Hospital or home birth?

Birth certificateYou've got several alternatives about where to give birth – at home, in hospital (some hospitals have midwifery units attached to the main obstetric unit) or at a birth centre. 

You can get all the information to help you decide where to have your baby from your midwife, GP and other mums (including Mumsnetters, obviously), but here are some of the pros and cons of each option to think about before you reach your decision.

Giving birth at home

You don't need your GP's 'permission' - you can book one direct with the midwifery team providing community care. If your request is refused, you may need to talk to the supervisor of midwives at your local hospital.

NHS guidelines say two midwives must be present for a home delivery. You can also hire an independent midwife who will look after you throughout your pregnancy.

Having had a caesarean previously doesn't rule out a home birth, contrary to popular opinion, but you'll need to agree to go to hospital at the first sign of any problems.

A home birth takes a bit of preparation, but not much in the way of gear or equipment.

You'll need some plastic sheets to protect your bed and floor coverings, good lighting so your midwife can see what's going on, clean towels and blanket to wrap your baby in and an overnight bag for hospital, which contains your pregnancy notes (and birth plan if you have one) in case you end up being transferred to hospital.

Home birth questions for your midwife

  • How will they handle any complications?
  • What emergency equipment will they bring?
  • If you want a water birth, will your floor take the weight of a pool?
  • If you live a long way from hospital, what happens if you need to be transferred?
  • Can they do stitches if you need them?

You can't have an epidural with a home birth, so you're ruling out one form of pain relief before you go into labour, but you can have gas and air, and pethidine.

Home births are not recommended if:
  • You're expecting more than one baby
  • Your baby is lying in a breech position
  • You've got complications such as placenta praevia or pre-eclampsia
  • You've got a health condition such as epilepsy
  • You're less than 38 weeks pregnant when you go into labour (some areas say 37 weeks)

If you end up having to be transferred to hospital, it can be a pretty painful journey. A few miles to the hospital might not sound like much, but it's no fun if you're in the advanced stages of labour.

If you've got other children, you'll obviously need to work out in advance who will look after them while Mummy's not available for playing Duplo or doing bedtime stories. 

And do be certain that your partner, if you have one, is as committed to the idea of a home birth as you are. You don't want them having second thoughts when you're in transition.

Giving birth in hospital

If you want the option of things such as epidurals and set visiting times, then your first point of contact is your midwife or GP, who'll probably assign you to a consultant unit at a local hospital. The choice you have over this will obviously depend upon where you live.

Before you get too hung up on which hospital, think about the sort of birth you'd like in an ideal world (it won't be ideal, of course, but hopefully this increases your chances of it being pretty good):

  • Do you want a water birth?
  • Are you anxious to avoid a caesarean?
  • Do you want the birth to be led by midwives or a consultant obstetrician?
  • Is it important you get to know the midwife who'll be helping you to deliver beforehand?
  • Is there an anaesthetist available 24/7 to do epidurals?
  • Can you have more than one birth partner present?

When you're choosing which hospital it's important (probably vital) to take account of other mums' experiences, but don't listen too hard to hospital horror stories. Every hospital or practice will have slipped up at some point, but that doesn't mean the overall standard of care is necessarily poor.

Statistics on things such as c-section and induction rates are available online, but view these in context: if the hospital you're thinking of has complicated pregnancies referred to it, for example, then its rates for interventions are likely to be higher. 

And it's worth asking your midwife which hosptial they'd recommend - they've got the insider knowledge, after all. 

Go and look around the hospital(s) you're keen on. But if you decide to switch once you've decided, you may have to be prepared for a bit of a battle. Although as this Mumsnetter points out: "You can, of course, simply turn up at the hospital of your choice in labour if you have any problems switching."

Birth centres and midwife-led units

If your pregnancy is low risk, or you really want a non-interventional birth in an intimate atmosphere, with more personal care, then a birth centre might be your best option or a midwife-led unit.

Birth centres aren't available everywhere, so start by finding out the options in your area, and then ask around and go and visit before you make your decision.

Epidurals and caesareans aren't an option in birth centres, so if there are complications during labour you might have to be transferred to hospital.

What Mumsnetters say about...

Home births

  • No strangers were able to walk in when I was facing the door with my legs in the air. The food was considerably better and on demand and, despite my partner's fears, no mess went beyond the pads and sheets we had prepared. Bubbly
  • I gave birth on the edge of the sofa with a beanbag behind me, which was very comfortable. The midwife was wildly excited as I ‘breathed the head out’. After the birth I snuggled down on the sofa while my daughter had a feed and the midwives tidied up and made tea. My son slept through the whole thing and wandered in the next morning to find a baby in the bed. Hopeful
  • My son was born with a severe infection and had to be whisked to an ITU within minutes, where he spent the next two or three days fighting for his life. Giving birth isn't just about 'you' and which whale music you want to listen to, but also about your baby and the unforeseen things that can happen, which is why I'd have any subsequent babies in a hospital. Emmabee

Hospital births

  • I'm not certain it matters that much whether you know your midwife when you deliver - I'd much rather have continuity of care during the pregnancy, and an open-minded midwifery team during the birth. Boyandgirl
  • Ask around. Find out what kinds of experiences people have had at each hospital. Weigh those personal experiences in with the statistics. Expatka

Birth centres and midwife-led units

  • I had my son in a birthing centre. It was fantastic - very clean and new - and the care I got was great. I had my first two children in the labour ward, and the birthing centre was just a million miles better. TalkingTree
  • NHS midwife-led units cater for low-risk, 'natural' births. The one I attended had a birthing pool, low sensory room, showers and baths, gas and air, and pethidine (or equivalent) on hand for pain relief. Epidurals are not available but the unit was on the floor below the maternity unit so I could have been transferred if necessary. The small team of midwives were brilliant at helping me manage without an epidural." Nicki
     

Where you end up giving birth will depend on lots of factors, such as where you live, your personality and preferences, whether it's your first child, whether there are any known complications and so on.

But, like most things to do with pregnancy, there are known unknowns but also unknown unknowns. So, even if you've gone all out to have your baby in one particular place, it can still change at the last minute owing to things such as your baby stubbornly refusing to get in the right position for his or her outward journey, or someone else getting to the birthing pool before you. 

As this wise Mumsnetter puts it: "It's good we have choices, but sometimes those choices aren't available at the time."

  • Still can't decide where to give birth? Got specific questions about hospitals in your area? Head for our Childbirth Talk forum and ask all those niggly questions 

Image: Shutterstock

Last updated: 14-Jun-2013 at 12:13 PM