Home Birth

Someone may plan a home birth because they:

• See birth as a natural process, with no need to be in hospital.
• Feel safer at home.
• Have had a previous positive birth experience in hospital, and now feel confident about birth at home.
• Dislike being in hospital.
• Are expecting their first baby and are worried about the effect of a hospital environment on their labour.
• Want to keep birth normal and avoid interventions.
• Want to reduce the risk of infection and avoid hospital-based illnesses.
• Don’t want to be separated from other children.
• Don’t want to travel in labour.
• Want the option of water birth.
• Want privacy.
• Want to feel more in control.
• Had a previous negative birth experience in hospital that they think could be improved.

There is no one ‘type’ of person who has a home birth; people from all backgrounds choose home birth. In Ontario, about 20% of midwifery-attended births occur at home.

Midwives provide all necessary care for those who plan a home birth. Midwives are experts in normal birth, and are trained to recognize signs of complications during pregnancy. Midwives will consult with a doctor or transfer to hospital if necessary.

Most clients, regardless of place of birth, receive their care from a team of two or three midwives. Once you are in established labour, a midwife will stay with you. The second midwife usually arrives shortly before the birth or earlier. The midwives will monitor you and the baby, provide comfort measures, and ensure equipment and supplies are ready for the birth.

The majority of home births occur after a normal, healthy pregnancy, with one baby who is head down. Your midwife will discuss with you whether or not home birth is a safe option for you.

Under certain circumstances, a home birth would not be advisable. These include:

• Placenta previa (placenta covering the cervix).
• Breech or transverse position.
• Prematurity (less than 37 weeks gestation).
• Certain health concerns related to the client.

Home birth is increasingly common for first babies. It isn’t necessary to have had a baby before to plan a home birth.

People who labour and deliver at home tend to be more relaxed and feel more in control. However, there is no doubt that managing labour pain can be challenging, wherever you deliver your baby. Some choose techniques such as breathing and relaxation exercises. Midwives often encourage massage, visualization, positioning, and labouring in a warm tub for pain relief.

Midwives can bring nitrous oxide (laughing gas) to a home birth, which can be a very effective form of pain relief. Some people also find TENS machines are helpful in managing pain.

You might find these tools for managing labour pain useful:

• Different positions – at home you are free to labour in whatever position you find most comfortable.
• Movement – swaying, walking, dancing, circling hips.
• Focusing on breathing – breathing out very slowly, slow rhythmic breathing, panting or blowing.
• Vocalization (making sounds – e.g. singing, moaning, humming).
• Distraction – keeping busy, watching TV, listening to music.
• Warm water – a bath, shower or birth pool.
• Relaxation techniques.
• TENS (transcutaneous electrical nerve stimulation).
• Self-hypnosis – e.g. learned on ‘hypnobirthing’ courses.
• Massage, aromatherapy, acupuncture, or other complementary therapies.
• Nitrous oxide (laughing gas).

Some of these options, such as distraction, are most useful in early labour, while others, such as warm water, movement and focusing on your breathing, can be invaluable all the way through.

Research over the last several decades has found that home birth is at least as safe as hospital birth for healthy persons with normal pregnancies if attended by trained midwives. What do organizations involved in childbirth have to say about home birth?

Here are statements from several professional organizations:

Excerpt from College of Midwives of Ontario Statement on Home Birth, 1994 “The College of Midwives of Ontario (CMO) believes that clients have the right to choose to give birth in their own homes with their families. The World Health Organization describes health as multi- dimensional. Decisions about health are based on many factors including physical, emotional, social, spiritual and cultural considerations. Clients must be free to make decisions regarding birth based on all of these factors. Birth is more than a physical or medical event.”

Position statement: Home Birth, Canadian Association of Midwives, 2001 “The Canadian Association of Midwives believes that people have the right to make an informed choice regarding their place of birth. Home birth should be an available option for all childbearing people in Canada.The Canadian Association of Midwives believes that midwives are the appropriate care providers for people choosing home birth.”

Society of Obstetricians and Gyneocologists of Canada Policy Statement on Midwifery, March 2003 “The Society of Obstetricians and Gynecologists of Canada (SOGC) recognizes and stresses the importance of choice for clients and their families in the birthing process. The SOGC recognizes that people will continue to choose the setting in which they will give birth. All persons should receive information about the risks and benefits of their chosen place for giving birth, and should understand any identified limitation of care at their planned birth setting. The SOGC endorses evidence-based practice and encourages ongoing research into the safe environment of all birth settings.”

