Раждане вкъщи 10

Бащатко твърди, че "те" имали много по-висок морал и етика (колко са успешни към момента не е от значение). И за мен е загадка при такава ценностна система, как е възможно да се стигне до тук?! Застрашиха дори каузите на още няколко свързани организации! Аз лично бих се оттеглила, за да не дърпам всички със себе си към дъното...

За противопоказанията, да, те са медицински проблем и е редно мед.лице да ги разпише. Обаче на първо място трябва да пише: ако сте готови да жертвате бебето си, за да изживеете приключение, изберете домашното раждане.

За ултрасаунд, ако някой се интересува, това е много подробно поручване:
http://www.jultrasoundmed.org/cgi/content/abstract/27/4/503
Не знам дали някъде го има безплатно обаче. Отговорът обаче не може да бъде еднозначен според мен.

Тук намерих едни препоръки за ултразвук, които могат да се четат свободно:
http://ult.rsmjournals.com/cgi/reprint/18/2/52

Като става дума за рискове при домашно раждане - мисля че трябва да са от медицински източници или написани от лекар. Както и в болниците трябва информираното съгласие да е истинско, да има описани рисковете и страничните ефекти на всяка процедура. Но нито тук, нито за информираното съгласие можем сами да си ги напишем.  

Без съмнение, но това, че дом. асистирано раждане не е регламентирано и няма как лекар да разпише противопоказанията, не означава, че може безогледно да се списват глупости от сорта на "домашното раждане не крие риск". Най-малкото щом противопоказанията трябва да се пишат от специалист, то НЕ би следвало и да се разпространяват откровени глупости за безопасността при преносване, увита пъпна връв или тесен таз, и то от икономистки, филоложки и прочее неспециалистки. Не ми допада ваденето на двойния аршин, когато това е угодно на Родилница.

Докато няма някакво регламентиране, може поне да преведем противопоказанията от други държави и да ги постнем тук с ясното указание, че това е любителски превод на чуждоезичен документ. Така по-разумните жени поне ще се замислят дали да не се заслушат малко по-внимателно в лекарските указания, вместо да ги определят като "нищо" с подкрепата на съфорумките си.

Аз мога да постна от моя щат Standards of Care на midwifes. Предполагам, че се различават от щат до щат, но това е така със всичко тук:
http://214mmguild.simplweb.com/images/stories/pdf/standards%20of … 20care%202009.pdf

Appendix A
Contraindications for Home Birth
Based On Health History
Conditions exist that require care outside the scope of practice of traditional midwives. Due to
their potential life and health threatening nature, midwives should refer pregnant women who
exhibit the following conditions to a medical health provider for prenatal care and birth
attendance:
1. Regular alcohol use or drug use / abuse / dependency
2. Cardiac disease
3. Diabetes Mellitus
4. Renal disease
5. Liver disease
6. Lung disease caused by emphysema, cystic fibrosis, scoliosis, active TB, or severe
pathological asthma
7. Unresolved seizure disorder
8. Systemic Lupus
9. Sickle Cell disease
10. Active Hepatitis
11. Marked skeletal abnormalities that would interfere with the birthing process
12. Congenital defects of the reproductive organs that would interfere with the birthing process
13. Essential Hypertension
14. Bleeding disorders
15. Thromboembolism or thrombophlebitis
16. Mother has PKU disease
17. Rh negative disease as indicated by positive titers
18. History of low birth weight infants (of less than 5 lb.), stillbirths or neonatal deaths which are
related to intrinsic maternal health problem
19. Unwillingness to accept midwife’s limitations, prohibitions, and responsibilities for safe
practice
20. Any other condition which may preclude the possibility of a normal birth, at the midwife’s
discretion
21. Any other major medical problem or congenital abnormality that affects childbearing


Appendix B
Contraindications for Homebirth
Based on Conditions Identified During Prenatal Care
At any point during prenatal care, conditions may be identified that show a contraindication for
home birth. Except in emergency situations, a midwife should not assume or continue to share
responsibility for prenatal and / or birth attendance for women with the following conditions:
1. Failure to document adequate prenatal care:
(a) Prenatal lab work; Rh antibody screening,
Rubella titer, VDRL, Blood Group and Type,
Hemoglobin, Hepatitis, GBS screening (or signed waiver)
(b) Must have initiated prenatal care by 28th week gestation.
2. Rubella during the first trimester
3. Primary outbreak of genital herpes
4. Persistent pregnancy induced hypertension
5. Pre-eclampsia
6. Convulsions
7. Central Placenta Previa
8. Placental abruption or signs indicative of placental abruption
9. Placenta located over previous uterine scar
10. Suspected or diagnosed congenital fetal anomaly that may require immediate medical care
after birth
11. Hemoglobin less than 9 at 36 weeks
12. Premature labor: 36 weeks or less
13. Serious viral/bacterial infection at term
14. SGA
15. Suspected IUGR
16. Unresolved fearfulness regarding home birth or midwife care, or otherwise desires transfer
of care
17. Any other condition or situation which may preclude the possibility of a healthy birth, at the
midwife’s discretion

