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Homebirth in the UK
( percent of total )
( per 1000 births )
Rona Campbell and Alison MacFarlane also examined statistics for home and hospital birth, and they found no evidence to support claims that the safest policy for women is to deliver in hospital. Indeed, their analysis of data collated by the Oxford Perinatal Epidemiology Unit shows that for many women home is safer than hospital. The perinatal mortality rate for women having planned homebirths is very low, and women who have had both hospital and homebirths prefer home (Where to be Born—the Debate and the Evidence).
In the table below, the values for GP units and homebirths are combined, as they are very similar.
|Level of Risk||Perinatal Mortality
( per 1000 births )
|GP Unit and Home||Very Low||3.9|
|GP Unit and Home||Low||5.2|
|GP Unit and Home||Moderate||3.8|
|GP Unit and Home||High||15.5|
|GP Unit and Home||Very High||133.3|
Vicki Junor and Marianne Monaco, authors of Home Birth Handbook, point out that it is unlikely that any of the deaths occurring at home could have been avoided in hospital, despite the technological backup. A study of 5,000 homebirths in Holland shows that none of the few fatalities could have been prevented by hospitalisation.
The World Health Organisation gave some official sanction to homebirth in 1985. "It has never been scientifically proven that the hospital is a safer place than home for a woman who has had an uncomplicated pregnancy to have her baby. Studies of planned home births in developed countries with women who have had uncomplicated pregnancies have shown sickness and death rates for mother and baby equal to or better than hospital birth statistics for women with uncomplicated pregnancies" (Having a Baby in Europe).
More recently, the 1992 House of Commons Select Committee on Maternity Services, now known as the Winterton report, went to the heart of the issue in the first of more than 100 recommendations and conclusions on pregnancy, labour and postnatal care.
"On the basis of what we have heard, this Committee must draw the conclusion that the policy of encouraging all women to give birth in hospitals cannot be justified on grounds of safety."
Elsewhere the report went further. "There is no convincing or compelling evidence that hospitals give a better guarantee of the safety of the majority of mothers and babies. It is possible, but not proven, that the contrary may be the case."
There is now a sizable body of statistics and research about the safety of homebirth—we have quoted just a little of it. If you would like to read more, we have a number of books and articles available for loan.
Labour complications can arise, and it is important when booking a homebirth to recognise all may not go as planned. However, it is reassuring to remember that much evidence shows that problems are less likely to occur at home than in hospital.
Community midwives are experienced in detecting abnormalities in labour. They will closely monitor the baby's heart rate and your temperature, pulse, and blood pressure. They will watch your progress by noting the strength, length and frequency of contractions. Regular checks assess cervical dilatation and the descent of the baby through the birth canal. These observations provide warning signs of any complication, and the midwife can arrange an immediate transfer into hospital.
The local midwives recommend transfer to hospital-based care in the following cases:
Labour starting before the 37th week or after the 42nd: Prematurity or postmaturity can mean added risks to the baby.
Antepartum haemorrhage or excessive vaginal bleeding before labour: Bleeding just before labour starts is common, but a steady flow of blood or continual spotting can sometimes mean the placenta is starting to peel away from the lining of the uterus (placental abruption) or that it is in front of the baby's head (placenta praevia). This will probably be revealed well before you go into labour, although it usually means a caesarean section to deliver the baby.
Raised blood pressure: This can cause problems for mother and baby. Antenatal monitoring is geared to the detection of preeclampsia (sometimes referred to as toxaemia), which is dangerous for both mother and baby.
Malposition of the baby: Breech position or other malpresentations should usually be detected well before labour begins, but occasionally the baby may move at the last minute. Although it may be difficult to arrange a homebirth for a breech baby—many consultants still believe caesarian section is the only answer—the only one that absolutely requires a transfer is "transverse," when the baby is lying across your abdomen and will definitely need to be delivered by caesarean.
