Around three percent of women choose to give birth at home. It is more common with second babies and subsequent births. Some people worry home births are unsafe since if anything goes wrong expert help isn’t immediately available. However, the National Institute for Clinical Excellence (NICE) guidelines published in 2023 reported that for low-risk births, a home birth would be a better option for the mother who have already given birth and as safe for the baby in at least 45 percent of births.
Mums often choose to give birth at home because they:
The National Institute for Clinical Excellence (NICE) guidelines have different advice for first-time mums compared to women who have given birth before.
The NICE guidelines advise low-risk women who have previously given birth that planning to give birth at home or in a midwife‑led unit (freestanding or alongside an obstetric ward) is particularly suitable for them because the rate of interventions is lower and the outcome for the baby is no different compared with an obstetric unit.
The NICE guidelines advise low‑risk first-time mums that planning to give birth in a midwife‑led unit (freestanding or alongside an obstetric ward) is particularly suitable for them because the rate of interventions is lower and the outcome for the baby is no different compared with an obstetric unit. First-time mums who give birth at home have a small increase in the risk of an adverse outcome for the baby.
For more information on NICE guidelines on where to give birth click here.
Here is a list of medical conditions and situations that NICE list as indicators of high-risk
Medical conditions indicating increased risk suggesting planned birth at an obstetric unit
| Disease area | Medical condition |
| Cardiovascular | Confirmed cardiac disease
Hypertensive disorders |
| Respiratory | Asthma requiring an increase in treatment or hospital treatment
Cystic fibrosis |
| Haematological | Haemoglobinopathies – sickle‑cell disease, beta‑thalassaemia major
History of thromboembolic disorders Immune thrombocytopenia purpura or other platelet disorder or platelet count below 100×109/litre Von Willebrand’s disease Bleeding disorder in the woman or unborn baby Atypical antibodies which carry a risk of haemolytic disease of the newborn |
| Endocrine | Hyperthyroidism
Diabetes |
| Infective | Risk factors associated with group B streptococcus whereby antibiotics in labour would be recommended
Hepatitis B/C with abnormal liver function tests Carrier of/infected with HIV Toxoplasmosis – women receiving treatment Current active infection of chicken pox/rubella/genital herpes in the woman or baby Tuberculosis under treatment |
| Immune | Systemic lupus erythematosus
Scleroderma |
| Renal | Abnormal renal function
Renal disease requiring supervision by a renal specialist |
| Neurological | Epilepsy
Myasthenia gravis Previous cerebrovascular accident |
| Gastrointestinal | Liver disease associated with current abnormal liver function tests |
| Psychiatric | Psychiatric disorder requiring current inpatient care |
| Factor | Additional information |
| Previous complications | Unexplained stillbirth/neonatal death or previous death related to intrapartum difficulty
Previous baby with neonatal encephalopathy Pre‑eclampsia requiring preterm birth Placental abruption with adverse outcome Eclampsia Uterine rupture Primary postpartum haemorrhage requiring additional treatment or blood transfusion Retained placenta requiring manual removal in theatre Caesarean section Shoulder dystocia |
| Current pregnancy | Multiple birth
Placenta praevia Pre‑eclampsia or pregnancy‑induced hypertension Preterm labour or preterm prelabour rupture of membranes Placental abruption Anaemia – haemoglobin less than 85 g/litre at onset of labour Confirmed intrauterine death Induction of labour Substance misuse Alcohol dependency requiring assessment or treatment Onset of gestational diabetes Malpresentation – breech or transverse lie BMI at booking of greater than 35 kg/m2 Recurrent antepartum haemorrhage Small for gestational age in this pregnancy (less than fifth centile or reduced growth velocity on ultrasound) Abnormal fetal heart rate/doppler studies Ultrasound diagnosis of oligo‑/polyhydramnios |
| Previous gynaecological history | Myomectomy
Hysterotomy |
| Disease area | Medical condition |
| Cardiovascular | Cardiac disease without intrapartum implications |
| Haematological | Atypical antibodies not putting the baby at risk of haemolytic disease
Sickle‑cell trait Thalassaemia trait Anaemia – haemoglobin 85–105 g/litre at onset of labour |
| Infective | Hepatitis B/C with normal liver function tests |
| Immune | Non‑specific connective tissue disorders |
| Endocrine | Unstable hypothyroidism such that a change in treatment is required |
| Skeletal/
neurological |
Spinal abnormalities
Previous fractured pelvis Neurological deficits |
| Gastrointestinal | Liver disease without current abnormal liver function
Crohn’s disease Ulcerative colitis |
| Factor | Additional information |
| Previous complications | Stillbirth/neonatal death with a known non‑recurrent cause
Pre‑eclampsia developing at term Placental abruption with good outcome History of previous baby more than 4.5 kg Extensive vaginal, cervical, or third‑ or fourth‑degree perineal trauma Previous term baby with jaundice requiring exchange transfusion |
| Current pregnancy | Antepartum bleeding of unknown origin (single episode after 24 weeks of gestation)
BMI at booking of 30–35 kg/m2 Blood pressure of 140 mmHg systolic or 90 mmHg diastolic or more on 2 occasions Clinical or ultrasound suspicion of macrosomia Para 4 or more Recreational drug use Under current outpatient psychiatric care Age over 35 at booking |
| Fetal indications | Fetal abnormality |
| Previous gynaecological history | Major gynaecological surgery
Cone biopsy or large loop excision of the transformation zone Fibroids |
If you would like a home birth it’s important to discuss it with your doctor or midwife as it’s possible that your particular situation it isn’t appropriate. For example, if you have a high-risk pregnancy. These risks are harder to assess for a first baby, but research suggests similar safety rates for home and hospital births, once high-risk/complicated pregnancies are removed from the sample. If it is possible, your choice will be put in your maternity notes. You can book an independent, private midwife if there is one in your area. She will charge around £2,000-£5,000 to help you right the way through your pregnancy, labour and birth.
It’s also a good idea to check that your maternity unit provides a home birth service. It might be that the hospital you choose doesn’t cover your residential area and you might be advised to book at another hospital that covers homebirths within your geographical area. It’s best to check this out sooner rather than later and avoid disappointment.
It’s a good idea for the midwife to visit your home to make sure it’s suitable. She’ll notice things that you simply won’t have thought of. Discuss this possibility with her when you first meet. One or two midwives will be with you throughout the labour and birth. If there are any problems or labour is not progressing (and the baby is distressed) you will be transferred to a hospital in an ambulance where you will be taken straight to the labour ward.
If you would like to birth in a pool you can hire a birthing pool. If your property is above ground level it is advised to have a structural survey carried out to ensure that your floor can take the weight of a filled pool.
Your midwife will talk you through everything you need to prepare to give birth to your baby at home.
You will need plastic sheets to protect the area where you are birthing.
A bowl or bucket is useful to have by your bed in case you feel sick.
Have lots of face cloths to help you freshen up throughout labour and a clean warm towel to wrap your baby in when she’s born.
You might want a hand mirror so you can see your baby’s head crowning, and the midwife will need a desk light or torch so that she can check your vagina for tears.
Have a bag of toiletries ready and some sanitary towels and big old clean pants (or disposable maternity pants) to wear afterwards. You’ll need loose old clothes for you after the birth, and all the clothes your baby will need – and don’t forget the nappies!
Also good idea to have a small bag packed in the unlikely event that you need to transfer to hospital.
Make sure you have written information from your hospital or ambulance service with regards to the transfer time to the consultant obstetric unit when choosing an out-of-hospital birth. Transfer times will of course vary according to ambulance availability and traffic etc – so it’s good to have a realistic idea of these in advance.
