I don’t want an episiotomy (cut). Can I refuse one?
You should be asked before a midwife gives you an episiotomy, as your consent is required for any medical procedure. You can refuse to have an episiotomy, but you need to be aware that this may be an emergency procedure to enable your baby to be born quickly. Sometimes a midwife will give an episiotomy if she thinks it will avoid a serious tear that may cause longer-term problems.
If possible, discuss your concerns about having an episiotomy with your midwife before you go into labour, so you can understand the circumstances in which you may need one.
I’ve been told I can’t have a home birth. What are my rights?
If you’re unable to arrange a home birth, contact the hospital and ask for the contact details of the supervisor of midwives. Talk to them about your situation and discuss the differences in safety, transfer rates and intervention rates so you can weigh up the risks and benefits personally. If you still want a home birth, let the supervisor of midwives know. If they still can’t arrange a home birth for you, you can seek support from a variety of organisations.
Can I ask to have a caesarean?
Yes. If you want to have a caesarean for no medical reason, you can ask your midwife or doctor, who will outline the risks and benefits of both a caesarean and a vaginal birth to support you in making an informed choice. If you’ve been planning a vaginal birth, you may decide during labour that you would like to have a caesarean instead. At this point, you’re not entitled to a caesarean unless the doctor decides there’s a medical need.
I’ve been told I can’t give birth in a birth centre. What are my rights?
You might not be offered the choice of a birth centre if there’s not one in your local area, or if you don’t meet the clinical criteria. For example, most birth centres accept only women who are at low risk of complications and are within certain age and weight limits. If you’re at increased risk of complications, you may find it more difficult to arrange to give birth in a birth centre.
Can I refuse to be induced?
Your consent is required for any medical procedure, and you’re within your rights to decline an intervention such as having your labour induced. It’s important that you weigh up the risks and benefits of accepting or declining induction, and if you refuse one your decision should be supported.
How many women have an unplanned caesarean?
Around 15 women in every 100 have an unplanned caesarean in England, although this varies around the country. Older mothers are more likely to have one than younger women, and first-time mothers are more likely to have one than women giving birth for the second time. Look up your local units in our search to compare unplanned-caesarean rates.
Am I allowed to bottle feed my baby in hospital?
If you’ve decided that you want to bottle feed with formula milk, ask your midwife to include this in your notes so the midwives at the hospital know. The midwives should support your decision and help you with feeding after your baby is born. You’ll still be encouraged to have skin-to-skin contact with your baby immediately after the birth.
Hospitals vary as to whether or not they provide formula milk, bottle and teats. If you intend to formula feed, ask your midwife in advance what’s provided, so you know what to bring in when you’re in labour. They should have facilities for you to store your milk and bottles, and show you how to safely sterilise equipment and make up feeds.
When will I be able to go home after giving birth?
If you’ve had an uncomplicated birth, you could go home within a few hours, as long as you feel well and able to cope with being at home with your baby. Some units like you to stay for up to 24 hours. You can see how long women usually stay at your local maternity unit by looking the unit up in the search.
If you’ve had a more complicated birth such as an assisted birth or caesarean birth, you’re likely to stay for one to three days. Fewer than 10% of women stay longer than three days after the birth.
Will my partner be able to stay overnight after the birth?
If you stay overnight, your partner may be able to stay with you, depending on the policies of the local unit. An increasing number of units allow partners to stay overnight on a reclining chair in the postnatal ward, on a camp bed if you’re in a single room and, in some units, you might be able to share a double bed. As local policies vary, it’s best to check before you arrive to have your baby. It’s worth bearing in mind that, as new mum Cat describes in her birth story below, staying overnight isn’t always the most comfortable situation for a partner.
Should I be prepared to transfer to hospital during a home birth?
You may not want to think about the possibility of transfer when planning your home birth. But it’s a good idea to discuss the process in advance with your midwife, so you can relax and focus on having your baby at home, knowing that plans are in place should the need arise.
