Preparing for Labour. Where should I give birth? FAQ.
Where should I give birth?
home or hospital?
Do I have options for where I can give birth?
Yes you do Choosing where to have your baby is
a personal choice and knowing all the relevant facts can help you to make an informed decision. You can contact an organization called BirthChoiceUK for more information (see p.310) and talk to your midwife and other mothers in your area to widen your perspective. Where you live will affect your choice, as will the decision to have NHS care, go to a private hospital, or hire an independent midwife, who can arrange to deliver your baby in the local maternity unit If your pregnancy has been straightforward, you should be offered the option of delivering your baby at home, in a birthing centre (if one is available in the vicinity), in a hospital birthing unit (see p 154), or in the hospital obstetric unit itself
Is it safe to have my baby at home?
Research has shown that for healthy women who have had a normal pregnancy. a planned home birth attended by an experienced caregiver is as safe as giving birth in hospital. There are similar findings for
birth centres and GP units. Statistically, women who have home births are less likely to use drugs to cope with the pain and less likely to have an assisted delivery or Caesarean, even if they have to be transferred to hospital during labour. They are also more likely to use upright positions for giving birth compared to hospital births. Likewise, women who give birth in a birthing centre (see p 154) are less likely to use drugs for pain relief and less likely to have their labour speeded up artificially. They are also more likely to be satisfied with the care they receive.
Can I choose which hospital to give birth in or does it have to be the one nearest to me?
Although, technically, you have a right to choose any hospital in which to give birth, you should consider the practicalities of distance for attending antenatal appointments and scans at the hospital you choose, as well as thinking about how far you want to travel while in labour. A local facility is therefore probably the most sensible choice. You may have a variety of services nearby, including hospitals, GP units, or birthing centres Discuss all your options with your midwife and doctor and try to talk to other mothers locally to see if they have recommendations.
My pregnancy hasn’t been straightforward. Will I have to give birth in hospital?
There are several reasons why you may be advised to deliver in hospital. If this is a second baby and there were complications before, such as bleeding in pregnancy or a Caesarean, your midwife might suggest you deliver in hospital. Or if this is your first baby and there are complications, such as diabetes or high blood pressure, or it is a multiple pregnancy, you may be advised to have your baby in hospital
What additional things do I need to think about if I’m having a home birth?
It may be worth having all the items you need for the labour and birth gathered in the place you intend to deliver, and it can also be helpful to organize your items separately from the baby’s items As well as practical items, such as clothing, toiletries, and sanitary pads, you may also want to have to hand music phone numbers, and a camera It’s a good idea to have a well-stocked fridge to ensure that you have nutritious snacks to hand during labour as well as helping you and your partner in the first few days after the birth. Your baby will need nappies, cotton wool, vests, clothing sheets and blankets If you have other children, you may need to make arrangements for them with family friends, or neighbours, or have meals planned for them in advance and plenty of activities to occupy them.
Even though you are planning a home birth, there are occasions when things don’t go quite as you wish and you need to be transferred to hospital. This can happen before, during, or after labour and so even though you may not wish to contemplate this outcome, it’s a good idea to have an emergency bag packed for such an occasion.
Hospital birthing units
Unlike ‘’stand-alone” birthing centres, which may be some way from a hospital unit with emergency equipment a hospital birthing unit is situated in the hospital delivery suite, or nearby, but there is still little medical intervention and doctors are not in the unit. However, if there is an emergency or you want an epidural, instead of having to await transfer to a hospital, the midwife can transfer you rapidly to the delivery suite on site
Do I have a right to give birth at home?
The issue of a legal right to home birth has become a bit complicated recently because there is no right in law for women to give birth at home, and the Department of Health has issued advice to NHS Trusts saying that they should provide a home birth service ‘ where practicable ‘, rather than insisting that they provide one However, the bottom line is that in law no one can be compelled to attend a hospital for treatment or care, and that includes for birth. Your local services are likely to influence your choices greatly and the organization BirthChoiceUK can help to inform your decision (see p 310).
What’s the difference between a birthing unit and a maternity department in a big hospital?
Birthing units are run by midwives and the emphasis is on a natural birth. They can be situated next to a hospital maternity unit or on a completely separate site. Some hospitals have a birthing unit facility in the actual maternity unit, known as a hospital birthing unit (see left), where midwives provide total care in a dedicated area of the maternity unit
As the majority of women give birth without needing medical intervention, these units provide a good alternative to a more medicalized hospital environment. The environment in a birthing unit tends to be more relaxed and flexible, which may appeal if -you want a home birth atmosphere with added support. You will also have continuous support from midwives and may even be attended by the same midwife throughout your labour and birth Furthermore, the midwives in these units are very experienced at handling a birth without medical intervention All of these factors therefore increase your chances of having a straightforward birth.
