Why does home birth matter?
In April 2020 The Lancet published a systematic review that showed out of half a million birthing people who had home births, 40% were less likely to need a caesarean (abdominal birth), 50%less likely to have an instrumental birth, 55% less likely to have an episiotomy, 40% less likely to have a 3rd or 4th-degree tear and 75% less likely to contract an infection.
The above was based on birthing people (with uncomplicated pregnancies) who intended to give birth at home. A different analysis of the same research had already shown that outcomes at home are a safe option.
So why is that?
When you start to understand the hormones and the physiology involved in birth, you start to see why there are fewer interventions at home. Home, in general, is YOUR safe space, where you feel unobserved and relaxed - these are ALL KEY for labour to progress. FYI this is also why if you decide to birth away from home I encourage you to take your ‘house nest’ with you). Despite research and knowing all of the above only around 2% of births are at home!
Who will look after you at a homebirth?
If you choose to give birth at home, you will be looked after by 2 midwives (1 initially, followed by a second midwife when birth is imminent). They will come to you at the same time you would head into the hospital i.e established labour. It is always a good idea to call the homebirth team when you are in early labour to give them the ‘heads up’ that things might be starting and that you might need support soon.
Some hospitals have dedicated home birth teams who will look after you throughout your pregnancy, birth and postnatal period. This continuity of care is amazing and has many benefits, better outcomes and safety for mum and baby as well as offering a more positive and personal experience (NHS England, 2016) and better user experience. Whereas others cover home births through their community midwifery team.
What pain relief options do I have?
Midwives will bring Entonox (gas and air) to a home birth. Other pain relief options are
TENS machine
Birth pool
Complementary therapies such as aromatherapy
What if complications arise?
As with all births, the midwives caring for you will be closely monitoring your baby’s heartbeat and your vital signs, to keep an eye on any potential complications. The midwives attending a home birth will have a lot of equipment with them and this includes emergency equipment. Midwives are very highly trained to deal with emergency situations should they arise. If you have any questions regarding the ‘what if’ situations it is always a good idea to sit down and talk through everything with the midwife.
For first time mums around 40% will transfer into a hospital during labour (10% for subsequent births) (Birth Place in England, 2011). However, the main reason for this is
Requiring further pain relief such as an epidural
Labour stalls or slows down
The baby passes meconium (first poo)
None of these situations are emergencies in themselves but may be a reason to transfer to an obstetric unit for extra monitoring and support. It is also worth noting that the above statistic is a national average. You could ask your homebirth midwifery team what their statistics are.
Next steps.
I always encourage all women, birthing people and their birth partners to really consider all of their birthplace options. Gather specific information regarding their local maternity units and not dismiss an option due to assumptions and fear. Yes look at all of the facts and figures but also listen to your gut instinct - what feels right for you? For example for some women the thought of hospitals and doctors sends them into a panic yet for others it brings a sense of comfort. Homebirth for some women is a natural choice, where they feel safe, in control and unobserved, but for other women, this choice won’t sit right for them. We are all individuals and incredibly lucky in the UK to have access to all of these options.
What I should also highlight is that you can change your mind at ANY point. However, a home birth does require some forward planning such as equipment, birth pools, staffing etc. So it is much easier to plan for a homebirth and change your mind and transfer in than to plan a hospital birth and decide 3 hours in actually you would like to be at home!
The final decisions are ALWAYS yours.
*home birth should be offered to ALL low-risk women. However, even if your pregnancy comes with some complexities it is still within your right to request a home birth. It is very important to have an open non-biased conversation with your healthcare provider. If you don’t feel like you are being fully supported further support can be found via AIMs, Birthrights, a Head of midwifery and or a consultant midwife (to name a few). For the purpose of this blog, I have based it on Low-risk pregnancies.
References
Birthplace in England Collaborative Group. Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. BMJ 2011;343:d7400.
Maternity Review, NHS England. Better Births: Improving outcomes of maternity services in England: a Five Year Forward View for maternity care. London: National Maternity Review, NHS England; 2016. Available from: https://www.england.nhs.uk/wp-content/uploads/2016/02/nationalmaternity-review-report.pdf
Medley N, Vogel JP, Care A, Alfirevic Z. Interventions during pregnancy to prevent preterm birth: an overview of Cochrane systematic reviews. Cochrane Database of Systematic Reviews 2018, Issue 11. Art. No.: CD012505. DOI: 10.1002/14651858.CD012505.pub2. Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012505.pub2/full National
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