Choosing where to give birth
- What are my options regarding where to give birth?
- What do I need to look out for on a tour of a maternity unit?
- How do I know if my local maternity unit is good?
- I had a really bad birth experience last time. How can I make sure it doesn't happen again?
Coping with pain in labour
- What are my pain relief options?
- What pain relief can I have at home?
- What pain relief can I have at a birth centre?
- What is hypnobirthing?
Water in labour
- What's a birth pool?
- Where do I get a birth pool from?
- Will I definitely get to use a birth pool if I want to?
NHS maternity care
- What is the difference between midwife-led care and consultant-led care?
- Can I choose which midwife I have in labour?
- Will I have a midwife with me all the time in labour?
Paying for care
- I've heard our local unit has private rooms. What does that mean?
- What is a doula?
- What is an independent midwife?
- Are independent midwives insured?
- Is 'going private' the same as having independent midwives?
- What is the difference between giving birth privately as opposed to NHS care?
Booking your maternity care
- I'm booked into one hospital but would now prefer to go to another one. Can I change my mind?
- What happens if the unit is full when I go into labour?
- I think I'd like a home birth but am not sure. What happens if I change my mind?
Safety and interventions
- Why might I be induced?
- What's the difference between forceps and ventouse?
- What is an episiotomy?
- Where is the safest place to give birth?
Women at increased risk of complications
- Which conditions increase the risk of birth complications?
- Can I have a home birth if I am at increased risk of complications?
- What is a breech birth?
- I'm expecting twins. What are my options for giving birth?
- Is home birth messy?
- Is my home suitable for a home birth?
- What should I do with my older child/ren if I have a home birth?
- Will I still get help with breastfeeding if I give birth at home?
- How does it feel to transfer in labour?
- Will my partner be able to stay overnight after the birth?
- When will I be able to go home after giving birth?
- Am I allowed to bottle feed my baby in hospital?
- How many women have an unplanned caesarean?
- Why does your website not show personalised statistics for women living in Scotland, Wales and Northern Ireland?
Choosing where to give birth
What are my options regarding where to give birth?
Most women have the choice of giving birth in a hospital labour ward, at home or in a midwife-led birth centre - either on the same hospital site as the labour ward, or a different site in a community hospital or purpose-built building.
What do I need to look out for on a tour of a maternity unit?
Whether you are visiting a maternity unit in person or watching a virtual tour online, you can check out our list of questions to find out what you need to know about the maternity unit you are interested in.
How do I know if my local maternity unit is good?
Finding the best maternity unit in which to give birth will depend on a combination of factors, including the type of birth you want. You can use our Find and Compare tool to find local maternity units which best fit your needs. You can then look in detail at the facilities, policies and personalised birth statistics there using our individual unit pages, or compare several units at a time.
Our unit pages also give you an idea of women's experiences of giving birth there, with reviews from Patient Opinion, and for England, scores from the Care Quality Commission (CQC) survey of women's experiences of maternity care and the results of the NHS England Maternity Friends and Family Test. Get started now at Find and Compare.
I had a really bad birth experience last time. How can I make sure it doesn't happen again?
There are a number of reasons why you might consider your last birth experience one that you don't want to repeat. Some women feel they had insufficient pain relief; some feel that they had interventions which they hadn't wanted and would like to avoid this time; and others feel that they suffered a loss of control or weren't listened to, or were even treated insensitively during the birth.
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 notes which may help to understand what happened. Some maternity units offer a "Birth Afterthoughts" or debriefing service with senior midwives or counsellors who can help you understand more about any prior birth experiences and help you come to terms with these. Find out more about what to do if you didn't receive the care you expected.
Your choices for your next birth will depend on what you are hoping to change. You may wish to ask to have a planned caesarean, in which case your reasons will be discussed with you and you will be supported with any feelings of anxiety resulting from your last birth. Find out more about asking to have a planned caesarean.
