Planning a home birth

Giving birth at home can be a very fulfilling experience for you and your family. This information has been compilied by midwives for women who are planning a home birth and we trust it will answer the questions you may have.

A midwife will care for you thoughout your labour, this may not be your named midwife. You may also be asked to consent for a student midwife to attend.

Towards the end of the labour a second qualified midwife will be called to be present.

Our contact number is : 0161 922 4921 (MLC contact)

The delivery suite number is: 0161 922 6172/6173

When you are in labour, contact the Midwifery Led Care unit (0161 922 4921), if there is no answer then contact the delivery suite (0161 922 6172/6173).
Inform them that you are booked for a home birth and please provide:

• your name
• your address
• your telephone number
• your midwife's name

The midwife taking your call will discuss all aspects of your labour to date and advise you accordingly.

When a midwife has been contacted, she may telephone you and make arrangements to visit you, either immediately, or later as appropriate.

The home birth rate is on the increase and on some occasions, if several women are labouring simultaneously, deploying the services of all the available midwives, you will be advised and requested by a hospital midwife, to go to the maternity unit for your labour care and delivery.

All women should contact the Midwifery Led Care unit or the Delivery Suite at any time if they have any concerns or anxieties.

• If labour begins during the day it is useful for us to know early in the labour so that your team of midwives can reorganise their workload.
• If labour begins at night, contact the Midwifery Led Care/Delivery Suite when your contractions are coming every five minutes.
• If your 'waters break', with or without contractions please phone the Midwifery Led Care unit/Delivery Suite straight away. It is particularly important to let us know if the 'waters' appear green, brown or yellow.

Once labour is established a midwife will stay with you at your home.

Please ensure your home is easily identifiable by the midwife. If she is attending you at night please put on all your house lights until she has arrrived. If your home is not easy to access or does not have a number or name plaque displayed, please arrange for an adult to meet the midwife at the door, gate or nearest accessible tarmac road.

Throughout the labour the midwife will take your temperature, pulse and blood pressure and will test a sample of your urine at regular intervals.

The midwife will encourage you to have a regular intake of fluid, a light diet and to have rest as well as active periods throughout the labour.

Most women choose to have a birth 'partner' present for support in labour. This may be the baby's father or relative or friends. In addition another adult should bepersent at the home to:

• Take care of other children
• Make or answer telephone calls
• Assist in making drinks for you and your partner

• 24 hour access to a telephone
• Ensure there is adequate heating in the room you plan to give birth in
• Assist in making drinks for you and your partner
• Means of gently warming baby linen i.e. hot water bottle with cover(not used for the baby)
• A clean hot water supply
• Clean hand towel and soap for the midwife
• Bucket or washing up bowl for wet rubbish
• Plastic bin liners to protect cushions/pillows etc
• Plastic sheeting or old shower curtain for the floor (available from DIY stores)
• Plastic mattress cover to protect mattress/futon etc (available from chemists)
• Old clean sheets and towels
• Pack of full sized maternity sanitary towels

For the baby

• 2 soft towels (old but clean)
• a vest
• babygro or nightdress
• cardigan
• socks or bootees
• nappies
• cotton wool
• cot sheets and blankets

The equipment for the birth will be delivered to your home when you are approximately 36 weeks pregnant, along with entonox (gas and air) and oxygen.

The entonox will already be in your home and if any more is required the second midwife will bring this from the hospital. Midwives do not carry pethidine.

You may like to hire an obstetric tens machine to aid with pain relief at home.

Syntometrine

Syntometrine is a combination drug, given by injection, which is used to speed up the delivery of the placenta and membranes and to minimise blood loss. It is your choice as to whether this drug is given as a preventative measure or only used in the treatment in the event of a problem occurring. Please discuss this with your midwife prior to the birth.

In certain circumstances the midwife will advise that the transfer to hospital is necessary. This journey is always made be ambulance. (The midwife will accompany you). By this means, heavy traffic can easily be negotiated and good communication links with medical staff maintained in the event of a difficulty. Your partner may wish to accompany you or follow in his/her own vehicle.

