Don’t Call Me Crazy: A Beginner’s Guide to Homebirth.

As some of you will remember, I had Primrose at our local Birth Centre, also known as a Midwife Led Unit (MLU). I really wanted a homebirth but, as we live in a boarding school and she was due in term time, I felt that the MLU was the right choice for us at the time. You can read about Prim’s arrival here. A smooth labour and positive birth there made me wish for a homebirth ‘next time’. As luck would have it, Wilf’s EDD fell within the summer holidays, meaning no students, and the topic of homebirth was firmly on my radar. 

When I think of home, I think of security, comfort and relaxation (most of the time) whereas, when I think of hospitals, I think of bright lights, illness and strange smells. Yet there seems to be a real anti-homebirth feeling in society: Just 2.1% of births in the UK took place at home in 2016. Sadly, mainstream media, as with anything that’s seen as ‘alternative’ – bedsharing, attachment parenting, homeschooling; the list goes on – has an absolute field day with it, often painting parents who make these choices as mad hippies and, at worst, peddling scaremongering stories, or mocking those who follow these paths. Indeed, the case of Agnes Gereb in Hungary rocked the midwifery world and has undoubtedly caused further damage to the reputation of homebirthing. However, it’s only in very recent history that hospital births have been popularised. Initially, they were extremely dangerous, with doctors performing autopsies on dead women before delivering babies immediately afterwards, spreading germs and causing an inordinate number of mother and baby deaths from puerperal fever. Thankfully, things have moved on in terms of hospital cleanliness, but the pendulum has swung so far the other way that the thought of homebirth, for some, seems alien and dangerous.

Space for the pool, with motivational bunting.

I am a firm advocate for women being able to choose where they give birth. For some, the clinical, sanitised setting of a hospital makes them feel safe. For others, being in one’s own environment, feeling cocooned and relaxed is the order of the day. I wouldn’t dream of questioning someone’s choice to birth in a medical setting, so got a little irked by the responses I got when I said we were planning a homebirth with Wilf:

“Oh my GOD, you’re brave!”
“You must be mad.”
“I couldn’t do that – what if something goes wrong?”

Homebirths, for women with low risk second (or subsequent) pregnancies, are deemed as safe as hospital births. Additionally, they reduce the likelihood of needing pain relief, an assisted delivery, or a caesarean section. This article from the NCT has further details of home birth safety. A homebirth also means two dedicated midwives whereas, in a hospital environment, one midwife may be overseeing multiple ladies, and shift changes can mean different faces throughout your labour.

So, with a (thankfully) low risk pregnancy and the need to keep things as normal as possible for Primrose, we set about researching what we’d need for this birth. Here’s what we discovered:

Trip to the DIY store for hose, bucket and tap connector. Cricket bat optional!

Am I allowed a home birth?
In short, yes. Where you give birth is entirely your choice so, if you’d like one (and aren’t planning an elective section), you can give birth at home. Of course, you may be advised against a homebirth if your midwife or consultant believe you to be ‘high risk’. Your previous births, certain health conditions, maternal weight and age… there are many reasons why women fall into the ‘high risk’ category.  If this is the case for you, as with everything relating to pregnancy and birth, it’s crucial that you use BRAIN when making your decision (What are the Benefits? Risks? Alternatives? What does your Intuition tell you? What happens if I do Nothing? The latter is less relevant here.) This is a great resource, listing all  ‘high risk’ scenarios and their possible outcomes at a homebirth.

In the UK, midwives are obliged to attend a woman birthing at home, regardless of whether or not they agree with her choice. Furthermore, should you call the Labour Ward to let them know you’re in labour and they are short staffed, they have a duty of care to arrange for midwives to attend. Further information is available on the Birthrights website – a fantastic resource.

I’ve decided on a home birth. What now?
You will have a home visit from a midwife – for me this was at around 36 weeks but different trusts vary. If you’re having a pool they will discuss with you where it is best placed. My trust generally tend to bring everything with them on the day – paperwork, inco sheets, pads, gloves, those cardboard things that you have to pee in, though some bring these in advance. We are quite remote and, as my first labour was fairly speedy, we were given this bag of delights (on the right) in advance.

