Is down syndrome considered high riskfor home birth ?

[danifreeman]

I cant seem to find any information on home birth and down syndrome babies. My question is do mid wives consider down syndrome high risk? If the baby tests positive for down syndrome will I be denied a mid wife assisted home birth?

[cileag]

I know that many children with Down's Syndrome have underlying cardiac issues so I would be reluctant to birth at home knowing that. I would probably birth in a hospital if I knew in advance that my child had a more than fair chance at cardiac problems.

[fruitfulmomma]

Pg. 5 here states that a midwife could not continue to care for a mother who exhibits signs that her child may develop complications within the first six weeks of life... http://www.dora.state.co.us/midwives/Rules.pdf

So I am guessing that you mostly likely would risk out, but maybe not depending on your laws and what your midwife is comfortable with vs. what tests have shown with regards to your specific situation.

Personally I chose to birth in the hospital when we were told that our daughter possibly had birth defects specific to her heart and growth (not ds related). She was okay but needed room air for awhile and evaluation and testing.

[MsBlack]

I'd say it entirely depends on the mw and the state, and the baby.

If you know from tests that your baby has Down Syndrome, then you can get ultrasounds a few times during pregnancy to check on the baby's heart function and other organs. DS has a very wide variation! Yes, there is a much higher risk of heart defects--but not a guarantee. And when a defect IS present it's NOT necessarily life-threatening. Some are, many more aren't.

Many homebirth families do not want, and many homebirth mws do not require, any sort of prenatal testing or ultrasound. In these cases, it can mean that no one knows until the baby is born whether or not the baby is 100% normal or has issues/defects. Under standard prenatal care, only some issues/defects can be spotted or at least guessed-at, prior to birth--many heart defects, for instance, can go unnoticed prenatally due to the design of pregnancy...essentially, mom's circulation and the operation of the placenta 'cover' for baby. It is only when baby is born, and is working all on it's own, that heart defects become clear.

Personally, if I knew from testing or u/s that a baby had a defect, then I would want to be careful about working with such a family. I'd want as much info as possible so that I could provide the best, wisest care possible. I'd also want to know that the family was fully informed and making carefully considered decisions. In many cases, homebirth woud be the best choice IMO. This is because EITHER the known extent of an issue or defect is very unlikely to require immediate medical attention--in which case, a peaceful homebirth and plenty of bonding/breastfeeding can be best for the baby and the whole family--and most especially a baby who may well need medical care/surgeries in time (whether within days of birth or later).

OR, there is also the sadder, more difficult possibility that known defects/issues are most likely fatal or at least so profound that it's known the baby's life will be extremely difficult and limited in spite of great and ongoing medical intervention.

I believe that families should be able to make these choices themselves, within their own values, faith, and understanding of what kinds of costs they can bear (ALL costs, not just $$). And we now have the testing technology to get an often pretty good picture of the potentialities, prior to birth (tho no testing tech is foolproof).

[47chromosomes]

Yay, I would think a babe known to have Down Syndrome would be considered to be too risky to birth at home. I have a son with Down Syndrome. Incidentally, other than some decels during pushing, he was born very healthy, and no one even caught that he had Down Syndrome until he was 2 months old. That said, Down Syndrome can be such a mixed bag of medical issues. Some children will have none--like my son--and some will have many complicated issues. I have had a home birth, and am planning another. I do do prenatal testing after having my boy with Down Syndrome for the sole reason that if I were to have another child with an issue, well, for me that would be a very strong reason to want to be in a hospital. Normal is best at home. Some issues are what the hospital should be for. Down Syndrome, I would say, is one of them. There can be heart defects, bowel defect, low muscle tone that can affect breathing passage ways... These are things that may or may not be picked up by things like a fetal echocardiogram or level 2 ultrasound. Or, it may be something like a PDF that does not happen until the moment of birth. Either way, it would be impossible to know if defects will be cause for immediate need to medical intervention or not until the babe is out and coping in the world.

All that said, it is up to your personal comfort level and philosophy of whether you need or want this info. But if you do choose to have testing, and it shows there is a probability of Down Syndrome, well, then you can probably expect to be "high risk" as far as a home birth goes. I guess I would be surprised if a midwife said to me, "Oh, he has Down Syndrome. No big deal."

[HeatherB]

I definitely agree with MsBlack. I think families should have the choice, given full and complete understanding of the situation and factors involved. I have heard several cases (and my MW has shared some) of babies born with heart issues that did BETTER because they were at home. The defects varied and the reasons they were better off at home varied somewhat, but the main points were the gentle and natural birth; the constant care and contact; the responsiveness of the parents to the baby's needs. If you search around on the Birth Stories forum here, you'll probably find a couple of those amazing stories.

Now, DS doesn't have to mean heart issues, so if you KNOW you have a DS baby, then you might want to look further and see if there are known heart issues.

Myself, I'd be consulting with my MW, whom I know to take pretty much the same approach as MsBlack, and decide together with her what we're most comfortable with. I do absolutely know of Downs babies born at home with no ill effect from their place of birth.