It might surprise you to learn that I used to be fiercely against the idea that I would ever have children. I was adamant for a number of reasons, including being terrified of the pain of childbirth. All the movies and TV shows I had seen with women screaming and yelling in agony in cold, sterile hospitals while masked male doctors treated the situation like a potentially deadly surgical procedure put me off completely.
The story of how I went from anti-birth to writing a blog about how to give birth is another post for another day, but part of the journey involved me giving birth at home in a birthing pool, naturally and with no medical interventions.
In this post I’ll give you a rundown of what you need to know if you’re considering giving birth at home.
Giving birth at home was the best thing for me personally and is a birth-place option that I highly recommend considering, but please consult with your healthcare provider before making your final decision.
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why have a home birth?
Here in the UK, your three main options for where to give birth are:
Hospital labour ward
Initially when considering home birth vs hospital birth and thinking about all the home birth pros and cons, I thought I’d probably end up choosing the midwife unit housed within one of my locals hospitals. It seemed like a good halfway house between the high-intensity environment of the labour ward and the comfort of home. However, after my initial booking appointment with a midwife I basically ruled out going anywhere near a medical environment if I could possibly help it. The midwife declared my pregnancy “high risk” due to historical asthma and ticked the labour ward box option on my form despite my insistence that my asthma was mild, under control and that I wanted a midwife unit. If this was how they treated my birth preferences at the very first appointment, I thought, I’m not going anywhere near a hospital on the day!
The more I researched the practicalities and process of giving birth at home, the more I set my heart on it. Here are some of the reasons I chose to birth at home:
- I have GAD (generalised anxiety disorder) and I knew I would feel safer and less anxious in my own home rather than a hospital. This isn’t the case for everyone – some people feel safe in a hospital knowing medical staff are right there in case of an emergency. For me, however, I’d had several very negative experiences in surgery and A&E over the years including one that resulted in PTSD, so I associate hospitals with high drama and stress.
- I wouldn’t need to transfer from home to hospital in the middle of labour. Anyone who’s seen a labouring Kirstie Alley get driven to hospital by John Travolta in Look Who’s Talking will understand why my anxiety went through the roof at the thought of a 20 minute car ride with contractions!
- I would be more in control of my birth preferences. That experience of being told I would “have to” give birth on the labour ward despite my objections told me everything I needed to know about how I would get treated during labour. I’ve read numerous horror stories from women who felt as though their choices were overridden and ignored when they didn’t need to be and I didn’t want that happening to me. Obviously in life or death situations then it’s entirely appropriate for a medical professional to take charge but, in the case of where and how to give birth in my low risk pregnancy, I wanted to be in control of the situation.
- Less chance of unnecessary interventions such as forceps or ventouse. I’ve heard far too many stories of women ending up having horrendous birth experiences to the point of swearing off having more children all because their bodies’ natural processes were interfered with unnecessarily. This ties in with the previous point about consent, too – it’s all too easy in a hospital environment to get pressured into agreeing to procedures that aren’t always in your best interests and you might not actually want to consent to just because you’ve got medical staff insisting that you should. I can imagine it’s all the more difficult to keep your bodily autonomy in tact when you’re in the throes of labour, so not being in a highly medical environment where I might be pressured into having interventions was very important to me.
- Not being separated from my husband after the birth. Depending on the facilities at the hospital, mothers and their birth partners can get separated after the birth and partners either can’t stay with you overnight or have to sleep separately. Of course, at a home birth you can just curl up in bed together and this was one of my most blissful moments. A few months after Ursula was born, we were sent a photo by friends of ours from hospital the morning after the birth of their own baby. The father was trying to sleep while horribly squished up onto an uncomfortable looking travel bed in the corner of the room – my husband took one look and thanked me profusely for choosing a home birth!
Other reasons for why you might want to consider giving birth at home include:
If you have older children you don’t have to leave them.
It can be very distressing for children when their mother leaves the family home to give birth, particularly if they have negative associations with hospitals. If this is their first sibling as well it may make that already-difficult process even harder for them during the separation. Having a home birth means that they can be aware of what’s going on and childbirth can be normalised for them.