Meconium-stained liquor: Fresh greenish-black waters can indicate a baby in distress. Inhalation of meconium may cause the baby severe breathing difficulties. However, at full term about half of babies pass meconium in the uterus. An experienced midwife can judge if transfer is necessary.
Fetal distress: If the labour is very prolonged, the baby may become distressed, and its heart rate will become irregular. Transfer will be recommended.
Haemorrhage: Although some bleeding during labour is common, it can occasionally be a sign of placenta abruption (see above).
Maternal exhaustion: Occasionally labour may be very intense, prolonged or difficult to cope with, despite good antenatal preparation. Lack of progress, with poor dilatation of the cervix or a long delay in second stage, can be very painful and hard for the mother to bear. You can have gas and air (Entonox) at home, but stronger pain relief is usually only available in hospital. Transfer may also be necessary if you need a Syntocinon drip to stimulate contractions. However, there are other things you can try first: a change in venue, from the bedroom to the bathroom, for instance, or something to eat. Eating regularly during labour can lead to a quicker and easier outcome.
Postpartum haemorrhage, or excessive bleeding after the birth: This may occur when the uterus fails to contract after delivery, leaving a raw area left by the detached placenta that remains large and free to bleed. This is much more common when labour is induced or artificially accelerated. The midwife will have drugs to stop excessive bleeding, but in extreme cases she will call an ambulance.
Retained placenta: The placenta may need removal under a general anaesthetic.
Baby fails to breathe at birth: Very occasionally a baby shows no inclination to breathe, even when labour has been normal. Midwives are trained to deal with this situation and carry special resuscitation equipment. If the baby fails to breathe in one minute, she can keep the baby oxygenated with a special mask and bag. In most cases the baby breathes within two to three minutes. If not, an ambulance would be called immediately.
Cases requiring specialized stitching: Only cases requiring specialised stitching will be transferred to hospital. Usually at least one of the two midwives attending a homebirth will suture a cut or tear.
It is essential to remember that serious problems are relatively rare. Although transfer is deemed necessary in some 10 percent of cases, there is much midwives can do to help should transfers occur. It's worth bearing in mind that problems are more likely to occur in hospital due to the frequency of intervention in labour. Overall, the risk to your baby is higher in a consultant unit, whatever technology may be at hand.
Most midwives will recommend a transfer only when they consider it to be absolutely necessary, but if you remain unconvinced, there are some questions you might like to ask:
It is important that you feel you have been part of the decision to transfer to hospital, if that is possible. It can greatly reduce later feelings of disappointment or failure.
The government's response to the Winterton report on maternity services has at last given some official sanction to homebirth, although it made no commitment to change the policy of encouraging the majority of women to give birth in hospital.
"The government recognises that there are women for whom homebirth may be an option they would prefer. Health authorities are obliged to recognise a woman's right to choose, and to see that a midwife service is available for a woman to give birth at home, if that is her choice."
Homebirth is becoming increasingly common in the Brighton area, so arranging one for yourself should be fairly straightforward. Most women go to their GP for confirmation of pregnancy sometime in the first few months. If you have already decided to book for a homebirth, it is well to make your preference clear from the beginning.
Remember that you do not need your GP's permission to book a homebirth, and a GP does not need to be present at the birth. Most GPs who take on home confinements usually offer only antenatal care and honour their obligation to check the baby within 24 hours of the birth. Although GPs should not turn away women requesting homebirths, some unfortunately still do so. You may feel it is worth trying to persuade your doctor to reconsider, but it may be simpler to find one that is more sympathetic.
It can be quite daunting to face a GP opposed to homebirth, even if you have made up your mind. Comments about endangering yourself or the baby can be very upsetting, especially as we are accustomed to treating doctors as experts. Remember, your GP is probably equally alarmed, as they are used to booking women into hospital and assume that is the best option. Read as much as you can, arm yourself with the facts, and take along a supportive friend or partner. Homebirth is a safe and responsible choice!
