Homebirth ~ Midwives views
Survey Compiled – December 2007

If you are considering a homebirth or maybe you are simply curious what the opinions of midwives is regarding this matter then we hope this gives you some insight. We asked Midwives from all over the UK a few questions that parents often wonder about…..
If you wish to take part in the Parents on Homebirth section then please email us for a form.
If you are wondering WHY we asked midwives these questions it is because in our experience these are the things that parents wanting to birth at home worry about. A lot of women feel they would like an unassisted homebirth because they feel the MW may interfere too much, well we can see from all of these midwives that they are only too happy to sit back and take a quieter role but that the importance of having a professional nearby is paramount.
We’ve also learnt one more thing from this section….. FEED your midwife!!  lol…. How many of us back at the office gasped at the realisation we too had left our poor midwives hungry while busy huffing and puffing??? ooops… a collective sorry to you all (These are the questions we asked the Midwives:
1] How long have you been a midwife?
2] Do you think homebirth is more dangerous than hospital births?
3] Have you attended a homebirth?
4] Have you given birth at home?
5] Do you prefer to attend a homebirth to a hospital birth, if so, why?
6] What things make your life easier at a homebirth?
7] What things make your life hell at a homebirth?
8] What tips would you give to a couple wanting a homebirth that come up against a refusal?
9] What are your thoughts on unassisted homebirths legal, emotional and practical?
10] What things would make you refuse to go through with a homebirth [eg; breech, multiple, history of complications etc]
Any other comments regarding homebirths?
Finally, an optional question that you can comment further on if wanted;
In YOUR opinion should the cord be left to stop pulsating before clamping/cutting?
YES……… NO……… MAKES NO DIFFERENCE………..

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Name: C.T ~ Notts.
1] 3 years this February
2] I think there is no difference between the two. Homebirths carry less risk of infection and a better recovery time for mother & child.
3] I have attended 5.
4] I have one child born by ECS. If I birth again I would consider it yes.
5] I do prefer it as the atmosphere is relaxed, I get to stay with the mother and not leave at shift change. I get to relax and build up a rappor with the family where as in hospital I would be attending to other duties etc.
6] Knowing what the family want, what the mother wants, plenty of tea on offer and a good lamp for seeing into dark bits!
7] Dogs and cats! No where to sit comfortably during those long labours.
8] Write to the supervisor of midwives and ask why you have been refused.
9] Have to be careful here as I know some do do it but I would say no, dont. If anything went wrong and you willingly kept help away you would be in serious trouble.
10] The only thing that would make me refuse attending a homebirth is violence or danger to me and my college.
Most births are safe to have at home and it should be [in my opinion] the first choice a mother is given.
I’ve not read much about early cord cutting [apart from on this site] it is something I can not coment on.

