Home birth information and checklist

The Rosie offers women the choice of birthing at home. This leaflet is intended to help you plan your baby’s birth at home. You will have the opportunity to discuss this leaflet and your individual birth plan with your community midwife at your 34 week home birth appointment which may be undertaken in your home. However, you are welcome to discuss your wishes for your birth with your midwife at any time during your pregnancy.

Home birth: benefits and safety

For women and birthing people with no complications in pregnancy, childbirth is generally very safe. The ‘Birthplace study’ looked at a large number of women with no complications in pregnancy and compared the safety of births planned in four settings: home, freestanding midwifery units, alongside midwifery units (midwifery unit within a maternity hospital) and obstetric units. The study showed that among those with an uncomplicated pregnancy who plan to give birth at home (or in a midwife-led unit) there is a higher likelihood of a normal birth and significantly less intervention. For example, caesarean section, epidural, episiotomy and instrumental birth.

The study showed that, for those with a low risk pregnancy having their second or subsequent baby, a home birth is as safe as birthing in an obstetric unit and can offer additional benefits to the mother.

For those with a low risk pregnancy having their first baby, the study showed that there is a slightly increased risk of a poorer outcome for the baby at a home birth (such as increased risk of death in labour or shortly afterwards; or birth injury) compared to those who give birth in a midwife led unit or obstetric unit. (1:110 risk of a poor outcome for a home birth compared to 1:190 in an obstetric unit). With respect to midwife led units, the risks to the baby were the same as those born in an obstetric unit, but again there was less intervention during labour and birth.

The National Institute of Clinical Excellence (NICE) provides guidance based on the best available evidence and acknowledges that women and pregnant people should be offered the choice of planning birth at home, in a midwifery led unit or in an obstetric unit.

NICE also advises that you are made aware that:

• Giving birth is generally safe for both you and your baby.
• The obstetric unit provides direct access to obstetricians, anaesthetists, neonatologists and other specialist care including epidural analgesia.
• The possibility of being transferred into the obstetric unit exists and this possibility and the time this may take should be discussed with you by your midwife.
• If something does go unexpectedly wrong during labour, at home or in a midwife-led unit, the outcome for you or your baby could be worse than if you were in the obstetric unit at the hospital with access to specialised care.
• If you have a pre-existing medical condition or have had a previous complicated birth that makes you at higher risk of developing complications during your next birth, you will be advised to give birth in an obstetric unit.

Contacting a midwife when you are in labour

When you think you are in labour you should call the Rosie Birth Centre midwives on 01223 217003, stating you are planning to have your baby at home. The midwife who takes your call will ask you some questions to help decide if it is time for a midwife to attend you at home and to confirm if there are any new risks that may indicate a different place of birth being recommended. The midwife will answer any questions you may have and agree a plan of care with you. If you require a midwife immediately, then arrangements will be made to send a midwife to you. The first midwife will attend from the Rosie hospital and the second will be the on call community midwife.

The Rosie hospital aims to provide a home birth service to all women who choose to stay at home to birth. However, this is not an absolute guarantee and sometimes, due to the number of women birthing at any one time and the midwives available, in the interest of safety for you and your baby, you may be asked to attend the Rosie birth centre or delivery unit to give birth.

Identifying your home

You will need to prepare clear directions to your home, in advance of the birth, for the midwife who will attend. They may be unfamiliar with the area. You could identify your house in some way, such as fairy lights around a window, balloons on the door or hazard lights on your car.

The midwife attending you will need to have good access to your house and be able to park nearby. They may need help from your birthing partner to carry in the home birth equipment.

