Written by: Cally Worden
Having your baby in the comfort of your own home is a warm, snuggly blanket of a thought for many women, yet the stuff of nightmares for others. The choice remains yours and statistics show that, in the main, a home birth is perfectly safe and most are free from complications. If you are trying to decide what to do then make sure you arm yourself with all the facts about your own individual situation. Here are a few thoughts to get you started.
Home Birth? That’s NICE
The National Institute for Health and Care Excellence (NICE) has recently dipped its toe into the debate on home birthing, suggesting that your own pad is one of the safest places to give birth. For women whose pregnancies are deemed to be ‘low risk’ there is compelling evidence that indicates they may be better off at home. Rates for caesarean and forceps deliveries are known to be lower among the home birth, for example. This could, however, simply be due to the ‘low risk’ factor that drives the decision to remain home.
No two births are the same, and the potential for difficulties exists wherever you give birth. On average, a third of women planning home births have to be moved to hospital either during, or shortly after labour. The risk is higher for first time mothers. Transfer to hospital occurs most usually in the first or second stages of labour, when unforeseen difficulties may become apparent. If labour does progress at home, transfer occurs most commonly as the result of abnormal infant heart rate, the appearance of meconium (indicating foetal distress), and the need to repair the vaginal tissue after the trauma of birth.
It is perhaps worth noting too that for first time mothers home births present a slight increase in the risk of such complications as nerve injury to the baby’s hands and arms during labour, the swallowing of meconium that indicates distress, and brain damage. NHS statistics show that complications like these arise in 0.5% of all first time births wherever they take place, but this rises to 0.9% for first time mothers giving birth at home.
The women I know who have opted for a home birth swear they would never again choose hospital as the way to go unless there was a health risk to them or their baby. They loved the familiarity of their surroundings, and the ability to hop straight into their own bath for a relaxing soak at the close of business, secure in the knowledge that Daddy was on hand to tend their newborn. When I look at where these women live, their choice makes a lot of sense. Within a matter a minutes an ambulance could have been at their door if needed, whisking them away to a nearby hospital for specialised medical attention had it been required. For women in more rural locations this back-up is there, but with such a time delay built-in that the risk becomes too high. Location is everything.
The Importance of Being Fit and Healthy
It should not be missed that the NICE recommendation for home birthing relies on the woman being assessed as fit and healthy, and her pregnancy free from any identifiable complications. Pregnancy brings with it the potential for many medical problems and it is important to be in possession of all the facts about your physical condition before you make a final decision. Things also change throughout your pregnancy and even if you plan a home birth you should be aware of the potential need to change your plans should your situation change.
But What If …?
As I’m writing this I’m reflecting on my own two birthing experiences in a French clinic. Home birthing is unusual where I live – it’s a rural location and the distance (45 mins) from specialised care made my decision a no-brainer. I was going to the clinic when labour started, no question. But I’m not sure that even living in a town, close to all the facilities, would have changed my decision. I’m naturally quite risk averse and something of a worrier.
And with my second child that concern was vindicated – he was born with the cord trapped and not breathing. Without immediate intervention from a highly qualified and very experienced obstetrician he may have died, or at best suffered brain damage (in fact, he’s fine). Would a home midwife have been equipped to respond in the necessary way? I don’t know. But I’m glad I didn’t have to find out. I applaud the freedom of choice any woman has in respect of giving birth and support whatever decision any individual woman makes, but home birthing was not for me. What do you think?