Where to give birth

Most people assume they’ll have their baby in hospital. If TV programmes are anything to go by, that usually looks like a bright, medical space with lots of Doctors rushing in and beeping machines.

The reality can be completely different. Even on the deemed ‘high risk’ labour wards, the environment tends to feel much calmer as you receive one on one care with your midwife. The Doctors are around, but they tend to stick to popping in for reviews (with your consent of course) and being called when Midwives need assistance or a second opinion.

Aside from the Labour Ward, there are also Midwife led units, Midwife stand alone units (sometimes known as birthing centres) and the option to have your baby at home.

There is a lot of talk about whether you are ‘allowed’ to give birth at home or on the labelled ‘low risk’ units. You have birthing rights as much as you have human rights (check out Emma Ashworth for more on birthing rights), however the Doctors and Midwives are there to recommend what they think is safest based on their policies and research. This does not mean you have to follow what is recommended, it means you can be given all the information and make the decision that is right for you and your family.

A lot of the information you will be given about where to give birth will be from the Birth Place Study (Brocklehurst, 2011). It showed that women planning to give birth on a midwifery led unit or at home, had no difference in the outcome of the babies wellbeing than those in the labour ward. It did find there was a slight increase in the baby being poorly when born for first time mums who chose a homebirth. The figures they are talking about is 5 per 1000 births in hospital and 9 per 1000 births for homebirths (NHS, 2024).

Once you start to understand the differences between these environments, it can really shift how birth feels for you. Not just practically, but in terms of how safe, calm, or in control you feel while it’s happening.

Midwife led units can be attached to the labour ward/ maternity ward or they can be freestanding. The ‘criteria’ hospitals have for them are usually the same. Anyone who doesn’t require constant monitoring (also known as CTG machines), usually is offered these places. Please remember, you still have a voice and a choice. In these units, there are no Doctors! It is one to one care with the Midwives. All policies vary from trust to trust but usually, you can only have limited pain relief here. So if stronger pain relief is important and part of your plan, make sure to ask what they can offer so you don’t need to change location unexpectedly during your labour!

Wherever you choose, labour is predominantly done at home. Your contractions will usually start there and you aren’t encouraged to come to the hospital until you are in ‘established’ labour. Which means the contractions are frequent and lasting a good minute. The early work of labour is tough, involves lots of patience and sometimes isn’t spoken about much! But this is the hard graft. When we aren’t pushing a baby out but the body is getting ready to do exactly that. So even if you are on the fence about a home birth, prepare to labour in your own space for some time. Think about the environment, the things you may need and action your birth plan from then! Not when you first step into wherever it is you may have chosen to give birth. A template to help guide your birth preferences is a great place to start, we have one here at The Naked Doula, a visual one, to make this step less daunting. 

This is usually the point where it helps to have things thought through in advance, rather than trying to figure it out in the moment. Some women find it useful to have something simple to refer back to here, so they’re not trying to hold everything in their head once labour starts.

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