Some trusts, such as Milton Keynes, have a dedicated homebirth team. meaning you can meet all the midwives ahead of your EDD, so they’re all familiar. This is fantastic for continuity of care.

Lots of the information the follows varies, depending where you live – it’s worth making a list of questions in advance to ask at the home visit.

Then you have some decisions to make and bits and bobs to gather…

The Birth Pool in a Box Eco (Mini)

To pool, or not to pool?
For me, a pool was an absolute must, as I found the water so comforting when I had Primrose. The two most popular brands are La Bassine and Birth Pool in a Box (BPIAB) and both can be purchased, along with anything HB related, at Made in Water or Home Birth Supplies UK, amongst others. Alternatively, there are various rental companies, including the highly regarded Mermaid at Heart, based in Hertfordshire, but serving the whole of the UK.
It’s a good idea to have the pool by 36-37 weeks. This means you have plenty of time for a test run, to check your hose is long enough and see how long it takes to fill the pool.

– Size and Space: At one stage, it looked as though we weren’t going to be able to have a pool – we had to wait for the thumbs up from a structural engineer to confirm that our floors were stable enough. We opted for a BPIAB Eco Mini – the smallest option but still easily spacious enough, with handles on the edge, and a cup holder. We sourced a second hand pool locally, then purchased a new liner and hose.

The size of the Mini and Regular BPIAB can be compared here, along with the La Bassine. Consider where you’ll position the pool and remember that you’ll need your birth partner, midwives and (if you’re having one), your doula to fit around the edge.

With regards to weight, you’ll be reassured to hear that I didn’t find a single story online about a pool coming through anyone’s ceiling. The BPIAB Mini weighs 487kg when 80% filled; the Regular, 659kg, and the La Bassine, 450kg. Add in your weight, plus that of your birthing ‘team’ and the total combined weight is roughly that of 10-12 adults. The structural engineer we spoke assured us it would be fine and advised us to use some sheets of plyboard to spread the weight further. If, like us, you live in a flat and cannot place the pool on a downstairs floor, your best position is near an external wall and over a supporting wall, in a corner or in front of a bay window.

– Hose: A new one is necessary every time the pool is used because they can’t be completely dried, so bacteria collects inside. A food-grade hose is recommended, but (again, after much research), we ascertained that a garden hose would work, so long as it doesn’t contain any nasties (phthalates etc) that will leach into the water. Hozelock have recently changed the components in their hoses and they’re safe to use.

– Tap attachment: The Home Birth UK group was great for things like this – there are often pictures of taps popping up and someone will comment with details of a suitable connector. There is also a brilliant hack with a plastic bottle, should you have very awkward taps!

– Pump: Though water can be siphoned back out of the pool once you’re done, or even emptied with buckets, a submersible pump makes things much quicker!

– Thermometer: It’s worth getting a decent digital one – luckily we realised this in advance as the one we initially bought was beyond useless.

– A bucket: As the pool gets topped up with warm water during labour, the midwives will need to remove water so the pool doesn’t overflow.

– A sieve: For removing ‘debris’ from the water. An interesting word for ‘poo’ if ever I’ve heard one!

(Almost) everything I could possibly need during labour.

Other useful equipment
– Floor covering: We had some plastic sheets taped down underneath the pool (shower curtains can be acquired cheaply for this purpose.). I also got a huge bundle of bath towels second hand, though your own towels can easily be washed. Had we not had the pool, we wouldn’t have needed many – it was mainly soaking up water that they were used for. Inco sheets from the midwife can be used to cover beds, sofa and carpets too.

If you aren’t planning to have a pool (or even if you are), think about your ‘dry land’ birth space. Sofa? Bed? Floor covered in cushions? Give lighting consideration, as well as aromatherapy diffusers etc. We aren’t allowed candles where we live but these battery operated ones gave off a realistic glow.