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Terri, MW on Dartmoor
1] How long have you been a midwife?
About 10 years.  I was a general and psychiatric nurse prior to this but feel I’ve found my niche.
2] Do you think homebirth is more dangerous than hospital births?
Absolutely not, so long as the woman is ‘low risk’ – although you could argue what low risk means!  In fact there is some evidence that the reverse is true.
3] Have you attended a homebirth?
Yes, I am part of a midwifery group practice which has a case load of 240 women approx.  We have one of the highest homebirth rates in the country – this year averaging about 25% so far.
4] Have you given birth at home?
No, but this is something I will always regret not being more assertive about 16 years ago.  I watched my midwife have a atand up row with my GP.  I was browbeaten into having a DOMINO.  There were no community midwives on when I went into labour so I had a very rapid hospital birth with a short stay.  I nearly had my son in the car.  Very scary and totally unnecessary.
5] Do you prefer to attend a homebirth to a hospital birth, if so, why?
Yes.
Because I am the family’s guest, and so they are more at ease and in control instead of vice versa.
Because I can be an autonomous practitioner without interference from telephones or curious registrars etc. etc.
Because the environment is more interesting – I can be browsing bookshelves!
Because the siblings can be as involved as they want and none of the family are excluded.
Because the birth itself is usually totally amazing and beautiful. (I get withdrawal symptoms if I don’t get to attend a home birth on a regular basis;-)
Oh loads of reasons.
6] What things make your life easier at a homebirth?
All the above reasons as given for no 5.  The labour and birth often goes smoother, like a dance.
7] What things make your life hell at a homebirth?
Having to make the decision to transfer in, if necessary.  Running out of entonox once the woman has started using it.
I once had a dog running riot, bouncing thru’ my sterile pack,  whilst the mother was on all fours and concentrating on giving birth beautifully, and a barely composmentis partner (absolutely pi**ed) and a toddler laughing at the wonder of it all.  That wasn’t hell tho – that was hilarious!
8] What tips would you give to a couple wanting a homebirth that come up against a refusal?
Be very well informed and not inflexible.  Be very willing to take on full responsibility for your own birth experience.  Try using the ‘broken record’ technique of repeating your wishes over and over until you are heard (as suggested by Mary Cronk).
We recently had a client who had a lovely successful home water VBAC – She had been told that she could use the pool on the unit but would have to get out for the birth.  She was very polite and diplomatic but this was the deciding factor in her decision to stay at home.  She was seen by supervisor and listened carefully to all the recommendations before making her own decision.  She was also very willing to accept the full consequences of her decision.
9] What are your thoughts on unassisted homebirths legal, emotional and practical?
I think most women want some form of support in labour as it is a scary, empowering, amazing rite of passage.
I like to think there are enough good midwives around who would make unassisted homebirths unnecessary.  However I’m not sure that the law should have to enter into it, although I am aware that the law exists.
10] What things would make you refuse to go through with a homebirth [e.g.; breech, multiple, history of complications etc]
Anything which I am not confident to deal with, unless I could get good supervision.  This includes, unfortunately, breech births – I’ve only seen two in my career – and one of those was the second twin when I was a student.
If a woman wanted a home birth regardless of her medical condition and recommendations that hospital would probably be a safer option, then we have had paramedics on call outside the home.
I have only experienced one major PPH – in hospital.  A rare complication which I wouldn’t like to have to deal with at home, so if someone had a previous history of such a complication I wouldn’t be very comfortable.  I would certainly be upfront and honest about any misgivings I might have in the case of eg. a medical condition such as IDDM, or VSD of the heart, or twins.
Any other comments regarding homebirths?
WE are very fortunate to work in a way that allows women to decide to stay at home once in labour and not have to make up their minds before.  We can visit all our clients at home in early labour – and share the oncall between the 6 of us (4.6 WTE midwives).  This is one of the reasons our home birth rate is so high.
In YOUR opinion should the cord be left to stop pulsating before clamping/cutting?
> YES…So long as the labour and birth have been normal and straightforward to that point.  If the labour has been interfered with then I think it prudent to continue intervention (eg where labour has been augmented)  Also if there are any previous medical indications that a phys. third stage unwise (prev. PPH?)
..We don’t know how important it is to the baby to have his or her own full complement of blood from the placenta.  A physiological third stage can also be wondrously unhurried and allow the mother and father to fully aquaint themselves with their new offspring.  That certainly does make a difference.

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Sara McAleese, Community Midwife in Wales
1] How long have you been a midwife?
5 Years
2] Do you think homebirth is more dangerous than hospital births?
For low risk women I believe home birth is safer.  For some women, for example those with preexisiting medical conditions, severe preeclampsia, babies likely to need special care, hospital is safer.
3] Have you attended a homebirth? Yes lots
4] Have you given birth at home? No I don’t have kids – but I most definitely would!
5] Do you prefer to attend a homebirth to a hospital birth, if so, why?
The ones I remember most fondly have been at home.  Why?  Because they’re more personal, more intimate and somehow more like real life.  You can hear the neighbours coming and going or the cows mooing or the kids playing upstairs and see birth as what it is, a part of life.
6] What things make your life easier at a homebirth?
A small space to put your kit where no-one walks on it, a calm or at least keeping a lid on it Dad, a landline, and food.
7] What things make your life hell at a homebirth?
No food.  Really.  A mate of mine went to a homebirth the other day, about three in the morning (and it’s not like you have fry up before you go) and they hadn’t so much as offered her a cup of tea by the time she fainted, at three in the afternoon.  Nowhere to park.  Being expected to answer the phone.  Animals not under control (eating your kit.)  You know, just general lack of good manners, really!
8] What tips would you give to a couple wanting a homebirth that come up against a refusal?
Put your foot down.  Say it assertively enough and you’ll get it.
9] What are your thoughts on unassisted homebirths legal, emotional and practical?
I think it’s a sad indictment of maternity care.  Don’t, find a midwife you like and respect, and share it with her.
10] What things would make you refuse to go through with a homebirth [e.g.; breech, multiple, history of complications etc]
It’s not my business to make decisions about other people’s lives.  If a woman percieves homebirth to be safer for her than hospital birth – whether that’s physically or emotionally – my job is to support her.
Any other comments regarding homebirths?
It is no more normal to birth a baby in a hospital, under bright lights, surrounded by strangers, than it would be to concieve it under those circumstances.
In YOUR opinion should the cord be left to stop pulsating before clamping/cutting?
YES………

