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Home Birth

Dr. Panagiotis Polyzos, obstetrician gynecologist in Athens
Dr. Panagiotis Polyzos MD PhD MSc

Obstetrician-Gynecologist
PhD, University of Athens Medical School

Obstetrician-gynecologist Panagiotis Polyzos practices at the Institute of Life, the IVF Unit of IASO Maternity Hospital.

Gynecology services by Dr. Polyzos

Contents

Home birth with medical support

Home Birth

Know the pros and cons

Are you wondering whether a planned home birth is right for you?

Get the facts about the potential risks and how to prepare for the big day.

If you’re considering a planned home birth, you probably have questions:

  • Is it safe?
  • Will you need a midwife?
  • How do you create a backup plan?

 

Learn what it involves and how to decide whether this method of childbirth is right for you.

Why do women choose planned home births?

If you give birth at home, the management of labor may differ from what you would experience in a hospital setting.

During a home birth, your healthcare provider will monitor your temperature, pulse, blood pressure, and your baby’s heart rate periodically, rather than continuously.

You may choose a planned home birth for many reasons, including:

  • A desire to give birth without medical interventions such as pain medication, labor induction, or continuous fetal heart rate monitoring
  • A wish to give birth in a comfortable, familiar place surrounded by family
  • Dissatisfaction with hospital care
  • A desire for freedom and control during the childbirth process
  • Cultural or religious concerns
  • Lack of access to transportation
  • Lower cost
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What might require transfer to a hospital?

During a planned home birth, you may need to be transferred to a hospital for monitoring or treatment if complications develop. Your healthcare provider may recommend hospital transfer if:

  • Labor is not progressing
  • Your baby shows signs of fetal distress
  • Your baby is not in a head-down (cephalic) position
  • You need pain relief
  • You have high blood pressure
  • You experience bleeding
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What are the potential risks of a planned home birth?

While most pregnant women who choose planned home births deliver without complications, research suggests that planned home births are associated with a higher risk of infant death and seizures compared with planned hospital births. Several factors may reduce the risks of these complications, including:

  • Assistance from a certified nurse-midwife
  • Access to a practicing obstetrician
  • An emergency transfer plan to the nearest hospital

How do I prepare for a home birth?

You can prepare for a planned home birth by:

  • Choosing trained healthcare providers. Select a certified midwife, a midwife whose training meets specific standards, or a doctor who practices obstetrics within an integrated and regulated healthcare system.
  • Ensuring access to consultation. Make sure your provider has access to consultations with doctors or specialists at a collaborating hospital.

Create a birth plan

  • Will you use specific methods to manage pain? Do you want a water birth in a tub?
  • Will you breastfeed your baby immediately after birth?

Discuss your birth plan with your healthcare provider and ask about supplies you may need, such as protective coverings for your floor or mattress.

Prepare for hospital transfer

Talk with your healthcare provider about the signs and symptoms that may require going to the hospital and how a transfer would affect your birth plan.

Ideally, your home or other planned birth location should be within 15 minutes of a hospital with 24-hour maternity care.

Make sure you have access to transportation

Ask your healthcare provider to make arrangements with a nearby hospital to ensure that you can be transferred immediately and receive treatment if necessary.

Hospitals or certified birth centers are the safest facilities for childbirth. However, you have the right to make an informed decision about your preference.

Keep in mind that life-threatening problems can occur during labor without warning.

In such cases, the need to transfer you and your baby to a hospital could delay care, potentially putting your life at risk.

Understand the risks and benefits of a home birth before deciding where your baby will be born.

Which pregnancies are suitable for a home birth

A home birth is considered only when the pregnancy is low risk from start to finish. The assessment is not done just once. It is repeated at every visit, because a pregnancy that started out simple can change in the third trimester.

Key criteria

  • A single baby, in a head-down position.
  • Labor that starts on its own between 37 and 42 weeks.
  • No previous cesarean section or other surgery on the uterus.
  • Normal blood pressure, with no high blood pressure in pregnancy or preeclampsia.
  • No pre-existing diabetes or gestational diabetes that requires medication.
  • Normal placental position and normal fetal growth.
  • No serious chronic illness (heart disease, thrombophilia requiring treatment, epilepsy) and no significant obesity.

When the plan changes

Even with all criteria met, the birth is moved to the maternity hospital if your waters break and labor does not start within about 24 hours, if the amniotic fluid is green or brown, if the pregnancy goes beyond 42 weeks, or if there is bleeding before contractions. These limits must be written into the birth plan before the big day.

What large studies show about home birth

The best-known study, Birthplace in England, followed tens of thousands of low-risk women. The findings differ greatly depending on whether the woman is giving birth for the first time.

  • First birth: a planned home birth was associated with about double the risk of a serious complication for the newborn compared with a maternity hospital. In absolute numbers the risk remains low, but the difference is real. In addition, almost half of first-time mothers needed transfer to a hospital during labor or right after.
  • Second or later birth: no significant difference was found for the newborn, and transfers were far fewer, about one in ten.
  • For the mother: fewer interventions, such as epidurals, assisted delivery and cesarean sections.

These results come from systems where home birth is organized: certified midwives, defined criteria, fast access to an ambulance and a partner maternity hospital. In Greece, home birth is rare and there is no equivalent unified network. This means that safety depends almost entirely on the team you choose and on how close you are to a maternity hospital.

Danger signs: when to call an ambulance right away

Some complications cannot wait. In these cases, call the EKAB ambulance service at 166 or 112 right away, even if the midwife is already with you, to save time.

