Your home birth

It is common to hear people talking about what they are/have/were allowed during pregnancy and childbirth. When it comes to what is best for a mum and baby there seems to be a subtext of ‘rules’ pertaining to:

• What you eat
• How you work
• What tests you take
• Who you consult with
• Where you go
• Where you birth
• What medication or supplements you take
• When you must give birth by
• Who you tell
• It goes on and on

We are here to tell you that actually, the choice is yours. Of course with choice comes responsibility. In order to make good decisions that are right for you, your baby and your whānau those decisions need to be based on robust, factual information. This is where the skill to ensure you are making informed choices comes in. Our health system is based on the premise of informed consent. This means that you ultimately have the final say in the care you receive, and that your health practitioner is required to keep you informed about the care, the benefits and the risks of the care and their professional opinion about what the Most Unexceptional course of care is for you. One of your rights under the Code of Health and Disability Services Consumers’ Rights” is to “receive a service only when you have made an informed choice and given your informed consent”.

In order to give informed consent, you need to be

• provided information about the proposed treatment/procedure in an unbiased manner
• Given unbiased information about other options if you ask for it
• Given time to consider this information
• You must have freely decided to give your consent.

You have the right to be treated with respect and dignity and to continue to receive maternity care that is provided with reasonable care and skill, which meets relevant professional standards and is responsive to your needs, whether or not you consent to a recommended treatment or procedure. Within our website, on our Why home birth? and Your home birth pages, we endeavour to provide you with an overview of information about pregnancy and childbirth related to home birth in a factual way. We use evidence based research to create our content and also provide a wealth of interesting and relevant resources on our resources page. Asking questions is a critical skill that will assist you in making informed choices. The acronym B.R.A.I.N.S may help you to ask relevant questions of your midwife, doctor or anyone else offering you services, choices or interventions.

B is for Benefits

• How will this help my pregnancy?
• How will this help my baby?
• How will this help my labour?
• How will this help me?
• how will this help my family?

R is for Risks

• How will this affect my baby?
• How will this affect my labour?
• How will this affect me?
• What are the risks of not doing this?
• What are the risks of further complications if I say yes?
• How common is this risk? What are the statistics?
• Are the risks directly related to your particular level of experience and knowledge?
• what harm is there if we wait?

A is for Alternatives

• What are the alternatives to this procedure/medication/course of action?
• What are the benefits and risks of the alternatives?
• Is there someone else I can speak to?
• Is there something we could try first?

I is for Intuition and information

• What is my/our gut feeling about this?
• what do you see that tells you we need to do this?
• what is the medical indication here?
• why do you feel this is necessary?

N is for Need time/ not now thanks

• Is this an emergency?
• I need time to think this choice through
• I need a private moment to discuss with my family
• I would like to wait for now
• No thank you.
• I have made a decision to decline this treatment

Printable version of BRAINS

Choosing a Home Birth Midwife is one of the most important decisions you will make during your pregnancy so it’s important that your midwife is someone you feel comfortable, confident, and compatible with. The services you can expect from a midwife as your Lead Maternity Carer are outlined here.

If you are planning a home birth, it is important to find an experienced home birth midwife, who has the relevant experience to help facilitate an empowering birth experience for you and your whanau. We believe there is a tangible difference between a home birth midwife, and a midwife who offers home birth as an option. All midwives will operate within their own scope of experience and comfort.

Midwives who are committed, experienced and knowledgeable about home birth will have more personal and professional resources to draw from to help you birth at home. From their experience, they will also know to trust you and your body to give birth in your own way in your own terms. The more a woman is empowered to do this, the more satisfying and smooth her birth is likely to be.  Recommendations from friends and members from local home birth support groups are good ways to find home birth midwives.