Some mothers even offer to let the children get involved in the birth process by doing anything from helping to fill the birthing pool to cutting the umbilical cord after the birth. Whether or not you invite older children to be there for the actual birth, giving birth at home means they don’t experience you being taken away from them.
Increased likelihood of continuity of care with a midwife you know
I WISH this was just something you could rely on anyway and it certainly should be a priority for the UK healthcare system in my opinion but sadly most labouring women end up with midwives they don’t know. Given the intimate and personal nature of childbirth, and the stress and anxiety that it can cause under the wrong circumstances, it’s no surprise to me that having continuity of care is shown to result in fewer interventions, more natural births and less risk of loss of life for the baby.
If you have a home birth you are more likely to be assigned one or more midwives who will stick with you throughout the whole process and be there at the birth. In my case, my terrible booking appointment inspired me to investigate independent midwives and I discovered an amazing private practice that was offering a trial NHS outreach scheme. I was blessed enough to get on the scheme, enjoy continuity of care under a private practice for free, and three fantastic midwives attending to my every need on the big day. Sadly this scheme is no longer available but it goes to show that it’s always worth searching for alternatives to your local hospital to see what other options might be available to you.
is giving birth at home safe?
After my lovely 13-hour water home birth, which was followed by champagne and pizza all ‘round from the comfort of my bed, a friend of ours who was visiting the baby looked at me in horror and said, “Ohmygodthough, a HOME BIRTH?! What the actual HELL?!?” It was as if she’d just heard that I gave birth in a pile of used heroin needles in a ditch in war-torn Afghanistan. Fortunately I didn’t discuss my birth plans with her or anyone outside my immediate family while I was pregnant, but I know plenty of expectant mothers who are planning a home birth and being told by friends and family that giving birth at home is practically signing their baby’s death warrant. So let me spell this out and remove all doubt:
YES 👏 GIVING 👏 BIRTH 👏 AT 👏 HOME 👏 IS 👏 SAFE 👏
In the case of women who have given birth before it is just as safe as giving birth in a hospital.
For first time births, it’s statistically safer to choose a midwife unit but giving birth at home still represents a perfectly safe option. A UK study in 2011 found that, out of 1,000 planned home births, only 4.3 resulted in serious complications. The odds of serious complications occurring did double in the case of a first-time pregnancy, but the odds were still very low (9.3 out of 1,000 births – see “Can I have a home birth with my first baby?” below).
It’s also worth bearing in mind that this study revealed that the chances of having an emergency caesarian section were dramatically lower among women who planned a home birth, and there are circumstances under which having a hospital birth poses a greater risk.
Perhaps because hospitals are (theoretically) so clean and sterile, some folks assume that a home birth is somehow dirty and unsanitary but, assuming you don’t live in an actual pile of filth, the average home is clean enough to welcome a baby into the world.
Another reason people think a home birth is dangerous is due to the lack of medical equipment and heavy-duty painkillers on standby. In the case of a low-risk pregnancy where no complications are foreseen, you’re unlikely to need the specialist equipment or high level anaesthetics of a maternity unit.
If it starts to look as though there may be complications that require medical attention not available at home, the midwife will be able to spot the signs early enough to be able to initiate a hospital transfer in plenty of time. In the study referenced above, 45% of first-time mothers transferred to a hospital either before of after the birth and for women who had given birth before only 12% transferred, but most transfers are at the request of the mother and not the result of an emergency.
A more recent international study from the summer of 2019 has concluded that there is no greater risk of infant mortality whether the planned place of birth is at home or in hospital.
what if home birth goes wrong?
