Why Home Birth?

It is my mission in life to get more families to consider birthing their babies at home. Research and statistics aside, home birth is a sort of everyday magic that for some has to be seen to be believed. 

What does the research say? 

I personally use the language of  ‘chance’ in place of ‘risk’ where possible, but have used the accepted language of high and low risk in the following discussion. 

The first priority for most families when considering where to give birth is safety. There is a large and growing body of research showing us consistently great outcomes when birthing at home. The research study that is most quoted by midwives in the UK is the Birthplace cohort study (Brocklehurst et al. 2011). This showed that for healthy women who have had a baby before there is no difference in outcomes for the baby when comparing home to hospital birth. For all women the following were all less likely for those planning home compared to hospital birth: caesarean or instrumental birth, receiving artificial hormones to speed up labour (augmentation) and episiotomy (surgical cut to the perineum). 

Another large study (500,000 planned home births) was published in 2019 by Hutton et al. The authors observed that among low risk women planning home birth there was no increase in babies dying or becoming seriously unwell compared to similarly low risk women in hospital. This was the case both for women having their first and subsequent babies. The same data was used to look at maternal outcomes. Caesarean & instrumental birth, augmentation, episiotomy, infection and significant perineal tears all occurred more frequently for women birthing in hospital. This rings true alongside the disturbing trend towards ever higher rates of induction, instrumental and caesarean birth across the UK. 

But there is more to giving birth at home than what the research tells us…

We are mammals and rely on huge amounts of self-made oxytocin and endorphins to get through labour unaided. The kind of environment that facilitates this is undisturbed, dark, warm and quiet. There are unfamiliar sights, smells, sounds and people at the hospital which all consciously and unconsciously disturb this highly evolved process. If you are planning to use hypnobirthing in labour this tends to work much better at home, as there are less distractions. 

Many mothers take it for granted that a car journey in labour will be necessary. This presents different challenges depending on which number baby you are having. Too early is more likely for those having their first baby. This may mean travelling in and being advised to go home again and return when things have intensified. This can be worrying and demoralising; especially if you are having a hard time with the current level of intensity. It is not uncommon for everything to slow down on arrival either (as a result of the above mammalian physiology). For those planning a home birth, the midwife can do the coming and going in early labour according to your needs and progress. For women having second babies and beyond, too late is more likely than too early; the intensity of contractions can escalate quickly. Home birth may be particularly appropriate for those with a history of quick labours. This allows the midwife to do the rushing, and for you and your partner to avoid a stressful car journey in advanced labour.

Home birth can be wonderful for partners too; who can sometimes feel sidelined and unhelpful in the hospital environment. I have also attended many home births with older siblings present. When it all happens overnight, many little ones sleep through and wake up the next morning to find the new baby has arrived as if by magic. Equally, children of all ages seem pretty unfazed by seeing and hearing birth, though I would always recommend a dedicated adult to care for them. I once attended a home birth where the older siblings cut the cord, and another where two toddlers slept in their double buggy in the same room as their labouring mother. 

Mess & noise…

Two common concerns about giving birth at home are mess and noise. Many home births happen in hired pools which are great at containing mess. The dirty water is then simply pumped out (pump included with hire of pool) and down the toilet.  Even in the case of birth out of the pool absorbent ‘puppy pads’, waterproof sheets and old bed sheets and towels contain everything well. Midwives are compulsive tidiers and sorters and take great satisfaction in leaving without much of a trace. When it comes to noise I find many women at home don’t make all that much. Some women can be reassured by giving some advanced warning to neighbours. 

The very best part of giving birth at home (and I have experienced this both as a new mother and many times as a midwife) is getting into your own bed and settling down for the hardest earned rest of your life, with toast and a cup of tea. 

Brocklehurst, P. et al. (2011) Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. Available at: https://www.bmj.com/content/343/bmj.d7400

Hutton, E.K. at al. (2019) Perinatal or neonatal mortality among women who intend at the onset of labour to give birth at home compared to women of low obstetrical risk who intend to give birth in hospital: A systematic review and meta-analyses. Available at: https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(19)30119-1/fulltext