July 14th, 2012

Why should I consider planning a home birth?

Many women book a home birth because they think they will be more relaxed in a familiar environment and therefore labour will be quicker and easier; you can guarantee access to a birth pool if you get one yourself and you get individual care and attention from one midwife who doesn’t have to look after other women.

Do I need to get permission to have my baby at home?

No, all the decisions are in your hands: the medical profession are there to give you information and advice and then to support you in your decisions. Your midwife may come out to do a home assessment but this is to make sure she and her team are aware of anything they might have to plan for, such as access issues. It is not to see whether you are “allowed” a home birth – you are the only one who can do the allowing!

What if I am ‘high risk’?

Sometimes it is clear cut that you would be better off in hospital, but not always. You may fit into a high risk category but it your attitude to risk is important: the benefits of being at home may outweigh the other risks associated with being in hospital (such as being more likely to have interventions including caesarean, greater chance of infection, and so on). Planning a hospital birth would be a good idea if it seems that you might need extra help or your baby might need specialist care after the birth. A useful question to ask to help you decide is “What would be done differently in hospital that couldn’t be done by a competent midwife at home?”

I am not sure if I can cope with a home birth – what happens if I decide I want an epidural after all?

Epidural is the only option not available at home for relieving or helping you to work with labour pain. But planning a home birth only means that you are keeping your options open to stay at home for as long as you want to: if you change your mind at any time you can just go into hospital. In some areas of the UK the maternity services are set up so that most people only decide on place of birth once they are actually in labour and know how they feel: lots of women then choose to stay where they are. And of course, it’s easier to plan a homebirth and then transfer than to plan a hospital birth and then change your mind and go home!

How much support will I get in labour?

Usually you will have a midwife with you once you are in established labour and then a second midwife who will come out before the baby arrives. You can have your partner; friends or relatives; a doula; your pets; any other children (if they are young it might be a good idea to have someone to look after them so you can concentrate)as many or as few people as you like.

How will my partner’s role be different at home?

Many partners say that they feel more relaxed and confident at home because they can potter around, get some rest when they need some without abandoning you and they know where things are. Some partners may need reassurance that things are going normally and they may need to find out what would happen if the midwife was delayed and the baby decided to come quickly (basically, don’t panic and call 999: they will talk you through everything and an ambulance should be there within minutes).

Someone said I was selfish for taking midwives off the labour ward – am I?

The set up around the UK varies but usually there is a division between labour ward midwives who attend hospital births and community midwives who cover home births.  This is the case in Hull and East Yorkshire. Community midwives generally enjoy supporting home births and are committed to women having this choice.

What about the mess?

Lots of people worry about the mess: quite often there is very little. The midwives take away the placenta (unless you want to keep it) and will be happy to help in getting things back to normal, perhaps while you spend time with baby, or go and have a bath or shower. Speak to your midwife or ask other women who had a homebirth for tips. If you have a birth pool it will have to be emptied, but most come with pumps.

Won’t I make a lot of noise?

Everyone is different: some women make lots of noise and others much less. Most neighbours seem oblivious. And babies, especially as they get bigger, will probably make more noise . . .

Is home birth safe? What happens if something goes wrong?

As Marjorie Tew and others have found, for the vast majority of women booking a home birth is as safe, if not safer than booking a hospital birth. A midwife giving one to one care can keep an eye out for the signs that mother or baby might need help and take appropriate action: she is trained to deal with emergencies and can arrange to transfer into hospital if that seems appropriate. Most women who do transfer in do so because labour is going slower then might be expected. The main difference at home is that there isn’t a bell to ring to summon a group of people, so the midwife has to be competent and confident to deal with emergencies. Usually problems can be spotted in advance of them becoming an emergency but sometimes things might not go as well as hoped. There are no guarantees wherever you plan to give birth: perhaps the difference is that people are less likely to say “Oh, you should have had a homebirth” if something unfortunate happens during a hospital birth . . .

What do people say are good things about having a home birth?

Being able to do things on their own terms; not having to drive into hospital and no worries about parking; feeling relaxed and more able to cope with the hard work of labour; having a lot more privacy than in a hospital environment; not having the stress and worry of being in a strange/clinical/bright environment; having undisturbed family time after baby arrives; having other children and family members around; no worries about infection; getting into their own bed; being able to get into their own bath or shower afterwards; no one throws your partner out after the birth; home cooked food; an amazing sense of achievement of giving birth at home.

What is harder about giving birth at home?

* It can still be seen as a strange choice and lots of people say “You’re so brave!” You need to be happy with taking responsibility for yourself and your baby.

* You may feel that there would be more postnatal support in hospital with someone around at all times to help with feeding or concerns you have, but this isn’t necessarily true as postnatal wards can be very over-stretched. You may want to research where to access support beforehand in case you need it – such as breastfeeding counsellors, peer supporters and breastfeeding drop-ins and the NCT helplines. Also you can hire postnatal doulas and arrange to have postnatal care from independent midwives.

* You do need to be flexible because sometimes things don’t go to plan and you may need to go into hospital, so having stuff ready (even if you don’t want to pack a hospital bag) might be a good idea.

* If you have a wonderful home birth that you would do again tomorrow, other mothers might not want to hear about your experience . . .