When choosing a midwife you have the right to meet with more than one midwife on a no obligation basis before making a choice. We strongly encourage you to consider what you are planning for your birth and then interview midwives accordingly.
Here are some suggested questions you may like to consider / ask when interviewing and choosing a home birth midwife:

General

• How long have you been in practice?
• What are your beliefs about pregnancy and birth? What is your birth philosophy?
• What birthing options / locations do you offer?
• How many births have you attended?
• How many home births have you attended?
• How many of your clients have home births?
• How many women do you book each month? (the NZ College of Midwives recommends no more than 4 – 6 per month)
• Who is your midwifery partner(s)? How do you work together? When will they provide back up? When will I have the opportunity to get to know her as well?
• What percentage of your client’s births do you attend?
• Do you know of anything now that may cause you to be unavailable around the time of my birth?
• Are you a member of the New Zealand College of Midwives?
• Are you a member of your local Home Birth Association?
• When was your last Midwifery Standards Review?
• Do you have a current practising certificate?
• Does this have any restrictions imposed on it?
• Do you have any additional qualifications outside of midwifery? Have you undergone any additional professional development?
• Do you have skills and experience in assisting breastfeeding?

Pregnancy Care

• Where do you provide antenatal visits?
• What kind of antenatal care can I expect?
• How do you ensure that women in your care are given balanced information to make informed choices?
• How often will I see you? What is the process if I need to see you outside of or planned visits?
• Do you encourage family / whanau participation?
• If my pregnancy becomes complicated what are my options? Will you remain involved in my care?
• Are you likely to refer me to other professionals for different aspects of my care?
• Will you advise me on pregnancy diet and what philosophy do you have?

Labour & Birth

• What equipment do you carry?
• How do you support the optimal flow of the birth hormones?
• Will there be a second midwife at the birth?
• What is your transfer / intervention rate?
• When might I need to birth in a hospital? If this happens what role will you play in my care?
• If my labour is long who will relieve you?

After the birth

• How often do you visit after the birth?
• How many weeks do you visit after the birth?
• Between visits are you available for me to phone for advice?
• Will you help me to establish breastfeeding?
• Do you work with or refer to other health professionals or support groups?

Preparing the space – Homebirth equipment and preparation

Practicalities – what to gather for a birth at home?

Please also see tools for pain management during birth

Thanks to all those in the Home Birth in Aotearoa Facebook community for their suggestions and information. We have compiled some suggestions for what you may like to do in the way of preparation for your birthing space. Birth happens with or without special equipment and your preparation and level of expectations will be individualized. The purpose of this page is to provide you with some inspirations and ideas you may not have thought of yourself. It’s by no means a list of essentials, nor is it the definitive, exhaustive list!

Waterbirth at home

What you may need:

• The pool itself – you may like to partially inflate or set up the pool, and then finish it off once labour has commenced Some have suggested having a nice throw over to hide the birth pool if you think you’re going to have a week’s worth of prodromal labour or you’ll be wanting to jump on it and pop holes in it by about day three! You may like to have the pool in the garage or a spare room to keep it out of the way too.
• You can put pillows or soft mats underneath or around the pool, under waterproof layers, for extra softness and padding
• You may like to have other materials for waterproofing floor and furniture, such as more tarpaulins, drop sheets, shower curtains, etc.
• You may choose to hire a califont for instant hot water, or:
• A spare electric jug – handy to have 2 on the go for topping up pool or for hot towels. You may consider running these from different circuits to avoid an electrical overload.
• Clothing: bra, T shirt, bikini top, sarong, or something you find comfortable to wear in the pool if you don’t want to be naked.
• Lots of old towels. Old woollen blankets are good as they are very absorbent
• Sieve or net or similar for collecting floating poo from the pool
• A water thermometer to check the pool heat is optimal
• A insulated cover for the pool will help keep in warm when not in use
• A small mirror if you want to see crowning
• A small torch if lighting is low

Consideration for water birth

• You may need to turn off your smoke alarms if there is a lot of steam
• Check the strength of the floor where you plan to locate the pool. Ground floor rooms are more likely to be strong, as are corners, in a bay window, or above a supporting wall. A full pool with a laboring woman is no heavier than 10-12 adults. If you would have a gathering in the room, you can probably rest assured about having a birth pool in the room.
• Think about how you plan to empty and fill the pool, so you aren’t worrying about it at the time.
• If you are planning to take photos, consider what these will look like in relation to the colour/patterns on the pool. An alternative liner or sheet can be used to customise the pool for your labour and birth pictures.