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Mary Cronk
1. 35+years
2. No
3.yes 1500
4. Sadly no
5.It depends on the case.   For a few woman there are definate advantages to a hospital birth but for most women home is nicer and safer.
6. Better resources/equipment than most hospitals, sofas, beds, cushions, pillows surfaces of different heights . Easier for woman to have  choice of persons present.(or not present). Less danger of infection. Better food. Greater privacy.
7. Not much, difficulty with car, long drive to home. parking, intrusive relatives. But then I should be able to sort most of this out entenatally.
8. I would inform them of their rights and responsibilities and of my five phrases to be committes to memory.  I would suggest replacing the word “want” as in I want a home birth with the words “I intend or I plan to have” a home birth.  (I want to have 28 hours in each day I want a holiday in Iceland) I am unlikely tohave my wants fulfilled!!
9.  Unattended unplanned home births are statistically  dangerous. I do not know any research about planned unattended home births. I feel that their taking place is a very sad reflexion on the midwifery profession and the NHS midwifery provision.  They are of course totally legal there is no legislation that compels a woman to have professional attendance if she does not wish to have it.
10 Once a woman who has engaged my services is in labour, I cannot refuse to continue to attend her, I have a legal duty of care to her.  If she choses to disregard my advice.  I would carefully document what is happening and inform my Supervisor but continue to care for her to the best of my ability within what she will permit me to do.  During the pregnancy I would “unbook” if I felt that the relationship had broken down, but probably in such circumstances the feeling would be mutual.  Breech and twin births are in my view unusual but normal births and I do not have a problem attending BUT they have more potential to become complicated.  If a woman who had engaged me decided to terminate the pregnancy I would know that I am the wrong midwife for her and would advise her to engage someone else.
11.  The place of birth is where a woman chooses to give birth.  My job is to inform her and, if asked advise her.

About cord clamping My normal practice is to leave the cord unsevered usually until the placenta is out, but sometimes, eg if it is very short and with the woman’s permission I will clamp and cut it, but only after it has ceased pulsation.  With known monozygotic twins and following discussion, I would prefer to clamp and cut the cord of twin one to avoid the rare event of twin to twin transfusion.

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Midwife from Scotland Wished to be Anon
1] How long have you been a midwife?
17 years
2] Do you think homebirth is more dangerous than hospital births?
no
3] Have you attended a homebirth?
yes
4] Have you given birth at home?
yes
5] Do you prefer to attend a homebirth to a hospital birth, if so, why?
prefer home. Less machines which go ping and less possibility of intervention
6] What things make your life easier at a homebirth?
Enough support people for that woman, be it one or many
7] What things make your life hell at a homebirth?
Nothing really
8] What tips would you give to a couple wanting a homebirth that come up against a refusal?
Go to HOm or SOm and be insistent. Have as much evidence as possible.
9] What are your thoughts on unassisted homebirths legal, emotional and practical?
I feel it is a real shame if women feel that they are driven to go down this route. Of course, it is illegal.
10] What things would make you refuse to go through with a homebirth [e.g.; breech, multiple, history of complications etc]
I have limited experience of breech but would support a woman’s choice for one at home. Also no experience of twins at home so would be very apprehensive. if given plenty notice, I would try to enlist the help of a midwife who had plenty of experience of multiple birth at home. I would have to take each case of history of complications on it’s own merit.
In YOUR opinion should the cord be left to stop pulsating before clamping/cutting?
YESSSSS

