While more than nine in ten babies in the UK are born in hospitals, the rates of home births are steadily increasing, sparking a contentious debate among medical professionals and advocates. Proponents highlight advantages such as the comfort of one's own home, minimal medical intervention, and greater maternal control over the birthing process. However, this trend is fraught with controversy due to the inherent lack of specialized care readily available should serious complications arise. Experts have frequently expressed concern that the evidence regarding the risks associated with home births, contrasted with the relative safety of hospital deliveries, is often disregarded by those advocating for at-home delivery.

These risks have been brought into sharp focus following a tragic inquest into the deaths of Jennifer Cahill, 34, and her newborn daughter, Agnes Lily, both of whom died after a home birth in June of last year. Mrs. Cahill, from Prestwich, Greater Manchester, had chosen a home birth for her second child after feeling 'unsupported' during her first hospital delivery three years prior. Despite the presence of her husband Rob and two midwives, Mrs. Cahill, who had a higher risk profile due to a previous postpartum haemorrhage, suffered complications. Both she and Agnes were rushed to North Manchester General Hospital, where Jennifer died a day later, and Agnes passed away after three days.

Statistics reveal that approximately one in 50 women in England and Wales choose home births, with nearly 50,000 out-of-hospital births recorded in the US in 2023. Professor Dimitrios Siassakos, an honorary consultant in obstetrics at University College London Hospital, emphasizes that labour problems are far more common than generally perceived. He notes that while women with a history of uncomplicated vaginal births may have good chances for a straightforward home delivery, first-time mothers face a significantly higher risk of complications, including stillbirth. Professor Siassakos stressed the critical need for immediate intervention when complications arise, stating, 'During labour, when intervention is needed, it is often needed there and then.'

He further elaborated on the speed with which life-threatening emergencies can develop during childbirth. Severe blood loss, known as exsanguination, can prove fatal in pregnant women within just 10 to 15 minutes, while a baby can suffer brain injury from low oxygen in the same timeframe and die within 20 to 25 minutes. Both blood loss and oxygen deprivation are 'relatively common' emergencies. If these situations occur at home, the time required to transfer to a consultant-led unit for life-saving interventions can often exceed the critical window needed to save mothers, babies, or both.

Professor Bassel Wattar, an associate professor of reproductive medicine at Anglia Ruskin University, highlighted the difficulty of monitoring fetal asphyxia (reduction in oxygen flow to the baby) at home, unlike hospital settings where continuous fetal heart rate monitoring can detect early signs of distress. He underscored that timely access to medical support is essential for assisted delivery or caesarean section if labour exceeds a safe threshold. He also pointed out that shoulder dystocia, where the baby’s shoulder becomes impacted due to its size, is a true obstetric emergency that can be complex to manage even in hospitals. Professor Wattar advocates for robust risk strategies and a clear 'Plan B' for rapid transfer to medical care to safely support women in their preferred birthing environment.

National studies indicate that nearly half of first-time mothers attempting home births require transfer to a consultant-led unit due to lack of progress, fetal distress, or bleeding. Professor Siassakos advises families to be fully aware of these key statistics to make informed decisions, balancing the acknowledged advantages of home birth with its potential risks. Research also suggests that approximately half of pregnant women in the UK will develop complicating factors, such as high blood pressure or diabetes, making a hospital birth advisable.

The NHS states that home births for first-time mothers can 'slightly increase the risk of serious problems' for the baby, from five in 1,000 for a hospital birth to nine in 1,000 for a home birth. Professor Siassakos cautioned that this 'almost doubling in incidence of serious complications, including the risk of the baby dying, up to about one in a hundred previously healthy babies,' is a significant factor for families to consider. Furthermore, the Royal College of Obstetricians and Gynecologists does not recommend a planned home birth for women with a previous C-section, those carrying multiple foetuses, or if the baby is not in a head-first position.

In Mrs. Cahill's case, she had suffered a postpartum haemorrhage after her first birth and was advised to deliver her second child in hospital. Her husband, Rob Cahill, testified at the inquest that Jennifer opted for a home delivery due to a 'highly stressful' experience in hospital during her first birth in 2021, where she felt 'unsupported' by midwives. Mr. Cahill stated that they believed the warnings for a hospital birth were primarily based on a Strep B infection his wife had with their son, Rudy, leading to sepsis, which she thought could be managed if it recurred. However, Mr. Cahill claimed the full risks were not adequately explained to them.

Manchester University NHS Foundation Trust, which manages the hospital, has accepted that Mrs. Cahill should have been referred to a senior midwife to discuss the dangers more thoroughly after her decision for a home birth. The Trust described the home birth as 'outside of clinical guidelines' and reiterated that doctors had informed her a hospital birth would be safer and preferable.