You may wish to avoid any interventions as far as possible, in which case you might plan to give birth in a birth centre or at home where interventions are less likely. This may be more difficult to arrange if you have an increased risk of complications. Find out more about negotiating your care if you are at increased risk of complications.
Coping with pain in labour
What are my pain relief options?
These will depend partly on where you choose to give birth.
What pain relief can I have at home?
While you are labouring at home, you can use self-help methods of coping with pain, such as massage, gentle movement, relaxed breathing or self-hypnosis. If you have planned a home birth, you can hire a birth pool so you can use water to cope with any pain, and your midwife will provide you with gas and air (entonox). She may be able to administer pethidine or a similar opioid depending on the policy in your local area. You won't be able to have an epidural unless you transfer to hospital.
What pain relief can I have at a birth centre?
You can use self-help methods of coping with pain, such as massage, gentle movement, relaxed breathing or self-hypnosis. Many birth centres have birth pools so you can use water to cope with any pain, and gas and air (entonox) will be available. Some birth centres have pethidine or a similar opioid available. You won't be able to have an epidural unless you transfer to the labour ward.
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 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 to work with their bodies during labour.
There is currently insufficient research 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.
Water in labour
What's a birth pool?
This 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 (water birth). Birth pools are deep enough for a women to be immersed above her abdomen when kneeling. They can be permanently plumbed-in (for example, as in a birth centre) or portable for a home birth.
Where do I get a birth pool from?
There are many companies which hire out birth pools, together with all the necessary equipment and instructions for their use. Some companies will sell you an inflatable birth pool. There are many different types of pool 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 will 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. The majority of birthing pools rented for use at home are filled from domestic hot water at the time of labour and there is no concern about these pools or indeed pools used in NHS birth centres and maternity units.
Will I definitely get to use a birth pool if I want to?
You are not usually able to book a birth pool in a labour ward or birth centre in advance of your labour. If you think you will want to use a pool, let your midwife know so this can be written in your notes. You should also mention it when you arrive at the hospital in labour.
Booking at a maternity unit with a larger number of pools may make it more likely that there will be one available. Some birth centres have a pool in every birthing room.
If there are any complications in your pregnancy or labour then your midwife or doctor may recommend that you do not use a pool in labour.
NHS maternity care
What is the difference between midwife-led care and consultant-led care?
Midwife-led care is when midwives (not doctors) are responsible for all of your maternity care. This is ideal if you are healthy and your pregnancy is straightforward. 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.
Can I choose which midwife I have in labour?
It's unlikely that you will be able to choose the midwife you have in labour. If you know a midwife who is working when you are in labour you may be able to request that she looks after you, but there is 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 of your care, but this is currently the exception rather than the rule. If this is important to you, you should try to find out if you can be looked after in this way in your local service. You are more likely to get continuity of care if you live in the catchment area of the hospital where you book your care. This information is available on our individual maternity unit pages.
Will I have a midwife with me all the time in labour?
Most hospitals aim to have one midwife looking after each woman in established (strong) labour, and this is the gold standard for care in labour. This midwife may not be with you in the room the whole time, however, if you're happy and confident to be left alone with your partner for short periods of time. If your labour is long, she may hand over your care to another midwife at the end of her shift.
If the maternity unit is very busy, or there are staff shortages, your midwife may be looking after one or more other women at the same time. Maternity units may close their doors to newly arriving women in these circumstances to ensure safe standards of care.
Paying for care
I've heard our local unit has private rooms. What does that mean?
Usually this will mean that the hospital has single rooms which can provide extra privacy once you've had your baby. There is normally a nightly fee for using the room, although sometimes women with a clinical need (for example after a complicated birth) may be accommodated in a single room for no charge.
The charge is only for the room, and 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 are not able to pay to stay in these rooms.
What is a doula?
Doulas can also give support while you are pregnant and after your baby is born. You can find out more about doulas at www.doula.org.uk (external link).
What is an independent midwife?
