Home birth: requirements and costs

Data and facts about home birth

Up until the mid-20th century, home births were the most common way of bringing a baby into the world. Only when hospitals spread across the country and became more accessible in industrialized countries did hospital delivery become common practice. This development was accelerated by the creation of better medical standards and better equipment in the clinics. The risks for pregnant women and babies have been significantly reduced in the last century. In Germany today only two percent of those giving birth give birth in their own four walls. In contrast, in developing countries where hospitals are not widespread, home delivery is still common. But also in some European countries there is a trend in hospitals to give birth back again. Because the fear of dangerous pathogens there is growing and makes many women prefer the intimate and homely atmosphere again. For example, the number of home births in the Netherlands is around 30 percent. An infrastructure of clinics that are easy and quick to reach creates a safety net should problems arise during the birth. Home births are even subsidized by the state. It can therefore also be expected for Germany that the number of home births will increase again in the next few years. An infrastructure of clinics that are easy and quick to reach creates a safety net should problems arise during the birth. Home births are even subsidized by the state. It can therefore also be expected for Germany that the number of home births will increase again in the next few years. An infrastructure of clinics that are easy and quick to reach creates a safety net should problems arise during the birth. Home births are even subsidized by the state. It can therefore also be expected for Germany that the number of home births will increase again in the next few years.

Are home births safe?

If the pregnancy proceeds normally, a home birth is an absolutely justifiable risk. With the support and help of experienced midwives, you are just as safe as births in other facilities, such as a birth center . 85 percent of home births proceed without major complications, only 15 percent of those giving birth at home still have to be transferred to a hospital. Most transfers are carried out very early in the birth process, when it is foreseeable that complications could arise. They usually happen calmly. Very few transfers are emergencies. However, the safety of a home birth requires that the pregnancy meets a few characteristics.

Requirements for a home birth

The prerequisite for a home birth is that everything is fine with you and your baby. If you are healthy and the pregnancy went smoothly, nothing stands in the way of a home birth.
However, a home birth is not recommended under the following conditions:

• Pre-existing conditions such as high blood pressure , diabetes
• A previous caesarean section or other complications from previous births
• Occurrence of preterm labor
• Classification of high-risk pregnancy
• Breech or transverse position of the baby
• Presence of placenta previa
• multiple pregnancies
• Multiparous women (from the fourth child)
• diseases of the child

Benefits of a home birth

• The birth takes place in your familiar environment, where your personal germs prevail and therefore good hygienic conditions for your baby. While a clinic is very sterile, highly contagious, dangerous pathogens can be present that are bad for you and your baby.
• A home birth saves you the trip to the hospital, which many expectant mothers fear.
• Most women giving birth feel more comfortable and secure in their own four walls. This makes it much easier for them to relax and concentrate fully on the exertion of birth and the baby.

Disadvantages of a home birth

• In case of complications, transfer to a hospital is necessary (15 percent of all pregnant women who give birth at home still have to be transferred to a hospital)
• You might worry that the neighbors will be disturbed because of the increased noise level
• Pain relief with strong painkillers or epidural anesthesia (PDA) is not possible
• Furnishings and utensils must be protected due to blood and amniotic fluid
• The midwife cannot be there for you 24 hours a day like the staff in the hospital. Depending on the agreement, she will usually check on you and your child twice a day
• It means more preparation and organization upfront if you don’t have the standard hospital equipment to fall back on.

