Home Birth Series: Part2 – What to expect and how to prepare from independent midwife Tina

Answer by Apparently Kids Professional, Independent Midwife Tina Perridge @southlondon_im

So, you are planning a home birth, great choice! If you are a healthy, low risk woman enjoying a straightforward pregnancy (and your doctor has given the go-ahead) then the evidence shows that home birth is a good safe choice for you.

What to expect from a home birth:

The big thing about a home birth is that it is usually a very low key affair. This is your home, so the midwives are visitors in your home and that makes a difference. For the greater part of the labour you may be alone with your partner or the midwife will be quiet in the corner or in the the kitchen, popping in to check on you from time to time.

It is easy to carry on as normal for a good part of the labour as you can move about freely around your home, rest, sleep, eat etc. Your partner can be with you or just in another room if that seems appropriate. You don’t need to worry about how dilated you are and when to transfer to a hospital. You can be in touch with your midwife and discuss with her when she should come to you. If she comes and it is too early she can reassure you and go away until you are ready for her. Somehow it takes all the stress out.

Once the midwife does decide that you are in established labour and she stays, she will try to be unobtrusive. She will ensure that her equipment is ready and keep an eye on you, probably listening in to your baby’s heartbeat every 15 minutes or so, and once you are in second stage, it will be every 5 minutes or after every contraction and at this time she will remain close to you. Her job is to ensure that you, the baby and the labour are all normal. This can generally be done by observation and checking the heartbeat. She may ask you some questions about what you are feeling etc. She will encourage you to be mobile and to drink and pass urine frequently. She may or may not need to do any vaginal examinations if the labour progresses as expected. Either way, it is your choice whether you agree to these.

Once the baby is moving down your birth canal and the midwife expects the birth to be imminent, she will prepare all her equipment nearby and there will usually be a second midwife present by then. She will encourage you to breathe the baby out gently and may use a hot compress if you are not in a pool. Often the head is born and then there is a quiet couple of minutes until the next contraction which will help the body to be born. Typically, the midwife will gently move the baby through your legs so that you can pick your baby up and bring them skin to skin. The cord will still be attached at this point and there is no need to cut the cord until the placenta is out unless the baby needs support or you are bleeding.

Once you have birthed your placenta the midwife will examine your perineum to establish whether it needs suturing. Normally this can be done at home and then its time to celebrate, eat some good food and drink a welcome cup of tea or even some champers! You might want a bath and to get into a fresh clean bed with your baby. The midwife will weigh and check the baby over as well as ensuring that all your observations are normal and the baby is feeding well before she departs. She will usually clean up everything leaving a bag of washing and a bag or rubbish.

Some people are concerned about what will happen if there is a problem with the labour. This is what the midwife is trained to identify and she will act accordingly. The reassuring aspect of this is that the majority of transfers from home birth into hospital are quite calm affairs and the most common reason is a rather long labour where the woman decides that she would like some help or pain relief. Of course, you can use Entonox (gas and air) at home and most women find that, plus a birth pool and the comfort of home are sufficient for them.

How to prepare:

The decision to have a home birth will often be influenced by who will be caring for you. It is important that you feel comfortable with the midwife and therefore most NHS home birth teams will aim to ensure that you know the team who will be caring for you.
If you have opted for an independent or private midwife you will have become comfortable with her during your antenatal care and she will know what your plans are.

During your pregnancy you might want to optimise your wellbeing by paying attention to your diet and physical wellbeing. I recommend 70g of protein a day spread over 5 portions, moderate amounts of complex carbs, plenty of fresh veg and limited fruit. This type of diet will help to stabilise your blood sugars, pick up your energy and help your baby grow well. To keep you body physically active and strong, some women enjoy pregnancy yoga or pilates but walking and swimming can be just as effective.

Finally, you may want to think about some form of hypnobirthing as a preparation. This can help you approach your birth calmly and with confidence.

Many people think that having a baby at home will be messy and complicated. Think again. Invest in some plastic dust sheets, a few old duvet covers or sheets, an old duvet or pillows and a good selection of old towels, and you are ready to go! Once the birth is over the sheets and plastic can be rolled up for disposal and the towels washed. Simple!

Most women give birth kneeling on the floor or in a pool and the only other props you might need are some bendy straws or a bottle you can drink from at any angle, a torch, some disposable mats (changing mats from Boots), some easy to digest food, low lighting and music. You won’t know in advance where in your home you will give birth so try not to get fixed on a certain room. I once attended a birth in an enormous house and the woman gave birth in the tiny loo under the stairs!

Finally ensure that you know what you want and what is important to you and believe in yourself. You can do this.

Tina Perridge RM (Registered Midwife)