How to Have a Safe Home Birth

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1Determining If You Are A Candidate For Home Birth

2Preparing For A Home Birth

3Understanding And Handling The Risks

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Many women opt for a home birth as opposed to birthing in the hospital setting. As long as your pregnancy is deemed low-risk, and you are within close proximity to a hospital should any complications occur, a home birth can be almost equivalent to a hospital birth safety-wise. It is important to learn how to prepare for a safe home birth, to ensure that the process goes as smoothly as possible. It is also important to be able to recognize when additional help may be needed.

Steps

Part 1

Part 1 of 3:

Determining If You Are A Candidate For Home Birth

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   Ensure that your pregnancy is proceeding normally as you approach the time for birth. In order to be a candidate for home birth, your baby must be between 37 and 41 weeks gestation. Any earlier than 37 weeks carries additional risks, and anytime later than 41 weeks is also higher risk as the health of the placenta and the nutrient supply begin to fade.

   • Your baby must also have had no health concerns or abnormalities during the course of the pregnancy.
   • In order to qualify for a home birth, you are advised not to have multiples (that is, you are not pregnant with more than one baby at this time, as that carries a significantly higher risk of complications).
   • Note that, in low-risk settings where the pregnancy and time-frame of the birth are normal, studies have shown that there is very little difference between a home birth and a hospital birth in terms of creating a safe and successful outcome for your baby.
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   Evaluate your baby's position prior to the birth. It is important that your baby be correctly positioned for labor and delivery. Delivery for a home birth needs to be head first, so if your baby is breech — with their feet first — this is an indication to proceed with the birth in a hospital setting.
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   Consider your own health and wellbeing to see if you are a candidate for a home birth. Prior to proceeding with a home birth, it is important to ensure that you yourself do not have health concerns such as diabetes, high blood pressure, a seizure disorder, or other chronic health concerns that may increase the risk of the birth for you and/or your baby. It is also important to rule out any pregnancy complications such as preeclampsia (which requires hospital care).

   • Note that a home birth is not advised if you have previously had a C-section (if you have, a hospital setting is recommended).
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Part 2

Part 2 of 3:

Preparing For A Home Birth

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   Select a midwife or other qualified individual to guide you through the home birth. The first step in planning a safe and successful home birth is to select a qualified healthcare professional to work with. Normally this is a midwife; however, it can also be a family doctor.

   • It is important that whomever you choose as your healthcare professional for the home birth has hospital privileges at a hospital nearby, or connections with physicians who can help should an emergency occur.
   • It is also key that you and the midwife or family physician that you choose have compatible views on how you see the birth proceeding, the type and quantity of prenatal care that will be received, and how any emergency situations will be handled.
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   Select a location for the birth. Most people will choose a location in their home; the one caveat is that the location should ideally be within 15 minutes of a hospital that has 24-hour maternity care. This is because, in the small chance that an emergency should occur requiring additional hospital care, it is important to be able to get there promptly and also for the care to be accessible at any time of the day or night.

   • Assuming that you are having the birth at home, choose a room that feels like a good fit for you.
   • Consider whether or not you want a water birth, and discuss the pros and cons of this with your midwife or physician.
   • Ask your midwife or doula (a professional labor assistant) to bring sheets or towels to cover the bed or floor where you are having the birth.
   • You should also make sure you have immediate access to reliable transportation.
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   Choose your support team. It is important to think about who you want to have present for your baby, in addition to the healthcare professional (normally the midwife). Think about the role you want the father or your partner (if you have one) to play, and which other family members or friends, if any, you want to have present.

   • If you want additional support during the labor process, you can consider hiring a doula.
   • A doula is a professional labor assistant who can be there to support you throughout the entire process.
   • The American Academy of Pediatrics also recommends having at least one person present who is trained to assess the health and wellbeing of your newborn upon birth.
   • You should also book a follow-up appointment with a pediatrician (a medical specialist) a few days following the birth in order for your baby to receive a complete medical check-up.
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   Decide how you want to manage your pain. Having a child can be a painful experience, yet women have a variety of opinions and personal preferences as to how they would ideally like to handle the pain. Think about your own personal views and beliefs, and talk to your midwife or doctor about the type of pain control strategies you would like to use during your home birth.

