Draft: Birthplace Decisions, Information for pregnant women and partners on planning where to give birth

Where can I give birth

Your midwife will discuss the available options for giving birth with you. These could include:

At home

• ‘At home’ means planned birth at home, with a midwife who takes responsibility for providing care during labour and birth.
  • Midwives are trained to support you to give birth at home and will also advise you if any situations arise during birth where transferring into a hospital obstetric unit would be advised for the ongoing care for you and your baby.
• 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.
• If you or your baby need to see a doctor, your will be transferred to a hospital obstetric unit (labour ward). Speak to your midwife to find out more about local arrangements in your Health Board regarding modes of transfer.
• Pain relief options may include a bath or birthing pool (which you may provide), gas and air (Entonox), or an opiate injection of pain relief. If you wish to explore services such as hypnobirthing or aromatherapy you will be supported to do so.^[3]
• You can choose who is with you during your labour and birth.

Questions to ask your midwife

• Would you recommend a home birth for me?
• How do I find out about home birth in my area and speak to women who have had a home birth?
• Is it possible to have a birthing pool or other amenities within my home to support me during labour and birth?
• What pain relief is available to me at home?
• How likely is it that I will need to transfer from home to hospital during labour?
• What will happen if I need to transfer to a hospital?
• If I plan a home birth, will my primary midwife, buddy midwife or a midwife I have met whilst I was pregnant, look after me in labour?
• What happens after I have my baby at home?
• What will happen if my baby becomes unwell during labour or after they are born?

In a community midwifery unit (CMU)

• A CMU is a birth centre on a separate site from the nearest obstetric unit, that may be closer to home.
• A CMU unit may provide a more familiar and comfortable and relaxed setting.
• A midwife will take responsibility for your care during labour and birth.
• If you or your baby need to see a doctor, or you decide to have an epidural, transfer is normally by car or ambulance to a hospital obstetric unit (labour ward).
• Pain relief options may include a birthing pool (if available), gas and air (Entonox), or an opiate injection of pain relief. Hypnobirthing or aromatherapy may be available.

Questions to ask your midwife

• Is a birth in a midwife-led unit a viable option for me?
• What pain relief is available to me at a CMU?
• Does the CMU have any birthing pools or other facilities to support me during labour and birth?
• How likely is it that I will need to transfer to hospital during labour?
• What happens if I need to be moved to an obstetric unit?
• If I plan a birth in the CMU, will my primary midwife, buddy midwife or a midwife I have met whilst I was pregnant, look after me in labour?
• Can I visit the CMU before I make my decision?
• What will happen if my baby becomes unwell during labour or after they are born?

In an alongside midwifery unit (AMU)

• An alongside midwifery unit is based within hospitals with obstetric units, but are separate from the obstetric unit (labour ward).
• Midwives take responsibility for your care during labour, and support you during birth.
• If you or your baby need to see an obstetrician, or if you decide to have an epidural you will be transferred to an obstetric unit on the same site.
• Pain relief options may include a birthing pool (if available), gas and air (Entonox), or an opiate injection of pain relief. Hypnobirthing or aromatherapy may be available.

Questions to ask your midwife

• Is a birth in an AMU a viable option for me?
• Does the AMU have any birth pools or other facilities to support me during labour and birth?
• What pain relief is available to me at the AMU?
• How likely is it that I will need to transfer to hospital during labour
• What happens if I need to be moved to an obstetric unit?
• If I plan a birth in the AMU, will my primary midwife, buddy midwife or a midwife I have met whilst I was pregnant, look after me in labour?
• Can I visit the AMU before I make my decision?
• What will happen if my baby becomes unwell during labour or after they are born?

In an obstetric unit (usually known as labour ward or suite)

• An obstetric unit is based in hospitals that provide services including obstetric, medical, midwifery, neonatal and anaesthetic care.
• Women with a low chance of complications can choose to give birth in an obstetric unit. If you choose this option a midwife will take responsibility for your care. If you have a higher chance of complications (see page 13 and 14 for further information) you may be advised to give birth in an obstetric unit and this will be discussed with you.
• Care is provided by a team of people. Obstetricians (doctors who specialise in pregnancy, labour and birth) lead your care if you are at higher chance of complications during labour and birth or are having a planned Caesarean birth.
• Midwives continue to provide all your midwifery care as part of the team in an obstetric unit, and support you through birth.
• Other members of the clinical team may include anaesthetists and neonatal/paediatric staff.
• Pain relief options include a birthing pool (if available), gas and air (Entonox), an opiate injection of pain relief and an epidural. An epidural is only available in an obstetric unit.

Questions to ask your midwife

All Board areas in Scotland have at least one obstetric unit. You may want to ask whether you have a choice of obstetric units.

• Does the obstetric unit have any birth pools or other facilities to support me during labour and birth?
• What pain relief is available to me in an obstetric unit?
• If I plan a birth in the obstetric unit, will my primary midwife, buddy midwife or a midwife I have met whilst I was pregnant look after me in labour?
• Can I visit the obstetric unit before I make my decision?
• What will happen if my baby becomes unwell during labour or after they are born?

You and your midwife/obstetrician will have discussions throughout your pregnancy, ensuring all options and recommendations are fully explored so that you can choose what is right for you.

Wherever you choose to have your baby, your midwife and obstetrician (if you have one) will help you with this, and ensure you have all the information you need to make the right decisions for you and your family.

For further information see the

Ready Steady Baby! resource on Deciding Where to Give Birth