Information for Patients
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Information for patients Planning for your Home Birth This section is for the patient to make notes if they so wish: Name: _______________________________ Who to contact and how: _______________________________ Notes: _______________________________ _______________________________ _______________________________ _______________________________ Diana, Princess of Scunthorpe General Goole & District Wales Hospital 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 For more information about our Trust and the services we provide please visit our website: www.nlg.nhs.uk Information for patients 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 midwife 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 midwives 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 child care (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 pregnancy • Lower likelihood of having an intervention, such as episiotomy, caesarean section 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) For more information about our Trust and the services we provide please visit our website: www.nlg.nhs.uk Information for patients 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 stillbirth, 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. For more information about our Trust and the services we provide please visit our website: www.nlg.nhs.uk Information for patients 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 pregnancies, 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 position 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. Water Birth - 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 For more information about our Trust and the services we provide please visit our website: www.nlg.nhs.uk Information for patients 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 Midwifery Unit sooner • Your waters have broken or have any unusual vaginal fluid loss, with or without contractions.