Why choosing where to give birth matters
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:
Birth centres are either an 'alongside midwifery unit' at a hospital or a 'freestanding midwifery unit' located elsewhere.
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 factors to take into consideration when choosing where to have your baby.
Pain relief available during labour
The pain relief available to you depends on the birth environment you choose and the use of it more likely in some birth settings than others.
The 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.
Having a water birth or using water for pain relief
Women who plan to give birth in a freestanding birth centre or at home are more likely to have a water birth than women who plan to deliver 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.
If you're really keen on a water birth, it's worth considering this when you're planning where to give birth.
Getting to know your midwife
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 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 a study 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.
How far you have to travel in labour
If you choose to give birth in a hospital or a birth centre, it's likely you'll travel there while you’re having contractions.
Even if you're planning to have your baby or in a freestanding birth centre, you may have to travel to a hospital if it turns out you need extra help during labour, such as the intervention of a consultant.
Think about how far you’re prepared to travel, as this will affect your options.
Your chance of having medical interventions
If you have a home birth or give birth in a birth centre, you are less likely to end up having medical interventions such as being induced, having an assisted birth or having an unplanned caesarean.
However, if it turns out you need intervention for the safety of you or your baby, you'll be transferred to a hospital.
Your postnatal care
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.
If you’re at higher risk of complications
Certain medical conditions or circumstances can increase your risk of experiencing complications during labour. Some more common examples include if you’re carrying multiples, your baby is breech or you’ve had a for a previous birth.
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 it's more likely than for 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.
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 or doula.
- 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 . 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). .
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.
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 be helpful 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:
- – a volunteer organisation supporting women in their choice of maternity care and providing information on choices and rights.
- – this organisation has useful fact sheets 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.
Coronavirus and birth choices
The RCOG says, 'Maternity units everywhere are working around the clock right now to manage additional pressures and facilitate women's choices.'
Although, like all areas of the NHS, maternity services are being affected by the pandemic, it says maternity units are working to ensure services are provided in a way that is safe, with the necessary staffing levels and the ability to provide emergency care where necessary.
In some areas of the UK, Trusts and Boards had to pause their home birth service or close their midwife-led unit but most of these cases have now been reinstated. You will be told if this is not the case.
Pregnant women with suspected or confirmed coronavirus are being advised to give birth in a hospital obstetric unit for the safety of both mum and baby, even if they had been planning delivery at home or in a midwife-led centre.
This is so that the baby can be monitored using continuous electronic foetal monitoring, and your oxygen levels, temperature and respiratory rate can be monitored, too. This kind of monitoring can only take place in an obstetric unit where doctors and midwives are both present.
It is also reported that women with symptomatic COVID-19 have an increased risk of caesarean birth, making it even more important that they give birth in an obstetric unit where prompt access to emergency care is available.
The RCOG says that women's birth plans should be followed as closely as possible and advises checking with your local maternity team as to what birthing options are available.
If you have chosen private antenatal care and to give birth in a private facility, contact them directly to see how coronavirus will impact you.