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Key takeaways

• You can choose to give birth in a hospital, birth centre, or at home.
• Midwives will support you in any chosen birth location.
• Your pregnancy risk level helps guide your birth location choice.
• Discuss your birth preferences with your midwife early on.

Exploring your birth location options

You have several options for where to give birth. These include hospitals, birth centres, and your home.

Hospital birth

Most births in the UK happen in an NHS hospital maternity unit. If you choose a hospital birth, midwives will look after you on the labour ward. Doctors will be available if you need their help.

Hospitals offer access to obstetricians (doctors who specialise in pregnancy and birth) if your labour becomes complicated. Anaesthetists are also available if you need an epidural or general anaesthetic. A special care baby unit is on site if your baby needs some extra help or monitoring after birth.

Birth centres

Birth centres are run by midwives. They aim to offer a more comfortable, homely environment. These are also known as midwife-led units, midwifery units, or birthing units. Birth centres focus on birth with less medical intervention. They often have a more relaxed atmosphere and more birthing pools. They may be part of a hospital or completely separate. Separate units do not have access to certain types of pain relief, such as an epidural.

Advantages of a midwifery unit include feeling more relaxed and being better able to cope with labour. You are also more likely to be looked after by a midwife you know. The unit may also be much nearer your home.

Most birth centres have certain rules or criteria for who they can safely accept in their centre for delivering their baby. Ask your midwife if you are suitable for having your baby in your local birth centre if this is what you wish.

Home birth

You can choose to give birth at home. In England, about 1 in every 50 babies is born at home.

A midwife will come to your home when you are in labour. They will stay with you until after your baby is born. A second midwife will join you before the birth for extra help. If you need help or your labour is not progressing well, your midwife will arrange for you to transfer to hospital.

Home birth is usually recommended if you have a straightforward pregnancy. Both you and your baby should be well.

Giving birth is generally safe wherever you choose. If this is your first baby, it's helpful to know that a home birth has a slightly higher chance of the baby needing extra help compared to a hospital birth. This risk increases from 5 in 1,000 for a hospital birth to 9 in 1,000 for a home birth. 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.

Understanding your caregiver choices

When planning your birth, you will primarily be cared for by either an obstetrician (OB-GYN) or a midwife.

Obstetricians (OB-GYNs)

Obstetricians (OB-GYNs) are doctors who specialise in pregnancy, childbirth, and women's reproductive health. They manage both routine and high-risk pregnancies. They can also perform medical interventions, including C-sections.

If you have a complex medical history or develop complications during pregnancy, an OB-GYN will typically lead your care.

Midwives

Midwives are healthcare professionals who care for women during pregnancy, labour, and birth. They also provide support in the postnatal period. They support women with low-risk pregnancies, focusing on natural childbirth and providing emotional and physical support.

Midwives can deliver babies in hospitals, birth centres, or at home. They work closely with OB-GYNs and can refer you to a doctor if complications arise.

How to decide what's right for you

Choosing where to have your baby is an important decision. Your midwife will discuss the options available in your area. Depending on your situation and any risks your pregnancy may have, they can advise you on the most appropriate choices for you.

You can usually consider any birth location. You can also change your mind at any point in your pregnancy.

Factors to consider

• Your pregnancy risk level – If your pregnancy is high risk or you have certain medical conditions, it is safest to give birth in hospital. Specialists are available there if you need treatment during labour.
• Low-risk pregnancy – If your pregnancy is low risk, you might give birth at home or in a midwife-led unit. In these settings, you are less likely to need assistance such as forceps or ventouse.
• Personal comfort and values – The place you choose should feel right for you. Think about what would be the most relaxing labour experience.
• Pain relief options – Consider the pain relief options you would like to have available.
• Facilities and equipment – Think about equipment you would like to use, such as birthing pools.
• Avoiding interventions – Consider if you want to avoid interventions like forceps.
• Special care for your baby – You might prefer to be in hospital in case your baby needs special care after birth.
• Local services – Find out what maternity services are in your area and how close they are. You are free to choose any maternity services, even if you need to travel.

Types of units

• Alongside midwifery units – These are midwife-led units within or on the same site as a hospital that provides obstetric care.
• Freestanding midwifery units – These are midwife-led units on a separate site from a hospital that provides obstetric care. They may be on their own or on the same site as a community hospital.
• Obstetric unit – This is within a hospital, with consultant obstetricians and anaesthetists available. Care for newborn babies (neonatal care) is also on site if needed.

Your midwife can explain the pros and cons of each place of birth during your antenatal appointments. Some labour wards and birth centres offer tours. Most will also have video tours on their website.

Discussing your preferences with a potential caregiver

Your midwife will encourage you to make a birth plan. This helps you think about your choices and what you would like to happen during the birth. The plan will be included in your maternity notes or app.

What to include in your birth plan

Your birth plan can include many things. These are some examples:

• Who you want to be with you at the birth.
• Where you want to give birth.
• What is important to you when moving into different positions during labour and birth.
• How you want your baby's heart rate to be checked and monitored.
• How you feel about having your labour induced or contractions increased.
• What kind of pain relief you may like access to.
• If you plan to use hypnobirthing techniques.
• Your feelings or preferences about an assisted delivery, if one is needed.
• Your feelings about potential interventions, such as an episiotomy.
• How you want the delivery of the placenta and membranes to be managed (the third stage of your labour).
• Whether you want your baby to have vitamin K after they are born.
• Your preferences for skin-to-skin contact with your baby after they are born.
• Any special needs you have, such as a sign language interpreter.
• If you would like to follow any religious customs.

Discussing your preferences

Your midwife can answer your questions about labour and birth options. They can help you work out your wishes for your birth experience. If there are labour interventions you would prefer not to have, tell your midwife in advance. You can then discuss the risks and benefits.

Making notes ahead of time can help you remember your questions. You can also make your own notes of meetings with your care team. If you want to record meetings, let the healthcare team know.

A good way to discuss preferences is to say: "This is what I would like. How can we work together to achieve that?"

If you need to assert yourself or gain clarity, consider using phrases like:

• "It feels like you're not hearing what I'm saying."
• "It feels like you're pressuring me."
• "Am I in immediate danger? Is my baby in immediate danger?"

This helps start a conversation about the actual risk and how urgently a decision is needed.

It is always okay to ask for a moment to think. You can say, "I need a minute to think," or simply, "Stop, please."

While a birth plan is not a legal document, it is an important guide for your care team. If it has been agreed with your midwives and doctors, they should follow it. They should respect your choice of care, even if it is not what they recommend.

Remember that birth plans sometimes need to change during labour. You may not always have the birth you planned. Your baby's safety and yours are very important. It can help to think of changes as keeping your baby safe.