The birthing environment is very important, and in the UK there are generally four options: an obstetrics unit in a hospital, a birth centre attached to a hospital, a freestanding midwifery unit, or your home. The option that’s right for you will depend on your pregnancy, your baby, your medical case, and your personal preference. In general, you have the most choice if your pregnancy is low-risk and uncomplicated, but, as we’ve noted previously in our Antenatal Journey, labour and delivery are unpredictable, and it may help you to be informed of the considerations involved with each. If you’ve opted for a freestanding midwifery unit or home birth, for example, you may need to be transferred for extra help. It’s also good to prepare yourself psychologically for the hustle and bustle of a hospital setting. In this article, we look at your options.

Why is the birth environment important?

If a woman does not feel comfortable, secure, and happy in a space, labour may well slow down. This is sometimes seen when women go from home to a hospital environment. Labour progressed well when they were in that private, familiar space but slowed down again when they entered a more intimidating clinical environment. You can avoid this entirely by arranging a home birth. If you do have to change environments, you may find it useful to practice going into your own little world so you can focus on your body and your labour rather than what’s going on around you. Hypnobirthing techniques can help you ‘get in the zone.

We can’t make a hospital or midwifery unit quiet, but we can control our own minds. It’s worth making every effort to ensure the transfer from home to hospital as soon as possible, including running through the route in advance. Putting your earbuds in, closing your eyes, and practicing visualisations are usually the trick. When you’re given a private space, you can usually speak to your midwife and express in your birth plan how you’d like to make it your own. Do you need a translator present? Is there a room fragrance you’d have in the comfiest parts of your home? Would you like some music? Your midwives will usually avoid disturbing you if you’re coping well and ask to be left alone unless absolutely necessary. Even if your pregnancy is at higher risk and someone will always need to keep an eye on you, you should be able to work with them to plan for an environment that feels calm and private.

What should I know about home birth?

We share what you can expect from a home birth in episode 16 of this journey. Perhaps the most obvious benefit is that at home, you will be in a familiar place and feel comfortable in your own surroundings. A midwife will be with you for your labour, and a maternity support worker or second midwife will be there for the birth of your baby. You are more likely to see the same person throughout your care. If you or your baby need to see a doctor, your midwife will call an ambulance, and you will be transferred to a hospital obstetric unit. Pain relief options may include a bath or a birthing pool that you provide, gas and air, or an opiate injection of pain relief administered by your midwife. You can use your own shower and get into bed with your new baby afterwards.

What should I know about giving birth in a Freestanding Midwifery Unit (FSMU) or a birth centre attached to a hospital (an ‘alongside’ midwifery unit)?

Planning to give birth in a freestanding or attached midwifery unit is considered a great option for first-time mothers going through a straightforward pregnancy because of the low rate of intervention. These options are very similar; the key difference is that you’d be transferred to an obstetrics unit on-site in the case of a birth centre, and a midwife would call an ambulance to take you to one from an FSMU if problems arose. At a birth centre, a neonatal unit is also available on site; these will differ in the level of care provided.

At both units, a midwife will be with you for most of your labour, and a maternity support worker or second midwife may also be there. You are more likely to see the same person throughout your care (though keep in mind that midwives work 12-hour shifts). Pain relief options may include a birthing pool (if available), gas and air, or an opiate injection of pain relief, but you can’t usually have an epidural or spinal block. It is less likely that you will have to share toilet and bathroom facilities with other people, the way you might in a hospital.

What should I know about giving birth in a hospital obstetric unit?

Even with a low-risk, uncomplicated pregnancy, you are more likely to have an intervention in your birth if you go to a hospital, which is something to consider if you feel strongly about avoiding them. You’re also more likely to have to share a bathroom and other facilities. On the other hand, you’ll have full and quick access to a medical team (obstetricians, anaesthetists, neonatologists, and paediatricians) and hospital equipment. A midwife will be with you for most of your labour, and a maternity support worker or second midwife may also be there. However, in many hospital settings, you are less likely to see the same person throughout your care. If you or your baby need to see a doctor, your midwife will call a doctor who is available on site and will come to your room to see you. A neonatal unit is usually available on site; these will differ in the level of care provided.

Your pain relief options are greater in a hospital and may include gas and air (Entonox), an opiate injection of pain relief, a birthing pool (if available, though you won’t usually have this option if you’ve been drugged or induced), and an epidural.

What else should I know about my birth location?

It’s important to remember that giving birth in the UK is considered very safe, and an important part of feeling confident in giving birth at home or at an FSMU is that you have the opportunity to go somewhere where you’ll be well taken care of if problems emerge. In addition, no matter where you give birth, you’ll have ongoing support and a wealth of information available to you from midwives, another benefit of living in a country where maternity care is midwife-led.

Where should I give birth?

The birth environment is so important. Unii explains why.