Home birth FAQs
This article covers the following FAQs:
Women may plan a home birth because they:
- have had a previous positive birth experience in hospital, and now feel confident about birth at home,
- want continuity of care, with a midwife they know attending the birth,
- dislike being in hospital,
- are worried about the effect of a hospital environment on their labour,
- want to keep birth normal and avoid interventions,
- want to reduce the risk of infection,
- don’t want to be separated from older children,
- want more than one birth partner,
- want to avoid an overnight hospital stay without their partner,
- hope to use a birth pool and cannot be sure that this will be possible in hospital,
- want privacy,
- want to feel more in control, or
- have had a previous negative experience in hospital, and don't want to repeat this.
Ultimately, the decision to have your baby at home is yours but it always helps to have support and information in making that choice.
In deciding where to have your baby, you may find the results of the Birthplace Study 2011 helpful, as it provides detailed information about the four different places for planning birth. It compares planning to have a home birth with planning for a hospital birth, as well as comparing planning to use a ‘midwifery unit’ or birth centre with planning a hospital birth.
The main focus of the study is outcomes for women who are ‘low risk’, i.e. those who are healthy, with a straightforward pregnancy and no previous obstetric complications that might affect this pregnancy.
Guidance from the National Institute for Health and Care Excellence (NICE), updated in December 2014, also supports your right to be informed about your options and choose where you have your baby - be that in a midwife-led centre, at home or on a hospital labour ward. The NICE guidance advises that planning to give birth at home or in a midwifery‑led unit is particularly suitable for women with straightforward pregnancies who have already had a baby. For women with straightforward pregnancies who are expecting their first baby, it is advised that planning to give birth in a midwifery‑led unit is particularly suitable, but that there is a small increase in risk for the baby if they plan birth at home.
It is a good idea to talk to your midwife about the options in your area. All areas provide a home birth service but the extent of the service varies. If your own midwife cannot provide the information or support you need, the local supervisor of midwives should be able to help. You can contact her by telephoning or writing to your NHS maternity unit.
Planning for a home birth is a positive option for those who are healthy, with a straightforward pregnancy, and no health conditions or previous obstetric complications that might affect this pregnancy. For those who have previously given birth and had a straightforward labour, planning for care away from the labour ward either at home or in a birth centre is as safe as a planned hospital birth and can often be a very positive experience.
For first-time mothers, home birth can also offer advantages, such as continuity of midwifery care, greater control, and less need for interventions, such as an epidural or an assisted birth. There is, however, a small increase in risk for their baby.
In the following circumstances, evidence-based guidance to the NHS (NICE guidance) suggests that planning to have your baby at home is not recommended in a range of medical and obstetric circumstances. These include women with:
- previous haemorrhage after giving birth,
- previous caesarean section,
- pregnancy over 42 weeks' gestation, when the guidance suggests induction of labour
- pre-eclampsia or raised blood pressure,
- anaemia (low iron count),
- in a sixth or subsequent pregnancy,
- a baby remaining in a breech position (bottom- or feet-first) or
Some women with higher risk factors do weigh up the pros and cons of their individual situation and decide to give birth at home. It's always important to make the decision that feels right for you.
There is no simple answer to this very question. Certainly nobody can make you go into hospital to have your baby – it is not against any law to have your baby at home. But what most women want to know is whether they have a right to maternity services at home – in other words, does the health authority have an obligation to provide a midwife to attend a home birth?
The Nursing and Midwifery Council in its statement says ‘Should a conflict arise between service provision and a woman’s choice for place of birth, a midwife has a duty of care to attend. Withdrawal of a home birth service is no less significant to women than withdrawal of services for a hospital birth.’
Your health authority is legally obliged to provide emergency care, although it cannot be forced by law to provide a home based service. If you are finding it difficult to arrange to have your baby at home, get in contact with one of the supervisors of midwives from the hospital, or the community midwifery manager. In most areas, midwives are supportive of a woman’s choice to have her baby at home and will try hard to make suitable arrangements.
If a woman gets to the end of pregnancy and has not been able to make arrangements, but has made her intention clear, she should call the hospital labour ward when in labour. The labour ward manager will usually try to provide a midwife to go to her home to care for her. It is preferable though to make arrangements well in advance.
Until the autumn of 2013, women have been able to book care privately with an independent midwife. However, new legislation means that midwives may not practise without professional indemnity insurance and this insurance is generally not available.
A safe home birth is not possible if you have a full placenta praevia or low lying placenta (placenta covering the cervix), or your baby is in a transverse lie (sideways across the womb) because these births require a caesarean section. Many women also choose to have their baby in a hospital if they have severe health problems, or their baby is likely to need medical attention immediately after she is born, for example, if the baby is premature.
In certain situations, some professionals will suggest that it's best for you to have your baby in a hospital, while others may be willing to support you at home. You might also find our article about the safety of home birth helpful.
If your midwife does not consider you a good candidate for having your child at home, ask her to go through the reasons with you to help you weigh up the pros and cons for yourself. If you have further questions or need additional support, contact one of the supervisors of midwives at your hospital, or the community midwifery manager. You could also contact your local NCT home birth support group by calling 0300 330 0770 or the Association for Improvements in Maternity Services (AIMS) to explore your options.
It doesn’t matter if your home is small, untidy or in need of decorating. The important thing is that you feel comfortable there. Your midwife can discuss how long it would take an ambulance to reach you in an emergency, and any access concerns. She will also discuss with you what you will need for a home birth.
NCT's helpline offers practical and emotional support in all areas of pregnancy and early parenthood: 0300 330 0700. We also offer antenatal courses which are a great way to find out more about 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 email@example.com.
- Local NCT homebirth support groups. Call 0300 330 0770 or email firstname.lastname@example.org.
If you would like to read more about the evidence on the safety and other advantages and disadvantages of having your baby at home, the following are good resources:
The Home Birth Reference Site provides information and opinions about having your baby at home, 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