The best place to have your baby
‘Birth is natures ultimate creation’
Birth Centre ‘V’ Home Birth ‘V’ Labour Ward
The big day has come, you look at the stick and the pregnancy test is positive! For most of you this will be a time of rejoice, for others maybe a shock, but once you have absorbed the fact that you are pregnant you then need to think about Antenatal care and subsequently once you have booked your with a midwife, you will then be asked if you have thought about where you want to deliver you baby.
In most areas of the UK today women have good choice when choosing where to deliver their baby. Childbirth can be a life changing event, and women are exposed to lots of information and choice regarding where they want to have their babies. There has been lots of hype in the media regarding NHS care, some stories may fill women with dread and hopefully others will inspire women to seek choice in terms of birth location.
At the booking in appointment most first time mothers are undecided regarding place of birth. Women usually know what area they want to have their baby in but most are uncertain about what choice to make. Healthy women will be provided with the most choice, this is because they are able to undertake ‘low risk’ care. If you are healthy and your BMI is under 30 then you will be happily offered choices of either a birth centre or possibly a home birth. Conversely if you have a pre-existing health condition or you have a high BMI over 30 and in some areas over 35 you may be asked to consider delivering your baby on the labour ward. Here we discuss the three different choices that women have on offer today.
In the last ten years maternity services have striven to upgrade their departments to carer for the birth centre. This is because research has shown women prefer this home from home environment. RCM (2008) Birth Centre Standards promotes ‘An environment that protects and promotes women’s privacy and dignity, respecting their human rights and provides facilities to maintain adequate nutrition and hydration in labour.’ Furthermore birth centres usually provide built-in Water Birth pools as standard. The environment is relaxed and technology is limited in the room. The ethos is to focus on delivering you baby in a ‘home from home’ environment as nature intended with limited pain relief and one to one care.
You can keep mobile, the midwife won’t strap you to the bed on all sorts of monitors, and she will undertake normal observations and listen into the baby every 15 minutes in first stage of labour. You can be active or you can rest, eat and drink as normal too. For many this is the perfect environment and the new birth centres like the one in Greenwich are state of the art, with everything you need to help you including TV and Radio. There will be access to the labour ward if needed so there is a safety net of care right at hand.
The only disadvantage, if you call it that is that you will not have access to an epidural pain relief. Most women who opt for the birth centre want to avoid that kind of intervention anyway so it suits them.
The Royal College of Midwives (2012) state that ‘the environment in which a woman labours can have a great effect on the amount of fear and anxiety she experiences. Hospital is an alienating environment for most women, in which institutionalised routines and lack of privacy can contribute to feelings of loss of control (Lock and Gibb 2003; Steele 1995).
NHS choices website gives evidence based figures, There has been much written about the risk’s associated with homebirth for women having their first baby, home birth slightly increases the risk of a poor outcome for the baby (from five in 1,000 for a hospital birth to nine in 1,000 – almost 1% – for a home birth)., however for women having their second or subsequent baby, a planned home birth is as safe as having your baby in hospital or a midwife-led unit.
There are many women who prefer to have their baby in their own environment and many birthing gurus like Ina May Gaskin and Michelle Odent who feel that women birth better in the comfort of their own environment.
Many women feel in control when surrounded by their own things, having access to their own bathroom, kitchen and being able to walk freely around their own home. You will be able to sleep in your own bed with your new family without being exposed to the clinical hospital environment. There are companies that will rent or you can buy a portable birthing pool or you can labour in your own bath. You will be asked to undertake a risk assessment at 36 weeks and again you will be advised that the healthier you are, the lower the risk of a poor outcome.
The downside to homebirth’s are more obvious, if a complication arises then you will be required to transfer to hospital, usually via ambulance. On occasion this maybe after the baby is born; furthermore you will not be able to have an epidural at home. Speak to your midwife if you are really keen she will give your more insight and help you decide.
The Labour Ward
Finally we discuss the labour ward. Until the 1960’s most babies were in fact born at home, there was a government drive to encourage all women to attend hospital for their confinement. Midwives who had been used to working in the community were now encouraged to embrace the hospital environment and their practice and training changed immensely during the late 60’s and early 70’s. Labour wards become sterile, midwives became institutionalised and women became cut off from the natural process of giving birth. Families became disconnected and men at one point were not encouraged to be present at the birth.
Well you will be pleased to know things have come along way since then. Midwives integrate more and evidence has driven maternity services to provide more holistic care. There are many medical reasons why a woman would need to deliver her baby on a labour ward, where she and her baby will be closely monitored. The other reason is usually because she has been offered an induction of labour. Any intervention comes with risks, and the labour ward is the best place to care for any woman who’s health or situation has deviated from normal.
The advantages are that you can have your epidural if required, I would however strongly urge you to try your hardest to avoid this until absolutely necessary; unless of course you are advised for a medical reason.
Although labour wards are now friendlier environments, women are surrounded by lots of equipment and the environment can feel very stark and clinical. Women are usually strapped to the bed for long periods of time and in many cases food may be restricted. However there are Doctors present and other specialised clinical staff.
Again the midwife will discuss choice with you at 36 weeks. If you have a pre-existing medical condition or develop one during pregnancy, or have a high BMI then you will be encouraged to use the labour ward.
As you can see the choice is yours. Wherever you choose to have you baby, I would still ensure you do your research, and ensure you undertake Antenatal Classes. You can visit my other blogs on the positions for labour latent phase of labour, waterbirth, coping with labour Knowledge brings choice, knowing your choices reduces your fears, and a relaxed Mum will usually find childbirth easier.
Wendy Kuharska Registered Midwife and Childbirth Educator
The Royal College of Midwives (RCM) (2008) Standards for birth centres in England: a standards document. London: RCM