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Planning for your

This section is for the patient to make notes if they so wish:

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Diana, Princess of Scunthorpe General Goole & District Wales Hospital Hospital Scartho Road Cliff Gardens Woodland Avenue Grimsby Scunthorpe Goole DN33 2BA DN15 7BH DN14 6RX 03033 306999 03033 306999 03033 306999 www.nlg.nhs.uk www.nlg.nhs.uk www.nlg.nhs.uk

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Introduction This information leaflet has been produced for women who are considering a home birth. It includes details on the benefits and risks of a home birth, what to expect, and what you will need in preparation for a home birth. If you decide to plan a home birth, your community should support you in your choice and help you prepare for your birth (NHS, 2017). During a home birth, a community midwife will come to your home to look after you during labour and for a short while after the birth of your baby. There are community on call 24 hours, so the midwife will come to your home to assess you when you think you are in labour (NHS, 2017).

What are the advantages of having a home birth? • Women report feeling much more satisfied with their birth experience at home when compared to a hospital birth (NCT 2008) • Being in familiar surroundings – this may help you feel more relaxed and more confident in your body’s ability to birth your baby • Not having to worry about travelling to the hospital during your labour • Not needing to leave your children or organize (if you would like your children nearby during and after your birth) • Pain relief at home includes the use of a birth pool, tens machine, relaxation techniques and Entonox (gas and air) • Women who labour and birth at home report needing fewer drugs for pain relief (RCOG / RCM 2007). Women at home tend to be more relaxed, feel in control and are able to cope with the pain of their contractions (NCT 2008) • Not having to be separated from your partner or birth support after the birth. • Increased likelihood of being cared for by a team of midwives that you have met in your • Lower likelihood of having an intervention, such as , or instrumental birth, than women giving birth in hospital • There is less risk of acquiring infections which may be present in the hospital (including Covid-19)

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Considerations • If the midwife feels your labour is not progressing as it should or complications arise, she may advise a transfer to the hospital. This can cause anxiety for you and your family • Pain relief at home is limited to the use of a birth pool, tens machine, relaxation techniques and Entonox (gas & air). If you require anything further pain relief (such as opioids or an epidural), you will need to be transferred to the hospital • If you are not ‘low risk’, you will need to talk to your midwife and / or doctor about your wishes for a home birth • If you or anyone in the household is tested positive for Covid-19, this may affect your wishes to have a homebirth • The homebirth service may be temporarily stopped in some circumstances

Who can have a home birth and is it safe? Any woman can choose to have a home birth, including women having their first baby. In England and Wales, just over 1 in 50 pregnant women give birth at home. For ‘low risk’ women, birth is considered generally very safe. A ‘low risk’ pregnancy’ is one where a woman is not identified as having particular medical or pregnancy factors before the onset of labour. The incidence of adverse and serious outcomes including intrapartum , early neonatal death, neonatal encephalopathy, meconium aspiration syndrome, and specified birth related injuries are low (4.3 in 1000 births) (Birthplace Study, 2020) If you are healthy, having an uncomplicated ‘low risk’ pregnancy with a second or subsequent baby and planning to birth your baby at home, you will be delighted to know that birthing your baby at home is particularly suitable for you. It is actually as safe to birth your baby at home as it is to birth your baby on a labour ward or a midwife-led unit (NICE, 2014). In a recent Birthplace Study (2020), birthing at home was found to substantially reduce the odds of having a caesarean section, instrumental delivery or episiotomy in healthy women who were having an uncomplicated second or subsequent pregnancy. It was also found that only 12% of women required transfer to a hospital during labour or immediately after birth when complications arise.