To be eligible to give birth in such a facility, you would need to have had an uncomplicated pregnancy and be unlikely to require specialized medical care or monitoring in labour and birth. If complications do occur in labour or birth at a birthing unit you would need to be transferred to the nearest maternity unit, although this is a rare occurence as most women in birthing units have been identified as being ”low risk’
If you labour in a standard maternity unit, you can be subject to a range of policies and not enjoy the same degree of flexibility However, you will have access to an epidural and, if emergency intervention is needed, doctors will be close at hand.
I’m booked for a Caesarean as my baby is breech, but I want a natural birth. Is this possible?
You need to discuss this with your midwife and obstetrician and express your preference, as your feelings are an important factor when deciding how to manage your birth. You may be able to have a procedure called external cephalic version (which is usually done around 37 weeks) to try to turn your baby to a head-first position (see p.144) However, if you have this procedure and your baby still remains in a breech position, you may be advised to have a Caesarean, although some obstetricians will support you if you wish to try for a vaginal birth (see p. 183).
I don’t want to be monitored in labour. Will the midwives and doctors listen to me?
Unless there is a medical or obstetric complication, such a previous Caesarean section or high blood pressure, you don’t need to be strapped continually to a monitor to listen to the baby’s heartbeat Instead, a procedure called ”intermittent auscultation’, which means listening in regularly to the baby’s heartbeat with a sonicaid, should be sufficient to monitor the baby’s wellbeing. Ultimately, the choice of monitoring or listening in if all is well, is yours. If a midwife or obstetrician wants to monitor the baby’s heartbeat continuously, they should explain why
It’s a good idea to make a note of your wishes during pregnancy in a birth plan (see p.149) and discuss this with your midwife before you go into labour If you don’t have a chance to discuss this before labour when you do go into labour, the midwife on duty will first take a medical and obstetric history and ensure that you and your baby are well, and will then ask if you have a birth plan, or you can show her the plan.
Can I bring food and drinks into the labour room?
The latest NICE guideline recommends that all women should be able to drink in labour. Water may be refreshing, but isotonic drinks may be more beneficial, as they contain energy-boosting ingredients. If established labour is progressing well and you and your baby are well, you can eat light snacks to give you energy and help labour to progress. However, if you require pethidine or diamorphine, which can make you nauseous or sick, or need an epidural, or other risk factors develop, you may be advised to drink sips of water only. You may also be offered an antacid tablet to reduce acid build-up in your stomach This is a precaution in case you need an emergency Caesarean
Who will be with me while I’m in labour?
If you have a home birth, you will be allocated a midwife who will stay with you throughout your established tabour As you near delivery, she will contact the hospital and a second midwife will be sent to support her and you through the birth. Whoever else you have at your home delivery is
up to you Things may be different in hospital, where it is generally recommended that you have just two birthing partners, simply because the space in most labour rooms is limited. Once in established labour, NICE recommendations are that you are cared for by one midwife throughout labour. In reality although each unit will endeavour to offer one-to-one support, this may not be possible If this is the case, the midwife will be with you as much as she can, will show you how to contact her if she is not in the room, and will be with you for the delivery. It may be wise to organize one or two people such as your partner and a good friend, to support you during labour
and maternity support workers to support midwives Unfortunately, there have been times when maternity units are full If no beds are available, staff will find a bed for you at another hospital: many hospitals have “sister” units, to which they will transfer you. Most
maternity units are not full for long and will organize for you to be transferred back as soon as possible
I keep reading about infections like MRSA and now I’m worried about having my baby in hospital.
Although there is a great deal of media coverage of ‘ superbugs” such as MRSA, most people have
no problems at all with hospital infections. Infections are caused by germs, of which there are four major types: bacteria; viruses; fungi, moulds, and mildew; and protozoa. Hospital infections are bacterial There are thousands of different types of bacteria. Some bacteria, known as helper germs, are friendly or good bacteria, which aid the digestion and absorption of food in the gut. Others can cause infection and illness, methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile (C difficile) being two notable ones of concern in hospital.
MRSA is a bacterium that can live completely harmlessly on the skin of healthy people, but can lead to serious infection in vulnerable individuals. Good hygiene, particularly in the form of simple precautions such as hand washing, is an effective method in the prevention of MRSA infection and your chances of acquiring this in hospital are low. Even healthy relatives and friends of patients with MRSA
I’ve heard about hospitals
being understaffed and women not getting a bed. Is this true?
