Where can I give birth?
You can give birth:
- at home
- in hospital
- in a midwife-led birth unit or centre.
Where you give birth is up to you and you should be supported in your choice. But there are some things you and your healthcare professional need to talk about, such as where you live, or if you’ve had any complications during this pregnancy or any previous pregnancies.
Your midwife can explain the different options and the pros and cons of each, depending on your circumstances. You can add information about where and how you’d like to give birth to your birth plan.
Having a home birth
Having a home birth means you can give birth in familiar surroundings supported by a midwife (or two).
It’s a good idea to remember that that sometimes a home birth may not be possible on the day if there aren’t enough community midwives available.
You may find your needs and priorities change as your pregnancy progresses. Don’t worry, you can always change your mind about where you want to give birth.
If you have any risk factors
If you have any complications, you may be advised to have your baby in hospital. This means you and your baby can be monitored more closely and have instant medical help if there is an emergency.
There are some risk factors in pregnancy that you should talk to your midwife or doctor about if you are thinking about a having a home birth. These include if:
- you have pre-eclampsia or high blood pressure
- you have diabetes
- you have a high BMI
- you have had abnormal scans during this pregnancy
- you have had a caesarean section before (find out more about pregnancy and birth after a c-section)
- your baby is in the breech position
- you are having a multiple pregnancy
- you have given birth prematurely before.
Are home births safe?
Giving birth is generally safe wherever you choose to have your baby.
If you’re having your first baby, home birth slightly increases the risk of problems for the baby.
If you’re having your second baby, a planned home birth is as safe as having your baby in hospital or a midwife-led unit. There is also a lower chance of having an assisted delivery, which could be a caesarean section, instrumental delivery or episiotomy.
Does it make a difference if I live far away from a hospital?
You should be offered a home birth no matter where you live in the country, although it may not always be possible if staff are not available.
Your midwife will carry out a risk assessment if you decide to have a home birth. For example, they will come to your house and check that it is accessible for an ambulance, in case you need (or want) to be transferred to the hospital.
Benefits of giving birth at home
There are benefits of giving birth at home.
- You are more likely to be cared for by a midwife that you know. This is because midwives doing homebirths will be part of the community team that you will see during your pregnancy.
- If you have other children, you will not need to leave them. But you will need to have arrangements in place in case you are transferred to hospital.
- Your birth partner will not have to leave you at any point. But if you stay overnight in hospital, they may have to go home.
- You are less likely to have interventions such as an assisted birth or episiotomy than if you give birth in hospital.
Being in an environment I felt comfortable and relaxed in was so important.'
Things to consider when giving birth at home
For anyone having their first baby, around 45 in 100 will be transferred to hospital during labour or after the birth. Your chance reduces for second babies after a previous uncomplicated pregnancy and birth to around 12 in 100 pregnancies.
Your midwife will need to do a risk assessment to make sure your home is suitable for birth. They will make sure emergency services can access the property (just in case) and check whether you have enough space for the birth.
Who will be with me at home?
Other than your midwife, it is up to you who to have with you when you are in labour.
Most trusts will also arrange for a second midwife or maternity assistant to come to you when the birth is about to happen.
Taking care of other children during a home birth
It is a good idea to have someone (not your birth partner) at home or nearby to look after any other children you may have. You might find it easier to focus on the labour if you know your other children are being looked after. This is also important in case you transfer to hospital.
Can I have delayed cord clamping at home?
Most home birth teams will try to do delayed cord clamping (DCC) for every birth, as it is now standard practice. Waiting longer before cutting the cord can increase your baby’s iron levels and the amount of stem cells they have. This can help their growth and immune system.
If you or your baby suddenly become unwell just after birth, the cord may be cut sooner.
Transferring to hospital
Even if you have started labour at home, you can change your mind and go to hospital at any time. For example, some women decide they don’t feel as comfortable as they thought they would, or they want more pain relief. Whatever the reason, your midwife can organise a transfer.
You will need a transfer to hospital if your labour isn’t progressing or if there are any complications.
Here are some reasons why some people get transferred to hospital during labour:
- they’ve changed their mind
- they want stronger pain relief
- the baby has done a poo before it is born (called ‘meconium-stained liquor’), which can cause problems for the baby
- they are bleeding from the vagina
- labour is progressing too slowly
- they have a prolonged rupture of membranes
- the midwives have any concerns about the mother’s or the baby’s wellbeing.
What will happen if I transfer to hospital?
Your journey to hospital will depend on the reason for transferring. Most of the time, a paramedic ambulance will be called for you, especially if you are approaching or in the pushing stage of labour. In the ambulance, you will have access to Entonox (gas and air) for pain relief if you are in labour.
Sometimes, it may be possible to go by car with your midwife following. In both cases, the midwife will come with you to hospital. They may be able to stay and keep caring for you, or another midwife on the ward might take over and look you after.
When you arrive on the ward, you should have a room or bed waiting for you because the midwife will call ahead. If it is an emergency, the team on the labour ward will know you are coming. The obstetric and neonatal doctors will be ready to look after you and your baby.
Pack a hospital bag
You may not need to use it, but you should pack a hospital bag in case. Find out what to pack for labour and birth.
Pain relief during a home birth
You can buy, hire or borrow a TENS machine. TENS (Transcutaneous Electrical Nerve Stimulation) is a type of pain relief that uses a low voltage electric current. It is a small battery-powered machine with four pads, which stick on your lower back. The pads connect to electrodes that send small pulses of electricity through your skin and into your muscles. Many people use a TENS machine in early labour.
Remember. Do not use a TENS machine while you are in water if you’re using a birthing pool or bath.
