A Guide to Home Births in the UK: Answering All Your Questions

When preparing for your new arrival and looking forward to welcoming a new life, having a birth plan and a hospital bag checklist is a helpful first step.

Giving birth is a birth experience that is unique to every woman, and choosing where you would like to give birth is a big decision. It is important to chat to your care providers, starting with your community midwife during prenatal care, to gather detailed information and help you make an informed decision for you and your family.

In the UK, around 2% of births take place at home, which works out at roughly 1 in every 50 babies. While numbers rose briefly to around 2.4% during 2020, recent figures from the Office for National Statistics show that rates have settled back to pre-pandemic levels, sitting at just under 2% in England and around 2% in Wales. The Royal College of Midwives notes that rates remain much higher in areas with well-established community midwifery and continuity-of-care teams, such as Powys.

If you are considering a home birth, this essential homebirth guide serves as a complete guide to help answer all your questions as you begin your home birth journey.

Where can I give birth?

In the UK there are three locations for options for giving birth:

• In a hospital labour ward, where standard hospital births take place.
• In a midwife-led birth unit or birth centre, which offers a birth center birth option connected to or alongside local hospitals.
• At home.

You should be supported in your decision to give birth where you choose, but any complications in your pregnancy or previous pregnancies or births may mean that you are advised on a specific course. In the UK, the NHS can provide midwifery care for home births through your local nhs trust, or you can choose to use private certified midwives, just like choosing an NHS or private hospital.

Who can have a home birth?

A home birth is most suitable for women who have low-risk pregnancies and no complications, making them ideal candidates. Women with the following conditions, such as high blood pressure, gestational diabetes, or previous caesarean sections, will receive medical advice that a hospital remains the safest place for birth.

However, any pregnant woman can consider a home birth. You should discuss your options with your midwife or healthcare provider, who is the best person to assess your suitability and help you decide on the best option.

What are the pros and cons of a home birth?

There are many reasons that families choose to have a home birth, but the most common is that the mother feels that she may be more relaxed and comfortable in her familiar home environment, which supports the natural physiology of birth. The pros and cons of a home birth will depend on your specific situation, but for a straightforward natural birth or uncomplicated vaginal birth, these are the benefits and risks that you will want to consider.

The benefits of a home birth are:

• A comfortable, familiar birth space for labour and birth where you can build a supportive environment and do not need to break your focus to travel elsewhere.
• You have more control over your birth, including freedom of movement to set up your birthing area in your living room or bedroom.
• A better likelihood of a home water birth if you choose to have one and prepare a birth pool or birth tub.
• You may be more likely to be under the personalised care of a skilled midwife who knows you and your family, supporting you every step of the way.
• You are less likely to require an intervention, assisted delivery, or invasive medical procedures than if you give birth in a hospital. (Study from The Lancet)
• You can have as many people as you would like present at your birth, meaning family members, older children, or older siblings can take an active role and provide emotional support alongside your birth partner, rather than being limited by additional restrictions on visitors.
• If you have other children, you will not need to leave them with alternative childcare, although having a backup plan remains a good idea in case circumstances change.

The cons that you will need to consider for a home birth are:

• The pain relief options for a home birth are more limited than in a medical environment. This depends on your location, but while you can use water and basic pain medication, you will not be able to have an epidural at home.
• There is always the chance that you may need to transfer to a nearby hospital during labour or after the birth for clinical pain management or medical assistance. Common reasons include slow progression of labour, heavy blood loss, foetal distress, or the need for an assisted birth.
• Depending on the time and location, your community midwifery team may experience high callouts on your big day. If this is the case, you will be advised to transfer to hospital so you can receive the best care and additional support.

You can always change your mind about your choice of birth location at any point throughout your pregnancy and labour. Your supportive birth team will support your decision and can organise an ambulance if required to transfer you.

Is a home birth safe?

In a straightforward pregnancy, birth is generally safe in any location. For a second baby, a planned home birth is as safe as having your baby in a hospital or a midwife-led unit.

