Why choosing where to give birth matters
Find out how planning to have your baby at home, in a birth centre or in a labour ward can affect your birth experience and what to consider if you’ve been told you’re at higher risk of complications.
- Pain relief available during labour
- Having a water birth or using water for pain relief
- Getting to know your midwife
- How far you have to travel in labour
- Your chance of having medical interventions
- Your postnatal care
- If you’re at higher risk of complications
Where can I choose to give birth?
The type of birth you have and the care you receive will be shaped by the choices you make about where to give birth.
You can plan to have your baby in one of the following birth environments:
- a hospital labour ward (also called an obstetric unit)
- a birth centre (also called a midwife-led unit)
- at home.
Where you plan to give birth can affect many things, from the facilities available to how likely you are to know your midwife.
Here, we go through the top things to take into consideration when choosing where to have your baby.
You can also use our Where to give birth tool to find the best option based on what’s important to you as well as your personal circumstances.
Different methods of pain relief are available depending on the birth environment you choose – find out more about your pain relief options.
Using medical pain relief is more likely in some birth settings than others. The 2011 Birthplace study of almost 65,000 women at low risk of complications found that women planning to give birth in a labour ward were substantially more likely to have an epidural than those planning to give birth at home or in a birth centre.
The study found that even when a low-risk woman was transferred into a labour ward from home or a birth centre, she was still less likely to have an epidural than a low-risk woman who had planned to give birth in the labour ward all along.
Water is more likely to be used by women who plan to give birth in a freestanding birth centre or at home than by women who plan to give birth in a labour ward. Therefore, choosing to have your baby in an out-of-hospital setting gives you a better chance of using water in labour.
Where you choose to give birth can affect the extent to which you get to know your midwives before the birth.
Research from the NCT in 2013 found that women who gave birth in a freestanding birth centre or had a home birth were more likely to have already met the midwives caring for them than women who gave birth in a maternity unit.
In the 2017 survey by the NCT and the Women’s Institute, the majority of women reported that knowing their midwife had a positive impact on their labour, with around two-thirds saying it made them feel more relaxed, confident and safe.
If you choose to give birth in a hospital or a birth centre, you’re likely to have to travel there while you’re having contractions.
And if you plan on having a baby at home or in a birth centre, you may have to travel to a hospital if you need extra help during labour.
Think about how far you’re prepared to travel, as this will affect your options.
Planning a home birth or giving birth in a birth centre reduces the likelihood of needing medical interventions, such as being induced, having an assisted birth or having an unplanned caesarean.
How long you stay in the unit after the birth can vary from a couple of hours to a few days, depending on how you and your baby are, as well as on the policies of the hospital.
Our guide to postnatal care explains what you can expect after giving birth in a labour ward, birth centre or at home.
Certain medical conditions or circumstances can increase your risk of experiencing complications during labour. Some more common examples include if you’re carrying twins, your baby is breech or you’ve had a caesarean for a previous birth.
For a full list of risk factors see the NICE Intrapartum Care Guidelines. For more information about maternity care for specific conditions see the Royal College of Obstetricians and Gynaecologists (RCOG) Patient Information Leaflets.
If you have a higher risk pregnancy, you’ll be referred to a consultant who can talk you through what that means for you, your baby and the birth. It’s important to bear in mind that even if you’re considered higher risk, it doesn’t mean that you’re likely to experience problems, but rather that you’re more likely than someone who doesn’t have those risk factors.
Where will I be recommended to give birth?
If you’re at increased risk of complications, it’s likely that you’ll be recommended to give birth in a labour ward so that medical staff and equipment will be available at any time, should you or your baby need them. However, where and how you give birth is always your choice.
Planning a home birth or using a birth centre
If you’ve been recommended to give birth on the labour ward but don’t feel like it’s the right option for you, discuss your circumstances and options with your midwife, GP or obstetrician.
Planning to give birth at home or in a birth centre may reduce your likelihood of needing 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. For example, there are no official statistics comparing how safe it is for women planning to give birth at home compared to in hospital after a previous caesarean section.
Personalising your care
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 and/or supported by a birth partner.
- 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 consider using the services of a private midwife (such as an independent midwife). Read more about private maternity options.
Maternity care: how you should be treated
Whatever decision is reached, you should feel that your questions and 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 early in your pregnancy can be useful. It might help to bring your partner, birth partner or a friend to appointments - these can be difficult conversations, so it helps to have some moral support.
What if I still don’t get the care I want?
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 the Head of Midwifery at your maternity hospital.
You can also reach out to organisations working for women’s rights in childbirth:
- 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.