During the 60s and 70s, homebirth rates in the UK hit an all-time low – about 1% of all births. These days, however, the picture is changing, and in some areas, the rate is as high as 10%. Research from the National Perinatal Epidemiology Unit at Oxford shows that homebirth is at least as safe as hospital birth, for healthy women having a normal pregnancy. The argument that women and their babies are safer in hospital is really no more than unresearched prejudice, but even so, it weighs heavily with some women, since it has been perceived as wisdom for so long. This means that women who want to have their babies at home have to make more extensive preparations than those going into hospital, just to be able to counter the ignorance which pervades the subject. So, how do you go about it?
The booking visit can take anything up to two hours, so you need to allow for this, by arranging appropriate time off, or arranging childcare. At this meeting you are going to be asked a lot of personal questions – make sure both, or all, of you are comfortable and at your ease. Some midwives feel that, if there is a possibility that the woman may have matters to discuss which even her family may not know about, they prefer to have this visit with the woman on her own.
Use this time to begin a preliminary plan for your care and for the birth, by assessing those things which are important to you. Talk about your hopes and fears and about any relevant past experiences. You must be realistic and you must be honest; you won’t be diminished in anyone’s eyes if you’re frank about your own, individual needs. You should also consider between you what will happen if you need to be transferred in to hospital.
Once you’ve finished completing the information you both need, you’ll have an antenatal examination, and then you’re finished.
If you’re already booked into hospital, but change your mind at any point in your pregnancy (up to, and including, labour!) you can still decide to stay at home, and in any case, women book for homebirth at very different stages in their pregnancy. It’s always nice for midwives to get an early booking, though – it gives them and their client a chance to make a very close bond.
Make sure that, if you already have children, you arrange for someone to look after them while you’re in labour. You will probably want your partner with you, and if you know the children are settled you can give your whole attention to the task in hand. Pack a bag, just in case, and just before the baby is due, buy some easily digestible foods for yourself to eat when you’re in labour. This includes eggs, pasta, clear soup and so on, as well as any energy producing drinks such as apple juice.
You may well have your antenatal visits at home, or at the local health centre – this is one of the great things about homebirth. Some time prior to the birth, the midwife may leave some of the delivery kit at your home, sterile packs and so on, which you should put somewhere accessible, out of the dog’s/children’s reach, and tell your partner where they are. You’ll may like to have a big sheet of plastic to go over your mattress (you can get these from furniture shops, sometimes) and old sheets for when you’re in labour. Lots of pillows and cushions or beanbags are good to lean over, but cover them with towels, or something that doesn’t matter if it gets stained.
You may want to hire a birth pool, for labouring and/or delivering in, but do book this earlier rather than later, and the same applies if you think you’d like to use a TENS machine.
questions to ask
Is it a safe option for you and your baby?
Does anything in your past history suggest that you would be better off in hospital?
Do you know the limitations of the midwife’s role, or
Are you assuming that, having booked a homebirth, everything will magically go according to plan?
If homebirth does not seem to be the right option, can you arrange something else? A domino may well be a good compromise.
You may have to transfer – how will you manage if you do?
Do you feel comfortable with the midwife/wives?
Are they experienced in homebirths? Don’t be blinded by your past experiences.
Does the midwife feel comfortable with you ?
What do you want from them? If you have a need for someone to depend on, it may make them uncomfortable.
Do listen to your instincts, and take note of your first impressions.
How far away from hospital do you live?
Is it practical to book this midwife if she lives twenty miles away, along a notoriously congested road?
Is there anybody closer who could do it?
How many other women does she have booked, who are due about the same time?
Privacy, security, safety, comfort
Your own midwife to be with you in labour
Visits in the community
Eat and drink when/if you like
No need to go anywhere before, or after, the birth
if there are problems
When to phone, if you think you’re in labour, often worries people. The simple answer is, if you need advice or some professional support, then phone. Your midwife would rather you rang her on a false alarm than left it too late! Make sure you know what the arrangements are for contacting her and who is likely to come if your own midwife is off duty or away.
If you need to transfer your care in pregnancy, this is usually due to some condition caused by the pregnancy, which will require specialist obstetric assistance to maintain a successful pregnancy, or at delivery. This may apply to women who develop insulin dependent diabetes for example, or who are found to have twins. You may be able to have your midwife to look after you even if your care has been transferred, so do ask.
