Homebirth….Really?

Homebirth….Really?

Written by midwife Julie Watson (UB Academy)

It’s the day you’ve been waiting for, your surges have started and you are excited and nervous in equal measures, but you’ve prepared for this day, you know you can do it, you’re a strong, powerfully awesome woman who is going to birth her baby.

When anyone is asked to visualise a woman giving birth, more often than not the environment that the birth is taking place in is a hospital setting and usually it involves a hospital bed. Most couples who join the Underwood Baby Academy will initially talk about hospital birth as their preferred option. When we get down to discussing these decisions it seems their choices have been driven by what is deemed the most normal choice, the safest choice and is what sits in couples subconscious, an image of birth that is supported by the media and engrained in our society’s view of birth. 

But what if we told you that the place you give birth could have a direct impact on the path your birth may take and the interventions that could occur?

Before we go into what homebirth is like today I think it’s important to go back in time, I want to take you on a trip down memory lane, a journey that has been forgotten and is rarely depicted on TV or in the way birth is portrayed.

The way a woman in the Western world is encouraged to give birth has changed dramatically throughout the 20th century and into the 21st century.

If we travel back to before the NHS was created in 1948, women birthed at home, supported by the elder women in their community and midwives and at the beginning of the 20th century, less than 5% of women gave birth in hospital.

The second world war ended and we moved into the 1950’s, hospital births became more normal and birth became a medicalised process, rather than a natural one. Women and their births became the property of the obstetricians, birth was treated as a pathology that needed treatment and women handed over responsibility of their labour and birth as they walked through the hospital doors.

As a result of this move, assisted births using forceps was more common and episiotomies were routine and women laboured and birthed on their own, without their partners. This approach to birth continued through the 50’s and 60’s and then in the 70’s things became a little more woman focused; imparting information became a focus. Dad’s were encouraged to be present at the birth and antenatal classes were produced to ensure couples were informed, however, routine enemas and shaving before birth remained the norm.

The positive impact of obstetric -led care was the women and their babies who had complications were given appropriate, expert care but this was a blanket approach which meant that women with uncomplicated pregnancies did not receive women-centre care and were exposed to unnecessary intervention. 

In the mid 70’s a seminal book called ‘Birth without violence’ was published by a French obstetrician called Frederick Leboyer. The book explored the birth environment, it challenged societies beliefs and revolutionised the course of birth. He promoted the rights of the baby to be born into a gentle, calm and dimly lit environment. He confirmed that things had been put in place to suit obstetricians but were detrimental to the effectiveness of labour and its progress. This book was pivotal and was quickly championed by other influential obstetricians, including Professor Fisk of the UK.

Now we know a little of the history and how we have got to where we are now, what is it really like today for women like me and you? Well thankfully today women have so much more choice, the NHS has sought to offer pregnant women a variety of options, all safe, all staffed by wonderful experts. There are three choices when deciding where to give birth, they are in a hospital labour ward, a midwifery led unit or your very own home.

If you go back to the beginning of the 20th century women gave birth at home, and this stopped following the creation of the NHS, this change in place of birth was not because it was an unsafe option for low risk women. Today when we talk to couples about homebirth there are normally two topics that hinder couples from choosing a homebirth for themselves… for low risk women. ‘It’s not safe’ and ‘I’m not allowed’.

Therefore to tackle the ‘not allowed’ view, everybody gets to choose the place they want to give birth, there are guidelines and recommendations related to homebirth and it is important couples know what these are, they need to have and understand all of the available research to make the decision that feels right for them, but when it comes down to it you call the shots.

We then move onto the question of whether homebirth is safe? Well the simple answer is YES. Labour ward environments can make uncomplicated labours more complicated, however it is important to say there are situations where labour wards are the most wonderfully positively and safe place to birth.

So, am I just a homebirth enthusiast with a skewed view of how safe homebirth is? Well yes, I am a homebirth enthusiast and I can be because there is a vast amount of research to support my enthusiasm.

In 2011 the Birthplace study in the UK looked at 64,000 women and from that study women with uncomplicated pregnancies had a reduced rate of intervention when comparing to giving birth on a labour ward.

It showed that for first time mums giving birth on a labour ward they had a 46% chance of achieving a vaginal birth compared to a 69% chance if they birthed at home and for second or subsequent pregnancies the chances of a vaginal birth on the labour ward increased to 79% and increased to an incredible 96% if they were giving birth at home.This was great news and the Birthplace Study included a good-sized sample of women.

However providing us with a further insight into the safety of home births, in 2019/2020 there was a follow up study which has been published by the Lancet. This study included countries who mirrored the midwifery-led approach which is now common place in the UK and included 500,000 babies, just wow!! The first critical finding is that for uncomplicated pregnancies, whether it is your first or subsequent baby homebirth is as safe as a labour ward, something midwives have been passionate about all along. This second and much larger study also supported the reduced risk of intervention that the Birthplace study outlined, women who birthed at home were found to have a 40% less chance of having a caesarean section, 50% less likely to have an instrumental birth, 60% less chance of needing a drip to speed up their labour and 55% less likely to have an episiotomy.

As you can see the research is vast and consistent, it is safe to choose a homebirth if that is what feels right for you. What we know is women’s bodies are made to birth but to do this effectively they need to feel safe, relaxed, unobserved and undisturbed, if these things are in place then the oxytocin will flow and the surges will follow. Home is the one place where women inevitabley feel relaxed, it is their space, it’s the place they feel uninhibited and this will ensure the hormones are undisturbed. 

‘Homebirth with midwives is not a trend. Hospital birth with doctors was a trend that lasted about 70-80 years before women began returning to what they know truly works.’ – Darlene Dorries- Serivne

https://www.npeu.ox.ac.uk/birthplace

https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(19)30119-1/fulltext

https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30063-8/fulltext

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