Choosing where to give birth: what are the options?

To explore your birth location options, start by consulting your midwife or healthcare provider. They will be able to point you in the direction of the facilities and services available in your area. You can also take a look at the NHS website which should offer detailed information on birth locations. Typically, you can choose between giving birth in a hospital, a midwife-led unit (otherwise known as a birth centre), or at home. 

Hospitals are often regarded as the standard setting for birth, but this is largely due to societal expectations rather than necessity.

Midwife-led units or birth centres are run by midwives and offer a middle ground between home and hospital births. They can be attached to hospitals or operate as standalone units. They provide a homely environment with the added safety net of medical care if needed.

Home births can offer comfort and familiarity as you bring your baby into the world, which can enhance relaxation and hormone release.

It might surprise you to learn that for your body, delivering your baby in hospital is not the norm! In fact, hospital births are a societal expectation and this stems from a belief that birth is dangerous and should be managed closely. The truth is that your body is built to give birth, and you should do it wherever you feel most comfortable. For many people this is at home, but your choice will be individual to you and shouldn’t be influenced by anything other than your gut feeling.

You have the right to decide where to give birth, whether it be at home, in a hospital, or at a birth centre. The choice is entirely yours and you should feel free to assert your preferences and make your wishes known. 

In some cases there may be restrictions on your right to choose to give birth at a hospital or birth centre, but no one can force you to give birth away from home unless you lack the mental capacity to make decisions for yourself, which is rare. Usually, individuals maintain the capacity to make informed choices about their birth location without the influence of healthcare providers. 

It’s also worth noting that while medical advice is valuable, it’s just that – advice. You have the right to ask questions, seek second opinions, and ultimately decide what feels right for you and your baby. The support you receive should empower you to make the decisions that align with your instincts, free from coercion. As you approach motherhood, you deserve to feel in control, respected, and confident in the choices you make.

If you’re considered high-risk during your pregnancy, it’s completely natural to have questions about where you can give birth. Your healthcare provider should be there to discuss your options with you.

While they might suggest a hospital birth for added medical support, you have the right to ask questions and understand their reasoning. Your preferences and comfort matter, and you can make choices that feel right for you, even if they differ from the recommendations.

Some women find that working with independent or private midwives provides the reassurance they’re looking for. Gathering all the information available and discussing it with your midwife will empower you to make the best decision for your situation. For additional guidance and support, the resources from IMUK are worth a read.

Hospitals or labour wards can provide a huge sense of security as you give birth, knowing that immediate medical support is available if you require it. They’re equipped with technology and highly trained staff, and this is useful if any unexpected complications arise during labour. But rather than automatically deciding to give birth in hospital because it’s seen as conventional, it’s helpful to consider both the benefits and the possible drawbacks of this option to ensure it aligns with your preferences.

Pros:

• You’ll have direct access to obstetricians if any complications arise.
• Anaesthetists are available if you decide to use an epidural for pain relief. It’s worth noting here that if the anaesthetist is unavailable, you will have to wait for an epidural, and this can be distressing for some women. 
• Neonatal specialists and special care baby units are on hand to provide extra care if your baby needs it. This is rare. 

Cons:

• There will be a higher likelihood of interventions such as continuous monitoring, epidurals, instrumental births, or c-sections.
• Sometimes, these interventions can lead to further complications which may not be made clear. 
• You might be attended by a different midwife than the one you’ve known throughout your pregnancy, which could affect your continuity of care and your overall labour experience. 
• The clinical environment can be busy and noisy, which can make labour longer and more painful due to the fact that your natural hormone release is suppressed when you’re in a poor birth environment. 
• Every hospital has different practices for interventions, so researching statistics and discussing your options with your midwife can help you make a well-rounded decision. The maternity audit page of the NHS website is a good place to start with this.

Midwife-led units, often referred to as birthing centres, provide a warm and welcoming environment that many people find more home-like compared to traditional labour wards. These centres can either be independent or part of a hospital, but while they offer a cosy setting, they may not have immediate access to specialised obstetric care.

Pros:

• You’ll enjoy a relaxed, home-from-home atmosphere that can help your labour progress smoothly and enhance your overall birth experience.
• The quieter, calmer environment is conducive to what your body needs for labour to progress and be less painful. 
• Many birthing centres have birth pools, adding an extra element of comfort.
• There is often a reduced likelihood of interventions during labour, allowing for a more natural birthing process.

Cons:

• In case of complications or if you choose an epidural, you might need to transfer to a hospital. It’s a good idea to find out how long on average it would take to transfer to the nearest labour ward or hospital so you can weigh up your options.

Opting for a home-birth means delivering your baby in the comfort of your own home. They are supported by midwives who are often familiar faces you’ve met during your pregnancy. A planned home birth is as safe as giving birth in a hospital or midwife-led unit.

Pros:

• Being at home can help you feel more relaxed and may contribute to a smoother labour process.
• There’s no need to interrupt your labour to travel to a hospital, meaning you can bunker down and stay in your preferred environment.
• If you have other children, you can keep them at home, reducing the stress of arranging childcare and increasing oxytocin levels. 
• There’s more flexibility with birth partners, so you can include more family members or friends in the experience if you wish.
• After the birth, you’ll stay with your partner and you’re likely to be cared for by a midwife you know, enhancing your continuity of care.
• There’s also less chance of picking up infections from hospital.

Cons:

• If at any point during your home-birth a situation arises that requires a hospital transfer, you might need to go to a hospital. Your midwife will discuss this with you and make sure you’re comfortable with the arrangements before moving you. It’s important to consider how long it may take to get there if you do need to be moved.
• Some medical interventions, like epidurals or pethidine, aren’t available at home, though there are other pain relief options like gas and air, birth pools, and TENS machines. It’s helpful to understand these options ahead of time so you can feel fully prepared.

 Choosing freebirth, or unassisted birth, means giving birth at home without the presence of a midwife. While this choice is legal, it can come with risks (just like every birth location choice does!), so it’s wise to discuss your plans and any concerns with a midwife in advance. They will be able to help you understand and manage these risks on your own, and personalise your birth plan so it feels right for you.

Some women find it reassuring to hire private midwives or doulas (non-medical birth companions) for extra support during a freebirth. If you change your mind at any point, NHS midwives or paramedics should always be available to assist you. For more detailed information on freebirth, you can visit AIMS.

When it comes to booking and planning for your preferred birth location, your midwife will talk through your options during your initial appointment. But you don’t need to decide immediately – in fact, you have the flexibility to change your mind about where you want to give birth at any stage of your pregnancy. It’s important to gather information, understand your rights, and choose the setting that feels truly comfortable. Whether you opt for a hospital, a midwife-led unit, or a home birth, make sure that your decision reflects your personal feelings and circumstances.

Choosing where to give birth is a decision that should be made with careful consideration, factoring in your personal comfort, safety, and birth preferences. Each location has its unique advantages and potential challenges, and only you can decide which one feels right for you and your baby.

Your midwife and healthcare provider are there to support you in making this decision, ensuring that you feel empowered and confident in your choice of birth location. Do your research, stay informed about your options, and make the choice that best suits you and your family!