   • Some women opt for no pain control. Women have been birthing naturally for decades, so it is possible to do it without medication; however, it is recommended to discuss a back-up plan with your physician, in case the pain becomes too much to handle.
   • Some examples of pain medications you can consider include Entonox (nitrous oxide, or "laughing gas"), and pethidine (Demerol).
   • Note that epidurals are not available in the home setting. An epidural is a commonly used method of pain control in the hospital setting (where anesthesia is administered directly into the spinal cord); however, the procedure must be performed by a licensed anesthesiologist (a medical specialist), so women birthing at home do not have access to it.
   • Strategies for pain control without using medications include hypnotherapy, warm water, choosing comfortable positions, practicing relaxation strategies, using a birth ball, distracting yourself, receiving a massage, trying aromatherapy, or using heat on your tummy or back.
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   Create a birth plan. It is important to be well-prepared and to know what to expect going into a home birth. The midwife (or physician) serving as your healthcare provider will regularly measure your temperature, your heart rate, and your blood pressure, as well as your baby's heart rate, as a means to monitor how the birth is progressing.

   • Make sure you have covered all the details of how you hope the birth will proceed well before you go into labor.
   • This includes confirming the location of the birth, who you want present as your support team, strategies to handle the pain, expected time frames and details about each stage of labor, and how any complications will be handled should they arrive (including knowing the location of the nearest hospital with 24 hour maternity care).
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Part 3

Part 3 of 3:

Understanding And Handling The Risks

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   Understand potential emergency situations. It is important to be aware that there is a small chance that the home birth does not proceed as smoothly as expected. Complications to plan for and to be aware of include:

   • Labor that fails to progress quickly enough (as labor that stops mid-way or is moving very slowly can be dangerous for your baby).
   • Finding meconium (feces) in the amniotic fluid — this can put your baby at higher risk of complications following birth and may be a sign that the baby is being stressed by the labor.
   • Any signs that your baby is otherwise in distress, such as abnormal vital signs, or any signs along the way that your baby has health concerns or abnormalities.
   • Problems with the placenta, such as "placental abruption" (when the placenta detaches from your uterus before delivery), or if the placenta is unable to be fully delivered following the birth of the baby (this poses a risk for dangerous bleeding for mother).
   • Problems with the umbilical cord, such as "umbilical cord prolapse" (where the cord drops into your vagina before the baby and can potentially compromise your baby's flow of nutrients).
   • Excessive vaginal bleeding.
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   Create a backup plan. If any of the above complications do ensue, you will likely be advised to transfer the birthing process to the nearest hospital. Ideally, you will have chosen a location for the birth that is within close proximity of a hospital with 24-hour maternity care so that you can be transported there to receive professional help should an emergency situation arise.

   • The doctors may need to do an emergency c-section, or use medications to accelerate your labor if your baby's health is compromised.
   • It is important to prioritize the health and wellbeing of your baby in situations such as these, because failure to receive professional medical care could forever compromise your future child's quality of life.
   • Remember that having a healthy baby is the most important outcome of any birthing process; allow yourself to remember this if a change of plans becomes necessary and you are unable to safely proceed with a home birth.
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   Receive follow-up care after the birth. Right after the birth, your midwife can help you to initiate breastfeeding with your new baby, after your baby has been examined by the person present who is qualified to examine newborns. Assuming that your baby is doing well and that you did not need to move the birth to a hospital setting, you will be encouraged to spend time bonding with your baby (and breastfeeding) right off the bat.

   • Your midwife or doula may also provide you with ongoing lactation support in the initial stages as you work to establish a routine with your newborn baby.
   • You should bring your baby for an official medical check-up by a paediatrician within three days following the birth, to confirm that he or she has no health concerns.
   • You can then proceed with follow-up visits with your midwife at the designated intervals to ensure the ongoing health and wellbeing of your baby.
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