Whether it’s because of previous bad associations with the hospital environment, a fear or dislike of a clinical medical approach to childbirth, or just a desire to be in a comforting, familiar environment, there are many reasons women choose to have their babies at home in a planned home birth.
Internationally this is a huge trend, with the Netherlands and New Zealand leading the way, but in South Africa, home births are seen as unusual and strange and are frequently seen as a riskier option than a hospital birth.
The World Health Organisation (WHO) has released a statement supporting the right of women to choose where they give birth: “In the case of low-risk pregnancies, with appropriate support and contingency plans, women can give birth at home.”
If you want a home birth with a midwife in attendance, (who may or may not work with a doula), this is called a planned home birth. An unplanned home birth would be one where the labour progresses so fast that you don’t have a chance to get to a hospital or medical facility, even if you had intended to do so.
Finding the right caregivers
If you’re thinking of having a planned home birth, you’ll want to find a midwife who supports this practice – and not all midwives are necessarily in favour of it, or are prepared to support it. You may need to interview several midwives before finding the right professional who understands and supports your goal.
It’s important to choose a midwife who is experienced in home births, is registered with the South African Nursing Council and has a valid practice number, who is affiliated with a hospital and who has contingency plans should unanticipated complications arise.
The bottom line is that if this happens, you’ll need to be transferred to a suitably equipped hospital. Birthing centres like Genesis Clinic in Johannesburg will not accept patients who are mid-labour and experiencing complications – they will send you straight to the nearest hospital.
Are you a candidate?
“Any woman who has an uncomplicated pregnancy and who has been closely monitored throughout her pregnancy is a good candidate for a home birth,” says Philippa Hime, a midwife in private practice in Johannesburg. “A mother who has previously had a normal vaginal delivery with no complications is also a good candidate,” she comments.
However, she cautions, “if there has been any complication that has arisen during pregnancy or approaching her due date (such as an abnormal presentation or medical complications seen with mom), she should deliver in a birthing facility or hospital with the appropriate support on standby.”
The Mayo Clinic advises that any pregnant woman who has diabetes, chronic hypertension, a seizure disorder or any chronic medical condition; who has developed a pregnancy complication like pre-eclampsia, preterm labour or significant anaemia; who is pregnant with multiples; or is less than 37 weeks or more than 41 weeks pregnant, is not an ideal candidate for home birth and will likely be advised against it by their doctor.
Why labour at home?
The key hormones in labour, oxytocin and endorphins, are disrupted by adrenaline, which is produced when the mom experiences anxiety, tension or fear.
This is why so many women get to hospital when they’re in labour, only to have their labour slow down or in some cases, stop altogether. Think of it as a throwback to our ancestors who might have needed to move away from predators in mid-labour.
Having a home birth in a familiar and comfortable environment minimises the stress to a labouring mother, which means that labour has the chance to progress without interruption and with a reduction in pain. It’s also a more intimate setting, which may appeal to some moms who have specific religious or personal reasons.
What does it cost?
This is where you really need to do your homework. While many medical aids will pay for a midwife and home birth, if you’re on a hospital plan it may not cover the cost, so you’ll need to check with your medical aid provider on exactly what they do or do not cover.
That said, an uncomplicated midwife-assisted home birth will cost less than a hospital birth with an obstetrician or gynaecologist in attendance.
But is it safe?
“A home birth of a woman with an uncomplicated normal delivery is safe,” says Philippa. “Moms should ensure that their caregiver is skilled and has experience in home births. They should also be linked to a hospital facility in case an emergency arises.
A mom should be aware that at any stage, if any complication arises, they would need to be transferred to a medical facility,” advises Philippa.