**5. Home care for children**

## **5.1 Introduction**

Defining health like a human right, the United Nations Convention of the Right on the Child (UNCRC) ratifies the importance of the different aspects of child health in all types of care. In 2018 the global under-five mortality rate declines worldwide, but 5.3 million of children died under 5 years due the complications of prematurity, pneumonia or diarrhoea. The care of health especially on ill children is a permanent task for all health system, providers and caregivers. The World Health Organization (WHO) guide "Improving the quality of pediatric care -Operational guide for facility-based audit and review of pediatric mortality" provides data for the improvement, modifies the social, environmental and nutritional risk factors and supports healthcare workers by learning their medical practice [27].

## **5.2 Home care for healthy children**

#### *5.2.1 Planned home birth*

The prevalence of home birth is variable by country, from 0.4% in Australia to 3.3% in New Zeeland, with the highest percentage being in the Netherlands (20%) [28].

**127**

*The Family as Recipient and Provider of Home Care: A Primary Care Perspective*

mobility, the prevalence of planned home birth decreased.

eligible for home birthing than nulliparous [31].

or insurance/financial resources.

the content of the follow-up visit.

*5.2.2 Home care for full-term newborn*

Even in countries with no tradition in home birth and a low prevalence of planned home birth, mothers show a growing interest for non-medicalization of a natural process. Until recently home birth was widespread, with more than half of the pregnant women giving birth at home in the 1940s. Due to the significant increase in the number of hospital beds and controversies about the safety of home birth and population

The motivations of the women who desire to give birth at home are related to concern about the high medical interference (induction of labour with oxytocin, peridural anaesthesia and caesarean birth), cultural and religious background, unpleasant previous hospital experiences and the wish to give birth in the family

The main concern about out-of-hospital birth comes from the connection between perinatal and neonatal mortalities and the place of childbirth. A metaanalysis based on 14 studies and ~500,000 planned home birth of low-obstetrical risk women demonstrated no statically significant difference regarding perinatal or neonatal mortality between low-risk pregnant women who intend to give birth at home and those who opt for the hospital. All the studies were performed in wellresourced countries, and the midwifes were well-integrated in health system. The study revealed that multiparous low-obstetrical risk women are more

The safety of home birth is possible in countries with well-integrated healthcare programmes, including an educational programme for proper knowledge about low-risk pregnancies and specially trained midwifes. The Dutch midwifery care is one of the best organized systems. The Dutch midwives provide antenatal care and attend home birth. They are trained for the follow-up of low-risk pregnancies and are able to recognize and manage some complications. If women become noneligible for home birth, they are referred to secondary/tertiary care centres. Their Obstetric Manual (Verloskundig Vademecum) stipulates the agreement to be part in a complex, collaborative team involved in home birth and the clear stratifications of obstetrical risk. The recommendations of the American College of Obstetricians and Gynecologists stipulate that foetal malpresentation, multiple gestation or prior caesarean delivery are absolute contraindications to planned home birth [32]. The optimal candidates for home birth are women who express the option for home birth after being counselled on risks, benefits and alternatives. It is considered that eligible women for home birth are those who have no pre-existing medical and obstetrical conditions, with singleton full-term cephalic foetus having a weight appropriate for gestational age, with spontaneous labour and prior vaginal birth. It is essential not to overlook that home birth may not be a preference of the pregnant woman and can be caused by lack of proper transportation, local maternity facility

One of the characteristics of primary paediatric care in most of the countries is that home care for a healthy newborn starts after discharge with a follow-up medical visit taking place at the family home. The timing of follow-up visits is recommended to be done according to the duration of hospitalization, the discharge medical data and availability of the family and healthcare provider [33]. It is advisable for the healthcare provider to schedule it in such a way as to allow a generous amount of time. The durations of the visit must be appropriate to the complexity of

According to the reproductive-maternal-newborn-and-child-health (RMNCH) indicators, alongside a complete physical examination, it is necessary

*DOI: http://dx.doi.org/10.5772/intechopen.91926*

environment [29, 30].

#### *The Family as Recipient and Provider of Home Care: A Primary Care Perspective DOI: http://dx.doi.org/10.5772/intechopen.91926*

Even in countries with no tradition in home birth and a low prevalence of planned home birth, mothers show a growing interest for non-medicalization of a natural process. Until recently home birth was widespread, with more than half of the pregnant women giving birth at home in the 1940s. Due to the significant increase in the number of hospital beds and controversies about the safety of home birth and population mobility, the prevalence of planned home birth decreased.

The motivations of the women who desire to give birth at home are related to concern about the high medical interference (induction of labour with oxytocin, peridural anaesthesia and caesarean birth), cultural and religious background, unpleasant previous hospital experiences and the wish to give birth in the family environment [29, 30].

The main concern about out-of-hospital birth comes from the connection between perinatal and neonatal mortalities and the place of childbirth. A metaanalysis based on 14 studies and ~500,000 planned home birth of low-obstetrical risk women demonstrated no statically significant difference regarding perinatal or neonatal mortality between low-risk pregnant women who intend to give birth at home and those who opt for the hospital. All the studies were performed in wellresourced countries, and the midwifes were well-integrated in health system.

The study revealed that multiparous low-obstetrical risk women are more eligible for home birthing than nulliparous [31].

The safety of home birth is possible in countries with well-integrated healthcare programmes, including an educational programme for proper knowledge about low-risk pregnancies and specially trained midwifes. The Dutch midwifery care is one of the best organized systems. The Dutch midwives provide antenatal care and attend home birth. They are trained for the follow-up of low-risk pregnancies and are able to recognize and manage some complications. If women become noneligible for home birth, they are referred to secondary/tertiary care centres. Their Obstetric Manual (Verloskundig Vademecum) stipulates the agreement to be part in a complex, collaborative team involved in home birth and the clear stratifications of obstetrical risk. The recommendations of the American College of Obstetricians and Gynecologists stipulate that foetal malpresentation, multiple gestation or prior caesarean delivery are absolute contraindications to planned home birth [32]. The optimal candidates for home birth are women who express the option for home birth after being counselled on risks, benefits and alternatives. It is considered that eligible women for home birth are those who have no pre-existing medical and obstetrical conditions, with singleton full-term cephalic foetus having a weight appropriate for gestational age, with spontaneous labour and prior vaginal birth. It is essential not to overlook that home birth may not be a preference of the pregnant woman and can be caused by lack of proper transportation, local maternity facility or insurance/financial resources.
