Thursday, May 30, 2013
When choosing a home birth, be sure to do your research first

By Dr. Anthony Policastro
The birth of a child is a wonderful event. Everyone gets to celebrate. There are about 4.5 million births in this country per year. About 23,500 of them are what is known as home deliveries. In general terms, home deliveries are relatively safe. There is about one newborn death for every 1,000 births. However, that is still about twice the newborn death rate for infants born in hospitals. Those rates can be lowered if the preparation for home births are proper. There are less maternal complications from home deliveries so there are some advantages from that standpoint. Mothers are less likely to need an episiotomy (an incision to help the delivery). They are less likely to have a C-section. They are less likely to have a significant laceration at the time of delivery or to have an infection. We are fortunate that the American College of Obstetrics and Gynecology (ACOG) and the American Academy of Pediatrics (AAP) have both recently issued guidelines to help families make that decision. The ACOG statement has four major guidelines. The first is that parents need to make an informed decision ahead of time. They need to know what the risks are. They need to know what the benefits and alternatives are. The decision needs to be based upon logic and must involve as little emotion as possible. The second guideline is the most important one. Not every mother is a candidate for a home delivery. In many cases, we can predict potential complications ahead of time. In those instances home birth is not a good idea. There are several factors to use in that determination. The first is the mother should be healthy before pregnancy. She should not have a medical condition that would increase the risk for her and the infant. The second is that the mother needs to remain healthy during the pregnancy. Early pregnancy complications increase the risk for delivery complications. The third is that there needs to be a single infant. Twins and triplets have such high frequencies of complications that they need to be born in hospitals. The fourth is that the infant needs to be head first. Breech deliveries should not be done at home. They too have a high complication rate. The fifth is that the infant should be of average expected size. Infants expected to be small usually have a reason for that. They need to be in a location where that reason can be addressed. The sixth is that the infant should not be premature. The third guideline is that the delivery should be performed by someone who is formally certified to do deliveries. There are some individuals who hold themselves out to be certified. Sometimes their only certification is that they like to do home deliveries. I have seen an instance where one of these individuals was questioned about her qualifications. Her answer was that she was just there to support the husband so he could do the delivery. The fourth guideline is that there should be a transportation plan available. One important thing is to check on that plan before the delivery. Make sure the telephone works. Make sure the car runs and the weather is not bad at the time. Make sure the transport time is less than 20 minutes. We know that times longer than that are associated with a higher incidence of newborn death. The AAP also provides a list of guidelines that were just published this month. As expected they are more focused on the infant than the delivery. They do reiterate what ACOG said about planning transport ahead of time. However, they add some additional suggestions. The first of those is directly related to their guidelines for in hospital deliveries. Those guidelines indicate that there needs to be one person present at the delivery whose only job will be making sure the infant is doing well. It cannot be the person who does the delivery. In hospitals one person does the delivery. A second person assists the individual doing the delivery. A third person is responsible only for the infant. The AAP feels that this should be the same with home delivery. There are many times when infants have unexpected problems. When I was in the Air Force I lived on base. I can't count the number of middle of the night calls I got to help with a newborn who was having problems. I lived closer than the other pediatricians so, for that reason, I was the first one called. I was often there in time to give the infant their 5 minute APGAR score. Most infants who will suffer a newborn death will have problems at the time of delivery. Someone needs to be there to take care of them. A second recommendation is that the testing for Group B Strep that now occurs prior to delivery take place prior to home delivery as well. That will determine if the mother needs antibiotics during labor. We have seen Group B Strep almost disappear due to these recommendations. When I was in my residency, it was very common. Many children got meningitis. Of the ones that did, half of them died. Then half of the remaining ones had some kind of permanent brain injury. It is something to be respected. The next set of recommendations is to make sure that the infant receives all of the things that a newborn in the hospital would receive. This includes eye ointment to prevent eye infection, Vitamin K to prevent bleeding, immunization against Hepatitis B and screening for jaundice between 24 and 48 hours of age. That also includes newborn hearing screening and screening for PKU and other metabolic problems. There should be an ability to test for blood sugar if that is suspected to be a problem. The last recommendation is that there should be an arrangement to have the infant get a physical exam by a certified pediatrician or pediatric nurse practitioner within the first 24 hours. They need to look for things like heart murmurs. They need to make sure there are no minor birth defects that might suggest something else going on. They should be able to see jaundice if it occurs early. There are other potential issues that there should not be a delay in finding. While home deliveries are not common, there are some individuals who have a desire to have one. That occurs about 23,500 times each year in this country. That decision involves planning. You might spend hours selecting a name for the baby, buying things and planning the baby's room. You need to spend at least that much time planning the birth. Failure to do so might make all the other plans irrelevant.