Excerpt from RCOG/RCM Joint Statement No.2, April 2007 Canadian Association of Midwives (CAM) Society of Obstetricians and Gynecologists of Canada (SOGC) Royal College of Midwives & Royal College of Obstetricians & Gynecologists (joint statement) “The Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists (RCOG) support home birth for those people with uncomplicated pregnancies. There is no reason why home birth should not be offered to anyone at low risk of complications and it may confer considerable benefits for them and their families. There is ample evidence showing that labouring at home increases a person’s likelihood of a birth that is both satisfying and safe, with implications for her health and that of their baby.”

In the past, debates over the safety of home and hospital birth have been confused by inaccurate statistics. Often, outcomes for births out of hospital included unplanned as well as planned home births. For example, the birth of a very premature baby on the way to the hospital would be counted as a home birth. Similarly, if someone had concealed their pregnancy, received no prenatal care, and gave birth alone—that would be counted as a home birth for statistical purposes. The outcome is often poor in cases like these, but it has little relevance to the safety of planned home birth, with a midwife in attendance, for people with normal, healthy pregnancies.

Research has found no difference in the death rates of birthing persons or babies between planned home births and hospital births. However, home birth provided better outcomes in many respects. A study of nearly 6,000 people who planned home births in the UK noted the benefits of home birth. Each person was matched for risk level with a similar person in the same area who planned a hospital birth. The study found that, compared to those planning a hospital birth, the home birth group had:

• Roughly half the risk of having a cesarean section.
• Roughly half the risk of an assisted delivery; i.e. forceps or vacuum.
• Less risk of hemorrhage.

Babies in the home birth group were:

• Less likely to be in poor condition at birth.
• Less likely to have birth injuries.
• Less likely to need resuscitation.

Labours tend to progress well at home, where the client is relaxed and free to move as they wish. This often means there is less need for intervention such as drugs to speed up labour, or delivery with forceps or vacuum. A person delivering in their own environment has a greater control over the birth process because the caregivers are “guests” in their environment, rather than the other way around. Finally, there is less risk of infection at home, for both delivering person and baby.

All of our clients, whether planning home or hospital birth, pre-register with Grand River Hospital. This enables a smooth transition to hospital, if necessary, with your pre-registration information already on file. You can download and print your Grand River Hospital Pre-Registration Forms.

Your midwife will monitor your baby’s heart and your condition regularly through labour. If she has any concerns about the health of either you or your baby, she will advise that you transfer to hospital. The aim is to transfer well before the situation becomes an emergency. You would either travel by car or ambulance, depending on how advanced your labour is and how urgent the situation is. 

Note: The majority of transfers to hospital are not emergencies. The most common reasons for transfers include client requests to move to hospital or a sign of a potential complication. It is always possible that you may need emergency treatment, and it may take longer to get if you have to transfer from home to hospital. However, it is extremely rare for intervention such as a cesarean to suddenly become necessary with no earlier warning signs. If the midwife believes that you need an urgent cesarean, she will call ahead to the hospital so that they are prepared for you when you arrive.

Midwives are trained to provide emergency treatment if there are complications after the birth. They carry oxygen and resuscitation equipment for babies who are slow to breathe as well as intravenous fluids and drugs to treat heavy bleeding after birth. Midwives are trained to repair tears or episiotomies. They can administer local anesthetic for this procedure.

Occasionally, transfer to hospital occurs after the birth: e.g. because of problems with the delivery of the placenta, or because of concerns about the baby’s breathing. Although transferring from a planned home birth can be disappointing, most people who have transferred say that they were glad to have spent time labouring at home, and would plan a home birth for their next baby.

People give birth in homes of all shapes and sizes—in country homes, inner-city houses, apartments, student residences. It does not matter if your home is small, or in need of decorating. The important thing is that you feel comfortable there. Your midwife can discuss how long it would take an ambulance to reach you in an emergency, and any access concerns.

Some people arrange for their children to be cared for elsewhere by a family member or friend when they go into labour, while others are happy to keep them at home. If your children will be home, it is important to have someone there who can care for them so that your birth partner can concentrate on supporting you. Tell your children what noises they might hear, and what they might see, if they come into the birth room. You could look at books or videos together (available to loan from your midwifery practice.)