For some women there can be a feeling of relief associated with transferring to the labour ward during a planned home birth. If labour has been slow to progress, it can feel that something is finally happening. If labour has been more painful than expected, it can also bring the promise of stronger pain relief.
However, it can also be disappointing to have to transfer, and you may feel sad that the birth was not what you planned. So speaking to your midwife about the possibility of being transferred in advance can help you to feel more prepared.
Will I still get help with breastfeeding if I give birth at home?
Your midwife will be there immediately after the birth to help you feed your baby, and give you support with breastfeeding if that’s what you’ve chosen to do. She’ll try to make sure that your baby is able to latch on and suckle effectively before she leaves you and your partner alone with your baby.
Being at home provides a good opportunity to have uninterrupted time for skin-to-skin contact with your baby, which can help with the process of starting breastfeeding in an unhurried way. Some babies will instinctively start to breastfeed given this opportunity.
What should I do with my older children if I have a home birth?
It’s up to you whether your children stay at home with you while you have a home birth. It’s probably best to have someone other than yourself and your partner to look after them, as you’ll both become increasingly preoccupied as labour progresses. It’s also helpful to have your childcare arrangements covered in case you need to transfer to hospital.
Is my home suitable for a home birth?
Most homes are suitable for a home birth. Most midwives would prefer that you have access to a toilet, running water, electricity and a phone (either landline or mobile with signal). It’s also useful to understand how you would be transferred to hospital if there was an emergency – for example, whether there are several flights of stairs and if there’s road access for a vehicle. If you’re planning to use a birth pool, look into hiring one or buying one in advance.
It’s important that you feel comfortable while giving birth, so you need to consider whether it’s private enough for you (in terms of being disturbed, overlooked or overheard). If you have other children you may need to think about whether you want them to be at home while you give birth.
Is home birth messy?
There’s inevitably a bit of mess with a home birth, but forward planning will mean there’s no permanent effect on your home. Make sure you have some waterproof sheeting (such as plastic sheeting or oilcloth), and your midwife will bring large disposable absorbent pads to go underneath you. You can also use old towels or sheets that can go in the washing machine afterwards. Your midwife will make sure your home is clean and tidy before she leaves.
Women at increased risk of complications
I’m expecting twins. What are my options for where to give birth?
If you’re carrying twins, it will be recommended that you give birth in hospital because of the additional risks involved in giving birth to twins. In particular, twins tend to be born prematurely (before 37 weeks) and have a lower birth weight than babies who aren’t multiples, which means they’re more likely to need some special care. These risks are greater for identical twins sharing a placenta.
Evidence shows that the risks to the babies are increased if they’re not born by 38 weeks. Current guidelines say you should be offered an induction or an elective (planned) caesarean birth from 36 weeks if your babies share a placenta, and from 37 weeks if your babies each have their own placenta. Whether you have a planned caesarean or an induction will depend on the type of twins you’re having and the position of the babies.
If you don’t want to have a planned caesarean or an induction, you can choose to wait and go into labour spontaneously. If this is your choice, you’ll have a weekly appointment with your obstetrician and regular scans and other tests to check that your babies are healthy.
You’re unlikely to be eligible to have your twins in a birth centre, and will probably find it difficult to get support for a home birth. If you feel strongly that you would like one of these options, you can discuss it with your midwife or obstetrician.
What is a breech birth?
A breech birth is one where the baby is not in the usual head-down position, but instead has its head at the top of the womb. The part of the baby born first in a breech birth is usually the bottom although, on rare occasions, one or both feet can be born first.
If your baby is breech towards the end of pregnancy, you may be offered an ECV (external cephalic version) where a doctor will try to turn your baby around from outside the womb. If your baby remains in the breech position, current guidelines recommend that you are offered a caesarean birth. Some women with a breech baby prefer to birth their baby vaginally, although it may not be easy to find a midwife who is skilled in delivering breech babies.
Can I have a home birth if I’m high risk?
If you’re at increased risk of complications, it’s likely that your health professionals will recommend you give birth in a labour ward.
