Is home birth safe? How do I choose where to give birth?

These are questions that any pregnant person may have asked themselves whilst planning their pregnancy and birth. Whilst looking for answers, you may encounter lots of opinions, stories and myths about home birth. In this blog I bust 3 common myths about home birth that I hear quite often, so often in fact, that I think lots of people think them to be true. The evidence for all of this can be found at the bottom of the blog, so you can read the studies yourself if you want more details.

Myth 1: home birth isn’t safe

The truth: it’s safe for baby and safer for mum!

The evidence:

The Birthplace study 2011 is a pretty huge piece of research that has provided reassurance to those planning a home birth. It found that:

• Home birth and/or birth centre births are just as safe as hospital births for babies when the birthing person isn’t giving birth for the first time. (Here’s the detail: chance of adverse outcome for the baby of a first time birthing person planning a home birth was 9.3 in 1000, compared to 5.3 in 1000 for babies of mums who had given birth before- although more recent evidence contradicts this- see myth 2) 
• Home birth and/or birth centre births are safer for mum than going to hospital to give birth. They found that mums (regardless of whether they’d done it before) were significantly less likely to have a caesarean, assisted delivery or episiotomy when planning home/birth centre birth compared to planning hospital birth.
• It’s worth noting that the research looked at women with uncomplicated pregnancies.

Before first timers abandon their dreams of a home birth, give myth 2 a read, as there’s some more recent evidence you’ll want to hear…

Myth 2: It’s not safe to have your first baby at home

Truth: more recent evidence says the risk of neonatal (baby) or perinatal (mum) mortality ‘was not different when birth was intended at home or in hospital’ 

Evidence: Home Birth Meta Analysis – The Lancet 2019 (this is not a study itself, but a systematic review of lots of different studies) found that baby is as safe being born at home as in hospital, regardless of whether mum has birthed before. Again, this is in reference to uncomplicated pregnancies.

How can home be as safe as hospital?

People find it hard to believe that hospital isn’t safer than home as a place to give birth. So, let’s look at what actually happens at a typical home birth in order to try and make sense of the research and explain why home births are actually just as safe as birth centre births and safer (for mum) than hospital births.

Here are a few reasons that I can think of as to why home birth is safe.

Your own midwife

At home, your midwife is focused on you. In a hospital, they might be spread more thinly, looking after a few birthing people at once. If you think about it, it’s logical that it is therefore very safe to give birth at home with your own midwife. 

Home birth midwives carry specialist equipment and are well trained

Lots of people express concerns about home birth because they fear something going wrong and not having the excellent doctors and modern equipment on hand. This makes total sense, and is definitely something that I considered when planning my home birth. But when we look at the way home birth midwives work, we can start to understand why being at home doesn’t increase the likelihood of adverse outcomes for mum or baby, as we we might fear.

Firstly, midwives are experts in ‘normal’ birth and can spot things going wrong quite far in advance. If they have any concerns, they’ll talk to you about transferring to hospital in plenty of time. So, if you live reasonably close to a hospital, intending to birth at home is just that- an intention. It’s a first choice that you can review and re-consider during labour if necessary.

Secondly, the care you would receive for most emergency situations, such as baby needing help to breathe, or mum bleeding too much after the birth, isn’t actually different in the two settings. For example, home birth midwives have equipment to help baby to breathe, and they have the medications they need to help mum if she’s bleeding a lot.

You could be less likely to get an infection at home

You and your baby have already started to build up a resistance to the bacteria in your home, unlike the unknown bacteria of the hospital. Also, vaginal examinations carry a small risk of infection, and you may be less likely to be offered one if you’re at home. This is because a home birth midwife, having more time to focus on you and observe your labour unfolding, may feel there’s less reason for a vaginal examination (which is a much quicker, albeit far less reliable way of judging how labour is progressing). Of course, you can absolutely decline the offer of a vaginal examination wherever you give birth.

Birth hormones work better at home  

You’re more likely to produce those vital birth hormones if you’re uninterrupted and feel you have privacy. In a home setting, this is easier to achieve. Think of all the potential interruptions at a hospital: doctors coming in and out, shift changes, cleaning staff emptying bins and cleaning the loo… who enters the birth space at home? Whoever you want (and nobody else!) You might not think this has much to do with safety, but it does! Oxytocin (the birth hormone that we get when we feel happy, safe and unobserved) is not just a nice to have, but an entirely necessary part of birth. It’s literally what starts and keeps the contractions going. People who are induced are given a synthetic version of oxytocin to start their labour. Getting the birth environment right isn’t silly, woo or diva-ish! It’s logical and necessary. Without it, you might experience stalled labour or more painful contractions- these are not dangerous in themselves, but can lead to interventions that may then lead to things you don’t want becoming necessary, such as assisted delivery, episiotomy or caesarean.

Myth 3: home birth is too messy!

Truth: ok, it’s a bit messy, but nowhere near as messy as you’re probably imagining!

Buying a few waterproof sheets or mattress protectors or digging out some old towels is all you need to do to protect your beloved sofa or carpet! You’ll probably want something under you when the baby comes out, and something to sit on for a few hours afterwards. Other than that, it’s really not the scene from a Tarantino movie that you’re possibly imagining. 

Also, if you’re in a birth pool, which is one of the most popular reasons for choosing a home birth (where a birth pool can be guaranteed as you generally sort it yourself) then the mess is very much contained!

Is it a good idea to have a home birth?

Home birth isn’t for everyone and I wouldn’t ever try to persuade anyone to give birth somewhere that they don’t feel comfortable. But as I hear these misconceptions about home birth spoken quite often, I thought it was worth myth busting so that people can make informed decisions about where to give birth based on facts, not fiction.

Where’s the best place to give birth? Wherever YOU want to give birth, of course! 

Happy international home birth day and THANK YOU to all of the amazing home birth midwives who support women and birthing people who choose to birth at home. 

Evidence:

The Birth Place Study 2011

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

Home Birth Meta Analysis- The Lancet

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

Please note, this blog is not and should not be used as medical advice. Discuss your own personal circumstances with your health care providers.