Choosing where to give birth

Higher-risk pregnancy: how to negotiate your care

6 min read

Even if you’ve been told you’re at higher risk of complications during labour, you still have a say in your maternity care. This guide explains what you can do to pursue the birth you want.

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If you have a condition that increases your risk of complications, it’s likely that you’ll be recommended to give birth in a labour ward. But you may feel strongly that you want to give birth somewhere else. If this sounds familiar, you may need to discuss this with your midwife or doctor to arrange the birth you want – be prepared for some negotiation.

What is a higher risk pregnancy?

A higher risk pregnancy is if you or your baby are at more likely to experience problems during pregnancy and birth. Have a look at this list of conditions which increase your risk of complications.

If your midwife thinks you’re at higher risk, you’ll be referred to a consultant who can talk you through your individual circumstances and what that means for you, your baby and the birth.

It’s important to bear in mind that even if you have a higher risk pregnancy, it doesn’t mean that you’re likely to suffer complications, but rather that you’re more likely to experience problems than someone who doesn’t have those risk factors.

Planning a home birth or using a birth centre

In a labour ward medical staff and equipment will be available should you or your baby need them. This is why you will be recommended to give birth in a labour ward if you’re at increased risk of complications, in accordance with current NICE guidelines. If this isn’t what you want, or perhaps you don’t mind going to a labour ward but wish to have a water birth or be free from continuous monitoring then you can discuss your options for having a home birth or going to a birth centre with your midwife, GP or obstetrician.

Planning a birth in a birth centre or at home may reduce your likelihood of medical interventions, but of course you won’t have doctors and medical equipment close by. In many cases, there’s little evidence available about the relative safety of birth in these settings for women at increased risk of complications.

If, following discussions, you feel you will not get the maternity care you want, you can arrange to speak to a local Supervisor of Midwives, a consultant midwife or your Head of Midwifery (see below for details of how to contact these people). You can also see if the maternity care you want is available through another hospital in your local area by looking it up through our Birth Choice tool.

Still haven’t got the birth place you would like?

If you’re having difficulty getting support to give birth where you want, the following options could be useful to you.

  • Agree a plan where you give birth in the labour ward, but are supported to have a natural birth in that environment. You would need to ensure that you’ll be looked after by an experienced midwife or supported by an experienced birth partner. You could consider being supported by a doula or private midwife.
  • Arrange to give birth in an alongside birth centre, with easy transfer to the labour ward if problems arise. This may not be possible, as many birth centres have strict criteria on who can plan to give birth there.
  • Arrange your own home birth. If you’re unable to get support from the NHS for a home birth, you can contact one of the support organisations named below, or consider using the services of a private midwife (such as an independent midwife), although you would have to pay for this care. They’ll discuss with you whether they think they can look after you safely at home. If not, they may be able to help you with other options.

Maternity care: how you should be treated

Whatever decision is reached, you should feel that your concerns have been listened to, and that you’ve been fully informed about the condition that could affect you and/or your baby.

You should have a written care plan which sets out what has been decided, and the situations in which you may agree to the use of interventions, or when you would prefer to avoid these. If you’re not planning to give birth in a labour ward, the arrangements for transfer to one in the event of problems should be clear.

It could take a while to reach this point, so making contact with health professionals quickly makes sense. It’s often helpful to bring your partner, birth partner or a friend to appointments. These can be difficult discussions, so it helps to have some moral support.

Questions to ask

It’s easy to get overwhelmed when faced with making a decision about you maternity care, especially if you think you may want to go against the set guidelines or your consultant’s opinions.

To help ensure you have all the information you need, you may find it useful to ask the following three questions to your care provider, before you make your decision:

  1. What are my options?
  2. What are the benefits and possible risks of each option for me?
  3. How do I get support to help me make a decision that is right for me?

Getting support from the NHS

Contact any of the following people to discuss your NHS care, and to find out what your options are.

  • Your midwife or GP.
  • Your consultant obstetrician (whose name should be on the front of your maternity notes). Your midwife or GP can refer you for an appointment, or you can contact your consultant or his/her secretary via the hospital switchboard or by letter.
  • A ‘Professional Midwifery Advocate’ (PMA). PMAs are always available to hear your concerns and help you access the care you want. You can contact an advocate by calling your maternity unit. More information is available in this booklet about PMAs.
  • Consultant Midwives. Some NHS trusts, especially large NHS hospital trusts, have one or more consultant midwives (see your NHS trust maternity care website for details of staff). Consultant midwives are very experienced midwives who can discuss your individual care with you to help you have the birth you want.
  • The Head of Midwifery at your NHS trust (sometimes called the Director of Midwifery). The Head of Midwifery should be named on your NHS trust maternity services website. Contact them via the hospital switchboard, or via a ‘bleep’ system, or you can write to the Head of Midwifery at the hospital.

Other organisations within your trust may include the MSLC (maternity services liaison committee) and PALS (Patient Advice and Liaison services).

Finding support outside the NHS

A number of organisations and individuals can support you, and provide information and advice about decisions and choices during pregnancy and birth.

  • Non-NHS midwives, including independent midwives – some non-NHS midwives can also provide NHS care.
  • Doulas – these are women experienced in giving emotional and practical support to women before, during and after the birth.
  • Association for Improvements in the Maternity Services (AIMS) – a volunteer organisation supporting women in their choice of maternity care and providing information on choices and rights.
  • Birthrights – this organisation has useful factsheets on your rights around maternity choices.

It can feel difficult to negotiate care which conflicts with what’s being offered to you. Make use of whatever support is available so you can make the best decision for yourself and your baby.

Get the full picture of what your options are for giving birth in your area – use the Which? Birth Choice tool and uncover your options.

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These are the sources of information used in this article:

National Collaborating Centre for Women’s and Children’s Health, Intrapartum care: care of healthy women and their babies during childbirth. NICE Clinical Guideline 190, London: National Institute for Health and Clinical Excellence (2014)

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