Homebirth in the UK

by Brighton Homebirth Support Group

© 2002 Midwifery Today, Inc. All rights reserved.

Brighton Homebirth Support Group

Why Choose a Homebirth?

In previous generations homebirth was the norm. It is only fairly recently that it has been viewed as reckless, eccentric and even selfish.

With the backlash against decades of hospital-based interventionist obstetrics and increasing evidence of homebirth's safety, homebirth is gaining a renewed respectability amongst many parents and professionals.

There are many reasons people choose to give birth at home, and most have more to do with feelings than statistics. Conception, pregnancy, birth and breastfeeding are wonderful natural processes, and women are commonly reluctant to see labour as a medical event. This attitude is more easily fostered outside the hospital ward. In hospital you are far more likely to experience interventions in labour, such as electronic fetal monitoring, artificially ruptured membranes, or an oxytocin drip to speed up a "slow" labour.

Most people associate hospitals with being ill. Women may feel passive and alienated in a labour ward, unable to achieve the concentration and tranquility needed to manage contractions, distracted by strange surroundings and interruptions from staff, and even distressed by other labouring women.

Any increase in stress can dramatically increase the perception of pain, leading to drugs to relieve it. Even the journey into hospital can have a negative effect on labour; many women report that their contractions stop or slow down by the time they arrive.

While many hospitals are making welcome efforts to humanise the labour ward, ridding themselves of such unnecessary and degrading procedures as enemas and pubic shaving, there is increasing evidence that many common interventions can cause more problems than they solve.

"It is usually taken for granted that hospitals must be safe because they have the equipment and skilled staff to deal with medical emergencies," says Sheila Kitzinger, author of Homebirth and Other Alternatives to Hospital, "but sometimes they are the cause of these emergencies in the first place."

Over-reliance on electronic fetal monitoring makes caesarean section more likely, rather than less, with no evidence that it saves babies' lives. Induction can mean more painful, more managed labours, and you are much more likely to have an episiotomy in hospital than at home.

A bad experience is a bad introduction to motherhood, resulting in "Loss of control in giving birth in the early period of motherhood and affecting the relationship with the new baby," says Nicky Wesson, author of Home Birth.

Although safety is usually uppermost in any couple's mind, delivering a healthy baby is not the only criterion of a successful labour. Childbirth is one of the most intense emotional, as well as physical, experiences for any couple. The sheer power and joy of birth can survive a negative experience, but all too often something is lost.

Most women report far more satisfaction and fulfillment from birth at home than in hospital. Homebirth gives parents important psychological advantages. The knowledge that those caring for them come as guests makes the woman much more of a partner in labour than a patient, while for many the familiar surroundings give them confidence in their own beliefs and in the ability of their bodies to give birth without aid or intervention.

Wesson believes labour at home gives control back to the woman. "Not only are the professionals on alien territory…nothing will be done to her routinely or against her wishes. She is in a far better position to do exactly as she wants." This frequently means a shorter labour than in hospital.

Independent midwife Caroline Flint emphasises the benefits of a woman labouring in a place she has designed for her and her partner's needs. "It is totally unique; there is no other place the same. She can feel totally uninhibited when she wants to make a noise or if she wants to remove her clothes; she can be in the bath, leaning against the worktop in the kitchen, or sitting on a sofa in front of the TV having a fag and watching the racing—it is her choice, she is in charge."

Eating during labour, if not forbidden, is more difficult in hospital. Yet recent research has shown that this is frequently associated with swifter and easier birth. Home is also cleaner—or at least the germs are more familiar. A 1987 National Childbirth Trust (NCT) survey found that nearly 22 percent of women in hospital contracted a postnatal infection, compared with nearly 5 percent at home.

Many women feel home is the right environment for their newborn. They have much more say in how the baby is treated at birth and are able to behave more naturally. The luxury of getting into your own bath and bed, with no fear of being separated from your baby or partner and no nights disturbed by the cries of other newborns, cannot be underestimated. The home environment, in the warmth of the family bed, is probably the prime place to establish successful breastfeeding. Home, in all ways, offers the best beginning you can hope for.

For second-time parents, homebirth has even more to offer. Women have more idea what to expect during labour, and older children are spared the double trauma of a new sibling and the prolonged absence of their mother and father. "Women whose babies have been born at home really do seem to find that it makes it easier for the other children to accept," says Wesson. "A toddler's feelings at meeting a new brother or sister in hospital can only be guessed at. It must be daunting to find not only that your mother is in bed in totally strange surroundings in a room with a lot of other women, but also that the baby has her all to itself."