As I mentioned above, only a very small number of home birth end in serious complications but, for the sake of reassuring you (and, let’s face it, any skeptical partners/family members you may be researching on behalf of!) let’s first of all acknowledge that midwives are highly trained medical professionals who will know exactly what they’re doing. They will be monitoring your baby’s heartbeat throughout the labour and, if there are any signs of distress or other reasons to suspect something isn’t right, they will call an ambulance and get you transferred to hospital. A midwife will be able to pick up on complications in plenty of time and they tend to err on the side of caution, so there is no need to worry that you won’t get the medical help you need in the highly unlikely case of an emergency. They also have a range of equipment on hand to deal with emergencies including haemorrhages, umbilical cord complications and even resuscitation in a worst case scenario. It’s worth remembering that births at risk of requiring these kinds of treatments have usually transferred to hospital before they are needed.
can I have a home birth with my first baby?
I had my first baby at home and the birth was relatively short (13 hours), with no complications, tears or need for post-birth hospital treatment. As mentioned above, however, 45% of first time mothers planning a home birth do transfer to hospital either before or after the birth so there is a fairly high chance you won’t get the home birth you want.
Overall, there are slightly higher risks associated with giving birth at home if it is your first child but these risks are still relatively low. In a 2011 study, 9.3 out of 1,000 planned home births by first time mothers resulted in serious complications as opposed to 5.3 in labour wards and 4.5 in freestanding midwifery units.
Facts and figures can only tell you so much, though, and the whole context of your pregnancy, personality, home environment and personal circumstances should be taken into account when deciding whether a home birth with your first baby is appropriate.
can I have a home birth if I am high risk?
Let’s establish one thing first: you are completely and utterly, 100% entitled to give birth at home whatever your circumstances. Some people believe home birth is illegal in a high risk pregnancy but this is not true. Medical staff have no authority to dictate where you can or can’t give birth – they are there to provide you with advice and you have the right to take or ignore that advice.
Where a pregnancy is declared “high risk” it is important to start by establishing and understanding exactly WHY it has been given this label. As I mentioned, my pregnancy was deemed “high risk” because I had a history of severe asthma. However, my asthma had been mild and generally insignificant for some time – it was over 5 years since my last attack and I didn’t even know where my inhaler was, let alone need to use it regularly. It is my belief that the midwife told my I was high risk and put me down for a hospital birth to make life easier for her team. This is just my feeling but it is not uncommon for medical staff to say a pregnancy is high risk in an attempt to discourage home births – these require more resources and, in an under-funded NHS, it’s perhaps understandable why they would want as many women as possible birthing in the most convenient place for them.
However, your birthing rights should be at the forefront of any care provider’s mind and you must therefore get to the bottom of why you have been declared high risk. In my case, I felt absolutely confident that my asthma would have no negative impact on my labour and therefore ignored this label. The midwife team I ended up with agreed with me and supported my choice for a home birth. There are, of course, many circumstances under which the safest place for a woman to give birth is in the hospital and it is important that you seek a cooperative dialogue with your care provider under these circumstances.
A recent study from the Netherlands looking at why there has been an increase in women with declared high risk pregnancies ignoring medical advice giving birth at home, often without medical support, showed that the motivations for doing so included a lack of trust in medical staff and conflict during discussion of the birth plan. Many of these births had negative outcomes for both mother and baby and the study concluded that medical staff need to improve the quality of the discourse surrounding birth options.
If you have been told you have a high risk pregnancy and are still hoping for a home birth, don’t be afraid to be pushy and try to get the supportive conversations you need to have with your care provider. The organisation AIMS (Association for the Improvement of Maternity Services) can offer you advice on your rights and help you to find the information you need to make informed decisions.
can I have a home birth with twins (or more)?
In the UK a home birth with twins is rare as pregnancies with multiple babies are considered high risk and are therefore usually planned within an obstetric unit under the care of a consultant. As is the case with any pregnancy, however, you are entitled to give birth at home if you wish to and a home birth with twins is possible. They are most often attended by independent, private midwives specialising in multiple births. However, the risks with twin births include premature birth and the need for resuscitation so there are strong arguments in favour of following medical advice. There is an excellent (albeit archived) page on the arguments for and against twin home birth here with additional resources and home birth videos.
what pain relief is available at a home birth?
