Home birth

[shaky]

Hi, I am a community midwife and mother to a 2 1/2 yr old boy. The team of midwives that I work with are desperately trying to increase our home birth rate for low risk women. Do you have any ideas on how we can promote home birth? Have you had a home birth yourself or are you considering delivering your baby at home? I would love to hear your comments and suggestions please, many thanks in advance!

I had a homebirth with my 2nd baby and to be honest the main motivation for me was that I had ended up on labour ward twice (bleed @ 25 weeks and contractions @ 31 weeks) and I just couldnt face going back ever!

I didnt decide until I was 32 weeks so it wasnt something I was set on from the start. If anything made a difference it was the positive reactions/ reassurance from the community midwives (for example when I asked them about the procedure for scary things eg pph, resucitation etc). Round here there is an above average rate of homebirths. Although it is still only about 3.5% it is enough for me to know a few people who have had babies at home.

I'm only 12wks (and still waiting for my scan grrr ) but my MW planted the idea of a home birth at my booking in appt. I am definitely considering it though.

Obviously its early days, but I would be interested in reading more literature/discussing it further, trying to understand the mechanics of it in my health authority, rather than reading more general ideas on the web or in books. Don't get me wrong, I think MN, Homebirth.org etc are great resources for info, but for me to actually decide to do it, I'd like to know my community MW's particular provision, if that makes sense. Perhaps I will get this type of info at my next appointment...

My main consideration is not being turned away from the hospital again because I was not yet in active labour, but having to make a mad dash 2hrs later as I was almost fully dilated with broken waters. I would rather stay at home the entire time than have that stress.

I too am considering it this time (number 3!)
It's early days and I don't see midwife till next week, I was asked if I would consider it last time as my first labour was straightforward, I decided on hospital again as I had positive experience and saw no need not to. Since though I've had friends turned away as no beds (next nearest hospital 45 mins away!) I wouldn't make that as i progressed quickly and delivered not long after getting to hospital. Think I would almost feel guilty in hospital taking a bed that someone else might really need!
I've met people that have had positive home births, it's nice to hear from real people so if u could arrange a "workshop" with real ambassadors (similar to breastfeeding one that I found really good)
That might help, to also see the kit that comes, and a group question and answer session is always good fun and airs lots of ideas.

Both my babies were born at home.

Before I got pg I didn't think I would be up for a homebirth, but at an early MW appt I was handed a leaflet called something like 'choosing where to have your baby'. It outlined the options: homebirth, MW-led unit, consultant care etc. I think the fact that it was just down there as another option reassured me that it wasn't a 'way out choice'. I did know someone who'd had a HB, and my younger brother was born at home (although not really planned).

Good community MW support is essential I think. My MW for 2nd birth was particularly good, very calm & experienced. I trusted her completely.

I'm due in 17 days with DC2 and told the MW at my 16 week appt I wanted a home birth.

I think there would be a higher uptake if you asked women if they were thinking of having a home birth at their booking in appt.

Also, I have been given loads of leaflets on tests during pregnancy, breastfeeding etc but none on where I might want to give birth.

I think that normalising home birth, as has been fairly successfully done with breastfeeding, is the key: it needs to go from "only for lentil-knitting hippies" to "oh yeah, my mate did that", and to become a normal part of the conversations that we have about birth.

get partners on board! I'm only 10 weeks and would certainly consider it but my husband is dead against it. It's our first and I can understand he's scared but his apprehension is putting me off but I'm sure we'll have plenty of time to discuss at future appointments.

Same as thunderboltkid. I am booked in to hospital as a back up, but am definitely planning on home birth. I am 16 weeks, so a lot depends on pregnancy continuing to be low risk........ This is my second.

I had a homebirth with my first DD 8m ago

(planned it from before i was even pregnant)

My midwives were fully supportive, and were delighted to be attending a home birth (her favourite birth)

Not sure there was anything extra they could have done for me as my mind was made up from the beginning.

Thank you for asking for opinions / ideas. Here are mine:

Routinely mentioning homebirth during appointments (for low risk women) as a completely normal option (not just something for "other people"). Proactively bringing up the idea.

Being knowledgeable enough to respond to any concerns with evidence-based information.

Particularly recommending it for low risk second time mothers - only c10% of second timers (who are having a planned homebirth) transfer to hospital, compared to c40% of first timers having a planned homebirth.

Signposting mothers to the wonderful www.homebirth.org.uk to research it further.

Ensure there are enough midwives available to make it a reality. My second baby was a planned homebirth, thwarted at the very last minute when I was told there were staff shortages (and so I had to go to a midwife led unit, fully dilated).

