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Homebirth: what you need to know

by | Aug 12, 2020

Giving birth at home was the norm until about halfway through the 20th century, when hospital births became more common. Doula Donna Bland looks at what this choice entails.

Women have many birth choices available to them today, including homebirth. Although there are a lot of questions and controversy around this choice, many women are looking to give birth in an environment where they will receive more holistic, personalised care with a lower rate of intervention.

In the age of modern medicine, you might wonder why anyone would choose to give birth at home rather than in hospital. The answer to this question varies from woman to woman: some women simply feel more comfortable in a familiar place, surrounded by family. Others may have had a bad experience previously in a hospital.

Another drawcard is that labour is managed differently in this sort of setting. Intermittent, rather than continuous monitoring is favoured in a homebirth environment, providing more freedom for moms to move around during labour, creating a platform for a more instinctive, empowered birth.

 

Primary caregiver

A midwife is the primary caregiver in a homebirth setting. She takes care of mom during her pregnancy, making sure that mom and baby are both healthy and thriving. The midwife guides couples looking to go this route with all the necessary information and monitors the progress of the pregnancy to make sure that they are good candidates for homebirth.  She will recommend gynaecologists who are willing to act as back-up if the need arises.

The gynaecologist will need to be seen twice during the pregnancy to make sure that the mom and baby’s health are conducive to a birthing at home. A midwife will also not attend a homebirth alone. She will either be accompanied by a fellow midwife or a doula, making sure that there is always a second pair of professional hands available to assist when necessary.

 

Prerequisites

Unfortunately, not all women fit the criteria for homebirth. There are certain prerequisites to consider including:

  • Any significant medical condition, either pre-existing or pregnancy related.
  • Multiple pregnancy e.g., twins.
  • A breech or unfavourable birthing position.
  • Any previous obstetric history e.g., previous caesarean section or postpartum haemorrhage, etc.
  • Mom’s body mass index exceeding 35kg/m².
  • Significant mental health issues.
  • General health of mom and baby during pregnancy.

Providing an expectant mom and her baby are healthy and the pregnancy has been uncomplicated, she may be eligible to birth at home.

 

Safety

A common question about homebirth is around safety. Is it safe to give birth at home?

Research has shown that for a first-time mom, having a homebirth is associated with higher risk than with subsequent pregnancies. This is mainly due to the lack of medical history to compare with from a previous labour, and the uncertainty of how the labour will progress.

In the event of a woman choosing a planned homebirth, the midwife will make sure that there are back-up plans in place, including having the chosen gynaecologist on call. She will come equipped with all the essential equipment and medication that may be necessary for the birth, including some pain medication and resuscitation equipment for the baby.

One thing to keep in mind is that transfer to hospital is more common with a planned homebirth than you may think, but most hospital transfers are not emergency situations. Most often, women are transferred for reasons such as failure to progress in labour, or the water bag (amniotic sac) has been broken for an extended period.

 

Pros and cons

For many women, homebirth may provide the following benefits:

  • The comfort of delivering your baby in a familiar environment.
  • Less pressure to use medication and for interventions to occur.
  • More control over the experience.
  • Lower costs.
  • Convenience if previous labours have progressed very quickly.

The downside to birthing at home may include:

  • Medical aid may not cover all the associated costs.
  • There is more preparation involved than going to hospital.
  • Epidurals are not available at homebirths.
  • Having to transfer to hospital if the need arises.

 

Preparation

So, what will you need to prepare if you are interested in having a homebirth? The first thing I recommend, is to write a birth plan. This will help your midwife and doula understand exactly what you would like from your experience. From a practical perspective, make sure that the mattress on your bed is protected with plastic sheeting and that you have some spare to protect your floors. Towels are also a necessity when birthing at home. I would suggest using clean, older towels so that your nice towels do not get stained.

Make sure that you have a good supply of snacks and drinks to keep you energised and hydrated, and food to eat once baby is born. You may need to hire a birth pool from your midwife if your bath is not ideally suited to labour and delivery, should you want to use water for pain management or birthing. Besides that, there isn’t much else to prepare, because you are at home anyway. What I would suggest is having a bag packed for you and baby in case you need to be transferred to hospital.

 

Dad’s involvement

A wonderful benefit to homebirth is the freedom men have to play a valuable role in the birth team, without the restrictions of hospital protocol. This means that they can be present for all procedures if they so choose.

Even with a doula present, there is so much that dads can do to assist with a homebirth. Some men choose to be involved in the actual labour process and rub their partner’s back or help her to find comfortable positions. They may encourage her with loving words and a gentle touch. Some men even get into the water with their partners to be completely present for their baby’s birth.

Other men enjoy the practicalities that come with a homebirth: making sure that there is always hot water available for the birth pool, fetching snacks and drinks when needed, knowing where everything is and how everything works – this makes dads invaluable during a homebirth. When men are this involved, they feel empowered and part of this amazing process – something that is not always achieved in a hospital setting. There is a phrase that says, “when a baby is born, so is a mother”.

Regardless of how or where you choose to give birth, research all the options available so that you can make an informed decision, based on the existing information. Birth can be a beautiful, positive, empowering experience, so ensure that you know what is available to you and surround yourself with people who will help you achieve your goals. For every mom, their birth story is different. A home birth offers an amazing platform for you to write your own unique birth story.



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