Something you need to consider when deciding on whether to give birth at home is that the kinds of pain relief available to you will be much more limited than in a hospital or midwife unit. I know I’m probably in the minority here but this was actually a good thing as far as I was concerned. I very much wanted to have a drug-free, natural birth and giving birth at home meant that I wouldn’t be tempted to cave and scream for all the drugs. Turns out this was the right choice as I didn’t handle the pain with quite as much dignity as I thought I would!
You can read more in depth information about the full range of pain relief available during labour here, but the pain relief options you have available at a home birth are:
Enthonox AKA Gas and air
It’s a mix of oxygen and nitrous oxide gas and, rather than anaesthetising anything per se, it gives you something to breathe deeply with and takes the edge off the pain. It has no harmful side effects for either you or baby, although in researching this article I’ve learned that it’s a greenhouse gas that accounts for 2% of the NHS’s carbon footprint so technically not an eco option.
Pethidine or diamorphine
A morphine-like opioid injection into the buttock or thigh that takes about 20 minutes to take effect and lasts for between 2-4 hours. This method wouldn’t be suitable close to the end of birth as it can interfere with the baby’s breathing. It also can’t be used in conjunction with a birthing pool. Pethidine can make you feel sick and drowsy and many women dislike the sensation, which can’t be controlled and quickly got rid of as in the case of Enthonox. It also crosses the placenta and affects your baby making them drowsy and harder to breastfeed in the crucial first days.
A small machine with sticky pads that attach to your back and send a mild electrical current to the nervous system. It works by stimulating your body’s own natural pain relief mechanisms. You can hire or buy a TENs machine or sometimes your midwife may bring one with them. They’re generally only helpful in the early stages of labour and can’t be used in a birthing pool. Speaking of which…
The sheer bliss I felt at finally getting into my birthing pool towards the end of my labour was only topped by the magical feeling of holding my daughter in my arms for the first time. The sensation of entering the warm water of the birthing pool after hours of labour on dry land was pure heaven. You can hire birthing pools, where the company will provide everything you need for it and come and take it away and deal with cleaning it for you, but you can also buy water birth supplies online. In some cases your midwife may be able to provide one so speak to them before investing in anything. A water birth isn’t an ecologically friendly option due to the high water usage, but given the epic pain of childbirth you may decide you can live with a bit of eco-guilt…!
Meditation, deep breathing, hypnobirthing and affirmations are just some of the tools you can use to help you cope with the pain from within. I attempted to use some mind over matter during labour via a free hypnobirthing app, however I really wish I had invested in a proper hypnobirthing course. When it came to the big day, I wasn’t well grounded enough in hypnobirthing techniques as I’d had been way too casual about just throwing the affirmations on in the weeks running up to the birth. There are a lot of hypnobirthing courses out there and you may prefer to find a face-to-face practitioner in your hometown, but if you’re looking for a high-quality, excellent value product that you can download now and start using right away then I really recommend the the online antenatal hypnobirthing course over at KG Hypnobirthing.
The course is a full in-depth antenatal programme available online where you can enjoy learning at home where you feel comfortable. You can obviously learn at your own pace at any stage of your pregnancy and have the resources at your fingertips to refer to time and again. They provide easy to follow instructions for the simple but highly effective practice of hypnobirthing along with all the supporting documents you need, plus an exclusive Facebook support group. The course is normally a bargain at £100 but at the moment they have a 30% off discount count for a limited time, so do take a look and see if it might be the right course for you.
what do you need for a home birth?
There are lots of home birth checklists out there but, while there are certainly things that will always be essentials such as old towels, you never really know what you’ll use until you get there. Below is a list of the items I felt were essential for me and my home birth. I stashed everything in a large silicone bucket so that my birth team knew exactly where to find things as and when they needed them.
such as your natural birth plan, maternity notes and important phone numbers for medical staff to access (don’t just rely on having your contacts in your phone).
An extra large towel
If you’re planning a water birth you’ll need a nice, big clean towel for you and the baby to snuggle up in and get some post-birth skin-to-skin time.
