Is homebirth safe?

A very good question and one I would like to explore further with you...

Most women requesting homebirth don't take this thought lightly, they are considering:

- The logistics IE is there enough room, am I too many flights of stairs up?, can the ambulance get me out if needed? Is there somewhere for the midwife to put baby when its born to check it over? etc etc

- I am at any risk of having a baby at home? Did I previously bleed? have a bad tear? did I need an instrumental or a caesarean before? all these thoughts will visit their minds

- What about my family situation? what does my partner think and feel? have I got enough support? what about my children or animals?

- Would it be much calmer at home because I found my last birth traumatic for X,Y,Z reasons?
Will it be better to be away from the doctors? Will I relax more at home? Will my oxytocin be higher? I can be with my children, family or more than 2 birth partners etc etc

There is certainly a lot to factor in with homebirth, but the majority are doing it because it feels the safest option for them, they've done it before or they are anxious due to other peoples views IE the media, social media, there friends or family

The truth is no-one shouts about good birth experiences, your friend or family will always want to tell you about how bad it was, how much it hurt and how much they hated it! and that is exactly what you don't need! You dont need to be influenced by other peoples thoughts

This is your body, your experience and your journey!

Lets look at how the homebirth process works:

- You decide you want a homebirth and you tell your Midwife - this may not be a named Midwife or someone you have seen before but you tell them because at this appointment it feels relevant or it was just in your head at that time, if your booked with an Independent Midwife then you've had the luxury 5 star continuity-of-care treatment since booking so your Midwife will know you well and you will have built a trusting relationship

- The NHS Midwife notes your place of birth preference down and possibly informs a named Midwife and the team, again if booked with an Independent Midwife its only her that and your 2nd allocated Midwife who you will have already met or soon be meeting, that need to know

- As you approach 34 - 36 weeks a 'Homebirth Proforma' will be completed - this is something the Midwife will go through on paper/online and document all the logistics we discussed earlier but also including things like ease of parking, lighting, mobile phone signal etc, she will then look at the family dynamic - is there children or animals? where will they be or who will look after them? Do you meet 'homebirth criteria' is your request deemed safe by the local trust? if not then your classed as 'outside of guidance', she will also note down, the baby's growth, your blood results and any risks or concerns including previous issue such as a previous haemorrhage, tear, retained placenta etc. If your booked with an Independent Midwife she will already know most of this information, so will just need to re-affirm the safety logistics, a lot of the time people who book with an Independent Midwife either already know they will be deemed 'Outside of Guidance' but that Independent Midwives are more accomodating or theyve booked because of a previous traumatic experience or feel they need that advocate, that voice to ensure they are heard.

- She then takes all that info back to her team and if outside of guidance then meets with the consultant Midwife to discuss, an Independent Midwife would also discuss with our own Consultant Midwife just to ascertain levels of safety and formulate a personalised care plan.

- There is then usually an invite for you to discuss with your Midwife, the consultant Midwife and a doctor to get a personalised care plan (PCP/PIP) in place, ensuring you have been made aware of all the risks/benefits to everything including monitoring your baby, medicines available for homebirth use, reasons to transfer in via ambulance, the guidelines for things like observations, both maternal and for baby afterwards. You won't need to do this with an Independent Midwife, everything is discussed on your behalf, your Midwife is your advocate and voice and then will relay any information relevant and discuss the PCP.

- This info is all then collated, the PIP is updated and this is shared with the Maternity team for awareness. If your booked with an Independent Midwife this is only shared with the allocated second Midwife for awareness.

- Depending on your risks you may be advised to have your baby in the midwife led birthing unit instead or to go to delivery suite for continuous monitoring, as long as you have recieved all the information, are aware of the risks and benefits and feel fully informed, this is your body, your baby and your choice where you give birth to your baby. Independent Midwives will fully support you with this.

- You will also be advised that the NHS homebirth service is dependent on staffing and if on the day you go into labour there are not sufficient staff to cover the homebirth team then you would need to come into the hospital to have your baby, its important to understand that if you have booked with a trust they technically cant refuse you care, an Independent Midwife however is oncall solely for you, so will always be available no matter what time and not be bound by staffing capacity.

So back to the safety of homebirth, both NHS and Independent midwives will attend a homebirth with entonox(gas and air)and some medicines to help with the delivery of the placenta and any potential bleeding, its important to stress they only have a minimal collection of medicines so if bleeding becomes out of control, they would need to call an ambulance who can provide further support and medicines whilst transferring to hospital.

You should also know that baby's and mum's are no longer able to travel together in the same ambulance, 2 ambulances have to attend and a partner or 2nd midwife would need to travel in with the baby and the first midwife with the mother. Reasons for needing to transfer in would be dicussed prior with you and your partner.

So, to a degree, if you have a low risk birth with no complications at home then yes Homebirth is absolutely safe! A lot of homebirths go succesfully without any drama or complications and because little intervention is involved its generally a positive overall experience for mother and baby.

However I want to add a caveat that things can and do sometimes quickly change, bleeding can increase, the placenta may not deliver, baby may not be born in great condition, you may develop an infection and we cant know which mums and baby's this will happen to, we have immediate methods to try and control all of these situations and we will absolutely exercise these with your consent of course, but sometimes we may require further help and support.

As in hospital we are trained for emergencies and first-line support, so we will do all we can, so from a competent practitioner point of view we are ensuring safety for you and baby at all times but within our current situational remit. For example if the placenta doesnt come away despite all our efforts and methods in our tool kit we would need to transfer to hospital to help retrieve it as we dont have the kit or expertise at home to be able to facilitate this. So as long as you are aware of our professional capabilities and limitations this can sometimes help you to understand why we may suggest to transfer in if we have concerns, we don't take this decision lightly or for trivial reasons. We would always seek consent for everything and every decision that we make.

In very rare circumstances as is also the case in hospital, detrimental outcomes can happen and whilst we are always trying to avoid this, sometimes despite our best efforts it doesnt end with a positive outcome, but I want to stress this is very rare and can happen both in and out of hospital

To note, midwives carry resuscitation equipment and we keep up to date with regular emergencies and life support training, so we are well equipped to intiate resus if needed.

So lets get back to the positives of homebirth and what the stats say - these figures are based on studies carried out for Independent Midwifery Care:

39% of women are less likely to experience interventions in labour (Sandall et al. 2016)
24% of women are less likely to lose their baby before, during or after birth (Sandall et al. 2016)
33% of women less likely to experience emergency caesarean section (Sandall et al. 2016)
Women 2.7 times more likely to have a spontaneous vaginal birth (Sandall et al. 2016)
61% of women less likely to report postnatal depression (Cheyney et al. 2017)
Women 2.5 times more likely to initiate successful breastfeeding (Renfrew et al. 2012)
Women 4 times more likely to feel cared for as a whole person (Sandall et al. 2016)

So there is a lot of benefits to factor in when you make a decision of your place of birth and the bottom line is, its about where feels safe for you?
You will only labour well and have a positive experience if you are safe, warm, informed, well cared for, heard, held and included in your care, wherever that may be.
Homebirth can be very safe but its never 100% guarantee and as long as you are open minded to that and have plans in place should the journey take a detour then the experience is as safe as it can be, even hospitals are not 100% safe! 🩶