Giving birth is a life-changing event, and the care that a woman receives during labour has the potential to affect her – both physically and emotionally in the short and longer term – and the health of her baby. Place of birth is an important and complex subject. One in 50 women in England and Wales will choose to give birth at home supported by a midwife, yet home birth often exists within contemporary discourse as a polarising topic layered with opinions over safety and suitability, both within and outside of the NHS maternity services context.
The evidence around midwifery-led care outcomes for women with uncomplicated pregnancies is compelling; Sriram et al (2024) identified that midwife-led care is associated with a lower risk of unplanned caesarean section, augmentation in labour, epidural use, instrumental birth, episiotomy, rates of infection, admission to intensive care units and blood transfusion. Furthermore, the authors suggest that neonates born under a midwife-led care model have lower rates birth asphyxia, acidosis and of requiring care in a neonatal unit.
When considering midwife-led home birth, research highlights that for both first and second-time mothers, there are increased spontaneous vaginal birth rates and less interventions when birthing at home (Brocklehurst et al, 2011) with the odds being more favourable for women expecting their second or subsequent baby. The outcome for the baby in this group is no different compared with an obstetric unit (NICE, 2023) whereas there is an overall small increase in the risk of baby having an adverse outcome for first time mums birthing at home when compared with planning birth in other settings (Birth Place 2011; NICE 2023.) Scart et al (2018) further found that women experience lower rates of haemorrhage and severe perineal trauma when birthing at home, compared with birth at the obstetric unit.
Choosing the place of birth is deeply personal for many women with a multitude of factors to consider. It is a legal right for a person to choose where they give birth (Birthrights, 2021.) All NHS providers are expected to ensure that all 4 birth settings (home, freestanding midwifery unit, alongside midwifery unit and obstetric unit) are available to all women in the local area or in a neighbouring area (NICE, 2023) and that choices are explored, supported and respected during pregnancy. NHS maternity providers must ensure service infrastructure, availability and accessibility to support birth outside of the hospital alongside the other core birth settings, for any family who chooses this option (NICE, 2023). However, a recent report by the charity Birthrights highlighted that nationally, home birth services are often restricted, suspended or frequently interrupted (Birthrights, 2025) leading to widespread unreliability and patchy home birth services across the country. This both restricts the legal right to choose, can be traumatic for women and families and increases birthing numbers in already overstretched obstetric units.
Based on the principle of shared decision-making, maternity teams should have open discussions about home birth as an option for all women with an uncomplicated pregnancy and the evidence available on safety, including any potential limitations to care in this setting:- equipment carried by midwives at a home birth; limited pharmacological pain relief; distance and time to transfer to the obstetric unit an emergency, if required, and local statistics surrounding transfer rates; recommendations and options if the on-call midwife team are not available at time of birth.
Home birth at UHMB
Whilst the majority of women who receive care at UHMB give birth in one of the obstetric units (Royal Lancaster Hospital and Furness General Hospital, Barrow) a small number of women choose to birth outside of these settings, either at home or the freestanding midwifery unit in Kendal. In the past year, 1.9% of women gave birth at home (n=46) across the UHMB area; this falls just below the national home birth average of 2.2% (NHSe Digital, 2024.) The highest numbers of home births (>50%) fall within the area covered by the Kendal team, who also cover on-call for the freestanding midwifery-unit.
Operationally, organisation of midwifery home birth on-call services at UHMB is complicated owing to the vast geography and small, community midwife teams. 5-6 midwives are required to be on-call every night to cover the UHMB community areas. In February 2025, a new Standard Operating Procedure was introduced to ensure that birthing choices outside of the hospital are fully supported by safe midwifery staffing and cross-Bay working, together with robust daily communications and decisions to potentially suspend home birth services being made proportionately by a senior team when all other options have been exhausted.
The story - Holly’s home birth
Holly is a second time mum who birthed successfully at the freestanding midwife unit in Kendal (Helme Chase) with her first birth in 2022. Holly describes her first birth experience as a “straightforward, unmedicated birth; arrived at Helme Chase 7:30am, baby born 11:30am and discharged home at 7:30pm.”
Following her first birth experience, Holly’s midwives highlighted the success of her birth and encouraged her to consider a homebirth in the next pregnancy, if uncomplicated; this aligns with the evidence around safety and appropriateness of home birth. However, Holly brushed this off as thought “only hippies do that!”
