doctors at 36 weeks to get authorisation for a home birth. “The same doctor will ideally take care of the woman after or in case of any complication,” says Ms Muchiri.
Once the birthing process begins, she says she is able to pick up on any danger signs and call the doctor or a hospital. A risk assessment is done to minimise potential danger and need of hospital transfer.
The birthing process has to be natural, and labour has to start naturally. “We do not do labour inductions because they sometimes fail and we do not have a theatre,” she says.
On a monthly basis, Ms Muchiri says she does as many as four home births and five at the birthing centre.
As the new trend catches on, statistics show that the number of women delivering in health facilities has risen to 70 per cent from 43 per cent four years ago, following the introduction of the free hospital maternity programme in 2013.
In England and Wales, one in every 50 pregnant women give birth at home. “If you have a straightforward pregnancy and both you and the baby are well, you might choose to give birth at home,” states the UK’s National Health Service (NHS).
This practice is usually conducted under the care of a midwife who monitors both the mother and child, checking for danger signs that may require a hospital transfer.
For women having their second or subsequent baby, a planned home birth is as safe as having your baby in hospital or a midwife-led unit.
However, for women having their first baby, home births slightly increases the risk of a poor outcome for the baby (from five in 1,000 for a hospital birth to nine in 1,000 – almost one per cent – for a home birth), notes the NHS.
But as Kenyan women seek to walk in the footsteps of the old royal ladies, the country has no guidelines on home births.
The Kenya Medical and Dental Practitioners Board (KMDPB) says it does not have guidelines for home births, but has a provision for home visits as a follow-up for treatment.
“We license doctors for the place of practice. The premise is inspected for adherence to health codes,” said Dr Daniel Yumbya, the chief executive of KMDPB. This, he adds, would be difficult to assess in the home.
Kennedy Otieno, the programmes officer at the National Nursing Association of Kenya, says there is a provision on domiciliary practice where midwives can offer focused antenatal care which is done door-to-door. However it does not go as far as to encompass home delivery.
Between 1976 and 1982, Prof Miriam Were pushed for the provision of health services to the women in need, under which a pilot for domiciliary midwifery was conducted. She was at the time director of the National Pilot Project on Community Based Health Care.
The programme, however, took a back seat and the government is making an effort to train and equip traditional birth attendants to safely attend to pregnant women in remote areas without access to proper healthcare facilities.
But for the well-off women planning for giving birth, they have many options. Elective C-section or normal birth. Hospital or home?
For elective, private home births you need a spacious house. Where people live cheek by jowl in small apartments, home births are a challenge. And in neighbourhoods with spacious homes, majority of women may shun it.
“Places that would be fit for home births because of enough space have good maternity service units and, therefore, the same people who would be recruited and prepared for home care look down upon it and prefer to go to the maternity units in the neighbourhood,” says Dr Muriithi Waruingi, an obstetrician and gynaecologist.
Another challenge is getting a personal doctor who will be by your side throughout the labouring process.
On average, labour can take up to 12 hours and with the limited number of specialists in the country, it is nearly impossible to get one to dedicate all that time to one patient, not to forget the costs that would be incurred if someone decides to get one.
“Birth takes place at home for support. This is not popular among doctors because of the logistics and time factor,” says Dr Waruingi.