Almost as soon as you know you are pregnant your thoughts will turn to choosing baby’s place of birth. Often you are asked this as soon as you tell people you are pregnant – but do you know what the choices are? How do you know what would be best for you?
The decision should take many factors into account. In this summary I will try to set out some of the factors to think about when you are choosing baby’s place of birth, and some which may lead you to question your assumptions.
Homebirth
For millions of years, our ancestors had no choice but to birth at home (or wherever they were at the time). In much of the world, that is still the case. In the UK, most births happened at home until the 1960s. The reasons for the move to hospital birth are complex, but in large part was based on statistics which were at best “questionable” and could be argued to have been selectively presented at the time to support the medicalisation of birth for all.
Sixty years on, there is research evidence that indicates that for healthy women who have had a normal pregnancy, homebirth is at least as safe as hospital birth – and has a very much lower chance of interventions. The Hutton report looked at 14 studies which covered 500,000 homebirths. It concluded that “the risk of perinatal or neonatal mortality was not different when birth was intended at home or in hospital”. That is important to remember when choosing place of birth.
Having had two of my three children at home, I am very aware of the peace and comfort that comes from being in your own home. As a midwife, I am the guest, invited to join the family for this momentous occasion. A very different situation to the hospital ward which is super familiar to staff but totally alien to most of those giving birth.
Find out more about preparing for a homebirth here.
There are sadly only a few midwives outside the NHS who have insurance to provide care for homebirths. This is a legal requirement. I am very fortunate to be part of the Private Midwives organisation, which means that I have access to professional support and I work closely with a few Private Midwives colleagues. We always aim to have two of us at a birth. We have exactly the same initial qualification as hospital/NHS midwives, and between us have many years and a great range of experience. We bring with us the equipment and knowledge to deal with complications that can arise at any birth. The very great difference we bring is that we get to know our clients really well before labour starts. We understand what is important for you. We often visit in early labour, then can leave you in peace for a while, but you know we are nearby and ready to return when you need us. Once labour is established we stay with you, focussing only on you. We monitor your blood pressure and other important signs, and check baby’s heat beat, position and movement hour by hour.
Many people are worried because they have been told that labour and birth are very painful. In reality we all experience things differently, but it is important to recognise that feeling safe and relaxed makes the power and intensity of the experience easier to cope with for many people. You may use skills such as hypnobirthing, you may choose to use a pool or be held/massaged and we can also use entonox gas. We do not give injections of painkilling drugs like pethidine at home.
There are circumstances when homebirth does not feel to me to be appropriate, because 21st century medicine may be needed to give the best outcome for you or your baby. Such situations include preterm birth, insulin dependent diabetes, very high blood pressure and others, but every situation is unique and worthy of discussion. Sometimes during birth the situation changes – such as if there is a lot of meconium (baby poo) in the amniotic fluid – and I would advise (and can arrange) transfer in to hospital. Sometimes the birth is very prolonged or much more painful that the client feels able to deal with at home and we can transfer in for those reasons too. We are lucky in the UK to have that option and I always discuss possible scenarios with clients in advance. As a private midwife I am not allowed to provide hands-on midwifery care for you in hospital (because of hospital insurance issues) but I can normally accompany clients who birth in hospital.
Midwife led birth centre
Birth centres are run and staffed by midwives. No doctors are there and so the level of care and support available is very similar to what midwives can offer in your home. Some birth centres are “co-located” with a consultant led delivery suite (ie in the same building), others are “freestanding” (ie geographically separate).
Generally in recent years birth centres have been more aesthetically pleasing and less obviously medical, often with medical equipment hidden out of site. Some are positively spa-like! The idea of this more homely environment is to enhance relaxation and allow the flow of oxytocin, the love hormone, that drives labour.
Factors to consider are that you need to travel there whilst in labour, and would have to relocate if issues arose which required medical care – just as you would if birthing at home. Pain relief options are the same as for a homebirth. If you wanted an injection (perhaps if you are having a very protracted early labour) or an epidural you need to move to the ward where there are doctors available.
A birth centre can be a great solution if you want a low intervention, midwife led birth but do not have suitable facilities at home. I have had clients opt for a birth centre because they are in the process of rebuilding their home and it is a building site, or because their home is small and busy and the idea of peace and quiet for birth is very appealing!
Consultant led unit/ delivery suite/labour ward
Most people when choosing baby’s place of birth in the early 21st century picture the medical environment of a hospital delivery suite. It what you tend to see in films. A major potential problem is that this unfamiliar and potentially stress inducing environment can have exactly the opposite effect on the body to what is needed to encourage physiological birth processes to work. Adrenaline, the stress hormone, can lead to labour slowing down or stopping – we tense up when we are frightened. It is a common experience for someone to be apparently strongly in labour at home, only for everything to stop when they travel to or arrive at a hospital. Once they settle in and meet a warm and supportive midwife and start to feel safe again, labour will restart. This is sometimes referred to a sphincter law.
I am always delighted when I hear about initiatives in local units to personalise and demedicalise the environment. Very simple things help – keeping lights dim & curtains closed, playing your choice of music and so on. Although the room will have a hospital bed in it, that doesn’t mean you have to get onto it! I have worked with many people who have given birth on the floor or standing in such a room. Most units also have access to birth pools as additional options.
For some people, a consultant led unit is absolutely the right place to be, to benefit from advance medical care. Continuous monitoring of baby’s heartbeat, epidural anaesthesia or an assisted or caesarean birth may be entirely appropriate for you and your baby, Natural birth can be wonderful, but it isn’t right for everyone. Medical care can be literally lifesaving.
When choosing baby’s place of birth there are a great many issues to take into account. Something I suggest to read and think about is this piece by the wonderful Trisha Anderson. Sara Wickham has some valuable resources on her website and I suggest her book “What’s right for me” is a great start point for thinking clearly about your perspective and preferences rather than just going along with what others assume is “best”. However, as I often say to my clients, very few people become pregnant just to be pregnant. Being pregnant and giving birth are steps on the way to meeting your baby. The route may not turn out to be the one you expected, or the one that you preferred – but a safe birth and a healthy baby and parent is the ultimate goal. Nature isn’t always kind, and sometimes the use of modern medicine is absolutely justified to maximise your safety. Talk with your midwife, find out about the options and work out your preferences, but try to remain open minded and adjust your plans if things change.