Place of birth options

Read our guide below to help you understand the birth place options available to you. This will help you make an informed decision about where to have your baby with Buckinghamshire Healthcare Trust.

You can also download a PDF version of this patient information by following the link on the right.

You should use this information as part of a personalised discussion with your care providers. During your pregnancy your midwife, and sometimes a doctor, will discuss your health and your unborn baby’s wellbeing with you. With this information, they’ll make a recommendation on the place of birth.

Your caregivers’ recommended place of birth can change at any point during pregnancy or labour. You can also make a different choice on place of birth at any stage of your pregnancy or labour.

You can decide what feels right for you wherever you choose to have your baby. We will support you in your choice.

What are my options?

You have a few options available to you.

Homebirth

Giving birth at home is a safe option if you:

• have had an uncomplicated pregnancy
• don’t have any medical complexities
• go into labour spontaneously between 37 and 42 weeks.

If you fall into this category, evidence shows that the outcomes for you and your baby are comparable to birth on the Birth Centre or Labour Ward. There’s no increased risk to you or your baby if you choose a homebirth (Hutton. E,et al. 2019).

Evidence shows that if you start your labour at home, you’re more likely to have a vaginal birth, even if you transfer to hospital at some point (Reitsma. A, et al. 2020).

Having a homebirth assessment

If you choose to have your baby at home, your community midwife will undertake a homebirth assessment towards the end of your pregnancy at your home. During this assessment, the midwife will discuss how to prepare the home for a homebirth, your birth preferences, and indications for transfer to Labour Ward.

Risk assessment for homebirths

The midwife also completes a thorough risk assessment to ensure that homebirth is a safe and appropriate option for you. If you opt for homebirth when your medical or obstetric history is outside of the recommended criteria, your midwife will offer you a referral to our Consultant Midwife. They’ll discuss your birth preferences and establish an individualised plan of care.

Who will be with me when I go into labour?

A midwife will be with you for your labour and a second midwife will be there for the birth of your baby. They bring all the equipment they need to care for you during your labour and the birth of your baby including:

• pain relief
• the handheld device used to monitor baby’s heartbeat
• drugs to manage any bleeding.

They’ll closely monitor the well-being of you and your baby during the labour, watching for signs that may indicate a potential complication.

What happens if there’s a concern during labour?

You’ll need extra observations or support and a recommended a transfer to your local hospital’s Labour Ward (Obstetric Led Unit). Transfers are by ambulance.

Some of the common reasons for transfer include:

• request for an epidural
• delay in labour (the labour is not progressing at the expected pace)
• abnormal observations (such as high blood pressure or a raised temperature)
• concerns with your baby’s heartbeat or meconium-stained liquor (the baby has opened their bowels which can be a sign that they are stressed).

What happens if there’s an emergency?

There are clear processes for dealing with these. The midwives are experienced and have regular training for dealing with emergencies. Midwives carry the equipment needed to ensure the safety of you and your baby before and during an ambulance transfer.

We’ll discuss any emergencies which may occur and how we manage them at your homebirth assessment.

Pain relief options

These include:

• a bath/birthing pool (you will need to arrange a pool yourself should you wish to use one)
• TENS machine (you will need to arrange this yourself should you wish to use one)
• gas and air (Entonox)
• opiate injection of pain relief (Pethidine).

Benefits of a homebirth

These include:

• increased chances of having an uncomplicated vaginal birth with less intervention
• comfortable familiar surroundings helping you feel more in control and relaxed
• no need to travel once your labour has started to get to hospital
• partners and siblings can see the baby straight away and the family stay together after birth. If you already have children, it may be easier to arrange looking after them.

Drawbacks of a homebirth

Limited medical facilities at home. Although all midwives have regular training to deal with emergency situations, there are limitations to managing emergencies without access to additional members of the multidisciplinary team and specialist equipment.

If problems happen before or after birth, you’ll be transferred to the obstetric led unit at your local hospital in an ambulance with your midwife. The time this takes will depend on where you live and whether there is a wait time for an ambulance.

