The first step

Whether you are mildly curious, actively interested or entirely certain you want to stay at home to have your baby, the first step is to get clear on how it all works – from how to book midwife care at home, to what that care will involve, in pregnancy, for the birth, and right after you’ve had your baby. You will have been informed about your place of birth choices at your booking-in appointment. It should have been explained to you that home is a safe place to have your baby and that current clinical evidence confirms that midwife-led care at home is a positive and very safe option. If this conversation didn’t happen, you can ask the midwife about it at your next appointment, as NICE guidelines state that pregnant women should be provided with complete information on all their options for maternity care and place of birth. Some people start considering staying at home to have their baby early in pregnancy. Others may start thinking about it at 36 weeks. At whatever point in pregnancy you become interested, begin with a chat with a community or home birth team midwife. You’re bound to have lots of questions, as will your partner, and you’ll likely want these answering before taking your plan forward.

If you opt late on to change from care in hospital to care at home, never be deterred by the concern that it would be administratively complicated, or that there would be too much to organise.

Confidence builds over time, so it’s entirely normal for women to reach the decision to give birth at home in the last trimester. It will be simple to switch tracks as long as you make contact with the community team swiftly. In most cases, the midwives who’ll be supporting you will be nothing short of delighted to welcome you on board.

If your new plan necessitates a switch of hospitals (boundaries sometimes mean a booking hospital doesn’t cover your area for home birth), don’t be put off by what is, in the scheme of things, a tiny bureaucratic blip – transferring your care across will be fairly seamless once you’ve made your intentions clear.

There may be a good reason why another hospital doesn’t suit you, especially as you will need to factor in the possibility of transfer. But resist parking your home birth plan merely because your current hospital has come to feel familiar. You may well have got used to it, but it remains a public institution where the chance of you meeting a midwife more than once is slight. The reassurance you may feel about a hospital where you’ve had a handful of antenatal appointments doesn’t come close to the safety, comfort and all-round ease you’ll feel from being cared for in your own home.

You can usually obtain a number for your hospital’s community team by going to their website, where there may be an online option to self-refer. Alternatively, call the hospital switchboard for the community team office number, or, if you’ve plenty of time, ask your midwife at your next appointment. The community midwife may then visit you at home, and go through everything with you. If you get in touch and don’t hear back within 48 hours, always make a followup call to make sure your message has been received and the wheels are in motion.

Provision

Home birth services vary around the country. Theoretically, every woman is entitled to choose and receive midwife support to birth at home but, in practice, some areas have a more reliable, easy-to-access service than others. Cycles – both vicious and virtuous – predictably establish themselves, with women being discouraged and not following up where service seems sketchy, while strong, well-supported community midwife teams and mothers hearing from other mothers how wonderful it is, result in demand and supply thriving.

Lack of support can range from mothers being pushed from pillar to post regarding booking-in, to eleventh-hour obstacles being placed in the way, such as being told that there are staff shortages and that a midwife in labour can’t be guaranteed.

On a forward-looking note, things are changing. The recent national maternity review, Better Births, acknowledged the need for greater levels of personalised care and continuity of care in the maternity service, and work is underway to make this a reality.

Caseload midwifery is one proposed plan, and would be an efficient and effective way to meet both goals. One midwife is designated her own caseload of women, supporting them from first appointment, through pregnancy, to birth.

Development of dedicated home birth teams is another route – mothers and midwives get to know each other over time, and to form familiar, trusting relationships, which are the long-acknowledged bedrock of a positive birth experience.

Certain areas already have these systems in place, along with some fairly eye-opening statistics to confirm that they work. Sussex (9% home birth rate compared to 2.1% nationally), Powys, Wales (8%), Dorset (6%) and also Windsor, South Devon, Sussex, and Southwark in London all offer very highstandards of community care to local mothers, and take active steps to promote home birth as a safe and viable option for women at low risk of complications. Previous theories that linked low home birth rates to socio-economic status of an area, or even age of mothers, now need to be set aside in the light of new evidence. High rates of home birth show up when home birth has been offered as a realistic option, so NHS CCGs (Clinical Commissioning Groups) exploring how to take the National Maternity Review recommendations forward should look at these glowing examples of gold standard care and learn from their methods and models. So be hopeful. And should you encounter problems when trying to book for a home birth, don’t be discouraged. If expectations rise, better standards will follow. Take the stance of a consumer, examine the ts and cs and require and request that your service provider duly provides.

The midwives’ regulator, the Nursing and Midwifery Council (NMC), makes it clear that midwives should support women’s informed choice, even if that means the midwife has to improve her training or skills or if her employer claims that it does not have the resources. It states that the denial of a home birth service affects women just as much as denying them a hospital birth would (NMC Circular 8-2006).

Though there is now no legal obligation for a local health authority to provide a midwife to attend a home birth, you still have the right to birth at home, and there are no laws forcing you to go to hospital. If you find your health authority unsupportive, persevere. Write a letter to the head of midwifery, explaining that it is your intention to give birth at home and that you require a midwife to attend you, reminding them that it is government policy that the NHS should support a woman who intends to give birth at home, where clinically appropriate.

Copy in the chief executive, even your local MP if you feel like it and, if necessary, enlist the support of AIMS (Association for the Improvement of Maternity Services) and Birthrights. org. Both organisations offer free advice and are experienced and knowledgeable about your rights and health authority responsibilities. Attend local home birth and Positive Birth groups as well, as mother-to-mother support will help you to feel confident about your request and encouraged to get the care you need in place. In reality, it’s rare that you will need to negotiate at a high level to get what you need, but if you do find yourself bang in the middle of a home birth black hole, doggedly pursue your home birth wish and don’t give up. According to AIMS and the support site homebirth. org, when women stick to their guns, midwife care at home is usually arranged.

Why Home Birth Matters by Natalie Meddings is published by Pinter & Martin £7.99.  @pinterandmartin