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If this is your first pregnancy and it is uncomplicated, planning to birth your baby at home is slightly less safe for your baby than a hospital birth. There is a slightly higher risk that the baby will be injured, become seriously unwell or die during or just after birth. These outcomes are very rare among healthy women with uncomplicated , and they can happen in any birth setting. Serious problems like these increase from 5 in 1000 in a hospital birth, to 9 in 1000 in a home birth. However, you are also more likely to have a natural birth and less likely to have interventions such as an episiotomy, a caesarean or instrumental birth. Women who choose to birth their first baby at home have a higher probability of 45% of requiring a transfer to the hospital during labour or immediately after birth (Birthplace study, 2020). If you are at increased risk of complications you are likely to be advised against a home birth by your midwife and / or doctor and recommended to have your baby on a labour ward. You can discuss your wishes with your midwife and doctor and if you still wish to birth your baby at home, an enhanced birth plan can be made to manage these risks and consider factors to increase safety.

What are my coping and pain relief options at home? Once you are in established labour, the midwives, who will stay with you, will be helping and supporting you to cope whilst in labour. You will have discussed with your midwife your chosen method of coping / support in labour at your birth plan. There are lots of options for pain relief for your labour and birth (NHS, 2017). You may wish to consider self-help and natural techniques of pain relief such relaxation and breathing, aromatherapy, hypnobirthing, being active and changing regularly and the use of a birth pool. All of these methods are completely natural. Your birth partner is very important when helping you cope in labour by supporting you in positions, emotional support and the use of massage. - You can have a home water birth, but you will need to hire or buy your own birthing pool and have it ready for your labour. Pool hire may be available locally – ask your midwife for more details. Being submerged in water in your labour can help you relax and make the contractions seem less painful. It also allows you to mobilise more easily due to the water buoyancy making you feel weightless. The water will need be kept at a comfortable but warm temperature. TENS Machine - You may also wish to purchase or hire a TENS machine. The use of a TENS machine involves taping electrodes on to your back which are

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connected by wires to a small battery-powered stimulator. Holding this, you give yourself small, safe amounts of electrical currents through the electrodes. You can move around while you use TENS but cannot use it in the bath or birth pool. TENS is believed to work by stimulating the body to produce more of its own natural painkillers, called endorphins. It also reduces the number of pain signals sent to the brain by the spinal cord. Entonox - You will have access to Entonox (gas and air), which is brought to your house by the midwife. Opioid drugs and epidurals are not available at home, should you wish for stronger pain relief you will need to be transferred into hospital.

Who will be at my home birth? During your home birth, midwives (usually two) will attend your home and care for you in labour and after you have birthed your baby. Student midwives may also attend if you consent to this. You should also choose one or two birth partners who will be able to support you during labour and birth.

When should I call my midwife? All women should contact the Maternity Unit immediately if they have any concerns or anxiety at any time in their pregnancy or if you think you are in labour. Your maternity unit is open 24 hours a day, 365 days a year and a midwife will always be ready to take your call. Call your maternity unit if… • Your contractions are strong and regular and 5-10 minutes apart. Second babies often arrive more quickly than the first, so you may need to contact the Unit sooner • Your waters have broken or have any unusual vaginal fluid loss, with or without contractions. Put a pad on and call us immediately as we will need to assess the colour and consistency of your vaginal loss • Your baby’s movements have reduced, slowed down or changed in any way; call your maternity unit straight away. Don’t wait until the next day. Your maternity team should ask you to come in for assessment. Your baby’s pattern of movement should not slow down towards the end of pregnancy • You have any vaginal bleeding • You have any headaches, sudden swelling or visual problems

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• You have any form of mild or severe itching • You have any signs of infection, including a urinary tract infection • You have any abdominal pain • Your instinct tells you something is not right or with any other concerns • If you are concerned you may have Covid-19. When you and the midwife have decided that you are ready to be assessed, please ensure your home is easily identifiable by the midwife. If it is at night please put on your house lights until the midwife has arrived. If your home is not easy to access or does not have a number / name plaque displayed, please arrange for an adult to meet the midwife at the door, gate or nearest accessible tarmac road. Please leave your telephone answer machine off and your line clear until the midwife has arrived in case she tries to phone you. Also ensure your phone is fully charged.

