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

Birth Settings

Your clinician will discuss the maternity care that can be offered in different birth settings and where care can be provided in your NHS Health Board area. This could include:

At home

• ‘At home’ means planned birth at home, with a midwife who comes to your home and cares for you during labour and birth.
• Midwives are trained and equipped to support you to labour and birth at home.
• At home you will be in a familiar place where you will be able to use your own facilities and have the comfort of your own surroundings. You can choose how many people you have around you.
• At a home birth, pain relief options available to you include water, gas and air, and opiate injections. Epidurals can only be provided at a hospital. You will be supported to use any skills you and your partner have learned such as hypnobirthing, relaxation, massage, or aromatherapy.
• Labour progresses well when women are relaxed and feel safe and supported in a familiar own environment. For women with low chances of complications, the chances of needing an intervention are lower for home births than for births in a Labour Suite (also known as an obstetric unit).
• During any labour and birth unexpected complications or emergencies can happen. Midwives are able to carry out some immediate emergency procedures however these are limited by the environment, and you may need immediate access to medical care from a doctor. Or you may need something that can only be provided at a hospital. There are no doctors in home or CMU settings so you would need to be transferred to hospital by ambulance or by car. This can be discussed in more detail with your clinician.

Questions you may want to ask your clinician:

• Is there any reason that birth at home would not be advised for me?
• If it would not be advised, can you discuss the reason and any evidence?
• Can you tell me how midwifery cover will be arranged for me?
• What is the home birth figures for my local area?
• Can I speak to other women who have birthed at home locally?
• How would I arrange to have a birthing pool at my home birth?
• What pain relief will be available?
• Will I be supported and encouraged to be mobile and upright throughout my labour and birth with consideration of the best positions for birthing my baby?
• What if I want an epidural during labour?
• What are the chances of being transferred to the hospital during labour or following birth, for me and for my baby, in my local area?
• How is transfer arranged for me and/or my baby if needed including times?
• If me or my baby need a transfer, how long would it take for an ambulance to arrive, and how long might the journey to hospital be?
• How will my partner get to the hospital if I am transferred?
• Will my primary midwife or member of the team care for me during my home birth?
• How long will my midwife stay at my home following birth?
• Will I be supported to feed and care for my baby following birth?
• What will I do if I need support after my midwife has left?
• Will I have access to an interpreter during my labour and birth at home?
• In a community midwifery unit (CMU)
• A CMU is a birth centre on a separate site from the nearest Labour Suite, which may be closer to your home and can provide a comfortable and relaxed setting. Midwives will care for you and support your labour and birth.
• In a CMU, pain relief options available to you include water, gas and air, and opiate injections. Epidurals can only be provided at a hospital. You will be supported to use any skills you and your partner have learned such as hypnobirthing, relaxation, massage, or aromatherapy. Many CMUs have birthing pools for you to use during labour and birth.
• You are more likely to have a birth with fewer interventions in a CMU than in a Labour Suite.
• During any labour and birth unexpected complications or emergencies can happen. Midwives are able to carry out some immediate emergency procedures however these are limited by the environment, and you may need immediate access to medical care from a doctor. Or you may need something that can only be provided at a hospital. There are no doctors in home or CMU settings so you would need to be transferred to hospital by ambulance or by car. This can be discussed in more detail with your clinician.

Questions you may want to ask your clinician:

• Is there any reason that birth in a CMU would not be advised for me?
• If it would not be advised, can you discuss the reason and any evidence?
• Can you tell me how midwifery cover will be arranged for me?
• What is the CMU birth figures for my local area?
• Can I speak to other women who have birthed in the CMU?
• Can I visit the CMU prior to my birth?
• Is there a birthing pool? What if another woman is using the birthing pool?
• What pain relief will be available?
• Will I be supported and encouraged to be mobile and upright throughout my labour and birth with consideration of the best positions for birthing my baby?
• What if I want an epidural during labour?
• What is my chance of transferring to the hospital during labour, following birth, for my baby in my local area?
• How is transfer arranged for me/my baby if needed, including times?
• If me or my baby need a transfer, how long would it take for an ambulance to arrive, and how long might the journey to hospital be?
• How will my partner get to the hospital if I am transferred?
• Will my primary midwife or member of the team care for me during my CMU birth?
• How long will I stay in the CMU following birth?
• Will I be supported to feed and care for my baby following birth?
• Will I have access to an interpreter during my labour and birth in a CMU?
• What support will my family have (e.g. access to food and comfortable space) during my labour and birth in the CMU?

In an alongside midwifery unit (AMU)

An alongside midwifery unit (AMU) is based within hospitals with a Labour Suite but are separate from the Labour Suite. Midwives will care for you and support your labour and birth.

In an AMU, pain relief options available to you include water, gas and air, and opiate injections. Epidurals can only be provided at a hospital, in a labour suite. You will be supported to use any skills you and your partner have learned such as hypnobirthing, relaxation, massage, or aromatherapy. Many AMUs have birthing pools for you to use during labour and birth.

You are more likely to have a birth at an AMU with fewer interventions than if you plan to birth in a Labour Suite.

During any labour and birth unexpected complications or emergencies can happen. Midwives are able to carry out some immediate emergency procedures however these are limited by the environment, and you may need immediate access to medical care from a doctor. Or you may decide that you need something that can only be provided in the Labour Suite. In these circumstances, you will be transferred to a Labour Suite on the same site.

