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5. For social reasons.
6. Primigravidae. Most women prefer to arrange for their
first confinement to take place in hospital, not because they
feel it to be dangerous at home, but because they feel it is
safer in hospital—quite a different thing. After all, childbirth
is a new experience and must be considered to be a
trial.
7. Multiple pregnancy.
The first three of these should be regarded as absolute
indications.
So much for guidance in the making of hospital bookings. But
very often the patient first seeks advice, quite correctly, from her
general practitioner and this procedure will surely become more
frequent in the future. The list just cited and drawn up for use by
those responsible for booking patients for hospital care is based
upon abnormal factors. But those confinements arranged to take
place at home should be selected on grounds of normality.
The advice that should be given therefore would be better if
stated in a more positive manner and could be outlined as follows:
At the present time it is sensible to consider making arrangements
for a home confinement for patients who fulfil the following
criteria at the time of booking :—
1. As far as can be ascertained the woman's general physical
state is unimpaired.
2. She is pregnant for the second, third or fourth time, the
previous pregnancies, labours and puerperia have been
normal and she is under 35 years of age.
3. She is a primigravida under 30 years of age.
4. She is Rhesus positive, or is known to have no antibodies.
5. The home conditions are suitable.
The list is quite short and perfectly easily understood. It
would not be out of place to offer the suggestion to the effect that
such arrangements must not be contemplated unless the doctor is
prepared to accept responsibility for pre-natal care, care in labour
and care after delivery.
The position must be reviewed at 36 weeks or earlier if complications
arise.
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