A woman is likely to be more relaxed in her familiar surroundings at home with her partner and perhaps children around her. She is more likely to have an active birth, experiencing less intervention, also to feel more in control. She has more privacy, less risk of infection and more chance of continuity of care from the same midwives (Allen et al., 1997). NICE meta-analysis reports less intervention at home, i.e. less induction of labour, augmentation, epidural, episiotomy and instrumental/caesarean delivery (NICE, 2007). Women are more likely to breastfeed (National Birthday Trust Fund (NBTF), 1997).

Planned home birth neonatal outcomes, including Apgar scores, appear better in some studies (NBTF, 1997) and marginally worse in some low-quality studies (NICE, 2007): they are difficult to measure due to the self-selected population choosing home birth.

The woman is less likely to suffer from postnatal depression (Mind, 1995).

Home birth is not for everyone. Some women and/or partners worry about children or neighbours overhearing the birth, making a mess on beds and carpets and the trauma/perceived danger of any possible transfer to hospital. Those people will be more relaxed in hospital and that is the right decision for them.

Attending home births

Midwives should feel confident when attending home births. Inexperienced midwives may require support from more experienced colleagues. To help gain confidence, midwives should aim to attend regular home birth workshops. Home birth study days are usually inspiring as well as offering the opportunity for knowledge sharing and experience.

All midwives, especially those who practise in the community, need to keep their skills and emergency drills up to date as well as ensuring that they have practised the manoeuvres for breech birth and shoulder dystocia. Midwives must be able to cannulate, resuscitate adults and babies, and should know what to do if a postpartum haemorrhage occurs.

Personal safety checklist

• Know your destination/location and how to access the woman’s house/flat.

• If you are attending another midwife’s client, and particularly if the woman’s home is difficult to find, ensure that you have a map, with adequate landmarks or directions.

• Carry both an Ordnance Survey and an A-Z map of your area. Satellite navigation would be extremely useful.

• Have a system in place for informing your colleagues of your whereabouts both day and night.

• Inform any other relevant people, e.g. labour suite co-ordinator, supervisor of midwives (SOM), general practitioner (GP), should they need or wish to be involved.

• If you feel threatened going somewhere, take a second midwife with you.

• Ensure that mobile telephone battery charged, torch charged and car fuelled.

Supervision issues

Supervision is in place to protect the public by actively promoting a safe standard of midwifery practice. Supervision should be supportive and proactive.

As well as ensuring that the midwife carries out safe practice, the SOM also identifies personal and professional development needs and encourages evidence-based practice (NMC, 2006).

A SOM can be a useful resource for a home birth. SOM support can include attending a home birth with the midwife, especially if the midwife has concerns about a high-risk mother who insists on a home birth. A SOM can also provide a point of contact for the woman who wants a home birth but has been told that she cannot have one.

Build up a good rapport with your SOM, keep them informed of impending births in your area, share and discuss cases.

Midwives working outside the NHS also need supervision and support. These midwives may be working in independent practice, as a midwife teacher or employed by GPs as a midwife. These midwives may or may not have a contract with an NHS trust.

Preparation by the midwife