Women Requesting Home Birth Against Advice

WAHT-OBS-057
It is the responsibility of every individual to check that this is the latest version/copy of this document.
HOME BIRTH GUIDELINE (including information re.

Babies Born before Arrival (BBA))
This guidance does not override the individual responsibility of health professionals to
make appropriate decision according to the circumstances of the individual patient in
consultation with the patient and/or carer. Health care professionals must be prepared to
justify any deviation from this guidance.
INTRODUCTION
Maternity Matters (DOH 2007) sets out a national choice guarantee. Within this is a
guarantee that by the end of 2009 all women depending on their circumstances should
have a choice of where to give birth. One of these options is birth supported by a midwife
at home.
Women should be offered the choice of planning birth at home, in a midwifery led unit or in
an obstetric unit. Women should be assured that intrapartum-related perinatal mortality is
low in all settings (NICE 2007).
Pregnant women should be offered evidence based information and support to enable
them to make informed decisions regarding their care. Addressing womens choices
should be recognised as being integral to the decision making process. (Antenatal Care
Guidelines. NICE Oct 2003)
The results of a study of perinatal and maternal outcomes by planned place of birth for
healthy women with low risk pregnancies in 2011 support a policy of offering healthy
women with low risk pregnancies a choice of birth setting. Women planning birth in a
midwifery unit and multiparous women planning birth at home experience fewer
interventions than those planning birth in an obstetric unit with no impact on perinatal
outcomes. For nulliparous women, planned home births also have fewer interventions but
have poorer perinatal outcomes.
NB. See section on women requesting home birth against advice (page 7).
THIS GUIDELINE IS FOR USE BY THE FOLLOWING STAFF GROUPS:

Registered Midwives All midwives delivering babies in the home must have attended
yearly mandatory emergency obstetric updates.
Lead Clinician(s)
Margaret Stewart Matron - Community
Helen Walker Community Midwife
Approved by Accountable Director on: 16th September 2015
This guideline should not be used after end of: 16th September 2017
Home birth guideline

WAHT-OBS-057 Page 1 of 16 Version 7
WAHT-OBS-057
Key amendments to this guideline

Date Amendment By:
19.11.09 Clarification of arrangements for transfer by ambulance. H. Walker
04.10.10 Amendments to Home Birth checklist information T Cooper
H. Walker
16.11.12 Additions to Postnatal Care section: M Stewart
Offensive waste should be placed in a Tiger Bag. J A Barratt
Notify birth and obtain NHS number for baby (NN4B),
and complete Bluespier MIS.
Complete postnatal check including observations.
Measure and document first void of urine
29.04.15 Document extended for 3 months L Thirumalaikumar
06.07.15 Document extended for 6 months whilst being transferred Mr Agwu
into pathway format
28/8/15 Additional information regarding Born Before Arrival Rachel Carter
(BBA) and safeguarding Sharon Sarkar

WAHT-OBS-057
HOME BIRTH
GUIDELINE
Booking
Ideally women requesting Home Birth should fall within the low risk criteria, if not
discuss with Supervisor of Midwives. Women who are recognised as high risk from the
risk assessment tool (see WAHT-OBS-027 Antenatal Risk Assessment) should all
have been referred to an obstetrician who should also discuss place of birth using
evidence based information.
The advantages and risks associated with birth at home should be discussed with the
woman and her partner. Evidence relating to homebirth is included within the
homebirth checklist. Details of this discussion along with the completed checklist
(Appendix A) by 37 weeks by the named midwife if possible should be documented in
her handheld records.
Give homebirth leaflet (Appendix C).
The woman and her partners co-operation should be sought in case of a need to
transfer care either antenatally or during birth. Inform Supervisor of Midwives if co-
operation not obtained.
Complete Home Birth Notification Form (Appendix B) and send this to the appropriate
Supervisor of Midwives/Community Manager.
ANTENATAL CARE
Antenatal care is followed as midwifery led care (guideline A2 WAHT-OBS-071)
If any deviation from normal occurs reassess using assessment tool. If now high risk,
refer to Consultant and Supervisor of Midwives if appropriate. Discuss place of birth in
case delivery prior to seeing Consultant. Give evidence based information relating to
the deviation, ensuring women and partner are fully informed.
At 36-37 weeks of pregnancy refer to checklist (Appendix A) again ensuring the

