Deciding where to have your baby is an important decision. Before the 1970s many women had their babies at home, but during the 1970s and 1980s this became less common. This was mainly because many doctors and midwives believed that home birth was not as safe as birth in hospital, and discouraged women from making this choice.
Now the number of women booking to have a home birth is rising, although still less than 3% of pregnant women in the UK choose this option. But this rate varies greatly – from less than 1% in Northern Ireland to just over 1% in Scotland and just over 3% in Wales. And in west Somerset the figure rises to almost 14%.
Are there any extra risks to a home birth?
Research has found that home birth is as safe as hospital birth for healthy women having a straightforward pregnancy.
Are there any extra risks to a hospital birth?
Studies have found that there are some problems that are more likely to occur in a hospital birth, such as the baby being born with a lower Apgar score (this is an assessment of the baby’s condition at birth). It is also more likely that the woman will have interventions such as an episiotomy (a cut in the vaginal entrance made just before birth), a drip to speed up labour, and drugs for pain. Also, infections in both mother and baby are more likely in hospital.
Women booked to have their baby at home are less likely to have a caesarean section, even if they need to transfer to hospital during their labour.
What else does the research say?
If you have your baby at home you are more likely to have care from a midwife you know and to have a midwife stay with you throughout your labour. When women who had had both hospital and home births were asked which they preferred, the great majority said they preferred their home birth.Women having a home birth tend to feel more in control and more relaxed.
What if something goes wrong in labour?
For most women and their partners the major concern about having their baby at home is that a medical emergency may occur. You can discuss with your midwives what arrangements are in place in the event of a problem arising. The midwife is trained and equipped to deal with most problems; for instance, she will have drugs to stop heavy bleeding after the birth and can resuscitate a baby that is slow to breathe. 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 (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.
What else should I consider?
The decision about where to have your baby depends a lot on what is important to you, and where you would feel safe.
Women tend to choose hospital if they:
- want to be able to choose to have an epidural in labour
- would feel safer in hospital
- want to be with other women having their babies
- are worried about disturbing the neighbours
- think that the birth will make their home messy.
Women tend to choose home birth if they:
- would feel safer at home
- want to avoid interventions such as electronic monitoring and drips
- want privacy
- want to feel more in control
- would like their other children involved, or prefer not to leave their children
- want to be certain of having a midwife with them throughout.
Do I have a right to a home birth?
There is no simple answer to this very simple 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 their statement say ‘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 her... 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 birth service. So if a woman insisted on staying at home and called the hospital when in labour then they would do their utmost to provide a midwife to go to her home to care for her.
This is not the way most women would like their care in labour to be organised. If you are living in an area where you cannot, during your pregnancy, get the maternity services to support your choice to have a 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 provide a home birth service.
What if my GP won’t support me having a home birth?
You don’t need antenatal care from your GP or their support for a home birth, although many will be happy to help you make arrangements. You can book your antenatal care directly via a midwife; there are a number of ways you can contact a midwife directly. You can ask in your GP’s surgery if a midwife works from the surgery. If she does, then you can ask to see her directly. If a midwife does not work from the surgery then the staff may know where a midwife does work and be able to refer you. Alternatively, if you have a health centre or children’s centre near you then you can ask if a midwife works from there. You can also write to the Head of Midwifery at your local hospital and ask to be put in touch with a midwife. When you have your first antenatal check with your midwife she should discuss your preferences for care during pregnancy as well as where you might choose to give birth. Your midwife does not need to call a GP for the birth – in fact GPs are not normally involved at a home birth even if they are supportive. If problems arise during your labour the midwife will want to liaise with a doctor specialising in obstetrics. Midwives are trained to deal with emergencies, and it is now quite common for a second midwife to attend the actual birth. So it is perfectly OK to have a home birth without GP support.
For those women who can afford it, opting for an independent midwife can make choosing a home birth very straightforward. (Independent midwives are fully qualified midwives who, in order to practise the midwive’s role to its fullest extent, have chosen to work outside the NHS in a self-employed capacity, although they support its aims and ideals.) You can find out if there is one working in your area by phoning 01483 821104 or by going to www.independentmidwives.org.uk
If there is a birth centre in your area (also called 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. You may wish to look at the BirthChoice website at www.birthchoiceuk.com
NCT and other support for home birth
Some areas of the country have a home birth support group. To find out if there is one near you either visit the NCT website at www.nct.org.uk or contact the Enquiry Line on 0300 330 0770 to find out details of your local branch and make contact with them. One of the personal websites dedicated to home birth is http://www.homebirth.org.uk/
The NCT holds a special experiences register to enable mothers to talk to other mothers who have had similar experiences. Contact the enquiry team on 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 home birth, the following are good resourses:
MIDIRS and NHS Centre for Reviews and Dissemination (1999), Place of Birth.
Informed choice leaflet for professionals.
- Sheila Kitzinger, Rediscovering birth
- Sheila Kitzinger, Birth your way
- Nicky Wesson, Home birth: A practical guide
- Beverley Lawerence Beech, Choosing a home birth
- Home birth
- Midwifes and home birth, MC Circular 8/2006