You will be asked to make a choice of where you have your baby quite early on in your pregnancy. Rest assured that you can change your mind later if you want to – just discuss it with the relevant teams. You may even have to change your mind – for example, if you have chosen a home birth, but your pregnancy becomes more complicated. Your choice may also vary between areas. For example, some areas might not be well equipped for supporting home births.
The usual range of choices includes:
For most people, safety is the most important consideration. For a first baby, it is slightly safer to give birth in hospital than at home. For a second or subsequent baby, assuming the first birth was normal, a home birth is as safe as a hospital or midwife-led birth unit birth.
If you decide on a home birth, make sure you discuss what happens if you need to be transferred to hospital during labour. You need to consider things such as how long it would take for you to get there, and whether this would be sufficient time given an emergency. You also need to find out what would happen if you haven’t booked in in advance and the hospital maternity unit is full at the time you need to go in in an emergency.
If you have a medical condition or a high-risk pregnancy, then probably you will be advised to give birth in hospital. There you will have instant access to any extra help you may need.
In a report from NICE (the National Institute for Health and Care Excellence in the UK) released in December 2014, the guidelines on birth location were changed. Professor Mark Baker, NICE’s clinical practice director, said:
Around 1 in 50 women in the UK give birth at home. If you make this choice, you will be supported by a midwife throughout, and she will make arrangements for you to be transferred to hospital if anything goes wrong.
The advantages of a home birth include:
The disadvantages of a home birth include:
A midwife-led birthing unit may be independent or part of a maternity hospital. They are generally more cosy and comfortable than a hospital.
The advantages of a midwife-led birthing unit include:
The disadvantages of a midwife-led birthing unit include:
Most women in the UK – over 90% – give birth in hospital.
The advantages of a hospital include:
The disadvantages of a hospital birth include:
A natural birth generally describes a vaginal delivery where the woman labours with support from her midwife and birth partner, doesn’t have any pain relief and there is no medical assistance during the actual delivery. A natural birth can take place in water, squatting, kneeling on all fours or even on a bed. After the birth, the baby is passed straight to the mother and placed on her chest. If the birth is in a pool the mother may bring her baby out of the water herself.
The cord will not be cut for several minutes until it has stopped pulsating to maximizes the blood that is passed through the placenta to the baby. You will not have a managed third stage either. Instead, the placenta will be expelled naturally by contractions whilst the mother cuddles or breastfeeds her baby. After a natural birth, the mum and baby are generally left in quiet and low lights.
A woman can feel very disappointed and like a failure, if they wanted to have a natural delivery but needed help. It’s important not to feel like this. Remember that the ultimate goal of any decisions around labour and birth is your safety and that of your baby, so don’t be hard on yourself. There are lots of chance factors during labour and every birth is a unique event.
Water can play a wonderful role in birth, whether during labour or for the birth itself. Most midwife-led units and labour wards offer water birth as a birth option. Being in warm, deep water allows women to get in lots of comfortable positions to both cope with contractions during labour and deliver their baby. It has been argued that a water birth makes the transition from the warm, watery environment of the womb to the outside world more gentle for your baby. Babies can be safely born underwater without the risk of drowning as they receive their oxygen via the umbilical cord until they take their first breath of air. Due to the ‘dive reflex, ’ a baby does not take its breath of air until its face comes into contact with air, an amazing instinct to witness. Midwives have reported that babies born in water are calmer and cry less than other babies.
If you have a low-risk pregnancy your antenatal team should support you in wanting to use a birthing pool. During a water birth, you can only have gas and air for pain relief – you can’t have pethidine or an epidural. However, provided you are on a labour ward if you are struggling to cope you can ask to come out of the water and have pain relief.
Active birthing seeks to use gravity and your body movements to help birth your baby. The angle of the birth canal means that when you are lying down your baby you effectively have to push your baby ‘uphill’ to deliver her. By being in a more upright position gravity helps your baby move down through the birth canal. You can have an active birth in a pool too. Good positions for active birth include:
Active birth is a very woman-centred approach to birth, which seeks to empower and encourage pregnant women to get in touch with their own bodies and to keep active during labour. It works with a woman’s body and mind to bring their babies safely and gently into the world using the natural positions, and the techniques teach pregnant women to think and respond to labour with a positive mindset. Relaxation and visualisation techniques help cope with the contractions.
Your birth partner can work with you during an active birth to help you get into comfortable and effective positions. You might find it helps to stand with your arms over your birth partner’s shoulders, or if you are sitting on a birthing ball or chair you birth partner can massage your back to help ease any back pain.
Hypnobirthing, sometimes known as the Mongan method is a deep relaxation technique in which you take yourself into a state of hypnosis during labour (or your birth partner can hypnotise you). The theory is that anxiety and stress slow down and disrupt the natural process of labour. Indeed it is well-documented that labour can completely stop in both animals and labouring women during high stress.
There is also evidence that our pain perception is affected by anxiety levels – anxious people feel more pain from the same stimulus than relaxed people. If you are interested in using hypnobirthing it should be part of your birth plan. You will need to attend a special course with your birth partner speak and learn the hypnosis techniques before you go into labour.
Hypnotherapy is used before the birth in the antenatal period to embed positive messages and feelings about the birth into your brain. The idea is that when you go into labour you will respond to the birthing process more calmly and embrace it. If you would like to try antenatal hypnotherapy you will need to find a therapist who specialises in antenatal hypnotherapy and book in several sessions before you baby is due.