Pain relief at home, and the epidural you may still have
About one in five women planning a home birth for a first baby still receives an epidural or spinal in England. That is not the plan failing. It is the plan working.
An epidural or spinal cannot be given at home. That is not a finding, it is a description: it needs an anesthetist, sterile conditions and monitoring. What the research gives you is something more useful, which is how many women who plan a home birth end up having one anyway, by going to hospital.
From the English data, counted by where the woman planned to give birth, so it includes women who transferred:
| Planned place of birth | Had an epidural or spinal |
|---|---|
| Hospital labor unit | 5,817 / 19,576 (30.7%) |
| Home | 1,418 / 16,799 (8.3%) |
| Freestanding midwifery unit | 1,251 / 11,251 (10.6%) |
| Midwifery unit at a hospital | 2,464 / 16,661 (15.3%) |
Split by whether it is your first baby, per 1,000 women, from the English national guideline:
| Regional pain relief, per 1,000 women | Home | Freestanding unit | Unit at a hospital | Hospital labor unit |
|---|---|---|---|---|
| First baby | 218 | 200 | 240 | 349 |
| Later baby | 28 | 40 | 60 | 121 |
Read the first row honestly. About 22 in every 100 women planning a home birth for a first baby received an epidural or spinal, by transferring to hospital. If someone has described home birth to you as avoiding an epidural, they described an intention rather than an outcome. And a request for pain relief accounted for only 5.1% of transfers from home, so this is usually not the reason a transfer happens; it is often something that follows a transfer that happened for another reason.
What is available instead. Water immersion for pain relief was used by 5,523 of 16,443 (33.3%) of women planning a home birth, against 1,836 of 19,680 (9.1%) planning a hospital birth and 45.7% in a freestanding unit. Among low-risk women having a first baby, half of those planning a home birth used water for pain relief, and using it was associated with a slightly lower chance of transferring before the birth (adjusted relative risk 0.88, 95% confidence interval 0.79 to 0.99). That last comparison was published as a ratio only, with no transfer rate printed for either group, so the absolute difference behind it cannot be given here. As above, the Birthplace percentages are weighted for its sampling design and do not equal the counts divided out.
Beyond water, what pain relief is available at an American home birth depends on the state and on your attendant's licence. There is no national American answer to this and this guide will not invent one. English guidance lists nitrous oxide and various medicines as things that should be discussed as locally available, but that describes an NHS service, not American home birth practice.
"If I ask for an epidural at three in the morning, what happens next, and how long does it take?"
"Do you have a birth pool, and who fills it and empties it?"
"If I change my mind about pain relief, will you treat that as a failure?"