How do I contact my midwife? When you think your labour has started or if you have any concerns in your pregnancy, for Scunthorpe area women - contact the Maternity Unit Central Delivery Suite on 03033 302270 For the Grimsby area please contact the Team you are booked under: • Blueberry Team – 03033 304789 • Holly Team – 03033 304790 • Honeysuckle Team – 03033 304794 • Jasmine Team – 03033 304787 Please tell the midwife you speak to that you are booked for a home birth. The midwife taking your call will take all of your details and discuss all aspects of your labour to date and advise you accordingly. The community midwife will be contacted and she will telephone you and make arrangements to visit your home to assess you.

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How will the midwife monitor me and my baby? The midwife caring for you will continually assess you and your baby to ensure you are both well and safe to remain at home. Your baby’s heart rate will be listened to at regular intervals throughout labour with both a pinnard stethoscope (ear trumpet) and a Doppler (ultrasound). This is usually every 15 minutes in the first stage of labour and every 5 minutes in the second stage of labour. Your contractions and progress will be monitored throughout labour ensuring you are making progress and that you are coping. Throughout labour the midwife will ensure you remain well by taking your temperature, pulse and blood pressure and will test a sample of urine at regular intervals.

Why would I need to be transferred to the hospital? In certain circumstances the midwife will advise that transfer into hospital is necessary. This journey is made by an ambulance and the midwife will come with you. Some possible reasons why transfer to hospital is as follows: • Your labour starting before 37 weeks or after term +12 days of pregnancy • If your labour has not started and baby not born by 24 hours after your waters breaking • If the colour of your waters are brown / green (meconium). This indicates that the baby has had a poo, which may be a potential risk and the baby needs monitoring continuously and a paediatrician may be present at the birth • Any fresh bleeding • Raised blood pressure • Raised temperature • Concerns over yours or your baby’s wellbeing • An abnormality in your baby’s heart rate • Slow progress in your labour or birth • If your baby isn’t in the optimal position for birth • Your choice for more pain relief

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• Your being retained • If your baby’s condition at birth is unsatisfactory • If your baby has a low of under 2.5Kg • If there are any concerns with the bleeding after your baby is born • If you have sustained a third or fourth degree tear (tear to perineum which is more complex than those that can be sutured at home) or any tear if the lighting is not good enough for the midwife to repair In the event of needing to transfer to hospital the midwives decision should be respected and supported.

Is there any reason my home birth would not happen at last minute? Whilst the midwives do their absolute best to ensure that they can accommodate your wish for a home birth, there are occasions when this is not possible due to unforeseen circumstances such as: • Several home births happening at once • Severe weather that may compromise the midwives safety • Sudden sickness of midwife • Excessive workload on the maternity unit • Covid-19 causing service interruptions In these situations we would ask your cooperation in birthing your baby at the hospital maternity unit. We would endeavor to make it a home from home experience and facilitate early discharge home, firstly ensuring mother and baby’s wellbeing.

What do I need to prepare my home for a home birth? You do not need to do anything special to your home to make is suitable for a homebirth but there are some things you can prepare and have ready for your homebirth which will help you and your midwives. • The midwife will encourage you to have a regular intake of fluid and light diet and to have a rest as well as active periods throughout the labour • 24 hour access to a fully charged telephone or mobile phone

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• Ensure there is adequate heating in the room you plan to give birth in • A clean / hot water supply • Plastic sheeting for the floor – available from DIY stores • Plastic mattress cover to protect mattress • Old clean sheets and towels For You: • Breastfeeding / bra • Packet of maternity towels • Old pants / paper pants are useful • Packed overnight bag (in case you need to be transferred to the hospital) • Old T shirt / night dress for labour For Baby: • 2 soft towels (old but clean), a vest, baby grow or nightdress, nappies, cotton wool, cot sheets and blankets For Midwife: • Any soap in dispensable container • Towel for hand drying • Torch and mirror may be useful during birth

What about the mess? Usually there is very little mess. We ask that you provide some sheets that you do not mind getting soiled. The midwives will bring plenty of disposable pads and will dispose of all clinical waste upon leaving your home.

What if I need stitches? Midwives who attend birth can stitch most perineal tears. Any complicated tears would require transfer to hospital.