Hospice offers grief workshop Delaware Hospice invites anyone coping with a loss to attend a session, "Tear Soup - Video and Discussion," on Wednesday, June 19, from 1 to 2:30 p.m., at the Delaware Hospice Office in Millsboro "Tear Soup," a beautiful video, speaks to every generation about the universality of grief. Tear Soup offers a recipe for healing for anyone who has had a loss or anyone who is supporting someone who has had a loss. During this 90 minute workshop, participants will watch the video and have a follow-up discussion. Handouts will be provided which address loss as it pertains to everyone. There is no fee for this workshop which is provided as a community outreach by Delaware Hospice. Registration is requested by Monday, June 17, by contacting Midge DiNatale, bereavement counselor, at or 302-416-0581.

Cinema Therapy session Movies can be simple, but effective tools to get us "in touch" with our feelings. On Monday, June 10 at 1 p.m., VITAS Innovative Hospice Care of Delaware and Cancer Support Community Delaware invites you to join us in some Cinema Therapy and discover together how our shared experiences with grief and loss can move us forward in our journey of healing. After the movie there will be an open group discussion. The film, "We Bought a Zoo," and discussion are free and open to the public. Movie snacks will be provided. This collaborative program will be hosted at Cancer Support Community's Sussex facility, which is located at 18947 John J. Williams Hwy., Ste. 312, Rehoboth. To register, call 645-9150.

Diabetes education program Nanticoke Memorial Hospital, Seaford, will hold a four-session diabetes educational program on June 5, 12, 19 and 26 from 5 to 7 p.m., at the hospital. Registration is required. The cost of the four-session program may be reimbursable by insurance. This four-session program includes weekly education sessions and individualized meal planning for diabetes self-management. The goal is to give you the self-management skills to control your diabetes. Family members/significant others are welcome to attend the weekly sessions. To register and obtain additional information regarding the course, contact Nanticoke Memorial Hospital's Diabetes Education Department at 629-6611, ext. 2446.

'Miracle Mile' Cancer Survivor Walk In celebration of National Cancer Survivors' Day, Beebe Medical Center's Tunnell Cancer Center will host its 10th annual Miracle Mile cancer survivors' walk, on Saturday, June 8, on the Rehoboth Beach boardwalk.

Because this year's walk marks a decade milestone, plans are under way to make it a special one. As part of the festivities, a Spirit of Hope Award will be presented. The event will begin at 7:30 a.m. at All Saints' Episcopal Church on Olive Avenue in Rehoboth Beach with registration. Participants will gather at 8 a.m. and proceed to the boardwalk where they will gather for a ceremony and then a short walk. They will return to the church for a light breakfast. Everyone is welcome to this free event. Contact the Tunnell Cancer Center at 302-645-3770 for more information, to register, or for special assistance the day of the event. To nominate someone for the Spirit of Hope Caregiver Award, nomination forms are available at the Tunnell Cancer Center.

Rhone named vice president Beebe Medical Center announces that Steven Rhone, RN, BSN, MS, NE-BC, has been appointed vice president of patient care services. He joined Beebe Medical Center from Christiana Care Health System where he served as administrative director of patient access and capacity management. At Beebe, Rhone is responsible for the hospital's nursing units and for developing and implementing nursing strategy and system policies to ensure quality patient care. Rhone has nearly 15 years of nursing leadership experience. He holds a bachelor of science degrees in health policy and administration from Pennsylvania State University, State College, a bachelor of science in nursing from College Misericordia in Dallas, Pa., and a master of science in management, health care administration, from University of Maryland University College (UMUC).

Hospice offers Camp New Hope Delaware Hospice has spaces available at its Camp New Hope, which will be held from Aug. 6-9, at Killens Pond State Park, for children and teens who have suffered the recent loss of a loved one. Since 1990, Delaware Hospice's New Hope program has offered individual and family grief counseling to more than 1,500 children and adolescents aged 6-17. The New Hope program, including Camp New Hope, is a free, community outreach program. New Hope supports children referred from the community as well as members of Delaware Hospice families. Camp New Hope is the annual highlight of the New Hope Program. This inspirational day camp takes place over four days, connecting children in similar age groups in order to help them process their feelings of loss and grief. Many of the children in New Hope have lost a parent, sibling, or grandparent due to illness or sudden death. Learn more about Camp New Hope by contacting New Hope Coordinator for Kent and Sussex Counties, Robin Murphy at 302-678-4444 or

Annual Health Fair Delaware New Tech Academy at Seaford High School will host its second annual health fair on Tuesday, June 4 from 9 a.m. to 2 p.m. at Seaford High School. The theme is "Get Healthy, Stay Healthy." There will be student-managed booths about genetic diseases and heredity, a culminating project for the 10th grade unit on genetics and heredity. Other organizations including Powerhouse/SWEAT, Nanticoke Cancer Care, Massage Envy, Seaford Nutrition Services, our own Wellness Center, and more will be manning booths regarding health and wellness.

