Choosing your place of birth

I126t is important that you make an informed decision about where you would like to give birth. It is up to you where you have your baby and even after you have decided, you can change your mind. Midwives and doctors will support you in your informed choice of birth setting. At the booking appointment and throughout your pregnancy, your midwife will discuss birthplace options with you, using evidence-based information.  The most recent information based on studies in England is outlined in this patient information.

Evidence shows that a healthy woman having a straightforward pregnancy is likely to have fewer interventions and better outcomes if they give birth at home or in a midwife-led unit, compared with an obstetric unit (hospital) (NICE 2014).

Home birth is particularly suitable for women who are having a straightforward pregnancy and have therefore not experienced any complications. This means that you are pregnant with one baby, that both you and the baby are healthy and that you go into labour between 37 to 42 weeks of pregnancy.

Straightforward vaginal birth

794 women per 1000 (79%) women planning to give birth at home have a spontaneous vaginal birth, as compared to 813 (81%) in a freestanding midwife-led unit (FMU), 765 (77%) in an alongside midwife-led unit (AMU) and 688 (69%) in an obstetric unit.

Transfer rate

450 women per 1000 (45%) may transfer to an obstetric unit. Common reasons for transfer are:

• Request for stronger pain relief
• Slow progress in labour

Caesarean birth

80 per 1000 women (8%) transfer from their planned home birth and go on to have a caesarean birth, as opposed to 121 per 1000 (12%) in an obstetric unit.

Outcomes for baby

9 babies per 1000 (0.9%) will have a serious medical problem, compared to 5 babies (0.5%) born in a midwifery-led unit or an obstetric unit.

A more recent study in the Lancet (Hutton et al., 2019) that combined outcomes from 500,000 women, indicated that for women at a low-risk of complications intending to give birth at home, there was no difference in the chance of baby having a serious medical complication compared to hospital birth.

Advantages of Home birth

• More likely to feel relaxed in your own home
• More likely to be looked after by a midwife who you have gotten to know during pregnancy
• More likely to have a straightforward labour and birth
• Less likely to experience interventions such as having your waters broken or having a drip to speed up labour
• Less likely to require a pethidine injection or epidural for pain relief
• Less likely to need a caesarean, ventouse or forceps to assist the birth of your baby
• Less likely to need a blood transfusion
• More likely to breastfeed successfully

Disadvantages of Home birth

• May need to transfer to an obstetric unit during labour or after the baby is born. An emergency blue light transfer is rare
• The time taken to transfer to hospital can lead to a delay in accessing medical care in the rare situation of an emergency
• Water, gas and air and pethidine injections can be accessed at home, however, transfer is required to get stronger pain relief via an epidural

Transfer to Hospital

Maternity care providers aim to keep to your birth preferences and provide safe care for you and your baby at home. However, sometimes there are reasons why your midwife may suggest to you that it would be better for you and/or your baby to transfer to hospital for further care. It is important to remember that all women who go into labour at home and who are not planning a home birth, transfer in labour to their planned place of birth.

Transfer from a planned home birth normally takes place by ambulance. Emergency (blue-light) transfer is rare. Most transfers are slow, calm and peaceful.

Possible reasons for transfer

• Signs of infection in mum or baby
• Raised blood pressure
• You request to transfer
• You request an epidural
• Delay in labour
• Significant bleeding
• Baby has passed meconium (opened bowels in the womb)
• Baby has an abnormal heart rate during labour
• Complex perineal tear (the area between the vagina and the anus)
• Retained placenta (where the placenta doesn’t come out after the birth)
• Baby required active resuscitation
• Any congenital abnormality

Some helpful tips if home birth is right for you

• Speak to your community midwife about hiring a birthing pool – water birth is amazing!
• Do you want your pets to be there? If not, you’ll need to arrange for them to be looked after.
• Have the right food available – for you, your birth partner/s (and for the midwives, if you want to).
• You don’t need a huge room, especially if you’re not hiring a pool.
• Nobody will inspect your house for cleanliness! All homes are suitable for home birth (unless your home is unsafe in some way).
• Make your birth room special by putting up fairy lights and printing out affirmations, if you want to.

If you want to know more speak to your community midwife and check out the film about home birth on the Better Births Lincolnshire website.

Lincoln Labour Ward           01522 573889

Lincoln AAC                         01522 573138

Pilgrim Labour Ward            01205 445424

Pilgrim AAU                          01205 445144