woman and her partner are still happy with place of birth and that any
recommendations made at booking have been resolved.
Choice of analgesia to be discussed. (Appendix A).
Entonox cylinders may be left at womans home prior to delivery, but she must be
given Entonox information sheet (Appendix C). Note: Entonox heads and flow gauges
are not to be left in womens home.

WAHT-OBS-057
LABOUR
Once established labour has been confirmed midwife in charge should inform as
necessary:
a) Delivery Suite
b) The second midwife. The timing for contacting the second Midwife is
at the discretion of the attending midwife. Two practising midwives
should be in attendance for the birth.
At planned home delivery, neonatal and adult resuscitation equipment must be

ready for use in close proximity to the woman. IVI equipment should be available
and easily accessible.
Mother and Baby Identification bands to be completed prior to delivery if time

allows. Therefore if transfer needed bands are ready for use, if not for transfer,
parents may keep in baby book.
If women wish to have Pethidine or meptazinol for pain relief during planned labour
at home, this should be prescribed by the GP and is the responsibility of the
woman to follow storage instructions given by the GP or pharmacy. Community
Midwives can carry meptazinol as this is the drug of choice, obtained through
Pharmacy at hospital, without a prescription.
Care in labour should be in accordance with:

Normal labour including care pathways for
midwife led intrapartum care L2 (WAHT-OBS-058)
Waterbirth L13 (WAHT-OBS-022)
Aromatherapy L18 (WAHT-OBS-040)
Delivery Suite Co-ordinator to be informed if there is any deviation from normal.

Any deviation from normal will necessitate transfer to hospital consultant unit. The
midwife should dial 999 (or ask partner/relative) to request an ambulance with
paramedic support and check with the nearest delivery suite that a bed is available.
Read in conjunction with WAHT-OBS-050. If woman refuses, document and
inform Delivery suite Co-ordinator after discussion with woman and inform on call
supervisor of midwives.
Information regarding the reason for transfer and any care provided, interventions
and actions should be documented within the handheld notes. This information
should be relayed to the receiving health care professional to allow them to
continue with contemporaneous records. A copy of the Ambulance record should
be filed in the womans hospital notes.
SECOND MIDWIFES RESPONSIBILITIES

Record times and provide support to midwife in charge.
If second midwife not present for any reason, ask partner to write times on piece of
paper as an aide memoire.
Paramedics may be summoned for delivery of baby if second midwife has not
arrived.

WAHT-OBS-057
THIRD STAGE OF LABOUR

Physiological, or expectant management, of the third stage of labour involves the placenta
and membranes delivering spontaneously. Active management involves administration of
an oxytocic drug, clamping and cutting of the cord (after 2 minutes, as per delayed cord
clamping guideline), and controlled cord traction.
The woman should be offered all information regarding each method in order to make a
choice regarding management of the third stage of labour. This discussion should
preferably take place in the antenatal period and the womans wishes recorded on the
birth plan in her hand-held notes and documented in her records.
Active management is suitable for woman with complicated pregnancies/ labours or those
at higher risk of postpartum haemorrhage (PPH). It has been found to reduce the
incidence of PPH.
Physiological management of third stage of labour

