Sarah Noble, Consultant Midwife at Birmingham Women's NHS Foundation Trust, on the myths and frequently-asked questions about home birth

Despite robust evidence to show that low-risk women who are not first-time mothers' outcomes are significantly improved if they choose to birth at home and a national drive by organisations such as the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists to increase the homebirth rate in England, there has been no national increase in the rate of homebirths. This may be due to a deeply embedded culture favouring hospital birth.

At Birmingham Women's Healthcare NHS Trust, however, the rate has increased from 0.31% to 1.2% in two years. The Home Birth Team's success can be at least attributed to dispelling some of the common misconceptions about choosing home above other birthing options. 10 of which are below...

:: This article has been reproduced with the kind permission of the International Journal of Birth and Childbirth Education. To access more of their articles, click here.

Misconception #1: Homebirth is not safe.

NOT TRUE

In fact, for some pregnant women, homebirth is a safer option. If you have just seen a midwife in your pregnancy and are fit and well, then you can consider homebirth as an option. If you are a second-time mum with a healthy pregnancy, the benefits associated with home are that there is a higher chance of you having a normal birth; you are less likely to have interventions such as episiotomy and forceps and less likely to need drugs for pain relief. Homebirth is as safe for babies of second time mums as hospital.

Misconception #2: Homebirth is only for second-time mums.

NOT TRUE

While we promote homebirth for second-time mums, homebirth is an option for first-time mums, too, as long as they have healthy pregnancies. The outcomes for first-time mums are better at home than in hospital as they are less likely to need a caesarean, forceps, an episiotomy, an epidural for pain relief, or to have their labour speeded up with a hormone drip. First-time mums are also more likely to use water for pain relief, to use fewer drugs for pain relief, and are more likely to breastfeed their babies for longer. However, the risk for their babies of an adverse outcome is slightly higher at home than hospital. According to recent research, 991 out of 1,000 babies born at home to first time Mums will be well compared with 995 out of 1,000 babies born in hospital.

Misconception #3: Homebirth is messy

NOT TRUE

There is surprisingly little mess! Every birth involves some bodily fluids, such as blood and amniotic fluid (water), but the majority of home birthing families are pleasantly surprised at just how little mess there is and how quickly it is cleared away by the midwives. All clinical waste is taken back to the hospital. Your midwife will talk to you while you are pregnant about how to prepare for a home birth, including how to protect your furnishings and floors. We advise families to buy a dust sheet as additional protection for the sofa or bed. If you choose to give birth in a home birthing pool, the mess will be contained and is easy to dispose of.

Misconception #4: Home birth is for hippies

NOT TRUE

Homebirth is for everyone! Especially women who have had a straightforward birth before. Homebirth is the preferred choice of many women and their partners, no matter where they live, what they do or their ethnic background.

Misconception #5: Hospitals are cleaner than my house

NOT TRUE

Giving birth at home reduces the risk of infection for both mother and baby. You are regularly exposed to the germs in your home – they are ‘friendly’ germs, whereas the germs present in hospital can be unknown to your immune system and therefore present a much bigger threat.

Misconception #6: I cannot have a homebirth, because my house is not suitable

NOT TRUE

If your home is where you are intending to bring your baby up, it is suitable.

Misconception #7: If I choose a homebirth, I can’t have any pain relief

NOT TRUE

Pain relief options are available; for example, you might wish to consider a birthing pool. You can also use gas and air, which the midwife will bring, and self-administered aromatherapy oils. You can learn hypnotherapy techniques for labour which your midwife will support you to use. You cannot have an epidural at home, because it is a medical procedure that requires an anaesthetist. However, research shows that women who birth at home need less pain relief than women who birth in hospital. This is thought to be because they are more relaxed, able to move around freely and have as many or as few people around them as they choose.

Misconception #8: What if it all goes wrong? Doctors and not midwives are qualified to deal with emergencies

NOT TRUE

Midwives are highly-trained and skilled to deal with emergencies at home. Safety data supports this. Every step possible is taken to reduce the chances of an emergency occurring at home. Only women with healthy pregnancies are actively encouraged to birth at home. The need to transfer to hospital is relatively common, but most transfers are for non-emergency reasons, such as a longer than expected labour; some concerns about how the baby is coping with labour; waters breaking and not being clear. In an emergency, midwives have first line drugs and skills to cope at home until transfer to hospital.

Misconception #9: Even if I start my labour at home, the chances are I will end up in hospital

UNLIKELY

What is important is that you are in the right place at the right time. There is always a chance of transferring into hospital should complications arise. Transfer would be either in your own car or an ambulance depending on the reason.

• Approximately 45 in every 100 women expecting their first baby transfer.

• Approximately 12 in every 100 women expecting their second or subsequent baby transfer.

Very few transfers are for blue light emergencies.

Misconception #10: It’s not good to birth at home with children present

NOT TRUE

This is a personal decision for you and your family to make. Lots of children are present at a home birth and it is a very positive experience for them. The midwife will recommend that there is an adult on hand to look after a child should s/he become upset. Whatever you decide, it’s important that you feel free to focus on your labour rather than worrying about a child.

:: For more information about birthing options, see this page on the NHS Choices.

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