Home birth has always been an option but it has been highlighted in the press more in recent years. Kate Middleton is set to have a home birth this time round with her third, making giving birth at home with a midwife an even more popular choice. But what are the pros and cons of a home birth? Am I eligible? Do you need any equipment to birth at home? I will be answering all of your questions and more, so you can make an informed choice. I’m also including a free downloadable printable home birth checklist for you, so if you plan on giving birth at home, you’ll be prepared.
Who can Have a Home Birth?
In short, anyone! It’s your choice where you give birth no matter what your risk factors and a Midwife should and will attend you when the time comes. Ideally though, you would have a low risk pregnancy. It doesn’t matter if it’s your first baby or not. No-one can refuse you a home birth, but they will want you to know your options and risk factors so they can advise you best. Here are a some risk factors that can affect your choice, and your Midwife may recommend a hospital birth in these cases. If you have any of these factors or you have been told your pregnancy is high risk, discuss your options with your Midwife or Doctor.
- Age over 40 or under 16
- BMI over 35 or under 18
- Your 5th or more child
- If you have not received any antenatal care during the pregnancy
- Mental health issues that require a plan
- Atypical antibodies present in your blood test
- Significant Asthma requiring a change in treatment
- Diabetes – preexisting or gestational (pregnancy) related
- Epilepsy
- Hypo/Hyperthyroid
- Blood borne virus (eg HIV or Hep B)
- Clotting abnormality
- Increased risk of VTE (formerly DVT)
- Significant Fibroids
- Cardiac Disease
- Multiple Pregnancy
- Anaemia with a Hb of less than 90
- Significant bleeding in pregnancy
- Pregnancy under 37 completed weeks
- Pregnancy over 42 completed weeks
- Under or overweight baby (on scan)
- Too much or not enough amniotic fluid
- Low placenta on recent scan
- Foetal abnormality
- Meconium stained waters
- Waters broken longer than 24 hours
- High blood pressure
- Pre-eclampsia
- Abnormal lie or presentation (breech, transverse)
- Suspected sepsis
- Significant medical history
- Previous haemorrhage after birth
- Previous 3rd or 4th degree tear after birth
- Previous shoulder dystocia
- Previous manual removal of placenta
- VBAC or previous uterine surgery
There may also be other factors not on the list that can cause concern. This is so that you are in the best place for you and your baby at the time of birth. If you have one or more of these risk factors it may not be a definite no to home birth, if you feel the risk is minimal and you have a clear route to hospital, you may still feel a home birth is for you. Discuss things over thoroughly with your Midwife and make sure you understand why they are recommending a hospital birth for you. Being informed is so important. If problems arise during the labour, birth or immediate postpartum period, you will need to be transferred via ambulance to your nearest maternity unit.
Each hospital trust (in the UK) should facilitate home birth and they cannot refuse due to staff shortage or lack of skills. Your community Midwifery team will be the ones on call when the time comes. There are certain instances when the maternity unit is extremely busy, or there is another home birth (or two!) going on when you go into labour, and on these occasions they may advise you to go in to the unit. This is rare though.
Why choose a home birth?
Hopefully you’re not scared off now, you’ve watched Call the Midwife and a home birth is for you. You have a normal low risk pregnancy and you would feel comfortable at home. Here are the positives and research statistics about home birth:
- The percentage of women giving birth at home was 2.1% in 2016, according to the Office for National Statistics, a slight decrease on 2015 which was 2.3%.
- Nearly 50% of mothers having their first baby at home ended up being transferred to hospital, compared to around 10% of women who have had a baby before (with no complications)
- You can labour in your own time and environment, which is proven to relax you and make the labour go smoother
- If you have other children they can remain in the family home
- Your partner can stay with you afterwards
- If you give birth at home it is proven as safe as in hospital for uncomplicated pregnancies.
And the negatives of choosing a home birth?
- If you need to be transferred it can be scary, painful (riding in the ambulance)
- If you have other children you may feel under pressure to get straight back into your home chores (DON’T!)
- You can’t have an epidural or in some cases, Pethidine or Morphine
Who will attend my home birth?