If you feel that some aspect of your current pregnancy, previous labours or general health record is being used to dissuade you from having a homebirth, you have the right to a second opinion from someone with a more positive attitude. Try contacting an independent midwife (see below).
Occasionally women are asked to sign a disclaimer form intended to absolve the health authority of responsibility for your actions. This has no legal status and you may refuse to sign it without affecting your right to care through pregnancy, labour and the immediate postnatal period.
You can change GPs by contacting the Family Health Services Authority (FHSA), which should be able to put you in touch with a GP willing to take on couples requesting home confinements.
In the Brighton area you will now be booked in at 12 weeks pregnant by a community midwife—a welcome change from the old policy of booking in at the hospital. Your antenatal care will probably be shared between midwives and the GP, which will give you some opportunity to build up a relationship with your midwives.
Each pregnant woman has a named midwife; it is important you feel she supports your choice. If you are not happy, you are entitled to ask for another at any stage of your pregnancy. Contact the Community Midwives' Office at the number below.
The community midwives are divided into three areas in Brighton, and each area has monthly homebirth meetings where couples can meet the midwives who will attend their birth. Ask the midwife giving you antenatal care for details. If you attend as many meetings as you can, you are more likely to have a familiar face with you in labour.
You may decide you would prefer an independent midwife. You can obtain a list of midwives who cover this area from the Independent Midwives Association. Ask for a preliminary booking visit. There is usually a charge. If you decide to go ahead, the independent midwife will arrange all your antenatal care, including tests and scans, the delivery, and postnatal care until the baby is 28 days old. This can be expensive. Costs usually range between $1,000 to $2,500, although midwives may have ways of helping if you have difficulty paying the fees.
Remember that it is your prerogative to change your mind. You can opt for a homebirth as late into your pregnancy as you like simply by contacting your community midwives directly.
You should discuss with your midwife at what stage she would like you to call her, but if your labour begins during the day, contact the community room at the Royal Sussex County Hospital. Give your name, address and telephone number and your midwife's name. If you go into labour at night, telephone the labour ward instead. They will arrange for the duty midwife to come out to you.
A midwife will come and assess your progress and may decide to go away and return later. She may decide you are not in established labour. If you have already had one child, it is common to get quite strong practice contractions in the weeks preceding labour. These can easily be mistaken for the real thing, but they tend to stop or fade away after a few hours.
Once you are in established labour, the community midwife will stay with you throughout unless it is particularly long. She will call a second midwife at the appropriate time to assist with the birth. A student midwife may also attend if you allow it.
Remember, if you do not feel the midwife is supporting your decision to labour at home, you can call the labour ward or community office and ask for a replacement.
Community Midwives' Room, Royal Sussex County Hospital: 01273 685417. Labour Ward, Royal Sussex County Hospital: 01273 687599
(See Useful Addresses section for further contacts.)
You do not need a lot for a homebirth. The most essential things are a warm room, a midwife, a birth partner, power, water and access to a telephone.
Your birth partner need not be the father, of course. Single women or those whose partner would rather not attend the birth might like to arrange for close friends or relatives to help out at the labour. More than one birth supporter is always a good idea. You may need someone to collect more Entonox from the hospital, for instance. It's also worth thinking about the aftermath. Midwives stay only an hour, and there might be dishes and laundry to deal with.
Do discuss with your midwife what you might need for your homebirth. She might have some useful ideas. In the Brighton area midwives will either deliver or arrange for you to collect a big plastic bag full of all the equipment the midwife will need for the delivery. This contains everything from absorbent pads to the baby resuscitator. One of the best things about a homebirth is the half hour you spend exploring the plastic bag! Don't, however, open anything wrapped in sterile packaging.
The midwife may also give you syntometrine for the third stage, which should be kept in the fridge, and the gas cylinder of Entonox. She brings the mouthpiece for the gas and air when you actually go into labour, so forget the idea of happy parties!
