Home birth: is it possible?

Today, mothers have several options for giving birth: a maternity unit, a birth centre (available since late 2015) or their own home. This last option, known as an Assisted Home Birth (AHB), is legal but is not suitable for all mothers.
 

According to the latest figures, in 2019, 910 women gave birth at home without requiring transfer either during or after the birth (representing 0.14% of births in France) [1].

Home birth is not for everyone.

Here are the inclusion criteria that must be met in order to give birth at home [2]:

- Be in good health

- Not have a high-risk pregnancy (twins, congenital malformations, diabetes, maternal hypertension, etc.)

- The circumstances of the birth must be physiological and must not present a significantly increased risk of complications (breech presentation, multiple pregnancy)

- The birth must take place between 37 and 42 weeks of pregnancy.

- Live close enough to a maternity unit, as determined by the midwife who will carry out the home birth (20–30 minutes) [3]

In addition, genuine involvement and preparation from the whole family is needed, particularly from the second parent.

Here is a list of criteria that could be a contraindication (based on the judgement of the practitioners) [4]

How a home birth unfolds 

You will be cared for by the same midwife throughout your pregnancy, birth and postnatal period (covering both the mother's and baby's postnatal care).

As with any pregnancy, you will be monitored throughout the 9 months: scans, medical tests. Particular attention will be given to psychological preparation: involvement of the second parent and a home visit before the final month of pregnancy.

Any health concern arising during pregnancy will result in a consultation or referral to another healthcare professional. Once the issue is resolved, the midwife can resume medical oversight of the pregnancy.

You will also be registered in advance at a nearby maternity unit, and you will meet with an anaesthetist to prepare for any potential intervention in the event of a complication.

During birth, the midwife arrives with medical equipment ready to manage any emergencies if needed: oxygen for the baby, airway suction, suturing…

If labour does not start on its own (in the case of a post-term pregnancy or waters breaking), you will be transferred to a maternity unit. In 2019, 16% of women planning a home birth were transferred in this way [5]. It is worth noting, however, that your midwife may offer "natural" induction methods such as a membrane sweep, acupuncture or homeopathy.

It appears that being a first-time mother (primiparity) increases the risk of transfer before, during and after birth, whereas the mother's age and the baby's weight do not appear to be contributing factors.

Cost of a home birth

In France, medical procedures are priced on a per-act basis. For a straightforward birth (single baby), during the day (excluding night, Sunday or public holiday supplements), attended by a midwife, the agreed rate is €349.44 regardless of the place of birth and the time spent with the mother.

The majority of midwives charge fees above the standard rate, with prices varying considerably from one to another (it can range from €100 to €1,000). Some health insurance plans cover all or part of this additional fee. These extra charges are largely explained by the very high cost of their professional indemnity insurance.

And how does it work in terms of equipment and tasks?

Midwives generally protect furniture and floors with protective covers. Hydrogen peroxide can be used in the event of stains. Your partner will, if necessary, empty the birth pool, though a pump can also be used to drain it easily through the window (some midwives provide one).

Safety: what do the studies show?

Several studies conducted in different developed countries demonstrate that attended home births are as safe as hospital births for low-risk pregnancies.

The shortage of midwives who practise home birth
 

As noted by the CDAAD – Collectif de Défense de l'Accouchement à Domicile, midwives sometimes travel considerable distances, a consequence of the fact that few professionals support home births.

Currently, only 70 to 80 midwives offer assisted home births in France, which is relatively few.

Pas de soulagements de la douleurs via les méthodes classiques

Les moyens utilisés pour soulager durant l’accouchement sont “naturels”. Mais naturel ne veut pas dire inefficace, bien au contraire. Pour plus de détails là-dessus, consultez notre article avec ses conseils sur l'accouchement naturel.

On peut notamment évoquer :

-     L’accouchement dans l’eau à des fins antalgiques 

-     Les sons (vocalisés ou chant)

-     Les massages

-     L’homéopathie ou un complément grossesse à base de feuilles de framboisier

-     L’autonomie durant tout l’accouchement

-     La sophrologie et/ou l’hypnose

-     L’acupuncture. Pour en savoir plus sur ses bienfaits, retrouvez notre article acupuncture grossesse.

In an emergency, a transfer is required

Planning a home birth does not necessarily mean it will happen that way. In 2019, of 1,298 women monitored with a view to a planned home birth: 1,081 actually started labour at home and 910 (84%) actually gave birth at home without requiring a transfer either during or after the birth.

Even when no risk has been identified during pregnancy, serious complications (fortunately rare) can still arise that require hospital care and very rapid transfer.

Until the 1930s and 1940s, most births took place at home; they then moved to maternity hospitals, considered safer for reasons of hygiene and the safety of mothers and their newborns.

Whether you give birth in hospital, at a birth centre, with or without an epidural, or at home, what matters most is having the right information to make your choice and being able to experience your birth the way you wish.