Why home births aren't as scary as you think...
Updated: Jan 25
With hospitals now declaring themselves in a "critical state" (and that goes for maternity units too) many mothers are now considering home births as an option.
When you fall pregnant this probably won't be the first thing you think about, but further down the line it's inevitable you will explore your options on where to give birth. Or will you? Did you even know you have options Mama?
Many mothers don't realise there are options. Believe me, there are ALWAYS OPTIONS! These may depend on risks, needs and where you live, but it's always good to know what's out there. Let's take a look shall we?
For a start you may find these tables interesting.
If you have a straightforward pregnancy and you and your baby are well, you may choose to give birth at home.
There are many advantages to giving birth at home such as being in familiar surroundings, where you may feel more relaxed and better able to cope. This can help your labour progress more efficiently. You are not having to interrupt your labour to go into hospital, you won't have to be separated from your partner after birth, you're likely to be looked after by your community midwife - someone you already know and there's a statistically lower risk of intervention such as such as forceps or ventouse, than giving birth in hospital.
Also, if this is your second/third child, you don't have to worry about leaving your other children and the logistics of childcare. Infact, If you’re having your second baby, a planned home birth is as safe as having your baby in hospital or a midwife-led unit.
Here's some stats you may like to know:
Having a Home Birth increases your chances of normal birth, as opposed to be on Obstetric Unit (Labour Ward).
There is a lower rate for Section delivery
Lower rate of intervention in birth (instrumental birth, Section, episiotomy)
Outcome is no different for baby (risk of serious medical outcome at home is 5.3/1000 for mother who has birthed before and 9.3/1000 for first time mother)
Risk of transfer to hospital is around 45% for first time mother and just 12% for mother who has birthed before
Giving birth is generally safe wherever you choose to have your baby and in 2019, a large systematic review and meta-analysis was published in The Lancet on home births. It looked at 14 studies including data from around 500,000 intended home births. The authors found that, “The risk of perinatal or neonatal mortality was not different when birth was intended at home or in hospital.” (Hutton et al 2019).
What's more there was a 2020 Norwegian study by Skrondal et al (2020) which is freely available here. The findings conclude:
“Planned home birth may be experienced as a very positive occurrence for nulliparous women, and the care those women in this study received contained several elements that can help to promote normal labour and birth at a time in which reducing interventions in maternity care is of importance. Their positive birth experiences gave the women confidence both in their transition to motherhood as well as in other aspects of life.” (Skrondal et al 2020).
Some things to think about when birthing at home:
Epidurals are not available - but other pain relief such as gas and air, birthing pool, TENS machine and relaxation techniques can be used.
Your midwife may suggest you birth in hospital if your baby is breech or if you're expecting multiples
Midwife Led Units
Since 2014, when National Institute for Health and Care and Excellence (NICE) published guidelines suggesting mid-wife led units were the safest place for straight forward births, women have been strongly encouraged to seek low-tech midwifery care, rather than birthing on traditional labour wards.
This guideline covers the care of healthy women and their babies, during labour and immediately after the birth and can be viewed here.
The reason a midwife led unit is considered safer for straightforward birthings is because the rate of interventions, such as the use of forceps or an epidural, is lower and the outcome for the baby is no different compared with an obstetric unit.
Studies show that around 45 per cent of women have a low risk of developing complications during their pregnancy and are therefore suitable for having a midwife led birth.
Factors that can increase the risk of complications during birth include being over 35, being overweight or obese, bleeding after 24 weeks of gestation, and having a high blood pressure. Complications from a previous pregnancy can also increase the risk of complications during birth for pregnant women.
The reason midwife led units are so popular is they have a more comfortable, homely feel compared to a maternity unit in the hospital. Some midwife led units are within the hospital, where pregnancy, newborn and anaesthetic care is available. Although a stand alone midwife centre does not have this care available.
The advantages of birthing on a midwife led unit are that you're in surroundings where you feel more relaxed and better able to cope with labour, you're more likely to have a midwife if you've got to know during pregnancy, the unit is potentially nearer to home, and there is a lower likelihood of having an intervention such as forceps or ventouse than if you were giving birth in hospital.
It's worth noting epidurals aren't available on midwife led units and should there be complications, you may need to be transferred to hospital.
If you choose to give birth in a hospital midwives will look after you but doctors will be on hand too, if you need their help.
Within a hospital setting, you still have choices, and can express desires to have the birth you want.
Some people prefer hospital births because the doctors are there if you need them, anaethetists are around should you want an epidural, there are specialists for your baby, should they need care.
Some things to bear in mind with a hospital birth is may go home from the labour ward or you may be transferred to a postnatal ward with other mums and newborns. And statistically, you are more likely to require intervention during your labour, such as an epidural, episiotomy, ventouse or forceps.
Questions to ask
The NHS should support your birth rights in having options. They suggest you ask the following questions when thinking about where to birth:
Are tours of the maternity facilities available before the birth?
When can I discuss my birth plan?
Are TENS machines available for pain relief or do I need to hire one?
What equipment is available – for example mats, a birthing chair or bean bags?
Are there birthing pools?
Are fathers, close relatives or friends welcome in the delivery room?
Are they ever asked to leave the room – if so, why?
Can I move around in labour and find my own position for the birth?
Are epidurals available?
How soon can I go home after the birth?
What services are provided for premature or sick babies?
Who will help me if I choose to formula feed?
Will my baby be with me all the time or is there a separate nursery?
Are there any special rules about visiting?
How long would it take if I needed to be transferred to hospital from a birth centre?
Which hospital would I be transferred to?
Would a midwife be with me all the time?
Find out more on your birth rights.
Ultimately, I want mothers to realise they have a choice, whether they prefer to have their baby at home or in a midwife led unit because that is generally safer, then that is her right. If the mother wishes to have her baby in hospital because it makes her feel 'safer' then that is also her right. It's a very personal choice, and certainly not a 'one size fits all' model.
What is important is that you discuss your options with your community midwife, arm yourself with all the most up-to-date information, do your research, ask the right questions so that you can make an informed decision about where to birth your child.
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