Generally, however, you need very little. Most obviously a plastic sheet or ground sheet, perhaps with an ordinary sheet on top, is useful to protect beds or floors. The plastic bag contains plenty of absorbent pads, which will contain most of the leaks. You can buy plastic sheets from any hardware store or garden centre.
You may want to consider a birth plan, although the question of intervention is much less of an issue with homebirth. It should outline the type of delivery you want at all three stages, what you would like to happen and what you would wish to avoid. You may also consider how you would like the baby to be treated after birth: lights dimmed, perhaps, or an initial half-hour alone with the parents. You should also discuss the kind of birth you would like with the midwife beforehand.
The Brighton Homebirth Support Group was set up several years ago by a National Childbirth Trust (NCT) antenatal teacher and in early 1993 became annexed to the Brighton, Hove and Lewes branch of the NCT.
Our principal aim is to support parents who choose homebirth. One of the main ways we do this is through monthly meetings, which give prospective parents an opportunity to talk to others considering homebirths and to those of us who have already had one.
We also try to offer practical support. This pack is one aspect of it. We also keep books and articles on issues surrounding homebirth. In addition, we have a register of all the main support organisations for all areas concerning pregnancy, birth and parenthood, including crying babies, miscarriage, stillbirth and handicap. Please phone if you want details.
We are currently trying to monitor the outcome of couples who contact the homebirth group, with the view of getting a better picture of homebirth in the Brighton area and what we should be offering. This will also give us a register of couples willing to talk on particular aspects of homebirth, such as hiring a birthing pool or transfer to hospital. We may well contact you after your due date with a request to fill out our questionnaire. Your cooperation would be greatly appreciated.
Above all, we hope we can offer a wealth of different experiences. The descriptions below should give you a better picture of those of us running the group.
I was born at home and when I became pregnant I felt very strongly about having my baby at home. Home at the time was a small island 30 miles out to sea off the east coast of America. As luck would have it there was a great independent lay midwife who cared for me throughout my whole pregnancy. After a 22-hour labour with a few problems, Samson was born on the sofa. My midwife, doula and partner were truly wonderful, and I felt in safe and capable hands. My partner, myself and our lovely 9-pound baby boy were soon tucked up in our bed and left to enjoy our first precious hours together.
Two years later, our second son was born in Brighton. It felt calm and peaceful in our flat that night. Hot showers, soothing music, candlelight and flowers helped me through my 8-hour labour. Finn was born in front of the log fire (again, on the sofa!). It was beautiful.
Both my births were very special and positive experiences. I feel the main reason for this is that they were in an environment in which I felt safe, relaxed and comfortable—my home.
It was our first baby. Michael and I had strong convictions about where we wanted our child to be born. Conception occurred at home, and we felt the birth should take place there. We wanted as natural and as drug-free a birth as possible. The midwives were marvellous. They were totally unobtrusive but ready to lend support at any time. I really felt in control, and as a result I was able to deal with the pain quite well. It gave us more of a sense of sharing the birth; the midwives seemed like helping friends. Though my labour was short, I shall never forget the moment Aliya arrived. It was a magical one. Words really can't describe how we felt. Knowing that it was our birth and not some hospital's made all the difference. I didn't need any stitches or drugs, and I attribute this in part to my relaxed state, a state I don't think I would have been in had I given birth in hospital.
The decision to have a second homebirth was a natural choice after the birth of Gregory in our bedroom 18 months ago. First time around, in electing for a home confinement, I had encountered some opposition from my general practitioner, who did support me in my choice. I was also able to develop a good relationship with my midwife, and as luck would have it, she was on call when I went into labour and safely delivered me of my son. This is not to suggest everything ran completely smoothly. During the first part of my labour, Gregory was in a posterior position (his head and body faced my belly), making second stage very difficult. Despite this, the good relationship I had developed with my midwife, coupled with the fact I was in my own bed, with my partner at hand, made me feel quite reassured that I was in safe hands.