It is also a lot easier to have older children present at the birth. There is enough anecdotal evidence to suggest that children bond more quickly and strongly with babies if they feel part of their actual birth.

Many consultants and doctors are still convinced, however, that homebirth is unsafe for mothers and babies. The crude use of statistics in the past means that clinicians and parents have been misinformed for many years, and modern obstetrics is largely a science of abnormality in labour, even though the majority of deliveries are straightforward.

As Kitzinger and others have pointed out, the postwar policy of encouraging women to give birth in hospital coincided with a general rise in the standard of living, leading to more healthy lifestyles and eating patterns. As a result the perinatal mortality rate, that is deaths of babies around birth, dropped to an all-time low of around eight deaths per 1,000.

"Obstetricians claim that this is due to better obstetric services and to the policy of hospital birth for all," says Kitzinger. "Yet still today women who are at the bottom of the social scale—whose partners are manual workers or unemployed—are twice as likely as middle-class women to have a baby who dies.

"Social differences—education, general health, access to information, housing conditions, nutrition, attitudes to smoking, and ease of communication between care givers and patients—have a powerful effect on the perinatal mortality rate."

Unfortunately, official statistics are tainted; homebirths have been lumped together with unplanned, out-of-hospital deliveries. Unplanned births can include teenagers hiding a pregnancy, mothers giving birth on the way to hospital, women delivering prematurely and unexpectedly, or those who receive no antenatal care at all.

Most women, and certainly nearly all doctors, believe hospital is the safest place to give birth, and research to the contrary has generally been ignored.

Fortunately things are changing. In July 1992 the Winterton report was published. It contained the findings of the Select Committee on Maternity Services, which at last questioned the assumptions that hospital birth is the safer option. The government response also recognised women's right to homebirth.

We would like to thank Tandbrige Home Birth Group and Colchester Home Birth Association for their contribution to the material in this pack. We would also like to acknowledge our obligation to Sheila Kitzinger, Nicky Wesson, Vicki Junor and Marianne Monaco.

Safety

"Homebirth has been given such bad press that there now exists the need to redress the balance and challenge the widespread myth that hospital is the only safe place in which to give birth" (Ros Claxton, Birth Matters).

Every parent opting for a homebirth worries at some point about the issue of safety. Having a baby in hospital is the norm in our culture; try finding a children's book on the birth of a new sibling that doesn't show a hospital ward.

Breaking with convention is always frightening. Although many people regard homebirth as risky, there is no statistical evidence to prove this. In fact, there is a growing body of research that indicates just the opposite—that birth at home is safer than birth in hospital.

Until fairly recently it was difficult to get an accurate picture of the safety of homebirths, as official statistics included unplanned births outside hospital—often very risky indeed.

In Britain, lecturer and research statistician Marjorie Tew was the first to challenge conventional assumptions that the rise in hospital births was directly responsible for the drop in deaths. She set her students an exercise to prove that birth was safest in hospital, but their findings surprised them all. For many years ignored and discredited, her research is now widely recognised. Using statistics from the national perinatal surveys of 1958 and 1970, to which obstetricians made a significant contribution, she has done much to revise opinions about the safety of homebirth. Tew's analysis of 1986 statistics for the Netherlands, where more than a third of women give birth at home, shows a perinatal mortality rate of just 2.2 per 1,000 birth at home, compared with 13.9 for hospital. Although only low-risk women are accepted for homebirth in Holland, leading to a higher proportion of high-risk mothers giving birth in hospital, homebirth is still significantly safer.

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.

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.

Transfer Into Hospital

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:

Before Labour

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.

During Labour

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.

After Labour

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:

• What are the indications for transfer?
• What are the benefits of a transfer?
• Are there any risks involved in going to hospital?
• Are there any alternative treatments?
• What will happen if nothing is done?

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.

How to Arrange a Homebirth

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.

What to Do When You Go Into Labour

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.

Useful Numbers

Community Midwives' Room, Royal Sussex County Hospital: 01273 685417. Labour Ward, Royal Sussex County Hospital: 01273 687599

(See Useful Addresses section for further contacts.)

What Do I Need?

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.

