Home Birth And Your Legal Rights. How To Have A Natural Birth

Alicia pretending to be pregnant

Can I refuse An Episiotomy or other procedure?

Yes! Most doctors say you should state in a birth plan if you don't want an episiotomy, but doctors usually try to get you to change what you have written if you have a birth plan. They also say 'unless there is an emergency, then we will do one anyway'.

What they don't tell you is, you have an ABSOLUTE RIGHT to refuse and if you withhold consent, legally they cannot perform one. This applies to all other maternity procedures too.

You are not even compelled to have a caesarean if you don't want one. This is because the human rights we have as defined by law do not include unborn babies.
In the landmark case of St George's Healthcare NHS Trust v S in 1998, the Court of Appeal reiterated that fetuses are not legal persons and found that a court-ordered C-section on a detained mental patient (unlawfully detained at that) was unlawful. The lady who had a court ordered C section was offered compensation for her ordeal.

While I personally do not agree with abortion and think that reasonable care should be provided for the unborn baby, I don't believe that unborn babies should have rights. Why?

If that was the case, a woman would be compelled to undergo medical procedures which may endanger her health long term or even kill her, for the benefit of another human and this would mean that pregnant women would have less rights than any other member of society, including non-pregnant women, men and children.

If this is the stance that society would take, where would it end? Would people be compelled to give organs away because someone needed a kidney transplant to live?

Any mother wants the best for her child, but in order to be a good mother you have to be a happy mother and a healthy mother and if you don't want a procedure, or you know there is ample evidence that it is harmful, like with episiotomy, then you have a right to protect your own body as an individual.

What If There Is An Emergency?

The main reasons for episiotomies are cited to be to prevent tearing but this is nonsensical because nearly every study written shows that the pain of an episiotomy is worse than a tear, takes longer to heal than a tear and is associated with significant complications and even death.

In contrast, I had a tear with my second child and this didn't cause me pain. I was up walking around within a few hours of birth.

Other reasons include worrying that the baby will be brain damaged by its head hitting the perineum or being too big to be born. This is ridiculous as the vagina is designed to give birth to a baby. A baby is supposed to be born that way and is not going to get brain damage from hitting its head.

Very rarely, especially in first births, the mother might have difficulty in delivering the head but this is usually due to the hospital protocol of having her lie on a bed. Gravity helps solve this. Ventouse suction can also be used to assist without needing to cut the vagina.

If the baby is in severe difficulty and you absolutely don't want an episiotomy, you can request a caesarean. Although this is still painful, it is not female genital mutilation and is not associated with sexual problems in the same way.

Aren't Internal Exams Required For The Baby's Safety?

No. Internals are purely to check how far the cervix is dilated. The standard hospital model for birth is 1cm dilation per hour, with on average 12 hours *allowed* for a first birth without intervention. Dilation can vary enormously and is not an accurate indicator of how the labour is going.

For instance, in my third labour I was told I was 8cm dilated and they said I wouldn't have the baby for another 2 or 3 hours. However, my waters broke half an hour later and suddenly I was fully dilated and the baby was born. With my fourth I dilated 0 to 10 in 25 minutes. I personally believe it is a worthless examination and cannot predict how the baby is.
If you consent to exams, then they may try to give you drugs to speed things up if you aren't following their pattern, which puts you and your baby at risk of complications.
If you want to know how your baby is, listen to his heart beat!

You have an ABSOLUTE right to refuse exams, and to get your point across you can write 'I do not wish to have internal exams. If you do so without my permission I will see this as a sexual assault.'

Over-zealous midwives and doctors backed off me immediately when I stated this.

What If I'm Not Allowed A Home Birth?

You are allowed to give birth to your baby wherever you like. If you are told you need permission, they are lying.

If the NHS tells you they haven't got enough midwives, tell them they have to come out to you when you are in labour, as they are legally required to do so if you call them.

Do I Have To Have A Midwife?

No. There is no legal requirement for a medical attendant at your birth. No woman can be prosecuted for giving birth to her baby.

It is also legal for your husband or partner to be present. What is illegal is if he tried to do something medical, like performing internal exams on you, because then he could be charged with practicing as a midwife without a licence.
If he is there purely as an emotional support, he is not breaking the law.