If you feel strongly that this isn’t the right place for you, you may need to discuss this with your midwife or doctor to try and arrange the birth you want.
Which conditions increase the risk of birth complications?
According to national guidelines for England, there’s a number of factors that could increase your risk of complications during labour and birth.
Safety and medical interventions
Where is the safest place to give birth?
The safest place for you and your baby will depend on your individual circumstances, such as whether it’s your first baby or not, whether you have any conditions that could increase your risk of complications arising during the birth, and your personal views on risk and safety.
Women at increased risk of complications are usually recommended to give birth in a hospital labour ward, where doctors are on hand should medical help be needed. If you have a low risk of complications, you’re less likely to have medical interventions if you plan to give birth somewhere other than a labour ward.
A birth planned in a birth centre is as safe for your baby as a planned hospital birth if you’re having your first baby. For women having a second or subsequent baby, a birth planned at home or in a birth centre is as safe for your baby as a planned hospital birth.
What is an episiotomy?
An episiotomy is a surgical cut sometimes made just before the baby is born, to widen the opening and allow the baby to be born more quickly. This will be repaired under local anaesthetic following the birth, using stitches.
What’s the difference between forceps and ventouse?
Forceps are a surgical instrument that comes in two halves. Each half is carefully put round the baby’s head while it’s in the birth canal, and the two handles fit together. The doctor pulls at the same time as you push with a contraction.
A ventouse is a silicone cap attached to a suction pump. The cap is fitted on the baby’s head while it’s in the birth canal, and is kept in place using suction. The doctor then pulls the ventouse, as with a forceps delivery, to help the baby be born.
Why might I be induced?
Women are most commonly induced because they haven’t gone into labour when expected. Most women will go into labour by 42 weeks’ gestation, and guidelines recommend that women are offered induction between 41 and 42 weeks. Women can choose not to be induced, however, and are offered extra monitoring from 42 weeks.
There are other reasons why women may also be offered induction, such as if their waters break but they don’t go into labour within 24 hours, or if there’s a risk to themselves or the baby if pregnancy continues.
Booking your maternity care
I think I’d like a home birth, but what happens if I change my mind?
If you change your mind about having a home birth during pregnancy, your midwife can change your booking. It’s even possible to change your mind when you’re in labour – you can decide at any time that you would prefer to be in the hospital, and can transfer there. Be aware that, in some cases, transferring to give birth in hospital may mean you’re looked after by different midwives.
In some areas of the country, a final decision about where to have your baby is not made until you’re actually in labour, and the midwives stay with you wherever you choose to give birth.
What happens if the unit is full when I go into labour?
It’s best to phone your maternity unit before you arrive there in labour. This gives the midwives a chance to assess over the phone how far on in labour you are, and whether you need to go in yet.
Occasionally the maternity unit may not be able to accept you once you’re in established labour – either because it’s full or because it doesn’t have enough staff on duty. If this is the case, you’ll be told the nearest maternity unit you can go to. This can be unsettling, so it’s best to find out what your alternatives are so you know how to get there. If the unit has a history of closure, this information will be shown on the individual page for that unit on our site.
I’m booked into one hospital but would now prefer to go somewhere else. Can I change my mind?
It shouldn’t usually be a problem to change where you’re booked to give birth. The hospital or birth centre you plan to change to may have a strict catchment area, so you should check that you live in that area and that the new hospital is prepared to accept your booking.
To change your booking you can go via your GP to get them to refer you, or contact the new unit to ask for an appointment.
Paying for care
What is the difference between giving birth privately as opposed to NHS care?
NHS maternity care is free for UK residents, whereas you have to pay for private maternity care.
Is ‘going private’ the same as having independent midwives?
Some women will choose to give birth in a private hospital, or the private wing of an NHS hospital. This is often referred to as ‘going private’. There are several other private maternity-care options, including hiring the services of an independent midwife for a home birth or for antenatal and postnatal care. Most women in the UK have NHS maternity care, which is available free of charge.