For first-time mothers, having a home birth slightly increases the statistical risk of complications for the baby from 5 in 1000 for a hospital birth to 9 in 1000 for a home birth. Studies also observe these trends when evaluating infant mortality statistics for out-of-hospital deliveries, noting that while there is not much risk overall, first deliveries carry a slightly higher rate of infant death or clinical complications compared to hospital settings. Reviewing these figures helps parents make an informed decision based on evidence.

When you choose to have a home birth, your midwife will carry out a risk assessment check on your house to ensure easy access and quick access for emergency teams. They will help you establish a clear safety plan, arrange a resuscitation space for baby, and ensure you pack a hospital bag should you need to transfer. They will also provide you with a birth box or birth kit containing essential items such as sterile gloves and umbilical clamps.

You can make all other preparations for your baby’s arrival the same as you would for any birth. All of this means you are as prepared as can be for a successful home birth.

The role of your midwife is to bring the same medical equipment that would be available on a midwife-led unit. If you experience heavy blood loss, they carry medication to contract your uterus, along with resuscitation equipment for babies on the rare occasion that it is required. Midwives can also perform routine postpartum care and stitch minor tears, letting you rest in the comfort of your own home without needing to leave your bed.

What happens if the baby is born before arrival (BBA)?

Born before arrival happens when a mother delivers her baby before a midwife or healthcare professional has arrived, which is often the first question parents ask when planning a home delivery. This is sometimes known as an emergency or unplanned home birth and is generally due to precipitous labour, which is very different from a planned unassisted birth.

If your baby is arriving quickly, you or your birth partner will need to call 999. The emergency operators will talk you through the delivery steps and dispatch an ambulance immediately.

Can cord blood be collected at a home birth?

Yes, cord blood can be collected at a home birth. If you have chosen stem cell storage with Smart Cells, we provide you with the cord blood stem cell collection kit that your assigned phlebotomist will use to collect the sample after birth. They can perform this at a home birth just the same as they would at a hospital birth. The midwife may also provide assistance with the collection process and will ensure that the collection doesn’t interfere with the golden hour that you are experiencing with your baby after their birth. The sample will then be collected by a courier and transported to our laboratory for processing and storage as with any other birth.

If you have any questions about how cord blood collection and stem cell storage will work for you and your family, please do get in touch with our team.

What do I need for a home birth?

Aside from clean towels, a hospital bag in case of transfer, and warm layers for your baby, there are very few necessary supplies you must buy yourself. However, gathering these important supplies will help you prepare your space:

• Birth pool – some women choose to use water for pain relief during labour and birth. While you can use a bath in labour, you will require a birthing pool for the birth itself which you may need to hire privately or from your local hospital, if offered in your area, complete with a liner and birth pool kit, or you may need to buy one yourself.
• Pain relief – paracetamol, TENS machine and hot water bottle are good options.
• Waterproof sheet(s) – this is useful for your bed, sofa or floor, depending on where you choose to give birth and move afterwards.
• Blankets – for you and baby, to keep you warm after birth, especially if you’ve just got out of the water.
• Hat – for baby after birth. It’s important not to let their temperature drop.
• Flannels – these can be used on your forehead to cool you during birth or as cold compresses on your perineum.
• Food and drink – labour is hungry work and can take a long time! Your midwives will advise you to snack throughout and to keep well hydrated. It may also be a good idea to provide snacks and drinks, such as having the kettle ready, for the midwives too.
• Torch/light – you may want low lighting during the birth if you are practising hypnobirthing, so this will allow your midwives to check you if necessary during labour and after the birth. If you require stitches, this will also help the midwives to see better.
• Mirror – some women like to be able to see how baby is doing while crowning, and the midwives may use it too if you’re in a birth pool.
• Music – many families like to choose their own playlist to invigorate or relax them during the different stages of labour and birth.
• Aromatherapy – scented oils can provide relaxation, relief or energy during labour to help women get into the zone.

A home birth can offer a unique and personalised experience, and can be a safe and viable option for women with a low-risk pregnancy. With the support of a midwife and careful preparation, you can enjoy a positive and memorable birth experience with a same home birth in the comfort of your own home. And with the option to collect and bank your baby’s cord blood, you can also take steps to safeguard your family’s health and wellbeing for the future.