THE BIRTH BOX

Midwife Virginia from the Kent Midwifery Practice says:

For a homebirth I always reassure women that most items needed can be found
around the home, as I don’t like to think they are put at extra cost or
inconvenience. However most women like to get things ready and it appeals to
their nesting instincts. I suggest putting a box together so it’s easily
accessible.

There are lots of things that women may want to have ready such as
CD’s candles, nice foods, drinks, cool sprays etc but for the actual birth from
a practical point these are the things I would like to see put together in one
place.

In the Birth Box I suggest a few pieces of plastic sheet the size of a
fire side rug and an old sheet to cover them. One can be for birthing on and
another to put on sofa or bed for afterwards when blood loss may still be heavy.

If having a water birth as many old towels as possible as women are often in and
out. Towels then get wet and we constantly need dry ones. I reassure them they
do not have to be new towels, try and borrow or use old ones. They wash
perfectly well after, even if they get blood stained but best not to use pastel
colours or they will look pretty dull after the wash. Although ever aware of the
environmental issues and cost I just love disposable bed mats meant for
incontinence in the young or elderly. They are the perfect size for birthing and
fantastic at keeping new babies warm. They save on lots of work too. Can be
bought in Boots, Mothercare, supermarkets etc 2 packets serve well.

Container for placenta: I always suggest an old 1 litre ice cream box and this is
especially good if you are keeping your placenta. NHS midwives usually carry
yellow bags for the placenta if they are taking it away for disposal.

A bucket: I use a bucket with some water in for all sorts! Vomiting is very common in labour and so too is passing faeces. Both can be quickly disposed of in the bucket.

Sanitary towels: at least 3 packets to start but only put one packet in the box.
Leave another in every toilet and in the bathroom. Be sure they are the biggest,
thickest maternity ones you can find. Even if you usually only purchase slim
thin types they will not do for the immediate post partum period. Find your
oldest big knickers and put a couple of pairs in your box. Some women purchase
disposable ones but I find they are only good for slim women.

Put your nice warm dressing gown away and have a short light front opening top to put on after the birth. Partner’s short sleeve shirts are a good example. If you put your long thick dressing gown on it may get bloody very quickly and that is a whole load of washing. With a short outfit you can sit on the sofa or bed directly onto a
towel or bed mat.

For baby: all you need initially is a nappy and a warm light
blanket. The fewer clothes the better to start as this will encourage skin to
skin contact. Dressing him or her can come much later.

A cord tie: if you are using your own ribbon or tie then that will need to be in the box. A birth plan: if the midwife is not someone you know and who knows you she will need to read your birth plan so make sure it is in your box. Give someone the role of going through it with her if you have a birth partner, friend or mother with you.

Lastly put a small thin blanket or throw over the box so that one is handy in
case you are waiting around for the placenta or you feel shivery after the
birth, which is very common. A light cover will make you feel very cosy without
over heating you.

You will probably have a “just in case” bag packed although some women prefer not to do this. It will depend on each individual’s opinion
and her attitude towards the psychology of the whole issue of transfer. As a
midwife when I have to transfer a woman to hospital there is sometimes
difficulty in finding her some clothes and shoes to put on, when she may have
been naked, at the same time as calling for an ambulance, caring for her and
informing the hospital we are coming! Think ahead as it may not be about
transfer it may be getting some clothes on to go for a walk outside. Put a comfy
pair of shoes and a loose track suit ready near the box.

HOME BIRTH FACTS: NCT information

WHAT THE NCT WEBSITE SAYS ABOUT HOME BIRTH

For most women home birth is a safe alternative to hospital. It is your legal right to give birth at home if your wish.

Choosing home birth increases you chance of a straightforward birth and reduces your risk of medical intervention, and halves your risk of a caesarean even if you later transfer to hospital.

Research over the last decade shows that women who give birth at home use far fewer drugs to help them cope with labour. This is probably because it’s so much easier to deal with the pain when you’re in your own home, surrounded by familiar objects and people you know.

You are more likely to breastfeed following a home birth and you are less likely to get an infection at home than in hospital. [This might have more to do with the social profile of women who choose home birth, rather than the actual place of birth, however. SJ]

Women, who give birth at home, report higher levels of satisfaction that those using a hospital. At home women report they feel more relaxed. You are able to use your own toilet and bath, eat what you want and when you want it and take things at your own pace moving around and doing what you wish.