Preparations for a home birth

Your midwife will be able to suggest any changes or preparation you could make to ensure your home is ready for the birth of your baby. You will be given suggestions of the items or equipment you will need. For example:

• Good torch, angle-poise light or similar. New batteries or an extension lead.
• Plastic sheeting approximately two square metres. (for example old shower curtain or bubble wrap)
• Old sheet or large old towel to cover plastic sheeting.
• Several old but clean towels including one in which to wrap your newborn baby.
• Box of tissues or kitchen roll.
• Soap and hand towel for the midwife.
• Mirror.
• Adequate heating in the home.
• A work surface in the room chosen for the birth.
• A clear and designated area for your baby should they require any support at birth.
• A set of baby clothes and nappy, warmed for the birth.
• Cotton hat for the baby.
• Suitable clothes for you in labour.
• A packed bag for you and your baby in case of transfer to hospital.
• Birth paperwork (provided by the midwife)
• Any items you wish to have to support your comfort in labour such as pillows, birthing ball, beanbag, heat pads, TENs, paracetamol.

The equipment and medications carried by the community midwives will also be discussed with you.

Medications

Medications, including those essential for emergency situations will be provided in advance of your planned home birth. These medications will be prescribed for your use only, to be administered by the midwives attending your birth. During your home birth, these medications must be available for the midwife when they arrive.

The home birth medications will usually be prescribed between 34-36 weeks, and you can either collect them from Rowland’s Outpatient Pharmacy at Addenbrooke’s or they can be couriered to your home.. It is important to keep the medications at room temperature (between 15-25oC), ensure they are out of sight and reach of children, and to follow any additional instructions for storage printed on the label. If you have any problems with medication storage then please call the Addenbrooke’s Medicines Information centre on 01223 217502 (Mon-Fri 9am-5pm). On weekends (9am-5pm) you can contact the inpatient pharmacist via switchboard on 01223 245151/01223 805000. If urgent, out of normal working hours you can call this number to request the on-call pharmacist.

Any unused home birth medication, will be removed at the time of the birth by the attending midwife or the midwife seeing you the next day will collect them for appropriate disposal. They must not be put in a household bin.

Medication list

• Adrenaline (Epinephrine) 1mg/mL (1:1000) solution for injection x 2 ampoules
• Diclofenac 100 mg suppository x 1
• Lidocaine Hydrochloride Injection 1% (10mL) x 2 ampoules
• Oxytocin 10 units/mL injection x 2 ampoules
• Syntometrine® (ergometrine 500mcg/oxytocin 5 IU per 1 mL) x 2 ampoules
• Sodium Chloride 0.9% (500ml) IV infusion fluid x 1 bag

Entonox ® (‘gas and air’) and vitamin K (for administration to the baby) will be brought on the day by the midwives attending the birth.

Pethidine and diamorphine are not available for use at home births.

Care of other children and pets

During the daytime, child care should be arranged, although you may wish for your child/children to be present for the birth. In this case, a responsible adult should be available to look after your child/children’s needs, especially if they do not wish to remain with you. If the birth is at night your child/children may remain asleep. However, you should arrange for a nearby responsible adult to be available to care for them in case they wake up, or you need to be transferred to hospital.

For health & safety reasons, we request that pets in the home are kept in a separate area from the attending personnel and equipment.

Care in Labour

A midwife will care for you in labour, once labour is established. After your initial assessment they may keep in touch with you by telephone if you are in the early stages of labour (latent labour) until you need a midwife with you. If labour goes on for a long time, care may be provided by more than one midwife. Nearer to the time of birth a second midwife will be called. The attendance of a second midwife is not a legal or professional requirement but is recommended to provide additional support and assistance to the first midwife for the birth of your baby.

You may be asked if a student midwife can attend your birth with your midwife. We like to encourage student midwives to attend home births to gain valuable experience in normal childbirth.

During your labour the midwife will support you in your birth plan and monitor the wellbeing or you and your baby as per NICE intrapartum care guidance (2023). You should drink to thirst and eat little and often, as able to. We will also encourage you to empty your bladder every two to four hours. You will be supported in your choice of positions during labour.

Water birth

A warm bath can be relaxing in labour but it is not usually large enough for a water birth. Pools can be bought or hired. Your birthing partner will be responsible for filling the pool, maintaining water temperature and emptying the pool.

The surrounding floor should be protected. A quantity of towels will be required, including one or two large bath sheets for your use when you get out of the pool. An area outside of the pool is also needed for you to give birth if you decide to get out of the water.

A mirror suitable for use in water and a good torch are also useful, so that your baby can be seen being born under water.

