Home birth viability while the NHS is under pressure
The NHS, including maternity services, is under extreme pressure right now. While we like to focus on the positive, a large part of preparing for a positive birth experience is building the knowledge you need to make the right decisions for you and your baby, so let’s talk about the impact that stretched maternity services might have if you’re planning a home birth. That way, you can make informed decisions.
I want a home birth, is this going to be possible?
The current average home birth rate across the UK stands at around 2-2.5%. This is variable across England, Scotland, Wales and Northern Ireland. The variation in home birth rate is heavily related to the provision of services. It’s also related to locations that can boast well established home birth and continuity teams - these areas inevitably see the peaks.
Routinely, intended place of birth should be discussed at your early booking appointment and throughout pregnancy. It is important to ask questions about what services are available in your area and consider how this fits with your particular pregnancy and plans for birth.
If strikes are taking place, many trusts release statements to emphasise exactly how home births are affected, and what additional measures you may need to take if you happen to labour on these days. Speaking to your midwife on how your Trust plans to manage the strikes in regard to home birth and if your specific service will be available on such dates is essential to feel in control and prepared for birth.
Is it really safe to have a home birth at the moment?
Home birth is a safe option for healthy mothers and birthing people, whether a first or subsequent baby. There are now numerous studies published looking into neonatal mortality directly comparing home and hospital birth, which can confirm home birth safety.
Hutton et al, 2019, carried out a comprehensive systematic review and meta-analysis on 500,000 intended home births and found that 'the risk of perinatal or neonatal mortality was not different when birth was intended at home or in hospital'.
Obstetric emergencies in the home are one of the highest priority calls received for the ambulance service, with a rapid response time even in the face of stretched services - you can check the response rate of the emergency services within your specific location to get a better idea of the risk.
I’m told I can’t have a home birth - do I have any other options?
In the face of stretched services, strikes and limited homebirth provision, some women and birthing people are choosing to birth at home without medical support instead. This is known as free birthing, which is not something we advocate for as there is limited evidence on its safety. It is legal for a person to freebirth in the UK. However, it is a criminal offence for anyone other than a registered midwife or doctor to perform medical acts and 'attend' a birthing person.
The statistics we’ve mentioned in this article are related to homebirth only and are not reflective of freebirthing. But for more information on freebirth, a good place to start is Birthing outside the system: the motivation behind the choice to freebirth or have a homebirth with risk factors in Australia (Jackson et al, 2020) which explains why some families and birthing people choose this path.
What’s right for me?
Choices and options for birth are so important. While an environment such as a delivery suite will suit one birthing person, a homebirth would be completely the right decision for another, after all we are all individuals with different needs and views.
The bottom line is that unless you lack the mental capacity to do so, the choice of where you birth is yours entirely and you cannot and should not be pigeon-holed into a situation you are unhappy with.
That said, it is fundamental to understand what services are available locally as well as the ins and outs of your particular pregnancy. This includes understanding the risks and benefits associated with your personal circumstances. Taking these factors into consideration will help you when making the choice of where to birth, ensuring the safety of you and your baby, while getting the experience that you want from childbirth.
Further support and information:
RCM statement on dispute with Westminster
Free PBC resources:
Hypnobirthing Top Tips on YouTube
In-depth support:
Written by Resident Midwife, Christie Hardy