The midwives are guests in your home and you control who else comes into your house. Although some women transfer to hospital in labour, for most women choosing a home birth means you don’t have decide when to leave for hospital nor travel in labour.

After the birth you can sleep in your own bed and have the visitors you choose when you choose them. Partners often ay they feel more involved and get to hold and care for their newborn baby and become as expert as the mother.

Many people, including health professionals, friends and relatives will tell you that you are ‘brave’ to choose a home birth. But for women with a straightforward pregnancy – including women having their first baby – home birth is a safe and satisfying option.

The NCT also publishes a booklet on home birth, and you’ll find there’s lots of discussion about where to have your baby if you attend NCT antenatal classes.

May 2009 meeting

Chiswick and Hammersmith Home Birth Support Group
meets on Wednesday 13 May 2009
at
46 Aldbourne Road
W12 0LN
8pm to 10pm

Sarah

REsponses to Melanie Reid. The figure for St Mary's is wrong.
http://www.timesonline.co.uk/tol/comment/letters/article6127939.ece

Siblings at Home Birth

Some useful academic articles on siblings at home birth.
This is an issue that often comes up as a reason not to choose a home birth and can be raised by professionals as well as by family members.
I haven't read any of these articles here yet - I'm just noting them down for future reference.

some useful articles with regard to children at births
FRIESEN, E. 1996. Children Welcoming Children. The Birthkit, 12, p7-8.
SCULLION, P.A., MCCALMONT, C.P. 1995. Siblings in the Delivery Room: Some Issues Explored. British Journal of Midwifery, 3(1), p39-42.
SCULLION, P., SCULLION, J. 1994. Children in the Delivery Room. British Journal of Midwifery, 2(8), p375-377.
SIMKIN, P. 1993. When Should a Child Attend a Sibling's Birth? Midwifery Today, 28, p37.

Meeting 4 June

Where was everyone??? Watching The Apprentice I reckon.
Happily new mum-to-be Sarah turned up to the meeting at Christine's. We had a long chat and Christine told us her birth story. I'm hoping she'll have time to post it on the blog.
Many thanks to Christine for her support in getting this group off the ground - and for her generosity in opening bottles of wine for home birth group meetings!

"Home Truths" - in the Sunday Times

An article about home birth in the Sunday Times on 18/5/08. Thanks Innogen for pointing this out.

The home truth about homebirths
Homebirths are becoming increasingly fashionable, but are they really a safe alternative to the hospital delivery suite?

