Articles

Key takeaways

• Midwives are your main contact for straightforward pregnancies.
• Obstetricians specialise in more complex pregnancies and births.
• Doulas offer emotional and practical support during pregnancy and birth.

Choosing your primary care provider

Midwives are trained to care for you during pregnancy, labour, and after your baby is born. They are the primary caregiver for straightforward pregnancies and births. You will have several visits with your midwife throughout your pregnancy.

Your midwife is your first and main point of contact. They will provide most of your care during pregnancy and for the first few days after your baby is born. Midwives can work in communities and hospitals.

Independent midwives

A midwife who works outside the NHS as a self-employed professional is known as an independent midwife (IM). They provide the same antenatal, labour, and postnatal care as NHS midwives. Independent midwives charge for their services. They often attend home births. In some places, they can provide clinical care in hospitals. In other areas, they may only act as a doula within the hospital setting.

Obstetricians

A doctor who specialises in more complicated pregnancies and births is called an obstetrician (ob-ste-trish-an). Your midwife will refer you to an obstetrician if tests or your medical history suggest you need extra care. You may see a consultant obstetrician at least once during your pregnancy.

It is unlikely you will see an obstetrician if your pregnancy is straightforward. Obstetricians can help with vaginal births using special instruments to help guide your baby out (known as forceps or ventouse). They also perform caesarean births and manage complications after birth.

Choosing where to give birth

You can choose to give birth at home, in a midwifery unit (birth centre), or in a hospital. Your choices depend on your needs, risks, and where you live. You can consider any of these locations.

If your pregnancy is high risk or you have certain medical conditions, giving birth in a hospital is safest. This ensures specialists are available if you need treatment during labour. If your pregnancy is low risk, you are less likely to need assistance like forceps at home or in a midwifery unit.

Hospital birth

If you choose a hospital birth, midwives will look after you on the labour ward. You will have access to obstetricians if your labour becomes complicated. Anaesthetists are available if you need a type of pain relief where medicine is injected into your back (an epidural) or general anaesthetic.

There is also a special care baby unit for babies who need a little extra help after birth.

Midwifery unit or birth centre

Midwifery units or birth centres are often more comfortable and homely than a hospital maternity unit. They are run by midwives and focus on birth without medical intervention. They can be part of a hospital unit or separate. Separate units do not have access to some types of pain relief, such as an epidural.

Home birth

Around 1 in 50 babies in England are born at home. If you give birth at home, a midwife will support you during labour. A home birth is usually recommended if you have a straightforward pregnancy and both you and your baby are well.

For first-time mums choosing a home birth, there is a slightly higher chance of needing to transfer to a hospital during labour. Your midwife can talk you through this in more detail to help you decide what is best for you. If you have had a baby before, a planned home birth is as safe as having your baby in hospital or a midwife-led unit.

Making your decision

Your midwife and obstetrician will help you plan your baby's birth. They will give you information to make the right decisions for you. You should be offered a full discussion of the risks and benefits of all options.

You can think about the pain relief options you want and the facilities you would like to use. Consider the maternity services in your area and how close they are. You can change your mind about your birthing options at any point in your pregnancy.

Building your pregnancy support team

You may meet other professionals during your pregnancy. If you have health problems during pregnancy, you may see a consultant obstetrician. They are a hospital doctor who specialises in treating complications during pregnancy, labour, and after birth.

They work alongside midwives.

You might also be referred to other specialists, such as doctors who specialise in the health of babies during pregnancy (fetal medicine experts). These experts ensure you and your baby receive the best care.

Doulas

A doula is someone who can support you one-to-one through your pregnancy, labour, and birth. They can also provide support after you have your baby.

Doulas offer practical and emotional support. They do not have to be medically trained. Doulas cannot replace the clinical care you receive from your midwife or doctor. They provide extra support and help you find information to make informed choices. Research shows that continuous support during labour can lead to less need for assisted birth, caesarean sections, or pain relief.

Who you'll meet during labour and birth

During your labour and birth, you will be supported by a midwife. You may have more than one midwife if your labour lasts a long time. Once you are in established labour, your midwife will give you one-to-one care.

They will check on the wellbeing of you and your baby. They will also help you give birth to the placenta and support you with infant feeding choices.

Doctors during birth

If necessary, your midwife will consult with a doctor. For more complicated labours or births, a doctor will support the birth alongside a midwife. An obstetrician is a doctor who specialises in more complicated pregnancies and births.

Obstetricians can help with vaginal births that need instruments and perform caesarean births. They also manage complications after birth. In some situations, a doctor who specialises in babies and children's health (a paediatrician) may also be present.

Anaesthetists

A doctor who specialises in offering pain management is called an anaesthetist (an-eez-the-tist). They can provide pain relief like an epidural during labour. Anaesthetists also provide pain management for a caesarean birth. An epidural needs to be given by an anaesthetist. This means it is not available everywhere.

The postpartum and newborn care team

Your baby will be checked soon after birth. This check will be performed by a doctor, midwife, or nurse. They will offer a full health check for your baby within 72 hours of them being born.

Postnatal checks for you

Around 6 to 8 weeks after your baby's birth, you should have a postnatal check with a GP. This check ensures you are well and recovering properly. At this check, you will be asked about your mental health and wellbeing.

Your blood pressure may be checked if you had problems during or after pregnancy. Your GP may offer to check that any stitches you have are healing well. Your GP will also talk to you about your options for contraception for when you feel ready.

Your baby's 6 to 8 week check

Your baby's health will also be checked by a GP at around this time. This is known as the baby's 6 to 8 week check.

Feeding support

Your midwife will help you start breastfeeding after birth. They will help you with the first few feeds in the hospital. Your midwife and health visitor can help you find the right feeding position.

They can also check your baby is feeding correctly. Support with breastfeeding can also come from your health visitor or trained local volunteers. Some neonatal units have a specialist trained to help with breastfeeding and expressing (a lactation consultant).