This is a fully qualified, self-employed midwife who can provide private midwifery care. Private midwives, including independent midwives, generally offer care from a single midwife or a pair of midwives throughout your pregnancy. You have to pay for this care.
Are independent midwives insured?
Since July 2014 it is a legal requirement for midwives to hold appropriate professional insurance. Independent midwives who are self-employed can now access this Professional Indemnity Insurance through the Independent Midwives UK (IMUK) insurance scheme or through a commercial insurance provider. 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.
All independent midwives offering maternity care should now be fully insured. If you want to engage 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. Find out more about private midwives.
Is 'going private' the same as having independent midwives?
Most women in the UK have NHS maternity care, which is available free of charge. There are a number of different private maternity care options which can include hiring the services of a independent midwife or paying for a private obstetrician.
What is the difference between giving birth privately as opposed to NHS care?
NHS maternity care is free for people who are resident in the UK, whereas you have to pay for private maternity care.
Booking your maternity care
I'm booked into one hospital but would now prefer to go to another one. Can I change my mind?
It should not usually be a problem to change where you are booked to give birth. The hospital you plan to change to may have a strict catchment area. If 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 you can contact the new unit to ask for an appointment.
What happens if the unit is full when I go into labour?
It is best to phone up your maternity unit before you arrive there in labour. This gives the midwives a chance to assess how far on in labour you are and whether they are able to admit you to the labour ward.
Occasionally the maternity unit may not be able to accept you once you are in established labour - either because they are full or because they do not have enough staff on duty. If this is the case, you will be told which is the nearest maternity unit which will accept you. Because this is unsettling, it is best to find out in advance the likelihood of this happening (particularly if the unit has a history of closing) so that you can be prepared for an alternative journey and place of birth. If the unit has a history of closure, this information will be shown on our individual unit pages.
I think I'd like a home birth but am not sure. What happens if I change my mind?
If you think you would like to have a home birth, then there should be no problem with making your intention known to your midwife and planning accordingly. If at any time you change your mind, you can let them know and they can change your booking. It is even possible to change your mind when you are in labour - you can decide at any time that you would prefer to be in the hospital and you can transfer there. Be aware that, in some cases, transferring to give birth in hospital may mean that you are looked after by different midwives to those who care for women having home births.
In some areas of the country, a final decision about where to have your baby is not made until you are actually in labour, and the midwives stay with you wherever you choose to give birth.
Safety and interventions
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.
Women may also be offered induction for other reasons, such as if their waters break but they do not go into labour within 24 hours, or if there is a risk to themselves or the baby if pregnancy continues.
What's the difference between forceps and ventouse?
Forceps are a surgical instrument which comes in two halves. Each half is carefully put round the baby's head while it is 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 is in the birth canal, and is kept in place using suction. The ventouse is then pulled, as for the forceps delivery, to help the baby be born.
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.
Where is the safest place to give birth?
The safest place for you and your baby will depend on a number of factors, including whether it is your first baby or not, whether you have any conditions which could increase your risk of complications arising during the birth, and what 'safest' means for you.
Women at increased risk of complications are likely to be recommended to give birth in a labour ward, where doctors are on hand should medical help be needed. However, some women feel that this is not the right place, and wish to give birth with skilled help in a different birth setting. Find out more about negotiating your care if you are at increased risk of complications.
If you have a low risk of complications, you're less likely to have medical interventions if you plan to have birth in an environment other than a labour ward. For women having a first baby, a birth planned in a birth centre is as safe for your baby as a planned hospital birth. 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. Find out more about safety and intervention rates in different birth environments.
Women at increased risk of complications
Which conditions increase the risk of birth complications?
According to national guidelines for England there are a number of factors which could increase your risk of complications during labour and birth.
Can I have a home birth if I am at increased risk of complications?
If you are 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 is not the right place for you, Find out more about negotiating your care.
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 uppermost in 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 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 normally, although it may not be easy to find a midwife who is skilled in delivering breech babies.
