Homebirth – Frequently asked questions

Homebirth. Its a subject that divides opinion. Some see it as the worst thing possible, going against science and medicine and all the progress that has been made to make birth “safe”. Some see it as the ideal, a calm and peaceful way to bring their baby into the world with minimal intervention (and in some cases, without even medical personnel present).

The reality is that both opinions are right, and wrong. Homebirth isn’t right for everyone. But neither is hospital birth. Having had both (and a birth at a midwife-led unit too!) I can hand on heart say that I am in the latter camp. Hospital birth, with all its restrictions and medicalisation, just isn’t for me. I made a choice to have two homebirths after my 3rd pregnancy ended in a caesarean section (hbacs). I didn’t make this decision lightly, I researched extensively and weighed up all the pros and cons. In the end I felt the benefits for myself, my baby and our family far outweighed any risk. I will touch more on hbac at the end of the blog, so if you’re here for that then just skip to the end 😉

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Before my 3rd pregnancy all went wrong, I was planning to have my baby at home. With a previous (horrendous) hospital birth and a (lovely, but fraught) MLU birth. It felt like a natural progression for me. Plus my circumstances had changed somewhat. My childcare options were more limited. My husband didn’t drive at the time, and my Dad (my only real emergency transport option) was awaiting a hip replacement. Being at home seemed to be the obvious choice. But I still had questions.

So I wanted to cover some questions I had myself, and some of those I’ve seen and heard asked many times in various parent groups and forums.

Is it safe?

The NHS Choices website states that for women having normal, healthy second or more pregnancies and with no previous obstetric history that could pose a risk, homebirth is as safe as hospital birth. For first time mothers there is a slight increase in risk to baby (from 5 in 1000 to 9 in 1000). Its important to bear in mind though that this increase still adds up to less than 1% of cases.

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Will I be allowed a homebirth?

Some women may have had a previous pregnancy or birth that makes them automatically “high risk”, even if they are having a perfect pregnancy next time around. Some women may have some issues with their pregnancy, or suffer from a medical condition that puts a question mark over whether they should be in hospital or not.The general consensus amongst consultants, and even some midwives, in this case is that homebirth is not recommended. But each woman should be treated as an individual, and each woman is entitled to make her own choice about where to give birth. No-one can tell you you’re not “allowed”, although believe me, some consultants will try! They can only inform you of any risks, and give you the information to make an informed decision.

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Is it messy?

In my experience, no. Not at all. I had a birthing pool for both of my homebirths. I also had some cheap shower curtains (Asda do great quality ones in their basics range) and puppy training pads (Home bargains!) in strategic places (for me that was the floor between the pool and the sofa, and on the sofa itself). Once I’d given birth and was sat snuggling my new little bundle, my wonderful midwives just scooped thee up and put them in the bin. My husband set up the pump to empty the pool, and once it was empty he washed it out and sterilised it with Milton sterilising fluid. It took around an hour in total. Apart from some towels that needed a wash, all was back to normal!

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What pain relief can I have?

Not much. You can’t have an epidural at home. If you reach a point where you are really not coping and really feel you need one, your midwife will discuss transferring to hospital with you. Pethadine is available in some areas, but would need to be prescribed by a Dr beforehand for the midwives to administer. Gas and air is available, although you are limited to what the midwives carry. This is usually two or three canisters. You are free to use a TENS machine and water, be that the bath or a dedicated birthing pool (although obviously the TENS would need to be removed before you entered the water! Hypnobirthing  is also popular.

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For those local to me I will include some links to hypnobirthing practitioners. Its definitely worth it, even if you birth in hospital!

The good news is that many women find they need less pain relief than they would have in hospital. Being in their own surroundings, with less medical interference and able to move freely, eat and drink when they feel like it and have their own things around them is often enough to help a woman get into a place mentally where she copes better with the pain. This leads to less interventions and a calmer, happier birth.

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What will i need?

