Homebirth or Midwifery – led units

“Research over the last couple of decades suggests that home birth is at least as safe as hospital-based birth for healthy women with normal pregnancies”.

This quote is from a circular issued by our governing body the Nursing and Midwifery Council (NMC) as guidance for mothers and midwives attending home births.

Emergencies are rare in normal childbirth. If a transfer to hospital is needed it is most likely because the labour has slowed down. All transfers will ultimately be your decision after my recommendation. There is usually time to discuss the reasons for possible transfer. I will of course accompany you to hospital if a transfer is necessary.


What if something goes wrong?

It is unlikely that things suddenly go wrong in a normal labour, following a straight forward pregnancy. If a problem is detected there is usually time to discuss what is happening and arrange transfer to hospital. The most common reason for transfer to hospital during labour is that labour is progressing very slowly or for pain relief. Midwives carry emergency drugs and resuscitation equipment to all births.

This information from AIMS on the Benefits of homebirth   includes the National birthday report confidential enquiry into home birth 1994 showed “16% of women booked for a home birth transferred to hospital. Dividing women into primigravidae (having first baby) and multigravidae (having second or subsequent babies), 60% of first-time mothers who had planned to deliver at home, did so, and 40% transferred. 90% of multigravidae who had planned to deliver at home did so, and 10% transferred.”

Some of these transfers occurred before labour actually started, whilst others occurred in labour. The single largest reason for transfer was slow or no progress, accounting for 37.2% of transfers. Premature rupture of membranes accounted for 24.8% of transfers, and most of these occurred before labour started. Foetal distress accounted for 14.8% of transfers.” See more of the report at www.homebirth.org.uk


The Birth Place study 2012

The Birthplace cohort study compared the safety of births planned in four settings: home, freestanding midwifery units (FMUs), alongside midwifery units (AMUs) and obstetric units (OUs). The main findings relate to healthy women with straightforward pregnancies who meet the NICE intrapartum care guideline criteria for a ‘low risk’ birth.
Key findings
Giving birth is generally very safe. For ‘low risk’ women the incidence of adverse perinatal outcomes (intrapartum stillbirth, early neonatal death, neonatal encephalopathy, meconium aspiration syndrome, and specified birth related injuries including brachial plexus injury) was low (4.3 events per 1000 births).
Midwifery units appear to be safe for the baby and offer benefits for the mother
For planned births in freestanding midwifery units and alongside midwifery there were no significant differences in adverse perinatal outcomes compared with planned birth in an obstetric unit.
Women who planned birth in a midwifery unit (AMU or FMU) had significantly fewer interventions, including substantially fewer intrapartum caesarean sections, and more ‘normal births’ than women who planned birth in an obstetric unit.
For women having a second or subsequent baby, home births and midwifery unit births appear to be safe for the baby and offer benefits for the mother
For multiparous women, there were no significant differences in adverse perinatal outcomes between planned home births or midwifery unit births and planned births in obstetric units.
For multiparous women, birth in a non-obstetric unit setting significantly and substantially reduced the odds of having an intrapartum caesarean section, instrumental delivery or episiotomy.
For women having a first baby, a planned home birth increases the risk for the baby
For nulliparous women, there were 9.3 adverse perinatal outcome events per 1000 planned home births compared with 5.3 per 1000 births for births planned in obstetric units, and this finding was statistically significant.
For women having a first baby, there is a fairly high probability of transferring to an obstetric unit during labour or immediately after the birth
For nulliparous women , the peri-partum transfer rate was 45% for planned home births, 36% for planned FMU births and 40% for planned AMU births
For women having a second or subsequent baby, the transfer rate is around 10%
For women having a second or subsequent baby, the proportion of women transferred to an obstetric unit during labour or immediately after the birth was 12% for planned home births, 9% for planned FMU births and 13% for planned AMU births. Read more here

This study shows that people who plan to give birth at home have better outcomes than those who plan to give birth in hospital, and their babies do not have worse outcomes see here
If you have known risk factors you may be advised to give birth in hospital, but this is your decision to make.

What Pain relief can I use?

Everything but epidural!
Water pool, TENS, Entonox, Pethidine, meptid or diamorphine (rarely used), as well as any complementary therapies or techniques you currently use.
Support from a known and trusted supporter throughout, and comfort measures such as hot and cold packs, a warm bath or shower, enough to eat and drink, and the freedom to move around your own environment reduce the need for pain killing medication.
An updated systematic review of the effects of continuous labour support was published in The Cochrane Library in 2011, issue 2. This review summarizes results of 21 randomized controlled trials that involved 15,061 women and showed:
Overall, women who received continuous support were less likely than women who did not to:
  • have regional analgesia
  • have any analgesia/anaesthesia
  • give birth with vacuum extraction or forceps
  • give birth by caesarean
  • have a baby with a low 5-minute Apgar score
  • report dissatisfaction or a negative rating of their experience.

Women receiving continuous support were more likely than those who did not to:

  • give birth spontaneously (that is, with neither caesarean nor vacuum extraction nor forceps)
  • have a shorter labour.
You might like to use  a birth pool, massage, aromatherapy, acupuncture, shiatsu, reflexology, homoeopathy, hypnotherapy etc. which are not always supported in a hospital environment.