Find out more about negotiating your care if you are considered to be at increased risk of complications (e.g. if your baby is breech).
I'm expecting twins. What are my options for giving birth?
If you're carrying twins, it will be recommended that you give birth in hospital due to additional risks giving birth to twins. These risks are greater for identical twins sharing a placenta. In particular, twins tend to be born prematurely (before 37 weeks) and have a lower birth weight than singleton babies, which means that they are more likely to need some special care.
Current guidelines say that you should be offered an elective (planned) birth from 36 weeks pregnancy if your babies share a placenta, and from 37 weeks if your babies each have their own placenta. This could be by planned caesarean, or you could have your labour induced depending on the type of twins you are having and the position of the babies. Find out more about caesareans or being induced.
Evidence shows that risks to the babies are increased if they are not born by 38 weeks. 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. If you are not able to arrange the care you want, find out more about how to negotiate your care.
Is home birth messy?
There is inevitably a bit of mess with a home birth, but a bit of forward planning will mean that 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 which can go in the washing machine afterwards.
Your midwife will make sure that that your home is clean and tidy before she leaves.
Is my home suitable for a home birth?
The vast majority of 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 are several flights of stairs and if there is road access for a vehicle. If you're planning to use a birth pool upstairs, check in advance that your ceiling is strong enough to support the weight.
It is important that you feel comfortable giving birth, so you need to consider whether it is 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 present at home while you give birth.
If you want a home birth but have a concern about your home, discuss it with your midwife.
What should I do with my older child/ren 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 will both become increasingly preoccupied as labour progresses. It is also helpful to have your childcare arrangements covered in case you need to transfer to hospital.
Some children come and go freely into the room where their mother is labouring, and most seem to take it completely within their stride. If they are old enough, you may want to explain a bit about what is likely to happen beforehand so they understand the hard work involved and the noises you may make. You can also let them know in advance that you may decide to go to hospital, so that they are not frightened in the event of a transfer.
Ultimately it is up to you whether you want them around or not, but prepare to be flexible either way - they may decide to watch it all, or keep well away, or they may sleep through it all and wake up to find they have a new baby brother or sister!
Will I still get help with breastfeeding if I give birth at home?
Being at home provides a good opportunity to have uninterrupted time for skin-to-skin contact with your baby, which will help with the process of starting breastfeeding in an unhurried way. Some babies will instinctively start to breastfeed given this opportunity.
Your midwife will be there immediately after the birth to help you feed your baby, and give you support breastfeeding if that is what you have chosen to do. She will make sure that your baby is able to latch on and suckle effectively before she leaves you and your partner alone with your baby. A midwife will return the next day, and can give any further help you need. There are a number of other organisations such as NCT, the Breastfeeding Network (BfN), the Association of Breastfeeding Mothers or La Leche League which have breastfeeding support helplines or volunteers who will help if you have any problems, in addition to lactation consultants at local clinics or the hospital.
How does it feel to transfer in labour?
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 bring the promise of stronger pain relief.
However it can also be disappointing to have to transfer. Being transferred can feel very passive, in contrast to the active participation in labour at home. There can also be a loss of the continuity in your care when you are 'handed over' to hospital staff. For some women there is a sense of failure and grief that the birth they planned is not to be.
You may not want to think about the possibility of transfer when planning your home birth, but it could help to discuss the process in advance with your midwife to help you cope if it did happen. You will then be able to relax and focus on having your baby at home, knowing that plans are in place should the need arise.
Will my partner be able to stay overnight after the birth?
If you've had an uncomplicated birth, you may go home within a few hours of the birth and not stay overnight. If you do 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, for example on a reclining chair on the postnatal ward. Some can be accommodated on a camp bed if you are in a single room. Some rooms, particularly in birth centres, even have a double bed which you can share after the birth.
As local policies vary, it is best to find out whether your partner will be able to stay overnight before you go there to have your baby.
When will I be able to go home after giving birth?