Other things you might find handy:

• A couple of terries or disposable nappies. If your waters break early in labour they are much more effective than sanitary towels.
• An Aquavac or Vax, just in case. They are pretty effective at cleaning up accidents.
• Plasticine. Useful to block up the overflow drain if you want to wallow in a really deep bath.
• Plenty of clean towels.
• Bin liners for the rubbish. A plastic bucket or washing up bowl for the placenta.
• A portable lamp in case you need stitches.
• Food. Don't forget to feed your midwife, especially if this is a first baby. You don't want her to faint from thirst and hunger! If you have an appetite, you should also eat in labour. Women fare a lot better if they keep up good blood sugar levels. Try easily digested foods and fruit, such as bananas.
• Drink. Save the champagne until after labour. Alcohol can slow things down. Stick to fruit juice and soft drinks.
• Confidence. Your baby will know what to do and your midwife will be there to help.

For the baby (hard to believe, but there will be one!):

• A clean sheet or towel to wrap her up immediately after delivery. The midwife will check that you have the birth room warm enough.
• Baby clothes. Have them ready, ideally warming on a radiator. Enjoy doing this in early labour. Unpacking the tiny little sleepsuit is one of the best bits.
• Disposable nappies make the first weeks easier, even if you intend to use terries. Square terries are often far too large for a tiny newborn, but the shaped varieties may fit better.

Other:

• Camera or video recorder. Plenty of film. Bear in mind, however, that most newborns hate flashes from cameras and are easily startled.
• Massage equipment, homeopathic remedies, aromatherapy oils. Whatever you consider would be most helpful to you during labour.
• Nursing bras, clean pyjamas and sanitary pads.
• Other things you might find useful, especially in a long, leisurely labour, are a cassette player and tapes, candles and matches, face cloth or sponge, socks for cold feet, a plant spray filled with cold water for the face, eau de cologne, hair clips to hold long hair away from the face. Don't be surprised if you never get round to using them though!

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.

All About Us

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.

Jo Davis and Jon Sands

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.

Josey Maciel and Michael Traub

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.

Sally Green and Geoff Harding

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.

Common Questions

What About Our Other Children?

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.

What About the Father?

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.

What About Pain Relief?

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.

Recommended Reading

Homebirth

• Homebirth and Other Alternatives to Hospital, Sheila Kitzinger (Dorling Kindersley, 1991)
• Home Birth, Nicky Wesson (Macdonald Optima, 1990)
• Home Birth Handbook, Viki Junor and Marianne Monaco (Souvenir Press, 1984)
• Birth at Home, Sheila Kitzinger (Oxford University Press, 1980)
• Who's Having Your Baby? The Health Rights Handbook for Maternity Care, Beverley Beech (Health Rights Project, 1987)
• Where to be Born? The Debate and the Evidence, Rona Campbell and Alison MacFarlane (National Perinatal Epidemiology Unit, 1988)
• "Choosing a Home Birth," The Association for Improvements in Maternity Services (Aims) leaflet
• "Giving Birth at Home," National Childbirth Trust leaflet (1987)
• Safer Childbirth? Marjorie Tew (Chapman and Hall, 1990)

Pregnancy and Birth

• Birth Matters, Ros Claxton (Unwin, 1986)
  
• Birthrights, Sally Inch (Green Print, 1989)
• Sensitive Midwifery, Caroline Flint (Heinemann, 1987)
• Maternity Rights Handbook, Evans and Durward (Penguin, 1984)
• Giving Birth: How It Really Feels, Sheila Kitzinger (Gollanz, 1992)
• Your Choices in Pregnancy and Childbirth, Lewison (Ebury Press,1991)
• New Active Birth, Janet Balaskas (Thorsons, 1989)
• Water Birth, Janet Balaskas and Yehudi Gordon (London, 1990)
• Primal Health, Michel Odent (Century, 1986)
• Birth Reborn, Michel Odent (Fontana, 1986)
• The Experience of Childbirth, Sheila Kitzinger (Penguin, 1987)
• The Encyclopedia of Pregnancy and Birth, Janet Balaskas and Yehudi Gordon (MacDonald, 1987)
• Freedom and Choice in Childbirth, Sheila Kitzinger (Penguin, 1988)
• Pregnancy and Childbirth, Sheila Kitzinger (Michael Joseph, 1980)
• The NCT Book of Pregnancy, Birth and Parenthood, Glynnis Tucker (Oxford University Press, 1992)
• Spiritual Midwifery, Ina May Gaskin (Book Publishing Co., USA, 1977)
• The Gentle Art, Penny Armstrong and Sheryl Feldman (Corgi, 1986)
• Immaculate Deception, Suzanne Arms (Houghton-Mifflin, 1975)
• Birth Without Violence, Frederick Leboyer (Fontana, 1977)

