Home birth in Ireland – our expert Sophie Brigstocke, Director of Nurturing Birth, answers your questions and debunks some home birth myths.
One of the questions I usually ask prospective birth clients when meeting for the first time is where they would like to birth their baby. Often I get a response along the lines of “I think we will see how it goes first time round and then choose a homebirth for the second baby if all goes well”. I suppose there is logic to that – no-one knows how a labour is going to progress, and many see hospital or a midwifery unit as a safer place to birth their precious baby. Alternatively, some clients will assume that their baby will be born in hospital, without ever knowing about or considering homebirth as an option.
If I ask them if they have thought about the other options available to them they tend to come up with one or more of the following questions:
- What if something goes wrong?
- What if I need pain relief?
- Isn’t it very messy?
- Do doulas only support homebirths?
So, let’s debunk some myths – one of my favourite things to do as a doula!
Until the mid 1940’s birth was a home event and, despite only a small minority of pregnancies requiring more medical intervention or observation, there was a pendulum swing which meant that the vast majority of births suddenly moved in to hospitals. Those of you who are fans of Call the Midwife will have seen how women were enticed towards the high-tech maternity units in the most recent series. The problem is that moving birth in to the hospitals didn’t reduce the number of women requiring intervention and observation, it increased it! So, why did that happen?
Birth is a primal event – the physiology of labour and birth is an extraordinary thing. The hormones released in the body work together in a beautiful symbiosis – oxytocin, the hormone of love, providing effective contractions in the uterus, and endorphins, also known as happy hormones, providing the body’s natural pain-relief. Where we reach a sticking point is that oxytocin is a “shy” hormone (this term coined by the Obstetrician Michel Odent). For production it requires someone to feel safe, unobserved, away from bright lights, loud noise, strangers, questions etc. And, what is a hospital environment if not strange, unfamiliar, loud, bright, full of strangers and often associated with negative, painful or upsetting events?
If adrenalin, our natural fight, flight or freeze hormone comes in to play in early or active labour then our oxytocin levels plummet, as do our endorphins, thus resulting in a more painful, less efficient birthing process. Arriving in hospital, having laboured for a while at home, is a classic time for adrenalin to surge, and oxytocin to drop, so it is not surprising that a woman might reach for chemical pain relief to ease the sensations of birthing. At home a woman is able to move around her environment, to surround herself with familiar people and effects, to shut the door to anyone she doesn’t want around. The space can be quiet, calm, tranquil, beautiful – whatever the birthing mum wants – and a doula is able to facilitate that, having spent time antenatally with the family-to-be.
Midwives who work in the community and choose to be part of homebirth team tend to believe in the power of women’s bodies, trust that babies are able to work with their mothers to be born and have seen many babies born in the same way. They are generally calm, capable and able to recognize if there is something happening that is out of the ordinary. Transfers from home to hospital do happen – the majority not due to any urgent distress in either mother or baby – most commonly because a woman either wants more medical pain relief, or because the labour isn’t progressing as expected.
It surprises most couples I talk to that midwives attending a homebirth have everything with them that they would have at a hospital birth with the exception of an anaesthetist to give an epidural! They have portable resuscitation equipment if there is a problem with the baby breathing – they have Entonox for pain relief – they have the drugs necessary for minimizing blood loss – they are able to listen in to the baby with portable sonicaids. The bonus is that you have total continuity of care – a midwife entirely dedicated to you and your labour, rather than someone who is possibly supporting up to 3 or 4 women at a time, and might be absent from the birth room for long periods of time. Ultimately, if a woman decides she wants to transfer in to hospital she can! And if there is any cause for concern the team at the hospital will be on red alert ready to provide instant support if needed.
The added bonus of a planned homebirth is that most of your antenatal appointments happen in your home – no more trekking to the hospital and having to wait ages for rushed appointments. In your own home you can make yourself comfortable and often have more time to discuss all those niggling questions. You become familiar with the homebirth team and usually know each midwife by name by the time you go in to labour.
Occasionally birth is messy – many homebirthing women choose to labour in an inflatable birth pool which is very easy to empty and deflate. Midwives bring plenty of plastic-backed mats and pads which can be disposed by any other dustsheets or plastic matting the family has found to protect their space. Usually I leave a home after a birth with the washing machine running, full of towels, and a new family safely tucked up in their own bed with cups of tea, plates of food and occasionally a glass of celebratory fizz. The feeling of empowerment and satisfaction is palpable.
The Birthplace Study of 2014 identified that there were no significant differences in adverse perinatal outcomes between planned homebirths or midwifery unit births and planned births in obstetric units for multiparous women (those who had already given birth once or more times), and only a slightly increased risk for first time mothers. So, it would be lovely to see more women choosing to birth at home – to be aware of their choices and given the support to follow their instincts. The homebirth rate is increasing across the UK which is fantastic.
And, in answer to the final question that I am often asked about homebirth and doulas? Doulas support any type of birth – they are without agenda or judgment, able to signpost evidence-based research to help you make informed decisions, with time to listen, debrief and reflect. Having said that, I have yet to meet a doula who doesn’t love a homebirth!
Sophie Brigstocke is Director and Doula Course Facilitator at Nurturing Birth.
Visit www.nurturingbirthdirectory.com to find support for pregnancy/birth/parenting/feeding
Follow Nurthuring Birth on Facebook – https://www.facebook.com/nurturingbirthdoulas/
Thinking of becoming a Doula?
Nurturing Birth offer a 4-day Doula Preparation Course (for the current list of dates and venues visit www.nurturingbirth.co.uk/events).
The aim of the course is to introduce women to the doula role, looking at antenatal preparation, birth and postnatal support. In a safe, non-judgmental environment we have the opportunity to:
- Debrief our own birth and postnatal experiences (birth, feeding, first few weeks)
- Look at birth: physiology, anatomy, obstetric scenarios, antenatal support and discussions, optimal foetal positioning, supporting parents making informed choices, understanding partner’s needs, how to “be” in labour, knowing your boundaries
- Discuss the role of a postnatal doula and expectations of the client
- Discuss feeding options: an introduction to breastfeeding, the basics of positioning and attachment, understanding some of the common problems faced by mums of newborns, learning how to signpost good support, helping to get Mums off to a good start, safe preparation of bottles for formula feeding.
- Look at some of the common issues affecting new mothers and babies e.g. lack of sleep, too many visitors, unsettled babies, routines and/or lack of, postnatal illnesses.
- Consider the best way to support new families including listening skills, empowering the mother to look after her baby herself (showing versus doing), being non-judgemental, signposting good support.
- Think about the journey ahead – achieving recognised status as a doula, getting to know your local scene, making contacts/working with other health professionals, networking, becoming a member of Doula UK, further study/CPD.
- Consider running your own doula business, setting up as self-employed, looking at contracts, insurance, how to get clients, CRB checks
There is a comprehensive manual for each participant, which is given out during the course. In preparation for the four days every participant is expected to complete a pre-course module and submit that to her trainer at least one week prior to the course. The home-study is designed to allow the participant to best prepare and reflect. Following the course there is a post-course module to be completed. Once that module is completed to the satisfaction of the trainer then a Nurturing Birth certificate will be issued. Once you have your certificate from Nurturing Birth you can start a mentoring process, getting support from an experienced doula on a regular basis as you start working.
More like this:
Maternity options in Ireland
Everything you need to know about labour positions