You would phone the maternity unit as usual when you believe labour is starting. Then you will be allocated a Midwife to come and see you to assess the situation. Once labour is established, s/he will stay with you until the birth is almost happening, then she will call for a second Midwife. This is so that there is back up in case of any issues, plus it’s always handy to have an extra pair of hands! That’s one of the bonuses about having a birth at home is that you get the dedicated care of two Midwives in your own home.
What happens if something goes wrong?
The Midwives attending should be experienced Midwives, and they will be monitoring the labour and baby closely. If they suspect any issues arising they will phone for an ambulance. If anything urgent happens they will be trained in what to do until help arrives and they can get you and/or baby to hospital.
Can I have pain relief at a home birth?
Yes – Midwives carry Entonox to home births, although most of them do not carry it around as standard, and will need to collect it from a central point or get the second Midwife to collect it for them, so it may not be available straight away. If you call the Midwife as soon as you think you’re in labour you will be able to get the best options. In some areas, home birth Midwives can administer Pethidine, but it has to be prescribed by your GP prior to labour starting and would be kept in your fridge at home. You can also hire a TENs machine, use aromatherapy, massage, and water either in your bath or with a home water birth pool. Don’t forget good old paracetamol, which has its place. If you’re not sure about any of these methods, see my post on the pros and cons of pain relief in labour.
What happens after the birth at home?
Your Midwife can stitch up any tears you have unless they are complex or severe. The baby is weighed and has all the initial checks at home. The first paediatric check will come the next day or later that day by a qualified Midwife or GP. Occasionally you may get an appointment to go the hospital for this. The Midwives will stay for around 2 hours and get rid of any clinical equipment used. They will make sure you are safe and comfortable and that baby is doing OK and has fed. They will take your maternity notes away to be processed. They will arrange for another home visit later that day or the next day depending on what time of day you gave birth. You’ll be surprised how quickly everything goes back to normal, except you have a baby! There’s nothing like snuggling up in your own bed or sofa with your new baby (or so I’m told, it always looks so good).
How do I get a Home birth?
Tell your Midwife when you book in with your pregnancy that you’d like a home birth, or at any appointment before 36 weeks. It is around then that they will arrange with you to come and visit you at home to go through the paperwork and discuss some of the issues above. They will already know from your history if you are a good candidate for home birth.
What equipment do I need for my home birth?
So you’ve decided you want a home birth, you’re low risk and you know it’s the right choice for you and your family. Great! There isn’t a lot you need, and don’t feel you have to rush out and buy anything, but there are a few things you may need and some things to consider having in the house. Here’s my ultimate home birth checklist, you can download your printable one here:
- Old towels, or ones you don’t mind getting dirty. At least 4
- A large ground sheet or plastic sheet
- A couple of clean sheets (that can get dirty or be thrown away)
- Baby changing mat
- Torch or angle poise lamp
- Hospital bag packed for you and baby in case of transfer
- Camera
- Maternity notes
- Phone numbers of the Midwives and maternity unit
- Bucket in case you are sick
- Birth Ball (optional)
- Disposable bed pads
- Tea/ Coffee and biscuits/ snacks for the Midwives!
If you’re having a home water birth, you can hire a pool either privately or some maternity units have their own pools for hire, or you could buy one to use at home. Birth pools range from a large paddling pool style one or more elaborate ones with self heating and filters. They all do the same job, that of a large bath. Bear in mind where you’re going to put it as they take a lot of water, so downstairs is best. Have a practice run before labour starts and have it blown up ready. Your birth partner’s job will be filling the pool and keeping it at the right temperature (37 degrees). You’ll need plenty of hot water so check your boiler is up to it! There are a few bits you need as well as the pool:
- A waterproof bath thermometer
- A sieve (to get rid of bits of poop and blood clots)
- A small bucket (to deposit said bits)
- A big bucket (to adjust water temperature)
- A hand mirror
- A pool noodle or flotation aid like a rubber ring (to support you)
- A bath pillow
It’s a good idea to keep some frozen meals in and don’t forget your big sanitary towels, big granny pants and soft comfy pyjamas for afterwards.
Have you ever had a home birth? Would you? If you have one, let me know how you got on, I’m so nosy!
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