Planning for place of birth:
When Holly became pregnant again in June 2024, Helme Chase had been on a prolonged service suspension for several months. Holly knew she did not want to birth in a hospital setting like Lancaster or Barrow, so felt her only option was to birth at home.
Throughout Holly’s pregnancy, homebirth was actively encouraged by the maternity teams, with Holly being made aware that birthing care at Helme Chase and homebirth were similar in terms of midwifery-care and emergency support available. Holly’s thoughts around this time confirmed her home birth choice: “being curled up in my own bed with baby straight after birth sounded amazing compared to sitting around for hours waiting to be discharged at hospital!”
Holly was also informed about on-call provision and possible restrictions with the on-call service, with only two midwives being on duty each day, covering both Helme Chase and homebirths; this meant if anyone else was in labour simultaneously, then Holly would be advised to go to hospital. As part of the decision making, Holly also had to consider family childcare availability for her 2-year-old both during a planned homebirth or if there was a requirement to transfer into hospital.
Holly’s labour and birth
Following 4 weeks of prodromal labour and feeling her baby girl would never arrive, Holly’s labour started at 40+ weeks of pregnancy.
Following the waters breaking and contractions starting around 08:30am, Holly followed the process and called maternity triage to inform and request that the midwifery team would be needed at some point that day; Holly felt this allowed time to arrange the on-call team. Unfortunately, and as Holly had anticipated, the triage response was that the on-call team were already caring for another person at Helme Chase so could not attend her home birth; Holly was advised to attend the obstetric unit.
From Holly’s perspective, Lancaster and Barrow were both an hour’s drive away. Practicalities with transport meant that a car was not available, nor was childcare! Therefore, Holly informed the team that she had no choice but to stay at home, though the maternity team still asked Holly to inform them ‘when she would be attending.’
Throughout the morning, labour was progressing, and Holly remained at home. In the background, the maternity team were having communications with the wider community teams to establish if any midwives were available to attend the home birth. Unfortunately, following a further 3 telephone calls with the maternity teams, Holly was informed again that no midwives were available, so she took the decision to remain at home and birth unassisted [this is also known as ‘freebirthing], planning to call an ambulance if needed. The midwives advised against this plan, again informing Holly to attend the maternity unit. Holly felt she had no choice to birth without the presence of a midwife.
At 12 noon, Holly attached her TENS machine to support with the pain of labour and proceeded alone. Unexpectedly, maternity triage called during this period to say that midwives were now available and were on their way. Holly was relieved when the midwives arrived at her home around 1:30pm, being equally relieved that she did not make the journey into the obstetric unit unnecessarily and as advised.
When the midwives arrived, Holly’s contractions slowed temporarily; this is a normal physiological response. Holly took herself upstairs to be alone and was supported by the midwives to do so; this re-centred the physiology of labour and contractions soon re-commenced. Holy was supported to mobilise in an environment she felt comfortable in and spent much of her time leaning over the stairwell banister! Holly declined the offer of Entonox (gas and air) despite the discomfort and pain of the progressing labour.
At around 7.45pm, Holly took herself to her bed and began pushing. Following a further pop of waters and another 5 mins of pushing, Holly’s baby girl was born safely at home in the way that Holly intended. Holly was worried that her baby was taking too long to be born, though reports the midwives remained calm and reassuring, guiding Holly through and explaining that baby was just getting herself into the right position.
Holly’s baby girl cried straight away, was perfectly happy and healthy with no obvious issues. Holly birthed her placenta naturally 10 minutes after her baby was born and required no stiches, enjoyed the uninterrupted ‘golden hour’ post-birth with her baby, enjoying early breast feeding whilst the midwives quietly got on with their checks and notes [birth in the hospital often feels and looks very different to Holly’s story.]
Some time after the birth, Holly showered in the comfort of her own home and curled up in bed with her baby to enjoy tea and biscuits, which she describes as “perfection!” The midwives left the house around 10.30pm to allow Holly and her family to rest and enjoy this precious first night with their new baby.
Holly’s final message:
Holly has highlighted the skills of the attending midwives in supporting her birth by:
- Not being pushy
- Supporting things to unfold in ‘Holly’s/baby’s’ time
- Being ‘lovely and comforting’
“I really do believe in the cause and getting the message out there of how amazing homebirths are. Everyone we know in town thought we were crazy for choosing Helme Chase the first time round so you can imagine what they all thought when we said homebirth for the second round!
There’s just such a fear around it isn’t there.... being confident in my choice that I would go unmedicated whether in hospital or at home was one of the main things that made me confident to be at home.”