Appendix E
Situations / Conditions Requiring Hospital Transport
1. Cardiac arrest
2. Chest pain or cardiac irregularities
3. Signs of postpartum pre - eclampsia, or eclampsia
4. Eclampsia / maternal convulsions
5. Maternal respiratory distress
6. Unresolved signs of fetal distress
7. Cord prolapse
8. Transverse lie (in labor)
9. Heavy meconium staining and deviations in FHT’s (if the expected time of birth is greater /
longer than the projected transport time)
10. Foul smelling amniotic fluid
11. Infection: maternal temp. above 100.8, shaking, chills, elevated pulse
12. Excessive antepartum and intrapartum painless vaginal bleeding
13. Placental abruption
14. Suspended placenta accreta
15. Hemorrhage not responsive to treatment
16. Unresolved maternal shock
17. Apnea
18. Persistent uterine atony
19. Uterine inversion
20. Laceration requiring medical attention
21. Suspected meconium aspiration
22. Apgar score of 6 or less at 5 minutes and not improving
23. Unresolved respiratory distress of newborn
24. Abnormal color in newborn: persistent central cyanosis
25. Unresolved abnormal cry in newborn: weak, or high pitched
26. Obvious or suspected birth injury
27. Newborn cannot maintain body temperature
28. Projectile vomiting
29. Inability of newborn to feed well due to lethargy
30. Newborn temperature of 100.8 two consecutive readings ten minutes apart
31. Birthing woman desires transport for herself and / or her newborn

Every effort must be made to transport in good condition. The midwife will accompany the
mother and / or baby to the hospital if hospitalization is necessary. If possible, the midwife may
remain with the mother and / or baby to ascertain outcome and provide continuity of care. A
transport form should accompany the mother and / or baby to the hospital.

Супер, благодаря. Мисля да го пратя на една близка, която е преводач (вкл. на медицински документи), та поне преводът да е читав.

уф....ролята на Бащатко ми се струва идеално захранваща анти - каузата за домашно раждане. Аз лично се отказах да го чета.
С тоя афект и "скачане", ми се отдалечава понятието му за морал и етика.

Atti ,
много полезен линк. 
за съжаление  не си спомням в Родилница да е бил постван......

Реалист, никой не беше питал за такива документи. Не си спомням и ти да си питала или да си поствала такива, а все пак всички имаме нет.

Момичета, които раждате в болницата, правят ли ви прегледи за тези неща, разпитват ли ви за медицинската история? Как протича една женска консултация?

Засега ходя само на ЖК в едно ДКЦ наблизо, не съм била в болница. Да, лекарят ми направи досие и ме разпита подробно за всичко - не само лично за мен, а и за фамилията ми, както и за бащата и неговите роднини - фамилна обремененост, генетични заболявания и т.н. Носех му документи от предишен гинекологичен проблем, човекът ги разгледа и си ги снима, за да ги приложи към досието. Доволна съм, човекът е внимателен и спокоен, отговаря на всички въпроси, интересува от състоянието и настроението ми. Не всички са идиоти.

Flip, не се съмнявам, че има и свестни. Просто ми беше чудно какво включва стандартния преглед.

Ти към кои последно се броиш - защото доколкото разбрах, смяташ все пак да раждаш в болница?

Или вдигаме шум, защитаваме някакви тези, убеждаваме някакви хора в правотата си - и после "с отвращение" избираме болницата?

И за да не съм едностранчива рисковете от болничното раждане:
От тук: http://www.aims.org.uk/

INFORMED CONSENT FOR GIVING
BIRTH IN HOSPITAL
PLEASE READ, SIGN and DATE
Name: ...................................................…. Hospital: .............................................
Consultant: ................................................. Date: ..................................................

Dear Mrs/Ms/Miss: ………………………….

This Trust supports the view that women
have choice and in order properly to
exercise that choice they need to be fully
informed of the risks in association with
childbirth. You will already have had
information about the risks of home birth.

The following are the risks of a hospital
delivery:
This hospital operates a shift system
which means it is unlikely that you will be
attended by the same midwife throughout
your labour. Because we are short of staff
you are unlikely to have the continuous
support of a midwife as she will probably
be trying to attend to at least two other
women.

As this hospital has a 25% caesarean
operation rate this means that you have at
least a 1 in 4 chance of having a
caesarean. Please be aware that this is
major abdominal surgery that doubles the
risks of maternal mortality, increases the
risk of damage to other internal organs
and blood vessels, carries a risk of
infection, which may prolong a hospital
stay, interferes with the establishment of
breastfeeding and delays post operative
recovery.

Research has also shown that this type of
surgery produces harmful side effects
according to which anaesthetic is used,
lowers fertility rates in women, may
increase the incidence of post natal
depression, adversely affects the baby
because of the anaesthetic used, can
accidentally cut the baby as the incision is
made, produces babies who are less likely
to breastfeed, results in babies with
breathing difficulties because they haven't
received the benefits of being squeezed
through the pelvis, increases the risk of
miscarriage in future pregnancies,
produces a greater risk of childhood
asthma and results in a greater risk of
Sudden Infant Death Syndrome.