In the unlikely event of you being unwilling to accept the advice of the midwife and you decline transfer to hospital, the midwife will inform a supervisor of midwives and the medical staff, and she will continue to care for at home. However, it must be appreciated that the midwife does not have access to the more sophisticated equipment and medical expertise that is available in the hospital.

Your midwife will endeavour to assist you to deliver your baby as easily as possible to prevent tearing of the perineum.

Small tears may be left to heal naturally. Should you require stitches most midwives are able to suture simple tears at home. If the tear is more complex you will need to transfer to hospital for stitching. If this is necessary your baby and your support person could accompany in the ambulance, or follow in their own vehicle. You would be discharged afterwards using your own transport.

All babies are offered the routine injection of vitamin K. (You should have already received a leaflet which gives you information on this).

Your midwife will stay with you for at least one hour after the birth of your baby. She will assist you with breastfeeding as soon as possible after the birth. When the midwife leaves she will ensure that your have a telephone number which you can call if you have any worries or concerns and arrangements will be made for a further visit later in the day or early the following morning.

It is recommended that all new mothers be cared for by a friend or relative for the first few days after their baby is born.

The baby will have a neonatal examination between 6-24 hours following the birth. This is carried out by a midwife who has taken extra training in order to carry out this examination; it may not be your own midwife.

The majority of women who plan to give birth at home succeed in doing so. Complications are uncommon; however they do sometimes occur and for this reason the information below provides details on circumstances in which transfer to hospital would be recommended:

• Labour started before 37 weeks or after 42 weeks of pregnancy.
• If labour has not started within 24 hours of the waters breaking. You are advised to have labour induced in hospital. Your midwifewill discuss this issue with you.
• If the 'waters' are brown/green (meconium) when they break. This indiciates that the baby has opened his/her bowels, which may be a sign of distress. We therefore recommended that in these circumstances the baby's heart rate be monitored during labour.
• Abnormalities in the baby's heart rate. Both a very fast and a very slow heart rate can be a sign of distress. If either was to occur and persist and the birth is not imminent, you will be advised to transfer to hospital for closer monitoring.
• Excessive blood loss. This may occur during or after the birth.
• Raised blood pressure
• Exhaustion. Occasionally labour may be very prolonged or difficult to cope with despite good support and good preperation for the birth. However if you need stronger pain relief you may choose or be advised to transfer to hospital where additional help is available i.e. methods of increasing the efficiency of the contranctions and/or epidural anaesthesia.
• Retained placenta. Some placentae do not deliver in the normal way and transfer to hospital is necessary for removal.
• For perineal suturing.
• If there are any concerns regarding the baby's wellbeing after the birth. You will be advised to transfer to hospital for assessment, observation and /or treatment.

We wish you a happy and fulfilling birth experience.

Benefits/Advantages

• There is no evidence to support the common belief that home birth is less safe option for women experiencing uncomplicated pregnancies and not anticipated to need medical assistance at birth (House of Commons Health Committee 2003).
• Planned home birth is associated with good outcomes for both mothers and babies (Chamberlain et al 1997).
• You may feel more relaxed and in control in your own home.

Risks/Disadvantages

• You will be unable to have an epidural at a home birth.
• You may have to transfer to hospital if any complications arise during labour. If transfer is required there will be a delay in delivery, this could compromise the outcome.

References:

Chamberlain G., Wraight A., Crowley P. (1997) Home births: the report of te 1994 confidential enquiry by the National Birthday Trust Fund. Partheson Publishing Group: London/New York.
NICE Guidelines: electroinic fetal monitoring: Induction of labour.
R.C.M. (2002) Position paper 25: Homebirth. R.C.M. London.

We are now holding a 3 monthly meeting at the hospital to encourage women to have a home birth. We invite parents who have recently had a home birth to come and discuss their experience, and we answer any common concerns regarding home birth. We have a pool inflated to view, and refreshments.

The meeting is held in the antenatal clinic, from 7-8pm. the following dates are planned:

Wednesday 17th July 2013

Wednesday 16th October 2013

Any questions please contact your midwife or the M.L.C office (0161 922 4921).