Parenting

• The Continuum Concept, Jean Liedloff (Futura, 1976)
• Three in the Bed, Deborah Jackson (Bloomsbury, 1990)
• The Parents' Book, Ivan Sokolov and Deborah Hutton (Thorsons, 1988)
• Women as Mothers, Sheila Kitzinger (Fontana, 1978)
• Shared Parenthood, Johanna Roeber (Century, 1977)
• Babyhood, Penelope Leach (Penguin, 1986)

Breastfeeding

• Bestfeeding, Renfrew, Fisher and Arms (Celestial Arts, 1990)
• The Experience of Breastfeeding, Sheila Kitzinger (Penguin, 1979)
• The Politics of Breastfeeding, Gabrielle Palmer (Pandora, 1988)
• The NCT Book of Breastfeeding, Mary Smale (Ebury Press, 1992)
• Breastfeeding Your Baby, Sheila Kitzinger (Dorling Kindersley, 1989)
• Breast is Best, Drs. Penelope & Andrew Stanway (Pan, 1983)

Useful Addresses

Local

Brighton Health Care
Royal Sussex County Hospital
Eastern Road
Brighton BN2 5BE
Tel: 01273 696955

Family Health Services Authority
Springman House
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
support)

National

Home Birth Reference Site
www.homebirth.org.uk
(Further information on homebirth in the UK)

Birthright
27 Sussex Place
Regent's Park
London NW1 4SP
Tel: 0207 723 9296
(Raises money for research and
produces leaflets on aspects of
maternity care)

Special Delivery
34 Elm Quay Court
Nine Elms Lane
London SW8 5DE
020 7498 2322
(Independent midwifery care and
advice on homebirth)

Independent Midwives Association (IMA)
www.netcomuk.co.uk/~pvan/ima.html
Nightingale Cottage
Shamblehurst Lane
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)
www.aims.org.uk
Beverley Lawrence Beech
21 Iver Lane
Iver
Bucks SL0 9LH
Tel: 01753 652781
(Information and advice to parents and
health workers on all aspects of
maternity care)

Association of Radical Midwives (ARM)
www.midwifery.org.uk
The Coppice
62 Greetby Hill
Ormskirk
Lancashire L39 2DT
Tel: 01695 572776
Contact: Ishbel Kargar
(Supports those with difficulty
getting good maternity care)

Maternity Alliance
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)

Tens Hire

Obtens Tens Hire
17 Theresa Avenue
Bishopston
Bristol BS7 9ER
Tel: 0117 942 9221

Neen Pain Management Systems
Old Pharmacy Yard
Church Street
East Dereham
Norfolk NR19 1DL
Tel: 01362 698966

Active Birth

Active Birth Centre
www.activebirthcentre.com
25 Bickerton Rd
London N19 5JT
020 7482 5554

Active Birth classes in Brighton
Contact:
Karel Ironside
Tel: 01273 552698

Postnatal

Association of Breast-Feeding
Mothers
10 Herschell Road
London SE23 1EN
Tel: 020 8778 4769
(Education and local support groups)

La Leche League
www.stargate.co.uk/llgb/
BM 3424
London WC1N 6XX
Tel: 020 7242 1278 (24 hours)
(Encouragement, information and
support for breastfeeding mothers)

National Childbirth Trust (NCT)
www.nct-online.org
Alexandra House
Oldham Terrace
London W3 6NH
Tel: 020 8992 8637

Birthing Tubs

Gentle Water Birthing Pools
www.gentlewater.co.uk
50 North Way
Lewes
BN7 1DJ
Tel: 01273 474927

Birthrites Birthing Pools
1 Vicarage Cottages
Iford, Near Lewes
East Sussex
BN7 3EJ
Tel: 01273 475 307

Splashdown Water Birth Services
www.waterbirth.co.uk
17 Wellington Terrace
Harrow-on-the-Hill
Middlesex HA1 3EP
Tel: 0870 44 44 403

Birthworks
www.birthworks.co.uk
Unit 9 Fiddlebridge Lane
Hatfield
Hertfordshire
AL10 0SP
Tel: 01707 880333
E-mail: Birthworks@birthworks.co.uk

Active Birth Centre
www.activebirthcentre.com
25 Bickerton Rd
London N19 5JT
020 7482 5554

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