Some women also choose to have a birthing pool for a home water birth. You can use this for pain relief during the first stage of labour or later if you want to have a water birth. You can buy your own birthing pool or hire one.
If you cannot afford or would rather not use a birthing pool, you may be able to use your own bath instead. Fill it up to a level you are comfortable with, making sure you’re warm but not hot. This should be fine for pain relief, but you may not have space to move around or give birth in the bath.
Gas and air
Your midwife will be able to offer gas and air at home when you are in labour. They will bring portable Entonox with them and will be available to support you while you use it.
Some people choose to use breathing or hypnobirthing techniques. Hypnobirthing is a method of pain management that can be used during labour and birth. It involves using a mixture of visualisation, relaxation and deep breathing techniques. Find out more.
You don’t need to manage without pain relief if you’re giving birth at home.
Pain relief not available during a home birth
You will not be able to have an epidural at home because it needs to be given by an anaesthetist in hospital.
Try to have a think about pain relief in advance, you can talk about this as part of your birth plan. Find out more about pain relief in labour.
How to organise a home birth
Each NHS trust has a different way of organising care. If you are thinking about having a home birth at the beginning of your pregnancy, mention this at your first booking appointment. If you decide later that you would like to consider a home birth, speak to your midwife as soon possible. They can talk through your options and help you make the necessary arrangements.
What do I need for a home birth?
You probably have most of what you need for a home birth already, but there are some things to think about.
If you’re planning to give birth in your bed, your midwife will bring disposable pads for you to use. You might like an extra waterproof covering for your mattress.
Our midwife suggested just a cheap shower curtain, which was really handy as we were worried about the mattress getting damaged and it was taken away by them afterwards.'
If you would like a water birth at home, have lots of towels handy as you may want to get in and out of the water depending on how you’re feeling.
You will also need:
- a hose with connectors
- a water thermometer
- a sieve (in case you poo during labour).
Tips for preparing for a home birth
Here are some other things you might like to prepare.
- Try to create a calm and relaxing atmosphere that will help you focus. You might like to use music and soft lighting.
- Keep cool using flannels, a spray bottle or handheld fan. If you have long hair, you may want to tie it up or wear a headband.
- Get a birthing ball if you like, but you can use whatever is around you to get into a position that works for you.
- Have your birth plan and medical notes to hand.
- Don’t forget to charge up your phone or camera if you want your birth partner to take photos or a video.
- Get some snacks and drinks for you, your birth partner(s) and (if you are feeling generous) your midwives. For your drinks, you might like to have a straw to make it easier for you.
- It’s a good idea to have something you can be sick in, like a bucket or small bin.
- A hospital bag (just in case you need to be transferred).
Don’t forget. Keep your antenatal notes to hand.
What do I need at home after the birth?
Here are some of the things you might like to have at home ready for your baby’s arrival:
- a large, warm towel for wrapping around you and baby (put it on a radiator to warm them but make sure they’re not too hot)
- some big pants to change into afterwards
- sanitary or maternity pads – keeping these in the fridge can help with post-birth swelling
- nursing bras and breast pads, whether you plan to breastfeed or not.
- a light, breathable baby blanket (try to avoid the fleecy ones as these can get really hot
- a hat for your baby.
Find out more about what you will need for your baby.
Birthing the placenta
The placenta is delivered after your baby is born (the third stage of labour). This can be managed in two different ways:
- active management – having medicine via an injection into your thigh to help things along
- physiological management – this means that you will deliver the placenta without any drugs.
Your midwife should talk to you about your preference for delivering the placenta while you are pregnant. Find out more about delivering the placenta.
Your midwives will take the placenta and the umbilical cord to the hospital to be disposed of when they leave, unless you ask them not to.
If you need stitches
Up to 9 in 10 first-time mums who have a vaginal birth will have some sort of tear, graze or episiotomy. For most women, these tears are minor and heal quickly.
If you need stitches for a tear or episiotomy after you’ve had your baby, your midwife will probably be able to do those in your home. If you have a serious tear, you’ll be transferred to hospital.
Vitamin K for newborn babies
You'll be offered an injection of vitamin K for your baby. This helps prevent a rare bleeding disorder called haemorrhagic disease of the newborn (HDN) or sometimes called Vitamin K Deficiency Bleeding (VKDB). Your midwife should have discussed the injection with you while you were pregnant.
How long will the midwife stay after baby is born?
The midwife will usually stay with you for about an hour to offer you support with feeding your baby and to check that you and your baby are well.
When you are both ready, the midwife will go back to the hospital and complete your maternity records there. You will be given information about how to contact someone if you have any concerns. Find out more about your body after the birth.
The newborn physical examination
All parents are offered a physical examination for their baby within 72 hours of giving birth.
These can be done at a hospital, community clinic, GP surgery, children’s centre or at home. Speak to your midwife or doctor about arrangements for your baby after birth.
Find out more about your baby’s check ups after they are born.
Unassisted birth (sometimes known as freebirthing)
Some people choose to have an unassisted home birth without a midwife. This is sometimes called a free birth.
It is legal to have an unassisted birth. You do not have to accept any medical or midwifery care or treatment during childbirth.
However, we strongly recommend that you talk to a midwife if you are thinking about having an unassisted birth. This is because it involves some risks and it’s important that you understand what these are. For example, if you have any complications during labour, you may need medical attention to make sure your baby is born safely.
Where and how you give birth is up to you and you should be supported in your choice. But talking to your midwife about all your options will help you make a fully informed decision about what’s best for you.
If you have an unassisted birth, you’ll need to tell a GP or local maternity services about your baby’s birth as soon as they’ve been born.
This is because by law, every birth in the UK needs to be recorded (notified) within 36 hours. When the birth has been notified, your baby will get an NHS number for their NHS care.