Birthplace decisions Information for pregnant women and partners on planning where to give birth

Planning where to labour and birth

Planning where to labour and birth is an important decision that you can make at any time during your pregnancy and in early labour. You can also change your plans at any stage.

Throughout your pregnancy your clinician will talk to you about what they know about your health and your baby’s health and will advise you on place of birth. As part of your routine midwifery care your midwife will talk to you about your unique circumstances, provide you with information about labour, birth, and different birth settings, and will encourage you to access resources that will help you make the decision that is right for you. Your clinician will ensure you have all the information you need to make the right decisions for you and your family. During these discussions you can ask questions to help you make your decision.

If there are more complex issues to consider you will also be offered the opportunity to discuss your planned place of birth with members of the team who will support you and your midwife with birth place planning – for example, a senior midwife, your obstetrician if you have one, or a consultant midwife. These discussions will be about supporting your choice, making plans that are as safe as possible using the resources available within the maternity service and ensuring that when your labour starts everyone involved in your care knows the plan and what you have decided.

A wide variety of birth settings are provided in many areas. All birth settings should be comfortable, provide privacy and dignity, and promote active labour and birth, encouraging mobility. All NHS Health Boards should offer you a range of pain relief. More information on pain relief option is provided throughout the leaflet. Please also speak to your clinician about what pain relief options are available locally.

Evidence shows that giving birth is generally very safe.^[2] You have choices about where to have your baby and this guide can answer some of the questions you may have about the availability and safety of all the options you may be offered.

Developing your birth plan

Everyone is encouraged to develop a birth and postnatal plan with their clinician. Your plan should be reviewed by you and your clinician together throughout your pregnancy and should clearly detail what matters to you, what has been discussed and what you have chosen for your labour and birth. An important aspect of birth planning is choosing the place that is right for you. It can also be helpful to visualise the birth settings, and many units can support a visit or show you a video of where you will birth, if not at your home.

When developing your birth plan and deciding where to labour and birth you may find it helpful to consider these points:

• what your preferences are – what sort of birth you would like, who you want supporting you and where you will feel safe and supported.
• travel arrangements and time for you and your birth partner(s), and possible transfer time if required.
• whether you or your baby have any pre-existing medical conditions or any factors in pregnancy that make it more likely that you might need medical intervention during your labour or birth.
• birth outcomes in different settings.
• access to care from a doctor.
• what type of pain relief will be available.
• whether you want to use a birthing pool.

The philosophy of maternity care should be the same in all birth settings. In all birth settings maternity care should be kind, compassionate, respectful, and supportive of your choice and your human rights.

In all birth settings you should receive one-to-one supportive care throughout labour and birth, privacy, uninterrupted skin to skin and support with early feeding. Families should be supported to remain together, and you and your partner should be provided with effective support.

All birth settings have different risks and benefits, and your perspective of risk and benefit will be unique to you. You might be considering a birth at home as a safe and comfortable option; however, you will have to balance this with any clinical risk factors which may mean your clinician advises you to birth in a Labour Suite.

In all birth settings you will always be asked for consent for any procedure including intimate examination. More information on consent is provided on page 20.

Your decisions will be recorded in your birth plan which will be updated at each routine appointment with your clinician. Remember, you can change your mind at any time, including when you are in labour.

For further information see the Ready Steady Baby! resource on Your Birth Plan.

Your right to choose where you birth

You have the right to choose where to give birth. Only when it is determined that you lack mental capacity can someone else, such as a doctor, make decisions about your health care.

Your maternity care will be coordinated by your primary midwife, who will provide the majority of your routine pregnancy care. This helps you and your midwife build a trusting relationship, develop a plan that is right for you together, discuss birthplace throughout your pregnancy, and ensure you feel seen and heard throughout your journey.

If you feel that you need further support to discuss your choice about where to labour and birth, please contact the senior charge midwife, senior midwife, or consultant midwife in your local area. You can ask your primary midwife for their contact information.