Where will you have your baby?

Having a baby is generally very safe for women in the UK, which is why it is important that you are offered a choice of where to have your baby.

In Powys you can choose to have your baby:

• At home (yours, or perhaps that of a family member or friend if that feels right for you)
• In one of our midwife-led birth centres
• In a hospital labour ward

However, there are important factors which need to be considered when you are deciding the best choice for you, your partner and your baby. To help you fully understand the differences between these choices in relation to your own personal circumstances, ask your midwife to explain the benefits, risks and alternatives for place of birth as they apply to you and your baby.

It is important that you choose a place to have your baby that makes you feel safe, comfortable and in control of your choices as these will make a difference to your overall birth experience. It is important to know that whatever your decision, you can always change your mind at any time during your pregnancy.

Choosing place of birth - James, one of our midwives, talking about some of the considerations when choosing where you would like your baby to be born.

Introduction to place of birth – James looks at some of the statistics.

Some other sources

Which: Birth Choice - Which have an interactive tool to help with decision making.

Birthrights is a charity working to make sure decision-making in maternity services is based in a human rights approach.

The NHS pregnancy pages have great detailed information.

The Tommy’s charity website has lots of information about where you can have your baby.

The NCT is a charity working to support parents.

NICE, the National Institute for Health and Care Excellence, regularly review evidence for safe care.

Planning to give birth at home may be something that has always been on your radar, perhaps because of the experiences of family and friends, or it may be something that doesn’t sound like something that would be for someone like you!

We invite you to consider it, even if you hadn’t previously, as there can be significant advantages.

Home birth is safe and families who experience it find it a very relaxing and personalised experience.  Being in your own space can be very relaxing, both during the labour, and afterwards when you snuggle up in your own bed.  Many partners find home birth is less stressful, also. 

We are very experienced in supporting home births and have a good home birth rate. 8% of pregnant women who have care from Powys midwives have home births. Of the women who have their babies in Powys 40% give birth at home.

Being at home may help you feel more relaxed and in control and this can help the labour progress better and is linked to better emotional outcomes for women.

Many of our home births are planned, but some are unplanned and this might be because the woman has waited until her labour has started to make her decision about place of birth, or she has had a home assessment and labour is progressing well.

Home birth options can include water births and you can either buy or hire birth pools.

All midwives carry the equipment needed for a home birth in their cars. This includes entonox (gas and air) and oxygen. This equipment is exactly the same as would be available in the birth centre.

We aim to have 2 midwives present for your baby’s birth. One midwife is responsible for you and the other is responsible for your baby.

After your baby is born, the midwife will stay with you for around 2 hours to ensure that both you and your baby are well.

One of the things that people are concerned about with home birth is ‘mess!’  Don’t worry, the midwives will have a chat to you about some simple and cheap supplies you can find to protect your floors and furniture – this would mainly be from your waters breaking and from the normal bleeding which occurs after the birth.  The midwives will then clean up after the birth and remove any waste (just as they would in the hospital.)  If you hire or buy a birth pool, your birth supporter/s will need to empty and clean this.

Some possible advantages of birth at home are:

• You may feel more safe and relaxed
• This may be a good option if you feel nervous of hospitals or strange places
• Good research (see section 1) shows that women who give birth at home need fewer interventions and use less medicines for pain relief
• You have complete freedom to choose any birth partners, including perhaps your other children
• You don’t have to worry about when and how to get to hospital
• There is no chance of a hospital-acquired infection
• You have access to your own choice of food and drink at all times
• It may be easier for you to choose comfortable positions for your labour
• Your partner can choose whether to be with you all the time, or spend some time in a different room
• Our midwives are skilled at home birth and can advise you if something happens which means it would be a good idea for you to change your plan and move to hospital
• More restful after the birth – you will be able to sleep in your own bed!
• There is a very good chance you will have met the midwives who look after you – we cannot guarantee this, however

Some possible disadvantages of birth at home might be:

• Not all options for pain relief are available at home – you can’t have an epidural or injected pain relief
• If there are complications during your labour (see Transfer section) you may need to change your plan and go to hospital
• You may be worried about nosy neighbours or about noise
• You may be worried about space or access to your home.  If you know you are planning a home birth, one of our midwives will ask to have a look at the space/s you are planning to use and may give you some advice about, for example, where to place a birth pool.

We have freestanding midwife-led birth centres within our community hospitals in Welshpool, Newtown, Llanidloes, Llandrindod Wells, Knighton and Brecon.

Birth centres offer a home-from-home environment which actively supports and promotes physiological birth and aims to be welcoming and nurturing.

You will have the opportunity to have some or all of your antenatal care at your local birth centre, so it will become a familiar environment.

Our birth centres all offer a birth pool, plus a variety of aids designed to support you in labour such as of birthing balls, birth mats, birthing stools and chairs, in a warm, calm environment.

Our midwives are all skilled in waterbirth and can all provide aromatherapy to support your labour. We actively support hypnobirthing.

Following birth we always support uninterrupted skin-to-skin contact with your baby.

All our birth rooms have en-suite loos and almost all have en-suite bathrooms.  Hot drinks and snacks are available to you and your partner/s at all times.

You can have as many birth partners as you would like and there are no restrictions on visiting times in our birth centres. Your birth partners are welcome to stay with you.

Many of our clients choose to return home fairly soon after the birth, with six hours being the average, but you can leave earlier or later than that.

