Unplanned home birth: what you need to know

If you hadn't planned a home birth but your labour is progressing quickly, and you don't have time to get to hospital or for your midwife to arrive, the most important thing is to stay calm. Most rapid births are straightforward but it's worth being prepared...

• Getting help
• Getting ready
• The birth
• Your baby
• The placenta
• Afterwards
• Planning ahead
• In brief

Getting ready
Grab some towels - as many as you can get your hands on - plus, if possible, a bowl or plastic bag to put the placenta in. If you can, turn up all the radiators in the room or move to a warm room. If you have time, spread a couple of large towels or newspapers on the floor. 

Take off your knickers and lie or kneel on the floor. If you can, kneel with your forearms on the floor, your head down and your bottom up. This may delay the birth and gain a bit of time for your helpers to get to you.

The birth
Try not to push. Let your body do the work. If you have to push, breathe gently as you do so. Pant as your baby's head emerges. Let it slide out in its own time. You may like to put your hand gently over your baby's head as it comes out. Your baby's head and body may be born all in one go, or there may be a short pause between contractions. Both of these are normal.

If there is time, you or your companion can feel gently around your baby's neck for the umbilical cord once the head has been born (occasionally, babies are born with the cord looped around the neck). If there is a loose loop of cord, your companion can lift it and slip it over your baby's head. If this can't be done easily, don't worry - the cord can be untangled after your baby has been born. Do not pull on the cord or try to cut it. 

Once the head is out, push with the next contraction. If somebody is with you, they can gently support your baby as he is born, but they should not pull or twist the baby's body. If you are alone, make sure your bottom is close to the floor, so your baby does not fall. If there is any delay in the birth at this stage, move into a different position (for example, onto all-fours) and push again. 

Your baby
Immediately after your baby is born, wrap him in a dry towel and rub him gently all over to dry him. Pay particular attention to his head and keep him covered throughout. This drying is really important! Even in a warm room, a wet baby may become dangerously chilled in the few minutes after birth. When your baby is dry, remove the wet towel, and keep him warm. The very best way to do this is to put him (naked) between your breasts under your clothes. If you cannot do this because the cord is too short, wrap him quickly in a couple of dry towels, taking care to cover his head, and hold him as close as you can. Ask your companion to cover you and your baby with a blanket or large towel.

Do not cut your baby's cord! There is absolutely no rush to do this. Your baby may be blue and a bit floppy when he is first born. It's a shock for him, too! Rubbing him dry, as described above, will help to stimulate his breathing. Talk to him. He knows your voice and will be comforted. He will probably take a breath within 30 seconds, cry and start breathing. His body will then become pink, although his hands and feet may stay blue for several hours or even days. 

If a minute goes by and your baby still isn't breathing, wipe any mucus away from his face and cover his mouth and nose with your mouth. Breathe into him very gently, using only the air in your cheeks. Give five little puffs and pause for a few seconds to rub his chest gently. If he still isn't breathing, give a few more little puffs. Be sure to keep the rest of his body warm and covered whilst you are doing this. 

If your baby is still not breathing, or is becoming paler and floppier, he probably needs more technical help. Ask your midwife or health visitor during pregnancy how to do chest compressions, so you will be ready to do this should the need arise.

The placenta
Your placenta will come when it is ready - any time within five minutes and an hour. You will probably have a midwife, doctor or ambulance crew with you by the time it is delivered. If you are still alone, try to forget about the placenta until your womb starts contracting again and you feel your placenta moving down into your vagina. Kneel upright or squat and it will slide out by itself. Do not pull on the cord. 

You may lose a cupful or so of blood when the placenta is delivered. This bleeding should soon stop. Feeding your baby or gently rubbing your nipples for 5-10 minutes will help your womb clamp down and slow the blood loss. If you can, put the placenta in a bowl or wrap it in a towel or plastic bag because the doctor will want to examine it.

Now... relax, cuddle your baby and breastfeed him when you are both ready. Stay lying or sitting until help arrives - and tell yourself how wonderful you both are!

Afterwards
If the ambulance arrives and all is well, ask if you can be checked over by a midwife or GP at home, if you don't want to go to hospital. If you and your baby are both happy and in good health and you want to stay at home, do so. 

Try to talk things through in private with your midwife, to put events in order in your mind and sort out any worries or questions. Take time, too, to talk with older children who may have witnessed the birth. Your midwife will help you explain things to them, if necessary. 

Planning ahead
No one knows for sure exactly why fast (or 'precipitate') labours happen. They usually, but not always, occur to women having their second or subsequent baby, and they are defined as lasting less than an hour. If you know that you are at risk of an unplanned home birth - perhaps because your previous labour was very fast or your mother gave birth very quickly - you may like to prepare yourself by:

• Talking through with your midwife what to do if you are caught out
• Making a list of emergency telephone numbers to keep by your phone

• Learning about baby resuscitation - an important skill for all parents.

In brief

• See more information about home births
• Visit our comprehensive Labour and birth section
• Join your antenatal club
• Talk with other mums-to-be and parents on our Labour and birth discussion forum
• Enter one of our great competitions and giveaways

by Sue Allen-Mills and midwife Hannah Hulme Hunter