An oxytocic drug is not given.
The cord is not clamped and cut, thus enabling the baby to receive its full quota of blood
and prevent counter-resistance of placental blood flow. It is clamped and cut either once it
has stopped pulsating or after the placenta is expelled, depending on the womans wishes.
The baby can be encouraged to breastfeed if the woman wishes in order to stimulate the
production of oxytocin, thereby further supporting the physiological processes. The
average length of time for a physiological third stage is 15 minutes.
The woman will experience a contraction and the birth attendant can be guided by the
womans urge to push. The placenta and membranes are then expelled by maternal
effort. The woman can be encouraged into an upright position to assist this process. The
cord is then clamped and cut. Offer the woman and her partner the opportunity to observe
the placenta and membranes.
N. B. The midwife should not undertake controlled cord traction at any stage.
If haemorrhage does occur, proceed as for active management of the third stage having
previously discussed this with the woman and obtained her consent.
Active management of third stage of labour

An oxytocic drug is given intramuscularly following the birth of the baby.
Wait two minutes and then the cord is clamped and cut. Place the non-dominant hand
over the fundus and await a contraction, keeping the hand still. Mismanagement of the
third stage can disrupt myometrial activity and result in only partial separation of the
placenta and subsequent excessive bleeding.
Once well contracted, the uterus is guarded with one hand whilst controlled cord traction
is applied with the other hand, and the placenta and membranes are gently delivered. In
the event of the cord breaking, traction should cease and maternal effort encouraged to
complete delivery of the placenta.

WAHT-OBS-057
FOLLOWING EXPULSION OF PLACENTA AND MEMBRANES BY EITHER METHOD

The time is noted and documented.
The uterus is checked to ensure that it is well contracted.
The blood loss is estimated.
The genital tract is checked for trauma.
The woman is made comfortable.
Offensive waste should be placed in a Tiger Bag . The placenta placed in placental pot for
transfer to hospital for disposal unless woman wishes to keep her placenta. Explain if burying
placenta it must be at least three feet deep. Document in the notes re disposal of placenta if not
brought into hospital.
POST-NATAL CARE
Inform delivery suite following delivery that all is well.
Relevant records must be completed. Complete Home Birth Register at earliest
opportunity.
Notify birth and obtain NN4B, and complete Bluespier MIS.
The midwife should remain at the home for a minimum of 1 hour following delivery.
Ensure on leaving that all relevant contact numbers are given, complete postnatal check
including observations
Check to see if she has passed urine, if not call her in 12 hours time to recheck (see
guideline for Intrapartum and postpartum bladder care WAHT-OBS-094) measure and
document first void.
GP should be informed of delivery during office hours. Arrange for neonatal examination to
be performed.
Further postnatal care will be arranged according to the womans needs.
WOMEN REQUESTING HOME BIRTH AGAINST ADVICE

An individualised action plan should be drawn up in conjunction with the Supervisor of Midwives
and relevant Medical staff.
If the woman is assessed as being high risk she should be treated appropriately with the
support of a Supervisor of Midwives. Each woman is treated as an individual and makes her
own choices based on the evidence and information she is given and her own preferences.
Refer to Consultant in Antenatal Clinic. The consultant should record in the management
plan against advice
Inform Supervisor of Midwives Supervisor to visit woman at home and discuss issues.
Develop an action plan with the Community Midwifery Team.
In Labour
If the woman declines to accept your advice, continue to give care in labour after you have
informed the delivery suite Co-ordinator and the Supervisor of Midwives on call.
Record your advice and actions in the notes contemporaneously.
Inform Ambulance Control of situation.
Inform GP as appropriate. The midwife should note, however, that she can call upon
any General Practitioner on the Family Practitioner Committee list and practising in the
area for help in an obstetric emergency, and he is required to attend whether or not the

