There’s been a lot of comments and activity in my social media feeds over the last couple of days about the new NICE guidelines on intrapartum care (care during the birth of a baby) which have been reported as home birth being ‘best’ for many mothers.
The NICE guidelines advising women that giving birth at home or in a midwife-led unit (such as a birthing centre) are aimed at women with uncomplicated term pregnancies (i.e. 37 weeks onwards with no additional risk factors). For women who met this criteria and have previously had a baby, the evidence shows that birth outside of an obstetric unit (such as a labour ward or ‘delivery suite’) is “particularly suitable” due to a lower rate of medical intervention (such as forceps or ventouse births, caesarean births and episiotomies) and equally good outcomes for the baby when compared to giving birth in an obstetric unit. With women who are expecting their first baby, giving birth in a midwifery-led unit is shown to be as safe as giving birth in an obstetric unit although the evidence shows a small increase in risk to the baby for a home birth (9 babies born per 1000 with serious medical problems compared with 5 babies per 1000 in midwifery-led units and obstetric units).
Although the NICE guidelines do support and encourage birth outside of obstetric units for low-risk women, they are also clear that women should be offered the choice of where to give birth and supported in their choice. Women are most likely to labour well if they are relaxed and comfortable in their birth setting – whether this is at home, in a birthing centre or in a hospital setting.
Naturally, there have also been stories reported in the media of planned home births that required transfer to hospital and babies who needed medical care as a result. In my view, this is where the skills of the midwives are important. Midwives are trained and expert in normal birth – when things are going ‘wrong’, the midwife should identify this and arrange for transfer to an obstetric setting where appropriate. This may be if the labour is very slow, if there are signs that the baby is becoming distressed or the labouring mother requires analgesia which is not available in a home or midwife-led setting (for example, an epidural). Home birth midwives will be aware of the time needed to transfer to hospital and therefore are more likely to be vigilant in arranging for transfer if this is needed. For women having their first baby, the NICE guidelines show that 450 women in every 1000 may be transferred into an obstetric unit, whereas for women having subsequent babies, this figure drops to 115 per 1000.
It is important to remember that the NICE guidelines are there to promote choice and safety. Home birth or midwife-led birth is not the ‘right’ choice for every woman and nor should it be promoted as such. All women should be given the information to help them make an informed choice about the best place for them to give birth and if they decide they wish to be at home or in a birthing centre, that choice should be supported.
I had hoped for a home birth with my first daughter, however due to her heart defect being diagnosed at her 20 week scan, she was born in hospital with the help of forceps and had her first heart surgery just a few hours later. For us in those circumstances, the obstetric-led unit (labour ward) was the most appropriate place of birth. My second daughter, thankfully was heart healthy, and I did go on to have the home birth I had hoped for. Both experiences were positive ones and I was lucky in that I felt supported and empowered in my choices.
However, for many women, it can feel like birth choices are taken away from them due to circumstances and often women are left very traumatised by the experience of giving birth. I feel very sad that for so many women, birth is an incredibly negative experience and there is often not the support available to help women come to terms with their experience. Sadly, the NICE guidelines on postnatal care which have also been published recently do not address this save for the advice that health professionals should be aware of signs and symptoms of mental health problems and women should be assessed for postnatal depression if the ‘baby blues’ have not eased 10-14 days after birth.
