Sisters Marina Fogle and Dr Chiara Hunt discuss the pros and cons of home births.
Like with most things in life, the decision where to give birth is multifaceted and the right decision differs from mother to mother. There are plenty of women who hate the idea of having a home birth, they don’t like the messiness or the uncertainty. The idea of going into a hospital specifically designed for the job, with equipment and medical staff to cope with any emergency is really reassuring.
But on the other side of the coin, there are many women who find that their stress levels go up the moment they enter the unfamiliar and sterile environment of a hospital and would much rather experience birth in the security of their own home.
Whatever your decision and birth plan, it’s important you explore all your options. Here are some questions and home birth advice to consider before you make your decision.
Will I get the same antenatal care with a home birth?
Absolutely! Women opting for a home birth still have all the same antenatal care and scans performed by midwives who are often based in a hospital. Sometimes there’s a specific team caring for women hoping to give birth at home, and your midwife might even visit you at home for your appointments, rather than asking you to come to a hospital or clinic.
Can I change my mind about giving birth at home? Can I transfer to a hospital?
Just because you’ve opted for a home birth, it doesn’t mean that the hospital will shut its doors to you if you want or need to be there. You’ll most likely be looked after by midwives who are attached to a hospital near you and you’ll have discussed transferring there if need be. Similarly, if early on in your pregnancy, you like the idea of a home birth but change your mind as the pregnancy progresses, that’s fine.
It might also be that your risk factors change during your pregnancy and while a home birth might have looked like a sensible option early on in your pregnancy, you might want or need to rethink as your due date approaches.
Can anyone choose a home birth?
Home birth is only recommended for women whose pregnancy is low risk.
If you have any medical conditions yourself or had problems in a previous pregnancy or birth (like a caesarean section), developed any complications during your pregnancy (like pre-eclampsia), have a multiple pregnancy or if your baby is breech, you’d be strongly advised to give birth in hospital, where doctors can keep a close eye on you and intervene quickly if they needed to.
Where you give birth will always be a conversation between you and your midwife. No one can force you to go to hospital, but since the safe arrival of your baby is everyone’s priority, it’d be short-sighted to dismiss your midwife’s advice.
What are the risks of a home birth?
In 2011, a large study was conducted into whether home births were riskier for mothers and babies and it found that there was a slightly elevated risk of complications for women having their first babies at home.
For women having second or subsequent babies, the risk was no higher than giving birth in hospital. For this reason, many women having their first babies will opt for a birth centre, a midwife-led department often attached to a hospital which aims for a home-from-home atmosphere.
That said, because the risk is very small for first-time mothers, plenty of first- time mothers do opt for a home birth with a lower threshold for transfer. One thing to consider is your proximity to hospital. A home birth is probably more risky for a woman who lives two hours from her nearest hospital than for a woman who is 15 minutes away.
What are the labour pain relief options for home births?
Yes, but your options are more limited than if you were in hospital. You can, of course, take regular paracetamol and when your midwife arrives, she’ll bring gas and air. Sometimes they’ll also offer you an injection of an opiate-based painkiller, such as pethidine and diamorphine.
You can also use breathing techniques, visualisation and hypnosis, and often there’s an option to rent a birth pool so that you can be in the water for labour and birth. You can’t, however, have an epidural.
Where to give birth is a big, but not always easy, decision. When people book their antenatal classes with The Bump Class, we’re on hand to ensure that expectant mothers make an informed decision after carefully considering all options open to them, and educate them so they can ask their healthcare providers the right questions to ensure they make the decision that’s best for them.
Real Home Birth Story: Following The National Institute for Clinical Excellence support for home births, Vanessa Christie shares her experience
In December 2014, the National Institute for Clinical Excellence (NICE) published new guidelines on birth. One of the main messages it gave us was that, at the end of the day, it’s your body, your baby and your choice where you give birth. Having reviewed thousands of births, the guidelines concluded that, although there are no guarantees and always exceptions, for the vast majority of low-risk pregnancies, birth is generally safe wherever you are, be it a hospital-based obstetric unit, midwifery-led unit or at home.
In fact, the guidelines went further, saying that for low-risk women and babies, midwife-led units tend to be safer than hospitals (where sometimes unnecessary interventions can begin a cascade of events) and that for mothers who have already had at least one child before, home births are just as safe as those in any other setting.
As a children’s nurse, health visitor and lactation consultant, I have felt honoured and humbled to be a part of many births, both in the UK and abroad. Since they hadn’t always been plain sailing, it came as rather a surprise to my loved ones that I was thinking about home birth for myself. Surely it’s selfish? Surely it can’t be safe? Am I mad?
It has been known for a while that women perform labour best in an environment where their stress levels are low, allowing the natural physiological processes of birth the greatest opportunity to function most optimally. If your body is flooded with cortisol and adrenaline, it becomes harder for the muscles to contract and dilate, thus slowing things down and increasing levels of pain. With that information in mind and after a heavy dose
of research and soul searching I realised that, for my baby and I at least, the best decision was to be at home.
As my due dates disappeared further and further into oblivion, so too did most of my raspberry-leaf, pineapple and curry-fuelled sanity. With both of my pregnancies, I warded off the temptation of being induced and, after what felt like an eternity, at 42 weeks I went into spontaneous labour at home. And there I stayed.
The plan, both times, was to be in the pool – a blow-up number that my husband, Gav, thought could double up as a prop for summer parties… until he actually saw me in labour and, miraculously, it hasn’t been seen since! Anyway, neither of my babies were actually born in there.
With my first, I spent nearly eight hours inside it, drifting in and out of full consciousness. After a while, the gentle visualisations I’d been practising didn’t quite cut the mustard, so instead (and I have no clue why) I decided to take on the guise of an Olympic rower and heaved myself backwards and forwards, drenching the entire room in the process. In the end, helped by Gav and my lovely doula Yvonne, I clambered out to be examined and was given the green light to push. By this point I literally couldn’t move and was on a bit of a ‘gas and air high’, so Amelie was born on our sitting room floor.
Fast-forward two years and our second daughter, Laria, was born in exactly the same position, on exactly the same spot. This time around everything happened so quickly, there was no time to fill up the pool or burn the candles or essential oils I’d spent a fortune on. I woke up with a contraction at 1am. My first thought was “I can’t give birth now, the dishwasher is full.” So, in nesting overdrive, I fought with the plates in-between almost continual contractions, until I realised that it would probably be sensible to wake up Gav.
The animal instinct in me came out and I soon found myself curled up in a ball where Amelie had been born and around an hour later I gave birth to Laria, thankfully with the midwives arriving just in time.
Nothing in my life is comparable to those moments. I was elated yet totally shattered, and I had never loved my husband more than when we were curled up together on the sofa with a new baby in our arms.
I am not smug or superior and I certainly don’t judge anyone for making different choices to me. After all, it is an entirely personal decision and it is understandable that for many women giving birth at home just isn’t right. I do however feel that positive birth stories, including those at home, need a voice. Even more so, because it has been something that was rarely, until now, even presented as an option.