WAHT-OBS-057
patient is on his NHS list, and whether or not the doctor is on the obstetric list. Ref: The
NHS General Medical Services Regulations 1992 GP Terms of Service Schedule 2:4
(n).
BABIES BORN BEFORE ARRIVAL of healthcare professional (BBA) and

unplanned homebirth
In the event of a BBA or an unplanned homebirth, where the woman is unbooked

or unknown to healthcare professionals, transfer to hospital is required. As soon
as possible and , importantly, prior to discharge, ensure that there are no
safeguarding issues by contacting childrens services.
The checks should be undertaken in all cases where;
o There is no record of access by the woman to a programme of routine

antenatal care
o All cases of undisclosed/unknown pregnancy
o All births that have not been booked by a midwife in Worcestershire
o All late bookings of 30 weeks and above gestation
o All cases of no fixed abode
o All cases of women residing in a refuge
o All movements into the area
Appropriate action should be taken where safeguarding concerns are raised, with
reference to the Trusts safeguarding children policy (WAHT-CG-455).
Telephone handover to the community midwifery team to notify them of the discharge
should then take place, advising the outcome of the communication with childrens
services.

WAHT-OBS-057
MONITORING TOOL
How will monitoring be carried out? Audit of records
Who will monitor compliance with the guideline? Community Midwives Forum /
Obstetric Governance Committee
STANDARDS % CLINICAL EXCEPTIONS

Completion of Homebirth Checklist 100%

WAHT-OBS-057
REFERENCES
Albers, L, Anderson.D, Cragin.E et al (1997) The relationship of ambulation in labour to

operative delivery. Journal of Nurse Midwifery Vol 42, p4-8.
Anderson (2005) Normal Birth Conference. Grange-over-Sands.
British National Formulary (BNF) (2001). British National Formulary. London: British Medical
Association and Royal Pharmaceutical Society of Great Britain.
Brocklehurst P. et al, Perinatal and maternal outcomes by planned place of birth for healthy
women with low risk pregnancies: the Birthplace in England national prospective cohort study
BMJ 2011;343: bmj.d7400.
DOH (2007) Maternity Matters. www.doh.gov.uk
Enkin M., Keirse M., Neilson J., Crowther C., Duley L., Hodnett E., Hofmeyr J. (1995) A Guide
to Effective Care in Pregnancy and Childbirth. Oxford: Oxford University Press.
Prendiville W.J., Elbourne D., McDonald S. (2004) Active versus expectant management in the
third stage of labour (Cochrane Review). The Cochrane Library, Issue 3, 2004. Chichester, UK:
John Wiley & Sons, Ltd.
Rogers J., Wood J., McCandlish R., Ayers S., Truesdale A., Elbourne D. (1998). Active versus
expectant management of third stage of labour: the Hinchingbrooke randomised controlled trial.
The Lancet; vol 351, no 9104, pp. 693 99.
Elbourne D.R., Prendiville W.J., Carroli G., Wood J., McDonald S. (2004). Prophylactic use of
oxytocin in the third stage of labour (Cochrane Review). The Cochrane Library, Issue 3, 2004.
Chichester, UK: John Wiley & Sons, Ltd.
Harris T. (2001). Changing the focus for the third stage of labour. British Journal of Midwifery;
vol 9, no 1, pp 7 11.
Wattis L. (2004) The third stage maze: which practice pathway for optimum outcomes? In:
Wickham S. (2004) Midwifery: Best Practice 2. London: Books for Midwives.
Long L. (2003) Defining third stage of labour care and discussing optimal practice. MIDIRS
Midwifery Digest; vol 13, no 3, pp 366 370.
Kierse M. (1998). What does prevent postpartum haemorrhage? The Lancet; vol 351, no 9104,
pp 690
NICE (2007) Intra-partum guideline. www.nice.org.uk
NICE (2008) Antenatal Care : Routine care of the Healthy Woman CG62, revised guideline
March 2008 www.nice.org.uk
NMC (2010) Midwives Rules and Standards. www.nmc-uk.org

WAHT-OBS-057
APPENDIX A HOME BIRTH CHECKLIST

Please attach patient sticker here or record:
Name:...
NHS No:
Unit No:
D.O.B: ../../... Female
Address:
Postcode:..
DISCUSSION FOR PLANNED HOMEBIRTH