If you have had an uncomplicated birth, you could go home within a few hours of the births 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 find information about your likely length of stay for an uncomplicated birth on our individual unit pages on the postnatal tab.
If you have had a more complicated birth, such as an assisted birth or caesarean birth, you are likely to stay for one to three days. Fewer than 10% of women stay longer than three days after the birth.
Am I allowed to bottle feed my baby in hospital?
Many hospitals have a policy of promoting breastfeeding because it has a number of benefits for both you and your baby. You will have the opportunity to discuss your decisions about feeding with your midwife while you are still pregnant. If you have decided that you want to bottle feed with formula milk instead, this can be written in your notes so everyone is clear. The midwives should support your decision and help you with feeding after your baby is born. You will still be encouraged to have skin-to-skin contact with your baby immediately after the birth.
Hospitals vary as whether they provide formula milk, bottle and teats. You should ask your midwife in advance what is provided so that you know what you need to bring in when you are in labour if you intend to formula-feed. They should have facilities for your to store your milk and bottles, and show you how to safely sterilise equipment and make up feeds.
How many women have an unplanned caesarean?
Around 15 women in every 100 have an unplanned caesarean, although this varies around the country. Different groups of women can be more or less likely to have an unplanned caesarean. 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. Find out more about caesareans or use our Find and Compare tool to compare the unplanned caesarean rates of your local maternity units.
Why does your website not show personalised statistics for women living in Scotland, Wales and Northern Ireland?
The statistics can only be personalised if they are calculated from individual hospital records. Our data suppliers BirthChoiceUK have access to records for all women having babies in England, but not for the other three countries of the UK. For Scotland, Wales and Northern Ireland the statistics are calculated by official government or NHS departments. Please be reassured that all individual hospital records used for England are anonymised so that no-one can be individually identified from their record.
Can I refuse to be induced?
Your consent is required for any medical procedure and you are within your rights to decline an intervention. If you don't take up an offer of induction your decision should be supported. However, it's important that you weigh up the risks and benefits of accepting or declining induction.
Find out more information about induction from the National Institute for Health and Clinical Excellence (NICE) (external link)
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 is not one in your local area. You can use this website to find out about other birth centres in your region where you might be able to give birth.
Most birth centres only accept women who are at low risk of complications and who fit a list of criteria including being within certain age and weight limits, and being at the right stage of pregnancy when you go into labour. If you are at increased risk of complications you may find it more difficult to arrange to give birth in a birth centre.
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. If you have been planning a vaginal birth, you may decide during labour that you would like to have a caesarean. At this point, you are not entitles to a caesarean unless the doctor decides that there's a medical need. Find out more about caesareans and asking to have one.
I've been told I can't have a home birth. What are my rights?
You may be told that you can't have a home birth if you are having a first baby. In these circumstances it might be helpful for you to make sure you understand the evidence about safety, transfer rates and intervention rates for first time mothers having a home birth so you can weigh up the risks and benefits personally. Find out more about the evidence. If you are reassured that it is what you want to do, you can let your midwives know that you are making an informed decision to plan a home birth. If you're still unable to arrange a home birth there are a number of people and organisations you can contact to get help, including a Supervisor of Midwives, the Association for Improvements in the Maternity Services (AIMS) or Birthrights. Find out the contact details for organisations which can help you.
You may be told that you can't have a home birth because you are at increased risk of complications. If this is the case, find out about how to get the maternity care you want.
I don't want an episiotomy (cut). Can I refuse one?
Your consent is required for any medical procedure, and you should be asked before a midwife gives you an episiotomy. At this stage (when the baby's head is just emerging) you may not realise you are being asked for consent, but midwives and doctors are required during labour to make sure that you have clearly given consent, especially if you've taken pain relieving drugs.
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 which may cause longer-term problems.
If possible, discuss your concerns about having an episiotomy with your midwife before you go into labour, so that you can understand the circumstances in which you may need one.
Find out more about consenting to treatment from Birthrights (external link)