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Sarah Montagu
1] How long have you been a midwife?
I qualified in July 1993
2] Do you think homebirth is more dangerous than hospital births?
No, I think they are almost always safer – the only exception would be the client in whom problems are identified during the labour
3] Have you attended a homebirth?
Yes around 85
4] Have you given birth at home?
Yes 4 times out of 4 – wouldn’t dream of having a baby in hospital
5] Do you prefer to attend a homebirth to a hospital birth, if so, why?
Yes; quieter, calmer, the birth proceeds at its own pace without interruptions from anyone; the woman is in control in her own environment, I could go on and on….
6] What things make your life easier at a homebirth?
Knowing the woman and her partner, so I know what her thoughts, feelings, sensitivities, preferences etc are for the birth
7] What things make your life hell at a homebirth?
Not much – except of course the converse of the above, where I don’t know the woman and have to make her acquaintance during labour. The only thing I wouldn’t like at a home birth would be if I felt the woman and I didn’t have a relationship of trust
8] What tips would you give to a couple wanting a homebirth that come up against a refusal?
Remember at all times that it is your body and your baby and you are an adult, fully capable of making your own decisions about how when, where and with whom you will give birth; keep calmly and quietly reiterating your plans and make it clear that you expect the professionals will fall into line!
9] What are your thoughts on unassisted homebirths legal, emotional and practical?
Sadness mainly, that anyone needs to go down this road to get the birth they want. I’m quite happy to melt into the background at a birth but wouldn’t like to feel that anyone so mistrusts what I might do that they would rather I wasn’t there at all. Legally, it is not a problem – the laws about not having anyone help at a birth who is not a midwife or a doctor is set up to prevent anyone pretending to be a health professional who is not properly qualified, not to prosecute fathers/partners who happen to catch their own baby. Practically, again it may not be a problem – most babies birth quite happily without any assistance from a health professional; however, there is always the possibility that either baby or mum might need help and that is what I am trained to recognize and help to deal with.
10] What things would make you refuse to go through with a homebirth [e.g.; breech, multiple, history of complications etc].
The only client I have turned down was a woman who I didn’t feel was taking responsibility for her decisions. I have assisted at twin births, previous caesarean sections x 1 and x2; previous high blood pressure; previous assisted births etc etc at home and my main criterion is that the woman, her partner and I have discussed the implications of the previous/current history and she is fully informed of the potential for complications and has reached her own decision about what she wants to do in the current situation.
Any other comments regarding homebirths?
I have participated in many beautiful, some challenging home births; I have had some clients transfer who have needed to transfer; but I have never been at a home birth where I have wished to be elsewhere whereas I have not infrequently attended clients who’ve wanted a hospital birth and have wished we were at home!
In YOUR opinion should the cord be left to stop pulsating before clamping/cutting?
YES……yes it should be left, ideally until the placenta has birthed but certainly until it has stopped pulsating.  It benefits the baby, it allows the moment of birth not to be rushed.  Even if a woman wants a managed third stage (which not many of my clients do), there’s no need to jump in and clamp and cut the cord and give the syntometrine the minute the baby is out – there is always time …

