My job is to provide clear and reliable information so that you as a mother/couple/family can take a responsible decision on the location you prefer for your child's birth to take place (ALPACC, 2018; NICE, 2014, Butchart et al, 2007).
Every woman should get the necessary support regardless of where she wants to give birth, since labour and birth will progress best wherever she feels safest (ALPACC, 2018; Downe, 2007).
To date, no scientific evidence has shown that childbirth in low risk women is safer in hospital than at home (Reitsma et al, 2020, Homer et al, 2019; Hutton et al, 2019; Rossi and Prefumo, 2018; Scarf et al, 2018; Davies-Tuck et al, 2018; Wiegerinck et al, 2018; Elder et al, 2016; Hutton et al, 2016; Halfdansdottir et al, 2015; de Jonge et al, 2015; Li et al, 2015; Snowden et al, 2015; Cheyney et al, 2014; Dixon et al, 2014; Homer et al, 2014; de Jonge et al, 2013; Hiraizumi and Suzuki, 2013; Hodnett et al, 2012a; McIntyre, 2012; Olsen and Clausen, 2012; Hollowell et al, 2011; van der Kooy et al, 2011; de Jonge et al, 2009; Hutton et al 2009; Janssen et al, 2009; Lindgren et al, 2008; RCOG and RCM, 2007).
Many women feel safer in their own home environments: there they can control what happens around them and have more freedom of movement, more intimacy, more room for physical and emotional spontaneity. They are also able to build a strong relationship of mutual trust with their midwife (Larsson et al, 2019; Perriman et al, 2018; Sandall et al, 2016; Vargens et al, 2013; Hodnett et al, 2012b; Edwards, 2009; MIDIRS 2008; Healthcare Commission, 2008; Hollins, 2008; Heptinstall and Lee, 2004; Wilkins, 2000).
These women are more likely to have a physiological birth free from unnecessary interventions (NICE, 2014). Therefore, they are less likely to give birth by caesarean section or instrumental delivery instrumental (Reitsma et al, 2020; Homer et al, 2019; Rossi and Prefumo, 2018; Scarf et al, 2018; Davies-Tuck et al, 2018; Wiegerinck et al, 2016; Hutton et al, 2016; Sandall et al, 2016; Halfdansdottir et al, 2015; Snowden et al, 2015; Homer et al, 2014; Offerhaus et al, 2014; Cheyney et al, 2014; NICE, 2014; Hollowell et al, 2011 Hodnett et al, 2012a; McIntyre, 2012; Miller and Skinner, 2012; Davis et al, 2011; Hutton et al, 2009; Janssen et al, 2009; Lindgren et al, 2008; Maassen et al, 2008) and less risk of infection and at less risk of having a postpartum haemorrhage (Reitsma et al, 2020; Homer et al, 2019; Rossi and Prefumo, 2018; Scarf et al, 2018; Hutton et al, 2016; Halfdansdottir et al, 2015; de Jonge et al, 2013; Davis et al, 2012; Miller and Skinner, 2012; Nove et al, 2012; Janssen et al, 2009). They are also less likely to have a 3rd and 4th degree tear when birthing at home (Reitsma et al, 2020; Homer et al, 2019; Scarf et al, 2018; Bolten et al, 2016; Hutton et al, 2016; Halfdansdottir et al, 2015; Janssen et al, 2009; Lindgren et al, 2008).
The morbidity and mortality risk at home, are similar to those of the hospital birth, as long as we talk about low risk pregnancy and childbirth (Reitsma et al, 2020; Homer et al, 2019; Hutton et al, 2019; Rossi and Prefumo, 2018; Scarf et al, 2018; Li et al, 2015).
They tend to be women seeking less pharmacological analgesia due to the ongoing support offered by someone they know and trust (Bohren et al, 2017; Hutton et al, 2016; Sandall et al, 2016; Halfdansdottir et al, 2015; Cheyney et al, 2014; Lida et al, 2014; Offerhaus et al, 2014; Hodnett et al, 2012a; Hodnett et al, 2012b; Miller and Skinner, 2012; Hollowell et al, 2011; Janssen et al, 2009 Heptinstall and Lee, 2004).