Tick once
Women should be informed that:
discussed
A planned homebirth in uncomplicated pregnancies is associated with an increased likelihood of
spontaneous vaginal birth (NICE 2007).
Women who give birth at home have reduced morbidity compared to those giving birth in an
obstetric unit, for example, less likelihood of contracting hospital acquired infections (NICE
2004).
Women who give birth at home are less likely to have an episiotomy and more likely to have an
intact perineum, compared with low risk women who birth in an obstetric unit (NICE 2007).
Low-risk women, irrespective of parity, have much shorter labours at home. This is due to a
combination of factors, such as:
her ability to adopt positions favourable to facilitating normal birth (Albers et al 1997)
control over the birth environment,
more relaxed, which produces higher levels of oxytocin (Anderson 2005)
continuous labour support from her family and her midwife (Midirs 2004)
The evidence relating to place of birth currently lacks quality, especially in relation to perinatal
mortality, between planned home birth for low risk women and birth in an obstetric unit (NICE
2007).
Studies have suggested that intra-partum perinatal mortality is similar or may be slightly higher
in babies born at home.
This, however, may be related to women who have developed high risk labours and have been
included in the statistics despite appropriate transfer, or high-risk women who have had an
unplanned home confinement (NICE 2007)
The most recent study undertaken in 2011 provided the following evidence:
Perinatal and maternal outcomes by planned place of birth for healthy women with low risk
pregnancies 2011. The results support a policy of offering healthy women with low risk
pregnancies a choice of birth setting. Women planning birth in a midwifery unit and multiparous
women planning birth at home experience fewer interventions than those planning birth in an
obstetric unit with no impact on perinatal outcomes. For nulliparous women, planned home
births also have fewer interventions but have poorer perinatal outcomes.
Evidence shows that between 4% and 20% of labouring women will transfer to an obstetric unit
(primips 30-55%; multips 1-15%) (NICE 2007).
Local transfer rates are currently 17%

WAHT-OBS-057
Tick once
Women should be informed that:
discussed
When maternal or fetal complications arise at home during labour, emergency medical care may
be delayed due to the time needed to transfer to the consultant unit.
Midwives are experts in normal childbirth and trained to an exceptionally high level. The care
provided at home is governed by the trusts protocols in exactly the same way as in hospital.
Two midwives are always called to attend the birth. Midwives are highly skilled in recognising
when labour deviates from normal and transfer should this occur as soon as this is recognised.
There is evidence showing that women who opt for a home confinement report a positive birth
experience (NICE 2007), which is likely to contribute to improved psychological well-being in the
postpartum period.
Women are less likely to use pharmacological pain relief if having a homebirth. Please
document womans choice of pain relief in her Birth Plan/handheld notes.
If the woman declines ultrasound scan; discuss the implications of not knowing placental site
and number of fetuses.
Make aware that the eligibility criteria for planned homebirth is between 37 weeks and 41+5
weeks gestation (12 days post dates).
Discuss reasons for transfer to consultant care:
Raised BP/Pre-eclampsia
Prolonged spontaneous rupture of membranes over 18 hours if not in established labour
Failure to progress during labour - explain more relaxed at home so this is less likely.
APH/PPH - reduced incidence of PPH due to shorter labour at home.
Cord prolapse
Fetal compromise - less intervention that can cause fetal distress at home.
Maternal/Neonatal Resuscitation - babies born at home tend to have higher apgar scores
than those born in hospital.
Shoulder Dystocia - associated with semi-recumbent position and lack of mobilisation,
which is more common in hospital.
If drugs prescribed by GP, they should be collected in plenty of time (by 37 weeks)
Discussion of what is needed for mum and baby.

