Did you know that if you PLAN to birth at home you are much less likely to have:
- Caesarean birth (Hospital 11.1% and Home 2.8%)
- Forceps (Hospital 6.8% and Home 2.1%)
- 3rd/4th Degree Tears (Hospital 3.2% and Home 1.9%)
- Blood Transfusion (Hospital 1.2% and Home 0.6%)
- Hormone drip to augment labour (Hospital 23.5% and Home 5.4%)
- Epidural (Hospital 30.7% and Home 8.3%)
- Episiotomy (Hospital 19.3% and Home 5.4%)
(These are based on low risk women but studies are showing similar outcomes for high risk women who birth at home which are all published in the Birthplace study).
But why is this? Remember this isn’t based on ACTUAL place of birth but PLANNED place of birth (so includes those transferred to hospital). How can there be such a variance?
Why are more women starting to consider a homebirth?
Homebirth isn’t a new fad… women have been birthing at home (or caves, woods, settlements etc) since time began. On the other hand, hospital is in fact a new introduction to births with women only really commonly going to hospital since after the second world war.
In the UK, however, only around 2% of women birth at home. This is starting to change. The Birthplace study found such massive improvements to women’s care that it influenced the NICE Guidelines which now state that all low risk women should be offered a homebirth.
The biggest thing is that to change culture around birth is a massive paradigm shift – from women and health care professionals. The biggest outcome of the study was that giving birth was VERY SAFE.
Are there any risks to homebirth?
For first time mums, there was a very tiny increase in negative outcomes described in the Birthplace study – however, what the study did show is that midwife led care in a midwife led unit or birth centre, was safer for low risk first time mums, that for those women to birth in a hospital. However, this was a very tiny margin.
For second/third/etc time mums – the SAFEST place for them to give birth was at home.
Even for high risk mums (ie high BMI, advanced maternal age, vaginal birth after a caesarean), there were still huge benefits to birthing at home and women were much more likely to have intervention free births. The transfer rates to hospital, however, were higher but overall outcomes very good.
Why are there better outcomes?
Here’s my beliefs
The MOST needed hormone for birth but yet the shyest. It’s so temperamental and will hide when it feels under stress. It’s the same hormone that women have when the orgasm. And as such needs very similar environments to be released.
When oxytocin is released there’s a cascade of hormones including the super important endorphins. When oxytocin is released it means that our NATURAL pain relief is also released. I talked extensively about this in the Pain and Childbirth mini series which you can now find on youtube.
Oxytocin is easily susceptible to disruption therefore moving between space or anxiety can cause it to stop. So this might be knowing when to go to hospital, going to hospital and being sent home, dealing with a change of environment and people – are all going to halt oxytocin. And this is pretty typical for those who plan a hospital birth.
When we birth at home we can manage the environment in a way that means we can release all the right hormones, we can manage disturbances, we can move freely, we feel safe in a familiar space, we can eat and drink freely.
In hospitals – often we don’t feel comfortable in the space – it’s not a safe space for us. It’s filled with equipment. There’s a bed in the middle of the room. At home VERY FEW women give birth on the bed. They will normally find a small dark safe space where they feel comfortable.
And what does bed signify? Think about hospitals and beds… who do we see on them? Generally sick people…. When you are pregnant and giving birth – you are not sick – it is not a medical emergency. It’s your body doing a NORMAL PHYSIOLOGICAL FUNCTION.
At home – you are in control of the environment but also who comes into that space. Specifically, in the hospital you have little control of who is coming into the room, there are shift changes, sometimes registrars and consultants, midwives coming to sign off monitoring charts, I’ve seen ward rounds where 8 people turn up in the room to watch the labouring woman (please include this in your birth plan – no ward rounds). You have very little control if it’s dark or light, warm or cold. How it smells or feels.
This is probably one of the biggest things where we lose our sense of power – suddenly we’re in a space where we don’t have control of what, who or how things are being said or happening to us.
I feel often that what goes wrong is the loss of sense of control and boundaries with our birth – including what’s happening to us, who’s touching us, what they are doing to us. It’s almost as though when we enter a different space that we lose autonomy and control of our bodies.
When this happens, we go into our primal brain and fear mode. It’s this that makes birth harder, more painful and slower.
- The care
Most care is super respectful that I’ve witnessed both at home and in hospital – and especially recently here in Edinburgh. I know this is not always the case and I know care can also be on the biggest causes of birth trauma.
What I think is different between a homebirth and a hospital birth is familiarity and also low-tech, hands-off care. It’s a different skill set. It’s not that it is not done in the hospital, I think the difference is expectations between home and hospital and what is the standard procedure.
Also even in homebirths where there is a transfer is needed, the midwife has helped to go through the decision making process so mum isn’t sitting there thinking… when should I phone, when should I go in… there’s something there about confidence that it’s the right decision.
And finally, there is familiarity between the midwife and the woman. Whilst it might not be the midwife you have been seeing, it is very likely to be a midwife that you know of and certainly one that knows about you because they’ve discussed it at their homebirth meetings.
Finally, women who CHOOSE to have a homebirth and in the right mindset and are generally educated and informed about birth. They don’t believe that birth is a scary, awful and dangerous event. They know that birth is VERY VERY SAFE and as such they have that confidence and belief in their body to give birth.
That mindset is super helpful in achieving your birth and certainly giving you the confidence that you can deal with whichever scenario happens.
We know that mindset is no guarantee that you will birth at home – but confidence around birth and knowing what decisions you might need to make is super helpful.
What about if I need to go the hospital?
This is super important – just because you are having a hospital birth does not mean that you are going to have a bad birth. There is a lot of learning that we can take for this above that you can incorporate into your birth plans/preferences so you can still achieve a positive birth. We focus in on so many of these in our Birth Bundle.
Labour at home, birth in hospital
The best all time advice I’ve heard is from my friend Gemma Nealon who is a practising midwife and hypnobirthing teacher in Edinburgh. Her advice is to labour at home for as long as is possible and then birth at the hospital. This will achieve probably as good results.
Want to start making your own decisions?
If you’ve found this interesting and helpful then download the 101 Questions About Birth which is in the Resources Bundle and you will find the Birth Bundle super helpful for maximising your chance of a fantastic birth. All of these will help you get more informed and when you’re more informed and can make your own decisions, you are going to have a good birth.
A massive thank you to Cathy Williams for help with the information gathering. Cathy has been helpfully unpicking and publishing the data from the Birthplace study over the last few months and it was this that generated this blog. What she doesn’t know about the research in this area isn’t worth knowing. Go check her out at Chilled Mama.