cost of a home birth

Preparing for a home birth

• Midwife : If you are interested in a home birth, then look for a midwife as early as possible in the pregnancy, because many are in demand and no longer accept women at a later point in time. The time between the 12th and 20th week of pregnancy is ideal here. Then you have enough time to get to know your midwife and to discuss the course of the birth.
• Provision for emergencies : It should also be clarified whether a doctor should be present at the birth or not. This is not usually necessary as midwives can also repair minor birth injuries. In emergency situations, however, doctors must be consulted; so one should always be available at birth.
• Clinic : If there are major complications, you will need to be transferred to a clinic. Here it is important that you choose one early enough that you trust and to whom you should be taken. Find out if it might be beneficial to make an appointment to be prepared for an emergency. You should also have selected a clinic with an intensive care unit for newborns beforehand so that the child can be taken there directly in an emergency.
• Pediatrician : At least three weeks before the scheduled appointment, you should contact a pediatrician who can come to your home if the child needs medical attention. If you want, you can also ask if he can come to your home for the U2 examination (5th-10th day) in the first few days after the birth.
• Discuss the birth process : You can discuss with the midwife how you imagine the birth to take place, for example in which room it should take place and what you need for it. But don’t forget to include your partner in the birth planning. Depending on the birth position, he can also be actively involved in the birth and be a welcome help and support for you.
• Caring for other children : If you already have a child, you should consider whether and how much it should be able to take care of when it is born. You should definitely prepare the child for this experience. If the children are to be accommodated elsewhere, you should plan this in good time.

The midwife will bring that, you organize that

A clinic still offers the most comprehensive equipment for a birth. But midwives also have various means of monitoring and caring for your baby. Their tools include:

• waterproof underlays that are placed under the bed linen to protect mattresses and the like from blood and amniotic fluid, for example
• Instruments for cutting cords
• Respirators for the baby
• Aspirator for the mucus in baby’s airways
• medication and infusions
• Acupuncture needles for pain relief
• Essential oils for calming
• Birth stool that can be used to support a smooth birth

Anything else that you should have at home, the midwife will go through with you. This can include:

• Good lighting should be provided
• Everything must be created for sufficient warmth in the room (warmth pillows, cherry stone pillows, radiators, heat lamps, etc.)
• Fresh sheets and towels
• Possibly disposable documents and painter’s film to prepare the place of birth if they are not provided by the midwife
• Eating and drinking enough for the birth and afterward
• Everything for the baby (see our baby equipment list )

process of a home birth

Especially around the calculated due date, the midwife will always be on call so that she can be there as soon as it starts. If the first signs appear, it is best to call them immediately. She will ask you about the signs and decide with you when to come. She will listen to the baby’s heartbeat and check for labor and dilation of the cervix. In the following phases of the birth, the midwife will support you with your wishes and will always give you good tips, for example on correct breathing. If you want to go, she will accompany you. If you prefer to lie down, that’s fine too. Even during the expulsion phase, it can be tailored to your wishes, regardless of whether you want to give birth to the child in the bathtub, on the sofa, in bed or on the birthing stool. You only have to do without a PDA. Midwives also only rarely use substances that promote or inhibit labour. For this, many midwives are increasingly using acupuncture and natural medicine. Once the baby is born, the midwife will withdraw to give you plenty of time and peace with the child. Unlike in the clinic, there is no pressure to transfer here. Only then is the child examined in more detail and placed on the mother’s breast. The midwife can sew up minor birth injuries afterwards. She waits until you are ready and then leaves you alone for the first few hours. Usually she starts hersPostnatal care on the same or next day.

When is a woman giving birth transferred to the clinic?

The midwife can treat minor complications herself. With all home births, only about 15 percent of pregnant women experience major complications that require transfer to a clinic. Less than one percent is actually an emergency. A transfer to a hospital is necessary if:

• Severe exhaustion of the parturient and faltering birth process
• Danger to the child (for example, if the heart sounds weaken)
• Extreme contractions: the midwife usually does not use strong painkillers or epidural anesthesia (PDA). If these have to be used, transfer to a clinic is usually necessary
• For the care of a serious episiotomy and perineal tear
• Heavy postpartum bleeding or severe birth injuries
• Delayed afterbirth (placenta is not passed more than 30 minutes later) or the placenta is only partially passed
• If the child develops problems after birth (difficulty breathing, discoloration of the skin, low body temperature, etc.)

Childcare and after

The midwife will also take care of you after the birth. Nevertheless, it is advisable to seek further help early on, who will take care of the household, go shopping or wash after the birth. After all, you still have to recover and your partner would also like to spend time with you and not keep the household going. Talk to your health insurance, as a rule they not only cover the costs of the home birth but also the costs for a household help afterwards. However, various conditions apply here, which you should inform yourself about in advance.