Ensuring that new / trainee midwives understand what a homebirth is / what it entails / the safety issues. I was amazed that a student midwife I met whilst I was pregnant had almost no idea about homebirth (eg she thought I would be giving birth on my bed, and when I said I was planning on giving birth in my sitting room she asked how I would be bringing my double bed downstairs). It obviously wasn't something that had ever been covered in her training.

Supporting any local support groups, or at least being aware of whether any are out there and just signposting to them (eg my county has a group run by a local mother who's had two homebirths, and every couple of months she invites people considering homebirth to come and chat to people who've had one).

Good luck with increasing the homebirth rates in your area!

Hey am having a hb this time with my 2nd as my 1st labour was so quick and less than 5hrs from start (waters breaking was the 1st I knew) to finish! Did not want the stress of getting to hospital on time! Even tho I only live 10 mins away. When I told my mw about my 1st labour she suggested a hb before I even had to chance to say that's what I wanted. I do wish I had a hb for my 1st now as was fine. It was offered to me but just that they asked would I like hb, hospital or mlu. Didn't go for mlu cos its loads further than hospital. I opted for hospital cos my mum had a hard time in labour back to back labours with all of us 3 that is and forceps for me 1st baby as I did not turn on my way out and my grandmother had also had a hard time 1 still birth and she went into cardiac arrest for all 3 of her labours, so I thought hospital for me. However if the mw had explained to me that I was low risk and what the risks of hb were and what drugs were avalible for hb ie you can have gas and air I would have maybe changed my mind as I was under the impression a hb was drug free ie nothing was avalible I know different now. So just bit more time to explain t
At the begining would be a good start.

susie you can have all the drugs that you can have at a MLU at home

I strongly agree with it being suggested at the booking-in appointment. I am expecting DC2 and am seriously considering a home birth after a hospital birth with DC1.

I told the MW that I had found certain things v difficult when having my first child at hospital, and she asked me if I had considered home birth. She then told us (my husband was there too) all about the pros, but not in a pushy way. We are still weighing it up (I am 24 weeks) but genuinely do not think we would have considered it so early or possibly so seriously without the midwife actually suggesting it to us. She said the stats for second babies are really good and I found that encouraging.

The things that still worry me are: the hassle/mess factor, the safety factor (v much disputed I know), pain relief options, and my other child - if he's asleep will he wake up etc. But there are also things that worry me about a hospital birth! And big pros too on both sides - especially on home birth side. I will discuss it all more with my MW at my next appointment.

Thanks nannyl as I saod I know now but had no idea with my 1st and that's my point more info would mean more women would chose hb

I had a homebirth with dc2 3 weeks ago and it was lovely! Where I live (very pro hb area) the community mws hold a talk once a month for anyone considering hb. They talk through exactly how it works, what you need, when to call etc and answer any questions. They also have someone who has recently had a homebirth come in and talk about their experience and it was all so positive and encouraging we decided to go for it. Also having a totally supportive mw helped a lot and having a crap time in hospital first time around!

Hi Shaky

I've got risk factors so HB probably not the right thing for me but what was really nice was at the booking appt my MW mentioned it as an option and didn't seem overly concerned with my risk as she'd handled it before and that was very reassuring. I'm likely to be induced so alas not for me but all that aside the things that might put me off/sway decision:

• worried OH
• my MW is super busy and it takes over a month to got an appt. I've had to go to drop in centres for a couple of appts so perhaps haven't built up that relationship as might be needed
• more awareness of home birth pain relief options

Good luck, maybe next time for me :)

Thank you so much for your responses, it's great to read such positive stories.
Brettgirl- I agree that the midwives' attitude and confidence can play a big role. For me, the relationship that I build with the women is the most important and rewarding part of my job, it's a privalidge to be involved in their lives.

Chunky chicken - yes, definitely discuss it at your next appointment, you are exactly the right candidate for home birth, it's women like you that we are looking for!

Rhinestone cowgirl - we to have bf peer supporters (they are invaluable!) and we are considering asking mums who have had home births to come to our antenatal classes to talk to mums.

Openerofjars - yes, we are asking mums at booking and again during the pregnancy, especially at the 36 wk birth plan visit. Leaflets and posters are work in progress. I definitely agree about normalising home birth, the more women who have home births the more "normal" it will become.

Sunshine sue - very good point (and one we hadn't thought of!), partners opinion is important too, maybe we could develop some info directed at dads, thank you, great idea!

Thunderbolt kid - I'm so pleased you have a supportive midwife, good luck, I hope all goes well for you.

Wigeon - we are a very proactive team and we welcome your ideas. 2nd time mums are the group we are targeting, will definitely signpost the website.

Susiegrapevine - wow, your mum did have a rough time! Building of our mlu starts very soon, exciting times!

