HOME BIRTH PLANNING | EVERYTHING YOU NEED TO KNOW

BY RACHEL BRADFORD (GUEST WRITER)

HOME BIRTH

Hello, a quick introduction. My name is Rachel, mama to three kids under five (yes I know!). I’ve been really lucky to have the best of birth experiences, and had two home births out of choice and preference. I get a lot of shocked faces, and surprise when I’ve spoken about my home birth before (more so about my second born, first home birth as that was in 2018 so we’ve seen more people as opposed to my 2020 home birth where we obviously haven’t seen many people).

There’s a lot of thoughts and feelings about home births. Like most things there are facts and figures, both positive and negative, which add to preconceived ideas and feelings.

I’m a huge advocate of home births and women’s birth rights, especially around where they give birth and reducing the surprise that seems to surround home birthing. I promise, it is safe. It is no more risk than any other kind of birth.

Planning a Home Water Birth

For both home births, I discussed my plans with my midwife who gave me the go ahead at my 36 week appointment. She knew I wanted a home birth prior to this, but it was decided and agreed at 36 weeks during our birth planning appointment. If it’s your first home birth, your Trust will organize a home visit.

The home visit is not about judging the cleanliness of your home, or how well you’ve decorated. The midwife mostly just wants to know if there will be enough space, especially if you plan to have a home water birth as the pools are quite large. They also want to check parking and access, considering the possibility of ambulance being needed (this isn’t to scare you, but should absolutely be taken into account). Once your home birth has been agreed, which is dependent on your personal circumstances and pregnancy (see more on your rights below), your Trust will organise the home birth kit.

Depending on your Trust, some have dedicated home birth teams, others use their community midwives, others still use the midwives within the hospital and send them out as and when needed. Some Trusts will send your home birth kit to you at 37 weeks (the advised date at which a home birth is deemed safe as you are full term) which you store in your home until required. Or, your midwives will bring the kit with them on the day/night of the birth. The former happened for our first home birth, the latter happened for our second home birth. These kits include incopads, syringes, disposal kits, emergency resuscitation equipment, general medical supplies, and entonox if requested. This is usually brought by the midwives on the day/night of labour but I have heard of it being with the kits too.

I have always been a fan of the idea of water births, and have attempted water births for all three of my labours, with two successful (my first was a dry land birth, after spending a lot of time in the pool for the labour but needing some extra monitoring for my back to back baby for the last part of pushing).

Home births absolutely allow for a water birth if you wish to go that route. Some Trusts have the scope to offer birth pools on hire, some for free, some for a small charge. Many, unfortunately don’t. However, there are many birth pool hire companies, where they will provide everything you need for your home water birth, including instructions and courier service. We have used the Gentle Births Birthing Pool Hire for both of our home water births, which is a small independent company that have the very best customer service and excellent quality hired pools. You can also buy a pool outright, and then sell later. Both options are usually around the £100 mark. 

For pain relief, aside from the pool, you can use tens machines and paracetamol. Speak to your midwife and GP about pethidine or other heavier painkillers, which can be given in a home birth but has to be prescribed in advance by a GP. Entonox, or gas and air, is the most commonly used pain relief in home births.

Home Birth Facts

There’s quite a lot of fear associated with home births. Around 2% of births in England and Wales (I don’t have the data for other areas, sorry) happen at home (ONS) or outside of a NHS/hospital setting. 

“Overall around 80% of first-time mothers who planned a birth at home or in a Birth Centre had a straightforward birth, compared to only 60% of those that planned a birth in an Obstetric unit.” (Aims) This figure increases for the second time and subsequent mother’s.

There isn’t a definitive fact for why home births lean toward more straightforward births but many believe the reduction of stress from moving from one environment to another (especially a clinical one) can contribute to labour being managed better by mother’s.

“In the Birthplace Study, only about 5 or 6 in 100 women transferred from home or an FMU in order to have an epidural, and about twice as many from an AMU.” (Aims) 

Your Options and Rights

There are many reasons to birth at home, and why it may be a viable and preferred option. Many, like myself, don’t like a hospital environment. Particularly when you factor in the rates of intervention for a hospital birth compared to a midwife led unit or home birth. Some choose a home birth to regain control after a traumatic previous birth. Those who have had previous fast deliveries are often advised to consider a planned home birth as generally second births are faster than the first.