Birthing equipment

• Birthing mat – some people use a tarpaulin, although these can become slippery, especially if you are using water during the birth. Others make their own, or you can a picnic rugs with waterproof backing, they’re softer and non slip.
• A method for warming hot towels, such as a slow cooker/crock pot, dryer, hot water bottles, etc.
• A container with frozen face cloths
• A bucket/bowl in case of vomiting
• Oil burner if you plan to use aromatherapy
• Laundry basket (lined with rubbish bag in case of wet/bloody items) for used linen
• A camera, camera charger, video camera. Spare batteries and memory space.
• A way to play music, and a prepared music setlist
• A container for the placenta. A nice wide container that can float is good, as it is easily used in the pool and avoids having to leave the pool if you don’t want to. For more discussion on placenta, please see our Whenua (link to in your home birth – sprit ) page.
• A clamp, tie, muka, or other tool for tying the umbilical cord
• In some areas, you can hire a towel kit from your local group, midwife, DHB or laundry supplier.

Things to consider for the birthing space

• Privacy – you may like to think about how to make a private space for yourself, with a room divider/curtain, etc. A sign for the front gate to alert visitors to come in or stay away may also be useful.
• Some women like to use written affirmations in the birth space to focus on and keep them grounded
• A distraction box for toddlers, and a movie or books for older children. An auntie or uncle to be with them, love them and support them is very helpful too.
• Have a tidy – clear the decks of obvious chores that may distract you – this is a personal preference, but some suggestions include having all the washing done, dishes cleared, lots of nice clear spaces.
• Have firewood ready, a fan on hand, what you think you may need handy and tested to avoid any panics or drawn out waiting to get the environment how you want it if its too hot/too cold
• Lots of women spend some time in the bathroom during labour – you may want to plan ahead for this and have a clean bathroom and a lamp or candle in there as well. You may like to give a heads up to the neighbours that your support people might need to borrow theirs if you occupy the toilet for long periods.
• Lighting having ambient lights – candles, lamps, fairy lights, etc on hand to enable you to alter the lighting to suit your needs. The same goes for having curtains open and a private space in the house if you prefer to have the warmth and light of the sun.
• Some things that are special to you, to provide a point of focus, such as an item crafted at your blessingway, a favourite picture, photo, ornament, stone, crystal, candle, etc.
• It may be worth considering what your support people will do if labour is long. You could have a some books and DVDs on hand, or suggest they bring something to relax with. A list of some jobs to do such as having ingredients for cooking/baking or laundry to fold/put away, weeding in the garden, knitting, etc will also give them a focus.

Food and drink

Generally for labour where you wish to be proactive with positions, a bendable drinking straw is a useful addition to your toolkit for the drink bottle. You are less likely to need to change position or even move in order to drink if you have a straw.

Food of different varieties on hand: barley sugars, mints, scrambled eggs, homemade pizza, roast meat and veggies that everyone can pick at, some nourishing soup, fruit.

Lots of people enjoy having ice blocks in the freezer. They can be useful for a hydration and sugar hit when you don’t feel like eating or drinking. You can make these yourself with juice or herbal tea, or buy ready made.

Herbal tea in drink bottles in the fridge.

You may like to ask someone, or have prepared, something filling, warm and nutritious for yourself and your support people for afterwards. Some also like to have celebratory drinks and food for afterwards.

Things for after the birth

• Some clothes, wraps, nappies or other items ready for baby.
• Comfortable underwear and clothing for yourself
• Maternity pads and/or disposable underwear immediately after the birth. One tip is to freeze the pads before hand to help alleviate swelling and pain. Spares in the bathroom as well as a receptacle to put them in.
• Your preferred perineum healing mix/spray in the bathroom for application when you go
• Have your bed made up with nice fresh sheets, and a comfortable protective underlayer and everything you need nearby ( lamp/ torch, water, snacks, nappies, etc)
• A message on your answering machine asking people to call back later/leave a message/send a text or email instead
• A list on the fridge of things visitors can do when they ask “what can I do to help?” Ideas include: laundry, vacuuming, dishes, reading stories to children, taking the dog for a walk, taking out the compost, etc. It can be hard to ask for help, or hard to think of what needs to be done. If people can choose a task they will probably enjoy it more, and everyone likes to help.
• A sign for the door or gate to say mum & baby are sleeping, or express your wishes around visiting for friends and family calling by

Attending a birth, as a father, partner, mother, or friend is an honour and a privilege. This can be an intense time and its nice to be able to look forward to the birth with a healthy sense of anticipation as well as preparedness.