There are concerns about shortages of midwives and beds. Many hospitals now employ ancillary staff carry no risk If cutlery and plates are washed using soap and water (preferably hot) this removes MRSA, and the risk of acquiring MRSA through contact with curtains, sheets, and pillows is very low Healthcare workers use antiseptic solutions, such as alcohol hand rubs, and more recently many hospitals have alcohol gels for hand cleaning at the end of each bed.
C difficile is another type of bacterium mentioned frequently in the media Hospitals prevent and control the spread of C. difficile with antibiotics general hygiene measures such as hand washing, and by detecting cases early so that they can isolate affected patients to prevent it spreading further.
What measures can I take to prevent my baby or myself getting an infection in hospital?
Regular hand washing by yourself, staff, and visitors are likely to be adequate measures to prevent infection. Take your own soap, a flannel, and moist hand wipes with you. Always wash your hands after using the toilet and always wash your hands or clean them with a hand wipe immediately before and after eating a meal Make sure your bed area is regularly cleaned and report any unclean toilet or bathroom facilities to staff. Breastfeeding will provide your baby with protection against infection. A new innovation, silver-lined pyjamas designed to protect against MRSA, are now on sale in the UK! Silver is thought to have particular antibacterial qualities and to be an effective agent against infection. Hopefully these measures will help you feel in control You are unlikely to be in hospital for very long, and you and your baby should be safe
My partner can’t drive. Can an ambulance take me to hospital?
An ambulance can transport you to hospital in an emergency for example if you are bleeding heavily As this is an emergency vehicle driven by trained operatives it is expensive to provide. If you call an ambulance for a non-emergency you could be taking it away from an emergency situation and putting others’ lives at risk.
Part of planning for labour is finding out which facilities your local maternity unit provides and what you might need to provide yourself to help you through the labour and birth.
* Check if your local unit supplies
equipment such as birthing balls or TENS machines or whether you need to hire these in advance.
* Check in advance if the hospital has a birthing pool and midwives trained to deliver babies in water.
* Find out if your hospital has a dedicated birthing unit (see p 154)
be on call when you go into labour? Or can you call a minicab in early labour? If you can’t organize transport, discuss this antenatally with your midwife or, once in labour, call the labour ward for advice.
Can I ask for a private room in the hospital for me and the baby after the birth?
Unless you give birth in a private hospital, there are few hospitals that offer private postnatal care Many hospitals have postnatal ”amenity rooms”, which are usually single rooms, with or without ensuite facilities, on the postnatal ward These may be allocated to women who need a private room for medical reasons in which case they are free. Otherwise, they are offered on a first come, first served basis, so state in your birth plan if you wish to have one and remind your midwife after the birth.
The cost of these rooms and their facilities can vary between units and covers the room only The midwifery care is given by the staff on the postnatal ward and, in most units, your partner and visitors will still have to abide by the ward visiting times.
Although there are no guarantees that your labour will proceed in the
way you would like it to and it’s probably best to approach labour with a flexible attitude, there are things you can do to make it more likely that you will end up having the type of experience you would prefer Attending antenatal classes and being as informed as possible about labour and your choices will help you to prepare in advance Other things women find helpful are having a supportive birth partner, making decisions with the midwife, being positive, and using a birth plan.
Water births
Relaxing in labour
Some cultures have used water births for centuries to provide a gentle birthing experience. Today, there is evidence to support the fact that labour may be quicker and less painful in water.
How can it help with the pain? Possibly women feel more comfortable and therefore more confident and in control in water. It is thought that water sets off a surge of oxytocin (the hormone that triggers contractions), making contractions more effective Some women find they can move around more easily in water, which helps them find a good position in which to give birth. Some feel the benefits of immersion in warm water as soon as they get into the pool, but for others it can take 15-30 minutes before they relax. Water can
be a natural aid to relaxation as it soothes muscles and releases tension. When we feel less anxious, our bodies produce fewer ’stress” hormones. This encourages the brain to produce endorphins, the body’s painkillers, and promotes wellbeing Dimmed lights and relaxing music can further aid relaxation. Some studies suggest that women have a shorter second stage of labour in water, and there may be less exertion needed to push the baby out If contractions are too intense you can still use Entonox (gas and air).
Can the baby be monitored in water? Your baby can still be monitored by the midwife using a Pinard (ear trumpet) stethoscope or a waterproof hand-held electronic sonicaid.
