As your pregnancy progresses, you may want to start thinking about how and where you would like to give birth.
If you are in good health and your pregnancy is considered to be low risk, you will have a number of birth options to choose from. You could choose to have your baby at home, in hospital or in a midwife-led unit.
If your pregnancy is higher risk, your midwife will talk to you about which birth options are considered appropriate for you. If there is a high chance that you will need medical interventions during the birth or your baby will need specialist care when born, your midwife is likely to recommend that you give birth in a hospital where there are doctors and specialists on hand.
Research has found that having a home birth or having your baby in a midwife-led unit, which could include a birthing centre, reduces the chance you will need assistance during delivery using forceps or a ventouse. This is thought to be because you are in a calmer and more relaxed environment, which helps you to listen to your body, follow your instincts and cope with labour without medical intervention.
What factors should I consider when making my choice?
The most important factor to take into account is the health of you and your baby and any potential that you may need extra expertise from a doctor or anaesthetist. Your midwife will be able to talk to you about your options and whether you or your baby are likely to require additional care which would make a hospital birth a sensible option.
Find out what is available in your area, how far away each option is from your home and how easy they are to travel to. Even if you choose to have a hospital birth, you still have a choice when it comes to which hospital you go to. You may want to do some research and find out more about the facilities available before you decide which one is right for you.
Think about what kind of birth you would like to have. If you are keen to have a water birth, you will need to find a maternity unit with a birth pool or you could look into hiring one for your home.
If you feel nervous about the birth, you may prefer the idea of giving birth in a hospital where there are specialists on hand if anything goes wrong.
Your midwife can give you information about the different options available for you and there may be an opportunity to visit maternity services in your area to see the facilities for yourself and ask any questions. However, hospital tours are not offered as routinely as they used to be and you may be directed to an online video that shows you around the unit.
What do I need to know about home birth?
Giving birth at home means you can stay in a comfortable and familiar environment to welcome your baby into the world. You don’t have to worry about travelling while you are in labour and if you have older children, you don’t have to leave them in the care of someone else (although you may want to arrange someone to look after them and keep them busy while you are in the later stages of labour).
If your pregnancy is without complications, home birth is generally considered to be a safe option. If you are expecting your first baby, you are at a slightly higher risk than if you gave birth in a hospital but if you’re having your second baby, a planned home birth is considered as safe as giving birth in a midwife-led unit or hospital.
One major factor to consider if you’re thinking about a home birth is whether your home is suitable. If you don’t have a stable address, your home is cramped or crowded, you have a challenging living situation or there are problems with the heating, electricity or water supply, you will probably be much more comfortable going to a hospital or birth centre to have your baby.
You might also want to consider how far your home is from the nearest hospital with a maternity unit. If something does happen during your labour and birth which means you or your baby need medical treatment which can’t be provided at home, you will need to be transferred to hospital, which could be difficult if you live in a remote area.
If you do choose to have a home birth, a midwife will come to your home and support you throughout your labour and birth. This means you will get 1:1 care and attention, which isn’t usually possible in a midwife-led unit or hospital until you are at quite an advanced stage as they will have other women to care for.
Another advantage is that you don’t have to wait to be discharged from hospital after the birth so there is no need to be separated from your partner at any point when your baby has arrived. It also means there are no restrictions on who can visit you and when (apart from the ones you choose to impose yourself!).
For some women, the idea of a hospital environment makes them feel quite nervous and uncomfortable so remaining at home and being able to sleep in their own bed and eat their own food is very appealing.
If you have a home birth, you are also more likely to be assisted by a midwife you have got to know during your pregnancy. This is not always possible due to illness, staff absence and other commitments but usually your community midwife will try to be the person who attends your home birth.
This means you will be cared for by someone who understands your personal circumstances and will already know the details of your birth plan.
However, you will not have the full range of pain relief options you could choose if you were giving birth in hospital. You will not be able to have an epidural, although you can use gas and air, a TENS machine and any hypnobirthing or relaxation techniques you have learnt to help cope with labour.
Giving birth at a midwife-led unit or birth centre
Midwife-led units are often seen as a halfway house between giving birth at home and being in hospital. In a birth centre or midwifery unit, your care will be managed by midwives and the environment is usually less clinical and more relaxed.
Some midwife-led units are at hospitals and are part of their maternity services. They may be on a different floor or in a different area to the labour ward or they might even be side by side. The advantage of midwife-led units at hospitals is that you can be transferred very quickly if you need a caesarean section or medical intervention or your baby requires neonatal care after birth.
Some midwifery units and birth centres are completely separate entities to hospitals and you will not have immediate access to obstetric, anaesthetic or neonatal care if needed. However, staff will have a plan in place to transfer patients to a nearby hospital in an emergency.
Midwifery units may be closer to home and easier to travel to in some areas. And as your care is managed by midwives, you will be supported to give birth without medical intervention, unless it is considered necessary for you or your baby’s safety.
Birth centres and midwifery units are more likely to have birth pools for water births and things like birthing balls to help you with your labour. They are usually have a more comfortable and homely atmosphere.
However, if you are in a unit which is not attached to a hospital, you will not be able to get an epidural and you may need to be transferred to a hospital if there are complications.
Giving birth in a hospital maternity unit
Most women will give birth in the maternity unit of a hospital. If you choose a hospital birth, most of your care will still be managed by midwives but doctors will be available if necessary.
You will automatically go to hospital if you choose to have an elective caesarean section for whatever reason. You will also be recommended to choose a hospital birth if there are risk factors which mean you might need a caesarean section or an instrument-assisted delivery or if your baby is likely to need neonatal care after birth.
In hospital, you will have direct access to any medical specialists you need so it is the safest place to be in an emergency. Hospitals can be a more clinical environment but some maternity units will still have comfortable facilities and equipment like birthing balls, bean bags and mats so you may still be able to have the birth you want there. Ask your midwife if you want to know more about the facilities available at your local hospital.
Be aware that if your baby is late and you decide you want your labour to be induced, this will be carried out in hospital.
What questions should I ask to help me decide?
It is important to discuss your concerns and priorities with your midwife and your partner before making a decision. Here are some questions you might want to ask to help you make the right choice:
Can I take a tour of the facilities at the maternity unit/midwife-led centre?
Are there any birth pools available to use?
Do they have TENS machines I can use or would I have to provide my own?
What equipment is available to help me cope with my labour?
How many people are allowed to accompany me in the delivery room?
Will my birth partner ever be asked to leave the room and in what circumstances?
What is the policy for partners after the baby is born and what are the rules around visiting?
Will I be able to have an epidural if I choose to?
What pain relief options will be available?
What are the policies around routine monitoring?
How soon will I be able to go home after my baby’s arrival if all is well?
Are there any facilities to care for my baby if they need medical attention?
What support is there with infant feeding?
What is the procedure if I need to be transferred from home or a birth centre to hospital?
Who will look after me during my labour and after my baby is born?