Home birth

All babies were born at home before birth was included within the scope of medical care. Midwives/birth attendants have been assisting with birthing babies at home for centuries. In 1905 the first register for Midwives was established to ensure birth attendants were qualified and competent to support women during birth. Programmes such as Call the Midwife have helped affirm that homebirth was once ‘the norm’. However, emergencies are much more entertaining in a TV drama than repeatedly seeing uncomplicated labour and birth. The fear of emergencies is most commonly cited by women as a reason for hospital birth being safer. For some pregnancies, this may be accurate, as there is a known and increased risk to mum and baby whereby a team of health professionals and equipment being available is safer. However, for most women experiencing a healthy and uncomplicated pregnancy, the risk of intervention and complications leading to emergency situations is increased in hospital. National guidance advises women that they are more likely to achieve a spontaneous vaginal birth when birthing at home and outcomes for baby are not improved by birthing in a hospital.

The best place to birth your baby is where you feel comfortable. You might be more fearful at home if you like the idea of being surrounded by equipment and health professionals. Everyone has different ideas about how they want their birth experience to look and feel. It is important to know and consider all the options available and to take medical advice on board. Most importantly, you need to feel comfortable with questioning the plan of care recommended by health professionals, so that you remain in control and involved. Avoiding questioning routine care can lead to a dissatisfaction at the end of your pregnancy. Particularly if you have relinquished control and feel like a passive observer of your baby’s birth rather than the main carer. It is important your birth partner is on board with any decisions and will be supportive. It might be helpful to sit and discuss your options early in the pregnancy so you both have time to research and discover available support.

Some of the benefits of homebirth include having a sense of control and pride in achieving what you set out to do. You are less likely to use strong analgesia, as the environment feels safer and naturally more soothing. Most homebirths facilitate more movement as you feel more comfortable to potter about in your home. The uterus is made up of muscle fibres, and adequate nutrition is required to support the uterus to continue contracting. Having your labour at home might help you to tolerate light diet and fluids better as you are familiar with the scent of your own home, and the selection at home is everything you are familiar with. Avoiding hospital acquired infection is another positive for homebirth, as well as not having to wait for discharge once you have given birth and feel ready for home.

For pain relief, most home birthing mums like to have a birth pool set up as an option for pain relief during labour and sometimes for the birth. You can use a bath or shower if you choose not to have a pool, but the buoyancy the pool offers aids ease of movement. There are many pain-relieving tools that can be used at home. There are essential oils evidenced to be effective for labour pain, and massage and touch releases endorphins (natural pain relief). Having effective birth partner support, alternating positions and movement are all clearly evidenced to reduce the need for stronger analgesia such as opiates or epidural. Entonox (Gas and Air) can be used at home, and if you change your mind and wish to have stronger analgesia, you can ask to be transferred into the hospital.

If there is a concern for mum or baby during a homebirth, you will be advised to be transferred into hospital. Homebirth midwives are trained to manage emergencies at home, and have equipment to keep you both safe until you are transferred or emergency services arrive. The transfer rate for homebirth is difficult to analyse as there are too many variables to identify a clear rate of transfer. Currently, for a first-time mum the rate of transfer is between 23.4% and 45.4% often due to strict policies about expected progress. In comparison to subsequent births at home with a rate of transfer between 5.8% and 12%. If you plan to have a homebirth and change your mind at any stage, you can still give birth in hospital without having to make prior arrangements. However, if you arrange for a hospital birth, you will find it requires a few weeks of planning to change your place of birth to a homebirth. This is generally because the home birth team needs to ensure they can facilitate being on call for your labour. The team will also evaluate your home to assess for access in an emergency, and make sure that you understand your new care plan fully.

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