Will I be allowed to have a water birth?
You can use a birthing pool providing your pregnancy is normal and there were no problems in previous pregnancies If -you want a water birth in hospital and are going to be induced (without a drip), or there are other complications with the pregnancy, you may need to negotiate this with your doctor or midwife. You can talk to a Supervisor of Midwives (who can be contacted via the maternity unit) during pregnancy to help you to make a plan to meet your wishes
Is it possible to have a water birth in hospital?
This depends on the hospital maternity unit Some units have their own birthing pool; some have facilities for you to hire a pool and bring it in; some units have only room enough for a pool to labour in; and others do not have the facilities for you to bring one in or the structural ability to have one in the unit as the amount of water in the pool would be too heavy for the floor to hold.
If your maternity unit does have a birthing pool. it is possible that the pool might be in use when you go into labour. To improve your chances of being able to use a pool, you may want to consider a home birth and to hire a pool (see p. 153).
Can I use the birthing pool for labour and birth if I’ve had a previous Caesarean?
Unfortunately, it is recommended that if you have had a previous Caesarean section, your baby’s heartbeat and your contractions will need to be continuously monitored throughout a subsequent labour and delivery which cannot be done in a birthing pool The reason for continuous monitoring in this situation is that there is a chance, although quite a small one, that your uterus may rupture. This often causes no pain and the only indication may be a change in your baby’s heartbeat. If you decide you do want to labour and deliver in water after a Caesarean section, this is your choice, but you should be fully aware of the risks.
When can I get into the birthing pool?
You can get into the pool whenever you want, but some midwives suggest that you wait until you are 4-5cm (tin) dilated or in established labour. This is because some people are concerned that the water can be so relaxing that it may cause the contractions to slow down or even stop, although there is little evidence to support this However, if this does happen, getting out of the pool and walking around for a while is likely to increase the strength of the contractions You will need to get out of the pool if your baby passes meconium (see p.252) or if the midwife has any concerns about you or your baby.
The water temperature can be whatever you find comfortable, although 37°C (98 6′n body temperature is usual, especially if you are giving birth in the pool, as babies can get cold quickly once they are born.
Most units have guidelines on this.
Can I deliver my baby in a birthing pool, or are these just for labour?
You should ask your midwife to find out if the hospital that you have chosen to deliver at provides facilities for you to deliver in the water, or just use the pool for most of your tabour This often depends on whether the pool is big enough for the delivery, Occasionally, there may not be a midwife available who has been trained in delivering births under water, in which case you may only be able to labour in water and will have to get out for the delivery.
Home birth
Planning a birth at home
Although only around two per cent of women in the UK choose to give birth in their own home, this number is increasing. Research has shown that mothers may have shorter and less painful labours in their own home. It is not known why this is, although it may be due to them feeling more confident and comfortable in their surroundings. You will generally have at least one midwife with you constantly once you are in established labour during a home birth. Many women hire a pool for use during labour at home, and this may progress to a water birth.
Will I be allowed a home birth? If your pregnancy has been classed as ”low risk’ - you are healthy and have not had any complications in this or any previous pregnancies - then a home birth is a definite option If you desire a home birth and have experienced some complications during the pregnancy, talk to your midwife or contact a Supervisor of Midwives at your local maternity unit who will be able to advise you.
How do I plan for a home birth? If your midwife is happy for you to deliver at home, you need to talk to her about the type of home birth you wish to have, for example do you want a water birth (see p.156) or to use a birthing ball, and how do you plan to manage the pain? If you would like a water birth, you will need to hire a birthing pool in advance You may want to set up a special area in your home to have your baby, which ideally should be near bathroom facilities. Plastic sheeting and old sheets are advisable to protect your flooring, and shower curtains make a good surface for giving birth You will also need a supply of dustbin bags for waste.
What will happen? Most community midwives carry a homebirth pack with them, which they will bring along when you go into labour The kit includes a blood pressure monitor; a stethoscope and/or sonicaid; a thermometer; gloves; a gas and air cylinder; pethidine; scissors; antiseptic solutions; and emergency equipment Some midwives like you to provide towels and plastic sheets. You can use your TENS machine, and the midwife will arrange for gas and air (Entonox) to be delivered The midwife can also ask your doctor or obstetrician to prescribe pethidine or diamorphine if you wish.
What if there is a problem? If the midwives are concerned about you or your baby’s health, they will discuss this with you and it may be necessary to transfer you to hospital. This transfer is usually done by ambulance, accompanied by paramedics, your midwife, and your birth partner.