My second home confinement was altogether quite uncomplicated, and Geoff and I both felt very relaxed and able to fully appreciate the experience. Indeed, with one homebirth under his belt, my partner graduated from tea boy for the midwives to active birth supporter—providing massage, verbal support, and finally cutting the cord and holding Louis immediately after he made his appearance, an unforgettable experience for us both. Perhaps our best experience of all was when, some three hours after giving birth, the three of us were all tucked up in bed together, where we all fell asleep…until it was feeding time again.
This obviously depends on their ages and how you feel about having them present at the labour. One advantage of homebirth is that it is much easier to have your other children with you, although it is best to discuss it with your midwife first.
If you decide you would feel more comfortable without your children present, or they don't seem keen on the idea, you may want to make arrangements for them to stay with someone else during labour. Bear in mind, however, that one of the great benefits of homebirth is that you avoid the disruption of the hospital visit at what is a difficult emotional time for your older children.
If you want to minimise jealousy by keeping the children at home, you must arrange for someone to come and look after them. You really need someone there even at night. A child may wake up unexpectedly or be disturbed by noise, and you will not be able to spare your partner or the midwife to look after her. You should get someone in to help look after the children even if you want them at the birth. Small children may well get bored, or become distressed or uncomfortable.
It is important that children who may hear or witness the birth are well prepared. Even young toddlers are usually fascinated by videos of women giving birth, and books are also useful for teaching where babies come from and how. Remember that children do not necessarily have the same squeamish associations about blood as we do, and it is important they understand that their mother may sound much more distressed than she really is.
Birth is not a mystery or a trauma children should be shielded from. If parents and attendants are positive, even young children take blood and pain in their stride. Witnessing a birth is a unique opportunity for children to see childbirth as a normal part of life and to share in the miracle.
Many men are nervous about childbirth. Images of the father sitting anxiously in the hospital waiting room or fainting at the foot of the bed die hard. Seeing a loved partner in pain can be a very difficult experience to cope with, especially if the man feels unable to help.
Hospital births often exacerbate feelings of being helpless and superfluous, as the professionals so frequently take over. Homebirth on a man's own territory gives him a feeling of increased control over the birth experience.
At home, the man is likely to become actively involved in the birth of his child rather than a tolerated visitor. Women who have given birth at home often feel their partner was the most important person present.
Homebirth has one tremendous advantage for a man: He need never be separated from his partner and the baby. For couples whose children are born in hospital late at night, it can be heartbreaking for the father to have to leave shortly after the delivery.
It is important, however, that men take the opportunity to become involved from the outset of the pregnancy. Fathers are usually welcome to attend antenatal appointments—especially useful if the woman has older children. It may mean taking some time off work, but many women have to do the same.
Antenatal classes, such as those run by the National Childbirth Trust or local community midwives, are also an important opportunity for men to explore their fears and feelings about pregnancy, birth and the aftermath of fatherhood. Discussing options for labour and parenthood will be a lot more useful if the man is as well informed as the woman.
All women worry that they will not be able to cope with the pain of childbirth. Pain thresholds vary, and so do labours. Some women experience only mild discomfort, while others, especially in exceptionally long and intense labours, cannot cope without drugs. It is important to remember that labour is not a competition. There are no prizes for martyrdom and getting through to third stage without any help.
Pain is largely related to stress—the more anxious you feel, the more likely you are to feel pain during a contraction. Homebirth puts women at an immediate advantage; they are in familiar surroundings and in control of the situation. In this sort of situation, labour is likely to be swifter and the pain more easy to bear.
