Birthplace decisions Information for pregnant women and partners on planning where to give birth
This leaflet will help you plan where to give birth. You can use the leaflet to support discussions with your midwife or obstetrician and your partner or support person.
Decision Making
It is helpful to be able to weigh up the potential benefits, harms and limitations of the available options when making your decisions about your care and where to labour and birth.
Thinking BRAN before your appointments will help you to prepare and be more able to actively engage with decision making.
1. What are the Benefits?
2. What are the Risks?
3. What are the Alternatives?
4. What if I do Nothing?
To find out more see It’s Okay to Ask! – Publication | NHS inform and Realistic Medicine | NHS inform
What does the evidence show about births in different birth settings?
Birth is generally very safe for women who have a low chance of complications, and their babies.
You may wish to discuss what the evidence shows us about the risks and benefits of birth in different settings with your clinician when thinking about your birth choices. It might be helpful to know information specific to your Health Board, for example:
- birth outcomes for home births, CMU births, AMU births and Labour Suite births.
- the transfer rate from home, CMU, and AMU.
- feedback about experiences of different birth places.
- Caesarean, induction of labour and forceps/ventouse birth rate.
- breastfeeding rates for home, CMU, AMU, and Labour Suite births.
The tables on pages 16-18 show outcomes for women and their babies when birth is planned in different settings. The tables refer to healthy women with low chances of complications. This data is from the ‘Birthplace in England’ programme of research. The data is based on outcomes of women who gave birth between April 2008 and April 2010 in England. This information has been included to help give an idea about the sorts of outcomes that you may want to discuss with your clinician. Your clinician will be able to provide you with more up to date information from your own NHS Health Board area.
Spontaneous Vaginal Birth
Spontaneous vaginal birth means that you go into labour by yourself (labour is ‘spontaneous’) and give birth without assistance from instruments (ventouse or ‘vacuum’ birth, or forceps), without Caesarean and without general, spinal, or epidural anaesthetic before or after birth.
What are the chances I will have a spontaneous vaginal birth in each birth setting?
| Planned place of birth | Women who had a spontaneous vaginal birth (%) | Women who have had interventions (%) |
|---|---|---|
| Obstetric unit | 46 | 54 |
| Alongside midwifery unit | 62 | 38 |
| Freestanding midwifery unit (known as a community midwifery unit in Scotland) | 70 | 30 |
| Home | 67 | 33 |
| Planned place of birth | Women who had a spontaneous vaginal birth (%) | Women who have had interventions (%) |
|---|---|---|
| Obstetric unit | 70 | 30 |
| Alongside midwifery unit | 91 | 9 |
| Freestanding midwifery unit (known as a community midwifery unit in Scotland) | 95 | 5 |
| Home | 96 | 4 |
Birth with Forceps, Venouse/Vacuum, and Caesarean Birth
Birth with forceps and unplanned Caesarean birth, ventouse or ‘vacuum’, and forceps, are sometimes needed to help you birth your baby.
Like Caesarean births, births with forceps are more common amongst women having their first baby, compared to women having their second or subsequent baby. In some cases, the use of instruments is not successful, and then a Caesarean birth is performed.
What kind of birth can I expect to have?
| Planned place of birth | Women who had a spontaneous vaginal birth (%) | Women who had a birth with forceps or ventouse/vacuum (%) | Women who had a caesarean birth (%) |
|---|---|---|---|
| Obstetric unit | 61 | 23 | 16 |
| Alongside midwifery unit | 76 | 16 | 8 |
| Freestanding midwifery unit (known as a community midwifery unit in Scotland) | 82 | 11 | 7 |
| Home | 78 | 13 | 9 |
| Planned place of birth | Women who had a spontaneous vaginal birth (%) | Women who had a birth with forceps or ventouse/vacuum (%) | Women who had a caesarean birth (%) |
|---|---|---|---|
| Obstetric unit | 89 | 6 | 5 |
| Alongside midwifery unit | 97 | 2 | 1 |
| Freestanding midwifery unit (known as a community midwifery unit in Scotland) | 98 | 1 | 1 |
| Home | 98 | 1 | 1 |
Outcomes for babies
Birth is generally very safe for women with low chances of complications and their babies. Poor outcomes for you and your baby are rare but can happen in any setting.
These table show outcomes for babies when birth is planned in different settings.
| Planned place of birth | Without serious medical problems (per 1000) | With serious medical problems (per 1000) |
|---|---|---|
| Obstetric unit | 995 | 5 |
| Alongside midwifery unit | 995 | 5 |
| Freestanding midwifery unit (known as a community midwifery unit in Scotland) | 995 | 5 |
| Home | 991 | 9 |
| Planned place of birth | Without serious medical problems (per 1000) | With serious medical problems (per 1000) |
|---|---|---|
| Obstetric unit | 997 | 3 |
| Alongside midwifery unit | 998 | 2 |
| Freestanding midwifery unit (known as a community midwifery unit in Scotland) | 997 | 3 |
| Home | 998 | 2 |
Whilst your midwife will be able to provide some data on some measures (such as birth type, perineal trauma or clinical emergencies such as heavy bleeding and neonatal resuscitation) there are other outcomes that are more difficult to gather data on, but which should also be considered when choosing what matters to you. This might include:
- support for me and my partner with bonding, attachment and breastfeeding related to place of birth.
- postnatal psychological health linked to birth experience and birthplace.
- previous birth trauma linked to birth experience and birthplace.
- having a birth that aligns with my religious and cultural beliefs.
Some further information can be found here in these links:
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