These women refer having more satisfactory experiences (Sandall et al, 2016; Dahlberg and Aune, 2013; Hodnett et al, 2012a; Hollowell et al, 2011; Leap et al, 2010; RCOG and RCM, 2007) which allow these mothers to feel strong and healthy for motherhood (National Childbirth Trust (NCT), 2002). They recover quicker from childbirth and are less likely to suffer from Post Traumatic Stess Disease (PTSD), which is often caused by a negative experience (Fairbrother and Woody, 2007; Paradice, 2002), an unexpected emergency caesarean section or instrumental delivery (Rouher et al, 2008; Leeds and Hargreaves, 2008, Baston et al, 2008; Fairbrother and Woody, 2007, Lobel and DeLuca, 2007; Stadlmayr et al, 2006), and by negative relationships with health professionals during the delivery and a sense of loss of control over the process (Morton, 2019; Larsson et al, 2019; Perriman et al, 2018; Sosa et al ,2018;Hill, 2015; Holvey, 2014; Maggioni et al, 2006, Olde et al, 2006; Slade, 2006).
PTSD causes arousal symptoms like sweating, trembling, sleep disturbances, irritability, flashbacks and nightmares, and difficulties bonding with the baby (Olde et al, 2006). It may cause Fear of Birth in a subsequent pregnancy, also known as secondary tokophobia. This has been recognized in medical settings as an iatrogenic illness that needs treatment and is the result of a biomedical model (Walsh, 2002). However, a positive experience of childbirth can shift negative social erroneous concepts when planning a future birth, reducing fear (Larsson et al, 2019) and encourage other women to seek other options for a richer experience of birth (Hill, 2015 Walsh, 2002).
All this means that the economic cost of home birth is lower than hospital birth (Attansio et al, 2019; Janssen et al, 2015; Schroeder et al, 2011) but despite everything, the Catalan public and private health system is not willing yet to cover its expenses.
The Royal College of Obstetricians & Gynaecologists (2011) has stated that too many deliveries are taking place in hospitals, and the WHO insists that the number of caesareans without medical justification has increased dramatically in all countries (World Health Organisation, 2010), increasing risks to both mother’s and baby’s health in the short and the long term.
Every mother / partner / family is informed that home birth may take place only when it is
considered low risk, i.e. fulfilling the following conditions:
-The baby’s presentation is cephalic (i.e. head down)
-Labour starts spontaneously between 37 and 42 weeks pregnancy
-It is not a multiple pregnancy (there is only one baby)
-There are no complications, in the baby’s nor in the mother’s health.
(ALPACC, 2018; NICE, 2014)
What do I offer as a childbirth professional?
- Visits approximately in week 10, 16, 25, 28, 34, 36, 38, 40, 41 y 42 (NICE, 2008)
- Being on call 24 hours from week 37 to 42.
- Telephone support (or presential support if essential), in early labour or latent stage.
- Being at home with the mother once labour has begun.
- Ensure that the house temperature is favourable.
- Ensure that there are no distractions or external stimuli.
- Promoting high levels of oxytocin.
- Removing/avoiding elements and situations that cause stress, and therefore high levels of adrenaline and cortisol in mother and baby.
- Physical and emotional support.
- Monitoring the well-being of mother and baby.
- Monitoring the progress of labour.
- Promoting mother’s hydration and nutrition.
- Only if the mother requires, offering the use of non-invasive analgesic methods such as water in a bath, shower or birthing pool, mobilization and changing positions, massage, use of analgesic breathing, visualizations and aromatherapy.
- Helping the mother to deliver her baby and assist her in the delivery of the placenta until postnatal bleeding is under control.
- taking care of the mother's perineum to prevent tearing, avoiding routine episiotomy and suturing only when necessary.
- Not cutting the umbilical cord until the placenta has been delivered if the mother/couple opt for a physiological management of the 3rd stage of labour.
- Monitoring maternal and neonatal well-being after delivery, promoting skin to skin contact and breastfeeding, staying at the home for at least 3-4 hours after delivery.
- Cleaning and tidying the house after birth
- Being available by telephone for minimum 10 days after birth or until being ready for discharge.
- Visiting the mother and baby at home, on days 1, 3, 5, 10 and/or until discharge. I adapt my visits to the situation, specially if there are complications or specific needs.
- Pelvic floor evaluation before discharge with ergonomy, habits and carrying baby supervision. Personalized exercises recomendation according to each situation.
Every mother/couple/family is offered a personalised birth plan which is discussed point by point, signed by both the mother
and the midwife; this details the wishes of the mother/couple/family and the conditions under which some interventions may be needed according to my clinical
Every mother/couple/family should be advised of the possibility of transfering the woman to a Hospital (ALPACC, 2108; NICE, 2014; MCWP, 2007). Several trasfer options will be planned if needed, depending upon the urgency and/or the priorities expressed by the mother.
The goal of planning a homebirth is to have a safe birth for mother and baby and a healthy experience for everyone present, independently from where the baby is finally born.