If your partner is worried about the safety of home birth, it may help to share the references in this article, and the suggestions for further reading. Talking to others who have had home births can be reassuring. Attending our Labour & Birth Information Night together is recommended. Your midwife may also be prepared to reassure your partner about your plans.

Most partners who have experienced both home and hospital births say that they preferred the home birth, even if they had doubts initially. They are more likely to feel useful—that they have a definite role. You may be relying on your partner to provide practical support to a greater extent than in hospital (for instance, knowing where you keep the towels, baby clothes, etc.).

Some people opting for a home birth also rent or purchase a birth pool for use at home. There are several places in the region that rent birth tubs. Talk to your midwife. It is helpful if your partner takes responsibility for assembling the birth pool, and maintaining the water at the temperature you prefer.

Most home births produce little mess, which is easily contained with some pre-planning. Midwives bring large disposable pads to protect the surfaces you give birth on, and floors or beds can be covered with waterproof sheeting, a large waterproof tablecloth, shower curtain or old sheets. After the birth, they will clean up and leave instructions for garbage and laundry.

You do not need to plan a long list of special props for a home birth. Because you are at home, you can make use of things that you have around you every day. Towards the end of your pregnancy, your midwife will provide you with a ‘birth kit’ containing items that you/she might use. Your midwife will ask you to have the following preparations ready three weeks before your due date:

• home birth kit (provided by your midwife)
• clean washcloths (4)
• old clean towels (4-6)
• cardboard box for garbage
• laundry basket for dirty linens
• roll of paper towels
• plastic container or large Ziploc bag for disposal of placenta
• sturdy bowl for hot compresses
• a few pillows
• sanitary pads
• hot water bottle and/or heating pad
• baby’s first clothes
• newborn diapers
• receiving blankets (3)
• clean sheets for the bed after the birth
• good light source
• accessible electrical outlets

To prepare for birth at home

When you are in labour, make your bed with the plastic sheet over the mattress with the bedsheets on top as usual. The room should be clean and uncluttered. Clear off surfaces to make room for equipment.

After the birth

After the birth, your midwives will monitor you and your baby for at least two hours. They will help you to breastfeed, and help you to the shower or bath. Your midwives will do a complete newborn examination and tell you what to expect in the first few days. Your midwife will return within 24 hours of the birth and several more times in the first week. In between these visits you can always reach a midwife, if needed.

DVDs

Special Delivery

Homebirth Dads

Gentle Birth Choices

The Business of Being Born

Orgasmic Birth

Books

The Midwifery Option, Miranda Hawkins & Sarah Knox

Homebirth, Sheila Kitzinger

Birthing from Within, Pam England & Rob Horowitz

Gentle Birth Choices, Barbara Harper

Runa’s Birth: The day my sister was born, Uwe Spillmann & Inga Kamieth

Canadian Studies

Hutton EK, Cappelletti A, Reitsma A, Simionia J, Horne J, McGregor C, Ahmed, R.  Outcomes Associated with Planned Place of Birth Among Women with Low-Risk Pregnancies 2015.

Hutton EK, Reitsma AH, Kaufman K. Outcomes Associated with Planned Home and Planned Hospital Births in Low-Risk Women Attended by Midwives in Ontario, Canada 2003-2006: A Retrospective Cohort Study. Birth (2009); 36(3):180-189.

Jannsen PA, Saxell L, Page LA, Klein MC, Liston RM, Lee SK. Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician. CMAJ (2009); 181:6-7.

Johnson K, Daviss B. Outcomes of planned home births with certified professional midwives: large prospective study in North America. BMJ (2005); 330: 1416-1419.

Tyson H. Outcomes of 1001 midwife-attended home births in Toronto, 1983-1988.

International Studies

Ackerman-Liebrich U, Voegeli T, Gunter-Witt K, Kunz I, Zullig M, Schindler C, Maurer M, Zurich Study Team. Home versus hospital deliveries: follow up study of matched pairs for procedures and outcome. BMJ (1996); 313:1313-1318.

Boucher D, Bennett C, McFarlin B, Freeze R. Staying home to give birth: Why Women in the United States choose home birth. Journal of Midwifery and Women’s Health (2009); 54(2): 119-126.

Lindgren HE, Hildingsson IM, Christensson K, Radestad IJ. Transfers in planned home births related to midwife availability and continuity: A nation wide population-based study. Birth (2008); 35(1):9-15.

Links

CMAJ The Big Push for Midwives American Pregnancy