Are independent midwives insured?
It’s a legal requirement for all midwives to hold appropriate professional insurance, including independent midwives who are self-employed. This means that if your baby suffers an adverse outcome which is proved to be due to your midwife’s negligence, you can make a claim through the midwife’s insurance. Remember that no compensation is payable where the adverse outcome was unavoidable and not related to negligent care, wherever you have your baby and whoever provides your care.
If you want to pay for the services of an independent midwife, you can check with them what cover their insurance provides. Private midwives who are employed by a company or organisation should also be fully insured.
What is an independent midwife?
This is a fully qualified, self-employed midwife who can provide paid-for private midwifery care. Independent midwives generally offer care from a single midwife or a pair of midwives throughout your pregnancy.
What is a doula?
A doula is a woman experienced in giving emotional and practical support to women in labour, who can act as a birth partner. Doulas can also provide support while you’re pregnant and after your baby is born.
In the London boroughs of Newham and Tower Hamlets, the Maternity Mates project provides voluntary support to women who don’t have a suitable support network, or have specific needs or health issues. Visit the Women’s Health & Family Services website to find out more.
I’ve heard our local unit has private rooms. What does that mean?
Usually this means the hospital has single rooms where you can stay once you’ve had your baby. There’s normally a nightly fee for using the room. Sometimes women with a clinical need – such as having had a complicated birth – will be able to stay in a private room free of charge.
The charge is for the room only – postnatal care is provided free by the NHS. Sometimes partners are allowed to stay overnight in the room, too.
Some hospitals have private (non-NHS) care, and have private rooms available for women who have chosen to pay for this type of maternity care. Usually women having NHS care aren’t able to pay to stay in these rooms.
NHS maternity care
Will I have a midwife with me all the time when I’m in labour?
Most hospitals aim to have one midwife looking after each woman in established labour. This midwife may not be with you in the room the whole time, however, and it’s likely that you’ll be left alone with your partner for short periods of time. If your labour is long, the midwife may hand over your care to another midwife at the end of their shift.
If the maternity unit is very busy, or there are staff shortages, your midwife may be looking after one or more women at the same time. Maternity units may close their doors to newly arriving women in these circumstances to ensure safe standards of care.
Can I choose which midwife I have in labour?
It’s unlikely that you’ll be able to choose the midwife you have in labour. If you know a midwife who’s working when you’re in labour, you may be able to request that they look after you, but there’s no obligation for this to happen.
Some maternity services try to provide continuity of care by creating small teams of midwives who are responsible for all your care, from antenatal appointments through to labour, birth and postnatal care. You’re more likely to get continuity of care if you live in the catchment area of the hospital you’re booked in to. You can look up your local units in our search to see if you’re in their catchment areas. If you don’t like the midwife who is looking after you in labour, you can request a different one – get your birth partner to speak to the midwife in charge of the labour ward.
What’s the difference between midwife-led care and consultant-led care?
Midwife-led care is when midwives are responsible for all your maternity care, rather than doctors. In some hospitals, doctors called obstetricians take responsibility for your care and you see a consultant (senior doctor) for some of your antenatal appointments. This is usually only the case if you have some risk of complications and need extra medical care. Women having consultant-led care will usually give birth in a labour ward, but women having midwife-led care may give birth in a labour ward, birth centre or at home.
Water in labour
Will I definitely get to use a birth pool if I want to?
You’re not usually able to book a birth pool in a labour ward or birth centre in advance of going into labour. If you think you’ll want to use a pool, let your midwife know so this can be written in your notes, and mention it when you arrive at the hospital in labour. If you arrive and all the pools are already being used by other women, you won’t be able to use one. Therefore, booking at a maternity unit or birth centre with a larger number of pools may make it more likely that there’ll be one available.
Remember, things won’t always go to plan, so be sure to research other options and decide on your preferred alternatives. If there are any complications in your pregnancy or labour, your midwife or doctor may recommend that you do not use a pool in labour.
Where do I get a birth pool from?
