Home, hospital or birth centre?


Which would you choose?decisions pic

Hopefully at the beginning of pregnancy when you meet the midwife, you will be asked ‘Where would you like to have your baby?’ It seems unless you’ve already done a bit of research, or have a circle of friends who all gave birth at home, most women would probably say ‘hospital’. Well that’s where you have babies right? One Born Every Minute is in hospital. EVERYONE has their babies in hospital don’t they?

You don’t have to though. There’s home and there’s birth centres too. But if you didn’t know you had a choice, or the reasons why those choices are available to you you’d probably just go with what’s ‘normal’. Which in the UK today is hospital.

Sadly lots of women still aren’t being given a full run-down of their choices.

“I was advised not to have a homebirth as it’s my first baby.”

“I didn’t know there were other options apart from the hospital.”

Just to clear up the first myth – yes you can choose a home or birth centre for your first baby.  Sadly we’ve got a high transfer rate for first time mums in the UK at almost 50% . But most of these transfers in labour appear to be for slow progress, and not life-threatening emergencies.

I am not convinced that our bodies were made with such a design flaw that we can’t be trusted to birth our first babies successfully without intervention. My thoughts: An easy birth for your first baby.

This article gives a thorough examination of the ‘assessment of progress’ in labour.  Are you dilating at the appropriate speed? Are you dilating effectively? Could this be at the root of all those transfers?  The Assessment of Progress

And this one explores the 2nd stage of labour – lots of transfers occur when mums have been ‘pushing for too long’.  Pushing for first time moms

Perhaps we’re misjudging and misunderstanding the birthing process which is most likely to be a little harder and longer in first timers. All I know that I’ve worked with midwives who have a virtual 0% transfer rate from home/birth centre, and I know it’s not luck. They respect and support women and the physiology of birth.

The biggest question asked by women is ‘Is it safe?’  Good question. Staying at home to have your baby, or in a stand alone birth unit – which is no different than home – doesn’t have that ‘safety net’ you find in hospital. You will be cared for by midwives, there are no doctors available, no operating theatre and no neonatal unit. If the birth centre is not on the same site as the hospital, if an emergency arose you would be transferred in an ambulance. Just the same as home. Sounds a bit scary doesn’t it?

However, we have research that tells us as best it can how safe home and birth centres are. A large study looking at around 64,000 births of mamas with low risk pregnancies in 2010, demonstrated that giving birth at home or in a birth centre, was as safe as giving birth in a hospital with emergency facilities. The Birth Place in England Research Programme Q&A neatly explains the key findings of the study including the difference between all the options available.

One of those key findings was that mamas choosing to birth outside of a hospital had an increased chance of a normal vaginal birth, and less chance of interventions.

However it suggested that babies of first timers were at a slightly increased risk of an ‘adverse outcome’. 9.3 per 1000 births as opposed to 5.3 per 1000 births planned in an obstetric hospital. So for every 1000 babies, 4 more are at risk if their mamas choose to stay at home.

What would you do?

So you can stay at home and have more chance of a normal birth, or try to eliminate risks by going to hospital. Although going to hospital doesn’t actually eliminate risks does it? 5.3 babies per 1000 are still at risk. And then there’s the increased chance of interventions in your labour, with all the subsequent risks that each of those entail. No intervention is without risk. And actually no birth is without risk either.

When I’ve talked to mamas about choosing where to have their babies, I like to understand where they’re coming from. What journey have they had to getting pregnant, who is this woman, her thoughts and belief about birth, and her views on risk and safety.

There isn’t one answer that’s right for everyone. Just because research says it’s safe doesn’t mean you’d feel safe there, whether that’s home, hospital or birth centre.

What’s right for you?

  • Do you want to reduce your chances of intervention in birth?
  • Do you want to maximise your chances of a normal birth?
  • Do you want a more physiological/natural approach to birthing your baby?
  • Are you prepared for a transfer time if an emergency arose in labour?
  • Do you feel confident in your body to birth your baby without intervention or epidural?
  • Are you prepared to take responsibility for your choice?

Maybe home or stand alone birth centre is for you.

  • Do you want the option of an epidural?
  • Would you be anxious if you weren’t in close proximity to doctors, operating theatre and a neonatal unit?
  • Do you acknowledge that you may have an increased chance of intervention in your birth?
  • Do you accept that you may have less chance of a normal vaginal birth?
  • Would you feel safer and more able to relax with high-tech equipment at immediate availability to the midwives and Drs?

Then hospital is probably right for you.

Choosing carefully where you birth your baby is a crucial decision that may impact on the course of your labour. I’ve seen mamas having ecstatic, empowered births in hospitals, and peaceful beautiful births at home. But it has to be your choice, and a truly informed choice, where you can trust your body, your baby and your caregivers.

No choice is without risks, whether that be home or hospital. But if you really understand and take that responsibility for your birth, perhaps you will come out of it feeling truly empowered.

PS. This post has been written mainly with healthy, first-timers with a low risk pregnancy in mind. That doesn’t mean it’s not relevant if you’re high risk though. Don’t write off your options before fully understanding the risks and benefits of place of birth in your own case.

These are some useful links to find out more about your choices and rights.

Choice of place of birth  : your rights to your choice

BirthChoice UK     : find your local maternity statistics and choices

Midwifery units and birth centres

Unassisted birth : the legal position on freebirth

Facing critiscm

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