Planning a homebirth?

There's no denying it, planning a home birth is risky. Not for your baby - for your reputation (what? I hear you say). Currently, about 5% of Kiwi women give birth at home, and it's a fair bet most of them have had to deal with a disapproving relative or co-worker reminding them, "If I hadn't been in the hospital when I had my first, I'd have died."

Wondering if a planned home birth is right for you? guaranteed you have lots of questions such as, is it safe? Will you need a midwife? How do you create a backup plan? Is it messy (not as much as you think), Is it even possible?

Find out what's involved and how to decide if this birthing method is right for you.

If you labour and deliver your baby at home, labour management might differ from what you may experience in a hospital setting. During labour at home, your LMC will periodically — rather than continuously — monitor your temperature, pulse, blood pressure and your baby's heart rate.

Many families choose a planned home birth for many reasons, such as a desire to give birth without medical intervention, such as pain medication, labour augmentation (speeding labour up), induction, fetal heart rate monitoring, a desire to give birth in a comfortable, familiar place surrounded by family and friends, possible dissatisfaction with previous hospital care, maybe you have a desire for freedom and control in the birthing process, cultural or religious concerns, maybe a lack of access to transportation or you just like the idea of climbing into your own bed straight away (yay!).

Stereotypes, misconceptions, myths and stories of home births and midwives abound. Many people seem to believe midwives turn up to birth with no equipment save a bag of dusty herbs, happily allowing a mother to haemorrhage by candlelight while everyone listens to whale song, holds hands and hums. Homebirth is seen as the selfish choice (it's not) - made by mothers who prioritise an idyllic birth over their babies' health.

The problem is, the statistics don't support that reasoning. Several studies in New Zealand, and dozens overseas, have confirmed that for low-risk women (single, no maternal conditions such as pre-eclampsia and so on), a planned, attended home birth, involves no higher risk of the mother or baby dying than comparable low-risk hospital birth.

In fact, in a sense home-birthing mothers and babies are safer - the same studies show that home birthers are less likely to end up with Caesarean sections, episiotomies, epidurals or analgesic pain relief, and babies with low Apgar scores. Recent figures received from the New Zealand College of Midwives indicate that the rate of Home Births in New Zealand appears to be on the increase. The overall rate of home birth in New Zealand sits somewhere in the vicinity of 3-5% of all recorded births (3.37% the latest figure from the Ministry of Health in 2012, and 4.9% latest figure from Midwifery and Maternity Partners Organisation in 2011). As a result, home birth in New Zealand is widely accepted by the medical community. Home births are fully funded by the government, and transferring in the case of an emergency is usually efficient.

What equipment do I need?

You won't need much. A few weeks before your due date, your midwife will bring around a birth pack containing all the bits and pieces she’ll need for the birth. She will give you a list of other items to gather and you probably already have most of these dotted around your home. The list may include things like plastic sheeting or bin liners to protect your floor, bed or couch. Old towels or sheets to cover the plastic sheeting, a couple of containers (in case you vomit during labour). A warm blanket or throw, in case you get cold. Bin liners for dirty linen and rubbish. Clean warm towels, a baby blanket (natural fibres only). Otherwise, you need the same things that you would pack for a hospital birth. These will probably be clean, comfortable clothes for you and your baby, toiletries and home comforts. At home, you can have candles, too! (yay). In fact, in your own home you can go all-out and have time to create your perfect environment for giving birth (so important). If you'd like to use a birth pool you'll need to borrow, hire or buy one. Ask your midwife if there’s one available to hire or contact our local Home Birth Group.

Are there situations when a planned home birth isn't recommended?

During a planned home birth, you might need to be transported to a hospital for monitoring or treatment if complications develop. Your LMC might recommend transfer to a hospital if: Labour isn't progressing, your baby shows signs of distress or your baby presents in a position other than headfirst, you need pain relief (she will have nitrous oxide with her). Your blood pressure rises or you experience excessive bleeding.

A New Zealand study of 16,400 low-risk women giving birth during 2006 and 2007 found that women who planned to birth at home were at "less risk of augmentation of labour, artificial rupture of membranes, pharmacological pain management, episiotomy and perineal trauma than those planning to give birth in primary units".

What happens if I need to go to hospital in labour?

Your LMC will organize your transfer to hospital if needed, this may be during labour or after you've given birth. You may feel disappointed if you have to be transferred to hospital, either before, during or after your baby’s birth. Although you’re much less likely to feel this way if you are well informed about why the decision has been made. The two most common reasons for transfer to hospital, your labour is taking a long time and progression is very slow, your baby becomes distressed during labour, you may require added pain relief such as an epidural. Although this all sounds like it’s happening at the last minute, be reassured that your midwife will be monitoring you and your baby throughout your labour. If she suspects a problem is developing, she'll recommend that you transfer to hospital in good time. Even if you’re planning a home birth, make sure you have a hospital bag packed and ready. Put the things you'll need just for the birth in one place, in a box or plastic container. Then you can still use them at home, but they'll be ready to put in a bag at quick notice.

How do I prepare for a home birth?

Choosing your LMC will be one of the most important decisions you will make during your pregnancy so it’s important that your midwife is someone you feel comfortable, confident, and compatible with and someone who fully supports homebirth as your choice and has experience. For more information about home births in NZ check out https://homebirth.org.nz/