Where to give birth may seem like a difficult decision, with a lot of things to consider, or it may seem straightforward and obvious from the outset – and you may find that many people have an opinion about where you should give birth!
Where to have your baby is your choice to make. Giving birth is generally very safe for women in the UK and it is important that you are offered choice of where to have your baby. We can give you advice, but the final decision is yours.
At your first visit, your midwife will advise you of the different options for where you can have your baby, taking into account previous pregnancy history and any medical issues.
If there are no problems, you will be given the choice of having your baby at home or in one of our Midwifery led birth centres, or a neighbouring district general hospital.
If your midwife thinks you need additional care, they will recommend that you birth in a district general hospital obstetric unit, where you will have access to obstetric, anaesthetic and midwifery care.
Discussions about where to have your baby will happen throughout your pregnancy, and advice may change if your health or pregnancy circumstances change.
Your midwife will facilitate a full birth plan discussion with you and your birth partner/s at around 36 weeks of pregnancy, although if your pregnancy is straightforward, you can leave the decision on where to give birth until you are in labour if you prefer.
We base our advice and discussions with you around the best available evidence. This includes the Birthplace Study Birthplace in England Research Programme | NPEU (ox.ac.uk) which showed definitively that midwife led birth settings (home and birth centres) are just as safe for babies as hospital birth, and offer significant advantages in terms of outcomes for mothers.
Decisions on where to give birth are personal to you. You need to decide what factors are important for you. These may be based on any number of factors such as distance, birthing environment, or options for pain relief.
If you are finding it difficult to choose where to have your baby you can delay deciding until late in pregnancy, there is no need to decide at your first appointment although your midwife will introduce the options to you
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:
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:
Some possible disadvantages of birth at home might be:
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
Some possible disadvantages of birth in our birth centres might be
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:
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.