I know this is a bit of a Hollywood home birth cliché (“GET ME HOT WATER AND TOWELS RIGHT NOW!!”) but seriously, get as many as you can lay your hands on. They’ll be especially useful in the case of a water birth but midwives seem to get through piles of them even with a dry birth. For a good ecological option try posting in your local Facebook group and asking for people’s old towels. Most folks are more than happy for you to take them off their hands!
Not a very eco-friendly essential but pretty important to protect furniture, carpets etc from water (if you’re having a water birth) and, let’s face it, the various bodily fluids you’ll be producing! To minimise the environmental impact you could again ask in your local Facebook groups to see if anyone has any old shower curtains or plastic table covers that would otherwise be getting sent to landfill anyway. Or you could invest in proper tarpaulin if you think you’ll continue to have a use for it after the birth – the downside is you’ll need to clean it but I’ll leave that problem with you 😜
Blankets to wrap baby in
Preferably more than one as the first one may get wet or covered in post-birth goop (technical term). I bought traditional cellular blankets from an NCT sale but if you want to follow with the tradition of the cellular receiving blanket, John Lewis have some gorgeous ones made from organic, responsibly sourced cotton. They also sell utterly stunning Aden + Anais bamboo blankets if you’d like something truly special to envelop your little one after their long-awaited arrival into the world.
Somewhat more unglamorous and utilitarian than soft organic receiving blankets but probably more important. I spent a lot of my time with my head in one of these and, much as I hope you won’t have to, I was very glad to have it on hand!
A way to keep cool
I had a USB rechargeable hand fan that provided a lot of relief from the nausea of labour. I also made sure there were flannels available. Labour is hot work and, depending on the season, you might find yourself in the middle of a heat wave like I did so make sure you’ve got options for keeping cool.
A hot water bottle and foil
Fortunately these items weren’t necessary in the end but they were requested by my midwife in case there was a medical need to quickly raise the baby’s body temperature. A hot water bottle is also useful for pain relief in the early stages of labour.
Container, cool bag and ice blocks for placenta storage
This is only necessary if you plan on keeping your placenta for consumption, burial or artistic purposes. I’ll write a post on placenta practices at a later point, but if you already know you’ll be keeping yours, you’ll need a 1.5-2.5L container and a large enough cool bag to store it, along with at least 8 ice blocks to keep it cold until your placenta practitioner comes to collect it.
Water bottle with straw
I had another water bottle already but someone recommended one with a straw for labour and I am SO glad I got one. It just means you can sip water from any position and don’t have to shift position to have a glug. It made a huge difference and I still use it on a daily basis as it makes it easy to drink a load of water. Mine is plastic and was purchased in my pre-Amazon-boycotting days so I don’t want to recommend the one I got, but I found these awesome stainless steel ones on Etsy that you can even have personalised if that’s your jam.
Birth is never completely zero waste so you’ll need a load of bin bags for the midwives.
Snacks and drinks for your birth team
Depending on how long you’re going at it you may even want to go the extra mile and shove on a slow cooker stew in the early stages so you and your crew can get some much-needed sustenance later on.
Excellent for helping relieve pain in the early stages. I bought mine from a local sell or swap Facebook group for £10.
These are super useful for finding comfort and aiding various birthing positions – you can pick one up from John Lewis. Also, check out the Spinning Babies® website for excellent free resources on optimal birthing positions using the birthing ball, plus tips on preparation for labour.
Having your birthing partner, doula or midwife give you a massage between contractions is a wonderful way to get some much-needed TLC during labour. Personally I love sweet almond oil and Neal’s Yard have a beautiful organic 100% vegan one available in glass bottles. A great investment for use in baby massage too.
Again Neal’s Yard is the place to go for ethical essential oils to add to your massage oil or diffuser. They have everything from calming lavender to invigorating citrus blends. Just make sure you know how to use essential oils safely during pregnancy – obviously during birth you’re FINALLY near the end of your pregnancy but better safe than sorry!
Investing in a good diffuser will really help see you through not only your home birth but the rollercoaster ride of baby sleep over the months ahead. I got my diffuser with labour in mind but I still use to fill the bedroom with lavender scent for Ursula’s bedtime routine and with eucalyptus when she has a stuffed up nose.
