Home births: Advice from a midwife on the pros and cons

If you're pregnant and want to follow in the footsteps of the Duchess of Cambridge, you may be considering a home birth.

One provider of home birth services, Private Midwives says it's had a 44% increase in enquiries following the announcement that the Duchess is expecting her third child and reportedly wants to have the baby at home.

A new Private Midwives survey suggests 29% of mums would prefer to give birth at home, although the actual home birth rate is only 2.4% of deliveries.

The Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists have said they support home birth for uncomplicated pregnancies, stressing: "There is ample evidence showing that labouring at home increases a woman's likelihood of a birth that is both satisfying and safe, with implications for her health and that of her baby."

However, some women may shy away from home births because they fear not being in a medical environment at either a hospital or birth centre could put their baby's, or their own, health at risk should there be complications.

But the Home Birth Reference Site says research has found only 4.3 UK births out of every thousand have serious complications, and planned home, hospital or midwife unit births all have a low level of risk.

Mandy Forrester, the RCM's head of quality and standards, says: "Normally the women who choose to give birth at home have straightforward pregnancies, and the risk factors are very minimal, as long as there's a risk assessment and the woman has made the most appropriate choice for her.

"This is an experience we don't have very often in our lives, and it should be the best experience and as close as it possibly can to how you think it should be."

Home birth advantages

1. Being at home is more relaxing

The woman is in her own environment, with her own things around her. Mandy says: "It very much makes women feel more comfortable and relaxed, and labour will progress more efficiently."

2. Better relationship with the midwife

This continuity of care has a major impact on safety. Mandy says: "A midwife who knows the woman will understand the nuances around her behaviour and what she wants, as a trusted relationship will have built up. That's a real positive."

3. Family can be there

Children, grandparents and even pets can be at the birth if the mother wants them there.

4. Less pain relief needed

Pain relief such as epidurals and other medical interventions are used less frequently during home births.

5. Homebirth specialist midwives

Most midwives who deal with home births are trained to perform baby's first examination, checking its heart, lungs etc as a paediatrician or midwife would in hospital.

6. No hospital stay

The mother doesn't have to go anywhere afterwards - she's at home and can have that first period with her new baby without any interruptions. "It's quite magical," says Mandy. "Mothers have that uninterrupted time that must feel so much more comfortable, if that's what she wants to do."

Home birth disadvantages

1. Possible risk from medical complications

Sometimes a woman with medical complications or complexities such as a raised BMI or pre-eclampsia, may want a home birth when medical professionals want her to give birth in hospital.

"When that happens, you have to work with the woman and draw up a robust birth plan, discussing all the risk factors and outlining what the midwife may be looking for that indicates there's a need to go into hospital," says Mandy.

"If women start where they want to, even if they do transfer to hospital, they have more of a positive birth experience than if they're told right from the start they can't have a home birth."

2. Issues with access for an ambulance

Accessibility for emergency services can be an issue if a woman lives in a rural location, for example. Mandy says this isn't necessarily prohibitive, but very precise planning is needed to make sure emergencies can be dealt with swiftly and a woman can be transferred to hospital quickly if necessary.

3. Paramedics may be called

Midwives working at women's homes are trained to manage emergencies, but in dire situations such as placental abruption (where the placenta separates from the uterus), paramedics will be called for an emergency transfer to hospital.

"These are the situations that need to be discussed with women so they understand that if they do need to transfer quickly, it will have to be by ambulance," explains Mandy. "But a lot of women say even if there's the slightest risk, they want to be in hospital."

4. Neighbours should be prepped

If a woman's likely to scream a lot during labour, it's worth preparing the neighbours.

"If she's going to feel really inhibited in her own home by that, it may well be best that she's not at home, as all that inhibition will just slow down the oxytocin cycle that makes the contractions happen," says Mandy.