GuidelinesOther guideline
Home Delivery – ‘Born Before Arrival’
The guidelines recommend management of common obstetric conditions at primary and referral level, based on local experience and evidence-based practice. They are not intended as strict protocols nor as standard operating procedures, but rather as a guide to safe effective management of common obstetric problems. The guidelines should be most useful to interns, medical officers and registrars.
After home or in-transit delivery, the mother & baby require full assessment & examination to detect any risk factors or problems. For the mother:
- Check the antenatal card carefully for risk factors & problems
- If the woman is unbooked, do RPR & Rh blood tests, & offer HIV testing
- Ask about the circumstances of the delivery
- Examine the woman for evidence of systemic illness, e.g. pneumonia, severe blood loss, retained products of conception & perineal injury, & manage appropriately
- Give oxytocin 10 units IM
HIGH RISK CONDITIONS FOR TRANSFER TO HOSPITAL IN LABOUR
- Primigravida ≥35 years
- Parity ≥5
- Previous caesarean section or uterine surgery
- Previous postpartum haemorrhage requiring blood transfusion
- Serious medical disorder (e.g. diabetes, epilepsy, symptomatic asthma)
- Heart disease
- Anaemia (Hb <10 g/dL)
- Hypertension or eclampsia
- Multiple pregnancy
- Breech presentation or transverse lie
- Estimated fetal weight <2 kg; SFH <30 cm
- Suspected big baby >4 kg; SFH >40 cm
- Rupture of the membranes before the onset of labour
- Maternal pyrexia ≥37.5 degrees
- Vulvovaginal sores or blisters
- Extensive vulvovaginal warts that may obstruct delivery
- Antepartum haemorrhage
- Suspected fetal distress
- Thick meconium staining of the liquor
- Offensive liquor
- Cord prolapse
- Poor progress in latent phase of labour (≥8 hours)
- Poor progress in active phase of labour (crossing 2-hour partogram action line)
- Poor progress in second stage of labour (≥1 hour)
- Any woman who is in shock, short of breath or appears very ill