Reasons for transfer to hospital

The midwife will recommend transfer of you and/or your baby to hospital if:

● There are any concerns about your baby’s wellbeing during labour. This may be if there are concerns about your baby’s heartbeat or if your baby has passed meconium in your waters.

● There is any abnormal bleeding from the vagina.

● There are concerns about your health during labour. For example raised blood pressure, pulse or temperature.

● Your labour is progressing slowly and it is considered likely some assistance is necessary.

● Your baby is in a position that could make the birth more difficult.

● You wish to transfer for any reason, such as for other pain relief.

● Following an obstetric emergency (possible scenarios will be discussed with your midwife).

● After the birth if there is any concerns with your baby’s breathing or temperature.

● After the birth if you have a tear to your vagina or perineum that is considered too difficult to repair in the home or if it requires repair by a doctor.

You will have an opportunity to discuss this list further with your midwife at your home birth appointment at around 34 weeks.

The Birth place study showed that transfer rates in labour to obstetric units from home are higher for first time mothers (45%) compared to mothers who are in their second or subsequent pregnancy (12%).

If you are transferred, it will be by ambulance. The midwife will accompany you in the ambulance, but may hand over your care to another midwife on arrival at the Rosie delivery unit. Your birth partner is likely to have to travel in your own car, not with you in the ambulance. If your baby needs to transfer to hospital following the birth, where possible you or your partner may go with your baby in the ambulance. Your midwife will talk to you about the locally available services and possible transfer times to your nearest obstetric unit.

Other concerns

If during your pregnancy additional risks have been identified and you are at higher risk of complications developing during your birth, you will be advised to give birth in an obstetric unit where specialised care is available. Your midwife will discuss these factors and appropriate Rosie hospital guidelines with you.

If you still wish to birth at home an appropriate plan of care will be discussed with you and this will be put in place with any necessary arrangements made in time for your birth. It is also recommended that the planning of your birth be discussed with a senior obstetrician; to ensure you have all the information required to make an informed decision about your birth.

Postnatal care

The midwife will remain with you for around two hours after the birth of your baby. During this time the midwife will repair any perineal tears (if required), check that you are well, and that you have been able to have a wash/shower and emptied your bladder. After skin to skin contact and a feed, your baby will be checked and weighed by the midwife, and vitamin k given if you have given consent for this.

Before leaving you, your midwife will provide you with contact phone numbers in case of emergencies and for help and advice. Your own community team will be informed of your birth and plans for your next visit made. Your midwife will ensure you have information on basic safety and care principles in looking after yourself and your baby, including:

● Sleeping positions

● Environmental temperature

● Pain relief for yourself

● What to expect in relation to your recovery from birth

Your baby will have an Oxygen level check prior to leaving you after the birth. A neonatal examination by a specially trained midwife, within 72 hours of the birth. This may be performed at your home, local children’s centre or at the Rosie hospital. Your baby’s newborn hearing test will also be arranged as an outpatient appointment.

We hope this leaflet will prove useful and that you enjoy the birth of your baby wherever that will be.

Useful websites and information

National Perinatal Epidemiology Unit (NPEU) Birthplace in England Research Programme (opens in a new tab)

NICE Guideline Intrapartum care: care of healthy women and their babies during childbirth (2012) NICE The National Institute for Health and Care Excellence (opens in a new tab)

The Royal College of Midwives (RCM) The Royal College of Midwives (RCM) (opens in a new tab)

National Childbirth Trust (NCT) NCT Giving birth at home (opens in a new tab)

Association for Improvement in Maternity Services (AIMS) AIMS For a better birth (opens in a new tab)

Birth Choice UK Which? Where to give birth (opens in a new tab)

NHS Choices The NHS website (opens in a new tab)

Home birth checklist: record of discussion

A community midwife should complete this discussion with you, ideally in the intended place of birth at your 34 week appointment, or as soon as possible after this.

WiFi code and password to aid documentation in electronic patient record:

Midwife undertaking discussion:

Signed: _________

Print Name:___________________ __________

Contact no: _________________

Date: