Planning for your home birth

If you’re considering a home birth, this guide will give you the information you need to make an informed choice. It includes details on the benefits and risks, what to expect, and what you will need to prepare.

If you decide to plan a home birth, your community midwife should support you in your choice and help you to prepare for your birth.

During a home birth, a community midwife will come to your home to look after you during labour and for a short while after the birth of your baby. There are community midwives on call 24 hours a day, so the midwife will come to your home to assess you when you think you’re in labour.

What are the advantages of having a home birth?

• According to an NCT report in 2008, women report feeling much more satisfied with their birth experience at home when compared to a hospital birth

• You’ll be in familiar surroundings, which may help you feel more relaxed and more confident in your body’s ability to birth your baby

• You won’t need to worry about getting to hospital during your labour

• You won’t need to leave your older children or organise child care, if you’re happy for them to be nearby during and after the birth of your baby

• Pain relief at home includes the use of a birthing pool, tens machine, relaxation techniques and Entonox (gas and air)

• The 2008 NCT report states that women giving birth at home reported feeling more relaxed, in control and able to cope with the pain of their contractions. They also report needing fewer drugs for pain relief

• You won’t be separated from your partner or birth support after the birth

• You’re more likely to be cared for by the team of midwives you met in the course of your pregnancy

• You’re less likely to need an intervention, such as an episiotomy, Caesarean, or instrumental birth than you would if you were in hospital

• There’s less risk of acquiring infections which may be present in hospital, including Covid-19

Things to consider

• If the midwife feels your labour is not progressing as it should, or complications arise, they may advise you that you need to be transferred to hospital. This can cause anxiety for you and your family.

• Pain relief at home is limited to the use of a birth pool, tens machine, relaxation techniques and Entonox (gas and air). If you require anything further (such as opioids or an epidural), you will need to be transferred to the hospital

• If you’re not considered to be ‘low risk’ you will need to talk to your midwife and/ or doctor about your wishes for a home birth

• If you or anyone in your household has tested positive for Covid-19, this may affect your wishes to have a home birth

• The homebirth service may be temporarily stopped in some circumstances

Who can have a home birth and is it safe?

Anyone can choose to have a home birth, even if you’re having your first baby. In England and Wales, just over one in 50 people give birth at home.

For ‘low risk’ pregnancies, birth is generally very safe. You’ll be considered low risk if you’re not identified as having particular medical or pregnancy factors before you go into labour.

The number of adverse and serious outcomes is low – around 4.3 in 1,000 births.

These include:

• Stillbirth

• Early neonatal death

• Neonatal encephalopathy (abnormal neurological function, predominantly as a result of lack of oxygen to the brain)

• Meconium aspiration syndrome (when a newborn breathes a mixture of meconium and amniotic fluid into the lungs around the time of delivery)

• Specified birth related injuries

If you are healthy, having an uncomplicated, ‘low risk’ pregnancy with a second or subsequent baby and planning to have your baby at home, having your baby at home is particularly suitable for you. It’s actually as safe to give birth to your baby at home as it is to have your baby on a labour ward or a midwife-led unit.

In a 2020 Birthplace Study, birthing at home was found to substantially reduce the odds of having a Caesarean, instrumental delivery or episiotomy, where the woman was healthy and having an uncomplicated second or subsequent pregnancy. It was also found that only 12% of women needed to be transferred to hospital during labour or immediately after birth, if complications arose.

If this is your first pregnancy and it’s uncomplicated, planning to have your baby at home is slightly less safe for your baby than a hospital birth. There’s a slightly higher risk of your baby being injured, becoming seriously unwell, or dying during or just after birth.

This is still very rare if you’re healthy and having an uncomplicated pregnancy – and can happen in any birth setting. However, in hospital the risk is five in 1,000 compared to nine in 1,000 at home.

However, you are also more likely to have a natural birth and less likely to have interventions such as an episiotomy, Caesarean, or instrumental birth.

If you chose to have your first baby at home, there’s also a higher probability (45%) of needing to be transferred to hospital during labour or just after birth.

If you’re at increased risk of complications, we’re likely to advise against you having a home birth, and recommended to have your baby on a labour ward.

You can discuss your wishes with your midwife and doctor and, if you still wish to have your baby at home, an enhanced birth plan can be made to manage these risks and consider factors to increase safety.

What are my coping and pain relief options at home?

Once you’re in established labour, the midwives – who will stay with you – will be helping and supporting you. You will have discussed what method of coping/ support during labour you would prefer with your midwife at your birth plan appointment.

There are lots of options for pain relief for your labour and birth.

You may wish to consider self-help and natural pain relief techniques, such as relaxation and breathing; aromatherapy; hypnobirthing; being active and changing position regularly; and using a birth pool. All of these methods are completely natural. Your birth partner is also very important when helping you cope in labour, as they can support you in positions, give you emotional support, and use massage.