Ensure she is aware of how to contact midwife.
Tick once
Other Checks
discussed
Health and Safety and risk assessment carried out
Is house easily accessible for ambulance
Adequate lighting e.g. torch available, lamp for suturing if necessary.
If only mobile phone available, ensure signal at location.
Ensure protective covering available for birth.
Ensure childcare arrangements are in place in case of having to transfer to hospital in labour.
Signed: Date:
Designation:
To be filed with the Antenatal Pregnancy Health Record.

WAHT-OBS-057
APPENDIX B
NOTIFICATION OF HOME BIRTH TO

MIDWFERY MANAGER/SUPERVISOR OF MIDWIVES
Patients Name: .
Hospital No
NHS No
Address: ...
Telephone No: ..
(including local code)
Please attach directions to address to the back of this form in all instances.
E.D.D.: .. Gravida:
Named Midwife: ....
GP: ..
AGAINST MIDWIFERY/MEDICAL ADVICE: YES NO
REASON:
NAME: ..
SIGNED: ..
Please also notify the Supervisor of Midwives:
1) When the booking has been transferred to Hospital, Antenatally or when delivered.
2) The Supervisor of Midwives should be informed of any problems encountered, antenatally

or during delivery

WAHT-OBS-057
APPENDIX C
ENTONOX
Information about:
NITROUS OXIDE/OXYGEN (Entonox) cylinders that are left at your home prior to your
planned home delivery.
At this time, we will assist you in storing it safely. The points you need to bear in mind are:
Check Household Insurance covers you to store Entonox at home.
Storage
Store cylinders lying on the side.
Cylinders should be under cover, preferably inside and not subjected to extremes of
heat.
To be kept dry, clean and well ventilated (both top and bottom).
Be sited away from any sources of heat or ignition.
Smoking and naked lights prohibited within the vicinity of the cylinder.
Entonox cylinders to be stored at above 10oC for 24 hours prior to use.
It may be necessary to store 2-3 small cylinders of Oxygen/Entonox at your house for a period
of about one month. You are advised to inform your house buildings and contents insurers of
this situation as it is a material fact which could affect the cover provided under your policies.
Worcestershire Acute Hospitals NHS Trust will cover any legal liability for bodily injury to third
parties (or its own staff) or any damage caused by negligence of Trust staff.
Handling
Precautions
Cylinders should be handled with care, never knocked violently.
Cylinders are heavy.
Do not attempt to use without the supervision of your Midwife.
In the event of fire

As soon as a fire is discovered, notify the Fire Service, warning them of the presence of
compressed gas cylinders.
Unless you are trained in the use of fire extinguishers or fire hoses, do not attempt to
fight a fire.
Do not take any undue risks.

If you are concerned, contact Ambulance Control and ask for your duty Midwife.

WAHT-OBS-057
CONTRIBUTION LIST
Key individuals involved in developing this document

Name Designation
Helen Walker Community Midwife Kidderminster
Tracey Cooper Consultant Midwife/Supervisor of Midwives
Barbara Kavanagh Midwife Team Leader Redditch Community
Alison Tilley Midwife Team Leader Worcester Community Midwives
Sue Castle Midwife Team Leader Bromsgrove Community
Yvonne Cowling Community Midwife Malvern
Circulated to the following individuals for comments
Name Designation
Margaret Stewart Matron Community
Alison Talbot Matron IP Services Alexandra Hospital
Rachel Carter Matron IP Services WRH
Karen Kokoska Maternity Risk Manager
Patti Paine Head of Midwifery
Members of MGDG (For consultation with their peers)
J A Barratt Clinical Midwife Specialist
T Cooper Consultant Midwife/Supervisor of Midwives
M Byrne Midwife, Alexandra Hospital
H Doherty Community Midwife, Bromsgrove-Redditch Team
J S Farmer Midwife, Antenatal Clinic, WRH
C Parry Community Midwife, Evesham Team
J Martin Midwife, Alexandra Hospital
T Meredy Midwife, Antenatal Clinic, Alexandra Hospital
R Rees Audit & Training Midwife/WRH representative
G Robinson Community Midwife, Worcester Team
H Walker Community Midwife, Kidderminster
L Thomas Midwife, Alexandra Hospital
V Tristram Midwife, Kidderminster Hospital/Supervisor of Midwives
J Voyce Community Midwife, Malvern Team
R Williams Midwife, WRH
Rosie Fletcher Lead Pharmacist Medicines Information and Maternity

