Why do some women choose a home birth?
- The see birth as a natural process and don’t see the need to be in the hospital
- They dislike the hospital environment: the noise, business, etc.
- They want to avoid having to stay overnight at the hospital
- They do not want to be separated from their other children
- They want to have a water birth
- They feel more comfortable at home
- They want to avoid hospital acquired infections
- The list goes on as every woman may have different motivation for choosing a home birth
Advantages of a home birth for the mother
Canadian Research based evidence:
- Mom is less likely to hemorrhage,
- Decreased risk of needing a c-section,
- Require fewer procedures during labour: forceps or vacuum,
- Decreased risk of perineal tears, and
- Overall, fewer intrapartum interventions needed.
Advantages of a home birth for the baby
Canadian Research based evidence:
- Less likely to require resuscitation,
- Less likely to have birth injuries,
- Less interruptions for breastfeeding, and
- More bonding time with mother.
Is a home birth safe?
Research has shown that home births are AT LEAST AS SAFE AS hospital births for women with low risk pregnancies.
Canadian Research: Literature Review
Hutton, K.E., Cappelletti, A., Reitsma, H.A., Simoni, J., Horne, J., McGrefor, C., & Ahmed, J.R. (2015). Canadian Medical Association Journal. doi: 10.1503/cmaj.150564
The purpose of this study was to compare neonatal mortality, morbidity and rates of birth interventions between planned home births and planned hospital births in Ontario. The provincial database was used for all midwifery booked pregnancies between 2006 and 2009. The outcome measures were stillbirth, neonatal death, serious morbidity, and resuscitation. Eleven thousand four hundred and ninety-three births were compared to the same number of hospital births.
CONCLUSION: There were no differences in the adverse neonatal outcomes associated with home births compared to hospital births. As well, fewer intrapartum interventions were required among the home births.
Janssen, A.P., Lee, K.S., Ryan, M.E., Etches, J.D., Farquharson, F.D., Peacock, D., & Klein, C.M. (2002). Outcomes of planned home births versus hospital births after regulation of midwifery in British Columbia. Canadian Medical Journal, 166(3), 315-323. Retrieved from http://www.cmaj.ca/content/166/3/315.full.pdf+html
This study was conducted to determine the outcome for planned home births attended by registered midwives and compared it to the outcome of planned hospital births. The outcome of eight hundred and sixty-two planned home births attended by midwives was compared with those of planned hospital births either attended by a midwife or a physician.
- Women who gave birth at home required fewer procedures.
- Women were less likely to request or require epidural, be induced, require an augmentation or have an episiotomy.
- There was no increase in maternal or neonatal risk associated with a home birth attended by a registered midwife.
Janssen, A.P., Lee, K.S., Klein, C.M., Saxell, L., Page, A.L., & Liston, M.R. (2009). Outcomes of planned home births with registered midwives versus planned hospital birth with midwife or physician. Canadian Medical Journal, 181(6-7), 377-383. doi: 10.1503/cmaj.081869
This study was conducted in 2009 and the purpose was to evaluate the outcomes of planned home births with registered midwives compared to planned hospital births. All planned home births between January 1st 2000 and Dec 31, 2004 that took place in British Columbia and were attended by registered midwives were included in this study (n=2889). As well, all planned hospital births that were attended by the same midwives, over the same time frame were included in the study. The outcome measure was perinatal mortality, secondary outcomes, obstetric interventions and maternal and neonatal outcomes.
- The planned home births were less likely to require obstetric interventions.
- Newborns were less likely to require resuscitation at birth.
- The planned home births, in which a registered midwife is in attendance, were associated with low risk of perinatal death, and a reduced risk of adverse perinatal, maternal and newborn outcomes.
Johnson, C.K., & Daviss, B. (2005). Outcomes of planned home births with certified professional midwives: Large prospective study in North America. The BMJ, 330, 1-7. Doi: http://dx.doi.org/10.1136/bmj.3307505.1416
This study aimed to evaluate the safety of home births in North America in which a registered midwife was in attendance. The study included all home births that involved midwives across the United States and Canada in the year 2000. The main outcome measures were intrapartum and neonatal mortality, perinatal transfer to a hospital, medical interventions during labour, maternal satisfaction and breastfeeding.
CONCLUSION: Only 12.1% of the women planning home births required transfer to hospital. 4.7% required medical interventions which included epidural (4.7%), episiotomy (2.1%), forceps (1.0%), vacuum extraction (0.6%) and caesarian section (3.7%). These rates are substantially lower than those of women having hospital births. In conclusion, planned home births for low risk women, in which a registered midwife was in attendance, were associated with lower risk of intrapartum and neonatal mortality as well as lower rates of medical interventions.
AM I A SUITABLE CANDIDATE?
The “must have” list:
- Normal, healthy pregnancy
- Normal position: head down (cephalic)
- Full term: 37 weeks +
Some examples of why a hospital birth would be advised:
- Placenta previa (placenta is covering the cervix)
- Twin pregnancy
- Health concerns related to the mother
*If you have any questions about whether you are a suitable candidate, please speak to your midwife at your next visit.
What needs to be done to prepare for a home birth?
You will be given a “birth box” around your 37-week visit. This box includes some necessary supplies for the birth.
