Choosing a Home Birth

By Pat Thomas

This is an excerpt from the AIMS booklet, "Choosing a Home Birth".
This book has now been replaced in the AIMS Publications List by Nicki Wesson's book: Home Birth - A Practical Guide .

Why A Home Birth?

Giving birth at home in familiar surroundings, in the company of your loved ones, in your own way and in your own time can be an experience that enriches and strengthens the growing family.

When choosing where to give birth, many women start with what "feels right" for them. For a woman, choosing a home birth may simply be a matter of acknowledging her needs for privacy, security, comfort, safety, control, freedom and respect for the emotional and spiritual aspects of birth. She may have had a previous bad experience in hospital and wish to avoid another. Equally she may feel alienated by the clinical environment of the hospital or clinic. She may feel strongly about the need for continuity of care and carer. She may wish to avoid unnecessary interventions, or have a desire to put birth back into the context of a family event, to improve the quality of her early contact with her baby and ensure the establishment of breastfeeding. Finally, for some, more practical reasons may prevail such as wishing to minimise the disruption of the routine for their other children.

While some professionals belittle home birth as merely a middle class fad, the experience of practitioners, both GPs and midwives, with a diverse clientele suggests otherwise. In today's climate there is certainly research to show that the women who pursue home births tend to be older and more highly educated and having their second or subsequent child. However, this is more likely to be a reflection the single-mindedness and determination which is often required in order to get a home birth, rather than a class-specific trend.

As one group of GPs who have been attending home births in the UK for 12 years comment, "Birth at home may seem to be an interest of the eccentric middle class, but our experience is that an appreciable number of working class women will opt for home birth if the service is available [our emphasis]."[1]

Equally a pioneering group of midwives in South East London with a 75% home birth rate (as opposed to 1.8% nationally) note that "A third of our clients are on benefits and many more are grappling with heavy socio-economic pressures." [2] These midwives, whose services have been contracted into the NHS, reserve most of their care for women who are often denied choice within the health service including those from ethnic minorities, those considered to be high risk and those with mental or physical disabilities. Yet in addition to a high home birth rate these mothers go on to achieve a rate of spontaneous vaginal delivery in 87% of cases, a caesarean rate which is less than half the national average and 74% need no pain relief during labour. In addition, the rates for breastfeeding 28 days after birth stand at 96% as compared with the national average of 25%.

Birth at home is an option available to any woman. A recent NCT survey concluded that "the home birth rate is increasing where women are given a real choice." [3] Yet because home birth is still the exception, you may find that making your choice will require a great deal more thought as you process fact, opinion and feeling, to arrive at a choice which is right for you.

Making Choices

All of life involves some risk, and this applies to giving birth and being born, wherever the birth takes place. At home there is always the possibility, no matter how small, of a tragic complication which could have been more effectively dealt with in hospital. Parents choosing home birth will consider and come to terms with that risk, knowing that the risk of unnecessary interventions and the possibility of damage to the mother or baby, or both, may be far greater in hospital.

Hospital birth also increases the risk of the emotional/psychological disruption of being in an unfamiliar institution. It is well documented that other mammals, when disturbed in their nests in labour or moved to unfamiliar surroundings, have longer labours with more complications. Entering hospital undermines a woman's need to feel safe, secure and in familiar surroundings. This in turn interferes with her ability to relax and ultimately give herself up to the experience of birth. This 'letting go' - the ability to respond to a deep, instinctive knowledge of how to give birth to your baby - is an important part of letting the birth process unfold a smoothly and safely as possible.

Deciding on a hospital birth, and thus handing over responsibility to the experts, may seem the easy option. The responsibility for choosing a home birth is more obviously yours and on the surface of things may seem more complex. But the truth is, wherever you choose to give birth, it is still your baby, your body and your responsibility to balance the risks and benefits of the services on offer.

In the end, statistics alone cannot provide all the answers about where a baby should be born. They may give you food for thought, help guide you through the maze of conflicting viewpoints, help to free you from some popular misconceptions and perhaps make home birth a real option for you. To arrive at a choice which is right for you it is important to go beyond statistical data and consider the things which really influence a good birth outcome for both mother and baby. These include your own level of health, being well-nourished throughout your pregnancy, the practical as well as emotional and psychological support and care available to you during pregnancy, labour and beyond, the skills of your midwife and your own intuitive sense of where your baby should be born.

Many parents will anxiously sort through the pros and cons, but once they have chosen home birth, they discover a growing excitement and confidence in the rightness of their decision. Where to give birth is not a matter of choosing between physical safety or going with your feelings. The two are inextricably linked. Knowing this can help you trust the wisdom of your instincts in choosing the right place for your baby to be born.

Pat Thomas
1998

AIMS makes information and articles freely available on its website as a public service. We also provide advice and support to parents and professionals at no charge. We receive no government or charitable funding, and rely solely on donations, membership subscriptions and the efforts of our volunteers. If AIMS has helped you, please help us to help others by joining or making a donation.

References

[1] Ford, C, Iliffe, S, Franklin, O, Outcome of planned home births in an inner city practice, BMJ, 1991; 303: 1517-1519

[2] Demilew, J, South East London Midwifery Group Practice, MIDIRS Midwifery Journal, 1994; 4(3): 270-272

[3] Dodds, R, Newburn, M, Availability of home birth - experiences of women planning to give birth at home, and the responses of some general practitioners, NCT (London), 1995

Useful Contacts

For AIMS contacts please see contacts page. AIMS has a list of local home birth support groups throughout the country. Call Beverley Lawrence Beech for details of the contact person in your area.

For links to other useful website including Active Birth centre, Association of Radical midwives, National Childbirth Trust(NCT), Association of independent midwives and the homebirth reference suite, please see the links page.

"Choosing a Home Birth" : Original version © AIMS 1994
Fully revised edition © AIMS 1998
Published by AIMS on behalf of the British Maternity Trust
ISBN 1 874412 08
This book has now been replaced in the AIMS Publications List by Nicki Wesson's book: Home Birth - A Practical Guide .

AIMS makes information and articles freely available on its website as a public service. We also provide advice and support to parents and professionals at no charge. We receive no government or charitable funding, and rely solely on donations, membership subscriptions and the efforts of our volunteers. Please help AIMS to help others by joining AIMS or making a donation.

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