Birthplace Choices

 

Planning for your labour and birth can often feel daunting, especially if you are first time parents. Choosing where to give birth is one of the most important decisions that you make during pregnancy. There is no ideal time to decide where to give birth, and you can change your mind as your pregnancy progresses. Everyone has different thoughts on what their ideal birth environment should be like, so it can be a good idea to have a think about which aspects of birth are important to you. Our midwives and doctors will support you and your birthing partner to prepare for labour and the birth of your baby. Taking into account the wellbeing of you and your baby, they can talk through all the options available, enabling you to choose where to have your baby.

Wherever you choose - hospital, midwife-led unit or home - the place should feel right for you.

 

You can also look at the Which? Birth Choice website for more information.

 

Birth is generally very safe for healthy women and their babies. In the UK, midwives and doctors are trained to respond to birth emergencies and to ensure you have access to the right care. However, healthy women are much more likely to have interventions (such as caesarean or birth assisted by forceps or ventouse/vacuum) if they plan to give birth in obstetric units, compared to similar women who plan birth at home or in midwifery units . Intervention rates are lower for planned home and midwifery unit births, even if women are transferred into obstetric units during labour, so the increase is not because women can’t have interventions at home or in midwifery units. However, it is really important that you feel safe and supported in making the right choice for you and your family.

 

Home Birth

 

The Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists support home birth for women with uncomplicated pregnancies, and suggest it may have considerable benefits for them and their families. There is considerable evidence showing that giving birth at home increases a woman's likelihood of a birth that is both satisfying and safe.

 A recent Lancet paper looking at outcomes of half a million mothers all booked for homebirth found the following outcomes:

40% less needed a Caesarean section
50% were less likely to have an instrumental birth
55% were less likely to have an episiotomy
40% were less likely to have a 3rd/4th degree tear
75% were less likely to have an infection

These results were regardless of where the birth actually happened. So even if the mother required transfer to hospital, they were still more likely to have improved outcomes.

For full paper please follow this link

 

The Birthplace Study 2011 found that for women having a second or subsequent baby, home births appeared to be safe for the baby and offered benefits for the mother.

 

For women having a first baby, a planned home birth increases the risk of a poor outcome for the baby by a very small amount, compared with giving birth in hospital. This includes a slightly higher risk that the baby will be injured, become seriously unwell or die during or just after birth. These outcomes are very rare among healthy women with uncomplicated pregnancies, and they can happen in any birth setting.

 

The Birthplace Study showed that the transfer rate into hospital was 45% for first-time mothers and 10% for women in subsequent pregnancies.

 

The advantages of giving birth at home include:

  • being in familiar surroundings where you may feel more relaxed and able to cope
  • less chance of interventions during the labour process
  • you don’t have to interrupt your labour to go into hospital
  • you will not need to leave your other children, if you have any
  • you will not have to be separated from your partner after the birth.

 

There are some things you should think about if you’re considering a home birth:

  • you may need to transfer to a hospital if there are complications This means that, in an emergency situation, it will take longer to get specialist treatment for you and you baby which may be associated with a poorer outcome.
  • epidurals are not available at home
  • your doctor or midwife may recommend that you give birth in hospital; for example if you are expecting twins, or if your baby is breech – your midwife or doctor will explain why they think a hospital birth is safer for you and your baby.
     

Midwife led Units

You can choose to give birth at a midwifery unit or birth centre. Midwifery units can either be alongside a hospital maternity unit  (Dundee Midwifery Unit ) or can be freestanding from the hospital ( Angus Community Midwifery Unit & Perth & Kinross Community Midwifery Unit ). Both types of midwifery unit are led by midwives and tend to be more comfortable and homely. In the birth centre  philosophy, pregnancy and birth are normal and healthy processes that should be interfered with as little as possible.

In separate birth centres, you won’t have immediate obstetric, neonatal or anaesthetic care. If you’re low risk and whether you’ve given birth before or not, having your baby in a midwifery-led unit can be a good option. That’s because you have a lower rate of intervention at a midwifery unit and it’s as safe as giving birth in a hospital.

It’s important that you and your partner research possible choices for birth near to where you live and discuss your birth options so you can make an informed choice. You can weigh up the advantages and disadvantages of giving birth at each location. If you’re willing to travel, you can choose any maternity services.

The advantages of giving birth at a midwifery unit include:

  • being in surroundings where you may feel more relaxed and better able to cope with labour
  • the unit potentially being much nearer your home.
  • lower likelihood of having an intervention such as forceps or ventouse than women giving birth in hospital

 

There are some things to think about if you're considering giving birth in a midwifery unit or birth centre.

You may need to be transferred to a hospital if there are any complications. The Birthplace study found that approximately 4 in 10 women having their first baby in a midwifery unit or birth centre were transferred to hospital, compared with approximately 1 in 10 women having their second or subsequent baby.

You will be have to transfer to Labour Ward , if you wish  to have certain kinds of pain relief, such as an epidural .

Your doctor or midwife may feel it's safer for you to give birth in hospital.

 

Obstetric Unit (Labour Ward )

In an obstetric unit (OU), care is provided by a team of midwives and doctors.  You’ll be looked after by midwives, but doctors will be available if you need their help.
Labour and Birth in an obstetric unit benefits women who have problems either with their own health or the current pregnancy.You may be encouraged to have OU (labour ward) birth if during your pregnancy you have complications which indicate that this is the safest option for you and your baby.
 There are many reasons why Labour ward  would be suggested as the best place for you to give birth; you will be able to discuss those reasons individually with your consultant and midwife. It is important to know, that if recommended birth in labour ward you will still have choices about the care you receive and will be encouraged to participate in any necessary decision making processes. Your midwives and doctors will provide information about what your OU can offer. Although the environment is more clinical , we try to make it as comfortable as possible for you and your partner .

Advantages of OU birth include:

  • direct access to obstetricians if your labour becomes complicated
  • direct access to anaesthetists, who  provide pain relief options such as epidural and will assist in labour suite & theatre if so required
  • there will be specialists in newborn care (neonatologists) and a special care baby unit if there are any problems with your baby

Considerations

  • There are some things you should think about if you’re considering a OU birth:
    you may go home directly from the labour ward or you may be moved to a postnatal ward.
    in hospital,
  • women giving birth in OU are more likely to have an epidural, episiotomy, or a forceps or ventouse delivery. Statistically, you're more likely to have medical interventions, for example a c-section, if you're planning a birth in a labour ward.