One of nature's aids to labour pain is noise. Long, deep bellows at the height of a contraction can do a lot to make the pain more bearable. The midwife will be able to offer you gas and air (Entonox) at home. This is a mild analgesic, 50 percent nitrous oxide and 50 percent oxygen, which you breathe in through a mouthpiece or mask. It does provide a degree of pain relief, especially at the end of the first stage when contractions can be particularly hard to cope with. Some women, however, find Entonox makes them feel sick and drowsy, while others find it gives them something to concentrate on during contractions. The mask is particularly effective for muffling the sound of a good long yell!
Another common method of pain relief is transcutaneous electrical nerve stimulation, or Tens, which directs an electrical stimulus to the back, interfering with the passage of pain signals to the brain. Many women find it effective, and again a good distraction technique. It cannot, however, be worn in the bath. Some GP surgeries have Tens machines for loan.
Birthing pools, or a deep bath, can also help a great deal with contractions by making the woman more relaxed and by absorbing some of the force of the contractions. Many women stay in the bath throughout the first stage, others actually deliver in the pool.
Other natural methods you might like to consider are hypnosis, acupuncture, aromatherapy, or massage.
Brighton Health Care
Royal Sussex County Hospital
Brighton BN2 5BE
Tel: 01273 696955
Family Health Services Authority
8 North Street, Lewes
East Sussex BN7 2PB
Tel: 01273 476262
Community Health Council
22 Connaught Road, Hove
East Sussex BN3 3WB
Tel: 01273 771186
(Handles complaints about treatment
during pregnancy and birth)
National Childbirth Trust (NCT)
Brighton, Hove and Lewes
Tel: 01273 472066
(Antenatal classes and postnatal
Home Birth Reference Site
(Further information on homebirth in the UK)
27 Sussex Place
London NW1 4SP
Tel: 0207 723 9296
(Raises money for research and
produces leaflets on aspects of
34 Elm Quay Court
Nine Elms Lane
London SW8 5DE
020 7498 2322
(Independent midwifery care and
advice on homebirth)
Independent Midwives Association (IMA)
Botley, Nr Southampton
Hampshire SO3 2BY
Tel: 0703 694429
(Provides continuity of care for those
wishing to give birth at home. List
of independent midwives.)
Association for Improvements in
Maternity Services (AIMS)
Beverley Lawrence Beech
21 Iver Lane
Bucks SL0 9LH
Tel: 01753 652781
(Information and advice to parents and
health workers on all aspects of
Association of Radical Midwives (ARM)
62 Greetby Hill
Lancashire L39 2DT
Tel: 01695 572776
Contact: Ishbel Kargar
(Supports those with difficulty
getting good maternity care)
15 Britannia Street
London WC1X 9JP
Tel: 0207 837 1265
Contact: Chris Gowdridge
(Campaigns for improvements in
rights and services for mothers,
fathers and babies)
Obtens Tens Hire
17 Theresa Avenue
Bristol BS7 9ER
Tel: 0117 942 9221
Neen Pain Management Systems
Old Pharmacy Yard
Norfolk NR19 1DL
Tel: 01362 698966
Active Birth Centre
25 Bickerton Rd
London N19 5JT
020 7482 5554
Active Birth classes in Brighton
Tel: 01273 552698
Association of Breast-Feeding
10 Herschell Road
London SE23 1EN
Tel: 020 8778 4769
(Education and local support groups)
La Leche League
London WC1N 6XX
Tel: 020 7242 1278 (24 hours)
(Encouragement, information and
support for breastfeeding mothers)
National Childbirth Trust (NCT)
London W3 6NH
Tel: 020 8992 8637
Gentle Water Birthing Pools
50 North Way
Tel: 01273 474927
Birthrites Birthing Pools
1 Vicarage Cottages
Iford, Near Lewes
Tel: 01273 475 307
Splashdown Water Birth Services
17 Wellington Terrace
Middlesex HA1 3EP
Tel: 0870 44 44 403
Active Birth Centre
25 Bickerton Rd
London N19 5JT
020 7482 5554
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