Home delivery: The alternative to a hospital birth

There are risks but many rewards for the growing number of women now having home births, says Arlene Harris.

When Meghan Markle joined ‘The Firm’ it was obvious that she was going to do things differently to her predecessors. And while Stateside baby showers probably ruffled a few blue feathers, the fact that she is supposedly planning a home birth may cause some to reach for the smelling salts.

For many people, the idea of giving birth at home is unthinkable as they imagine all sorts of dangers occurring away from the ‘safety’ of the delivery suite.

But women have been having babies at home since time began — some are planned, some not so — and these days many midwives offer a home birthing service and keep strong links with the local hospital should intervention be required.

Shelly O’Halloran had her two children — Clíodhna (4) and Luna (23 months) — at home and says both were positive experiences which worked for her and her partner, Glen.

I did a lot of research on my first pregnancy and realised what a normal physiological event birth is for the majority of women

- says the Clare woman. “I was healthy so it made sense that birth could be relatively low risk.

“I don’t really like leaving things to chance so attended a Gentlebirth workshop which was empowering as it prepared us for all eventualities and we felt mentally well-equipped.”

Shelly, who works as a doula, sometimes suffers from anxiety and, believing the hospital environment could make her feel anxious, made the decision to give birth at home.

“I like to be in control and worried I wouldn’t be in hospital,” she says. “I was also concerned that having to deal with multiple new faces while in labour might hinder the optimisation of my hormones.”

Supported by two midwives, she remained active for as long as possible before becoming immersed in the birthing pool surrounded by candles. This, along with various exercises, encouraged the birth of her first daughter.

It was such a positive experience, that when she became pregnant again there was no decision to make and her second daughter was also delivered into a ‘calm, loving environment’ at home.

“There is a lot of misinformation and scaremongering and many first-time mothers don’t even realise it’s an option, but I would highly recommend homebirth,” Shelly says.

Midwife Gail Mackey says, while there are no official figures regarding the amount of women choosing home births, interest does seem to be on the rise.

“With my experience of a full workload each year and anecdotal evidence from social media, there seems to be a steady number of women seeking this model of care in Ireland,” says the Dublin-based midwife.

“And many want to plan this but can’t due to the lack of homebirth services in some areas.

“The number of planned homebirths has been quoted by AIMS as 200-300 per year between the three pathways — hospital-based schemes such as the Domino midwives in NMH, the HSE national homebirth scheme and privately insured companies such as Private Midwives Ltd.

With more and more families looking for a more personal experience of childbirth which is a statistically safe option, I predict the numbers will rise over the next few years and hope the number of midwives in community practice will increase too

According to the experienced homebirth midwife there are some instances when a home delivery is not advisable.

“If a woman wishes to consider a homebirth she will have a full assessment of her current and past obstetric and medical history and evidence-based recommendations regarding place of birth are discussed,” she says.

“In some circumstances — such as placenta previa, a history of more than two caesarean births or some underlying medical conditions — it would be advised to birth in hospital.

“Sometimes distance from a hospital is brought up as a reason not to have a homebirth but research does not back up the claim. And in some circumstances, it may be preferable to have the midwife come to the woman’s home rather than risking a road-side birth or unassisted home birth.”

It’s essential to have a link between the hospital and delivering midwife and expectant mothers are advised to book into their local hospital in order to have scans and bloods done — should a transfer to hospital be necessary, the transition of care would be easier if the information is already on file.

Indeed, Tracy Donegan, midwife and founder of gentlebirth.com, says it is important for professionals to work together to give the best possible care.

“The safest care is collaborative care between midwife and hospital to ensure the best outcome for mother and baby,” she says.

“A positive working relationship with your closest maternity unit is essential especially in the unlikely event of a transfer to hospital which needs to be as seamless as possible.

“Birth is not risk free at home or hospital but one of the benefits of homebirth is continuity of carer. Midwives have emergency training and if there are any clinical indicators that the labour is not progressing normally your midwife will recommend a transfer to hospital. We need to keep in mind that the majority of caesareans in Irish hospitals are due to slow labour progress than a true emergency.”

A home birth in the public sector is free of charge while a private birth at home can cost from €4000 – some of which may be redeemable from private insurers.

“Currently issues with GP indemnity insurance mean that most GPs are prevented from supporting women who plan a homebirth, both publically and privately,” says Mackey.

“This can be a particular issue in the postnatal period as parents are often unable to get recommended baby checks done locally. We would love to see this issue being investigated and resolved.”

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