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Alison Ross
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Registered Midwife, DipHe, BSc (Hons) Was a midwife at Kingston Hospital and Specialist Midwife in Perinatal Mental Health.
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Birth and Labour

Home births

The advantage of a home birth is that you are likely to feel more relaxed in your own surroundings. This means labour might move along effectively since stress and anxiety can slow or even stop labour in both humans and other mammals.
In Short
NICE guidelines for 2014 recommend giving birth at home to low-risk women who have previously given birth but there is no reason why low-risk first-time mums cannot give birth at home too.

Have a home birth gives a woman the chance stay in the same location for all of labour, birth and postnatal care.

One of the cons of a home birth is that you will be limited to gas and air and small doses of pethadine for medical pain relief.

Another is that you won't have instant access to a medical team. However, your midwife is an experienced health professional who will be monitoring your labour and seek timely medical input if any concerns arise.

Around three percent of women choose to give birth at home. It is more common with second babies and subsequent births. Some people worry home births are unsafe since if anything goes wrong expert help isn’t immediately available. However, the National Institute for Clinical Excellence (NICE) guidelines published in 2014 reported that for low-risk births, a home birth would be a better option for the mother who have already given birth and as safe for the baby in at least 45 percent of births.

Mums often choose to give birth at home because they:

  • Feel that birth is a natural process and not a medical pathology that needs to be treated.
  • Want to be more in control of their birth
  • Feel more comfortable surrounded by their things and family.
  • Have other young children they don’t want to leave.
  • Feel they will have more attention from their midwife.
  • Feel that they will feel less pain and be able to manage it better in a familiar environment with the assistance of a focused midwife team.
  • Have had an unpleasant experience in a hospital before and want to avoid a repetition.
Would a home birth be the best choice for me?

The National Institute for Clinical Excellence (NICE) guidelines have different advice for first-time mums compared to women who have given birth before.

The NICE guidelines advise low-risk women who have previously given birth that planning to give birth at home or in a midwife‑led unit (freestanding or alongside an obstetric ward) is particularly suitable for them because the rate of interventions is lower and the outcome for the baby is no different compared with an obstetric unit.

The NICE guidelines advise low‑risk first-time mums that planning to give birth in a midwife‑led unit (freestanding or alongside an obstetric ward) is particularly suitable for them because the rate of interventions is lower and the outcome for the baby is no different compared with an obstetric unit. First-time mums who give birth at home have a small increase in the risk of an adverse outcome for the baby.

For more information on NICE guidelines on where to give birth click here.

What conditions and situations are considered high-risk?

Here is a list of medical conditions and situations that NICE list as indicators of high-risk

Medical conditions indicating increased risk suggesting planned birth at an obstetric unit

Disease area Medical condition
Cardiovascular Confirmed cardiac disease

Hypertensive disorders

Respiratory Asthma requiring an increase in treatment or hospital treatment

Cystic fibrosis

Haematological Haemoglobinopathies – sickle‑cell disease, beta‑thalassaemia major

History of thromboembolic disorders

Immune thrombocytopenia purpura or other platelet disorder or platelet count below 100×109/litre

Von Willebrand’s disease

Bleeding disorder in the woman or unborn baby

Atypical antibodies which carry a risk of haemolytic disease of the newborn

Endocrine Hyperthyroidism

Diabetes

Infective Risk factors associated with group B streptococcus whereby antibiotics in labour would be recommended

Hepatitis B/C with abnormal liver function tests

Carrier of/infected with HIV

Toxoplasmosis – women receiving treatment

Current active infection of chicken pox/rubella/genital herpes in the woman or baby

Tuberculosis under treatment

Immune Systemic lupus erythematosus

Scleroderma

Renal Abnormal renal function

Renal disease requiring supervision by a renal specialist

Neurological Epilepsy

Myasthenia gravis

Previous cerebrovascular accident

Gastrointestinal Liver disease associated with current abnormal liver function tests
Psychiatric Psychiatric disorder requiring current inpatient care

Other factors indicating increased risk suggesting planned birth at an obstetric unit

Factor Additional information
Previous complications Unexplained stillbirth/neonatal death or previous death related to intrapartum difficulty

Previous baby with neonatal encephalopathy

Pre‑eclampsia requiring preterm birth

Placental abruption with adverse outcome

Eclampsia

Uterine rupture

Primary postpartum haemorrhage requiring additional treatment or blood transfusion