Some possible advantages of birth in a freestanding birth centre are

• For most Powys residents, a birth centre is well within a half hour drive.  This is slightly longer if you live in Ystradgynlais or Machynlleth
• This may be a good option if don’t want or need to go to a hospital labour ward, but home birth isn’t for you
• Good research (see section 1) shows that women who give birth at home need fewer interventions and use less medicines for pain relief
• You can have any birth partners and there is no restriction on visiting times – if your family want to come and see the new baby at midnight, they are very welcome!
• Birth centres are separate from the hospital, and only take care of healthy pregnant women, so there is a low chance of a hospital-acquired infection
• You always have access to drinks and snacks
• Our midwives are skilled and can advise you if something happens which means it would be a good idea for you to change your plan and move to hospital
• After the birth there is no need to move to another ward – you, your partner and your baby can all rest together in the room you gave birth in.  Sometimes we may ask you to move into another room if there is someone else in labour
• There is a very good chance you will have met the midwives who look after you – we cannot guarantee this, however

Some possible disadvantages of birth in our birth centres might be

• Not all options for pain relief are available – you can’t have an epidural
• If there are complications during your labour (see Transfer section) you may need to change your plan and go to hospital
• For some of our residents a birth centre is some distance away and you may have an alternative service closer

For some women, giving birth in a hospital, with immediate access to doctors who specialise in higher risk pregnancy or doctors who specialise in the care of newborn babies with complications will definitely be advised, and will be safer.

Some examples of this would be if you have Type 1 diabetes, if your labour is premature, if you are having more than one baby, or if you have a serious pregnancy complication such as pre-eclampsia.

For others, giving birth in hospital, just in case that specialist care is needed, feels like the safest thing to do.  Also, some people know in advance that they will need or want a Caesarean section, or epidural pain relief, or a longer postnatal stay than we offer in Powys.

Depending on where in Powys you live you will be aware of which hospitals are closest to you.  Your midwife can let you know which services are available – do check, as some hospitals may for example offer an obstetric led birth service, but no neonatal services.  Services offered change across time as well so check with your midwife.  Some women will have to travel to a hospital which is further away, for example to access specialist neonatal care.

Hospital labour units will generally have the same equipment, such as birth pools, as our birth centres, although as they are busier you may not be able to use them.  You will have your own room for labour and birth, but you will need to move to another ward, where you may be in your own room, or you may be in a bay with other women who have just given birth.  Hospitals have different visiting rules – while your partner can stay with you the whole time you are in labour, they may be asked to leave and attend at set visiting times after you have moved to the postnatal ward.

If you have decided to give birth in a hospital outside of Powys, you will need to make your own way there when you are in labour.  Generally you would ring them directly to arrange admission, though if you are unsure of whether you’re in established labour, or whether it is safe to travel, or still undecided about

where to give birth, you can have a labour assessment at home from a Powys midwife.

Pregnancy and birth can be quite unpredictable, and plans may need to change at short notice. 

Sometimes complications can occur at the end of your pregnancy – for example you may develop signs of pre-eclampsia, a potentially serious complication, you may labour early, or we might find out your baby is not growing as well as they should be.  In this case you may be advised to change your plans and birth in a hospital, instead of at a midwife led unit.  This can also happen in the other direction – perhaps there are concerns about your pregnancy, and then they resolve, and you may then choose a home birth instead of hospital.

Sometimes of course complications can occur during the labour process, and you may be advised to transfer to hospital from home or a birth centre. 

Some of the main reasons why this may happen are:

• Your labour is very long, either in the first or second stages – transfer recommended for a full obstetric review, and perhaps medicine given to make your contractions stronger, or assistance given to birth your baby
• Assessment of your baby’s heart rate is difficult or suggests there may be a problem – transfer recommended for continuous electronic fetal monitoring.
• Your waters (liquor) are coloured by thick meconium (dark green or black) – transfer recommended for full review and electronic fetal monitoring
• You need epidural pain relief.
• Concerns about your heart rate, blood pressure or temperature, suggesting you may have a medical complication such as infection – full obstetric review and possible treatment needed
• Suspected unusual or breech presentation of the baby
• Heavy vaginal bleeding, either before or after the birth
• Difficulty delivering the placenta
• Suturing (stitches) needed following the birth that need obstetric review (your midwife can almost always provide perineal suturing in Powys, but sometimes review is needed)
• Your baby is born needing some support to establish breathing – although our midwives are fully trained and update in resuscitation, transfer is recommended for review by a neonatal doctor, and a period of observation

This list is not exhaustive, and other reasons may come up, but be assured you will be kept fully informed and involved in decision making.

Transfer to hospital is something that we know people worry about when making the decision about where to birth, but remember, if you plan to birth in hospital from the outset, you have a 100% chance of having to make that journey in labour!

Our most recent statistics show that 18% of our clients need to be transferred to hospital during labour, which means that 82% of people (more than four in five) who plan to birth at home or in one of our midwife led birth centres do so.

A further 5% of the people who birth locally need to transfer post birth. 

Very few transfers in labour are ‘emergencies’ – but if an emergency does occur you will be transferred to hospital in an ambulance, with your midwife on board.  For some things, if there is not an immediate risk to you and your baby, and you are not in established labour, we may advise transfer in your own car, or in a taxi which we will arrange, with a midwife escort.