Where Should I Have My Baby? Understand Your Options To Make Your Choice

Of course the answer will depend a bit on your own personal circumstances but I wanted to write about the options you have for your birth because I meet so many people who are not aware of the different places you can have your baby. If you don’t know there are choices you are relying on your midwife to discuss it with you and, although this should be an ongoing conversation through your pregnancy, I can see that it often isn’t as I meet many women who have no idea.

I will outline the different options and some of the pros and cons and then I would advise you to do some research for your own situation, chat with your midwife about your preferences and see what is available where you are. If there is resistance to your choice there will be someone else you can talk to (often a consultant midwife) to get a plan in place to works for you. This is assuming you have already selected a hospital – there are choices there too! Your choice of hospital might be based on facilities they offer so it is worth looking at that first.

Home birth

Home birth can be a great option, it should be offered everywhere but sometimes staffing levels make it tricky to manage. Usually your care will be with a home birth team or the community midwives who cover an on call rota from about 36 weeks. When you are in labour you call and someone will come out to you. When birth is close a second midwife will usually attend too. This means there is a midwife to look after you and one to look after your baby – just in case.

You still have pain relief option at home. You might choose to hire a pool, TENS machine, or use many of the natural methods of pain relief. Your midwife will also be able to bring gas and air for you to use.

Being in your own environment makes it easier to relax and often birth happens better at home because of that. No stress or worries, and your own calming environment means the cocktail of hormones are able to flow in just the right combination. You also have the support of a midwife who is confident to look after you this setting; she will encourage you to move, help you stay focused and in control. If you and your partner have this covered she will sit quietly and observe. This means you are less likely to need the pain relief you might have had in hospital.   

There are lots of great parts to being at home. You can move around as you like, eat and drink as you choose, be comfortable in your surroundings and your midwife is your guest rather than you being theirs. It is much easier to feel in control. And let’s not forget the huge bonus of your own bathroom and bed afterwards!

If you have older children you might want them there with you or have someone else to take care of them (at home or elsewhere) but it can make the logistics a little easier (have a just in case back up plan though).

If you need to transfer to hospital your midwife will discuss it with you. There are lots of reasons you might need to relocate but mostly they aren’t an emergency and you can make your own way. It could be your need for pain relief, meconium in your waters, baby’s heart rate etc. It might be that you birth at home but there are concerns afterwards and you need to go to hospital for some observations. If it is needed your midwife will call an ambulance to take you. Check with your hospital how many home births they do and what the transfer rate is, it will give you an idea on how they manage home births.

I am sure at least one person reading this is thinking ‘No way, what about all the mess!. Honestly this is the one occasion where you should be the last person worrying. Your midwives will have the usual absorbent pads for you to use and you can easily protect areas with plastic sheeting covered in blankets, throws or an old duvet and towels. Some home birth midwives will pop a wash on for you when they clear up or your partner can do it. A cold rinse first is always good for blood but you might be surprised how little mess there is.

If you know people, or you are that person, saying they would have died in they weren’t in hospital take a moment to look at what happened. It might be true, but would they have been in the same position in they weren’t in hospital? Did they have interventions that wouldn’t have happened at home? Sometimes labour ward is safer but the evidence shows that, certainly for low risk births, home is a safer place to be.

Your midwives will have things with them to deal with emergencies in your home. They will bring resus equipment for baby and drugs to deal with blood loss from you. They are well trained to manage situations that may arise.

Midwife Led Unit (MLU) or Birth Centre

A place that is staffed by midwives and support workers is the Midwife Led Unit or Birth Centre – the same thing but called differently in different places. It might be located in the maternity department of the hospital or could be a stand alone location in a community hospital or other venue with no other maternity services. These units provide a home from home environment with reassurance of being in a medical setting for the back up if you need it.

The rooms are usually designed to feel more relaxing and comfortable than a hospital room would do with any medical equipment hidden away, no hospital bed in the room and more things to promote natural birth like pools, bean bags, stools, balls etc. You can expect dimmable lighting and a calm, relaxing space.

You will have access to gas and air and possible opiate drugs like pethidine or diamorphine and will be supported by the team of midwives. In some locations you may be offered aromatherapy or hypnobirthing techniques to help you.

These units provide a really lovely space for birth, away from the medical feel of the labour ward but a great compromise if you aren’t comfortable being at home. Being somewhere so relaxing is great for the progress of your labour and you will have a midwife looking after you who will be able to help and encourage you with lots of tools to manage your contractions.

Usually the MLU is for lower risk women because there are doctors there, no continuous monitoring (they will still check your baby regularly) and so less medical back up if there are any complications. But, if you are low risk then the evidence show that an MLU is the safest place to have your baby because the chance of you needing that intervention is low but would be increased if you were in the labour ward.

If you are not low risk and would like to consider the MLU have a conversation with your midwife or doctor. As with the home birth you can work together to get a plan in place that works for you. That might be with access to the MLU or it might be on the labour ward but with support to birth in the way you wanted to.

If you do need more medical help or maybe you want an epidural you would need to transfer to the labour ward. If you are in an onsite MLU that will be really easy, just a quick trip along a corridor or in a lift and you will be there. The midwives looking after you will talk you through this if it needs to happen and ensure you understand and agree to the change in care needed. If you are in a stand alone unit it will probably be an ambulance transfer to your nearest maternity unit. This could be during your labour or afterwards, if you need medical attention for you or your baby.

Like with the home birth, your midwives will be well trained to deal with any situation that arises and there is equipment there if baby needs help after birth or you do. If an emergency occurs the necessary staff can be called to the MLU to assist.

Labour Ward/Delivery Suite/Obstetric Unit

It might come under various names but this is where the medical equipment is, where the doctors work and where the theatres are.

Birth here tends to be more medicalised, with more monitoring of babies and you and more interventions.

This may be the best place for your birth if you pregnancy has been more medically complex or there are any concerns about you and your baby. You have access to all the emergency care should you need it and things are more closely monitored by the doctors.

It can mean a less relaxing environment but lots of hospitals work hard to still have that feel. You will be more aware of medical equipment and there might be more people coming and checking in on you. If you have monitoring, an epidural or any IV drugs it can restrict your movement and position choices but you can ask for help to move around if you want to.

The reason the MLU or home is considered safer for lower risk women is because once you come into this more medical environment with more checks, more equipment, more interruptions it can really disrupt your focus and your labour. It can actually cause more complications in a labour that was otherwise unfolding quite nicely, and that can lead to more interventions being needed.

For some people the labour ward feels like the right option because all the medical back up is there if you need it and it feels like a safety net, but you are more likely to need it because you are there. This is when the MLU option can be good, if you need that extra medical care it is just along a corridor.

If you want an epidural then the labour ward is the place you need to be so that may be a consideration for you if you know it is part of your plans.

What is best for you?

This might have give you a lot to think about and there will be more considerations. If you haven’t already, speak to your midwife or doctor about your preferences for birth and see what is best for you. That doesn’t mean they will tell you what to do! They can advise you with information and then you can make your choices. It is your call and if you want to do something that is outside the usual guidelines for your hospital there will be someone you can speak to to make a plan that works for you.

You can read more about the Birthplace Study here https://www.npeu.ox.ac.uk/birthplace/results