Birth box supplies:
- IV Supplies including saline (contains sharps)
- Blood draw equipment
- Pads, sterile gloves, sterile sponges, sterile drape, peri bottle, elastic underwear, sling, cord clamp, herbal bath, etc.
- Postpartum package – breastfeeding matters and discharge package from public health.
*Keep this box in a safe place, away from young children, as it does contain sharps. Also, please do not open the box until it is needed.
Things you need to do to prepare your home:
Prepare the bed: (Even if you are planning a water birth, you should still prepare the bed in case you are required to move to the bed for the remainder of the birth.)
- Put on a good fitted sheet
- Put on a good top sheet
- Cover with a plastic sheet or shower curtain
- Next is a clean but OLD fitted sheet
- Last is a top sheet and other blankets you want to use for the birth.
Have the following items ready:
- 4 to 6 pillows
- 2 medium stainless steel bowls (one in case you are nauseous, one for the afterbirth)
- 4 to 8 clean older towels (to use as cool compresses)
- 6 large clean older towels (to wrap the baby in)
- 6 receiving blankets
- Hot water bottle or heating pad (or both)
- Loose gown or something comfortable to wear
- 1 package of overnight sanitary pads
- Digital thermometer
- 1 large roll of paper towel
- 1 package of soft toilet paper
- 2 newborn size baby caps
- Pain medications for after pains (acetaminophen (Tylenol), ibuprofen (Advil), gravol
Supplies for the baby:
- Diapers – disposable are a good choice at first
- Vaseline – to keep the meconium stools from sticking to the baby
- Clothing & hat – have them clean and ready
- Car Seat – have ready in case you should transfer to the hospital
Supplies for the Mother:
- Pack a suitcase as there may be a chance that the birth will need to be transferred to the hospital, so having it ready will make it a lot quicker and prevent you from forgetting something.
What to expect when you are in labour
Once you are in active labour the midwife will stay with you. This midwife is the Primary midwife and is responsible for you.
The second midwife arrives just before the birth and stays for a couple of hours after the birth. The main responsibility of the second midwife is the care of the baby and to assist the primary midwife.
What will the midwife do?
- Monitor mom and baby (including vitals, fetal heart rate)
- Provide comfort measures, and
- Set up equipment and ensure the equipment is prepared for the birth.
How do midwives respond to emergencies?
Midwives are trained professionals that know how to respond to emergencies.
Midwives carry the same equipment available at a Level One Community Hospital:
- They carry oxygen and resuscitation equipment for babies who may be slow to breathe. They can intubate the baby if needed.
- They carry drugs that treat heavy bleeding after delivery (oxytocin, misoprostol).
- The midwives are trained and have the skills to repair episiotomies and tears (suturing).
What happens if there is a complication?
Complications may include:
- Slow progress
- Concerns about baby
- Concerns about mother
If there is a complication, the midwife will advise that there will be a transfer to the hospital. Transfers will take place by car or an ambulance depending on the severity and urgency.
Example: If these is more pain management required (such as epidural), the transfer can be by car.
Example: A postpartum hemorrhage, the client will be transferred by ambulance.
*The midwife will still be with you when you are transferred to the hospital.
Some emergencies/situations requiring transfer to hospital:
- Shoulder dystocia – anterior shoulder gets stuck against the pubic bone
- Postpartum hemorrhage – abnormal bleeding
- Abnormal fetal heart rate
- Failure to progress (require augmentation) – Oxytocin is needed in order to regulate the contractions.
*Your midwife will go over these in more detail around your 37-week visit.
If the baby comes out before the midwives arrive?
- Get on your hands and knees to keep pressure off the cervix.
- Call 911, and tell them you need to call your midwife.
- Have your partner help you to “pant like a dog” to slow down the process.
- If the baby keeps coming, lay on your side!!
- Once the baby comes out, dry the baby off with a towel and place the baby skin to skin, covering with a warm and dry towel or blanket
- Put a hat on the baby’s head
- DO NOT CUT THE CORD, the midwife will do that when they arrive.
- DO NOT DO ANYTHING WITH THE PLACENTA.
*At the back of your binder, there will be an orange coloured sheet explaining everything to do in this scenario.
What pain relief is available?
Women who labour and deliver at home tend to be more relaxed and feel more in control.
At home, midwives promote and provide self help techniques:
- Breathing & relaxation techniques,
- Warm water (bath or shower),
- Different positions,
- Movement – swaying, walking,
- Sterile water injections for back labour, and
- Analgesics such as Tylenol.
*Should further pain medication be required, such as an epidural, morphine or nitrous gas, care will be transferred to the hospital.
OTHER HELPFUL RESOURCES TO REVIEW: RECOMMENDED READS
- Special Delivery, Rahima Baldwin, 1986
- The Midwifery Option: A Canadian Guide to the Birth Experience, Miranda Hawkins and Sarah Knox, 2003
- Homebirth: The Essential Guide to Giving Birth Outside the Hospital, Sheila Kitzinger, 1991
- Homebirth: A Comprehensive Guide to Planning Child Birth at Home, Nikky Wesson, 1995
- Home Birth: The Spirit, the Science and the Mother DVD, Sage Femme (available in our library)
Created for Quinte Midwives by Brianna Sitwell