Where should I give birth?
I recently saw the headline: “What it feels like to give birth in a bus lane.” My heart went out to the mum whose husband delivered their fourth child after she went into labour in the car.
No one plans to bring their baby into the world by the side of a busy road, but many do deliberate over where they do want to give birth.
Your baby, your choice
This is what NICE (National Institute for Health and Care Excellence) says: “Where you have your baby is your choice, and you should always be supported in this choice.”
There are three usual options: at home, in a birth centre (also called a midwife-led unit) or in an obstetric unit (a hospital labour ward.)
Birth centres are more 'home like' and relaxed, with the likelihood of being cared for in labour by a midwife you already know, and a midwife looking after just you – “one-to-one care.”
Hospitals obviously have more medical facilities, and women who have had a medically complicated pregnancy, are expecting twins, have previously had a C-section, breech birth or a history of difficult labour will be strongly advised to birth in a hospital. Although emergencies arise rarely, they can turn suddenly into life-or-death situations for mother or baby. Unusual as this is, it is reassuring to know that lifesaving treatment is at hand.
Pain relief is another factor, as epidurals are only available in obstetric units. The flip side is that hospital births may come with unwanted intervention.
How many women have home births?
Parents often choose home births because they want to be in comfortable, relaxed, familiar surroundings. They want a birth in privacy and on their own terms, and the mother can look forward to recovery in her own bed.
Fewer women have home births than you might expect. There were 696,271 live births in England and Wales in 2016, and 2.1% of those took a place at home. This compares to 34% in 1960. In fact, the percentage of home births was in freefall from 1960 until the mid 70s, when it stabilised at around 2%. Women aged 35 to 39 are most likely to give birth at home (2.9%), according to the Office of National Statistics.
How safe is a home birth?
Yet research has found that home births for women with low-risk pregnancies carry no increased risk of harm to the baby compared with a planned hospital birth. The study, published in the Canadian Medical Association Journal, compared 11,493 planned home births and 11,493 planned hospital births and found the rate of stillbirth or neonatal death was 1 per 1000 births in each case.
Louise Silverton, Royal College of Midwives director for midwifery, said the research showed that, “It is wrong to assume that for women at low risk of complications, hospital birth is safer than that in a midwifery-led unit or at home.”
I have also been struck by new World Health Organisation guidance that medical staff should not intervene to speed up labour unless there are real risks of complications, because too many women are not having the experience of natural childbirth that they want. This overturns decades of previous advice.
I welcome this, because I feel that women do not have enough information about how safe home births actually are. My personal conviction is that it is each woman’s choice and she should birth where she feels most content. As long as the mother-to-be does her homework and weighs up her options, she should get the right support wherever she chooses to birth.
Deciding what's right for you
Some women have great fears about going to hospitals, and others fear having a baby at home. Some women like to birth in the knowledge that there is a medical team about should anything go wrong. Other women trust in their body and home-birth team.
It depends on each person and what they have heard from other mums. I know women who have taken years to conceive and won’t take any risks with a home birth.
Of course, not all mothers can give birth where they planned or hoped for. Some women need to be moved to hospital during labour if there are concerns about them or their baby. Others, after plenty of research and talking to friends, come to the conclusion: “I’d like to give natural childbirth a try.”
I support them all. Better than a bus lane!
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