Water birth

You can have a home water birth but you will need to hire or buy your own birthing pool and have it ready for your labour. Pool hire may be available locally – ask your midwife for details. Being submerged in water in your labour can help you relax and make the contractions seem less painful. It also allows you to be more mobile,, as the water buoyancy will help to make you feel weightless. The water will need to be kept at a warm, comfortable temperature.

TENS Machine

You may also wish to purchase or hire a TENS machine. The use of a TENS machine involved taping electrodes on to your back, which are connected by wires to a small, battery-powered stimulator. Holding this, you give yourself small, safe amounts of electrical currents through the electrodes. You can also move around while using TENS – although you can’t use it in the bath or birth pool.

TENS is believed to work by stimulating the body to produce more of its own natural painkillers, called endorphins. It also reduces the number of pain signals sent to the brain by the spinal cord.

Entonox (gas and air)

You’ll have access to Entonox (gas and air), which will be brought to your house by your midwife.

Opioid drugs and epidurals are not available at home so, should you want to have stronger pain relief, you will need to be transferred into hospital.

Who will be there?

During your home birth, midwives (usually two) will come to your house and care for you during labour and after you have birthed your baby. Student midwives may also attend if you’re happy for them do so.

You should also choose one or two birth partners, who will be able to support you during labour and birth.

When should I call my midwife?

Whether you’re planning to have a home birth or come into hospital, if you have any concerns or you think you are in labour, you should call the Maternity Unit immediately. We’re open 24 hours a day, 365 days a year, and a midwife will always be ready to take your call.

You should also call your Maternity Unit if:

• Your contractions are strong, regular, and five to 10 minutes apart. Second babies often arrive more quickly than the first, so you may need to contact the Midwifery Unit earlier.
• Your waters have broken or you have any unusual vaginal fluid loss – whether you’re having contractions or not. Please put a pad on and call us immediately, as we will need to assess the colour and consistency of the fluid.
• Your baby’s movements have reduced, slowed down, or changed in any way. If this happens, call us straight away – don’t wait until the next day. Your maternity team should ask you to come in for an assessment. Your baby’s pattern of movement should not slow down towards the end of your pregnancy.
• You have any vaginal bleeding
• You have any headaches, sudden swelling or visual problems
• You have any form of mild or severe itching
• You have any signs of infection, including urinary tract infections
• You have abdominal pain
• Your instinct tells you something is not right, or you have any other concerns
• If you’re worried you may have Covid-19

When you and the midwife have decided that you’re ready to be assessed, please ensure your home is easily identifiable by the midwife. For example, if it’s at night, put your lights on.

If your home is not easy to access or find, or doesn’t have a name or number plaque displayed, please arrange for an adult to meet the midwife at the door, gate, or nearest accessible tarmac road.

Please leave your answer machine off and keep your line clear until the midwife has arrived, in case they try to call you. If you’re using a mobile or cordless phone, make sure it’s got plenty of charge.

How do I contact my midwife?

When you think your labour has started, or you have any concerns, you can contact:

Scunthorpe

The Maternity Unit Central Delivery Suite – 03033 302270

Grimsby

Please contact the Team you are booked under:

• Blueberry Team – 03033 304789
• Holly Team – 03033 304790
• Honeysuckle Team – 03033 304794
• Jasmine Team – 03033 304787

Please tell the midwife you speak to that you’re booked for a home birth. They will take your details and discuss all aspects of your labour and advise you accordingly.

The community midwife will be contacted and they will call you and make arrangements to assess you.

How will the midwife monitor me and my baby?

The midwife caring for you will continually assess you and your baby to ensure you are both well and safe to remain at home.

We’ll listen to your baby’s heart rate at regular intervals throughout your labour with both a pinnard stethoscope (ear trumpet) and a Doppler (ultrasound). This is usually done every 15 minutes in the first stage of labour and every five minutes in the second stage of labour.

Your contractions and progress will be monitored throughout labour, ensuring you are making progress and that you are coping.

Throughout the labour, your midwife will ensure you remain well. They’ll take your temperature, pulse, and blood pressure, and will take a sample of urine at regular intervals.

Under what circumstances would I need to be transferred to hospital?

In certain circumstances, the midwife will advise that transfer into hospital is necessary. You will be taken by ambulance and your midwife will come with you.

