Did you know: You can have your first baby at home?

Lots of people (all of whom have never had a home birth or attended one) are very fond of telling the world that women are not “allowed” have their first baby at home. Has someone said this to you? I am sure that many people said it to me before I ever got pregnant, and some still quote it now.

Reasons people give are usually fairly random but often centre on some kind of notion that a woman’s body is akin to an untested, untried machine. The same people are usually eager to concede that once a woman s body has been “tested” in a pregnancy and birth and performed (one presumes) to appropriate standards, its fine to have a homebirth on baby two.

Interestingly, some people believe that nothing could be further from the truth!

A midwife speaks:

“I love having clients that are having their first baby. Things happen so slowly with a first birth that I always have plenty of time to get to the couple when the mum goes into labour. The labour and birth unfold slowly and it’s such an honour to support not just the woman in the birth of her first baby but also in actually becoming a mother for the first time …I like to see first time couples from very early on in pregnancy and I work closely with them all through their pregnancy helping to dismiss all the nonsense that most people think labour and birth is about and support them in preparing for what will actually happen. First time couples do not have previous experiences of birth that colour their mindset”

The most recent large scale study comparing outcomes for mother and baby reported in the British Medical Journal last month showed that for women who had previously given birth, adverse outcomes were less common among planned home births (1 per 1,000) than among planned hospital births (2.3 per 1,000). The rate of postpartum haemorrhage was 19.6 per 1,000 for a planned home birth compared with 37.6 per 1,000 for a planned hospital birth. For women having their first baby the rate of severe outcomes for a planned home birth was 2.3 per 1,000 compared with 3.1 per 1,000 for a planned hospital birth. The rate of postpartum haemorrhage was 43.1 per 1,000 for a planned home compared with 43.3 per 1000 for a planned hospital birth.

Nonetheless, having acknowledged the above, the Royal College of Obstetricians and Gynecologists in the UK provided this statement on their website: “The RCOG supports the choice of a home birth for low-risk women expecting a second or third baby.” Their opinion, one assumes is based on a previous study in 2011, also published in the BMJ which indicated that first time mothers had a higher rate of transfer to hospital and a small but significantly higher chance of minor complications than second time mothers. No doubt the 2011 article suited their agenda better than the one in 2013.

One of the reasons that women do not get to have home births on their first babies is that no one actually told them that there was such a service and that they could avail of it. So here you go. I am telling you that you can. Yes, when you get pregnant for the first time, provided your pregnancy is low risk you can indeed have a baby at home. Tell that to your friends, to your relatives, to your sisters your cousins, your neighbours your daughters and your GP!

Other reasons why mothers don´t have a home birth on baby number one is that society in Ireland tends to be a bit suspect of home birth in general. We tend to believe that hospital is a safer bet altogether. This is merely a notion, one of the many accepted myths about birth. It is not based on any hard facts or research, but on a general vague notion that hospitals are havens of safety. The research in fact shows that in some cases home is safer for low risk mothers than hospital.

A midwife speaks

“The continuity of the care I offer throughout pregnancy, knowing that I will be there for a family during pregnancy, the labour the birth and afterwards when they are adjusting to motherhood is one of the factors that contribute to the safety of home birth. I know my clients so well that I know if their bodies or their minds are behaving in a way that is unusual for them.”

For most of us when we are pregnant for the first time, it’s hard to come from a place of knowing, as this is new territory, and so others do the knowing for us. We then often hand over responsibility and choices to others, whether it is our mother in law, our GP or our antenatal teacher. So it is hard to buck the trend and choose to birth at home rather than in hospital. Yet some women do. They do because they found out before they were pregnant that home birth is a safe free option available to them from the HSE, and they do because someone supported them in their choice. They key, as ever, in making choices about birth and early parenting is information and support. Find out as much as you can and get your partner on board before you get pregnant if possible.

Your first birth is in many respects your most important birth. It will launch you into motherhood. It will determine whether you become a mother in a positive and healthy way, enabling you to focus easily on your baby´s needs, or whether you arrive into motherhood with physical and emotional issues that make mothering so much more challenging in the early days. Depending on how your first birth goes physically may also determine your risk status for subsequent babies.

Most first births are slower than actively managed maternity units would like and so labours in hospitals get hurried along by either physical or chemical means, and whilst most babies can cope well with this artificial speeding up of the labour, some find it a challenge and become distressed requiring further interventions. Having a first baby at home allows labour to unfold at its own pace, and since the mum doesn’t have to go anywhere to birth, there is less emphasis on identifying the actual start of labour and trying to put time limits on early contractions or surges. In this way babies are not subject to any unnatural stresses at home.

The 2011 BMJ article cited above highlighted the rate of transfer to a hospital setting. Although no national statistics currently exist in Ireland for transfer rates it is presumed that they are higher for first time mothers than subsequent mothers as this seems to be a worldwide trend. Even if a transfer from a home birth to a hospital birth is required later on in the labour, by starting at home, mothers will have evaded many of the routine interventions that are common in hospital settings early on.

Aside from all of the above, having the care of a self employed or community midwife as your first carer for your first pregnancy will keep you shielded from all of the ill informed notions and myths that surround birth and early mothering in our culture today. It will also prepare you for mothering in ways you never realised. Most domiciliary midwives are lactation consultants and very supportive of breastfeeding. Most will suggest early gentle parenting tips and show you in your own home how to take care of your baby´s needs. Whilst other mothers are struggling with crying babies and feeling overwhelmed, home birth mothers who have their own midwife on call feel supported and comfortable.

Many mothers who did not choose a homebirth on their first baby wish they had known that they could.

A mother speaks

“I desperately wanted a natural birth. I did not want to have unnecessary interventions, I didn’t think it was good for me or my baby, but I didn’t think I was able to get a home birth because my GP did not offer it as an option. I ended up going into hospital to have my baby. I had a natural birth plan and thought that it would be followed in hospital, but I was just told that a lot of things had to be done  because it was” hospital policy” to do them,  whether I liked them or not…My baby ended up in distress and I had an emergency C-section. Now of course I am classed as high risk and I’ve been told I will always have to have a more medicalised birth should I fall pregnant again.”

Birth is not a disease or an illness that has to be cured, or that requires experts to analyse and prepare a treatment plan for. Birth is a natural physiological event that women’s bodies are designed to cope with. We have an innate capacity to birth our babies, even our first. Choosing a home birth for your first birth gives your body a chance to do what it knows it can to birth your baby.

Home births are available countrywide in a service overseen by the HSE but provided by self employed community midwives. The service is free and available to low risk women (about 85 – 90% of the population). Some hospitals also offer home birth services e.g. NMH Holles St, Waterford General and Wexford General. Information on homebirth is available from the Home Birth Ireland and the HSE.