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How to get the birth you want

How to get the birth you want

“Women have more choice than ever before and outcomes have never been so good,” says Emma Cronin, registered nurse and midwife, and one of our Health at Hand nursing team. “So make sure you explore all the options and discuss them with your midwife so that she knows what you want.”

The Office of National Statistics last bulletin on ‘Births in England and Wales: 2015’ revealed positive outcomes for pregnancies in the UK.

The stillbirth rate in 2015 fell to its lowest point in a decade (to 4.5 per 1000 births) and the number of live births is on the increase, as is the average age of mothers. In fact the fertility rate for women aged 40+ was higher than the rate for women aged under 20 for the first time since 1947.

The rise in birth rate is thought to be due to improved medical care allowing older women and women with underlying medical conditions who may not have been able to have children in the past to conceive. Rising immigration is also a factor.

Of the 697,852 live births in England and Wales in 2015, of which 339,716 were girls and 358,136 were boys.

11,073 mothers had a multiple birth in 2015 (10,901 women had twins, 169 had triplets and 3 had quads or more). Women age 45+ were most likely to have a multiple birth (approximately 1 in 10 in this age group had a multiple birth.)

But each birth is a very unique experience – whether you’re having a boy, a girl or twins, with your husband, partner or alone, age 16 or 46…You will want it to be special and safe and personal to you. Here are a just a few of the options to consider:

Booking yourself in

The midwife should be your first point of contact.

“In a normal low-risk pregnancy where a woman is not obese, has no underlying medical conditions or history of previous birth complications, her care can be managed by a midwife, without needing to see an obstetrician,” explains Emma.

"The midwife can book a scan to date your pregnancy from about 9-11 weeks and talk you through all aspects of care including antenatal screening tests, blood tests and regular check-ups you’ll need to monitor you and your baby’s health."

Choosing where to give birth

Antenatal childbirth and parenting classes can help you decide where to give birth and the type of birth you might want.

Women can also choose to pay for additional parenting classes from private providers or private natural birthing centres.

There are a number of choices including:

Home birth

According to the ONS, the percentage of women giving birth at home was 2.3% in 2015, remaining unchanged since 2012. Midwives will usually support your wish to have a home birth if the birth is considered low risk and without any medical complications.

Pros:

  • You give birth in a relaxed, familiar environment receiving one to one care from a midwife.
  • Some models of care offer two midwives at the point of birth.
  • NICE recommends home births for low risk mums, because evidence shows you are less likely to receive medical interventions, such as forceps.
  • The National Perinatal Epidemiology Unit (NPEU) ‘Birthplace cohort study’ found that, ‘giving birth [in the UK] is generally very safe… For women having a second or subsequent baby, home births and midwifery unit births appear to be safe for the baby and offer benefits for the mother.
  • Afterwards you can relax in your own bed and enjoy uninterrupted time with your baby without interference.

Cons:

  • The NPEU ‘Birthplace cohort study’ found that for a first baby, a planned home birth increases risk for the baby (with a poor outcome for 9 per 1000, compared to 5 per 1000 in an obstetric unit) and there is a 45% chance of being transferred to hospital during labour.
  • Women can have pain relief at home but can’t have an epidural at home.

Midwife-led birthing units

There are two types of birthing units:

  1. Freestanding midwifery units (FMU) which are separate from a hospital setting and will not have immediate access to obstetric, neonatal and anaesthetic care.
  2. An adjacent midwifery unit (AMU) which are attached to hospital obstetric units.

Both are staffed by midwives and the care is midwifery-led as midwives are specialised in uncomplicated, low risk, normal births. They are not available everywhere – there are currently around 53 nationwide.

“The emphasis is on natural birthing techniques such as women keeping mobile and in upright positions using gravity, water and birthing pools, birth balls and birth stools to support women in labour,” explains Emma.

Pros: 

  • Like home births, evidence suggests that midwife-led units are safe – The NPEU Study found that planned births in freestanding and attached midwifery units had no significant differences in adverse outcomes compared with those in an obstetric unit.
  • There are fewer interventions than births in an obstetric unit.

Cons:

  • You can’t have an epidural.
  • You may have to transfer to hospital if complications develop.

Hospital obstetric units

These are where most women give birth and are led by consultant obstetricians who can perform instrumental deliveries and caesarean sections.

“Having opted for a hospital birth doesn’t mean you can’t have a natural birth,” explains Emma. "For the majority of women, birth can be a wonderful experience, even in hospital. Some midwives are trained in acupuncture, aromatherapy, water births and hypno-birthing techniques – it’s not all about drugs and monitors. Midwives will support your choices wherever possible."

Pros:

  • Full range of pain relief options including epidurals.
  • Most units have birthing pools.
  • Medical assistance (likeCaesarean)available on site without needing to transfer.

Cons:

  • Statistically more likely to have medical intervention.
  • Setting is more clinical and less personal.

Private medical insurance doesn’t usually cover maternity services – so most births in the UK will be in an NHS-run unit or at home. However, there are a number of private maternity hospitals in England and women can choose to contact independent midwifery services.

For more information on pregnancy, postnatal care and early childhood, visit our Pregnancy and Childcare Centre, or ask our Health at Hand nurses a question  

Further reading

The Office of National Statistics ‘Births in England and Wales: 2015’ and ‘Birth characteristics in England and Wales: 2015

NICE guidance -- Intrapartum care for healthy women and babies

National Maternity Review ‘Better Births: Improving outcomes of maternity services in England

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