We are currently facing a global pandemic and encouraged to STAY HOME. So have you thought about having a home birth?
I have been to hundreds of home births in Ontario, Canada, during my career as a midwife. When it was finally time for my own delivery, I was living in a foreign country where home birth was illegal so I flew back to Canada. That is how much I wanted to deliver my baby at home. But I would have changed my plan and delivered my child in hospital in a heartbeat if the clinical picture had showed it was safer to be there. Here are a few things you might want to consider when assessing the option of home birth.
Know your risks
The risks of adverse or negative outcomes arising from having a baby at home are the same or lower than delivering in the hospital. An international study by Eileen Hutton at McMaster University compared outcomes in Canada and the UK, and the adverse neonatal outcomes were the same – less than 5% in both hospital and at home. The essential element for safety requires a skilled, fully trained caregiver at home to monitor labour.
There is a long list of reasons that would eliminate the possibility of a home birth, and you can read them here for both Ontario and British Columbia midwives. Many women are advised or informed prenatally that they are not safe to deliver at home. This screening is part of what makes home birth safe. You must be healthy with a low-risk pregnancy to deliver at home, and if those conditions are true, then there is no evidence of increased risk of home births.
Early labour assessment at home
We have all seen movies or heard stories about women in pain being sent home because they’re not officially in labour. Lots happens before active labour. A planned hospital delivery requires you to spend early labour at home, because you will not be admitted to Labour and Delivery until you are in active labour. This is tiring and hard. You usually have to figure this part out by yourself. If you consider a home birth and have a midwife, they will assess what is happening in your home so you can avoid packing and going out (usually in the middle of the night) to leave for an assessment in hospital.
A home assessment means you know someone is watching over you in early labour. You’ll be advised to rest, and they won’t leave you without a plan to check in or reassess your status after an agreed upon period of time has passed. The stress of having to change locations can slow down labour and invite opportunities for intervention. If you are admitted to hospital during the early phase of labour, before you start to dilate, then the risk of interventions and a Caesarean section rise exponentially. So if you have to labour at home anyway, why not consider the option of a home birth with a qualified caregiver and see how it goes?
What about pain relief?
The number one reason to transfer into hospital from a planned home birth with a first-time mother is for pain relief. This is uncomfortable for the labouring mom, but not an emergency. We don’t call an ambulance because someone needs pain relief. Women don’t need pain relief because they’re weak or not dedicated enough. It’s because their labour isn’t progressing.
I remember Beth who had planned a water birth at home, but despite enormous efforts to cope, was progressing in her labour slower than desired. It was obvious she needed to rest and have pain relief, but her enthusiastic support team wanted her to stay home and succeed. They didn’t want Beth to be disappointed. It was my role as her professional caregiver to find a quiet space to help Beth decide for herself to modify her plan for the safety of her and the baby. Beth ended up transferring, we got her an epidural, and she had a lovely spontaneous vaginal delivery in hospital.
Labours stall for many reasons. Often the baby just isn’t in the right position. Pain relief available in hospital is a viable option in this instance and in fact can aid a successful vaginal delivery. But when a labour is progressing at about one centimetre an hour, women can usually cope very well with solid emotional support and breathing techniques.
If you are still unsure about a home birth, keep an open-ended plan with your care provider. Have contingency plans and keep an open mind. Delivering a baby is not something you can control. You don’t need to feel forced into a home birth just because you said you wanted one, but you should also be able to decide in the moment if you want to stay home. For every transfer to hospital from a planned home birth for pain relief, there are two women who decide they are coping so well at home they might as well just stay there.
Veronica was a client who was sure she didn’t want the mess of a home delivery. She wanted an epidural and to rest in hospital after the delivery. (Midwives never leave a mess by the way, and I have yet to meet anyone who got a good sleep in hospital!) Veronica was having her first baby when I arrived for a home assessment. I brought my back-up supply of home birth essentials but didn’t think I would use them. Veronica was so comfortable in labour at home, she refused to get up to leave when she was almost fully dilated. I asked her if I could quickly protect her bed, she and her partner both agreed, and she delivered her little girl right at home. It’s better to be prepared just in case and the list is pretty simple.
Home birth essentials
- blue pads or absorbent pads
- waterproof mattress protector
- plastic sheets for floor protection
- hot water bottle
- mobile lighting
- space heater for hard-to-heat homes
- hard flat surface
- maternity underwear
- heavy flow pads
- loose comfortable clothing
- healthy foods for during and after labour
- good hydration options like water, ice chips
- black garbage bags
- baby hats and clothing
Choose a caregiver who will support you, educate you further, monitor your pregnancy closely, and provide information to help you make a safe decision. Midwives in Canada have varying rates of home birth because of the area they work in, the community culture, and their own comfort with home birth. A skilled practitioner has confidence in their clinical skills and assessments, access to peers to consult with, and a multi-disciplinary team to transfer to when the clinical picture appears unsafe.
Home birth during the COVID-19 pandemic
When considering COVID-19 specifically, you should take into account that most hospitals are currently allowing only one support person and a registered doula during the labour and delivery. Current Society of Obstetricians and Gynaecologists of Canada (SOGC) guidelines recommend hospital delivery if a woman has a positive COVID-19 test result, whether symptomatic or asymptomatic, so it’s best to arrange testing with your caregiver in order to ensure a home birth is a viable option.
Provided all is safe and well, delivering at home during the pandemic will reduce your risk of exposure to the virus as well as other hospital-acquired infections. Children are currently not allowed in many hospitals, and arranging childcare with social distancing is harder than ever. Fear inhibits labour, and if staying home with a trusted care provider can reduce that, this will assist with a progressive labour. Let’s hope the winter months bring a calm external environment of choice so you can keep an open-ended plan in mind resulting in not just the delivery of a happy, healthy baby, but also satisfaction with your birth experience.
Sandra is a retired midwife, after practicing in Ontario and the Middle East for almost 8 years. She lived most recently in West London, England, with her husband and two boys (9 and 11). She has worked with vulnerable families in England, facilitated parenting workshops, and spent dedicated time writing short stories and longer fiction pieces. She can’t get away from birth and all that goes with it. Once a midwife, it’s just part of you!