Wait, I Can Choose Where I Give Birth?

Yes, yes you can. Infact, this is one of the most important choices you will probably make for your birth, although I feel like most women don’t even realise they have a choice. The culture is slowly changing, as home births become more popular and healthcare professionals are getting better at providing options. So, how do you even decide?


You need to be in a place where you feel safe. You also need to be somewhere that you don’t feel too disturbed (difficult, I know, when midwives are caring for you).


You should consider the pros and cons for all of your options. Just because someone may recommend somewhere for you to birth, it does not mean you have to go along with it. Doctors, midwives, friends and family all have their opinions, but at the end of the day it is up to you to decide whether the benefits outweigh the ‘risks’ of your chosen birth place.


The Birthplace Study (2011) is a good resource to start with. They looked at 64,000 women, their intended place of birth and then outcomes such as whether they had a vaginal birth, caesarean section, epidural, tearing, water birth or baby admitted to the neonatal unit. They split the data into whether it was a woman’s first or subsequent baby (this has some impact on the outcomes). Although it is slightly outdated now, it is the most reliable evidence currently available with regards to birth place.


This post will give an overview of your choices and over the coming weeks I will go into more depth about each option.



The Obstetric Unit (Labour Ward)

  • In the hospital

  • The most common place of birth by ‘default’

  • Where you may be recommended by the doctor to give birth, if you have had any complications with your health, during pregnancy, previous births or your baby’s wellbeing

  • All the medical pain relief options are available

  • Likely to have a limited amount of pools for water birth, if they are available, they will be on a first come first served basis and not guaranteed

  • All the medical professionals are available – midwives, obstetricians, anaesthetist, paediatricians, theatre team

  • You will be cared for by a midwife, unless issues arise which require a doctor

  • There is a lot of medical equipment around, the bed is the centre of the room and space may be restricted

  • 46.4% of first time mothers and 79% of second time (or subsequent) gave birth vaginally when an obstetric unit was their intended place of birth

  • Lowest rate of water birth

  • Highest rate of caesarean section, when this was a woman’s intended place of birth (13% and 4%)


A Room In A Labour Ward

The Midwifery Led Unit (MLU)

  • Staffed by midwives only, no doctors available

  • May be attached to the main hospital, or completely free-standing

  • You will be cared for by midwives only, unless complications arise, in which case you may have to consider transferring to the obstetric unit

  • Classically for women who are ‘low risk’

  • You will have gas and air (Entonox) and possibly pethidine (an opiate) available to you as medical pain relief options

  • Birthing pools are widely available

  • You may have other options such as TENS, aromatherapy and massage available to you

  • Have an incredibly relaxed feel to them, your partner is more likely to be able to stay the night when the baby is born

  • A home from home environment

  • 71% of first time mothers and 94% of second time (or subsequent) gave birth vaginally when a freestanding unit was their intended place of birth

  • The highest rate of waterbirth of all birth places

  • Low caesarean section rate

Eastbourne Midwifery Unit

Home

  • In your own comfortable environment, that you can make your own

  • You should have 2 midwives at the birth, one for you and one for the baby

  • Recommended if you are ‘low risk’

  • If a complication arises, you may have to consider transferring to the obstetric unit via ambulance, but the midwives are very good at picking up problems quickly, so that you are transferred efficiently

  • The most common reasons for transfer are the request for an epidural, ‘slow progress’ or meconium in the waters (baby poo, which can be a sign of distress)

  • Around 50% of first time mums and 25% subsequent births were transferred to hospital

  • You will have gas and air (Entonox) available to you

  • You can have a birth pool, which you will be required to purchase yourself

  • You will have other options such as TENS, aromatherapy and massage

  • You can have as many birth partners as you feel comfortable with

  • For first time mothers, the rate of vaginal birth was 69.3% and subsequent 95.9%

  • The only slightly raised ‘risk’ of home birth identified was a 1.08% adverse outcome for the baby in a first time mother (compared to 0.28% in an obstetric unit), although this is still low and ‘adverse outcome’ was not defined

  • Please consider that we risk assess for home births, but not for a hospital birth. Why is this? Hospital births also carry ‘risks’ which we should consider

  • The midwife will have all the equipment required to manage any immediate emergency and is very well trained for this

What feels safest for one person, is not for another. Some people feel comforted by being in the hospital, whereas others hate the idea. It is important to look at all your options and make yourself as comfortable as possible with each option, because when you are in labour, anything can happen and you should be equipped to make informed choices about where you are giving birth, no matter what. Have a look at what is available in your area.


To find out more, stay tuned for further posts and get in touch if you would like to chat more about hypnobirthing!

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