Giving Birth At Home
Childbirth is one of the most wonderful events for most families. 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 on the television programmes or they have read about in books and magazines.
Those who advocate home birth claim benefits which 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 outcome for mother and baby.
- The baby is more likely to breastfeed.
- Lower rates of postnatal infections for mum and baby.
- The father is never sent away or reduced to visitor status.
- The childbirth is seen as a natural event to be enjoyed by the family and an ideal way to start parenting.
- A better emotional experience.
- If you have other children they can be as involved as much as you want them to be.
We all work and function more effectively when we are relaxed and most of us agree that relaxation of women in labour provides better and more enjoyable outcome. There is some suggestion that she will also produce endorphins that reduce pain.
If you would like a homebirth, you should discuss it with your midwife in the prenatal period. During pregnancy, you should attend antenatal classes to learn about confinement. At these classes you will have opportunity to raise questions and also discuss childbirth choices with other pregnant women. During your pregnancy, you should be encouraged to produce a birth plan where you can indicate your various preferences for your delivery.
Home birth in the UK 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.
Today, if you are a low risk mother having a straightforward pregnancy, there is some reassuring evidence that you and your baby are as safe at home as in hospital and probably less likely to have operative interventions including ventouse, forceps, tearing and caesarean section, you are arguably safer at home. It is natural to hope for a normal vaginal delivery that is as unassisted as possible.
In your own home setting, you have the comfort of familiarity. Many believe that the family relationship is enhanced by home-birth. You can lay on special requirements such as a birthing pool for a water birth. Many women find it easier to initiate breastfeeding in the home environment.
Homebirths are becoming increasingly popular as we learn that I have favourable outcomes for mothers and babies with low perinatal mortality (deaths).
It is important if you go looking for the research evidence on home birth that you look at research on planned home birth. 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. The Dutch research shows compelling evidence that birth at home is safe provided it is for those thought to be at low risk of complications.
The home birth rate in the UK averages about 2% but there are areas within the country where this is much higher - 20% in Torbay. If you have intended giving birth at home, there should be no difficulty arranging transfer to a consultant obstetric unit if the support services of obstetricians should be required.
You have an right to choose your place of birth although you will be taking a chance if you insist on home birth when you health care workers identify a high risk factor. 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. 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.
Many maternity units have a 'low risk' unit staffed by midwives and outside the main labour ward environment. These units seek to provide a more homely setting whilst having the reassuring safety-net of the main labour ward and obstetricians close by should unexpected complications arise.
A review of the literature in 2000 to assess the effects of planned home birth compared to hospital birth on the rates of interventions, complications and morbidity as determined in randomised trials by the Cochrane Group.0001 Only one study involving 11 women was sufficiently robust to be included. The trial was of reasonable quality, but was too small to be able to draw conclusions. There is no strong evidence to favour either planned hospital birth or planned home birth for low risk pregnant women.
A study in 2008 of the Dutch midwifery database (LVR1), covering 95% of all midwifery care and 80% of all Dutch pregnancies (2001-03) was undertaken.0801 Low-risk women (280,097) under exclusive care of a primary level midwife at the start of labour either with intention to deliver at home or with a personal preference to deliver in hospital under care of a primary level midwife were evaluated. Women were classified into three categories (no referral, urgent referral and referral without urgency) and were related to maternal characteristics and to neonatal outcomes. In this study, 68.1% of the women completed childbirth under exclusive care of a midwife, 3.6% were referred on an urgency basis and 28.3% were referred without urgency. Of all referrals, 11.2% were on an urgency basis. The main reasons for urgent referrals were fetal distress and postpartum haemorrhage. The non-urgent referrals predominantly took place during the first stage of labour (73.6% of all referrals). Women who had planned a home delivery were referred less frequently than women who had planned a hospital delivery: 29.3 and 37.2%, respectively (P < 0.001).No maternal deaths occurred. Adverse neonatal outcomes occurred most frequently in the urgent referral group, followed by the group of referrals without urgency and the non-referred group. It was concluded that risk selection is a crucial element of the Dutch obstetric system and continues into the postpartum period. The system results in a relatively small percentage of intrapartum urgent referrals and in overall satisfactory neonatal outcomes in deliveries led by primary level midwives.
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This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.
I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.
