Coronavirus: maternity services update
Due to the ongoing coronavirus (COVID-19) pandemic we understand that many of you will be worried about the situation and the impact it will have on your pregnancy and care. We have created a list of frequently asked questions to reassure you in this difficult time. You should also read about the changes we have made to our community midwifery services and specific advice for women who are breastfeeding.
St Thomas' Hospital offers a home birth service, which means that if you plan to have your baby at home, and live in areas which the Trust serves, a midwife will visit you to help you prepare, and to support you at home throughout labour and birth.
The benefits of a home birth
- You are more likely to feel relaxed in your home, which can help the progress of your labour
- Some research has found that women who gave birth at home tend to use less pain relief than those in hospital, suggesting birth at home may be more manageable
- You can choose who is present during the birth and afterwards, therefore you won’t need to be separated from your family
- You don’t have to worry about when to go to hospital or how to get there
- Research shows women who choose to have a home birth are less likely to need epidural or instrumental birth (they experience fewer interventions).
Things to think about
Is it safe?
Women typically experience fewer interventions during birth, are more likely to have a straightforward birth and to establish breastfeeding.
Recent birthplace research undertaken in England shows that home birth is safe for healthy women who have no medical complications (such as diabetes or raised blood pressure) during pregnancy or early labour, or problems in previous births (for example, caesarean section or excessive bleeding following birth).
Home birth is also safe for babies of healthy women who have given birth before, but less so for babies of women who are pregnant for the first time and planning a home birth, although the difference is small. Your midwife can discuss the risks and benefits of different birth settings with you, and help you decide which setting is likely to best meet your preferences.
Am I suitable for a home birth?
Home birth is a good choice for you if:
- you are experiencing an uncomplicated pregnancy
- you are carrying only one baby (a singleton pregnancy)
- your baby is head down (cephalic presentation)
- you go into labour naturally between 37 weeks and 42 weeks (spontaneous onset of labour)
- you are having your 1st-6th baby without previous complication
- you have a body mass index (BMI) greater than 18.5 or 35 or less at booking.
Who will be with me during birth?
Two qualified midwives will be present during the birth. During the labour and birth we will closely but discretely monitor the well-being of you and your baby.
You can labour in a familiar environment with your family and friends around you.
What if I change my mind?
If you plan to give birth at home, but change your mind, you can transfer to hospital during labour. Also, if your attending midwife is concerned about you or your baby, you will be advised to transfer into the Hospital Birth Centre if a problem occurs during labour or just after birth.
If this is your first birth, research suggests that around 45% of women transfer into hospital during or just after birth. This is for a variety of reasons, including delay in labour or requiring more options for managing pain. Around 13% of women expecting their second or subsequent baby transfer into the Hospital Birth Centre during labour or birth. It is relatively unusual for women to be transferred in from home as an emergency, but it can happen. Your midwife will discuss this with you when you are pregnant, and explain what happens in the event of concerns being identified.
Will it be messy and what if I need pain relief or stitches?
Usually there is very little mess. The midwives will bring disposable pads. We ask that you provide some sheets that you don’t mind getting soiled. The midwives will dispose of all the clinical waste appropriately.
The pain relief available at a home birth is:
- TENS - a method of pain relief involving electrical nerve stimulation - you can hire or buy a TENS machine for personal use
- hydrotherapy (water birth) - can relax you and make your contractions seem less painful
- gas and air (entonox).
If you would like stronger pain relief, you will need to transfer into hospital.
Midwives who attend birth can suture most perineal tears; any complicated tears would require transfer to hospital.
I want a home birth - what do I do next?
If you are already booked in with us for maternity care, please ask your midwife to refer you to the caseload team covering home births for your area.
If you are not booked in, you can do this by emailing a referral form. More information on making a referral.
What will happen once I am booked in?
A midwife (a caseload midwife) will book your first appointment, which is an antenatal check up that can take place at the clinic or at your home. Your midwife will explain how the team works, discuss place of birth and the care you will receive during your pregnancy.
Your midwife will see you almost every month. You are also invited to attend the team antenatal classes and meet the other team midwives. Around 36 weeks the birth plan will be discussed, as well as home birth practicalities. We will give you a birth pack and bring the rest of the equipment at the birth.
After your baby is born, your midwife will provide postnatal care at home, including postnatal check ups and support with breastfeeding. If you need any extra care, referrals can be made for you at our specialist hospital clinics. A health visitor will take over once you have been discharged from midwifery care.
Read about Chiara Paderni's experience
Midwives Laura Latina, Lia Brigante and
baby Maya, mum Chiara, and dad, Paul
Baby Maya is Chiara Paderni’s first baby, born on the day that she turned 46 years old.
“Everyone warned me my age might be an added risk, but I still really wanted a home birth,” says Chiara.
On the day, it was the personal and homely experience that Chiara had wanted. “I don’t tell everyone they must have a home birth,” says Chiara, “but for me it was just the best experience ever. I used a birthing pool. It was not messy, it was natural. In fact, because my partner Paul had made enough food for everyone, both midwives stayed for dinner after Maya was born.”
It was a friend who had first encouraged Chiara to consider having her baby at home. When the option was raised at her first registration meeting, Chiara took the opportunity to find out more from her midwife.
“Being at home is a blessing for the family and the midwives,” says Lia. “It can be a joyous event, not a medical emergency.”
Read the full article in issue 17 of the GiST magazine.