My first birth was horrendous due to bad advice & bad experiences, plus I was young & didn’t know how to communicate what I wanted properly. With my second I knew exactly what I wanted and had a much better experience x
I’m so sorry you had such a horrible birth experience first time round but glad your second experience was much better. I think those negative experiences often spur us on to fight harder for what we do want x
Good points. I was hoping to give birth in my local midwife-led centre but had pre-eclampsia at the end so had to be induced. To be honest I didn’t feel like the midwife-led centre was quick enough to pick up on this or on my 6 day pre-labour (I had my last couple of appointments there) whereas the consultant saw it straight away. That’s my only criticism. x
That’s a shame that the midwife-led centre didn’t pick it up more quickly but glad the consultant did. Hope all went well in the end x
beautiful images. Wishing you all the best 🙂
Thank you 🙂
Now this is a subject very, very close to my heart. I have been a Midwife for 10 years and am a massive advocate for homebirth, plus I was blessed enough to have my 3 at home. So without banging on and on about it I would just say that I am thrilled this has hit the media because for some women it is definitely the best choice, but I would always want a woman to plan to birth where she was most comfortable as that’s what it’s all about. I guest blogged for a website about it here: http://www.mummyandlittleme.co.uk/blog/have-you-thought-about-a-homebirth.html
It’s a subject close to my heart too – I have been at many homebirths and was lucky enough to be my sister’s midwife when she had her second baby at home too. For my homebirth I had two lovely independent midwife friends supporting me because it was important for me to have midwives that I knew and could completely trust. They were amazing. I think it is so important for women to be able to be given those choices as much as possible. I know a lot of women are more comfortable birthing at midwife-led centres though rather than at home and it would certainly be good to have more of these available. Loved your guest post – very informative
How lovely you got the home birth you wanted.
What a great post. I really wanted a home birth but when I was about month, I had a little bleed and went to hospital. After a few tests they discovered I had Strep (no reasons for bleeding but thankfully everything was OK) so I ended up having a hospital birth. Everything was OK but I would’ve loved to have been at home. These guidelines are so important. #PoCoLo
Thank you – it is such a shame when matters beyond your control mean you can’t have the birth experience you hoped for although I am glad that everything was OK and it is good to have access to hospitals when needed x
The Mothers say – These are such important guidelines and you’ve highlighted them brilliantly. Excellent post. #PoCoLo
Thank you 🙂
Great post. All three of our births were very different and all all three made me a massive advocate for anything midwifery led, providing it is safe to do so. The midwifes were total superheros. They fought to keep Renee the centre of everything each time.
I’ll never forget the midwife who delivered our second facing off against a group of doctors and consultants who wanted to take Renee to theatre as she’d been pushing for too long – “No! You will give her five more minutes”. And she was right, Clara was born naturally inside five minutes. What a legend.
That midwife sounds amazing – so glad she was able to fight your corner and help Clara to be born naturally. So glad that you have had such positive experiences with the midwives who supported the births of your three children and that they focused on making sure that Renee was the centre of it all – this is exactly the type of care that all women should be able to have.
Living in the Netherlands, where home birth is very actively encouraged and midwife-unit deliveries are the norm, I’m very interested to read that the UK is moving back this way again (I’m from the UK originally). Although I had to deliver in a hospital here due to circumstances, the skills of the midwives made me feel incredibly confident at the prospect of a birth lead by them. They constantly impressed that birth is a natural and not a medical event which is very empowering. Ok mine became medical, but still, I had the belief that I could do this and the birth was a very positive experience. I would advocate the Dutch approach any day. #PoCoLo
I’m glad that the UK is moving in this direction and the Dutch approach sounds wonderful. Birth is indeed a natural event which sometimes requires medical assistance and thankfully we have hospitals and good medical care in this country to aid that. I’m so glad that your birth experience was positive and empowering even though it did become medical. I felt that way about my first birth – it was very medicalised and necessarily so, but I felt in control and empowered throughout which helped immensely. Thank you for sharing your thoughts and a bit about your birth experience.
I gave birth in a hospital because my water broke a month early but all of my cousins gave birth at home and I saw it and its pretty magical! So much support when you give birth at home. A lot of people will hold your hands and worry with you. That is what I missed as I gave birth alone.