Retained placenta requiring manual removal in theatre

Caesarean section

Shoulder dystocia

Current pregnancy Multiple birth

Placenta praevia

Pre‑eclampsia or pregnancy‑induced hypertension

Preterm labour or preterm prelabour rupture of membranes

Placental abruption

Anaemia – haemoglobin less than 85 g/litre at onset of labour

Confirmed intrauterine death

Induction of labour

Substance misuse

Alcohol dependency requiring assessment or treatment

Onset of gestational diabetes

Malpresentation – breech or transverse lie

BMI at booking of greater than 35 kg/m2

Recurrent antepartum haemorrhage

Small for gestational age in this pregnancy (less than fifth centile or reduced growth velocity on ultrasound)

Abnormal fetal heart rate/doppler studies

Ultrasound diagnosis of oligo‑/polyhydramnios

Previous gynaecological history Myomectomy

Hysterotomy

Medical conditions indicating individual assessment when planning place of birth

Disease area Medical condition
Cardiovascular Cardiac disease without intrapartum implications
Haematological Atypical antibodies not putting the baby at risk of haemolytic disease

Sickle‑cell trait

Thalassaemia trait

Anaemia – haemoglobin 85–105 g/litre at onset of labour

Infective Hepatitis B/C with normal liver function tests
Immune Non‑specific connective tissue disorders
Endocrine Unstable hypothyroidism such that a change in treatment is required
Skeletal/

neurological

Spinal abnormalities

Previous fractured pelvis

Neurological deficits

Gastrointestinal Liver disease without current abnormal liver function

Crohn’s disease

Ulcerative colitis

Other factors indicating individual assessment when planning place of birth

Factor Additional information
Previous complications Stillbirth/neonatal death with a known non‑recurrent cause

Pre‑eclampsia developing at term

Placental abruption with good outcome

History of previous baby more than 4.5 kg

Extensive vaginal, cervical, or third‑ or fourth‑degree perineal trauma

Previous term baby with jaundice requiring exchange transfusion

Current pregnancy Antepartum bleeding of unknown origin (single episode after 24 weeks of gestation)

BMI at booking of 30–35 kg/m2

Blood pressure of 140 mmHg systolic or 90 mmHg diastolic or more on 2 occasions

Clinical or ultrasound suspicion of macrosomia

Para 4 or more

Recreational drug use

Under current outpatient psychiatric care

Age over 35 at booking

Fetal indications Fetal abnormality
Previous gynaecological history Major gynaecological surgery

Cone biopsy or large loop excision of the transformation zone

Fibroids


How do I arrange a home birth?

If you would like a home birth it’s important to discuss it with your doctor or midwife as it’s possible that your particular situation it isn’t appropriate. For example, if you have a high-risk pregnancy. These risks are harder to assess for a first baby, but research suggests similar safety rates for home and hospital births, once high-risk/complicated pregnancies are removed from the sample. If it is possible, your choice will be put in your maternity notes. You can book an independent, private midwife if there is one in your area. She will charge around £2,000-£5,000 to help you right the way through your pregnancy, labour and birth.

It’s also a good idea to check that your maternity unit provides a home birth service. It might be that the hospital you choose doesn’t cover your residential area and you might be advised to book at another hospital that covers homebirths within your geographical area. It’s best to check this out sooner rather than later and avoid disappointment.

It’s a good idea for the midwife to visit your home to make sure it’s suitable. She’ll notice things that you simply won’t have thought of. Discuss this possibility with her when you first meet. One or two midwives will be with you throughout the labour and birth. If there are any problems or labour is not progressing (and the baby is distressed) you will be transferred to a hospital in an ambulance where you will be taken straight to the labour ward.

If you would like to birth in a pool you can hire a birthing pool. If your property is above ground level it is advised to have a structural survey carried out to ensure that your floor can take the weight of a filled pool.

Things to prepare in advance

Your midwife will talk you through everything you need to prepare to give birth to your baby at home.

You will need plastic sheets to protect the area where you are birthing.

A bowl or bucket is useful to have by your bed in case you feel sick.

Have lots of face cloths to help you freshen up throughout labour and a clean warm towel to wrap your baby in when she’s born.

You might want a hand mirror so you can see your baby’s head crowning, and the midwife will need a desk light or torch so that she can check your vagina for tears.

Have a bag of toiletries ready and some sanitary towels and big old clean pants (or disposable maternity pants) to wear afterwards. You’ll need loose old clothes for you after the birth, and all the clothes your baby will need – and don’t forget the nappies!

Also good idea to have a small bag packed in the unlikely event that you need to transfer to hospital.

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DISCLAIMER
This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Essential Parent has used all reasonable care in compiling the information from leading experts and institutions but makes no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details click here.