Jacqui Smith MP, Minister of State, Department of Health, wrote to Julia Drown MP on the 23rd September, 2002 stating:

'Attending a woman in childbirth, as opposed to general support given by partners and relatives, has been an offence against the protected function of midwifery since the Midwives Act 1902 and the fines are set at a level to reflect the seriousness of the offence. By 'attend' we mean, 'assume responsibility for care' and this is not intended to outlaw husbands, partners and relatives whose presence and support during childbirth are extremely important'.

How Can I Monitor My Baby's Wellbeing Without Internal Exams?

How your labour is progressing is a good indication of how your baby is. If you are having contractions which are increasing in regularity and strength, and you don't have any unexplained pain in between times, then this is a good sign things are going to plan.

You can also:

1. Listen to your baby's heart beat. There are doppler's available that you can buy online and from home birth stores.

2. You can take your own blood pressure using a blood pressure monitor which can be bought from most large chemists. It's important YOU do this and not your husband, so you stay within the law.

3. Some women like to check themselves internally to estimate how dilated they are or if they can feel the baby's head. Personally I wouldn't do this because I think that dilation is misleading, based on the hospital model of having to dilate 1cm an hour and it does not have anything to do with the safety of the baby.

Warning Signs In Labour

If you have any of these symptoms, it is a sign that you may need to seek medical help:

1. You don't feel the baby moving, or he is moving much less, or you can't hear him on the doppler.

2. Your waters have broken and they are a green or brown colour. This means the baby has had a bowel movement inside you and is a sign that he is in distress.

3. Your waters have broken but your contractions have stopped for a long time and not re-started.

4. You suffer unexplained pain inbetween contractions (particularly if you've had a caesarean in the past).

5. You think you have lost an excessive amount of blood, you feel faint, feverish, have a low blood pressure, or are vomiting a lot.
Vomiting in transition is NORMAL because the baby presses on the stomach, but if you keep being sick all through the labour, you might have an infection or virus.

6. If you have been pushing and appear to be stuck at the same stage in labour and want assistance.

You can also change your mind about unassisted home birth, or indeed home birth, and decide to go to hospital if you want, at any time in the labour, for instance, if you feel you are not coping with the pain and want pain relievers.

Higher Risk Groups

There are some groups of women who are at higher risk of labour complications who should research thoroughly before deciding whether or not to give birth unassisted, these are:

1. Women who have had a caesarean in the past. This is because the scar can rupture during labour and cause internal bleeding. However, this can also happen during pregnancy as the baby grows and puts pressure on the scar tissue, so the risk is from the onset of pregnancy and not just in labour.

I have known ladies who've had caesareans and then had unassisted home births safely, and in particular one lady with 8 children who had the first by caesarean after inappropriate hospital interventions. She then had her second child with a midwife at home, the third child with a doula at home and all the other 5 by unassisted home birth. So it CAN be done but I would advise EXTENSIVE reading to anyone considering it so you are aware of what to do in an emergency.

Personally, if I had had a caesarean, I would be very happy to have a home birth but I would probably hire an independent midwife. (Most NHS midwives aren't experienced at assisting with vaginal home birth after caesarean because of the policy of asking women to labour in hospital after a previous caesarean).

2. If you have a low-lying placenta, there is a risk of it detaching first and the cord coming down before the baby, cutting off the baby's air supply (cord pro-lapse). You can also bleed heavily with this condition. I would still have a home birth if I had this, but I would choose a midwife. If there are any mums out there who had low lying placenta and had an unassisted home birth, I would be happy to include your tips on this page.

I myself have had a successful unassisted home birth and a successful assisted home birth despite the NHS saying I was 'high risk' (because I have cerebral palsy, I have had several children and I was 'underweight' - I actually wasn't under weight for me. I weigh 7 stone when not pregnant and wear size 8 women's clothes and 'petite' jeans and when 3 months pregnant last time I weighed 7 and a half stone which was great because it meant I'd put on half a stone in 3 months - but I didn't fit in with NHS protocol about what is normal).

So if you are in a higher risk group, don't worry, you can still have a home birth, you might just need to do a bit more reading and be prepared to be strong against medical staff who may not agree with you.

What About Pain In Labour? How Can I Cope?

