Dealing with complications at a home birth

For most women and their partners the major concern about having their baby at home is that a medical emergency may occur. This could happen regardless of whether a home or hospital birth is planned. You can discuss with your midwives what arrangements are in place in the event that a problem arises.

This article covers the following problems that might arise during birth:

Blood loss after the birth (postpartum haemorrhage)

Baby slow to breathe

Lack of progress in second stage of labour

Emergency caesarean

Looped umbilical cord

Midwives are trained and equipped to deal with most problems during a home birth. There is some equipment the midwife is unable to use in a home birth, for example an epidural is not available nor are ventilators.

Blood loss after the birth (postpartum haemorrhage)

Midwives at home births carry the same drugs which are used to expel the placenta and contract the uterus as would be used in hospital. If these do not control the bleeding, the midwife would call an ambulance to transfer you to hospital, and undertake other emergency measures in the meantime, such as giving intravenous fluids and manually compressing your womb.

Statistically speaking, it is significantly less likely that you would have a post-partum haemorrhage (excessive blood loss after birth) after a home birth than after a hospital birth, because the risk of blood loss rises with interventions such as assisted delivery and induction of labour, which are only carried out in hospital.

This was confirmed by the Birthplace study 2011 which found that women planning a home birth were more likely than women planning for birth in other settings to have a normal birth: 88% of planned home births are ‘normal births’ compared to just under 60% of planned obstetric unit births.

Baby slow to breathe

Your midwife will have equipment to manually resuscitate a baby that is slow to breathe after a spontaneous vaginal birth (straightforward birth). The methods used to resuscitate a newborn at home include:

• stimulating baby by rubbing the skin,
• manual suctioning of mouth and nose, or
• ventilating (giving oxygen) via a special bag and mask which the midwife carries.

In a hospital birth, mechanical suction and ventilation would be available. These would also be available in an ambulance, in cases when a midwife requested a transfer to hospital.

Lack of progress in second stage of labour

Assisted deliveries are no longer performed at home in the UK because of increased risks to the baby and mother. If labour is progressing slowly in the second stage, transfer to hospital may be needed.

Emergency caesarean

Any unplanned caesarean is referred to as an 'emergency' but true emergency caesareans are rare. Women who end up needing a caesarean after planning a home birth usually do so after lack of progress in labour, when neither mother nor baby are in immediate danger. If the baby were showing signs of real distress, the midwife would call an ambulance immediately and notify the hospital.

Looped umbilical cord

Around 1 in 3 babies are born with the umbilical cord looped around their neck. This does not prevent the baby from being born vaginally: in most cases the cord is loose enough to be unlooped. The midwife would always be monitoring the baby's heart rate and would deal with this situation at home the same way as in hospital. If baby's heart rate indicated that the cord was tight enough to cause distress, then transfer to hospital would go ahead.

The most common problem is a long labour where the mother or baby gets tired and progress slows. Transfer to hospital may be needed. But women who started to have their baby at home and needed to transfer say that they valued having spent even part of their labour at home.

A first-time mother has a 70% chance of achieving a home birth if she has planned for one (although this rate varies widely in different areas). For women who have already had a baby, the chance is much higher – between 88 and 99% of women. There is a small chance (about 1 in 30) of having to be transferred to hospital after the baby has been born, usually because of problems with the delivery of the placenta, or sometimes because of concern about the baby’s breathing.

Further information

The results of the Birthplace study were released in December 2011 and provide useful information for parents about their choice of place of birth.

NCT's helpline offers practical and emotional support in all areas of pregnancy, birth and early parenthood: 0300 330 0700. We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby. Other NCT resources include:

• ‘Homebirth All you need to know’ leaflet available from NCT shop.
• ‘Mums the Word’ DVD available from NCT shop.
• 'Daddy Cool' DVD available from NCT shop.
• NCT's shared experiences register, which enables mothers to talk to other women who have had similar experiences. Call 0300 330 0770 or email enquiries@nct.org.uk.
• Local NCT homebirth support groups. Call 0300 330 0770 or email enquiries@nct.org.uk.

If you would like to read more about the evidence on the safety and other advantages and disadvantages of home birth, the following are good resources:

The Home Birth Reference Site provides information and opinions about home birth, for parents who think that it might be the right choice for them, and for health professionals looking for resources. 

BirthChoiceUK provides information on choosing maternity care to help parents make the right choice for them.

• MIDIRS and NHS Centre for Reviews and Dissemination (1999), Place of Birth.
• Rediscovering birth by Sheila Kitzinger
• Birth your way by Sheila Kitzinger
• Home birth: A practical guide by Nicky Wesson
• Choosing a home birth by Beverley Lawrence Beech
• Midwives and home birth, MC Circular 8/2006