Homebirth Support Group

Information on Home Births

Home Birth Support Group Monthly Coffee mornings

Would you like to find out more about home birth? Whether you are already planning a home birth or would like to be able to consider if a home birth could be an option for you, come along to discuss the advantages and any worries you might have as well as practical issues and what it’s really like to have a baby at home. Mondays 10am-12pm once a month.

Contact 0844 243 6241 for further information.

Why Consider a Home Birth?

Women in the Petersfield and Liss area are very lucky to have more choice than many over where to have their babies. There is a choice between 1 of 4 Consultant Units in the cities within 30 minutes of Petersfield or the Midwife-led Unit at St Mary’s Hospital (The Mary Rose Unit). Until July 2005 this choice also included the Grange Birth Centre at Petersfield Community Hospital. The Grange Birth Centre was closed ‘temporarily’ due to staff sickness and vacancy levels in Portsmouth. But what about having your baby at home? Is this an option many women in the area consider?

In 2003 49 babies were born at home in the East Hants Primary Care Trust (PCT) area: this is about 2.6% of the total number of births in the area. The home birth rate for the East Hants PCT and Portsmouth together increased to 3.2% in 2005. This rise in the home birth rate is likely to be a consequence of the closure of the Grange Birth Centre and Blackbrook Birth Centre (in Fareham) from July 2005 as many women who were planning to give birth in these birth centres choose to have a home birth instead. However a home birth is a valid option in its own right. It may be that as a result of the closures women locally are discovering the benefit of home birth. Home births rates vary from region to region. While the rate for England as a whole is just over 2% annually, in some parts of the country it is as high as 10% (in parts of Devon) and many areas in the South-West are over 5%. However many regions within England have home birth rates below 2%. The table below shows how home birth rates vary closer to home.

Regional Home Birth Rates 2003(BirthChoiceUK¹)

Why do home birth rates vary so much?

Most people assume that home birth rates vary because in some areas there are more women who are interested in having a home birth than in others. But is it that simple? Many women, especially those having their first baby report that they were not given a choice where to have their baby. It is almost impossible to choose something that has not occurred to you or wasn’t mentioned as an option by the health professionals you have seen. It is easy to assume that it isn’t ‘allowed’ or that there are very good reasons why it has not been offered.

Up to the 1970’s many women had their babies at home, in fact many didn’t have a choice! From the 1950’s onwards the medical establishment believed that it would be safer for women to give birth in hospital. Over a period of 20 years the home birth rate decreased to almost zero in 1980, as a result of the influence of obstetricians and paediatricians on Government policy. We now know that this move to institutional birth was based on erroneous assumptions between the already occurring reduction in perinatal mortality (deaths at or around the time of birth) and the increase in hospital birth. Since 1993 there has been a change in Government policy that recognises that home birth is as safe as hospital birth for women with a normal pregnancy and that women should be offered choice regarding place of birth.

Research by the NCT suggests that many GP’s do not offer women the choice of having a home birth (NCT 2001²). In many areas home birth is not always supported by midwives, so that even when women are well-informed and feel confident in their choice, obstacles are put in their way to prevent them having a home birth. Most women inevitably look to their health professionals to offer them support and guidance with their pregnancy and birth. If midwives do not offer confident support of home birth, then women will not be likely to feel confident in making it a choice for themselves.

Why are some midwives not fully supportive of home birth?

As a result of low home birth rates for 20 years many midwives have minimal experience of home birth. Many student midwives never see a home birth during their training and when they qualify they are usually expected to work within a consultant unit. Often this experience reinforces a perspective that birth is difficult for most women, with high epidural and intervention rates. No wonder many midwives do not see a home birth as a realistic option for women! In my experience this can change when the number of home births increases. If more women opt for home birth midwives quickly gain experience and confidence and begin to offer home birth to more and more women. At the same time pregnant women meet more women who have had a home birth and increasingly see it as an option for themselves. Of course many community midwives have always known the advantages of home birth and what a special experience it can be- as a result many prefer them to hospital births.

So why choose a home birth?

There is no evidence from research to suggest that home birth is less safe than hospital birth; in fact there is a lot of evidence that in many ways home birth offers advantages for both mothers and babies. The evidence comes from observational studies: where women choose their place of birth. The National Birthday Trust Report (1997³) studied all women planning a homebirth in 1994 and compared their births with similar women planning hospital births. There were 10,675 women in the study with 7571 homebirths. There were no significant differences in the rates of baby deaths (there were 5 babies who died in each group). The most significant differences between the women who gave birth at home and those who gave birth in hospital are listed below:

• Women who gave birth at home had half the risk of having a cesarean section or instrumental delivery.
• There were lower rates of induction and augmentation (having a slow labour speeded up) in the home birth group.
• There was less fetal distress (abnormal heart rates in babies) during labour in the home birth group.
• Women at home used less analgesia and anaesthesia (even including those who transferred to hospital).
• Babies born at home were less likely to have lower apgars scores (a way of assessing the baby’s condition at birth) or to need resuscitation and had fewer birth injuries.
• Women at home were less likely to have a haemorrhage after the birth.
• Women who gave birth at home had less severe perineal trauma than those who gave birth in hospital.
• Women who gave birth at home were more likely to be successfully breast feeding.
• Women who gave birth at home were more likely to feel relaxed and in control.
• Those who gave birth at home and previously in hospital strongly preferred home birth.

The two possible disadvantages of having a home birth are that you are not able to have an epidural, should you decide you need one and that there may be a reason to transfer to hospital. Of course evidence from studies shows that women at home are less likely to need an epidural. A further advantage with home birth is that you are more likely to receive one to one care in labour; this is known to be associated with needing to use less pain relief in labour. Transfer rates can vary and it is likely that in areas with fewer homebirths transfer rates may be higher, as midwives may have less confidence and therefore be more likely to recommend transfer earlier than experienced midwives would. Women having their first baby are more likely to be transferred to hospital, as their labours are often longer. This does not mean that it is unwise to plan a home birth, as a slowly progressing labour is rarely an emergency: allowing plenty of time for midwives to support women to help their labour progress before resorting to transfer to hospital. Transfer rates when women have already had a baby are very low.

How is a home birth different to a hospital birth?

Giving birth at home can make the event much more family orientated: your partner is likely to feel more relaxed and more involved with supporting you in labour (without having to worry about the unfamiliar territory of the hospital). It means that you do not need to be separated from your partner or other children after the birth; the hours after the baby is born when the whole family can be together can be magical. The environment at home is more relaxing and intimate than that in hospital, which enables a labouring woman to feel more in control of her birth experience. In your own home midwives are guests, which is a different relationship dynamic from that in hospital. Some women opt for a home birth because they feel that they are more likely to have a normal birth and avoid the high levels of intervention that take place in most hospitals.

Home Birth Support

Petersfield and Liss NCT are now offering support for women who would like to find out more about having a home birth, or feel they need some support with their choice and would like to meet others also planning or considering a home birth. This support will take the form of a monthly coffee morning. Women can come to the support group anytime in their pregnancy and can come as often as they wish. The coffee mornings are free, but a donation to cover expenses would be appreciated.

References:

1: Birthchoiceuk: www.birthchoiceuk.com (2004)

2: Home Birth in the United Kingdom. NCT. 2001

3: Home Births. Report of the 1994 confidential enquiry by the National Birthday Trust Fund. 1997

Charlotte: Home Birth Support Coordinator 0844 243 6241