– Handheld mirror, lamp, a torch: For obvious reasons, these will come in handy, especially if you plan to keep the room you’re birthing in dark. A bendy or Anglepoise-style lamp will be most practical.

– Personal items: I had the bunting and necklace from my Mother Blessing close by, along with a bottle of gin* on the shelf above me as an added incentive! (*Obviously not cracked open during labour)

Snacks, aromatherapy diffuser and candles.

– Food and drink: We made sure we had plenty of our favourite foods in the kitchen, and asked our midwives what food they would appreciate. We were assured that toast and tea/coffee would suffice but had lots of snacks available too.

Should I pack a hospital bag?
– This is very much a personal choice. Many don’t, as they feel it’s ‘tempting fate’. Others do, to prepare for every eventuality. Some put the things they need regardless of where they give birth in a box that can be easily packed up and taken to hospital if necessary. We didn’t pack a bag, though ended up transferring to hospital after Wilf was born. There was time to pack, though had we been in hospital for more than 12 hours, I would have been missing a few things. Should there be a ‘next time’, I will pack a bag in advance. See our hospital bag post for some top tips.

– What about my other children?
Keeping things consistent for Primrose was my main reason for wanting a home birth (As well as being in the comfort of my own home). Many ladies choose to have older children in the room they’re birthing in, which must be incredibly special. We felt that Primrose was too young to understand what was going on and, as I made a lot of noise when in labour with her, I didn’t want to frighten her. We were told that, as most babies arrive at night, she’d be likely to sleep through it, and she did.
Once again, this comes down to personal choice – you know your children and will know whether or not being present will be a positive experience for them.

– What happens when I go into labour?
Just as with a hospital or MLU birth, it’s advised that you call the labour ward once you’re experiencing regular contractions and at a rate of three every ten minutes. Sometimes, as was the case for us, it may be recommended to call sooner – our trust covers a huge area and the community midwives are up to an hour away.
Your first midwife will arrive and take details of what has happened so far. They will also go through your birth plan/preferences with you. I was asked not to get in the pool until the first midwife arrived as doing so can speed things up, but got in very quickly once she did.
The second midwife will usually arrive later, once called by the first midwife. Our arrived quite quickly, again based on the speed of my previous labour.

– What about pain relief?
Many women choose home births because the need for pain relief is often diminished – being in your own space, with oxytocin flowing without the interruption of a journey to hospital can be all it takes to avoid pain relief. Water, too, is a form of pain relief – this is why I opted for the pool. Your midwives will bring gas and air (I asked them to leave it out of sight). Hypnobirthing was invaluable, too, for keeping breathing focused and visualisations positive.
With regards to drugs, this varies from trust to trust. Some take the view that, if you need more than gas/air, home birth isn’t for you and there are risks associated with opiates that make them unfavourable in a home setting. Others allow Pethidine or Diamorphine but it is up to you to get it prescribed in advance by your doctor.

– Recommended Reading: I read a lot of books in my second pregnancy. Some specifically related to home birth, others were more general. The Positive Birth Book by Milli Hill is fantastic regardless of where you plan to have your baby but includes a great section on home birth. Home Birth: A Practical Guide, by Nicky Wesson was really useful, though I felt like I’d already got much of the information from the Home Birth UK Facebook group by the time I read it. My favourite book was Lady’s Hands, Lion’s Heart by Carol Leonard. This is a memoir, rather than a practical guide, and is truly inspirational. Similarly, A Midwife’s Story by Penny Armstrong and Sheryl Feldman will make you wonder how we’ve reached a point where home births are seen as the ‘mad’ or ‘brave’ option. I wish Why Home Birth Matters had been published in time for me to read it, too! I’d also recommend Sara Wickham’s website and Cathy at Chilled Mama, who has previously written for us and who writes and shares lots of fantastic articles about pregnancy, birth and babies.

Did you have a home birth? Or are you planning one? We’d love to hear about it.Jo, The Mother Side xx

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