The birthplace is one of the most important decisions that you will make when it comes to planning for your baby's birth.
Most people make this decision based on assumptions rather than reliable information and studies so I thought that I would share an overview of your options including the benefits of each setting and the things that you will want to consider.
Remember that this choice is very personal and although everyone seems to have a strong opinion on the topic, it's important that you only consider what feels right for you and your baby. It's also worth bearing in mind that there are benefits and risks to everything, so your decision will have to be based on what you are most comfortable with, while considering important factors that will give you the best chance to have a more positive and straightforward experience: feeling safe, relaxed and undisturbed (privacy).
Homebirth
In the UK, every woman with an uncomplicated pregnancy should be offered the option to welcome their baby into their home. This is supported by the Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists (RCOG), and is free on the NHS.
Although only 2.1% of babies were born at home in 2017, this option is becoming increasingly popular, and particularly since the Covid pandemic as many restrictions were put in place in hospital settings.
When you plan for a homebirth, and your labour is 'established' with regular surges lasting about a minute, two midwives will be sent to your home to care for you and baby. One of the main draw for homebirth is the 1:1 care which is not possible in the other settings.
Although homebirth is sometimes viewed as a 'risky' option, recent comparative research has shown that it might actually lead to better perinatal outcomes (1) for low risk mamas, and particularly for subsequent pregnancies. Please not that the study excluded unplanned home births and those during which an attendant midwife was not present (whether by choice or due to a rapid birth).
Benefits
Home comforts and privacy.
1:1 care.
Reduced risk of unnecessary interventions - see data below (2).
30% less likely to have a C-section –> 60% for subsequent births.
50% less likely to need an epidural –> 75% for subsequent births.
25% less likely to have a operative vaginal birth –> 60% for subsequent births.
25% less likely to have an episiotomy –> 50% for subsequent births.
35% less likely to need labour augmented with artificial oxytocin –> 65% for subsequent births.
Home births can be more straightforward than hospital births.
No need to transfer while in active labour.
You can always change your mind during labour and decide to transfer.
Things to consider
Not all pain relief options will be available - see table below.
In the rare event of a serious complication, outcomes could be worse for you or your baby than if you were in hospital with quicker access to specialised care.
Midwife Led Unit
Also often called Birth Centre, Midwife led Units are very popular with mums with 'low-risk' pregnancies. As the name suggest, the care in these settings is solely provided by midwives.
There are two types of Midwife Led Units: the Freestanding ones (FMU), or the ones attached to hospitals (AMU).
All midwife-led units are different so I always recommend parents to book a tour or ask your community midwife in advance what facilities are available (birth pools, etc.).
Benefits
Can be more homely than labour ward.
More likely to have birth pools, beanbags, pillows and mats than labour ward.
Higher likelihood of a straightforward vaginal birth.
More likely to see the same midwife throughout your care than you would in a labour ward.
Things to consider
Not all pain relief options will be available.
No 1:1 care.
If in a freestanding setting, and in the rare event of a serious complication, outcomes could be worse for you or your baby than if you were on a labour ward with quicker access to specialised care.
Obstetric Unit
Also called labour ward, OU or consultant unit, Obstetric Units offer a more medicalised environment in a hospital.
Although technically all medical professions are present (midwives, doctors, anaesthetists, consultants), the care is still led by midwives unless further expertise is required.
Benefits
Access to stronger options of pain relief if you think that you will need it (including epidural analgesia).
Quicker access to specialised care and equipment in case of an emergency.
Things to consider
Higher rate of interventions.
Higher risk of infection.
Environment less conducive for a natural birth (importance of feeling safe, relaxed and undisturbed to release the right cocktail of hormones including Oxytocin); which leads to a higher rate of labour augmentation with synthetic oxytocin.
Higher risk of postpartum haemorrhage (PPH).
Less likely to have access to a birth pool.
Limited access to continuity of care.
Comfort measures and other things to consider | Home | Midwife Led Unit | Obstetric Unit |
Gas & Air | -------------------------- | -------------------------- | -------------------------- |
Birth Pool | -------------------------- (hire/buy) | - - - - - - - - - - - - - (most will have a few pools but no guarantee) | - - - - - - - (some will have one or two but access is generally limited) |
TENS | -------------------------- (hire/buy) | -------------------------- (hire/buy) | -------------------------- (hire/buy) |
Pethidine | - - - - - - - (with prescription only) | - - - - - - - - - - - - - (sometimes) | -------------------------- |
Epidural | | | -------------------------- |
1:1 care | -------------------------- | - - - - - - - - - - - - - | - - - - - - - |
Privacy | -------------------------- | - - - - - - - - - - - - - (stick a note on the door) | - - - - - - - - - - - - - (stick a note on the door) |
Food | -------------------------- | - - - - - - - - - - - - - (depends on the time of the day –FMU may have shared facilities/ vending machines) | - - - - - - - (depends on the time of the day – may have vending machines) |
Stitching | - - - - - - - (midwives are competent in suturing and carry local anaesthetic – more serious tears will require a transfer) | - - - - - - - - - - - - - | -------------------------- |
Injection for haemorrhage (Syntometrine) | -------------------------- | -------------------------- | -------------------------- |
(1) Hutton et al. 2019: meta-analysis based on 14 studies (500,000 births) between 1990 and 2018.
(2) Lancet 2020: meta-analysis of over 500,000 low risk planned home births for first time mums.