As mentioned above, shower curtains or tarpaulins, puppy training pads (or potty training/maternity bed mats, although these tend to be more expensive), old towels. A large bowl or bucket for the placenta (although they will bring a tub to take it away in if you don’t want to keep it, they will need to examine it to ensure it is intact at delivery). A pool if you are wanting a waterbirth, and accessories to go with it such as a clean hose to fill/empty it, a water thermometer, a mirror.

The midwives will provide everything else you need from a medical point of view, either bringing it with them on the day or dropping off a homebirth kit in the weeks before.

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What about my other children?

If you want them there, then there is no reason for them not to be there! With my first homebirth my younger children were both in bed upstairs, whilst I laboured and gave birth downstairs with their Daddy and their big sister watching and supporting me. I’ll never forget their little faces when they woke and came down to us cuddling up to their new baby sister 🙂 With my second homebirth, all the other children were awake before he was born. I ended up sending them to my neighbour for the last half an hour or so, as I found myself focusing on them and worrying about scaring them, instead of focusing on my breathing and birthing. They were fetched back within minutes of my son being born. My older daughter was my birth photographer!

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What if no midwife is available when I go into labour?

Sadly for some women, home birth isn’t that well supported. Sometimes you will ring and be told you will have to come in, as no-one is free to attend you at home. This can be an upsetting and stressful time. Labour can be stressful enough, without having your plans changed at the last minute. No-one can make you go to hospital. You are free to give birth where you want, and you have a right to be supported in that choice. If there are genuinely not enough midwives available then an ambulance may be called, and paramedics on hand to deliver your baby. But often the case is that when you make it clear you will be staying at home, a midwife is made available to you. Of course you don’t have to stay at home. If you aren’t invested in a homebirth and don’t mind hospital then you can go in. Your body, your birth, your choice 🙂

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What if something goes wrong?

Midwives are trained to spot problems. When you labour and birth at home you will have one, in most cases two, midwives present. These midwives are there solely to make sure you and your baby are safe. Unlike in hospital, where you may be sharing your midwife with other labouring women, they are entirely focused on you. In the majority of cases they will spot any potential issues very quickly, and transfer to hospital can be arranged. In the event of something unforeseen, such as shoulder dystocia at birth, they are trained in methods to deliver baby safely. They carry the same equipment as a MLU should baby need some help to breathe, and carry medication to help slow bleeding in the case of maternal haemorrhage.

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What happens afterwards?

Bliss! Total and utter babymoon heaven 🙂 The midwives will do yours and the baby’s checks when you are ready.They are really inobtrusive. Baby’s APGAR score is observed at one minute and five minutes after birth (it is also sometimes done at 10 minutes, if needed). You probably won’t even notice the midwife doing this. You are free to cuddle your baby, have skin to skin, cuddle your partner, whatever you want. You can drink champagne, eat a full 3 course meal or just have a cup of tea and beans on toast, all in the comfort of your own bed, chair, sofa or wherever you fancy! At some point the mdwife will want to weigh baby, but theres no rush. Usually one of the midwives will stay for an hour or two after the birth, to help with the clean up and just observe yourself and baby. But you have no restrictions. If you want your whole family to visit straight away, thats fine! If you want no interruptions and just to cuddle up as a family and enjoy your new addition, thats fine too! You can sleep when you want, with no other babies or ladies (or their partners, if your hospital stay was anything like mine!) keeping you awake, no Drs coming to poke or prod you. This is where homebirth really comes into its own 🙂

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A special note about HBAC (homebirth after caesarean), and other high risk pregnancies

As I mentioned above, both my homebirths were hbacs. Both were technically against medical advice. But I was confident in my own ability to birth my babies, and I had 100% trust in the midwives’ ability to spot any problems early.