This is such a nice post giving soptlight to the fact that you have a choice. Thanks for sharing your voice =)
#pocolo
Giving birth alone sounds like a very lonely experience and I’m so sorry you didn’t have as much support as perhaps you might have wished. Being able to choose who you want to be around you is a bonus of being at home (most hospitals will limit birth partners – not necessarily a bad thing as most mums don’t want a huge audience but it was nice not to have to worry about who I could and couldn’t have there)
Brilliant, balanced post considering all sides of the argument. It’s fab you’ve acknowledged both your birth experiences were positive – the first in hospital because of Jessica’s diagnosis, and the second being the home birth you wanted. It exemplifies the point that there is no right place to give birth, and there are different levels of risk. Thank you also for mentioning trauma and the women who have no choice xxx
Thank you Leigh – having experienced a very medicalised hospital birth and a very natural home birth helps with being able to see both sides and keep a balanced perspective. The ‘right’ place very much depends on circumstances as well as wishes. There definitely needs to be far more done to help women who have a traumatic experience though – it’s one of the areas where the health service is really failing women.
I agree, the birth experience is so important for a woman, that she needs all the support she can get. At home or at the hospital, they should be given the right information to make their choices. #PoCoLo
Thank you – yes informed choice is so very important.
I consider myself so lucky with Grace’s birth as it all went according to plan. I never considered a home birth and I think I would be too scared to. Thank you for sharing with #PoCoLo 🙂 x
So glad that all went well with Grace’s birth – I think if you would not feel comfortable at home, then it wouldn’t be the right place for you and that is what informed choice is all about really. Lovely to link up to #PoCoLo again and thank you for hosting 🙂
Fab post, and I completely agree hon. I planned on a home birth with my first but she got stuck and we were blue lighted to the hospital for a very gory forceps delivery. There was no way it would have panned out well if we had stayed at home, and the expertise of the midwives basically saved us both. I tested positive for GBS in my second and third pregnancies so it ruled home births out but we went for the midwife led baby unit and had two natural deliveries a far cry from the first time round.
I’m so pleased you got the birth you wanted second time round with Sophie xx #thetruth
Thank you – so glad that the midwives reacted quickly and got you to hospital for your first baby’s arrival even though it wasn’t the birth experience you would have hoped for. How lovely that you were able to have much more natural births for your other two babies in the midwife-led unit, so glad all went well with those x
Funny how subsequent births can be so different to what can be a traumatic first. I guess it stands to reason that we are that much more confident in our abilities to cope without medical intervention right on hand after we’ve done it once. I never wanted to have a home birth but the second time round I really wanted a water birth after seeing a couple of episodes of OBEM – the women who opted for this seemed so much calmer and more in charge of their own destiny! It is fabulous if choice is being both offered and promoted. Midwives are awesome. Thanks for linking up to The Truth about.. linky again with such an informative and measured post Xx #thetruthabout
I think that is true – either we are more determined to avoid things we didn’t want first time around or more confident in our abilities to give birth second time around and that can help subsequent births to be very different experiences. I’m glad that more choice is being promoted in the guidelines although the media mostly seems to be reporting it as women being encouraged to have home births which isn’t quite what the guidelines are saying. Lovely to link up to #thetruthabout again x
I would have been too scared first time round to have a home birth to be honest, and after a rather traumatic first experience with an emergency section, I chose electives for my other two. For me, the right place to give birth is the one that you choose, heavily caveated with the one that is safest for you and the baby, based on, circumstance, advice given, previous experiences etc. And that may be a different place for each birth. There is no one right answer. Great post Louise x #thetruthabout
Thank you Sara. I think your choice second and third time round was a sensible one given your traumatic first experience and I know many other mums who have opted to do the same. I agree there is no ‘right’ place to give birth – it depends very much on circumstances as well as choice and hospital is the right place for many women – it certainly was for me first time around just as home felt right second time around. I hope your subsequent births were much more positive experiences x
There are no right or wrong choices, I was in hospital but the Midwife made mistakes, I am just thankful we are here and well.
#thetruthabout
I am so sorry that your midwife made mistakes but glad that your little one arrived safely.
What a great post. Unfortunately I’m high risk so would never be able to have one but I am all for informed choice for people who can.
Thanks for linking up to #MaternityMondays
Thank you – informed choice is so important. Lovely to link up to #MaternityMondays, thank you for hosting.