As the World Health Organisation has
stated that there is no improvement to
maternal or infant health when the
caesarean operation rate exceeds 10%
you should understand that we are trying
to reduce our caesarean rate.
This hospital is a medical training centre,
so in February and August we have a new
intake of junior doctors and the caesarean
operation and forceps delivery rates
increase at that time. But please be aware
that doctors have to be trained and you
may be the person especially selected as
a training subject.

As a first time mother you may wish to
stay in hospital for a number of days in
order to establish breastfeeding. However,
as we are short of staff and the postnatal
wards are grossly understaffed you are
unlikely to receive consistent advice and
you will be vigorously encouraged to leave
as soon as possible as we need the bed.
At one time the midwives were required to
visit a postnatal woman for at least 10
days. We have introduced a system that
allows the midwives to make a judgement
about your needs in this respect so you
are unlikely to be visited on more than a
couple of occasions.

You should understand that in this
hospital, which is a high technology
obstetric unit, only 1 in 6 women expecting
their first baby and only 1 in 3 women
expecting their subsequent babies will
have a normal, straightforward, birth.
AIMS Journal 19 No 4 2008 Pages 11-12
This hospital applies a time limit on the
second stage of labour, this is not applied
for your benefit; it is imposed in order to
ensure that you deliver as quickly as
possible so that we can use your bed for
another woman.

At this hospital the midwives will cut the
cord as soon as the baby is delivered. This
has adverse effects on the baby, but you
need not worry we have resuscitation
equipment at hand to help the baby
breathe.

At this hospital the majority of women will
give birth on their backs, despite the
research indicating how this position
makes it more difficult to push the baby
out and causes trauma to both mother and
baby.

During your labour you may find that your
room is visited by multiple members of
staff many of whom will fail to introduce
themselves or justify their reasons for
being there.

This hospital prefers women to be quiet
when they are in labour as shouting or
screaming may upset others in the ward,
especially the doctors. Therefore, in order
to maintain a more subdued atmosphere,
you will regularly be offered a range of
opiate-based drugs either in the form of
pethidine or diamorphine (also known as
heroin). Please be aware that this can lead
to an increased chance of your child
becoming a drug addict in later life and if
administered at the wrong time during
labour, will result in your baby being born
in a dangerously stupefied state. Do not
worry, as the medical staff will inject the
baby with an antidote as soon as it is born.

Visiting hours for husbands and partners
are between 11am – 3pm and 6pm – 9pm.
Although postnatal midwives will be on
hand for advice, they are extremely busy
and therefore you will be expected to cope
on your own with your new baby in
between these times and overnight.

It is our policy to encourage women to
choose whomever she wishes to have with
her during labour. We will require you,
however, to put a request in writing should
you wish to have more than one person
with you. All requests will be considered
sympathetically but will probably be turned
down as we have to consider the risks of
hospital spread infection, security, our
small rooms and our desire to maintain our
control. Wherever possible, this hospital
operates a system of continuous electronic
fetal monitoring. This has not been shown
to improve outcomes for mother or baby,
however, it will lead to an increased
likelihood of a caesarean
operation.

At this hospital, our philosophy is ‘one size
fits all', therefore, we would prefer it if you
did not write a detailed birth plan as this
interferes greatly with our ability to make
decisions about your care without your
knowledge or consent. If you feel a bir th
plan must be under taken, a simple ‘I
would like a natural birth with gas and air'
will suffice.

A hospital birth involves a much higher risk
of serious infection. One in three babies
will leave with an MRSA infection. In the
event that this happens to you, this
hospital will bear no responsibility,
however, you are welcome to utilise NHS
facilities for your recuperation. If you would
like an epidural or spinal block during your
labour, please note that this will interfere
with your body's natural production of
oxytocin hormones and therefore will be
likely to impair the bonding between you
and your baby. In turn, this may lead to a
higher chance of postnatal depression and
unsuccessful breastfeeding.

If your baby is presenting by the breech
research has shown that more damage is
caused when the doctors attempt a
vaginal delivery than if they do a
caesarean operation, so they will
invariably recommend a caesarean
operation. Skilled midwives trained in the
Cronk/Evans breech birth procedures are
able to assist a woman to birth by the
breech with excellent outcomes.
Unfortunately, the midwives in this hospital
have not taken advantage of regaining
these lost skills so you will need to do your
own research to locate these midwives if
you want a vaginal birth. A similar situation
arises should you be expecting twins.

Signed:
............................................................
Date:
............................................................

Това за коя болница се отнася?

И тя не знае от кои е. Сума страници мрънка как искала да има домашно асистирано раждане, и после изведнъж  заяви, че то и да имало, тя нямало да ражда с лекар или акушерка вкъщи, щото не искала да ги вижда, най-много някоя "дула" можела да понесе. Нейна работа.

Това за коя болница се отнася?
[/quote]

Като гледам има поле да се попълни за коя болница. Организацията е от UK.

Списък на документи за ИС от наши болници има тук: http://www.rodilnitza.com/blog/rights-laws/documents-informed-consent/