Choosing where to have your baby

Choosing where to have your baby

Where you have your baby is your choice, and you should always be supported in this choice.

Giving birth is generally very safe for both you and your baby, wherever you choose to have your baby. Your midwife should explain that you can choose to give birth at home, in a midwife-led unit or in an obstetric unit.

Midwife‑led units (also called birth centres) are more 'home‑like' and relaxed. They can be in or next to a hospital (called 'alongside' units) or in a different place (called 'freestanding' units). Obstetric units (also called labour wards) have more medical facilities.

If you have had a baby before, your midwife should advise you that planning birth at home or in a midwife‑led unit is particularly suitable for you. This is because the evidence shows that:

  • you are less likely to have interventions (such as a ventouse or forceps birth, caesarean section and episiotomy) compared with planning birth in an obstetric unit

  • the chances of your baby having a serious medical problem (which are very low) are not affected by where you plan to give birth.

If you are having your first baby, your midwife should advise you that planning birth in a midwife‑led unit is particularly suitable for you. This is because the evidence shows that:

  • you are less likely to have interventions (such as a ventouse or forceps birth, caesarean section and episiotomy) compared with planning birth in an obstetric unit

  • the chances of your baby having a serious medical problem (which are very low) are not affected compared with planning birth in an obstetric unit, but there is a small increase in the chance of a serious problem for your baby if you plan to give birth at home.

NICE has said this based on the best available evidence from a number of studies. This includes a study called Birthplace, which looked at where lots of healthy women in England planned to give birth and what happened when they had their babies. The box below gives more details about what was found in the study.

Not all women are able to give birth where they planned or hoped for. Some women will need to be transferred to an obstetric unit during labour if there are concerns about them or their baby, so that extra care is on hand if needed (see what if I need to be transferred to an obstetric unit during labour?).

Information from the Birthplace study

More information (including tables containing figures from Birthplace and other studies) is available in section 1.1 of the version of the guideline for healthcare professionals.

Note that the information here:

  • is about healthy women who were at low risk of having problems during labour and birth

  • is based on where the women planned to give birth, whether or not they ended up having their baby where they planned.

Women who have had a baby before

  • Women planning birth at home or in a freestanding midwife‑led unit were more likely to have 'normal' (vaginal) birth than women planning birth in an alongside midwife‑led unit. Women planning birth in any of these 3 places were more likely to have a normal birth than women planning birth in an obstetric unit.

  • Women planning birth in an obstetric unit were more likely to have interventions, such as ventouse or forceps birth, caesarean section and episiotomy, than women planning birth in other places.

  • The chances of a baby having a serious medical problem were the same, and not affected by where women planned to give birth.

Women having their first baby

  • Women planning birth at home or in a freestanding midwife‑led unit were more likely to have a normal (vaginal) birth than women planning birth in an alongside midwife‑led unit. Women planning birth in any of these 3 places were more likely to have a normal birth than women planning birth in an obstetric unit.

  • Women planning birth in an obstetric unit were more likely to have interventions, such as ventouse or forceps birth, caesarean section and episiotomy, than women planning birth in other places.

  • The chances of a baby having a serious medical problem were the same for women planning birth in an alongside midwife‑led unit, a freestanding midwife‑led unit or an obstetric unit.

  • The chances of a baby having a serious medical problem were slightly higher for women planning birth at home than for women planning birth in the other 3 places.

To help you make a decision about where to have your baby, your midwife should give you information about home births and about all birth units in your local area, including:

  • the likelihood of being cared for in labour by a midwife you already know

  • the likelihood of being cared for in labour by a midwife who is looking after just you (this doesn't necessarily mean the same midwife throughout the whole of your labour) – this is often called 'one‑to‑one care'

  • which medical staff will be available

  • types of pain relief available (epidurals are only available in obstetric units – see epidurals section).

You may be advised to give birth in an obstetric unit if you have certain health conditions. This may also be the case if you have had problems with a previous pregnancy or birth, or if complications develop during your pregnancy. If any of these apply to you, your midwife or doctor will talk with you about your options.

All options should be available to you. Wherever you choose to have your baby, you should be supported in your choice.

Questions you might like to ask about where to have your baby

  • What are the different places where I can choose to have my baby?

  • What are the advantages and disadvantages of these different places?

  • Where can I find more information or support for my choice about where I have my baby?

  • Can I change my mind about where to have my baby?

  • How likely am I to have a midwife I know looking after me during labour?

  • What different types of pain relief are available in the different places?

  • Can my birth companion(s) stay with me after the birth?

  • What types of serious medical problems can affect babies, and how common are they?

  • Information Standard