I've had 5 children and I have found 2 of the labours painful (they were both in hospital) and 3 not painful. In fact, my fourth daughter's birth was painless other than gastrointestinal symptoms, so it needn't be the screaming agony you see on TV.

Beginning of Labour

This starts usually with backache or period like pain or an stomach upset.

Sometimes your water can break first before any other symptoms happen.

Sometimes it starts with a feeling of sickness. I thought my daughter Alicia was food poisoning!

You might also pass a blood stained mucus, which is the plug that holds the cervix closed. This is called a 'show'.

Middle of Labour

The period like pains get more regular or stronger.

For me, my contractions have always been one every 2 minutes from onset of labour to the end and never changed in frequency so you may be like this too. I also did not find them get anymore painful until a few moment's before the baby's birth, so they stayed as 'period cramp' for the majority of the labour. A lot of home birth mums report this.

Birth

Before birth you'll feel massive pressure from the baby pressing on your cervix and rectum. It will feel like you need to go to the toilet urgently!(except to pass a house instead of a bowel movement). I hated this sensation, it wasn't painful, just really uncomfortable.

Imagine sitting in a car for a really long journey absolutely bursting to go for a number 2 and not being able to and this is similar to what it feels like.

The period pain changes and becomes explusive so your muscles start pushing the baby down. This happens automatically. This increases the pressure even more, so you know you either push or explode. Some women get an 'urge' to push, where they absolutely have to no matter what. I never did with any of my 5 children but I knew when to start because the pressure became too overwhealming if I didn't and pushing stops pain from happening.

You may feel sick or actually vomit because the baby's head presses on your stomach.

You might feel like giving up at the end, or that you can't do it. This is normal. My cramps changed to one long constant one at the end so I was not able to talk and went silent until after the baby was born. My focus was solely on getting the job done.

Then you might feel this burning sensation as the baby's head presses on your perinium. I didn't get this with my 4 daughters and with the 4th daughter, delivery of the head was painless (in fact, I was on the phone!). However, I did experience this burning with my son.

If you've ever had a thrush infection and then had to empty your bladder and it stings, well, it feels similar to that. It only lasts for a few moments and I personally did not find it particularly bad, so don't worry if you're panicking about it - it might not be any bother at all.

After that your baby is born and then you will continue to get cramps until the placenta is delivered, which is not usually painful.

I found the 'after-pains' quite painful as the baby acted as a cushion while I was still pregnant, and stopped my womb from contracting completely, but when he was born, there was nothing there to cushion the blow so I actually found the post-partum period painful, rather than the labour.

It often feels different for every woman so my account is probably not accurate but meant as a guide to someone worried about labour pain.

How To Ease Pain In A Home Birth

I used a TENS machine from the onset, which was BRILLIANT. You stick electrodes to your back and press a button and tiny electrical pulses are sent into your back, scrambling over the pain. You can increase the intensity as your labour progresses.

I found it masked my contractions very well and made them manageable period cramps. In moments where I wasn't wearing it, I suffered pain, so I know the TENS worked very well for me.

Some women say they don't work and others are irritated by the electrical pulses, so it's pot luck as to how you get on with it. I personally would never labour without one.

You can also use warm water to ease pain and hire a water birth pool. This has been shown to reduce pain and length of labour in a lot of women. I didn't have a water birth because you cannot use TENS with water.

You can use aromatherapy massage. I bought oils specifically for pregnant women and massaged them into my abdomen. You should check first and make sure the oils are safe for the baby, as not all are.

You can use a hot water bottle or lavender wheat bag on your back or abdomen to ease discomfort, or even hot flannels.

Moving around and changing position can ease pain. Lying on your back makes labour hurt like hell because of the pressure on your pelvis from the baby. Get up and stay upright. I found when I moved from lying down to upright, any pain I had disappeared. If you don't like being upright you can find an alternative position that's comfortable to you. Maybe lean over a birth ball. The fact remains, a lot of birth pain is purely due to poor positioning.

If you have a midwife at your birth you can also choose gas and air. It doesn't actually relieve pain but takes the edge off it and makes you feel merry like you've had too many gins. I had it with my first daughter and hated it because it distracted me from the labour and made me feel drunk and out of control.

Some women find it helpful, though, and it doesn't stay in the body so it wears off very quickly and is less likely than other drugs to affect the baby.