Having some relaxing music and birth affirmations really helped me towards the end of labour but you may also want an energetic soundtrack for motivation! Whatever your choice of tunes, some kind of music playing device (with plenty of charge if it’s wireless) is definitely a home birth must-have. I’ve got a Bluetooth speaker from John Lewis to link with my phone and I love the convenience of being wireless.
Hospital transfers aren’t always emergency ones, often women decide on the day that they would rather be where the drugs are! Obviously if you’re planning a home birth the hope is that you won’t end up transferring but I do recommend having a bag ready just in case, even if it’s just the bare essentials. The last thing you need is to have to think about packing while you’re in the middle of labour and, for me, I’m the sort of person who wants to pack my own bag rather than have someone else do it for me on the fly.
Post-birth bleeding is very much a case of skipping nearly a year’s worth of periods and then having them all come at once! I highly recommend Nooby Noo’s customised cloth sanitary pads as the greenest postpartum option. Her Monstress cut is hands down the most comfortable towel I’ve ever used and you can pick your own fabric, length and absorbency to suit your needs. Bear in mind that she’s just one woman making cloth pads and you need to order 4-6 weeks in advance. They’re well worth the wait though and I continue to use her cloth pads every month.
Having said that, in the first few days after birth I couldn’t face the laundry and faff of reusable towels so I initially used Natracare maternity pads, which were brilliant. Nothing is 100% biodegradable in landfill so these do have an environmental impact, but they’re pretty ethical as far as disposable pads go and are very reasonably priced for an organic product.
Speaking of endless periods you’ll be needing some big, baggy comfy knickers for immediately after birth and the next couple of weeks.
Reusable bed pad
One of the most wasteful items usually listed on a home birth kit is disposable bed pads. As useful as they are for protecting your bed sheets and sofa from the inevitable leakage in the first few days postpartum, I personally couldn’t bear all that waste. Instead I opted for buying two second hand cot mattress protectors, one to wash and one to use. They’re the perfect size for popping under your bottom while you sit back, take it easy and snuggle your lovely little newborn.
can a midwife refuse to attend a home birth?
A midwife is under a professional obligation to support women in their right to choose where to give birth. You cannot be forced to give birth in a hospital and every NHS Trust in the UK is expected to have provisions in place to ensure home births are attended.
It is not uncommon, however, for medical staff to attempt to coerce expectant mothers into having a hospital birth they don’t want simply because home births are less convenient for them. I have seen countless stories in home birth groups on Facebook of women being told they “aren’t allowed” to have a home birth for a variety of implausible reasons. If you are told you can’t have a home birth despite having a generally low risk pregnancy, always ask for a second and even third opinion. If you need support in order to have the home birth you are entitled to, visit the Birthrights and AIMS (Association of Improvement to Maternity Services) websites to find out how they can help you.
do you have to go to the hospital after a home birth?
No, not if everything has gone smoothly – that’s one of the awesome things about a home birth, you get to just curl up in your own bed to snuggle your newborn straight away.
There are certain circumstances under which your midwife may advise a transfer such as issues delivering the placenta, heavy blood loss or tearing that needs extra attention but most midwives will be reluctant to move you unnecessarily.
At my home birth, once I was clean and dry, nursing and cuddled up in bed with Ursula, my husband, birth team and I all clinked a glass of champagne saved from the wedding and then enjoyed some local wood fired pizza. I tell you, that was the best pizza I’d ever had!
Giving birth at home was the most phenomenal experience of my life and I was as surprised as anyone to discover that the process of giving birth naturally can be a positive one. I have no doubt that if I had given birth in a hospital rather than at home, my birthing experience would have been far less positive.
If the idea of giving birth is something that fills you with fear and anxiety, I highly recommend considering a water birth at home where you can feel comfortable in your own familiar surroundings, birthing your new bundle of joy naturally and with the love and warmth of your own home to welcome them to the world.
I now have a guide to making sure you have an empowered birth during the current COVID-19 lockdown, whether you give birth at home or in a hospital. Check it out HERE.
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