As with all aspects of maternity and perinatal care, your choices are your own and you are well within your rights to change your mind, before, and during labour. If you do, you can be reassured that being at home isn’t going to endanger your child. You can still be transferred. This also applies to births that develop complications. We all know that no birth is the same, and to expect the unexpected. Midwives are trained to look for signs of distress, just as they would within a hospital environment, and will have you transferred to hospital if you need the additional assistance. Ambulances will rank you highly on their priority list too.

“The most common reason for transfers is that labour is going slowly and the mother wants it to be speeded up artificially. The other main reason is that her midwife has picked up signs that her baby may not be coping well with labour. Midwives are trained to spot these warning signs early, so the transfer can normally be done in plenty of time and in a calm way.” (Aims)

Unfortunately, some parents to-be are not supported with their choice to home birth by their Trust. This does not remove your right to birth wherever you choose.

“If you are keen to have a Homebirth and your Hospital Trust is reluctant to support you, another option is to hire an Independent Midwife to provide your care. (link to IMUK) and in some areas private companies are offering midwifery services, some of which are paid for by the NHS.” (Aims)

You are also able to free birth should you wish for no medical intervention. This is sometimes the path taken by those who have been advised that a midwife cannot get to them at home, usually due to staffing, who do not want to go into a hospital environment. You can also call for a paramedic crew to attend should you need emergency support but you should remember that they are not trained to the same level as midwives about intervention and baby monitoring, and will likely transfer you to hospital unless a midwife can arrive shortly after the birth in the case of quick and sudden births.

“Some women choose to birth at home without midwife support (known as free-birthing). This is legal. It is also legal for a relative or friend to support a woman who is labouring without a midwife present, as long as they are not acting in the capacity of a health professional or giving medical or midwifery care.” (Aims)

Shopping List

Birthing Pool

if you want a water birth (they come with liners and pumps. You may need to purchase a thermometer and sieve).You will also need a hand mirror so the midwives can use it in the water to monitor your visible progress. I found an affordable hairdressers hand mirror for about £4 on Amazon.

Lots of towels

preferably old ones in dark colours but I promise home births really aren’t as messy as you would like. You’ll want ones for around the pool, for you when you get out of the pool (if applicable) plus ones for your sofa or bed, plus for baby to be wrapped in.

Cheap shower curtains or tarpaulin

 This helps to protect your floor especially if you have carpet (you can duct tape to the carpet to stop it sliding). Also can be used on your sofa or bed to protect them. Cheap is fine. I used £2 shower curtains from ASDA that we threw away at the end with the pool liner and incopads.

Maternity Pads

are helpful too if you have the funds. Your midwife team will bring incopads in their kits, but these are great for between calling and the arriving, as well as after birth if you are a heavy bleeder. Boots do a good pack of five pads.

Tea, biscuits and snacks

For you, the family and the midwives. For my first homebirth I gave birth at shift change so it wasn’t hugely necessary. But my second, I laboured right through to lunch (more about that later) which made for some peckish midwives who didn’t even appear to contemplate food. We offered tea and biscuits which they gladly accepted as I held our new born daughter and they did their paperwork. Chocolate hobnobs will forever remind me of giving birth.

Candles/lighting

are great options for creating a cosy atmosphere. Some midwives advised against real candles due to naked flames near a flammable substance, i.e. the entonox, although I’ve never had that problem personally. Many choose fairy lights to go around the pool, and battery powered candles as they also last a long time with no fire risk.

I also packed an emergency hospital bag, just in case. You never know if your circumstances are going to change, and with every birth and baby different, it doesn’t hurt to have a plan B. I packed all the basics for a hospital stay in case we needed some extra help. Fortunately I’ve never had to use it, and raided it after the birth for my hidden extra snacks!

Most of all, if you’re planning a home birth, enjoy the process. Own your choice. Home births, not so long ago, were the norm, and hospital births unusual. They are safe. You are safe.

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