Many companies hire out birth pools, together with all the necessary equipment and instructions for their use. Some companies also sell inflatable birth pools. There are many different types available, in varying price ranges. The most expensive come with filters to keep the water clean, and heaters to keep the water at the right temperature.
You’ll need to check that your floor is strong enough to take a filled pool’s weight, and that you have the means to fill it with enough water to cover your abdomen.
Update July 2014: Public Health England is currently advising people not to use heated birth pools that are filled before labour begins, and where the temperature is maintained by a heater and a pump. This advice applies to these particular birth pools only. Most birthing pools rented for use at home are filled from domestic hot water at the time of labour, and there’s no concern about these pools or, indeed, pools used in NHS birth centres and maternity units.
What’s a birth pool?
A birth pool is a wide, deep bath or pool filled with clean, warm water that can be used to cope with pain during labour, or as a place to give birth if you have a water birth. Birth pools are deep enough for a woman to be immersed above her abdomen when kneeling. They can be permanently plumbed in, such as those in a birth centre, or you can hire or buy an inflatable pool for a home birth.
Pain relief during labour
What is hypnobirthing?
Hypnobirthing is a birth-education programme for pregnant women which teaches self-hypnosis, relaxation and breathing techniques for labour and birth. There are also other types of self-hypnosis courses, such as natal hypnotherapy. These types of course generally focus on reducing fear and increasing confidence, providing women and their partners with techniques that help them to work with their bodies during labour.
There’s currently insufficient evidence to say whether self-hypnosis is helpful or not. However, anecdotal evidence (eg women’s testimonials) suggests that self-hypnosis is effective in reducing the need for pain medication, increasing confidence and helping women remain calm and in control.
What pain relief can I have at a home birth?
At home you can use self-help methods to cope with labour pain, such as massage, gentle movement, relaxed breathing or self-hypnosis. If you’ve planned a home birth, you can hire a birth pool so you can use water to cope with pain, and your midwife can provide you with gas and air (entonox). The midwife may be able to administer pethidine or a similar opioid, depending on the policy in your local area, but you won’t be able to have an epidural unless you transfer to hospital.
What are my pain-relief options during labour?
There are numerous forms of pain relief that can help you to cope with pain during labour, including gas and air, epidurals and self-help methods.
Choosing where to give birth
I had a really bad birth experience last time. How can I make sure it doesn’t happen again?
You may find it helpful to discuss your previous birth with a health professional or childbirth educator. You can ask the hospital for a copy of your maternity notes, which may help you to understand what happened. Some maternity units offer a ‘Birth Afterthoughts’ or debriefing service with senior midwives or counsellors, who can help you to come to terms with your previous experiences. Your choices for your next birth will depend on what you’re hoping to change. You may wish to ask for a planned caesarean, in which case you can discuss this with your doctor or midwife, and you’ll get support with any feelings of anxiety from your last birth.
How do I know if my local maternity unit is any good?
Finding the best maternity unit or birth centre will depend on a lot of things, from the type of birth you want to your medical circumstances. You can use our unique Birth Choice tool to find local maternity units that best fit your needs, and find out details about their facilities, policies and birth statistics. You’ll be able to get an idea of women’s experiences of giving birth at a particular unit by reading reviews and (for England) scores from the Care Quality Commission (CQC) survey of women’s experiences of maternity care which are both shown on the individual pages for each unit that you can access through the tool.
What do I need to look out for on a tour of a maternity unit?
Ask whether the hospital has a midwife-led unit as well as a labour ward, and what the main differences are between them. Find out what types of pain relief are available and, if you’d like the option of using a birth pool, ask how many there are. It’s a good idea to ask how often they’re all occupied to get a sense of how likely it is that there will be one available when you go into labour.
What are my options regarding where to give birth?
You will usually have the choice of giving birth in a hospital labour ward, at home, or in a midwife-led birth centre. This can be either an alongside birth centre in the same hospital as a labour ward, or a freestanding one in a community hospital or purpose-built building.