Should I have a home birth?
I wanted to write a little about home births because I think there is a lot of opinion about them which is entirely inaccurate. Society has built up a perception that birth is dangerous and unsafe. Therefore the idea of birthing at home without access to all the medical devices and doctors that hospital has, which people will *clearly* need.. to a lot of people seems absurd.
Recently there has been a lot more research into home births and I think a lot of people are shocked by how un-scary the statistics of home births actually are. I learnt a lot about this in my own pregnancy and have done even further research now from a hypnobirthing instructor perspective. So I wanted to share my findings with you! I have compiled various guidelines, research and articles together to help try and give a round view of home births, the pros and the cons.
So lets start with what the NHS say… ‘The advantages of giving birth at home include:
being in familiar surroundings, where you may feel more relaxed and better able to cope
not having to interrupt your labour to go into hospital
not having to be separated from your partner after the birth
increased likelihood of being looked after by a midwife you have got to know during your pregnancy
if your pregnancy is low risk, a lower likelihood of having an intervention, such as forceps or ventouse (vacuum delivery), than giving birth in hospital
Considerations of having a home birth:
You may need to transfer to a hospital if there are complications.
Epidurals are not available at home, but you can use gas and air, a warm bath, a birth pool, TENS and any relaxation techniques you've learned. Find out about pain relief in labour.
Your doctor or midwife may recommend you give birth in hospital – for example, if you're expecting twins or if your baby is lying feet first (breech). Your midwife or doctor will explain why they think a hospital birth is safer for you and your baby.
If you choose to give birth at home or in a unit run by midwives, you should be given information by your midwife or GP about what would happen if you had to be transferred to hospital during labour and how long this would take.’
Read more from the NHS site where this information has been taken from HERE.
Next up is NICE (National institute of clinic excellence for anyone who isn’t sure what NICE meant!!). Lets see what their guidelines are saying…
‘Explain to both multiparous and nulliparous women that they may choose any birth setting (home, freestanding midwifery unit, alongside midwifery unit or obstetric unit), and support them in their choice of setting wherever they choose to give birth:
Advise low-risk multiparous women that planning to give birth at home or in a midwifery-led unit (freestanding or alongside) is associated with a lower rate of interventions and the outcome for the baby is no different compared with an obstetric unit.’
So this is interesting because this definitely (in my opinion) doesn’t support the societal view that birth is dangerous at all. This was taken directly from their guidelines which you can read HERE.
Some research was done specifically into birthing at home. The study is called Birthplace and is collected data from over 64,000 low risk births in England. The births took place at home, a midwifery-led unit and labour wards. They looked at births from labour, to delivery and birth outcomes for both the baby and the mother. The first key finding that came from this study was that birth is generally very safe. Here are some other statistics from the study:
For 'low risk' women the incidence of adverse perinatal outcomes (intrapartum stillbirth, early neonatal death, neonatal encephalopathy, meconium aspiration syndrome, and specified birth related injuries including brachial plexus injury) was low (4.3 events per 1000 births).
For home birthers on first babies there are 9.3 adverse perinatal outcome events per 1000 planned home births compared with 5.3 per 1000 births for births planned in obstetric units.
The transfer rate (home to hospital) is 45% of first time birthers.
If you want to read the research article in full, click HERE.
Sibohan Miller wrote in her book ‘Practical ways to make your birth better’…
‘For first time mums the 'Birthplace' study (in link above) showed that the risk of the baby experiencing an adverse outcome, although still very low, increased from 5 in 1000 to 9 in 1000 within the homebirth group. However, the risk of intervention for first time mums was still lowest at home. The study also found that first time mums are more likely to be transferred to a hospital - 45% compared to 12% of second time mums. This does not mean that 45% of first time mums experienced an emergency at home though. Common reasons for transfer include: wanting more substantial pain relief (epidural), not dilating as quickly as expected, meconium in the baby's waters, or other signs that would indicate continuous monitoring might be a good idea. So, whilst the study certainly doesn't rule out home birth for first time mums (there are clear benefits as well as risks) it highlights how choosing where to give birth is not always straightforward but requires some careful consideration, research and weighing up of the pros and cons. Ultimately, where you chose to give birth has to be right for you; it's your choice.’
NCT put together this fabulous article about common worries expectant parents have about home births.
‘1. Hospital transfers aren’t normally emergencies
Actually, the most common reason (32.4% of transfers to hospital) for home birth plans not to work out is because you’re tired and things are progressing really slowly. The other reason (5.1% of transfers) is that you might decide you want an epidural. So if you hear about people deciding to go to hospital after planning a home birth, you’ll understand why.
2. Transfers to hospital happen quickly
Transfers to hospital usually take less than an hour from making the decision to arriving. Ask your own midwife how long it takes locally. So if you do need to change your home birth plans, it will all be sorted quickly.
