Where should you give birth?
When it comes to giving birth, you have a number of options at your disposal – at home, in hospital (some hospitals have midwifery units attached to the main obstetric unit) or at a birth centre
Hospital or home birth?
You can get detailed information to help you decide where to have your baby from your midwife, GP and other mums (including Mumsnetters, obviously). However, recent NICE guidelines recommend that women with 'straightforward' pregnancies should be encouraged to give birth at home or in midwife-led-units, with labour wards reserved for 'difficult' births only, such as if you have gestational diabetes and your baby has macrosomia.
If you are healthy and considered to be “low risk” you should be offered a choice of birth setting. If you choose to give birth at home or in a unit run by midwives, you need to be given information by your midwife or GP about what would happen if you have to be transferred to hospital during labour, and how long this would take. It's rare, but if something were to go wrong during your labour the impact could be greater for you or your baby than if you were in hospital with access to specialised care.
Here are some of the pros and cons of each option to think about before you reach your decision.
Giving birth at home
Giving birth is generally safe wherever you choose to have your baby. However, for women having their first baby, home birth slightly increases the risk of complications and a poor outcome for the baby – from five in 1,000 for a hospital birth to nine in 1,000 (almost 1%) for a home birth. [Source: NPEU]
A poor outcome would encompass anything from stillbirths during labour and early neonatal deaths or conditions associated with trauma at birth, the baby becoming distressed or being deprived of oxygen during labour.
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, according to the NHS. You don't need your GP's 'permission' – you can book one direct with the midwifery team providing community care. NHS guidelines say two midwives must be present for a home delivery so if your request is refused, try talking to the supervisor of midwives at your local hospital. Alternatively, you can 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.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 sheets we had prepared.
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 a 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.
There are several advantages to choosing a home birth:
- You'll be in familiar surroundings, where you're more likely to feel relaxed and in control
- You don't need to interrupt labour to go into hospital
- Your partner, if you have one, and any other children don't have to be separated from you unless you prefer it
- You are more likely to be looked after by a midwife that you have got to know during your pregnancy
- You're less likely to need intervention with forceps or ventouse than women giving birth in hospital. 88% of women who opted for a planned home birth had a “normal” birth with low levels of intervention in comparison to 58% of those who opted for a planned birth in an obstetric unit [Source: NPEU]
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 and how can you get hold of one?
- 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. 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. You really should 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 like 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.
In terms of the availability of medical assistance, the advantages of a hospital birth are clear: there will be specialists on hand if you have a complicated labour, which many women find to be of massive comfort at such an emotional and life-changing event. Others with certain medical conditions will be advised that a hospital birth will be safest for them and their baby.
There will also be anaesthetists available to give you an epidural if you start effing and blinding – an option which isn't available at home or in a midwife-led birth unit. You'll either be able to go straight home from the labour ward, or you may stay in hospital in a maternity ward. Your maternity care team will be able to advise you further on this and what to bring with you to hospital. Ask around. Find out what kinds of experiences people have had at each hospital. Weigh those personal experiences in with the statistics.
In hospital, with a non-complicated birth, you'll be mainly looked after by midwives, but it's possible that it won't be the same one you have got to know during your pregnancy. It's also possible that the maternity unit you choose may not be available if many women are in labour at the same time and the unit is full. Ask your midwife what to expect if this happens to you.
Before you get too hung up on which hospital to go for, think about the sort of birth you'd like in an ideal world (it's rarely 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?
- Are your partner or other visitors allowed in?
- How soon can you go home after giving birth?
- What support will you have for formula or breast-feeding?
- What are the rules on visitors just after giving birth?
When you're choosing which hospital to give birth in, do take account of other mums' experiences. Try not to listen too hard to hospital horror stories though – every hospital or practice will have its moments, but that doesn't mean the overall standard of care is necessarily poor. Most women give birth in NHS hospitals and have happy, healthy babies to show for it.
Statistics on things such as c-section and induction rates are available online, but you must 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. It's absolutely worth asking your midwife which hospital they'd recommend – they've got the insider knowledge, after all. Go and look around the hospital(s) you're keen on. You can decide to switch once you've decided, but be prepared for a bit of a battle.
Birth centres and midwife-led units
If your pregnancy is low risk, or you really want to give birth in an intimate atmosphere, with more personal care and minimal intervention, then a birth centre or a midwife-led unit might be your best option. Women who give birth in a unit with midwife-led care, just as with a home birth, are less likely to need assistance, such as the use of forceps or ventouse (sometimes called instrumental delivery).
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.
Birth centres have similar advantages to home births, in that:
- You're more likely to feel relaxed in a birth centre than in a hospital setting
- The unit may be nearer to your home than a hospital, so you'll have less interruption to labour and it'll be easier for people to come and visit
- You are more likely to be looked after by a midwife that you have got to know during your pregnancy
- You're less likely to need intervention with forceps or ventouse than women giving birth in hospital
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, you might be thwarted by your baby stubbornly refusing to get in the right position for his or her onward journey, or someone else getting to the birthing pool before you.
You know that old adage about how best laid plans always go awry? It is as true in this context as in any other, so you really shouldn't get too hung up on one birth option; remember, it's really about choosing what is best for your baby.