The important thing about being transferred to consultant care is to accept that there will be occasions when it is the only sensible thing to do. Don’t look on transfer as a failure of some sort. It isn’t. It’s the responsible action of a trained professional who understands the limits of her expertise.
Transfer in labour usually presents as one of two scenarios. Either you are getting nowhere very slowly, and both of you need some help, or you need to transfer fast as some emergency is looming. With slow progress, it is important to differentiate between a long prelabour stage, and actual failure to progress in terms of cervical dilatation and descent of the presenting part. You may decide to have an epidural, because you are exhausted, and the baby is in an occipito-posterior position. You will have time to do all the things that need to be done, such as pack a bag and arrange childcare, so that your partner can come too, instead of having to stay with the children. Booking for a homebirth does not mean that you won’t have access to the hospital if you need it.
If things go awry
It’s extremely rare for things to happen in midwifery which require that you transfer five minutes ago, but if it does look like that, don’t panic. Use your breathing to keep calm, and listen to what’s being said. Midwives are trained to deal with emergencies and will do just that, while they keep you and your partner informed. Women who have been in this situation say that what made the most difference was feeling that they were involved in making the decisions, even when things didn’t go according to plan.
Your midwife may well visit you at least a couple of times a day for the first two or three days, just to make sure everything is going well, and at some point in those first three days a GP, probably your own, will come to check the baby. Do ask your midwife how to get in touch between times if you’re concerned about anything. She will then come every day for the next week or so and the Health Visitor will take over after that – you don’t need to do anything, all the relevant professionals will be notified automatically.
When you’re tucked up in your own bed, and you and your partner are listening to the soft breathing of your new baby; when you’re drinking champagne and eating something scrumptious that you chose for the occasion; when you’ve had a luxurious soak in your own bath – you’ll know exactly why you chose to have your baby at home.
what parents say
Alison Baines is 43 and married to Richard. She has two daughters, Imogen, 7, and Gabriel.
“Imogen was breech, but I still wanted to try for an active birth. The obstetrician was very unsupportive and at 38 weeks wanted to section me. I didn’t want this and decided to go elsewhere, where I could be encouraged to give birth the way I wanted.
When I was expecting Gabriel, I booked in at a hospital just to keep my options open. I wasn’t keen but my GP advised it. I knew I wanted a homebirth.
I had gone along to an antenatal class and it was the midwife who noticed I was having contractions – I hadn’t! – and when she checked me, I was about 4cm dilated. I went home, made dinner, and had a bath. When she came to see how I was doing, about 9pm, she said, very gently, that if I wanted to go in, it had better be now. I’d already made the decision, though, and stayed put. I felt I just wanted to be on my own, people were there if I needed them, but I liked the quiet and the dark and stayed in the bath. Suddenly there was a crack like a pistol shot – I actually thought I’d been shot, for a moment – the waters had broken and I wanted to push. So Gabriel was born, on lots of absorbent padding, courtesy of the midwives, on the bathroom floor in the dark, because everyone else was too polite to put the light on! I felt marvellous!
It was wonderful. I had been fearful, but I found the experience such an incredible experience and so profound. The active birth worked and I could cope – I was so proud.
Meike Lawrence is 33 and married to Chris. They have a daughter, Carla.
I’ve always had a feeling that I’d like my children to be born at home. Hospitals are such unfamiliar places; they’re for illness and I felt that in labour I wanted to feel safe and secure and that means home.
When I got pregnant with Carla, I went to see my GP, but she was away, so I saw a locum. He asked me which hospital I wanted to go to, but I said I wanted to stay home so he said OK. It was only after Carla was born that I discovered my GP doesn’t support homebirths! The midwives were very supportive though, and really made me feel I’d made the right choice. They work in a team of five, so it was great to find that when I went into labour, my midwife was on duty.
Carla was two weeks late and I was being threatened with induction. I ate curries and did all sorts to get things going, which, finally, they did during the evening. I called the midwife at midnight and she said to ring when they were more frequent or when I wanted her. She came along the next morning and I was nearly ready to have the baby by lunch time, but the last little bit of cervix took ages to go – finally the midwife slipped it back over the baby’s head and I was ready to push. I was really exhausted, so I pushed as hard as I could, just to get it over with.
The midwives were so professional, so calm, so right in their judgements and for me, it was such a triumph – I felt embarrassed about feeling so good! A friend of my came to see me the next morning thinking I was going to be induced and was stunned to see me with the baby, looking so well.