Lily Cole speaks out about her happy home birth.

Here's our midwife Kate's guide for women who are considering home birth.

Lily Cole with her baby.

The topic of home birth has been in the news this week after model and mum Lily Cole wrote about its benefits following the arrival of her daughter in September:

"I am so glad my daughter's first experience of life - of that transition from womb to world - was a positive and gentle one."

Although only 2.4 per cent of women gave birth at home in 2012, Cole’s home birth success story comes at a time when the advantages of home births over hospital births are being increasingly put forward by mothers and midwives alike.

Annie Francis, CEO of Neighbourhood Midwives explains:

"As mammals, we birth well when our hormones flow normally, and for that to happen we need quiet, dark spaces supported by people we know These circumstances are the opposite of bright, noisy labour wards - which can mean "anxiety levels go through the roof and you have a dysfunctional labour."

These views are supported by changes to the 2014 National Institute for Healthcare and Excellence (NICE) guidelines that focus on giving women more choice about where they give birth.

If you are thinking about having a home birth then the first step is to have a talk with your midwife, tell them that you are thinking about having a home birth.  You can discuss how your pregnancy is going and your medical history as this may have an implication on your decision.  

Here is our midwife Kate’s guide on what to think about and how to prepare.

Home birth tips from Tommy's midwife Kate:

  1. Be prepared. Talk to your midwife early on in pregnancy and find out your options.  Also think about who you want to support you during the labour and birth at home.  If you already have young children, try and organise childcare well in advanced, and hopefully someone who can stay overnight in case you need to go to hospital.
  2. Create a space at home which has low-lighting and is relaxing with enough room to move around freely into different positions. (Plastic sheeting is very useful to protect floors and furniture!)
  3. Think about your pain relief options, in advance.  You can research massage and breathing techniques, birthing balls and pools, TENS machines and anything else you think may help you in labour.  Also do not feel restricted to your home, you can always go for a walk outside to keep mobile.
  4. Stock up on foods you can snack on and are easy to eat.  Many women find having a straw to drink from much easier and ice cubes are often welcomed!
  5. Keep an open mind, labour and birth can be unpredictable so always have a plan B.  Mostly importantly stay positive, you can do it!

There are some circumstances by which a woman would be advised against having a home birth; these are outlined in the NICE guidelines (2014) and include the following:

  • BMI greater than 35
  • If you are having twins or more
  • Your baby is not cephalic (head down)
  • You go into labour before 37 weeks
  • You have developed a condition in pregnancy such as pre-eclampsia, gestational diabetes, high blood pressure
  • You have had episodes of bleeding in pregnancy
  • You have had a caesarean section before
  • Various medical conditions

This list is not exhaustive and not conclusive; therefore it is important to have a long in depth discussion with your midwife.  If your midwife does not recommend for you to have home birth but you feel that you would like to continue with this, then the next step is to speak to a supervisor of midwives (SOM) or a birth planning midwife to talk through how you feel and your options.

Following this discussion, the midwife will probably ask to come and visit you at home to see the space where you plan to give birth. The midwife will also help you to ensure there is good access to the space in case this is needed in an emergency.  The midwife will often leave some equipment at your home in a box ready for when you go into labour.  It is a good idea to have some clean towels and an old bed sheet is often really useful to protect your floor or furniture.

It is good to think about who you would like with you during the labour and the birth and how many people.  During the early stages of labour you may not have a midwife stay with you so good reliable support is important.  Some women like to have a doula also.

Think about your surroundings and pain relief options, this will be similar to if you were having your baby in a birth centre. You can use candles or low lighting with relaxing music to create a relaxing space.  Hypnobirthing is also something you can think about trying as well as breathing techniques and massage.

You can have paracetamol in the beginning and a warm bath or shower often helps too.  Some women find a TENs machine really effective.  When you are in established labour and the midwife arrives then she will bring Entonox (gas and air) with her and some also carry morphine or pethidine if necessary. Many women like to use a birth pool at home, these can be hired or bought, though remember that they can take quite a long time to fill up. 

One you are in established labour then a midwife will stay with you until the baby is born; a second midwife will be invited to attend for the actual birth.  The midwife will hopefully be the one that you have seen during pregnancy however this is not always the case.  You also have the option of having an independent midwife who you can book at any point during your pregnancy however they do charge for their service and this varies as to the extent of the support they provide you with.

If, at any point during the labour or birth, the midwife feels it is necessary to get extra help as there is a concern then they will consult you about a transfer to your nearest maternity unit, explain the reasons why and make a decision with you, however sometimes this needs to happen quickly.  Transfer will be done by an ambulance and the midwife will stay with you.

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