How safe is homebirth?
Updated: Mar 14, 2020
With the spread of Covid-19, and the potential pressures the virus may put on hospitals and the healthcare system, many women may be wondering if a home birth is a safe option for them and their baby. In this post I aim to provide you with balanced information so women can make an informed choice. This is not medical advice and you should discuss all options with your midwife, as risks and benefits vary depending on each individual woman’s situation.
First off let’s discuss the research. In 2011 the Birthplace Cohort study was conducted, looking at over 64,000 births in the UK. The main findings were that birth is generally very safe, and for second time or more births (multiparous), homebirths were as safe as births in midwife led units and obstetric units. In fact, for second, third time plus mums, homebirth has the benefit of significantly reducing the risk of medical interventions such caescarean, episiotomy or instrumental delivery via forceps or ventouse. For first time mums, there is an increased risk in adverse outcomes for baby of 9.3 in 1000 births (which is 0.93% chance) vs 5.3 in 1000 births (0.53% chance) for an obstetric unit. It’s important to note that while this increase is statistically significant, both figures are still very small percentages and that birth is generally safe for both mum and baby. There was however a higher rate of transfer to hospital during labour or straight after birth, at 45% for first time mums, vs 12% for multiparous mums. So for second time or more mums, homebirth is just as safe as giving birth in hospital statistically, but with less chance of interventions. For first time mums however, the risk is greater, with a 45% chance of being transferred to hospital during or after birth. Link to the study is included at the bottom of this post.
Now let’s look at the benefits of homebirth from a hypnobirthing perspective. In my classes I teach about the importance of the production oxytocin, the shy primitive hormone responsible for initiating labour, progressing labour, the build up of your surges and cervical dilation, amongst other things. It is much easier to produce and build stores of oxytocin when you feel safe, comfortable, loved, undisturbed and unobserved, somewhere familiar. Your own home is the perfect setting for these feelings, and as it’s your own personal space, it’s much easier to control who comes in to your birth space and how they behave. It’s an unfortunate truth of the hospital environment that it’s the opposite of what’s needed to promote a natural birth. Bright lights, unfamiliar noises, strangers, and possible anxiety and stress will all shut down oxytocin production in place of adrenaline, which in turn stalls labour. This explains why the research found that a home birth dramatically reduces your risk of medical intervention. If labour stalls in hospital, you’re more likely to end up being induced, which often leads to an epidural, which in turn increases your chances of an instrumental birth, episiotomy and c-section. That being said, even staying at home as long as possible in order to build up significant levels of oxytocin can help reduce the chance of intervention when you get to hospital, as well as potentially reduce the contact with numbers of people while you’re there.
So what about germs? The risk of catching Covid-19 in a highly populated hospital is something which is likely to play on a lot of expectant women’s minds. In more general terms, hospitals are likely to be full of sick people and therefore have a presence of a range of germs, viruses and bacteria. Avoiding hospital means you reduce the number of people you come in to contact with, hopefully reducing your chances of being exposed to the virus. There are plenty of cleaning and sterilising procedures in place to prevent the spread of these contagions in hospital, which you will not have in place at home, however, the germs in your home are likely to be less serious and possibly even beneficial as familial flora, a unique family microbiome of bacteria. That’s not to say there isn’t a risk of germs and viruses such as Covid-19 entering your home, but it is something to consider.
You don’t need much for a home birth unless you want a water birth and want to hire a birthing pool, which I did. I also bought an old shower curtain for the floor and sofa, but it was surprisingly mess free! Plenty of towels too. You will be allocated two midwives to attend the birth, one for you and one for baby. They also bring emergency equipment for baby. Generally, for most women, home birth is safe, just as safe as hospital if you’ve given birth before. If you are considering a home birth it may be worthwhile speaking to your midwife to find out what plans they have in place to support the potential increase in planned home births, as well as plans to cope with the demand on beds in hospital for those suffering from Covid-19 and whether this is likely to affect the labour ward. You also should ask about the potential effect strain on the NHS may have on waiting times for ambulances. All these situations currently are hypothetical and you may not get definitive answers, so it’s important to ask and make your own choices based on what information you do receive. Discuss all your options and the benefits of each and make an informed decision based on your individual situation. Official advice from the NHS if you have contracted COVID-19 and go in to labour is to give birth in an obstetric setting/labour ward. Again this is only advice and you can say no, but you do have to weigh up the risks and benefits of not following this advice.
You can read the results of the birthplace study here: https://www.npeu.ox.ac.uk/birthplace
You can also read the advice from Birthrights on how COVID-19 is likely to affect your maternity care https://www.birthrights.org.uk/2020/03/12/coronovirus-how-will-it-affect-my-rights-to-maternity-care/
You can also read the official guidance on pregnancy, labour and COVID-19 from the Royal College of Obsetricians and Gynocologists here https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/covid-19-virus-infection-and-pregnancy/