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The Home Birth Debate


An introduction to the arguments for and against home births


By Ruth Freed


The safety of home births is a subject of frequent debate, and the vast majority of mothers-to-be err on the side of caution with a hospital birth. Yet the numerous studies that have investigated birth safety have not drawn up any conclusive evidence that having a hospital birth is safer for low risk pregnancies. On the contrary, a British Medical Journal study in 2005 showed that home birth is as safe as hospital birth for healthy women with a low risk pregnancy.

The Department of Health is currently “carefully considering” a report published by the Royal College of Obstetricians and Gynaecologists which calls for a third of women to have babies at home or in midwife clinics. The number of women going into labour is 20% higher than just ten years ago, and they feel that by restricting hospital births to only those women who are at risk from complications, vital resources would be freed up for those requiring emergency and specialist care.

Did You Know?


  • Currently about 3% of women in the UK give birth at home, and about 7% in midwife units where there are no hospital doctors. In the US, only 1% of births take place at home, but in the Netherlands, home births make up a third of the total.
  • In the 60s, around one in three women gave birth at home. This fell to a record low of one in a hundred home births by the late eighties.
  • Around 40% of first-time mothers who plan to deliver their child at home end up being transferred to hospital; 10% of women who have already had at least one child. There is, however, no evidence that emergency transfers put the mother or baby at any risk.



For Home Births...


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One to one midwife care

At home, the same midwife will usually stay with a woman in established labour until the baby is born, and a second midwife will also be present for the birth. This makes the experience much more personal and reassuring for the woman and also means the midwife is more likely to notice any potential problems before they become an emergency.

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Familiar surroundings and home comforts

Not only do most women feel more comfortable in their own home, but at home you have everything you might need to drink, eat, wear, or to distract yourself between contractions - and there are no strangers to break your concentration. After the birth you can have a shower in your own bathroom, have tea and some biscuits, and snuggle up in your own bed with your new baby.

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Fewer interventions

In hospital women are often given “just in case” interventions, or time limit interventions to speed up the process. One intervention unfortunately often leads to another. Research has shown that women who have home births are less likely to have medical interventions, and one study showed that planning a home birth halved the incidence of both assisted delivery and Caesarean birth.

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No drugs to artificially speed up labour

Baby born at homeSyntocinon is often used to induce or speed up labour, which increases the risk of various complications for mother and child - e.g. it increases the risk of the baby going into distress, and of the mother finding labour too painful and needing an epidural.

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No separation from your partner

Women who give birth in hospital often have to stay overnight either during labour or after the birth, and their partner usually has to go home. With a home birth your partner can stay with you the whole time and when the midwives leave a few hours after the birth, both parents are left alone to bond with their new baby together.

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Less risk of infection

Far from being a sterile environment, hospitals are full of bacteria and ill people. Mother and baby are not exposed to any unfamiliar pathogens at home. The rate of postpartum infection in women who give birth in hospital is about 25%, compared to about 4% in home birth mothers. There is also less risk of infection to the baby.

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More likely to have an active birth

Keeping mobile during labour helps women to manage labour without needing heavy-duty drugs or interventions. It’s easier to remain active in your own home, and this can make the pain more manageable. It is also more likely that a woman will give birth in a physiologically advantageous position, rather than lying on her back.

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Labour often progresses better at home

Transferring to hospital interrupts the woman’s labouring and also the production of labour hormones, which make labour quicker and easier. Many women find labour slows down once they find themselves in the unfamiliar hospital environment.

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Being in control

Many women describe feeling out of control during a hospital birth, with things being done to them, drugs administered, and not really understanding or being able to influence what happens. In their own home, women naturally feel much more in control of the whole situation and tend to report a much more positive birth experience.

...and Against


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Full range of pain relief

The downside to having a home birth is that the only pain relief available is gas and air, or the warm water of a birth pool. In hospital there are many pain relief options including a spinal epidural which can take the pain away completely.

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Medical staff and equipment

Baby in hospitalIf anything were to go wrong in a hospital birth there are doctors and all the medical equipment you could need. With a home birth if a mother or baby needs medical help beyond the capability of the midwife, an ambulance would transfer them to hospital.

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Security

Many women feel more relaxed and secure knowing that they are in a hospital. Labour usually progresses better when the mother is relaxed, since stress hormones tend to slow down labour.

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Labour can be managed effectively

In hospital there are drugs and procedures to deal with whatever might happen. Labour can be speeded up if it is taking its time, pain relief can be given, or doctors called upon for a second opinion.

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Safety


Since women have been giving birth in hospital, birth has become a lot safer for women and their babies. In the past women frequently died in childbirth, and thanks to medical advances this is mostly a thing of the past.

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No mess in your house

Although midwives who attend home births bring large disposable pads to catch everything, and they clear up everything before they leave, for some people the idea of giving birth on their cream carpet or their new mattress is too much, and they’d rather do the whole thing in hospital!

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Enforced rest after the birth

In hospital it’s easy to rest after the birth as there’s nothing to do. After giving birth at home it can be tempting to start doing jobs around the house!

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Birth is not straightforward

According to Philip Steer, professor in obstetrics and gynaecology at Imperial College London, the reasoning that ‘giving birth is natural’ is not something women should put all their trust in. He says that over the last half a million years, the human pelvis has become much smaller, to adapt to our upright posture. And because being brainy is such an advantage, our baby’s heads have become much bigger. As a result, Steer says, human birth is not as straightforward as many claim, and not all women can achieve a natural labour.



Myth Busting!



Some people think that home births are a drain on NHS resources - this is a myth! Although home births require a midwife to attend to women individually in their homes, labour usually progresses well at home and ambulance transfers only occur in 16% of all planned homebirths. The lower caesarean rate for planned home births means less theatre time and staff, plus no hospital beds or postnatal care in hospital are required, freeing up resources for women who really need the extra help.



Topic: Your comments on The Home Birth Debate

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For more information...



Good sites to check out are: www.homebirth.org.uk and www.northamptonhomebirth.co.uk


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