juno midwives

Home birth is a safe option for many women, although figures from the ONS in 2020 show that only 2.4% of women in the UK had one.

The National Institute for Health and Clinical Excellence (NICE) guidelines in the UK say that home birth is safe for ‘low risk’ women, with uncomplicated pregnancies and the evidence supports this. There is also evidence to show that home birth and midwifery-led models of care result in good outcomes in women labelled ‘high risk’ – a reminder that it’s important to recognise that birthing women and people are more than the sum of their ‘risk factors’, which are often based on standardised guidelines. We shouldn’t be automatically excluding women with, for example, a BMI >40, an uncomplicated twin pregnancy or with breech babies on board from having home birth if they want to. What we do need to ensure is that these women have access to skilled professionals (if they want to engage with maternity care), who can support them to birth at home, with good hospital back up if needed, and crucially we need to collect the outcome data on these women, so the evidence can be updated. There are of course women who will be better off birthing in hospital, where there is access to the multidisciplinary team and specialist facilities. Ultimately, the decision on where to birth lies with the woman.

The safety of home birth depends on various factors which can include, the overall health and wellbeing of the woman and baby, the competency and skills of the midwives attending the birth and access to emergency transfer if needed. Experienced midwives, who can both sit on their hands when birth is unfolding physiologically and anticipate and act quickly when complications arise are vital to ensuring homebirth is safe.

The NICE guidelines further state that for women with uncomplicated pregnancies, who have birthed before, planning to give birth at home or in a midwife-led unit is as safe as hospital birth for the baby and can have several benefits for the mother. NICE maternity guidelines generally look at short-term outcomes for babies, for example, admission to neonatal units or neonatal mortality (death) rather than the long-term health and wellbeing of women and babies. For first time birthing women who are ‘low risk’, NICE continues to recommend that a midwife-led unit is the most suitable place to birth, as the 2011 Birthplace study demonstrated an increased rate in adverse outcomes for these babies. In contrast, more recent evidence published in the Lancet in 2019 has shown there to be no difference in outcomes for babies whether they are born at home or in hospital, even if they’re a first baby.

In 2020, a study reported these benefits of home birth for women:

• less likely to need a forceps or ventouse assisted birth
• more likely to have a normal vaginal birth (3 times more likely)
• less likely to need a caesarean
• less likely to need an episiotomy (cut to the vagina during birth)
• less likely to experience a post-partum haemorrhage (excessive bleeding after birth)
• less likely to experience severe perineal trauma (3rd / 4th degree tear)

And of course, a huge benefit of home birth that hasn’t been scientifically studied (and nor does it need to be!) – is having a shower in your own bathroom, getting into your own comfy bed afterwards, having whoever you want in your birth space and having exactly the snacks and foods you may be craving ready to go. It’s pretty magical.

Local home birth circles are a great place to learn more about home birth, meet people who’ve had one and hear birth stories – they are run all over the UK. Locally, Folkey Birth Club run monthly birth circles in Folkestone – check them out!

Further reading:

Is home birth safe? – Sara Wickham

Home birth also safer for higher risk women – Sara Wickham

A practical guide to setting up for a home birth