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What happens after my baby is born? Your midwife will stay with you for at least one hour after the birth of your baby when skin to skin will be encouraged. If you wish to breastfeed the midwife will give you support and guidance as soon as possible after birth. If you have decided to bottle feed your baby, the midwife will ensure that your baby has taken a first feed and that you are confident in the safe preparation of a bottle feed. When your midwife leaves she will ensure that you have a telephone number you can call if you have any worries or concerns and arrangements will be made for a further visit. The midwife will also arrange for your baby‘s first thorough physical examination called the ‘NIPE’ (Newborn and Physical Examination) which needs to be completed within 72 hours of birth. Usually this will be undertaken by a midwife qualified in the “examination of the newborn” however if there isn’t a midwife available, an appointment will be made to attend the hospital. The examination will include listening to the heart, checking hips and eyes. You will need to register your baby’s birth within 6 weeks of the birth.

How is Covid-19 affecting homebirths? The International Confederation of Midwives recommend that when the can support home births, healthy women experiencing a low risk pregnancy may benefit from giving birth at home rather than in a hospital as it reduces the potential exposure to covid-19. However, some temporary changes to all maternity services, including home births, may be necessary to keep you and your baby safe. Maternity services rely on having enough staff, and availability of an ambulance should it be needed, to keep you and your baby safe. Therefore, if there is not the ability to provide appropriate midwifery support and there is an insufficient ambulance service to transfer you in to the hospital, the home birth service may be temporarily stopped (RCM, 2020). The guidance around Covid-19 changes regularly so please ask your midwife for up to date guidance. If you have symptoms of Covid-19, which include a temperature, loss of taste and/or smell, and a new or persistent cough, or you have confirmed Covid-19, you will be advised to give birth in an obstetric unit. This is so the maternity team looking after you can monitor you and your baby closely and respond quickly if necessary.

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If anyone in your household or support bubble are positive or have symptoms, this may also affect your wishes to have a home birth.

Information for Partners A lot of partners have initial doubts when a woman wishes to birth at home. You should discuss your plans together during the pregnancy as it is important you both feel comfortable with the final decision. Your partner can always ask your midwife questions to ease any anxieties they have. Your partner or birth support may find it helpful to read the ‘Role of the birth partner’ leaflet for more information and attend antenatal classes.

Reference Section Birthplace study (2020). The Birthplace cohort study: key findings. Available at: https://www.npeu.ox.ac.uk/birthplace/results [Accessed 21st October 2020]. NCT Briefing: Home Birth (2008) policy. [email protected] NMC (2012) Midwives Rules and Standards NICE (2014). Intrapartum care for healthy women and babies. London: NICE. RCOG / RCM (2007) Joint statement: Home Births NHS. (2017) Where to give birth: the options. Available at: https://www.nhs.uk/conditions/pregnancy-and-baby/pain-relief-labour/ [Accessed 21st October 2020]. NHS. (2017b) Pain relief in labour. Available at: https://www.nhs.uk/conditions/pregnancy-and-baby/pain-relief-labour/ [Accessed 21st October 2020]. RCM (2020). Guidance for provision of midwife-led settings and home birth in the evolving coronavirus (COVID-19) pandemic. Available at https://www.rcog.org.uk/globalassets/documents/guidelines/2020-07-10-guidance- for-provision-of-midwife-led.pdf [Accessed 21st October 2020].

Contact Details for Further Information Grimsby / Louth 03033 304800 Scunthorpe Area Community Teams: Barton 01652 660052 Brigg 03033 306860

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Scunthorpe 03033 302050 Isle 01724 712925 Goole 03033 304079

Any Comments, Compliments, Concerns or Complaints If you have any other concerns please talk to your nurse, therapist or doctor. Our Patient Advice and Liaison Service (PALS) is available on 03033 306518 (Grimsby, Scunthorpe and Goole). You can also contact [email protected] As a Trust we value equality of access to our information and services, therefore alternative formats are available on request at [email protected]

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Date of Issue: January, 2021 Review Period: January, 2024 Author: Clinical Skills ＆ Governance Midwife IFP-0815 v1.2

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