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Laura Abbott IM
1] How long have you been a midwife?
4 YEARS
2] Do you think homebirth is more dangerous than hospital births?
ABSOLUTELY NOT! HOME IS THE SAFEST PLACE FOR A HEALTHY WOMAN TO HAVE HER BABY. SHE IS IN HER OWN SURROUNDINGS, WITH HER OWN CREATURE COMFORTS AND MOST IMPORTANTLY HER OWN PRIVACY.
3] Have you attended a homebirth?
LOTS!
4] Have you given birth at home?
NO, I HAD A VERY MEDICALISED BIRTH AGAINST MY WISHES(I AM SURE THAT THIS HAS INFLUENCED ME IN MY NON-MEDICALISED APPROACH TO CHILDBIRTH). I WAS YOUNG AND NOT A MIDWIFE AND THOUGHT THAT MY FLAT WOULD BE TOO SMALL TO HAVE A HOMEBIRTH.IF I AM LUCKY ENOUGH TO GET PREGNANT AGAIN, I WILL BE HAVING MY BABY/BABIES AT HOME!
5] Do you prefer to attend a homebirth to a hospital birth, if so, why?
DEFINATELY AT HOME BECAUSE IT IS SAFER, THE WOMAN IS IN HER OWN SURROUNDINGS, SHE IS UPRIGHT AND IN
CONTROL. THE MOST BEAUTIFUL THING IS WHEN A WOMAN IS SO EMPOWERED BY HER BIRTH EXPERIENCE AND WHEN SHE CAN SAY “I DID IT!”
6] What things make your life easier at a homebirth?
BEING WITH CLIENTS I KNOW, WHO KNOW AND TRUST ME AND JANE (MY MIDWIFE PARTNER). NOTHING LOGISTICAL EXCEPT SOME NICE BISCUITS MAYBE?!
7] What things make your life hell at a homebirth?
IF THINGS DON`T GO AS PLANNED AND WE NEED TO TRANSFER. I FEEL SO DISSAPOINTED FOR THE WOMAN.
8] What tips would you give to a couple wanting a homebirth that come up against a refusal?
BE STRONG, REMEMBER IT IS YOUR BODY AND YOUR CHOICE. GET IN TOUCH WITH “AIMS” WHO ARE FANTASTIC. SPEAK TO A LOCAL SUPERVISOR OF MIDWIVES. JOIN A HOMEBIRTH SUPPORT GROUP.
9] What are your thoughts on unassisted homebirths legal, emotional and practical?
I THINK IT IS SAD THAT A WOMAN MAYBE IN A POSITION NOT TO HAVE ANYONE TO TRUST AROUND HER.WOMEN ARE AMAZING AND BABIES BIRTH THEMSELVES, HOWEVER IT IS SO MUCH BETTER FOR A WOMAN IF SHE CAN HAVE A MIDWIFE/MIDWIVES SHE KNOWS AND TRUSTS TO BE THERE. WE HAVE ATTENDED BIRTHS WHERE A WOMAN MAY WANT A LOT OF SUPPORT/BACK RUBBING ETC. WE HAVE ALSO ATTENDENDED BIRTHS WHERE A WOMAN MAY WANT US IN THE NEXT ROOM ON HAND IF SHE NEEDS US AND GETTING ON WITH THINGS IF SHE DOES`NT.WE
ARE “HANDS OFF” MIDWIVES THEREFORE MOST OF THE BIRTHS WE ATTEND ARE “UNASSISTED”WHERE A WOMAN CATCHES HER OWN BABY. OF COURSE, WE ARE SAFE SO IF A COMPLICATION OCCURS WE WILL INTERVENE BUT BY BEING HANDS OFF WE KNOW INTUITIVELY AND BY USING OUR SKILLS AS MIDWIVES WHEN HELP IS NEEDED.
10] What things would make you refuse to go through with a homebirth [e.g.; breech, multiple, history of complications etc]
WE HAVE TAKEN ON MANY WOMEN DEEMED “HIGH RISK” IE: VBAC, HIGH BP, POST MATURITY(!) THE CLIENTS THAT I WOULD`NT TAKE ON WOULD BE ONES WHERE I FELT THAT I WAS`NT EXPERIENCED ENOUGH PROFESSIONALLY. IN THAT SCENARIO I WOULD CONTACT AN IM WHO MAYBE MORE EXPERIENCED. I HAVE ATTENDED BREECH HOMEBIRTHS AS A SECOND MIDWIFE BUT NOT AS A PRIMARY. THAT WOULD BE AN EXAMPLE WHERE I WOULD SEEK SUPPORT FROM EXPERIENCED BREECH BIRTH MIDWIVES. I DON`T THINK I WOULD BE HAPPY SUPPORTING A TRIPLET HOMEBIRTH!!
Any other comments regarding homebirths?
WONDERFUL, POWERFUL, BEAUTIFUL. AS A MIDWIFE THIS IS WHERE I AM HAPPIEST, SUPPORTING WOMEN WHO KNOW THAT THERE BODIES ARE CAPABLE OF BIRTHING WITHOUT THE NEED FOR INTERFERENCE. IT IS TOTALLY HUMBLING AS A HUMAN BEING TO WITNESS…
In YOUR opinion should the cord be left to stop pulsating before clamping/cutting?
YES…ABSOLUTELY!!!