3. If there is an emergency, the hospital will know
If you or your baby is showing signs of significant distress, your midwife will call an ambulance. They’ll tell the hospital it’s an emergency so staff will be ready and waiting for you. That means you and your baby will get the treatment you both need quickly.
4. A home birth doesn’t mean you can’t have interventions when necessary
If your midwife is concerned about you or your baby during labour, she will arrange your transfer to hospital for assessment. Sometimes, that assessment will lead to a decision to have an assisted birth (with forceps or ventouse) or a caesarean birth.
5. If the baby has the cord wrapped around its neck, the process is the same as in hospital
Just as if you were in hospital, your midwife will be monitoring your baby’s heartbeat throughout labour. If there are signs that your baby needs help, you’ll be transferred to hospital.
Over a third of babies are born with the umbilical cord around their necks. The cord’s usually loose enough to be unlooped and your birth plan will progress normally. If your baby isn’t coping well after the birth, the midwife will arrange transfer for both of you to hospital.
6. Midwives can deal with blood loss/postpartum haemorrhage
Midwives are trained to deal with complications that come up wherever you are. They’ll have the same equipment at home as they would have on a midwife-led unit (MLU). So if you do haemorrhage, the midwife will give you a drug to contract your uterus, and will massage your tummy to stem bleeding until an ambulance arrives.
7. For the rare occasion it’s needed, midwives bring some resuscitation equipment for babies
Most babies who are poorly will already be in hospital. Otherwise, it will become clear during labour that the woman and baby need to go into hospital. So it’s unusual for babies born at home to need resuscitation, although some newborns do need to be encouraged to breathe.
Your midwife gets annual training in these techniques, and will follow the same process as she would use in hospital:
keeping the umbilical cord intact so the baby gets oxygen from the placenta
keeping the baby warm and dry
making sure the airway is open
giving the baby five or more puffs of air
chest compressions
The midwives will also call a paramedic to bring the baby to hospital.
8. Some women and babies go to hospital after the birth
A few women have a complication after they give birth that means it’s a good idea to go to hospital. Complications might include a retained placenta, needing a lot of stitches, or concerns about the baby. If there are complications, the midwife will arrange a transfer to hospital.’
To read the full article, click HERE.
A further piece of research was carried out showing further benefits specifically for the mother with an uncomplicated pregnancy. This has been taken from The Lancet ‘systematic review and meta-analysis of maternal outcomes and birth interventions among women who begin labour intending to give birth at home’. Click HERE to read the whole report.
40% less likely to have a caesarean
50% less likely to have an instrumental delivery
55% less likely to have an episiotomy
75% less likely to develop an infection
40% less likely to get a 3rd or 4th degree tear
I also found it cropped up a couple of times about the impact of birth location on breast feeding.
Home birth mothers were more likely to exclusively breastfeed for six months – 22% versus 9%. Article for this is HERE.
Home birthed infants were overall twice as likely to be breastfed and sustained breastfeeding was consistently associated with home birth at various time points. To read the full article, click HERE.
Some of the evidence and information here is focused more toward first babies. There is evidence to suggest that the lowest risk place to have second babies is at home. I spoke about the Birthplace study above (link HERE), and this research was also found from it about second babies.
For women having a second or subsequent baby, home births and midwifery unit births appear to be safe for the baby and offer benefits for the mother
For multiparous women, there were no significant differences in adverse perinatal outcomes between planned home births or midwifery unit births and planned births in obstetric units.
For multiparous women, birth in a non-obstetric unit setting significantly and substantially reduced the odds of having an intrapartum caesarean section, instrumental delivery or episiotomy.
I have only used a couple of research projects into home birthing but it doesn’t take long to find various other studies if you do your homework. Hopefully having a compilation of all of this information from a range of difference sources is helpful to help people understand the true statistics and risks behind birthing at home. Obviously a lot of the information in this blog post covers ‘low risk’ pregnancies. I mean, the whole debate of what pregnancies are actually high risk is a topic for another day so we won’t get into that now. I would say birthing locations is a very personal thing to each individual. But for those of you who might be on the fence but fear it could be ‘risky’ or ‘dangerous’ , hopefully there is some reassuring points here to think about.
We talk about home births more in the full hypnobirthing course that I offer. Click HERE to have look at the courses I offer.
Are you local to Porstmouth, Fareham or South East Hampshire and pregnant, expecting in 2024/25?! Well, I’ve got what you need! The ultimate guide to help you navigate some of the choices that crop up in pregnancy. All in one place! This guide helps you to know what your choices are when it comes to things from where to birth, to how to feed your baby. Plus there is some amazing recommendations of local prenatal and postnatal services that I WISH I knew more about during my pregnancy! Don’t walk… run….!!!