Why does choosing where to give birth matter?
Planning where to have your baby is an important decision for you to make.
Birth is generally very safe for healthy low-risk women and their babies and there is a choice of different settings where you can give birth including the Obstetric Unit (Hospital), midwifery-led units (MLU) which are sometimes known as Birth Centres, or at home.
Women who have existing medical conditions or high-risk pregnancies may be advised to give birth in Hospital - the reasons for this will be discussed on an individual basis. As maternity health professionals our role is to provide you with information to support your decision making to help you understand the potential risk and benefits of the choices that are available to you.
At home you will be cared for by a midwife who will help you to prepare for your baby’s birth and look after you in labour, during birth and make you comfortable afterwards.
For healthy women with a low-risk pregnancy, compared to the obstetric unit (Hospital), planned birth at home has/is:
- More likely to have a normal birth*
- Fewer difficulties and better recovery
- Less likely to have a caesarean / medical intervention
- More likely to use a birth pool in labour
If it is your first baby, planning a home birth has been associated with a small increased risk of your baby having problems soon after birth (9 per 1000 births) compared to when you have had a baby before (5 per 1000 births) (Birthplace 2011)
When planning a homebirth your midwife will visit you at home when you are around 34 weeks pregnant to help you plan and make arrangements for your birth.
If you make a choice to give birth at home or in an MLU (Birth Centre) with any of the above conditions, your needs will be considered on an individual basis and following discussion of any potential risks to you and/or your baby with the multi-disciplinary team, an individualised care plan will be agreed.
We are committed to supporting you in your choice of a home-birth, however there are rare occasions when it may not be possible to provide a home birth service. If this situation arises, a plan will be discussed with you over the ‘phone. The plan may include an invitation into the Birth Centre for assessment. In exceptional circumstances we may ask you to give birth in the Birth Centre.
Midwifery–led Units (MLU)
Sometimes known as Birth Centres, MLUs are relaxing home-from-home settings run by midwives, and can either be freestanding (FMU) or alongside (AMU)
RUH has two Freestanding Midwifery Units:
- Frome Birth Centre
- Chippenham Birth Centre
Swindon has an Alongside Midwifery Unit on the GWH site:
- White Horse Birth Centre
Development of two further Alongside Midwifery Units are in progress with Salisbury birth centre planned to be completed on the Salisbury District Hospital site in Autumn 2021 and RUH, Bath unit in 2022/23.
For healthy women with a low-risk pregnancy, compared to the obstetric unit, planned birth in a Birth Centre (MLU) is:
- As safe
- More likely to result in a normal birth
- Associated with fewer difficulties and better recovery
- Less likely to result in a caesarean/medical intervention (Birthplace 2011)
Community Birthing Centre Virtual Tour
White Horse Birth Centre (GWH)
Maternity services have developed some safety criteria for women who wish to give birth in a Midwifery-led unit (Birth Centre) or at home. This relates to criteria where there is evidence that plans for birth can be safely supported at home or in a midwifery led unit and these criteria are made to help keep women and their babies safe, in general these are:
- You have an uncomplicated pregnancy
- You do not have a medical condition or pregnancy complication that requires you to see an obstetrician (A doctor specialising in pregnancy and birth)
- You are between 37 and 42 weeks pregnant
- That your baby is in a head down position
- That you are not severely anaemic
- That you do not have a BMI above 35 at booking (NICE 2017)
- Any other criteria specific to your local Trust – ask your midwife for details
Obstetric Unit (OU)
The Obstetric Unit (Hospital) is generally for more complex pregnancies and may look and feel more like a traditional hospital. You will be looked after by midwives as well as doctors if needed. Theatres, anaesthetists, neonatal intensive care units (NICU) and paediatricians are available on site.
For healthy women with a low-risk pregnancy, compared to a midwifery-led unit, planned birth in an OU is:
- As safe
- Less likely to result in a normal birth*
- More likely to result in a caesarean / medical intervention
- Less likely to use a birth pool in labour (Birthplace 2011)
Royal United Hospital Bath Birthing Centre Virtual Tour
Great Western Hospital Swindon Delivery Suite Virtual Tour
For more information about the different birth settings and facilities available see:
Continuity of carer
Transfers from community settings to the Obstetric unit (Hospital)
You may be booked on a continuity of carer pathway and looked after by a team of midwives that includes your named midwife who will co-ordinate your care from your initial booking appointment at the beginning of pregnancy to your post-natal discharge.
The aim is for you to have a known midwife at your birth who will accompany you to wherever you choose to give birth and transfer with you if your place of birth changes during labour. Continuity of carer is a model of care that is being rolled out nationally and is being implemented locally.
When planning to give birth at home or in a MLU (Birth Centre), there is a chance that you might need to transfer to Hospital if there is a delay in progress or complications arise during labour or immediately after the birth.
It is important that you understand the rates, reasons and timings of transfers should they become necessary, in order that you can make an informed choice about where you plan to give birth.
On average the rate of transfer from home or the MLU (Birth Centre) when having a first baby is around 40% and around 10% if you have had a baby before (Birthplace 2011). If you are transferred it is not usually because of an emergency and is most likely to be due to a delay in progress.
Your midwife will discuss the actual rates and reasons for transfer from home or your choice of Birth Centre and also provide you with information on transfer times to Hospital.
This information will form the basis of conversations around your choice of place of birth. These conversations will take place throughout your pregnancy with midwives and possibly doctors involved in your care.
Choosing where to have your baby is an important decision and one that may change as your pregnancy progresses. This may be because of a developing problem or simply that you change your mind. There is a lot of information to help you and your midwife will be happy to discuss the facilities available in different birth settings with you in order for you to make an informed choice.
*Normal birth means that you go into labour by yourself (it is spontaneous in onset) you give birth without the use of instruments (forceps or ventouse) without a caesarean and without general, spinal or epidural anaesthetic.