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:
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 guide lines 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.
Here is a list of medical conditions and situations that NICE list as indicators of high-risk
|Disease area||Medical condition|
|Cardiovascular||Confirmed cardiac disease
|Respiratory||Asthma requiring an increase in treatment or hospital treatment
|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
|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
|Renal||Abnormal renal function
Renal disease requiring supervision by a renal specialist
Previous cerebrovascular accident
|Gastrointestinal||Liver disease associated with current abnormal liver function tests|
|Psychiatric||Psychiatric disorder requiring current inpatient care|
|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
Primary postpartum haemorrhage requiring additional treatment or blood transfusion
Retained placenta requiring manual removal in theatre
|Current pregnancy||Multiple birth
Pre‑eclampsia or pregnancy‑induced hypertension
Preterm labour or preterm prelabour rupture of membranes
Anaemia – haemoglobin less than 85 g/litre at onset of labour
Confirmed intrauterine death
Induction of labour
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
|Disease area||Medical condition|
|Cardiovascular||Cardiac disease without intrapartum implications|
|Haematological||Atypical antibodies not putting the baby at risk of haemolytic disease
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|
Previous fractured pelvis
|Gastrointestinal||Liver disease without current abnormal liver function
|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
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 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.
You will need plastic sheets to protect your bed and surrounding floor, and to make a path between your bed and the bathroom. Old newspapers are less slippery and will protect floors too. You’ll also need some bin bags for dirty linen and rubbish.
A bowl or bucket is useful to have by your bed in case you are 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!