WAHT-OBS-057
Supporting Document 1 Checklist for review and approval of key documents

This checklist is designed to be completed whilst a key document is being developed /
reviewed.
A completed checklist will need to be returned with the document before it can be published on
the intranet.
For documents that are being reviewed and reissued without change, this checklist will still need
to be completed, to ensure that the document is in the correct format, has any new
documentation included.
1 Type of document Guideline

2 Title of document Home Birth guideline
3 Is this a new document? Yes No
If no, what is the reference number WAHT-OBS-057
4 For existing documents, have you Yes No
included and completed the key
amendments box?
5 Owning department Obstetrics
6 Clinical lead/s Mrs Margaret Stewart
7 Pharmacist name (required if
medication is involved)
8 Has all mandatory content been Yes No
included (see relevant document
template)
9 If this is a new document have Yes No
properly completed Equality
Impact and Financial N/A
Assessments been included?
10 Please describe the consultation Discussion with Community Midwife Team Leaders
that has been carried out for this and circulation to members of the Obstetric
document Governance Committees
11 Please state how you want the Home Birth guideline
title of this document to appear on
the intranet, for search purposes
and which specialty this document
relates to.
Once the document has been developed and is ready for approval, send to the Clinical
Governance Department, along with this partially completed checklist, for them to check format,
mandatory content etc. Once checked, the document and checklist will be submitted to relevant
committee for approval.

WAHT-OBS-057
Implementation
Briefly describe the steps that will be taken to ensure that this key document is implemented
Action Person responsible Timescale

Information included in Effective Handover Miss Rachel Duckett November 2012
Plan for dissemination
Disseminated to Date
Medical and midwifery staff via Effective Handover November 2012
Community Midwife teams via Community meetings November 2012
Step 1 To be completed by
Clinical Governance
1 Department
Is the document in the correct Yes No
format?
Has all mandatory content been Yes No

included?
Date form returned

____/____/________
2 Name of the approving body Obstetric Governance Committee
(person or committee/s)
Step 2 To be completed by Committee Chair/ Accountable Director
3 Approved by (Name of Chair/ Miss Rabia Imtiaz
Accountable Director):
4 Approval date 16 November 2012
Please return an electronic version of the approved document and completed checklist to the
Clinical Governance Department, and ensure that a copy of the committee minutes is also
provided (or approval email from accountable director in the case of minor amendments).
Office use only Reference Number Date form received Date document Version No.
published


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WAHT-OBS-057

HOME BIRTH GUIDELINE (including information re.

THIS GUIDELINE IS FOR USE BY THE FOLLOWING STAFF GROUPS:

Home birth guideline

Key amendments to this guideline

Home birth guideline

Give homebirth leaflet (Appendix C).

Antenatal care is followed as midwifery led care (guideline A2 WAHT-OBS-071)

At 36-37 weeks of pregnancy refer to checklist (Appendix A) again ensuring the

Choice of analgesia to be discussed. (Appendix A).

Home birth guideline

At planned home delivery, neonatal and adult resuscitation equipment must be

Mother and Baby Identification bands to be completed prior to delivery if time

Care in labour should be in accordance with:

Delivery Suite Co-ordinator to be informed if there is any deviation from normal.

SECOND MIDWIFES RESPONSIBILITIES

Home birth guideline

THIRD STAGE OF LABOUR

Physiological management of third stage of labour

Active management of third stage of labour

Home birth guideline

FOLLOWING EXPULSION OF PLACENTA AND MEMBRANES BY EITHER METHOD