If the maternity service is impacted by staff shortages or a lack of availability of ambulances, the homebirth service may need to be paused. This decision is only made once all options for keeping it running have been explored.

Giving birth at the birth centre (midwife led unit)

Giving birth in a birth centre is a safe option if you:

• have had an uncomplicated pregnancy
• don’t have any medical complexities
• go into labour spontaneously between 37 and 42 weeks.

If you plan to give birth in a birth centre, there’s a lower chance of having an intervention during the birth, such as forceps or ventouse, than if you plan to give birth on the labour ward (Scarf, V. et al. 2018 and Brocklehurst et al. 2011).

The Aylesbury Birth Centre is alongside the labour ward (obstetric led unit) at Stoke Mandeville Hospital. It’s run by midwives and provides a comfortable, home from home environment.

What does the birth centre include?

There are 3 birthing rooms, all designed to help you relax and promote the release of natural pain-relieving hormones. One of these rooms has a birthing pool. If this room’s in use, there are inflatable pools available.

In all birth rooms, you will find birth balls, peanut balls and birth stools. There are also light projectors which can play music through speakers. The birth room is your room, and we ‘ll support you to make it as comfortable as possible for you and your birthing partners.

Who will be with me for the labour and birth?

A midwife will be with you for your labour and a second midwife will be there for the birth of your baby. They’ll closely monitor the wellbeing of you and your baby during the labour, watching for signs that may indicate a potential complication.

What happens if there’s a concern during labour?

If a concern is detected that needs additional observations or support, we’ll recommend a transfer to the labour ward (obstetric led unit).

The Aylesbury Birth Centre doesn’t have the same medical facilities as the labour ward, but there are clear processes for dealing with an emergency. The midwives are experienced and have regular training for dealing with emergencies.

If you need to transfer to the labour ward, we can arrange this quickly and safely.

Pain relief options

These include:

• a bath/birthing pool
• TENS machine (you will need to arrange this yourself should you wish to use one)
• gas and air (Entonox)
• opiate injection of pain relief (Pethidine).

Benefits of giving birth at a birth centre

These include:

• an increased chance of having an uncomplicated vaginal birth with less intervention
• a relaxed environment helping you feel more in control and relaxed
• waterbirth available
• all services (including epidural pain relief, theatres and the neonatal unit) close by on the labour ward if needed.
• it’s a good option if don’t want a homebirth but don’t need an obstetric unit

Drawbacks

If problems happen before or after birth, you may need to be transferred to the co-located labour ward.

I’ve been advised to give birth on the labour ward but prefer to have my baby in the Aylesbury Birth Centre

Talk to your community midwife for further information. They can arrange for you to meet with the consultant midwife who will discuss your birth preferences and create an individualised care plan to support your birth choices.

Labour ward birth (obstetric led unit)

We recommend giving birth on the labour ward if:

• you or your baby need closer monitoring
• you or your baby are at an increased risk of complications
• you have a background medical condition that may affect labour
• you’re undergoing induction of labour and we recommend this location
• you prefer to give birth on the labour ward.

Midwives and doctors share the care on the labour ward. Medical facilities and support are immediately available if needed. Planning to have care on the labour ward is associated with an increased chance of having an intervention for all pregnancies (Scarf, V. et al. 2018 and Brocklehurst et al. 2011).

What happens during labour?

The midwives and doctors will closely monitor the wellbeing of you and your baby during the labour, watching for signs that may indicate a potential complication. We monitor your baby’s heartbeat with a hand-held device or on a continuous monitor. We recommend the safest way to monitor your baby depending on your individual circumstances. This may change during your labour, whether you’re at home, the birth centre or on labour ward.

What does the labour ward include?

We can provide birth balls, peanut balls, and birth stools. There are also light projectors which can play music through speakers. We support you to make it as comfortable as possible for you and your birthing partners.

There are inflatable pools available but labouring or birthing in water is not recommended for everyone. Talk to your community midwife if you think you fall into this category.

Pain relief options

These include:

• a bath/birthing pool
• TENS machine (you will need to arrange this yourself should you wish to use one)
• gas and air (Entonox)
• opiate injection of pain relief (Pethidine)
• 24-hour epidural service.

