Useful information to help you choose between a hospital or home birth.
Up until about forty years ago, most women gave birth to their baby at home. Following a series of reports, it was thought that hospitals were the safest place for most women to give birth. This means that now only one woman in 50 will have her baby at home, but, when the pregnancy is straightforward, research hasn't found any difference in the safety of having a baby at home or in hospital.
The main choice for most women is between giving birth in a hospital environment or at home. Hospital births are likely to be in a unit led by consultant doctors, however midwives deliver most of the babies where there are no complications. In some areas midwife-led care is offered, either within the same facilities as the consultant unit or in a separate birthing centre.
There are important factors that need to be thought through when you are making your decision. The main one being that of safety for you and your baby. Alongside this is your own preference, where you will feel more comfortable, more relaxed and more in control.
Each situation should be looked at individually.
When a hospital birth might be the right thing for you:
- If the mother has an illness such as, heart disease, kidney disease, diabetes, raised blood pressure, tuberculosis and habitual drug use.
- Although not everyone agrees, if you have had surgery to your uterus such as a previous caesarean, a previous difficult forceps delivery, haemorrhage after birth or a manual removal of the placenta, many midwives and doctors would advise giving birth in hospital. The best idea would be to discuss the situation fully with everyone concerned.
- You would be advised to opt for a hospital birth if you had placenta praevia (the placenta lies across the entrance to the birth canal). Also if you have a small pelvis and a big baby, (a possibility of cephalo-pelvic disproportion), pregnancy associated hypertension, more than one baby, pre-term labour and any Rhesus blood problems.
- If you want an epidural. To have an epidural requires hospital care and the services of an anaesthetist
- If you are under 18 or over 35.
- If this is your first baby or more than your fourth.
- If you are under five feet.
- If your pregnancy is very much over your expected date of delivery.
Good points about having a baby at home:
- Home is private. You can do your "own thing" more freely.
- Mothers having a baby at home often seem very calm. Remember, a relaxed mother means a relaxed baby, even before birth.
- There will be fewer people looking after you. However, hospitals/maternity units which offer midwifery teams and other schemes can give similar care.
- With fewer midwives you will get to know them really well and usually there is a build-up of trust between you and the midwives. This helps couples feel that the midwife is committed to helping them have the kind of birth they want. With this kind of relationship, it's easier to accept any change in plans if complications arise which make admission to hospital desirable.
- There is less intervention with a homebirth and less organised clock-watching.
- There is less disruption of family life, especially if you have other children.
- The natural thing to do when in labour is to move about, it is quite normal to be restless. However "homey" a hospital is, it's easier to be restless at home!
- Mothers in labour at home are more ready to adopt different positions for labour and birth. This encourages natural progress of labour.
- The need for strong pain-relieving injections is reduced in home births.
- You have access to your own bathroom.
- You can have whoever you like with you.
- You can give birth to your baby in whatever room you want.
What about pain relief if you are having a home birth?
Your midwife will take Entonox, 50% oxygen and 50% nitrous oxide (sometimes known as gas and air) to your house with a choice of mask or mouth-piece to breathe it in if you need it.
In addition you can, if you need it, have an injection of a strong pain-relieving drug like Pethidine. It is best to discuss this beforehand with your midwife so that you are all prepared.
If you are having a home birth you will not be able to have an epidural. To have an epidural requires hospital care and the services of an anaesthetist.
You can use TENS which stands for Transcutaneous Electrical Nerve Stimulation and current for the later stages. The strength of current-frequency is chosen by the mother. It is thought to stimulate the body's production of endorphins which are the natural analgesics or pain relieving substances produced in our central nervous system.
Remember your relaxation techniques, breathing exercises, music therapy, massage and changes of position. These are all positive ways of managing pain where you are in control and can be particularly effective in a home birth.