MS Walk at Heritage Shores For the 9th year in a row, Kelly's Crusaders, will be lacing up for the annual Delaware MS walk. The walk will take place on Friday, May 31, at Heritage Shores in Bridgeville. Registration begins at 5 p.m. and the walk begins at 6. It's a scenic 3 mile walk around the beautifully landscaped golf course at Heritage Shores. For more information and to join the team of Kelly's Crusaders, contact the DE MS Society at 302-655-5610.

Asthma Awareness Workshops The Sussex Coalition, Telemon, Department of Public Health, Nemours and the Western Sussex Boys & Girls Club are sponsoring Family Fun Nights to facilitate a series of asthma workshops and promote asthma awareness. Family fun nights and asthma training workshops will be held on Friday, June 7 and Friday, June 21 from 6 to 9 p.m., at the Western Sussex Boys & Girls Club in Seaford. Admission, activities (bring a swimsuit) and dinner are free. Presenters include Sheelagh Stewart, Nemours asthma educator; Denese Bell, public health educator and trainer; and Bill Leitzinger, Office of Healthy Environments. For more information, call Troy Hazzard at 302-444-9175 or Cathy Van Sciver at 302-262-9459.

CPR classes offered Nanticoke Memorial Hospital will offer community CPR classes to anyone interested in learning CPR at the Nanticoke Training Center on Water Street in Seaford. Participants will learn how to perform the basic skills of CPR on adults, children, and infants and how to help an adult, child, or infant who is choking and use of the AED. This classroom-based, video, and instructor-led CPR course offers families, friends, and community members the opportunity to learn CPR and need a course completion card. Classes are open to participants ages 12 and up. This program is specifically designed for those who prefer to learn in a group environment with feedback from an instructor. The target audience is those who have a duty to respond to a cardiac emergency because of job responsibilities or regulatory requirements. Cost is $45. Payment and registration is required by no later than five business days prior to the class. Late registrations may be accepted if seating is available. To register and to obtain a listing of class dates/times, contact the Nanticoke Memorial Hospital's Training Center office at 629-6611, ext. 8919. Pre-registration is required.

Dr. Azie joins Beebe Medical Cardiothoracic and Vascular Surgeon Nnamdi Azie, MD, has joined the Beebe Medical Staff and is in practice with Cardiothoracic Surgeon M.L. Ray Kuretu, MD, at 400 Savannah Rd., Lewes. Dr. Azie is board certified in cardiothoracic surgery, vascular surgery and general surgery. He has joined the Beebe Medical staff from Ohio where he was an attending cardiothoracic and vascular surgeon at Miami Valley Hospital in Dayton, Upper Valley Medical Center in Troy, Good Samaritan Hospital in Dayton, and Kettering Medical Center in Kettering, Dr. Azie earned his medical degree in 1986 from the University of Nigeria Medical School, completed a residency in Cardiothoracic Surgery at Hahnemann University Hospital in Philadelphia, and a Vascular Surgery Fellowship at Ohio State University. He also completed fellowships at the Royal College of Surgeons in England and at the Royal College of Physicians and Surgeons in Glasgow. Dr. Azie is an assistant clinical professor of surgery at Wright State University Boonshoft School of Medicine in Dayton. He is a member of the Society of Thoracic Surgeons, a Fellow of the Royal College of Physicians and Surgeons of Glasgow and a Fellow of the Royal College of Surgeons in England. To schedule an appointment with Dr. Azie, call 302-644-4282.

Alzheimer's Caregiver Support Group Cadia Rehab Renaissance near Millsboro is hosting and facilitating an Alzheimer's Association Caregiver Support Group that meets the fourth Tuesday of each month at 6 p.m. All meetings are open to the public and interested parties are invited to attend. Alzheimer's disease is the sixth leading cause of death in the United States. One person out of eight who reaches the age of 65 will develop Alzheimer's, as will one person out of every two who reaches the age of 85.

2013 Walk MS dates The Delaware Chapter of the National Multiple Sclerosis Society has announced the 2013 Walk MS dates and is inviting all Delawareans to join the movement. Each year thousands of loved ones, friends, and neighbors throughout Delaware – from Wilmington's Riverfront to Sussex County's Baywood Greens – lace up and step out in solidarity, with hopes of creating a world free of MS. Last year, over a quarter million dollars was raised to help out the 1,550 Delawareans living with multiple sclerosis. The Twilight at Heritage Shores walk in Bridgeville will be held on May 31 and the walk at Baywood Greens will be held on June 7. To register, visit or call 302-655-5610.