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G.K(Independent MW)
1] How long have you been a midwife?
8yrs
2] Do you think homebirth is more dangerous than hospital births?
NO! Probably more safer than hospital births if the baby is ‘term’ and the woman is healthy – everything is within the normal range.
3] Have you attended a homebirth?
Yes! Worked for a few years as an independent midwife – mostly homebirths.
4] Have you given birth at home?
Yes, twice – and planning to do so again when our next wee one comes (5/04)
5] Do you prefer to attend a homebirth to a hospital birth, if so, why?
Yes – as I feel that women are more likely to feel safer to embrace the power and wildness of birth in their own homes. I also feel safer from pressure from the medical model within the institution of a hospital.
6] What things make your life easier at a homebirth?
No anxious midwives/medics present (hopefully!) Everyone present usually trusts the woman can give birth herself – and this makes life easier! No doctors or Midwifery managers wanting everyone to follow protocols that deny women’s individuality. An atomosphere of normality and everydayness at home – as opposed to an potential atmosphere of drama and the medical model in a hospital.
7] What things make your life hell at a homebirth?
Never had my life “hell” at a homebirth. The only hardship I can think of is staying present for a woman for such a long time that I no longer felt I could practise safely. Also experienced this working in a hospital after back to back shifts and no breaks!
8] What tips would you give to a couple wanting a homebirth that come up against a refusal?
Find someone else to attend the birth. Rather have someone attending the birth who trusted the process of normal birth, and trusted the woman to give birth safely – than have someone present because they were ethically or legally bound.
9] What are your thoughts on unassisted homebirths legal, emotional and practical? I believe wholeheartedly in the ancient practise of midwifery – having a woman who has experienced many women birthing, and can offer ‘tips’, be a safety net, and support the woman with love and wisdom. I can understand why a woman would choose to birth without an attendent if they didn’t feel ‘loved’ by that person; or free to be themselves. I can also understand a woman choosing to birth unassisted may feel it necessary for political or spiritual reasons. I feel that with that they are inevitably taking full responsibility for their births, babies, and bodies. They are embracing the dark and light side of birth and life.
10] What things would make you refuse to go through with a homebirth [e.g.; breech, multiple, history of complications etc]  I have attended women with complications – even when I felt very concerned there could be problems, once I was assured that the woman was fully aware of all risks, and was still choosing to go ahead (with or without me.) I had to be convinced that she was taking full responsibility; and I also had very experienced back up. Re: breech – have attended a breech homebirth (planned) as the ’second midwife’. I am unsure I would feel confident with a breech birth at home by myself – would want to have a midwife experienced with many breech births with me. With twins – no probs if both head first; however, as previous for if breech present.
In YOUR opinion should the cord be left to stop pulsating before clamping/cutting?
YES – in every circumstance! Especially if the baby needs rhesus – can still keep the baby attached at this point.

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It is now 2010…… We have resurrected the survey above … however if you are or were a midwife and would like to add your answers then feel free to!

1] How long have you been a midwife?
2] Do you think homebirth is more dangerous than hospital births?
3] Have you attended a homebirth?
4] Have you given birth at home?
5] Do you prefer to attend a homebirth to a hospital birth, if so, why?
6] What things make your life easier at a homebirth?
7] What things make your life hell at a homebirth?
8] What tips would you give to a couple wanting a homebirth that come up against a refusal?
9] What are your thoughts on unassisted homebirths legal, emotional and practical?
10] What things would make you refuse to go through with a homebirth [eg; breech, multiple, history of complications etc]
Any other comments regarding homebirths?
Finally, an optional question that you can comment further on if wanted;
In YOUR opinion should the cord be left to stop pulsating before clamping/cutting?
YES……… NO……… MAKES NO DIFFERENCE………..

Use the contact form to send your answers to us!