  • Heavy vaginal bleeding before, during or after the birth. After delivery, bleeding that soaks a pad in less than an hour, or large clots.
  • Umbilical cord prolapse: if you see or feel the cord in the vagina, get onto your knees and elbows with your bottom raised until help arrives.
  • Green or brown amniotic fluid or fluid with an unpleasant smell.
  • A fever of 38°C or higher during labor.
  • Severe headache, blurred vision or seizures, which may mean preeclampsia or eclampsia.
  • Constant, hard abdominal pain with no breaks between contractions.
  • The placenta does not come out within the time agreed with the midwife.
  • The newborn is not breathing normally, is bluish, limp or unresponsive.

Before labor, reduced fetal movement is also a reason for an immediate check at a maternity hospital, not for waiting at home.

Practical checklist for preparing your home

The midwife brings the medical equipment: a fetal heart monitor, suturing materials, medication for bleeding, oxygen and newborn resuscitation equipment. You prepare the space, ideally from 36 weeks.

  • A warm room, at a temperature where a newborn will not get cold.
  • Good lighting, even if portable, for the moment of birth and for checking the perineum.
  • A waterproof cover for the mattress and floor, plenty of towels, and sheets that can get dirty.
  • Garbage bags and a basin.
  • Clothes, a little hat and a blanket for the baby, and postpartum pads for you.
  • A charged phone, with the phone numbers of the midwife, the obstetrician and the maternity hospital written down.
  • Clear access for a stretcher and an ambulance: an unlocked entrance and no obstacles on the stairs.
  • A packed bag and a folder with your pregnancy record, your blood type and the results of your prenatal care, in case of transfer.

Also arrange a support person who will have no other role: to look after older children, open the door and drive if needed.

The first hours after a home birth

The team's work does not end when the baby is born. The first two hours are the most critical for the mother's bleeding and for the newborn's adjustment.

For the mother

  • Delivery of the placenta and a check that it is complete.
  • Monitoring of bleeding and uterine tone at regular intervals.
  • Examination of the perineum and suturing of any tears. Tears involving the anal sphincter need repair in a hospital.
  • Blood pressure, pulse and temperature checks.

For the newborn

  • Skin-to-skin contact and keeping the baby warm.
  • Assessment of breathing and color.
  • Vitamin K, if you agree.
  • A full physical exam by a pediatrician within the first 72 hours, a hearing screening and the newborn heel-prick blood test.

The first hour is also the ideal time to start breastfeeding. The midwife should visit your home again in the following days to check on the mother, jaundice and the baby's weight.

Alternatives for a less medicalized birth in the maternity hospital

Many women consider a home birth because they fear a labor with many interventions. Much of that experience can also be achieved in the maternity hospital, with a safety net right next to you.

  • A written birth plan that you discuss with your obstetrician early on.
  • Intermittent listening to the fetal heart instead of continuous cardiotocography, when the pregnancy is low risk.
  • Freedom to move and upright positions during contractions.
  • Using water for pain relief, where a birthing tub is available.
  • Delayed cord clamping and skin-to-skin contact right after birth.
  • Mild pain relief or an epidural only if you ask for it.

Have this conversation with your gynecologist in Athens or the obstetrician who is following your pregnancy. Most of these options are fully compatible with safety, and deciding where to give birth becomes easier once you know what the maternity hospital can offer you.

Questions to ask the midwife before you commit

The quality of the team is the most important safety factor in a home birth. Do not hesitate to ask directly and to request written answers.

  • What is your training, and do you hold a license to practice?
  • How many home births have you attended, and how many ended in a transfer?
  • Will there be a second trained midwife at the moment of birth?
  • What equipment do you bring for postpartum hemorrhage and newborn resuscitation? Have you had recent resuscitation training?
  • Which maternity hospital and which obstetrician do you work with? Will they have my file before the birth?
  • What are the specific criteria you will use to decide on a transfer?
  • How many visits do you make after the birth, and when?

If any answer is vague, or if there is no partnership with a maternity hospital, that is a serious warning sign. Proper planning does not diminish the birth experience. It protects it.

Read also

Frequently Asked Questions

Is home birth safe?

In low-risk pregnancies, with a trained team and the option of a fast transfer to a maternity hospital, the risks are small. For a first birth, they are slightly higher for the newborn than in a maternity hospital.

Those with a previous cesarean section, a twin pregnancy, a breech presentation, preeclampsia, diabetes, preterm labor or another high-risk factor.

The team arranges an immediate transfer to the maternity hospital. That’s why the transfer plan is agreed before labor.

An epidural is not possible. Non-drug methods are used, such as water, movement, breathing and massage.

A planned home birth applies only to labors that start on their own between 37 and 42 weeks. If contractions start earlier, it is preterm labor and going to the maternity hospital is mandatory.

Call 166. Lie on your side or stay on your knees on a clean, warm surface. Do not pull the baby; let it come out with the contractions. After the birth, dry the baby, place it on your chest and cover you both. Do not cut the umbilical cord and do not pull on the placenta.

Staying in warm water during the first stage of labor reduces pain and the need for an epidural. The data on giving birth in water are more limited. It requires the right temperature, cleanliness and an experienced midwife, and it is ruled out when there is fever, bleeding or green amniotic fluid.

Yes, exactly as in a maternity hospital: a physical exam by a pediatrician in the first days, a hearing test, the newborn heel-prick blood test, monitoring for jaundice and weighing. Arrange a pediatrician before the birth.

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