Giving Birth At Home

Why is a home birth less painful and more straightforward?
So why don't we all do it
Where is the evidence?
So why are UK home birth rates so low?
Can I insist on a home birth?

Many women assume they will be having their baby in hospital because that is what their friends or relatives did. or it is what they have seen in television programmes or read about in magazines. Home birth has very many advantages which deserve careful consideration when you are choosing your place of birth. These include:

• A less painful labour
• Knowing the midwives who will be at your birth
• One to one midwifery care
• More privacy and control in labour and afterwards
• Greatly reduced need for medical intervention
• Healthier mum and baby
• Baby is more likely to breastfeed
• Lower rates of postnatal infections for mum and baby
• Dad is never sent away or reduced to visitor status: you can start family life from day one.
• If you have other children they can be as involved as you want them to be.

Why is home birth less painful and more straightforward?

When we look at how women's bodies work in labour, it is clear that women need to be relaxed and able to control their environment to let labour happen. When a labouring woman feels safe and private, when she has the ability to move around, eat, drink and deal with her labour pains in whatever way works for her, her body will respond by releasing the labour hormone oxytocin which makes the uterus contract efficiently. She will also produce endorphins that reduce pain. Because she is in familiar surroundings, her body is less likely to produce adrenaline, our fight and flight hormone, which interrupts labour hormones and actually makes labour slower and more painful.

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So why don't we all do it?

Home birth in this country has been unfashionable for years, mainly because in the 1950s it was actively discouraged by the health service which ran campaigns to persuade mothers to go into hospital to give birth. In post-war Britain, just as the NHS was being created, our housing conditions and general health were quite poor. For many poorer women at that time, it probably was safer to be in hospital. However, those campaigns convinced many people that home birth itself was unsafe and that hospital was always safer. This has been perpetuated by the media so that many, particularly older, people still believe that hospital is safer than home. This is an urban myth. Today, if you are a low risk mother having a straightforward pregnancy, the evidence is clear that you and your baby are as safe at home as in hospital and if you add in the reduced risks of infection, ventouse, forceps, tearing and caesarean section, you are arguably safer at home.

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Where's the evidence?

It is important if you go looking for the research evidence on home birth that you look at research on planned home birth. Sometimes the studies that are done have their results skewed by including figures on unplanned home births, some of whom will include very high risk mothers who unexpectedly had a birth at home or young mothers with concealed pregnancies. It is also important to look at research done on births in modern, industrialised countries like ours which have an effective health service. Studies from the Netherlands for example, where there has been a high number of home births for many years, are very useful in giving us high quality, high volume statistics. This sort of research shows very convincingly that home is a great place to be.

A National Childbirth Trust study in the United Kingdom done in 2001 showed that if you book a home birth you halve your chances of needing to have a Caesarean, ventouse, or forceps delivery and significantly that you are less likely to have a bad tear or need an episiotomy. The benefits are not just for you though: babies who are born at home are less likely to have infections after birth and are much more likely to breastfeed successfully. The numbers of babies in this country who die at birth or who are injured at birth are, thank goodness, very low but there are sufficient numbers to show categorically that you do not increase any risk to your baby by choosing a home birth. In fact, the figures are so compelling that the Royal College of Obstetricians, the Royal College of Midwives, the Royal College of General Practitioners and the Department of Health all agree that ALL low risk mothers-to-be should be told that home birth means better births and healthier mothers and babies. Birth Choice UK provides a good summary of the current research on the impact of the place of birth. The Association for the Improvement of Maternity Services has long been supporting mothers in their choice of birth place. Finally, both www.homebirth.org.uk and www.nctpregnancyandbabycare.com provide much information about giving birth at home. You can also buy books on home birth - a good list is here.

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So why are UK home birth rates so low?

The home birth rate in the UK averages about 2% but there are areas within the country where this is much higher: Torbay for example has a 20% home birth rate. So are the women of Torbay genetically better able to give birth at home? No, the reason is that their local maternity service has organised itself to enable as many women as possible to give birth at home and to educate the local population about the safety of home birth and encourage them to do so. Other maternity units, and the government are looking very closely at places like Torbay to look at how they can increase their home birth rates too, because the benefits for mothers and babies are also benefits for the health service too in lower costs and greater customer satisfaction. You can check out your NHS trust home birth rate at www.birthchoice.org.uk.

So what do you do if your local rate is very low or average? First don't panic – it may not be a problem with your maternity service it may just be that they haven't gone as far as other trusts in promoting home birth. As we no longer have a home birth culture in this country, because many people still, believe that home birth is unsafe, many women don't know that home birth is an option they can choose and many carers don't think to offer it. However high or low your local home birth rate is, it is entirely up to you where you have your baby.

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Can I insist on a home birth?

You have an absolute right to choose your place of birth, regardless of perceived risk, and at all times, even in labour, this remains your choice. The issue of a legal right to home birth has become a bit complicated recently, because there is no right in law for women to give birth at home, and the Department of Health has issued advice to NHS Trusts saying that they should provide a home birth service "where practicable" rather than insisting that they provide one. However, the bottom line is that in law no one can be compelled to attend a hospital for treatment or care, and that includes birth. Furthermore, the rules of conduct for midwives say quite categorically that no midwife may refuse care to a mother in labour. Due to midwifery shortages some hospitals tell women who book a home birth that if the hospital is short staffed when the woman goes into labour, they may have to come into hospital to give birth. This is not true, and if you are told this, you could write to the hospital and tell them firmly that you have no intention of coming in. Alternately, if you are in labour and are being told to come in, you can simply tell them you are in labour and you expect care and put the phone down. They are obligated to send someone to care for you. This might seem stroppy, and you might feel worried about being seen to be "awkward", but birth campaigners say women who assert themselves do not receive poor care nor hostility from their carers, but rather, quite the opposite. The Association for Improvements in Maternity Services (AIMS) has produced a sample letter which they suggest women send if they are told the "you have to come in" story or are asked to sign a form saying that you will come in, in the event of staff shortage.

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