Common Concerns About Home Birth

What happens if there is a medical emergency?
what pain relief can I use?
Is my house suitable for a home birth?
How will we cope alone at home after the birth?
What about the mess?
My partner is totally against the idea
My GP doesn't support home birthing
My midwife isn't keen on home birthing or I am not keen on her
I want a home birth, but I am too old, too big, too small, etc.

What happens if there is a medical emergency?

We have all grown up watching television dramas where mother and baby have to undergo live saving surgery following an emergency during labour. In reality, giving birth is usually very straightforward and usually problems arise with plenty of warning and time to react.

In the United Kingdom, only experienced midwives are allowed to attend home births. They have the training, the experience and follow strict guidelines that enable them to spot a problem before it becomes an emergency and, if needed, can quickly arrange a calm transfer to hospital. In the unlikely event of a baby being born with, for example, a breathing problem your midwife will have brought with her oxygen and resuscitation equipment and, if necessary, can call on a paramedic and ambulance. Most transfers from home to a hospital however are not due to unforeseen complications but rather to labour taking longer than expected and the mother requesting additional pain relief. The various studies on home birth show that complications during labour or after the birth are actually less likely than in a hospital setting. 

Some situations, such as shoulder dystocia, when the baby gets "stuck", are very difficult to handle in any setting and are often used as a deterrent to home birthing. Shoulder dystocia is very rare and an experienced midwife will have been trained to deal with it. Additionally, it seems to occur less during a home birth.

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What pain relief can I have?

Any with the exception of an epidural which has to be administered by an anaesthetist and makes the woman high risk anyway so is only suitable for hospital birth. It's important to remember that women who are in control, relaxed and in their own environment and having one to one care from a midwife are much less likely to experience severe pain. You can use self help measures like deep relaxation, breathing, massage and complementary therapies such as aromatherapy and homeopathy. You can hire a TENS machine and your midwife will bring Gas and Air (Entonox) with her. Increasingly, women who give birth at home use a birthing pool as a form of pain relief.

Is my house suitable for birthing?

You don't need a palace to have a home birth. If your home is fit to be a parent in then it is probably fit to give birth in. If you are involved in major renovations then you might want to think about getting one or two rooms finished and ready for birth and baby. Otherwise it doesn't matter if you are in a one bed flat or a ten-bed mansion, you need water, warmth and a midwife. Some people worry about their neighbours hearing them give birth – not all women make a lot of noise when they are in labour and it's up to you whether you give them advance warning.

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How will we cope at home alone after the birth?

This is a common concern for first time parents who may believe that mum and baby will get more care and attention on the postnatal ward after the birth. However, NHS staffing shortages mean that many postnatal wards are very busy and you might actually get much less support than you expect. After a home birth your midwife will stay for a while to ensure that both mum and baby are well, to write up her notes, help with the first breastfeed and to tidy up. Once she leaves, she will arrange to come back at regular intervals and will leave you with a number to call if you are worried about anything.

All new parents are worried about being on their own with their babies for the first time, a home birth parent just does it about 24 hours earlier than those who give birth in hospital. The big advantage of a home birth is that Dad can get involved earlier and get to know the baby from the very beginning. As you are better able to control your environment (noise, food, and heating), you will find that you will be able to rest more, as long as you control the flow of visitors that is to be expected after the happy event.

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What about the mess?

Birth isn't the total carnage that most people seem to imagine. Taking some sensible precautions to protect your carpets and furnishings is a good idea but very few people seem to report problems with mess and your midwife is responsible for disposing of the placenta and taking any disposable waste away with them. Most people use old sheets which will either wash out or can be thrown away.

My partner is totally against the idea

Sometimes partners feel very worried about home birth because they want to protect mum and baby and they may believe, like the rest of the population, that birth is a dangerous business best carried out in hospital. You can help yourself by encouraging your partner to read through the evidence for himself.

Sometimes partners are worried that they will be caring for the mum in labour or will have more responsibilities. More involvement on the part of your partner might not necessarily be a bad thing compared to the feeling of being only a spectator during hospital births. Your midwife is ultimately responsible for your medical well-being and that of your baby. As she is providing you with one to one care, you are likely to get more attention from her than on a hospital ward where typically a midwife will be responsible for more than one patient at any one time. It is the policy of most hospital trusts to send more than one midwife to attend a home birth, usually during the second stage of labour, so more hands are available to help when the baby is born.

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My GP doesn't support home births

Your GP’s support is not necessary. Some GP's get very worried about being called out to a home birth by a labouring woman because they usually haven't attended a birth in many years. Some are just ill-informed about home birth research and safety record. Your midwife will not call on a GP. If she needs medical support she will call a paramedic or seek telephone support from her supervisor at the hospital. You don't need your GP's approval or permission to have a home birth, it's not really anything to do with him. You don't need to even see him to arrange a home birth. That is usually done through the community midwifery team or via the head of community midwifery of your local hospital. However, some GP's are very supportive of home births and might even come out to do the postnatal "new baby check". If your GP is not interested, your community midwife will usually be able to do it.

My midwife isn't keen on home births or I'm not keen on her

A community midwife has home birth as part of her job description but if you don['t feel she is supporting and encouraging you in your choice, then write to or phone the Head of Community Midwifery of your local hospital to arrange for someone else to take over your pregnancy care and be on call for your birth. If you feel there is a personality clash between you and your midwife then you are not obliged to have her at your birth or involved with your care in any way, just contact the midwife's supervisor and ask for a replacement. Usually, for home births, there is a team of midwives on a rota so you may not get a midwife you know on the day of the birth anyway. But if there is a specific problem with one of them it is better to sort it out in advance.

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I want a home birth but I'm too old, too big, too small, etc.

There are very few absolute reasons why a woman cannot have a home birth . Hospitals vary in their policies about which women are considered "high risk". Some of them may do so in order to keep their home birth rate low believing it will save them money and resources. Some may be worried about being sued if something goes wrong and abide by catch-all policies that exclude large numbers of women without considering specific cases. Giving birth at home is your choice and you are supported in this by law. If you are meeting resistance, seek a second opinion, do more research or enrol the support of organisations such as the National Childbirth Trust or the Association for the Improvement of Maternity Services .

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