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In the old days of course, all women would labour and give birth in their own homes but over the course of the last century, as medical science developed, it became the norm to have a hospital birth. In fact, not only did it become expected that all mothers would have hospital births, but home births were discredited as an unnecessary risk and even selfish. These days however, the pendulum is slowly swinging back to a more balanced position. The number of home births is on the rise and the obstacles to homebirths are lessening. Home birth is still, however, tainted with an 'unsafe' reputation in many quarters, and many women still find that they have to overcome opposition from their doctors if they wish to have a home birth. So what are the real advantages of a home birth, and is it a 'safe' option?
Advantages of a home birth
- Familiarity - Giving birth in familiar surroundings can raise your confidence during labour, make you feel more in control (if all is proceeding well) and make you feel less inhibited: all of which can help ease labour.
- Low intervention - There's a far lower incidence of medical intervention in homebirths, whether that's prepping with shaving, having your waters broken, electronic fetal monitoring, medication or episiotomies. This is important because once medical intervention is initiated in a labour it's more likely that further intervention will be necessary, so your chances of a fully natural birth are usually higher with a home birth. It's also worth noting that the incidence of post partum haemorrhage for mothers rises following medical interventions such as assisted delivery and induction, both of which are common in hospital deliveries (though the rates of use may vary widely from hospital to hospital). For many women the lower rate of intervention at home is consequently an important factor in their decision to have a home birth.
- Privacy - The extent of privacy afforded by a home birth very much depends on your home, but even a flimsily-walled flat can offer more privacy than a hospital delivery room, where on occasion it can feel like half the medical staff is peering up your pins. With a home birth your birth will most likely be managed by one or two midwives with whom you have already developed a rapport and hopefully trust. It's important that you do trust your midwive for a successful and happy home birth, so particular care is needed in choosing one. Being able to control exactly who is present at the birth can increase your sense of control over the situation.
- Comfort - Birthing in your own home allows you to set the scene and arrange your surroundings in a way that will make you most comfortable and relaxed. You will also be able to use whatever alternative forms of relaxation and pain control you like to help you through labour, be that labouring in a waterpool, using aromatherapy, listening to music etc. In a hospital you may plan for these props but be more likely to end up without them: if there's someone else hogging the birthing pool just when your little one decides to think about an appearance you'll be out of luck.
- Mobility - Many hospitals do now encourage and allow for mobility during labour, but labouring women aren't always given the opportunity to move around as much as they'd like. Being able to move around can help manage the pain and help you find a more comfortable position, whether that's leaning over the basin, sitting on the loo or on all fours on the floor. It also serves as a good distraction during labouring. If you're hooked up for electronic fetal monitoring, which is more likely in hospital, your movements may be limited. What's more, wandering around your own house and garden may be far preferable to haunting the hospital corridors in your nightgown and slippers.
- Recovery & quiet - A significant advantage of a home birth is that you can start your recovery process in the comfort of your own home straight away. After the hard work of delivery it can make all the difference to be settled into your own bed and sheets, as TB member Daddyo found: "My wife was in her own bed within minutes - our son was born on the bedroom floor!". The peace and quiet of home is also a big plus - the last thing that new mums need is to be kept awake by the hollerings of other women labouring through the day and night - unfortunately in some hospitals this isn't a matter of choice.
- Germ control - While hospitals do their best to maintain clean wards and control cross-infection, it is naturally far more likely that you or your baby may pick up an infection in hospital surroundings given the sheer number of people in them.
- A family affair - Who's going to take the other children? Can we find a sitter for the dog? Did I leave a load in the washer? You can forget these worries with a homebirth. While you might still want a family member or friend to be on hand to help out with the rest of the family (and as a back-up in case you do need to transfer to hospital) you don't need to uproot your family and upset them with a separation. If you do have other children it can be wonderful for them to creep in to see mum and sibling in the hours after birth. It's a minor consideration - sorry guys - but it's also far nicer for your birth partner to spend the x many hours of labour with you at home where he can pop off and put the kettle on, rather than hanging around in a hospital falling prey to plastic cups of warm mud from the coffee dispenser.
Disadvantages of a home birth / hospital advantages
- Access to the trappings of the hospital - The weight of research indicates that homebirth is safe for most mothers with good health care (the exceptions being those with a medical background or pregnancy history that rules them unsuitable for home birth), in addition, when needed, most medical intervention is due to slow labour, in which case you would have plenty of time to transfer to hospital. But however good your midwives are, you're still distanced from "a big building full of trained doctors and lots of drugs", as one ThinkBaby member puts it, and if there are complications, or you really want an epidural once labour is underway, then you may face the mid-labour upheaval of a hospital transfer. If you aren't yourself comfortable with the idea of being at a distance from hospital then there's little point in considering a homebirth. Your birthing partner too, may have some reservations about this, and it's important that you reach an agreement you're both comfortable with. The distance of your home from hospital and condition of roads and traffic may influence your final decision.
- Ensuring rest - If you have a home birth and you're aware of your family's needs continuing around you then you may be tempted to get up and about before you've had your recovery time. It's important if you do have a home birth that you have family, friends or a home help to take care of the household and make sure there's no pressure on you to get back into the fray prematurely.
- Privacy? - If you have your own house then you're unlikely to disturb your neighbours when giving birth but if you live in a noisy conversion you might want to think twice about whether you'll be able to feel uninhibited in those conditions.
- Intervention rates vary - If the rate of intervention is one of your key reasons for considering a home birth, but you're reluctant to labour away from the full amenities of the hospital, then you might want to check out the rate of intervention when choosing a hospital. The approach to using induction, episiotomies and even caesarian sections can vary from hospital to hospital and doctor to doctor, so make sure you know where yours stand.
Next steps
If you're interested in exploring the possibility of a home birth then speak to your doctor or midwife. If there's any reason why the circumstances of your pregnancy or your medical history rule you unsuitable for home birth then your doctor will be able to advise you.
Some doctors and midwives are reluctant to allow home births, particularly with first pregnancies. If your carers attempt to put you off the idea without giving a reason particular to your own circumstances then don't be afraid to politely press the issue.
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