Who will care for me at a home birth?

This article covers the following topics:

Independent midwives

Doulas

Birthing centre

Support from family and friends

Further information

Most women planning home births receive their care from a team of two to eight NHS community midwives. You may not know until the day which midwife will attend you in labour, although you should have had a chance to get to know the team.

Read our article here about how to contact a midwife to organise your home birth.

Independent midwives

For those women who can afford it, opting for an independent midwife can make choosing a home birth very straightforward, and provides a better chance of continuous one-to-one care. Independent midwives are fully qualified midwives who have chosen to work outside the NHS in a self-employed capacity.

Independent midwives also have the same referral rights as NHS midwives, so women being cared for by an independent midwife are still entitled to scans, blood tests, emergency and specialist treatment under the NHS. You can find out if there is one working in your area by phoning 0845 4600 105 or visiting the independet midwives UK website.

In the future, the continuity of care provided by an independent midwife may start to become available under the NHS (i.e. free) in a 'Gold Standard' community midwife model, where women are able to select their own midwife to look after them throughout pregnancy, birth and the early weeks, and that midwife is contracted to the NHS. This system is common in other countries, such as New Zealand, but it is not yet in place in the UK.

Doulas

It is becoming increasingly common for women to pay for the services of a doula in addition to a private or NHS midwife. Doulas provide flexible and continuous support before, during and often after birth, and may help with other children, engaging a partner with supporting birth, nurturing and supporting the mother, and giving support for establishing breastfeeding. The role of the doula has, for some women, provided the continuity of care traditionally supplied by the mother's family and close female friends around the time of birth.

Birthing centre

If there is a birth centre in your area (also called a midwifery-led unit, maternity home or GP unit), then this is another choice you could consider. Some of the advantages and disadvantages are the same as for a home birth, and some are different. Visiting the centre and talking to the midwives, and to other women who have given birth there, should help you decide.

In deciding where to give birth, you may find the results of the Birthplace Study 2011 from the National Perinatal Epidemiology Unit (NPEU) useful. The results provide parents with detailed, up-to-date information about the four different places for planning birth. (The results are specific to England). The study compares planning to use a ‘midwifery unit’ or birth centre with planning a hospital birth. It also compares planning to have a home birth with planning for 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, no previous obstetric complications that might affect this pregnancy. The study finds that there are positive reasons for considering planning to use a birth centre or to have a home birth.

Support from family and friends

You may get valuable support from close family and friends during a home birth, if you choose to ask for help. In many cultures, a new mother is supported through labour and birth by a close-knit team of experienced mothers (aunts, sisters, mothers or friends) whose role is to nurture and support the mother in birth, and allow her to focus solely on herself and the baby.

Other ways of involving friends and relatives is to arrange in advance help with childcare for older children, meals, washing and cleaning. The concept of a 'babymoon' is now popular, where families with new babies ask for support from friends and family to achieve quiet, bonding time after the birth, with visitors bringing meals or helping domestically, but otherwise not intruding unnecessarily. You may find it useful to talk to your friends and family in advance about how best they can support you during a home or hospital birth.

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