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Key takeaways

• Choose to give birth at home, in a midwife-led unit, or in a hospital.
• NHS maternity care is free for those who are 'ordinarily resident' in the UK.
• You will always receive maternity care, even if you are charged for it.
• Costs for chargeable care can be around £7,000 or more.

Your maternity care options on the NHS

Deciding where to have your baby is an important choice. You can give birth at home, in a unit run by midwives, or in a hospital. Your choices depend on your needs, any risks, and where you live.

Home birth

If you choose a home birth, your midwife will help you decide if it is suitable. A midwife will support you during labour at home.

If you need help, or if your labour is not progressing well, your midwife will arrange a transfer to hospital.

Midwife-led units

Midwife-led units, also called birth centres, offer a more comfortable and homely environment. They are run by midwives and focus on birth without medical intervention. These units can be part of a hospital maternity unit or separate from a hospital.

If a unit is separate, it may not have immediate access to specialist medical care. This includes:

• An obstetrician (a doctor specialising in pregnancy and birth).
• Care for your newborn baby.
• An anaesthetist (a doctor who can give certain types of pain relief).

You may need to transfer to a hospital if complications arise.

Advantages include feeling more relaxed and being cared for by a midwife you know. If your pregnancy is low risk, you are less likely to need interventions like forceps.

Hospital birth

Most births 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. You will still have choices about the care you receive.

Hospital births are recommended if your pregnancy is high risk or if you have certain medical conditions. For example, if you are expecting twins or if your baby is lying feet first (breech).

Hospital units have doctors who specialise in pregnancy and birth (obstetricians). Doctors who give certain types of pain relief (anaesthetists) are also available.

They also have specialist care for newborn babies (neonatal care) on site if needed for your baby.

Considering private maternity care

You can choose to receive some or all of your maternity care privately. This is a separate option from NHS care and you will need to pay for it.

You can choose an independent or private midwife who works outside the NHS. They may be self-employed or work for a private company.

You can also receive care in a private hospital or a private wing of an NHS hospital. Most private maternity hospitals in the UK are in London.

You can pay for private scans even if you receive the rest of your care through the NHS.

Choosing private care does not mean you opt out of all NHS care. You can still access NHS scans, blood tests, and any specialist or emergency care you need.

Eligibility for free NHS maternity care

Everyone in the UK is entitled to NHS maternity care, regardless of their citizenship or immigration status. This includes:

• All standard scans.
• Blood tests.
• Midwifery.
• Care from a doctor who specialises in pregnancy and birth (obstetric care).
• Specialist care. This care is considered immediately necessary, as it is vital for your health and your baby's health.

Free NHS maternity care is generally available to those who are 'ordinarily resident' in the UK. The rules for who is considered ordinarily resident are complex.

They depend on your nationality, immigration status, and the circumstances of your residence in the UK. For example, British citizens who do not ordinarily reside in the UK are not eligible for free care.

Exempt groups

You may not have to pay for NHS maternity care even if you are not ordinarily resident. This applies if you are in an exempt group. Examples include:

• Someone who has claimed asylum and is waiting for a decision.
• Someone who has been granted refugee status.
• A UK Government employee or their spouse or civil partner.
• Individuals granted Leave to Enter or Remain in the UK who paid the Immigration Health Surcharge.
• Individuals granted Leave to Enter or Remain in the UK who were exempt from paying the Immigration Health Surcharge.

If you are not ordinarily resident and not in an exempt group, NHS Trusts must charge you for your care. However, you must still be given maternity care even if you cannot pay. Care must not be delayed or refused.

The charity Maternity Action can provide advice on these rules.

Understanding charges for NHS maternity care

You will be charged for NHS maternity care if you are not ordinarily resident in the UK and not in an exempt group. This includes care in hospital, in the community, and at home. Your NHS Trust must tell you if you will be charged for your care.

The amount you are charged will depend on how complex your care has been. The cost may not be easy to predict. As of 2021, the minimum charge for maternity care that includes the birth is around £7,000.

If you cannot pay

Even if you cannot pay for your care, you must still receive it. Care cannot be refused or delayed.

If you are charged and cannot afford to pay, the Trust must discuss a repayment plan with you. This plan should be based on your income and expenses.

The NHS must tell the Home Office about unpaid charges of over £500. This applies if the charges have been outstanding for more than two months. However, the NHS cannot tell the Home Office if you have agreed to a repayment plan and are following it.

You can seek free help with understanding the rules and agreeing to a repayment plan. Contact Maternity Action or Citizens Advice for support.