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Home Birthing Guide for Parents
Giving Birth at Home
My wife and I are looking forward to the birth of our first child and have decided to have a home water birth. While this may seem like a relatively uncommon and modern decision, it really isn't; a century ago, everyone gave birth at home! Many people are uncomfortable with the thought of a home birth - some even think that it places the baby in unnecessary danger.
Evidence suggests that, for low risk pregnancies, it is as safe to opt for a home birth as to have a hospital birth. It can be argued that home births are safer than hospital births, as you are guaranteed one-to-one midwife care. You are also at lower risk of an infection and caesarian section than someone booked for a hospital birth. Home births are also much cheaper than hospital births (not really a consideration if you are using the British NHS!)
After long and detailed discussions with our midwife team, we were convinced that a home birth was at least as safe as a hospital birth. In fact, our midwife team suggested and encouraged my wife and I to have a home birth. Regardless, there are many factors you need to balance when considering a homebirth.
NB: The practices in the UK and the US are vastly different. Home birth is legal throughout the United Kingdom, but not in the USA (see map at bottom of page). Most US hospitals prohibit vaginal birthing if the mother has previously had a Caesarian Section (VBAC), a practice not shared in the UK, where vaginal birth is preferred in most instances.
Check your local laws, practices and regulations closely with your healthcare professional before laying out a birthing plan including home birth.
Would you consider giving birth at home?
Can I have a Home Birth?
The midwives will honour your decisions but will advise against a home birth if:
- You live more than 40 minutes from a hospital - particularly in winter where roads may be impassable;
- You have gone into premature labour (less than 37 weeks);
- If you are more than 2 weeks overdue;
- If you have low iron stores, pre-eclampsia, high blood pressure or are Strep B positive;
- If your baby is in the 'breech' (bottom-down) position.
Disadvantages of a Home Birth
There are many risks to birth in general, whether you are giving birth at home or in the hospital. There are no specific risks associated with home births, but there are a few disadvantages:
- You will not be able to have an epidural - these must be administered by a trained anaesthetist (US: anesthesiologist);
- Kicking out your mother/mother-in-law is more difficult;
- Your partner may end up playing computer games;
- You may still have to go into hospital if complications develop;
- You may find getting the appropriate paperwork after the birth is more difficult
Benefits of a Home Birth
- You are in a comfortable and familiar environment;
- With less nervousness and fear, your labour is likely to progress more smoothly;
- Fewer strangers will be involved with your birth, making the experience more private;
- You will get one-to-one care from established labour, and a second midwife will attend towards the end of labour;
- You can have as many people around you, for as long as you like;
- You can move around as you wish;
- You are less likely to need medical intervention, and are more likely to achieve a 'natural' (medication free) birth;
- You are more likely to experience the birth you desire - for example, there will be nobody else in the birthing pool if you have a home water birth!
- If you choose, you can have other children at home, removing the need for a babysitter.
Home Births vs. Hospital Births
Your own home. You will feel safe, familiar and comfortable.
Unfamiliar and clinical environment
Available Pain Relief
TENS (if you have bought/hired), Entonox, Pethidine.
TENS (rentable), Entonox, Pethidine, Epidural, Spinal Block
One-to-one during active labour, two-to-one towards the birth.
Cared for by a team of midwives, but not necessarily the same one in your room each time
Your own locked door.
Check with your hospital, but most maternity wards are locked, secured and monitored by CCTV
Whatever you choose, but these are harder for you to enforce
Varies, but usually restricted. Most visitors (other than father and birth partner) will have to wait until you transfer to the post-natal ward
Number of Visitors
As many as you like, but keep it sensible - your midwife needs to be able to move freely and examine you regularly.
Varies, but usually limited to 1 or 2. Check with your hospital.
Will usually need to be collected
Filled out as a matter of course
Doctor follow up - reflexes etc.
A GP or specially trained midwife will attend your home within the first 24 hours of the birth
All follow up procedures completed prior to discharge. You will be completely unaware of them!
Home Birth Books
Continuing my personal crusade for more information for dads. These great book is written to answer all of Dad's questions about home birth
This book gives answers to the questions you never thought to ask, but are still nagging in the back of your mind. A great, down-to-earth read. Specifically written for the United States of America, and includes information on US rules and regulations, and sections on insurance
A book balanced between the genders, and between US and UK readers. A good general guide to home birthing.
What you need for a Home Birth
There is little you need to do to prepare for a home birth. You need:
- A place to give birth
- A bed (for examinations)
- A surface (table or similar) for the midwife's equipment, ideally close to your birthing space
- Towels and polythene sheeting
- A torch or lamp for examinations (midwives can forget these!)
You should also make sure that all through ways are clear of clutter so the midwives can move easily. You should also have a place for the midwives to go when they are not actively observing you. Labour can take a long time, and you don't want a midwife hanging over you for hours when all you want is a bit of privacy.
What the Midwife Should Bring with them
You need to have a large flat surface for the equipment the midwife will bring with them. This includes:
- Gas and Air (Entonox) pain-relief system;
- Baby resuscitation equipment;
- Ear trumpet/Doppler
- Intravenous fluids and medication to prevent heavy bleeding;
- Torch, mirror and rubber gloves (latex or otherwise);
- Vitamin K injection and drugs to manage the afterbirth;
- Disposal equipment for the placenta.
Homebirth Questions to Ask
What number should I call when I go into labour?
What type of equipment will you bring with you?
Are you comfortable with water births/orgasmic births/intermittent foetal monitoring/insert birth option here?
How long will you stay after the birth?
Where do I collect paperwork from?
Complications: When to go to the Hospital
99 times out of 100 a home birth delivery will go smoothly, but you need to be prepared for that one time when things go wrong...very quickly. The midwives will monitor baby at regular intervals (unless you request constant foetal monitoring) and will keep you well advised. Remember, midwives are trained and equipped to deal with any emergencies that may arise. There are times, however, when they will recommend you transfer to a hospital. These include:
- Signs of foetal distress (e.g. baby voiding bowels or irratic heart beat);
- Very slow progress of labour;
- Sustained bleeding during labour;
- High blood pressure;
- Any signs of infection (e.g. a fever).
No matter how much you have your heart set on a home birth, you should have a hospital bag packed just in case. The midwife should explain to you clearly why they feel you should transfer to hospital - take their advice, they are the experts! They are making decisions in the best interests of you and your baby.
States where Home Birth is Legally Unavailable
Pennsylvania and South Dakota also have no legal regulatory protection for midwives, and so home births are not legal there either!
Home Birth in the USA
- Direct-Entry Midwifery State-by-State Legal Status
An up-to-date page detailing where midwives can legally attend a planned home birth.
- Home Births in America: New Push for Midwife Licensing - TIME
"The push to increase American women's access to home birth reignites the debate over how safe it is." A 2010 article investigating the legality of home birth in the USA.