At your first booking appointment with your midwife you may asked ‘Where do you want to have your baby?’. You may not be expecting this question and might not know what to answer or even what your options are. Do not worry if you said ‘in hospital’ but now looking back you realise you want to give birth at home, you are allowed to change your mind as many times as you want.
The main options for where you can give birth are:
- In hospital
- In a midwife-led unit
- At home
Most women decide to give birth in an NHS hospital. Here you will go to the maternity unit and be looked after and cared for by a team of midwives, with doctors and consultants available if necessary. In a maternity unit, you will be able to receive any pain reliefthat you need as there is access to anaesthetists who can give epidurals and general anaesthetics. There is also access to obstetricians and also neonatologists who specialise in newborn care as well as being able to have a caesarean if required for the birth or needing premature care for your baby.
If you are considering a hospital birth, you should arrange a tour of the maternity unit and prepare a list of questions to ask your midwife to ensure you are happy with your choice. Some useful questions to ask include:
- Can I go home straight from the labour ward?
- How long do I have to stay in hospital?
- What equipment is available in the unit? E.g. birthing ball, mats, pillows, bean bags, music player
- Are there different types of rooms available?
- Can I have a water birth?
- How many birthing partners can I have?
- How long can they stay with me?
- What is the hospitals procedure for induction and pain relief?
- How closely monitored will I be?
- Will it matter how I choose to feed my baby? Breastfed or formula?
- How much support will I get after the birth?
- Can I have my own room?
- How big are the wards?
- Are there rules on when I can be visited or who is allowed to visit me?
If you live locally to two or more hospitals, you will be able to choose which hospital to attend. Visit each hospital and ask questions before deciding.
Birthing centres or Midwife led units are more homely and comfortable than a maternity unit inside a hospital. In some hospitals, the maternity ward may have an internal birthing centre but in some communities the midwife led unit or birthing centre will be a completely separate building and location. Many women prefer to give birth in a midwife led unit as they feel more relaxed in the ‘homely’ surroundings as the labour rooms will look like a bedroom rather than a clinical hospital.
However, if there are any complications during the birth, you will need to be transferred to a hospital and there may not be the option for certain types of pain relief such as epidurals. If you have gone into preterm labour, it is likely that your baby will need neonatal care and therefore you are unlikely to be able to give birth in a midwife led unit.
If you are considering using a birthing centre or midwife led unit, you should ask your midwife which ones are available in your area and arrange a tour of the facility. Depending where you live, you may be able to choose which one you prefer. You should prepare a list of questions to ask during your visit. These questions are likely to include some from the hospital section above and may also include:
- If I need to be transferred to hospital, how long would it take?
- Which hospital would I be transferred to?
More women every year are deciding to give birth to their baby in the comfort of their own home. As long as your pregnancy has been straightforward with no complications and both you and your baby are well, there is no reason why you cannot do this. Complications may include you are having a multiple birth or that your baby is breech. Your midwife or doctor will have to check you and your baby fully before labour begins before either agreeing to a home birth or explaining to you why they think a hospital birth would be the safer option for you and your baby.
Many women find that being in their own familiar surroundings, they are more relaxed and able to cope and your birthing partner will be able to stay at your side continuously during and after a home birth. They also feel that once labour has started, they do not want to transfer themselves to hospital whilst in the midst of contractions. A home birth can also be good if you have other children at home and do not want to leave them.
However, you will be unable to have an epidural during a home birth and if your labour is not progressing well or you need help, your midwife will need to transfer you to hospital.
If you are considering a home birth, discuss this with your midwife who will explain to you what happens next in your area and who the midwifery team are that can provide support for you. You should prepare a list of questions to ask. Some questions may include:
- How long would it take to be transferred to hospital if necessary?
- Which hospital will I be transferred to?
- Will there be a midwife with me all the time?
- How many midwives/health care professionals will be present?
- How long after the birth will they stay?
- How much mess will there be? What can I do to prepare the room?
- How do I get a birthing pool?
- What happens if my planned midwife is at another birth?
- What checks will my baby get after birth?
- What pain relief is available?
- If I require stitches after the birth, will they be able to be done at home?
Although it is ultimately your choice when deciding where to give birth, it is vital that you listen to the advice from your midwife, doctor or consultant as they may feel that one place is safer for you and your baby than another. You must also be ready to adapt and change your plans as situations can change quickly during labour and you may need to be transferred for more medical help. Talk to your midwife if you feel you need more information to make your decision.
by Jenny, mum to William and James