Births at home, an option against fear of coronavirus in Argentina

       

Home births are less than 1%, but failures in medical care due to the pandemic and fear of infection leads pregnant women to seek alternatives

Natalia’s baby was born in a Buenos Aires clinic on March 20, the same day that Argentine President Alberto Fernández decreed mandatory quarantine for the covid-19 pandemic. She was born that day because her gynecologist convinced her that it was better to induce labor than to wait, given the uncertainty of what was to come. Since then, hundreds of Argentines have lived the final stretch of their pregnancies with canceled and / or postponed medical studies, changes in the place of care and have faced childbirth sometimes without an escort due to new medical protocols. Given these problems and the fear of getting coronavirus in hospitals, some explore alternatives such as home births, which account for only 0.8% of the total.

“We do not have official figures, but I can say that I receive many more calls than before from women asking for home births, at least one a day,” says midwife Francisco Saraceno. His colleague Sandra La Porta agrees with him. Contrary to what they are used to, among the women who approach them now are not only those who were already determined beforehand to give birth at home, but also pregnant women of thirty or more weeks of gestation who seek to be contained before the lack of care and for the first time they are wondering if in this context it will not be safer than going to a hospital.

Sabrina gave birth to her third child at home last week with the Saraceno team. “In this pandemic situation, I was very calm with our decision. Some of my family members, who were usually very scared of giving birth at home, this time called me happy, saying how wise it was at the moment to have a planned delivery at home, ”she explains. “It was a beautiful and fast delivery. What worried me most was the presence of my other two children in the house. In a normal situation we would have made plans for someone to come look for them and take them away, but this time it was not that simple. So the children were at home, at first slept and woke up by the end of labor. They stayed quiet in their room and came when the dad went to look for them, “he recalls.

The tranquility of being accompanied in a familiar and intimate environment, maintaining autonomy, being able to move and change your posture, not feeling manipulated and knowing that medical intervention is the least possible are some of the arguments cited by women who have preferred their home. to the hospital to receive the baby they have been pregnant for nine months.

In theory, most pregnant women could follow suit, but there are exceptions. Those who suffer from some pathology, those who have a multiple pregnancy or whose baby is not placed upside down for delivery and require a cesarean section are excluded. If home birth is complicated, you should go to the hospital as quickly as possible. This transfer is always planned, but increases the risk compared to those who are only steps away from an operating room.

In Argentina, these births are legal, but many women do not know it. In addition, there is an economic obstacle: they are only carried out outside the public health system and are not covered by medical insurance either, so families who opt for this option – less in highly vulnerable contexts – need sufficient financial resources to pay for it or find professionals who accept barter as part of the payment. In practice, a massive return to home births would not be possible either, as was usual until the middle of the last century. “Midwives would be lacking to attend to them,” admits Saraceno.

Rigid protocols

Behind the renewed interest in home births is the abrupt adaptation of hospitals to cope with the covid-19 pandemic. Everyone who enters must undergo a triage at the entrance where they take their temperature and look for symptoms. The use of a mask is mandatory. They suddenly canceled all care except emergencies and the pregnant women were left in limbo.

Jessica had her obstetric controls suspended at her Monte Grande medical center, in the outskirts of Buenos Aires, once the quarantine began. The same happened to Luciana, with a risky pregnancy. Both asked Las Casildas, a feminist organization focused on obstetric violence, for help. On average, during the pandemic they receive fifty calls every afternoon. “Some of the reported practices, such as prohibiting the entry of a companion into the delivery room, are in conflict with current law.

For two weeks, routine consultations and analyzes have been enabled again, but the fear of professionals and patients is evident. “Yes, I am afraid, we all have, but we have to keep working. One of my colleagues stopped working out of anxiety and another left the house so as not to infect others. We are supposed to choose this profession to treat sick people, if you are scared you have to choose another profession ”, says the obstetrician Alejandra Avendaño when speaking about her daily work in a hospital in the Buenos Aires suburbs. Avendaño, who also attends home births, stresses that she also works there with much more protection than before.

Midwives like La Porta have been seeking for years to democratize home births with a project that already exists in other countries, such as delivery houses. “In Germany there are 120”, he gives as an example. They are places that work outside the hospitals, but only one or two blocks from them, to speed up the transfer as much as possible in an emergency. Immediately, Saraceno proposes to favor the voluntary discharge of the women in labor and to organize subsequent home visits to shorten their time in hospital and reduce the risk of infection.

Like his colleagues, Avendaño has also received more calls in these weeks, but he does not know if the interest in home births will be temporary or if it will set a trend. If confirmed, the increase will be low, he predicts, because it is outside the public health system and because of the opposition of many women. The fear of any emergency is compounded by the refusal to do labor without epidurals. “In the hospital, some ask for a cesarean section, which is a right recognized by the [Argentine] law,” emphasizes this midwife. Still, mothers like Sabrina feel for the first time how support for her choice grows and they don’t hesitate to share it.

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