Choosing where to have your baby is a very important part of your birth preparation and in the UK you have 4 options:
- Home birth
- A midwifery led unit
- A delivery suite/ labour ward
- A freestanding birth centre
Before you make a decision on which is right for you there are some key questions to ask yourself?
- What kind of birth experience do I want in regard to the environment and what is your preference for pain relief?
- What is your situation: is this your first pregnancy, if not what was your previous birth experience/s like? Is your pregnancy considered low risk? How accessible are you to your local facilities?
Once you are more familiar with the type of birth you are looking to have it makes sense to understand the options available to you and what each birth location can offer you in terms of achieving this.
All women in the UK have the right to request a home birth however it is heavily advised only women experiencing a low risk pregnancy and feeling well have one. In England and Wales, just over 1 in 50 pregnant women give birth at home so this is still a very small fraction of women.
For women having their first baby, home birth slightly increases the risk of serious problems for the baby – including death or issues that might affect the baby’s quality of life – from 5 in 1,000 for a hospital birth to 9 in 1,000 for a home birth.
For women having their second or subsequent baby, a planned home birth is as safe as having your baby in hospital or a midwife-led unit and often support women who wish to have a more physiologically ‘natural’ labour and a more relaxed experience
It’s very rare but, if something goes seriously wrong during your labour at home, it could be worse for you or your baby than if you were in hospital with access to specialised care.
If you give birth at home, you’ll be supported by a midwife who will be with you while you’re in labour. If you need any help or your labour is not progressing as well as it should, your midwife will make arrangements for you to go to hospital.
During the pandemic many Hospital Trusts are unable to support or often limited in the support they can offer parents in facilitating a home birth. It’s important to check this with your midwife for the most up to date information.
Alternatively, you can look to hire Independent Midwives who are NHS trained midwives that have chosen to work outside the trust and work in a self-employed capacity. The benefit of independent midwives is that you are not reliant on the availability of your local trust to be able to provide you with an NHS midwife and you will have the support from this same midwife throughout your pregnancy and labour.
It is worth noting that should you be required to transfer to hospital during labour or immediately after, this would again be dependent on the ability for your local ambulance unit to support you in a timely manner. If you are interested in learning more about independent midwives, visit the Home of Independent Midwifery where you can also find a local midwife.
Midwifery Led Unit (MLU) and Birth Centres (BC)
A birth centre can either be alongside a hospital which will have a dedicated labour ward but is considered a separate unit or can be a standalone birth centre.
A MLU, as the name suggests is led and run by Midwives and although often attached to a hospital where pregnancy (obstetric), newborn (neonatal) and anaesthetic care is available (specialist doctors) they do not routinely support the MLU. If you choose to birth in a freestanding BC then this won’t be available without transferring to a Hospital with a labour ward.
A MLU/BC is designed to provide women with a more relaxed and homely environment to birth and is again reserved for those who meet specific requirements such as a low risk pregnancy, good health and desire to have a more physiological birth.
There are some things to think about if you’re considering giving birth in a midwifery unit or birth centre:
You may need to be transferred to a hospital if there are any complications. The Birthplace study found that approximately 4 in 10 women having their first baby in a midwifery unit or birth centre were transferred to hospital, compared with approximately 1 in 10 women having their second or subsequent baby.
In a unit that’s completely separate from a hospital, you won’t be able to have certain kinds of pain relief, such as an epidural. Ask your midwife whether the unit or centre is part of a hospital or completely separate.
Labour ward/delivery suite
Most women give birth in a hospital, women who undergo an induction of labour, caesarean section, or have a desire to receive certain pain relief options such as an epidural are all required to do so in a labour ward. If you choose to give birth in a hospital, you’ll be looked after by midwives, but doctors will be available if you need their help.
You’ll still have choices about the kind of care you want. Your midwives and doctors will provide information about what your hospital can offer.
The advantages of giving birth in hospital include:
- direct access to obstetricians if your labour becomes complicated
- direct access to anaesthetists, who give epidurals and general anaesthetics
- there will be specialists in newborn care (neonatologists) and a special care baby unit if there are any problems with your baby
Birthing in a more regimented and medical environment doesn’t take away all your birth choices. A waterbirth is still possible for many women, although it is dependent on the labour ward’s resources and availability. Those wanting to have a physiological birth may still do so and this is still encouraged on a LW.
If you are still unsure where is right for you to have your baby, you have a variety of resources to support you in your decision.
- Although this isn’t possible currently due to COVID restrictions most Trusts offer open evenings and fares to allow you to take a tour of the facilities available to you.
- Local birth workers/organisations such as NCT, Hypnobirthing and Maternity Voices Partnerships are often able to support you in making an informed decisions.
- children’s centres – find a children’s centre near you
- your GP surgery
- local maternity units – find maternity services near you
- The Which? Interactive support tool – Complete questionnaire here
- the Birthplace study– published in November 2011, this compared the safety of births planned in different settings
By Ellie Dearden