Here are some tips to prepare for supporting a home birth

• Have a chat – talk with the birthing woman about the birth plan, the kinds of birth techniques she plans to use, the kind of environment she plans to have, the practical and emotional support she expects to need and specifically what she would like to have you offer. This conversation may get her mind ticking over as well. It also allows you to consider what your strengths are and how you can best support her when the time comes. If possible, arrange also to meet with the rest of the birthing team, including the midwife/s and speak with them about the birth plan too.
• Get into the zone. Read some birth stories, and delve into the home birth community to absorb some knowledge and ask questions.
• Inform yourself. Research home birth:
  • birthing techniques
  • birthing terminology
  • pain management ideas
  • informed consent and questions to ask
• Let go of your baggage and let the birth be hers. Whether its your own birth experience, your fears about the health and wellbeing of your loved ones or preconceived notions about risk and safety related to home birth, try to be reflective and let go of what you think or fear about what may happen and refocus on what you can do to improve this experience for the person you are supporting.
• Look after yourself too. You are the best kind of support when you are well within yourself. Try to arrange in advance someone to look after you other responsibilities, be it your children, your work, your household, etc. Prepare some good energy dense snacks and rest as and when you can. you don’t have to be a super person to be good support.

During the birth

• Keep the candles burning
• Take care of the practical aspects around the house – the birth pool, the heating/cooling
• Trust Intuition – both your own, the birthing womans and the midwives
• Avoid asking unnecessary questions
• Avoid making assumptions based on your own feelings, try to tune into the women’s instead
• Remember to breathe, and breathe slowly, gently and peacefully
• Guard the door, make the phone silent
• Play music
• Eat and drink away from the birthing woman, and brush your teeth afterwards
• Assist her in pain management techniques
• Ask pertinent questions of the midwife when necessary
• Bring something you can distract yourself with if the labour is long, such as knitting. The labouring woman doesn’t want or need to worry about keeping you entertained or feel like she is imposing upon you and your time.

Being supportive of a home birth family

Just because you aren’t there when a baby is born, there are lots of other ways to support a friend or family member having a home birth.

Your attitude can have a big impact on the experience and outcomes for a woman and her family. Avoid telling negative stories about birth, these will actually affect the pregnant woman’s ability to birth due to the fear tension cycle. Ask genuine questions such as ‘How are you preparing’ and ‘What help do you need/want’ rather than negative ones that question her choice. It is highly likely the birthing mother has researched her decision to birth at home thoroughly and understands the risks. Try not to make her defensive about her choice.

Even if you don’t ‘agree with homebirth’ recognise that this is not your decision and attempt to be supportive or stay silent with your views. You can also make sure you are informed yourself, by checking out research and testimonials.

Here are a few ideas for practical support

• Create a playlist of music
• Lend out books and magazines, birth and non-birth related
• Create some affirmations
• Offer to help with childcare before, during and in the weeks after the birth
• Make or buy food for the woman and her family. Be sure to ask in advance if they have any special dietary preferences or requirements.
• Some ideas for food you can make:
  • cooked, balanced, healthy meals that can be easily frozen/stored and reheated, such as: Soup, casseroles, stews, lasagna, curry, etc
  • frozen muffins (packed in small quantities)
  • muesli bars full
  • lactation cookies (download)
  •  of delicious and nutritious treats for mum whilst breastfeeding
  • homemade muesli
  • offer to bring around a hot meal one evening, drop it off and pick up the dish another day
  • snack pack of dried fruit & nuts
• Offer childcare to help with older siblings
• Provide an ear for talking through the experience, before and after to both mum and partner
• Mow the lawn, weed the garden
• Do a load of laundry or vacuum the house
• Lend or give away old bedding and towels that can be disposed of if necessary after the birth
• Help with decorating the space, gift a birth candle or pick fresh flowers
• Host a blessingway before the birth
• Lend any equipment that may be useful such as a camera, video camera, birth pool, music playing device, etc
• Visit when you are invited and generally respect the families boundaries so they feel secure at home
• Offer to bring food or drinks for the support people at the time. Be available to pick up some takeaways or provide some hot food for the tired support people
• Offer to do the grocery shopping for a couple of weeks or get some essentials delivered if you live in a different town
  organise a meal roster for the family for the first week(s)

