Staying in your own house with your partner, the midwife coming to you, being in your own bed the night after you give birth…
If you’re expecting and want to be one of these mums, you might wonder how you go about getting a home birth. Do you need permission from someone official? Does your home need to be checked for suitability? Could your health be an issue? All these questions and more are probably running through your head, which is why I’ve come up with this simple checklist to make coming to your decision a whole lot easier. Work through each section before you make your birth plan.
Consult your partner
The first person you need to run the idea past is your birth partner. Many men worry about home births because they feel it’s safer to be near to medical assistance if it’s needed. They may also think that having a baby at home means they’ll have to perform the delivery. Get your partner to tell you his thoughts about it all, and explain as clearly as possible why you feel this is a good idea. He might be more nervous if it’s your first baby. You could also get your midwife to have a chat with him, so she can reassure him about any concerns.
Talk to your midwife
Once you’ve reached an agreement with the dad-to-be, you need to speak to your midwife about a home birth. You can do it at any appointment; you don’t need to make one specifically.
It’s useful for your midwife to know by 36 weeks if you’re keen to go ahead, so that she can tell her colleagues. However, some women don’t decide it’s what they want until the last minute, and you’re allowed to change your mind at any stage.
Questions you might want to ask your midwife include:
- What’s the local home birth rate?
- How many home births have you attended in the past year?
- Is there a local home birth group where you can talk to other mums who’ve had or are planning a home birth?
- Is there an opportunity to meet other midwives in the team who might be looking after me in labour?
A midwife can’t ‘refuse’ you a home birth. However, things like staffing problems or the weather might affect whether it can go ahead. If your midwife’s reluctant to support a home birth, you can write to the Head of Midwifery or Supervisor of Midwives and ask for another midwife. However, if she has real concerns that you are not considered ‘straightforward’, it would be advisable to listen to her.
Check your health
There’s no exact list of medical reasons why you would be refused a home birth. However, some women are advised against it, and that can be because of complications during a previous birth, certain medical conditions, or problems during this pregnancy. For example, if you lost a large amount of blood when giving birth previously (postpartum haemorrhage) there’s an increased risk of this happening again and you’d be advised to have your baby in hospital. The same applies if you have previously had a c-section or if there are concerns about very high blood pressure or pre-eclampsia. Where there are worries about your baby’s growth during pregnancy or his wellbeing, you will be advised to be in hospital where paediatricians are on hand immediately after you give birth.
What’s important is that the ‘problems’ are relevant. For example if you’ve had your appendix removed or previously needed help with ventouse or forceps, that doesn’t mean you’re unsuitable for a home birth. In a straightforward pregnancy, the evidence is that home is just as safe as hospital.
Check your finances
Home births are free on the NHS but if you want a guarantee that you’ll know the person who cares for you in labour you might want to consider paying for an independent midwife. (If your NHS midwife is on her day off when you go into labour, a different midwife will attend you.) Midwives who work privately tend mainly to do home births, and provide all the antenatal and postnatal care in your house, too. Prices vary, but expect to pay around £3,000 if you go down the independent route. All midwives can bring pain relief to your home if you need it (not an epidural though) and you won’t receive a bill for the gas and air if you opt for it!
Think about your home
Your midwife may do a home visit to check the location and pass on directions to other midwives, but she won’t examine the skirting boards for dust! You don’t have to clean the house drastically, but if your nesting instinct kicks in you’ll probably find yourself doing this before going into labour anyway. Mums who give birth at home rarely have their baby in bed as they would in a hospital. They tend to move around, which helps the baby to move down and the contractions to keep coming. That in turn reduces the need for intervention. And despite the best plans to give birth in the largest room in the house, women usually end up in the smallest, such as the loo! It doesn’t take much room to have a baby, but it’s handy if there’s a bit of space for the midwife to put her equipment, even if it’s just on a table top. And clear the hallway so anyone can come in and you can get out if you need to transfer to hospital (or just walk around).
Of course you could also invest in a birthing pool. If you want one for a home birth, you’ll have to arrange it yourself. Take a look online for companies who hire or sell pools. Expect to pay anything from £60 to buy an inflatable one, to £300 to hire a top-of-the-range heated and filtered pool for several weeks.
Know your team
One of the best things about opting to give birth at home is that you get one-to-one care from a midwife. Because she’s not on a busy maternity ward, she won’t have to look after anyone else during labour. And we know that women who get one-to-one care are more likely to do well when it comes to the birth. As you approach your due date, she’ll call a second midwife to come and help out too. Midwives are the experts in ‘normal’ birth, so there’s no need to have a doctor there. So, if you want a doctor on hand in case of complications, this isn’t the option for you. As for birth partners, you can choose as many or as few as you want. Lots of women opt to have their other children around too, and make the arrival of a new sibling a real family celebration.
Understand Plan B
Choosing to have your baby at home doesn’t mean you absolutely won’t have to go to hospital. So if your reason for wanting a home birth is that you have fears or issues about being admitted, you need to talk those through with your midwife. Most mums have a safe, straightforward labour at home, but bear in mind that you could be transferred to hospital at any stage.
The most common reason for this is slow progress in labour. You’d usually be advised to transfer by ambulance to enable your midwife to stay with you. Midwives are trained in emergency procedures such as resuscitation or bleeding and will take equipment to the birth including drugs, which can be used if necessary. If you need stitches then your midwife should be able to do this at home.
Anne’s top tips
- “Keep a bag full of items you’ll need for your home birth as the big day draws closer. These include a bin bag, lots of old towels, a torch (to help your midwife see in case of stitches), and a hand-held mirror.”
- “It’s still a good idea to pack a hospital bag, in case you are transferred at any stage.”
Myths about home births
You need to make a decision well in advance
“I wasn’t sure whether or not I wanted a home birth so my midwife told me not to make a decision until I was in labour. When she arrived I was 7cm dilated and felt so relaxed I didn’t want the disruption of going to hospital. Three hours later Daisy was born on my living room floor. I think I felt relaxed knowing that my decision wasn’t written in stone.”
Laura MacDonald, 26, from Inverness, mum to Daisy, 6 weeks
Hospital birth last time round means you can’t have a home birth next time
“I didn’t think I was suitable for a home birth as I’d had forceps first time round. But it turned out that wasn’t the case. The birth of my son was the most magical experience of my life. After the birth, my husband lit the fire, poured champagne and we sat with the midwives eating pizza while the snow fell outside.”
Nicola Solly, 32, from Hampshire, mum to Freya, 3, and Jamie, 4 months
Not giving birth in hospital means you’ll make a slower recovery
Supermodel Gisele, 29, mum to Benjamin, 4 months, had a home birth – in the bath at her penthouse apartment in Boston. She used breathing techniques to control the pain. “The second day, I was walking, I was washing dishes, I was making pancakes in the kitchen,” she told Brazilian TV show, Fantastico.
If you tick all the boxes but are still unsure about a home birth, try:
- Talking to your midwife about any concerns or questions you have.
- Speaking to friends or finding mums on forums who’ve had home births to get their take on it.
- Visiting www.homebirth.org.uk or www.nct.or.uk/choice for facts and information.
Did you know…
Some areas have such a successful home birth rate that they’ve developed ‘home birth teams’ of midwives who exclusively care for women who choose this option.