Sally Brown

There is a quiet revolution going on among pregnant women. Giving birth at home is back in fashion, and not just among the “breast-feed until they start school” brigade. Although the number of homebirths is still relatively small - only 2.5% of all births in 2006 - this represents a 10% increase on the previous year.
Women whom you might have assumed would be happier having an elective caesarean at the Portland Hospital, with a mummy-tuck thrown in, are turning away from maternity wards and the risk of superbug infection in favour of a personalised experience over which they feel they have some control.
The homebirth movement has found an ambassador in the unlikely shape of the American talk-show host Ricki Lake. She has just released a campaigning documentary, The Business of Being Born, which has attracted a cult following among mums’ support groups in this country since it was released last month. The film contrasts her own vastly different experiences of home and hospital birth.
“During the hospital birth of my first son, Milo, now 10, I felt like stuff went on that was out of my hands,” she says. “The second time, I found a midwife who was comfortable with me giving birth in water at home. Everyone told me I was crazy - in America, less than 1% give birth outside hospital - but my first birth took 36 hours and my second took nine hours from start to finish. It was hard, and I was in a lot of pain, but it was an amazing and empowering experience.”
Angela Horn runs the online support group Homebirth.org.uk and has had five children at home. “It hasn’t all been wonderful, and I won’t deny it hurt at times. My last birth was lovely – it took one hour 20 minutes, of which only the last 20 minutes were painful - but the first one took nine hours, and I lost a litre of blood,” she says. “I don’t think doctors are the enemy, and some women are better off in hospital, but I do believe we’re naturally meant to give birth in a home environment.”
The big problem with homebirths is that it is impossible to predict what complications might arise. All too often, painstakingly created birth plans go out of the window. “I planned a homebirth with my first baby,” says Sarah Ockwell-Smith, 32. “Looking back, I was underprepared and quite frightened. I laboured for 10 hours at home, but I was dilating for only three of them. I was in a lot of pain and my pulse rate went right up, so, when my midwife suggested transferring to hospital, I didn’t argue. They gave me an epidural and I slept for two hours before pushing the baby out – he was 10lb, and I’m only 5ft 1in, which may be why it had been difficult. I went on to have another baby in hospital, then my last two at home, with quick, pain-free labours.”
Actually guaranteeing that you get a home delivery in the first place is something of a lottery. “In places where there is a shortage of midwives, it is the homebirth facility that is pulled first,” says Helen Rogers, of the Royal College of Midwives (RCM). “Some women are told that staffing levels mean they can’t be guaranteed the midwives on the day.” (NHS guidelines stipulate that two midwives must be present for a home delivery.) “In practice, if there are staff shortages, community midwives are diverted onto hospital wards and women who had planned a homebirth will be told to come into hospital.”
The safety of homebirths remains a contentious issue. The RCM’s line is that a planned, midwife-monitored homebirth in a normal pregnancy is as safe as a hospital birth. “Women used to routinely die in childbirth, but we are healthier now,” says Mervi Jokinen, practice and standard development adviser at the RCM. “We’re not giving birth year after year and we have drugs that can stop bleeding.” A British Medical Journal report on four studies published in 1996 concluded that planned homebirth was as safe as hospital birth, and that women who gave birth at home required significantly less medication and fewer interventions.
Last month, a report in the British Journal of Obstetrics and Gynaecology found that planned homebirth babies are 39% less likely to die than hospital-born babies if - and it’s a big if - nothing goes wrong. If complications occur and the mother is transferred to hospital – which the researchers say happens in one in seven homebirths - the risk of the baby dying shoots up to roughlt eight times more than the average for all births (though it’s still less than 1%).
“What makes this a difficult issue is that it’s perhaps easy to point to a case where a homebirth baby died and say, ‘That baby might have lived in hospital,’ ” says Horn, who believes that women at home are more likely to give birth without interventions such as oxytocin (to speed up contractions), forceps or ventouse because they are allowed to labour at their own pace. “People also need to consider cases where a baby died after a hospital birth, from hospital-acquired infection, or due to complications after a speeded-up delivery.”
It is not simply lack of funding, however, that is stopping women giving birth at home. For many, the idea of a natural birth is about as appealing as having their appendix out on the kitchen table. “Part of the reason women are scared of childbirth is that it is not normalised,” Jokinen explains. “In cultures where birth takes place in the community, young and old women are present at the labour - the older women to give advice from the benefit of their experience, the young women so they know what to expect. Now, women go into labour with no idea of what happens.” Time will tell whether the next decade finds Mrs Average comfortable with the idea of giving birth on the living-room floor, but the signs are that the tide is turning. As the natural-birth guru Gowri Motha puts it: “Women are starting to believe in their bodies again.”
For a screening of The Business of Being Born near you, visit independentmidwives.org.uk

HAVE A HAPPY HOMEBIRTH
- You don’t need your GP’s permission for a homebirth; you can book direct with the supervisor of midwives at your local hospital. Talk to your midwife as early as possible in your pregnancy about your interest in having a homebirth. She can assess your suitability and monitor your progress.
- A water birth isn’t obligatory, but hiring a birthing pool is popular, as the water supports the body and helps you to move around, which in turn assists pain management.
- Don’t be a hero. You can have gas and air, along with pethidine pain relief.
- Don’t get hung up about the mess. “There’s a lot less than people imagine,” says Helen Rogers, a midwife. “But midwives should provide plastic sheets to protect carpets and soft furnishings.”
- Homebirth is not advisable for multiple pregnancies or where there are complications such as placenta praevia, pre-eclampsia or obstetric cholestasis. “It is possible to have a homebirth after a previous C-section, as long as you agree to a hospital transfer at the first sign of trouble,” Rogers says.