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

What else do I need to know?

Transfer

When people think about ‘transfer’, they often think this will be an emergency, but in practice, most transfers are for non-emergency reasons (such as a long labour, or ‘delay’ in labour). CMUs and midwives providing home birth services work closely with hospitals and ambulance services to provide safe, timely and co-ordinated care during transfers. So, while you may be transferred, you may still go on to have an uncomplicated birth in the obstetric unit. Emergency transfers, while less common, will still be coordinated in a safe way between your midwife, the wider team and the ambulance service.

Transfer from home or CMUs is more likely for women expecting their first baby. Between a third (36%) and half (45%) of women who plan first births at home or in CMUs are likely to require transfer into an obstetric unit (labour ward). For women expecting their second, third or fourth baby, transfer into hospital is less likely. About 10% of women planning second or subsequent births at home or in CMUs are likely to require transfer into an obstetric unit.

National Institute of Clinical Excellence (NICE) quality standard on neonatal specialist care highlights that neonatal transfer services should be in place to provide babies with safe and efficient transfers to and from specialist neonatal care services. This is important as unwell newborns may have difficulty with breathing or keeping warm and require support as they are transferred.^[4]

You may wish to speak to your midwife about local arrangements for transfer in your Health Board.

What if my baby needs neonatal care?

Most babies are born healthy and without any problems. However, around one in ten babies will need some specialist care and some will need to be looked after in a neonatal unit. A baby might need neonatal care if they were born too early (preterm), too small, or if they become unwell after birth. Some babies are born with particular problems that require services such as surgery or help from heart specialists (cardiology). Babies born as part of a twin or multiple pregnancy are more likely to need neonatal care. There are 15 neonatal units in Scotland. Each of these units provides a particular level of specialised care. Neonatal care is available in most hospitals where babies are born in Scotland, but more specialised treatment for the smallest and sickest babies is limited to fewer more specialist neonatal units.

You will be advised about the best place to give birth for you and your baby. If your baby is likely to need neonatal care you will be advised to give birth in a unit that can provide that care.

For more information please see the Information for Expectant Parents resource on Neonatal Service in Scotland: https://www.perinatalnetwork.scot/wp-content/uploads/2023/09/SPN-Neonatal-Care-Info_A5_2023_Digital_v3.pdf

Consent: it’s your decision

Before a doctor, midwife, nurse or any other health professional can examine or treat you, they must have your consent, which means you give your agreement.

You can give consent if you can make decisions for yourself. Being able to make decisions means you can understand what is involved and can think clearly about the advantages and disadvantages of different actions. You must be given enough information, and you should be allowed to make up your own mind without pressure from other people.

Further information on consent is available:

https://www.nhsinform.scot/publications/consent-its-your-decision-leaflet