Violacrayola - yes you have a lot to think about, I'm glad it's been brought up as an option early

Our team had a brainstorming meeting today and these are some of the ideas we came up with, I would welcome your comments...

• posters promoting home birth to display in clinics, surgeries, toddler groups, chemists etc

*I have ordered some business cards to give out and leave in clinics etc saying "have you had a low risk pregnancy? Think about home birth - ask your midwife"

• having a health promotion day to promote home birth

• during bf week in June we are having a stand in our local stains buries to promote bf and will also promote home birth. We will take the kit, posters,leaflets and hopefully a mum who has had a home birth

*inviting a mum who has had a home birth to come and speak at our antenatal classes

• soon we will be having a van to use for our home births and are considering having a magnetic banner to stick to the van and spread the word.

• In our clinic we have a display of home birth stories, a lady who came to see me yesterday read it and is now considering a home birth, we are now going to copy it and display it in all our other clinics.

• we are also considering making a Facebook page but need to check if we are allowed to

This is just the start, we are an enthusiastic team committed to providing the best experience we can for our women. We are looking for ways to get our message across, basically - home birth? We're up for it if you are, go on, give it a go!

Thank you again for all your comments and suggestions, I really appreciate it.

Cutelittlecatlover - congratulations! That's fantastic. Awesome idea about having a talk once a month, I really like that idea, thank you.

Your team sounds awesome shaky where you based? :)

Loislane - we are in Ruabon near Wrexham, north Wales, our nearest hospital is Wrexham maelor, thank you!

If everything goes to plan I will try to remember to update when baby jars arrives.

By the way, the care I have has so far has been ace: home visits instead of hanging around in a clinic, same midwife each time etc. I can't fault it.

i think counselling second time mothers particularly that -

Home Birth greatly increases their chances of a 'normal' birth - versus hospital
It has been found to be slightly safer (fewer neo-natal admissions) than hospital by a large study (birthplace study , second and subsequent only)
they will have their own MW present throughout once labour is established.

if they had a fast labour first time, it would hugely reduce their chances of a BBA...

I wanted a hb with ds, but husband was really against it. Partly safety, but mostly mess! He is a clean freak. I think some total reassurance might have worked. What about getting dad's of hb to be willing to share.

I am planning on having this baby at MLU. Mainly because I want to use pool and don't want to have to buy one. And I don't want to freak out my ds with noise etc.

That's great, I just work in the community so I can always say to my women that " the only time you won't see me is if I am on holiday or if I'm Ill" continuity is important, I love to get to know women and I'm involved in such a special time in their lives. Just in case you hadn't guessed, I love my job! (most of the time)

Totally agree with Widgeon's suggestions.

DD2 was a planned homebirth and a wonderful experience. I asked my mw about it at booking in appt and was bowled over by her enthusiatic response. Turns out rates here are higher than national average, the community mw team were super supportive and enthusiastic all the way through.

It had always been in the back of my mind that I would rather give birth at home but I didn't feel confident enough with DD1 to ask about it (plus we moved 200 miles away during my pregnancy so care was a bit disjointed). After having DD1 in hospital I KNEW I could give birth at home as I coped with no pain relief except TENS. For me the deciding factors second time around were:

• being able to remove the stress of making the 'it's time to go to hospital now' decision. DD1 was a positive experience but without doubt would have been easier and better at home.
• being able to get into my own bed with tea, toast, DH and the new baby and not be abandoned all alone in hospital because the draconian visiting hours were over. It was bliss.

I think proactively talking to women about homebirth at booking in is essential. Maybe a leaflet especially for partners would help too, I know so many women who have told me they would have loved a homebirth but their DP was against it.

I didn't know a single woman who had had a homebirth until I was 38 weeks with DD2. If you can recruit some willing women who have had homebirths to put other interested women in touch with I think that would make a big difference too. No one from the mw team in my area has ever asked me but I would be more than willing to talk to share my experience with others.

I also think encouraging women to become better informed about birth would help. There's so much scaremongering these days that many women who could have a successful homebirth assume they have to be near an operating theatre 'in case something goes wrong' as if it's more likely than not, starting off with a negative frame of mind about their ability to cope. Spending a little more time with women to reassure them that most births are uneventful and totally normal might help. Despite the wonderful midwives here none have ever said anything like this to me (maybe they know it's what I think anyway so they don't bother). Maybe mw could give out a recommended reading list of books and websites as part of the pack you're given at booking in. I LOVE Ju Ju Sundin 'Birth Skills' without a doubt this book made my first experience the positive one that it was.

We had such a positive experience with DD2 that we're definitely planning homebirth for DC3 due in Octber.

Great to here you're trying to improve rates in your area! Hope all goes well.