Home Birth : Practical advice

At the start of the twentieth century, the vast majority of babies were born at home. Figures estimated at around 99% dropped dramatically as the decades passed, to around 1% in 1980. Since then, however, they have increased twofold, as significant numbers of women began to challenge the notion that hospitals were the only birth place option. Women are entitled to have their baby at home. With a normal pregnancy, it should not pose any problems. Many women feel that it is a good way of ensuring a high standard of midwife care. The advantages are;
• Familiar relaxing surroundings,
• Better family access,
• Bath more available for labour pains,
• Usually no interruption of labour by travelling to hospital.
The disadvantages are;
• Limited pain relief, (gas and air, perhaps other methods, but no epidural),
• In the event of complications, hospital transfer may be needed. This will mean some delay in treatment.
As in many hospitals and birth centres, water births are an option for the home birth. The midwife must, of course, have the proper training for this procedure.

Your rights to a home Birth

It is perfectly legal for a woman to have a home birth and not be forced to go into a hospital. Most health authorities will support the woman’s decision in the matter by providing appropriate midwife care. It must be said, however, that something of a grey area exists regarding the health authorities legal obligation to provide such care. In cases where there is claimed by the authority to be no midwife service available to a woman for a home birth, there may be organisations such as AIMS (the Association for Improvements in the Maternity Services), or the Department of Health who can help. Although there is every chance of a favourable response from the DOH (who claim to champion women’s rights in such matters), it is understandable that some women may choose another option, e.g. a private midwife, rather than campaigning for their rights while they are in the midst of pregnancy.
Doctors do not need to attend a home birth. Any normal pregnancy can be attended by qualified midwives alone. A home birth can be booked by contacting the supervisor of midwives at the local hospital without the need for prior consultation with a doctor.

Home birth safety

The British Medical journal regards home births, for normal, low risk pregnancies where there is an adequate level of support and infrastructure, as safe. Home birth is generally regarded as being at least as safe as hospital birth, and is less likely to require medical intervention. Things that may adversely affect whether a woman is classed as low risk include:
• First baby, or too many babies (grand multipara, 5 or more previous children).
• Too young (teenagers), or too old (35 upwards).
• Previous pregnancy injuries, conditions and interventions. Things like tearing, postpartum haemorrhaging, assisted deliveries and caesareans. Plus any surgery on the cervix.
• GBS (Group B Streptococcus, bacteria some women have that could harm the baby).
• Blood problems such as high blood pressure, anaemia, iron deficiency, low or high platelet levels or being on anticoagulants.
• Insulin dependent or gestational diabetes.
• Having a low or high body mass index.
• Having received IVF treatment.
• Expecting a small baby, a big baby or twins.
• Having a small pelvis.
• A breech baby, an overdue or early baby.
• Having asthma, MS, ME, any mental problems or class A drug use.

There may be other non medical factors that could affect the practicalities of a home birth. The home could be deemed unsuitable for a home birth, or poorly accessible for the emergency services if needed. A high floor in a block of flats may not be practical for such an eventuality.
Not all the conditions mentioned are necessarily an outright block to having a home birth, but they could be obstacles that need careful consideration, especially in combinations.

Although pain relief administrable by midwives is limited to Entonox (gas and air), and possibly other drugs like Pethidine, there is some evidence that suggests women find labour less painful at home than in hospital. This will be in no small part due to the surroundings, non pharmacological pain relief and preparations that can be made for home birth.
Women contemplating home birth will no doubt be anxious about the possibility of complications arising during labour. In the case of postpartum haemorrhage, for example, midwives will be equipped with similar drug treatments (such as Syntrometrine) as used in hospitals. These could be tried before having recourse to arranging transportation to hospital. PPH, however, is less likely to occur in a home birth than in hospital where medical interventions like labour induction and assisted delivery increase its’ likelihood.
In the event of the need for an emergency caesarean, it is worth pointing out that there is preparation time needed for this procedure regardless of where the woman is. The midwife would of course phone ahead to the hospital if this were needed, thereby reducing the waiting time. This is also the case with other procedures such as epidurals, which are dependent on the availability of anaesthetists.

Reasons Women choose home birth ?

It is unlikely that women choose home birth to save the government money, even though it is true that a successful home birth costs the NHS less than the average hospital birth.
Some of the reasons women choose to give birth at home are:
• It’s more natural. Many women are uncomfortable with the idea of being in hospital, as if they were sick, during a perfectly natural event. They don’t like the idea of the medical managing of the birth process and the reliance upon interventionist methods.
• Worries about childcare if they have other children.
• Worries about infection risks in hospitals.
• They want more partner and family involvement.
• They want to be sure they have access to their own facilities. They may, for instance, hire a birthing pool.

Care

The type of antenatal care received in the case of a home birth is much the same as in hospital but without the facilities for medical intervention:
• At 37 weeks the midwife will deliver a homebirth pack. This will contain blood loss medication, cord clamps etc.
• The midwife or hospital where the birth was booked should be contacted on the day of labour. One or two community midwives will then visit and assess the situation. Checks will be carried out on temperature and pulse. Other monitoring equipment may be used.
• Any pain relief methods including drugs, water and alternative methods like acupuncture that are required during labour will be administered.
• After the birth, the baby will be checked over with standard techniques, the placenta safely delivered, stitching of wounds done if needed and the uterus checked. The midwives will leave usually 2-3 hours after the birth.
• There are then follow up checks performed. Often the midwives will visit again the next day, a GP may attend soon after the birth or a hospital visit may be advised.

Other factors to consider

There are many other things that need thinking about and preparing when opting for home birth. These may include:
• Children. If other children are to be in the house during the labour, many things from their care, to their reaction (in those old enough to understand) need to be thought through and possibly discussed with them.
• Home birth plan. It is probably desirable for both midwife and mother that there is a birth plan which outlines how the birth will ideally progress. Such a plan may contain information on the level of support required from the midwife, degree of internal examinations preferred, pain relief, use of birth pool, who else will be there as birth companions and any special requirements in case of the need for hospital transfer.
• Birth pool. If using a birth pool some of the things to consider are the type of pool (one of several hired models or home made), floor strength (not usually a problem especially on the ground floor. Filled pool and pregnant woman may weigh as much as 10 or 12 people), water temperature (never warmer than 37.5 C, the temperature needs to be right for the labouring woman which may not seem right to someone else filling it), will the actual birth take place in water? (consult with the midwife about this ).
• Mess worries. Anecdotal evidence would seem to suggest that there is not as much mess associated with home birth as some people think. This is probably due to the preparations made by midwives and families. Midwives will be well prepared with plenty of incontinence pads and such, and they may even get involved with clearing up after the event. Preparations by householders of old towels, mats and tarpaulins under birth pools (the water in the birth pool can get messy, but is easily pumped away) all help to keep things tidy. Modern washing powders cope well with any bloodstained sheets etc, and there are good methods for dealing with any blood that manages to get on carpets, e.g. cold water sponging for wet bloodstains, or Hydrogen Peroxide for dried blood (test first on an area of carpet that is more hidden in case the solutions strength bleaches the carpet).