Health: Have yourself a happy home birth

A Question of Health

WHAT ARE the risks of home births?

Having a baby at home can be a wonderful experience, but it is not for everyone. The main risks arise when there are serious complications of labour, such as heavy bleeding, foetal distress inside the womb, or if the baby gets stuck and will not deliver without obstetric help. If you are considering having a baby at home, you need to find out what local facilities are available. Some districts have teams of community midwives who are happy to undertake home deliveries. The risks are increased in women who have had problems in previous pregnancies. Home births in first pregnancies are also a worry, and some doctors and midwives will be unhappy about agreeing to them. Careful planning of a home birth is essential, and this must include contingency plans for urgent transfer to hospital if things start to go wrong.

I LOVE walking in the hills, but I am having problems with one of my knees. I'm fine on the flat and uphill, but when I walk downhill I start to experience pain in the kneecap area. An X-ray does not show anything and I have been told it is "general wear and tear". Can you suggest anything else?

Pain at the front of the knee and around the kneecap is always worse going down stairs and downhill.

You should be able to improve things greatly strengthening the muscles that support the knee. Concentrate on the quadriceps muscles at the front of the thigh. Exercises forstraightening the knee against resistance are essential. A physio-therapist or a fitness instructor at a gym would be able to help you, but these exercises can even be done while sitting and watching the telly.

Would a ski-pole-type walking stick help? Lightweight sticks reduce the strain and weight on the knees and lower back by up to 50 per cent. The combination of quadriceps exercises and an adjustable length walking stick will help considerably.

Send questions to A Question of Health, `The Independent', 1 Canada Square, Canary Wharf, London E14 5DL; fax 0171-293 2182; or e-mail health@ independent.co.uk (Dr Kavalier cannot respond personally).