Benefits of a labour ward birth

This includes diret access to:

• obstetricians and specialists in newborn care if you have pre-existing complications or your labour/birth becomes complicated
• anaesthetists who give epidurals and general anaesthetics.

Drawbacks

An increased chance of intervention (episiotomy, forceps, ventouse and unplanned caesarean birth)

The environment within an obstetric unit is usually more medical than in a birth centre. This may inhibit labour hormones.

Giving birth in theatre

Our obstetric led unit also includes two theatres. These are for assisted vaginal births (ventouse or forceps births) when staying in the birthing room isn’t the safest option. It’s also for and planned and unplanned caesarean births.

What if I need a caesarean?

A caesarean section is a major operation whereby your baby will be delivered via an abdominal incision. Before the procedure, you’ll have a spinal block for your pain relief or, if you have an epidural already, you’ll have further pain relief this way.

In most circumstances, you’ll be awake so you can meet your baby as soon as they’re born. One birth partner can accompany you to theatre.

Can I request a caesarean?

Yes if you feel this would be the right option for you. An obstetrician will discuss with you your individual circumstances. They’ll talk you through the associated risks and benefits so you can make an informed choice.

Birth without the support of a midwife/freebirth

Some people choose to have a home birth without a midwife present (freebirth). This is a legal choice in England, and we’ll listen to and respect your informed choices.

We encourage you to talk to your community midwife if you are worried about the care you might receive from the NHS. They can refer you to the consultant midwife who can discuss the care midwives usually offer during labour and birth to help you make an informed choice.

They can also help you make a personalised care and support plan that’s right for you.

Can I still access NHS care?

If you decide to have a freebirth, we’ll continue to offer and recommend NHS antenatal and postnatal care throughout your pregnancy journey. You can opt into any or all appointments.

What if I change my plans during pregnancy or labour?

You can change your plans at any point during pregnancy or labour. NHS midwives will always support you. A midwife can offer you support and advice during labour and check on the health of you and your baby. They’ll know if you or your baby needs help and can arrange for medical attention if needed.

You should call an ambulance if there are problems when you’re giving birth so that we can give you immediate help.

Registering and notifying your baby’s birth

If you have a freebirth and there’s no midwife or other health care professional present within 6 hours of the birth, you’ll need to tell a GP, your local maternity services or appropriate local authority office to notify your baby’s birth as soon as they’ve been born.

By law, every birth in the UK must be recorded (notified) within 36 hours. When the birth has been notified, your baby will get an NHS number for their NHS care. It’s a legal requirement to register your baby’s birth within 42 days (this is different to notifying).

If your plans change during pregnancy of labour

Your caregivers’ recommended place of birth can change at any point during pregnancy or labour. You can also make a different choice on the place of birth at any stage of your pregnancy or labour. For example, you can come to the Aylesbury Birth Centre or the Labour Ward once labour starts, even if your original plan was for a home birth.

Wherever you choose to have your baby

If you and you baby are healthy, you’ll be cared for by a midwife. Doctors (obstetricians) will not normally be present during your labour and birth. You’ll be supported in your preferred method of feeding. Regardless of where your baby is born, we’ll encourage you to start skin to skin contact as early as it’s safe to do so.

Registered midwives often have student midwives working alongside them. Student midwives provide care under the direct supervision of a registered professional in order to gain valuable experience. You can decline having a student midwife at your birth.

Useful links

• Your choice where to have your baby
• Choice of place of birth
• Choosing your birth location

How can I help reduce healthcare associated infections?

Infection prevention and control is important to the wellbeing of our patients so we have procedures in place. Keeping your hands clean is an effective way of preventing the spread of infections.

You, and anyone visiting you, must use the hand sanitiser available at the entrance to every ward before coming in and after you leave. You may need to wash your hands at the sink using soap and water. Hand sanitisers are not suitable for dealing with patients who have symptoms of diarrhoea.

More help or advice

Contact our patient advice and liaison service (PALS) on 01296 316042 or bht.pals@nhs.net