Do I have the right to a home birth?

There’s no place like home!

Before the creation of the NHS, most women in the UK gave birth at home, surrounded by their female support network and supported by a midwife that they knew and had spent time building a trusting relationship with.

At the very start of the NHS, maternity care was the forgotten sister, and the provision of care was managed by midwives, GPs and some locally arranged maternity clinics - infrequently women received care from hospitals. From the late 1960s moves to coordinate maternity care across Britain resulted in reports claiming that birth should be moved into hospitals to improve safety. Despite being criticised for having no evidence base that hospital birth would improve safety, these reports led to a complete cultural change around the place of birth. In the 1940s the vast majority of births were home births. By the end of the 1970s, almost all births happened in a hospital setting.

Throughout this time, groups such as The Association for Improvement in Maternity Services (AIMS) campaigned to raise the voices and opinions of service users, and as early as 1970 the evidence base for the safety of homebirth began to be created. Read about myths vs reality of hospital birth.

Many routine interventions were introduced into the ‘management’ of birth - with the medical perspective that childbirth is a problem that needs to be solved, rather than the reality that birth is a physiological process that in most cases will progress effectively and efficiently given the required environment and support. Interventions such as continuous fetal monitoring, episiotomy, and separating mother or gestational parent and baby at birth, were introduced with no evidence. Echoes of these practices can still be seen in modern maternity services - with the onus now on research being carried out to evidence that these interventions are not required.

Changing Childbirth (1993) was a landmark government paper that finally included the voices of midwives and women and birthing people. Sadly, the medical model of childbirth had firmly taken hold and nothing has managed to reverse the mass move of childbirth into a hospital setting.

Fast forward to 2022. Most pregnant women and birthing people book their maternity care with their local maternity unit and assume that they will birth in the labour ward. Place of birth conversations should take place during the antenatal period, but the vast majority of babies are born in hospital. Home birth is viewed by many as unsafe, unmanageable, or a bit hippie. Much like those routine interventions, we have a culture where the default place of birth has no evidence to improve outcomes for most pregnant women and birthing people or their babies. But the medical model is the norm and even with a growing body of evidence that certainly for low-risk, healthy pregnancies, home birth is associated with safe birth and improved birth experiences. Read about hosting a home birth.

During the Covid-19 pandemic, we have seen home birth services impacted by short staffing within the NHS, and some of you continue to report that your local home birth services have been suspended. The amazing charity, Birth Rights, has some really helpful information and support if you feel that your plan to birth at home might be affected. All NHS Trusts are expected to run home birth services, and UK law enshrines your right to choose your place of birth. A Trust should consider all options available to keep their home birth service running, and they should have plans in place for staff shortages - such as working with independent midwives in your local area.

As a midwife who has spent over a decade attending birth in all settings, a hypnobirthing teacher, and a woman having given birth twice myself, I know how the birth environment can impact childbirth. I know that there is a huge evidence base proving that birthing outside of the medical model, is for most people, not only safe but incredibly positive and powerful. Those of us socialised as women, often have deeply ingrained mistrust of our bodies ‘too fat, too thin, too hairy, mustn’t make a noise, must be clean, and smell like flowers (please note vaginas are meant to smell like vaginas, not roses!). Please take the time to consider where you will give birth, use your BRAIN, and make an informed choice that is right for you, your baby, and your birth.

Did you have a home birth? Share your story with our community and help other pregnant women and birthing people with their choice of birth environment! Submit your birth story here, or (if you have our Hypnobirthing Pack), share it in our private facebook group.

Written by Senior NHS Midwife, Hannah O’Sullivan