Birth options Heather Welford One important decision you need to make during pregnancy is where you will give birth. Here are some of the things to consider before reaching your decision.

In this article

Place of birth Hospital birth Home birth

Birth centres Birth plans

Special situations Questions to ask

You can use your pregnancy as time to research your options for the birth. Talk to other women to find out about their experiences, discuss the issues with your midwife and read about them, too.

You'll usually have a choice of location for the birth. There may be a number of maternity units in your area, or a birth centre, or you may choose to have your baby at home.

You can get any information you need from your doctor, midwife, other mothers and organisations such as the National Childbirth Trust, BirthChoiceUK and the Association for Improvements in the Maternity Services.

You should consider:

• Whether this is your first baby
• Whether you're having one baby, twins, or more
• How any previous pregnancies and births went
• How your pregnancy is going at the moment
• Any special health needs
• Where you'd prefer to give birth

If you're over 40, some doctors and midwives might underline your age in discussions, but age in itself needn't change your decision.

Bear in mind circumstances that may have an impact on your choices. If you go into labour early, for example, or if it becomes clear your baby isn't growing well, you may be better off at a consultant-led maternity unit as small babies may need immediate paediatric care.

Normally, you 'book' your birth at your chosen hospital near the beginning of your pregnancy, although you can change your mind later if you want. This booking appointment may happen with a midwife, at your doctor's surgery or at the hospital.

If you have a choice of hospitals, think about the distance of the hospital from your home, not just for the birth but also for any antenatal clinic appointments you may have there. Ask other mums about their experiences.

Do some research on the policies and practices of hospitals in your area. The BirthChoiceUK website might help if you're keen to avoid a particular type of birth.

If you're not expected to have any problems with your pregnancy or birth, there's no evidence to suggest that a planned home birth is any less safe than a hospital one.

You can book a home birth with your doctor, a community midwife or an independent midwife. You'll have to pay for the latter, although the fee may be on a sliding scale according to ability to pay.

If you find you're having problems arranging a home birth, or are being pressured to choose a hospital birth, talk it over with your health professional.

There are a few birth centres in the UK that aim for a home-style birth but with medical technology on hand if necessary. They aim for a more personal level of care than can usually be achieved in a large maternity unit.

Some birth centres work within the NHS, others are private. Check with your midwife for details.

Writing a birth plan helps you to focus on the different aspects of your care during labour and birth. Your midwife might ask you about your plan as you get towards the end of your pregnancy, and she might be able to help with any information and advice you need. Ask as many questions as you want to work out what you'd like.

A copy should be kept with your notes. Take your own copy to hospital when the time comes.

Nothing in your plan has to be fixed

Nothing in your plan has to be fixed. You can change your mind at any time, even at the very last minute. Circumstances might change, too, which could make you see things differently or change your needs.

It's best to think of the plan as a guide for you and the people caring for you, rather than a blueprint of what has to happen.

Think about:

• How you feel about the induction or acceleration of labour
• Who you want with you during labour
• Whether you'd like the option of a birthing pool for labour and/or birth, for some of the time or all the time
• How you want your baby's heart rate to be monitored
• Your pain relief options
• For a hospital birth, how long you want to be in for (although you may not get the choice)

Having someone who can support you emotionally throughout your labour and birth is very helpful.

Research has found that mothers who have continuous support during labour have less need for pain relief, fewer interventions (including a caesarean section), shorter labours and high levels of satisfaction. Their babies were less likely to be born distressed, too.

If you have any potential difficulties with your labour - an underlying medical condition, you become ill or your baby develops a problem - you may be advised to go to a hospital where there's more specialist care on offer.

Antenatal care:

• What are my choices for antenatal appointments? Are they all at the hospital clinic or just some?
• Does the antenatal clinic run an appointments system?
• If I decide to take antenatal classes, where and when are they held?
• How likely is it that I'll have met the midwife who will help me in labour?
• Will I be shown around the labour and postnatal wards before the birth?
• Is there a chance for me to discuss and work out a birth plan?
• Can I be seen by a doctor of my choice if I prefer - for example, a woman?

Labour and delivery:

• Who can I have with me in labour?
• Will I be helped and encouraged to move around in labour?
• Can I choose my own position for the birth?
• Will my partner be able to cut the cord?
• Are we allowed to take photos/film of the birth?
• What's hospital policy on induction, pain relief, routine monitoring (or any other aspect than concerns me)?
• Will I be supported if I don't want to follow the routine policy?

Postnatal care:

• Are babies given every opportunity to enjoy skin-to-skin contact after the birth and throughout the hospital stay?
• What services are there for babies who have to be separated from their mothers because of illness?
• Who'll help me breastfeed my baby?
• How long can I expect to stay in hospital?
• What are the visiting hours?
• Are there any special rules about who can visit?

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