So lets look at the specific risk factors for HBAC. The biggest “fact” you will have thrown at you is the risk of uterine rupture. You will probably be told that your risk doubles once you have had a c-section, and technically this is true. What they don’t tell you is how small that risk still is. In a normal pregnancy, with no history of c-section or other scarring, the risk of uterine rupture is less than 1%. In a VBAC that risk can increase to up to 2%. But looking closer into these figures, they have actually included all scar disruptions, even those that caused no problems. The risk of a true scar rupture during VBAC is actually closer to 0.35%. Interestingly, the risk after a repeat caesarean is 0.12%. But that of course is only one risk factor of repeat c-section, infection being the biggest.

I saw a consultant before my first homebirth. He told me a horror story about a woman who’s scar ruptured during a homebirth and she lost the baby, very nearly losing her life. A horrifying situation for sure. After further questioning though, it transpired that this lady lived quite some distance from the hospital, and it took around half an hour for her to arrive there. I asked how long it takes them to perform an emergency c/s once the need has been identified. I was told 10-15 minutes. I know that I can drive from my house to the hospital in 10 minutes (I have sadly had to do so when my son had an accident as a baby), and thats without blue lights and sirens. I asked the consultant what difference it would make if I were to be en-route by ambulance whilst they were prepping theatre and paging staff, rather than in a hospital bed in the delivery suite. He admitted it would make none, as the paramedics and midwife would be suitably trained to look after me in that situation and they would be preparing for my arrival so I could be taken straight into surgery.

With these concerns assuaged I was able to address the more mundane aspects of hospital VBAC vs HBAC. I was told I would need continual monitoring, so wouldn’t be able to have an active labour. But further research showed me that there are many other signs to show that a rupture may happen. Pain in the area of the scar and/or between contractions, rapid maternal pulse and possibly shock, excessive vaginal bleeding and slowing of labour. By having two midwives in attendance at home, regularly taking my pulse and temperature and observing my demeanor, I felt I would be safer than just being stuck on a monitor in a hospital room, with midwives popping in and out. Midwives are also able to listen to baby’s heartrate at home, even underwater.

My other main concern was the fact that my c-section had been performed due to failed induction, which was largely put down to my previous bad hospital birth experience. In simple terms, my body had entered it’s fight or flight response. I was petrified, I didn’t feel safe, and so my body refused to go into labour. I didn’t see any reason why this wouldn’t happen again, were I to attempt a VBAC in hospital. So my choice came down to a repeat caesarean, which isn’t to be taken lightly, and carries its own risks just like any other major surgery, or a HBAC. Being in my own home, with my children and my husband allowed to stay with me and all the other positives, won out for me. My homebirths were both magical experiences. I delivered both of them myself (with midwives present), shared precious moments in the pool with them whilst waiting for the cord to stop pulsating so it could be cut. Being able to sleep in my own bed, with all my children with me, was bliss. I found breastfeeding easier in a less distracting and pressured environment, and my recovery was much much quicker (36 hours after my first homebirth I attended my eldest daughter’s last primary school May day celebration. My baby girl even got a special mention as the youngest audience member!).

Thats not to say it would be the right choice for everyone. If you are considering a HBAC then you should do your own research, and decide what is right for you 🙂

Here are some links to start you off 🙂

Caesarean.org

NCT-VBAC

Heathline.com – Uterine rupture

Babycenter – uterine rupture

Good sites for general homebirth questions are Homebirth.org and NCT – Homebirth, and AIMS is great if you are experiencing unfair resistance to your homebirth plans 🙂

As promised, here are some local (Kent, UK) hypnobirthing links:

Hypnobirthing in Kent (clinic in Hythe)

JMHypnotherapy Folkestone

Kent Hypnobirthing

I hope I’ve provided information that is useful to you! I loved my homebirths, and I am always happy to take enquiries for anyone wanting someone to capture theirs on camera 🙂 The photos on this post are from my own last homebirth, taken by my then-16 year old in very challenging conditions (I like to labour with the light really REALLY low). I treasure them.

Kelly.x

 

 

 

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