Questions you may want to ask your clinician:

• Is there any reason that birth in an AMU would not be advised for me?
• If it would not be advised, can you discuss the reason and any evidence?
• Can you tell me how midwifery cover will be arranged for me?
• What is the AMU birth figures for my local area?
• Can I speak to other women who have birthed in the AMU?
• Can I visit the AMU prior to my birth?
• Is there a birthing pool? What if another woman is using the birthing pool?
• What pain relief will be available?
• Will I be supported and encouraged to be mobile and upright throughout my labour and birth with consideration of the best positions for birthing my baby?
• What if I want an epidural during labour?
• What is my chance of transferring to the hospital during labour, following birth, for my baby in my local area?
• How is transfer arranged for me I need to go to Labour Suite?
• How is transfer or a review arranged for my baby if needed?
• Will my primary midwife or member of the team care for me during my AMU birth?
• How long will I stay in the AMU following birth?
• Will I be supported to feed and care for my baby following birth?
• Will I have access to an interpreter during my labour and birth in an AMU?
• What support will my family have (e.g. access to food and comfortable space) during my labour and birth in the AMU?

In a Labour Suite (also known as labour ward or obstetric unit)

• A Labour Suite is in a hospital and provides services including obstetric, medical, midwifery, neonatal and anaesthetic care. All mainland NHS Health Boards in Scotland have at least one Labour Suite. You may want to ask whether you have a choice of Labour Suites.
• Midwives will provide your midwifery care before, during and after your birth. If you need additional care or are having a planned Caesarean birth this will be provided a team of people on site, including obstetricians and sometimes anaesthetists and neonatal paediatric staff.
• There is advanced equipment for monitoring you and your baby’s health and well-being within the Labour Suite.
• You can usually choose to include up to two birth partners to support you.
• In a Labour Suite, pain relief options available to you include water, gas and air, opiate injections, and epidural analgesia. The Labour Suite is the only birth setting where epidural analgesia can be provided.
• You will be supported to use any skills you and your partner have learned such as hypnobirthing, relaxation, massage, or aromatherapy. Many Labour Suites have birthing pools for you to use during labour and birth.

If you or your baby have a health or medical concern your clinician may advise that birth is safest for you in Labour Suite. This does not mean that you cannot choose Home, CMU, or AMU, but that there are concerns that birth in one of these places will pose a more significant risk than birth in Labour Suite. This will usually be because in Labour Suite there is access to monitoring equipment, medications, doctors, more midwives and the wider team and hospital services and you are more likely to need that extra care.

If you still wish to consider giving birth in a CMU, AMU or at home, you can talk to your clinicians about this. They will work with you to support your choices about place of birth, discussing your plans and preferences. Discussing this with your clinicians as early as possible can help them support you to develop your birth plan accordingly.

The Neonatal Unit is within the same hospital as the Labour Suite and AMU, so any care for your baby is readily available. It is important that you are provided with the information about why birth in Labour Suite is recommended and where possible this will be discussed with you during your pregnancy. Your clinicians will provide you with the evidence to support their recommendation so you can make an informed decision.

Questions you may want to ask your clinician:

• Is there any reason that birth in a Labour Suite would not be advised for me?
• If it would not be advised can you discuss the reason, including evidence and data?
• Can you tell me how midwifery cover will be arranged for me?
• What are the Labour Suite birth figures for my local area?
• Can I speak to other women who have birthed in the Labour Suite?
• Can I visit the Labour Suite prior to my birth?
• Do you have a birthing pool? What if another woman is using the birthing pool?
• What pain relief will be available?
• Will I be supported and encouraged to be mobile and upright throughout my labour and birth with consideration of the best positions for birthing my baby?
• What if I want an epidural during labour?
• What is my chance of my baby transferring for neonatal care following my labour and birth in Labour Suite?
• Will my primary midwife or member of the team care for me during my Labour Suite birth?
• How long will I stay in the Labour Suite following birth?
• Will I be supported to feed and care for my baby following birth?
• Will I have access to an interpreter during my labour and birth in Labour Suite?
• What support will my family have (access to food and comfortable space) during my labour and birth in Labour Suite?

What happens if you are planning to birth in a maternity theatre (planned Caesarean birth)?

You will be given information about where and when to attend prior to your planned Caesarean birth. This will be in the hospital, and you will be cared for by dedicated staff throughout your journey. Midwives will provide your midwifery care before, during and after your birth.

Your midwife and obstetrician will encourage you to complete your birth plan with what matters to you and will explain the procedure and what to expect.

You will be introduced to the staff in the maternity theatre when you arrive. Please speak to your midwife and obstetrician if you would like to discuss the environment in the maternity theatre for your birth.

If your baby needs support from the neonatal doctors they will be in the maternity theatre and will ensure you and your partner are kept up to date about care being provided for your baby.

If you need an unplanned Caesarean birth this will also take place in the maternity theatre.

Questions you may want to ask your clinician:

• Why is a planned Caesarean birth advised for me?
• Can you tell me which midwife/team will support me in the maternity theatre?
• Can you provide me with planned Caesarean birth figures for my local area?
• Can I speak to other women who have had a planned Caesarean birth in the maternity theatre?
• Can I visit the maternity theatre prior to my birth?
• What pain relief would be provided, and can I speak with the anaesthetist about my options for anaesthesia?
• Why might a general anaesthetic be advised?
• Can my partner come into the maternity theatre with me?
• What is my chance of my baby transferring for neonatal care following my planned Caesarean birth?
• Will my named midwife or member of the team provide any care for me in maternity theatre?
• How long will I stay in the maternity theatre and Labour Suite following birth?
• Will I be supported to feed my baby and have skin-to-skin immediately following birth?
• Will I have access to an interpreter during my birth in maternity theatre?

For further information see the Ready Steady Baby! resource on Deciding Where to Give Birth