Dealing with birth pools

Many home births also involve the use of a birth pool for pain relief and for water birth. Here are some tips on dealing with birth pools and avoiding any panics or problems when the time comes:

• Do a trial run – where possible, practice putting up the pool and testing it is water tight before the actual time comes. This way you will get a feel for how long the set up takes and that you have all the materials you need to hand (including instructions if needed). Any problems with, or missing parts of, the pool can be rectified before its a problem. You will then know how much space it will take up and where a suitable location is. It is also a good opportunity for the birthing women to give it a whirl and a sense for the size and shape of the pool.
• Establish how you are going to heat and keep warm, the water in the pool. You can use a califont to retain the heat, or you may need to figure out a method for having continuous hot water.
• Figure out who, how when and what you will use to empty and pack up the pool afterwards. Having a plan in place will mean you are ready when the time comes and not so overwhelmed
• Make sure you have a sieve on hand and a container for the placenta.

Many people come to home birth after having direct experience with, or hearing stories about, undesirable hospital births. Hospital can be a good option if you are experiencing a high risk pregnancy, however many healthy women find themselves in a cascade of interventions within the hospital birth setting.

Some ideas for how to avoid an unnecessary hospital transfer

• Select an experienced and committed midwife. Experienced home birth midwives are more effective than obstetricians and medical midwives in facilitating a successful labour with less complications and interventions. Choosing a midwife who has trust in your body’s ability to birth is key in avoiding a referral to hospital or transfer during labour. Of course, a suitably qualified and experienced midwife will always ensure that you are well informed, particularly if they assess that you or your baby are at risk.
• Create a thorough birth plan. Do your research and decide how you want your birth to be. In conjunction with your partner, your birth support person/people and your midwife and backup midwife, create a written record of how you visualise your birth. Reading about, talking with our community and discussing with your midwife how you’d like things to go, will help you to feel confident going into labour that your wishes will be followed when you are in the labour zone.
• Think carefully and research your options for all routine testing. There are many common tests and procedures that are offered to pregnant women. These are conducted for the purposes of early identification of pregnancy complications. There is the potential for false positives with some tests, and different people will have different opinions on how necessary these tests and procedures are. For example, some people choose to avoid unnecessary ultrasound scanning of their baby. Ultrasound scanning can be used to estimate the size of a baby, but the accuracy is poor. Some women have found themselves succumbing to further interventions because their baby has been identified as too big or too small, when in reality the baby is born of average size, and of course healthy babies come in all shapes and sizes anyway! It is important to inform yourself about the tests and procedures available, discuss your options with your midwife and make decisions that feel right for you.
• Learn about informed consent. Women often feel as if they lose their agency when the time comes to give birth. By practicing techniques to ensure you and your support team are able to make informed choices, you can retain your power and make choices that suit you and your whanau.
• Create a positive birthing environment in your own home. Making your birthing environment at home what you want it to be, will in turn help keep you positive approaching your home birth. It needn’t be flashy or expensive, but having the basics at hand and specific to your needs and desires will help.
• Positive Thinking. Know that you will have a safe, peaceful birth in your home. Use positive affirmations to help visualise this.  Prepare for labour, learn about the physiology of birth. Immerse yourself in positive birth culture and empower yourself with birth knowledge. Read positive affirming birth stories and avoid reading, listening and talking about negative ones. If you are overcoming specific fears or blocks then undertake to educate yourself and use techniques to overcome them. Some women find birth classes dedicated to a natural birth ethos a good way to practice specific techniques to incorporate into their births.