Examples of when this could happen include:

• If your labour has started before 37 weeks, or after term +12 days of being pregnant
• If your labour has not started and your baby has not been born by 24 hours after your waters breaking
• If the colour of your waters are brown/ green (meconium). This indicates that the baby has had a poo, which may be a potential risk. The baby needs to be monitored continuously and a paediatrician may be present at the birth
• Any fresh bleeding
• Raised blood pressure
• Raised temperature
• Concerns over your wellbeing or your baby’s wellbeing
• An abnormality in your baby’s heart rate
• Slow progress in your labour or birth
• If your baby isn’t in the optimal position for birth
• You choose to have stronger pain relief
• Your placenta is retained
• If your baby’s condition at birth is unsatisfactory
• If your baby has a low birth weight (under 2.5kg)
• If there are any concerns with bleeding after your baby is born
• If you have sustained a third or fourth degree tear (a tear to your perineum, which is more complex than those that can be sutured at home), or any tear if the lighting is not good enough for your midwife to repair it

In the event of needing to transfer to hospital, the midwife’s decision should be respected and supported.

Could my home birth be cancelled at the last minute?

Whilst we will do our absolute bet to ensure that we accommodate your wish for a home birth, there are occasions when this is not possible, due to unforeseen circumstances, such as:

• Several home births happening at once
• Severe weather, that could compromise the midwives’ safety
• Sudden sickness of your midwife
• Significant demand on the maternity unit
• Covid-19 causing interruptions to our services

In these situations, we would ask for your cooperation in birthing your baby at the hospital maternity unit. We would endeavor to make it a home from home experience and get you discharged home as quickly as we can, after ensuring you and your baby are well enough.

What do I need to prepare for a home birth?

You do not need to do anything special to make it suitable for a home birth, but there are things you can do to prepare that will help you and your midwives.

Please ensure:

• You have a regular intake of fluid and eat lightly
• You have periods of rest and activity during your labour
• You have 24 hour access to a fully charged telephone or mobile phone
• There is adequate heating in the room you plan to give birth in
• There’s a good supply of clean, hot water
• You put some plastic sheeting (available from DIY stores) over your floor
• You cover your mattress with a plastic cover to protect it
• There are old, clean sheets and towels available

You will need:

• A breastfeeding/ nursing bra
• A packet of maternity towels (pads)
• Old or paper pants
• A packed overnight bag, in case you need to be transferred to hospital
• An old T-shirt or nightdress for labour

Your baby will need:

• Two soft towels (old but clean)
• A vest
• A babygrow or nightdress
• nappies
• Cotton wool
• Cot sheets
• Blankets

Your midwife will need:

• Soap in a dispensable container
• A towel for hand-drying
• A torch and mirror may also be useful during the birth

Will there be a mess?

Usually, there is very little mess. We do ask that you provide some sheets you don’t mind getting dirty but the midwives will bring plenty of disposable pads and dispose of all clinical waste before they leave.

What if I need stitches?

Midwives can stitch most perineal tears, but any complicated tears will need you to be transferred to hospital.

What happens after my baby is born?

Your midwife will stay with you for at least one hour after the birth of your baby, when you’re encouraged to have skin to skin contact. If you wish to breastfeed, the midwife will give your support and guidance as soon as possible after the birth.

If you have decided to bottle feed your baby, the midwife will ensure your baby has taken its first feed and that you’re confident in the safe preparation of a bottle.

When they leave, your midwives will make sure you have a telephone number you can call if you have any worries or concerns and they will make arrangements with you for a further visit.

They’ll also arrange for your baby’s first thorough physical examination – called the NIPE (Newborn and Infant Physical Examination), which needs to be completed within 72 hours of birth. The examination will include listening to your baby’s heart, and checking their hips and eyes. Usually, this will be done by a midwife with Examination of a Newborn qualifications. However, if there isn’t a suitable midwife available, an appointment will be made for you and your baby to come to hospital.

You will also need to register your baby’s birth with six weeks of them being born.

How is Covid-19 affecting home births?

The International Confederation of Midwives recommends that when the health system can support home births, healthy women, with low risk pregnancy, may benefit from giving birth at home rather than in hospital, as it reduces their potential exposure to Covid-19.

However, some temporary changes to all maternity services, including home births, may be necessary to keep you and your baby safe. Maternity services rely on having enough staff and availability of an ambulance, should it be needed, to keep you and your baby safe. Therefore, if there is not the ability to provide appropriate midwifery support and there is an insufficient ambulance service to transfer you to hospital, the home birth service may be temporarily stopped (RCM,2020). The guidance around Covid-19 changes regularly, so please ask your midwife for up to date guidance.

If you have symptoms of Covid-19, which include a temperature, loss of taste and/ or smell, and a new or persistent cough, or you have confirmed Covid-19, you will be advised to give birth in an obstetric unit. This is so the maternity team looking after you can monitor you and your baby closely and respond quickly if necessary.

If anyone in your household or support bubble are positive or have symptoms, this may also affect your wishes to have a home birth.

Information for partners

A lot of partners have initial doubts when their partner wishes to give birth at home. You should discuss your plans together during the pregnancy, as it is important you both feel comfortable with the final decision.

You can also ask the midwife questions to ease any anxieties you may have, read our Role of the Birth Partner leaflet, and come along to antenatal classes.