Where to give birth: the options

Choosing your birth location

You can give birth at home, in a unit run by midwives (a midwifery unit or birth centre) or in hospital. Some hospitals have a separate midwifery unit. The choice you have about where to have your baby will depend on your needs and risks and, to some extent, on where you live.

Wherever you choose, the place should feel right for you. You can find out more by reading this whole article, or by clicking on the links in this list to go straight to the information you want:

• making an informed decision
• home birth
• birth in a midwifery unit or birth centre
• hospital birth
• questions to ask

Safety of home versus hospital birth

Giving birth is generally safe wherever you choose to have your baby. However, 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).

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.

If you are healthy and considered to be "low risk" you should be offered a choice of birth setting. If you choose to give birth at home or in a unit run by midwives, you need to be given information by your midwife or GP about what would happen if you have to be transferred to hospital during labour, and how long this would take. If something goes seriously wrong during your labour – which is rare – it could be worse for you or your baby than if you were in hospital with access to specialised care.

Women who give birth in a unit run by midwives or at home are less likely to need assistance, such as through the use of forceps or ventouse (sometimes called instrumental delivery).

For women with some medical conditions, it is safest to give birth in hospital because specialists are available if you need extra help during labour.

Sometimes the maternity unit you choose may not be available if many women are in labour at the same time and the unit is full. Ask your midwife what to expect if this happens to you.

Making an informed decision

It's important that you and your partner have all the information you need to make choices about where you would like to give birth. It is your choice and, even after you have decided where you want to have your baby, you can still change your mind.

Your midwife will discuss the options that are available in your area, though you are free to choose any maternity services if you are willing to travel.

As well as your midwife, you can get information from:

• children's centres (find a children's centre near you)
• your GP surgery
• local maternity units (find maternity services near you)
• the NCT, which can put you in touch with other mothers
• maternity services liaison committees (ask at your local hospital's maternity unit)
• the Birthplace study, published November 2011, comparing the safety of births planned in different settings (at home, in hospital and midwife-led units)

Talk to your midwife about going to have a look around the local maternity services. Don't hesitate to ask questions if you don't understand something, or if you think you need to know more (see a list of helpful questions). You may also want to get advice from your friends and family.

Home birth

If you have a straightforward pregnancy and both you and the baby are well, you might choose to give birth at home. In England and Wales, 2.3% of pregnant women (just over 1 in 50) give birth at home.

If you give birth at home, you'll be supported by a midwife who will be with you while you're in labour. If you need any help or your labour is not progressing as well as it should, your midwife will make arrangements for you to be transferred to hospital.

The advantages of giving birth at home include:

• being in familiar surroundings where you may feel more relaxed and able to cope
• you don't have to interrupt your labour to go into hospital
• you will not need to leave your other children, if you have any
• you will not have to be separated from your partner after the birth
• you are more likely to be looked after by a midwife you have got to know during your pregnancy
• you are less likely to have intervention such as forceps or ventouse than women giving birth in hospital

There are some things you should think about if you're considering a home birth:

• You may need to transfer to a hospital if there are complications – the Birthplace study found that 45 out of 100 women having their first baby were transferred to hospital, compared with only 12 out of 100 women having their second or subsequent baby.
• 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. However, 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). Poor outcomes included death of the baby and problems that might affect the baby's quality of life.
• Epidurals are not available at home.
• Your doctor or midwife may recommend that you give birth in hospital. For example if you are expecting twins or if your baby is breech (lying feet first). Your midwife or doctor will explain why they think a hospital birth is safer for you and your baby.

Planning a home birth

Ask your midwife whether or not a home birth is suitable for you and your baby, or available to you. If it is, your midwife will arrange for members of the midwifery team to support and help you. Here are some questions you might want to ask:

• How long would it take if I needed to be transferred to hospital?
• Which hospital would I be transferred to?
• Would a midwife be with me all the time?
• How do I obtain a birthing pool?

Midwifery units or birth centres

Midwifery units or birth centres are more comfortable and homely than a maternity unit in a hospital. Midwifery units can be part of a general hospital maternity unit, in a smaller community hospital or completely separate from a hospital.

An adjacent midwifery unit (AMU) is attached to a hospital where obstetric, neonatal and anaesthetic care are available should they be needed in the same building or on a separate building on the same site.

A freestanding midwifery unit (FMU) is usually where a unit is on a separate site or some distance away from a hospital without immediate obstetric, neonatal and anaesthetic care.

The advantages of giving birth at a midwifery unit include:

• being in surroundings where you may feel more relaxed and able to cope with labour
• you're more likely to be looked after by a midwife you have got to know during your pregnancy
• the unit may be much nearer your home, so it is easier for your partner and friends/relatives to visit
• you are less likely to have intervention such as forceps or ventouse than women giving birth in hospital

There are some things to think about if you're considering giving birth in a midwifery unit or birth centre:

• you may need to transfer to a hospital if there are any complications – the Birthplace study found that approximately four in 10 women having their first baby in a midwifery unit or birth centre were transferred to hospital, compared with approximately one in 10 women having their second or subsequent baby
• in a unit that's completely separate from a hospital (FMU), you won't be able to have certain kinds of pain relief, such as an epidural – ask your midwife whether the unit or centre is part of a hospital or completely separate
• your doctor or midwife may feel that it's safer for you to give birth in hospital

Planning a birth in a midwifery unit or birth centre

Ask your midwife if there are any midwifery units or birth centres in your area. There may be others you can use if you're prepared to travel.

Here are some questions you might want to ask:

• How long would it take if I needed to be transferred to hospital?
• Which hospital would I be transferred to?
• Would a midwife be with me all the time?
• Can I visit the unit before I give birth?
• What facilities are available, such as birthing pools?

Hospital birth

Most women give birth in an NHS hospital maternity unit. If you choose to give birth in hospital, you'll be looked after by midwives but doctors will be available if you need their help. You'll still have choices about the kind of care you want. Your midwives and doctors will provide information about what your hospital can offer. The advantages of giving birth in hospital include:

• having direct access to obstetricians if your labour becomes complicated
• having direct access to anaesthetists (who give epidurals and general anaesthetics)
• there will be neonatologists (specialists in newborn care) and a special care baby unit if there are any problems with your baby

There are some things you should think about if you're considering a hospital birth:

• you may go home directly from the labour ward or you may be moved to a postnatal ward
• in hospital, you may be looked after by a different midwife from the one who looked after you during your pregnancy

Planning a hospital birth

Your midwife can help you decide which hospital feels right for you. If there is more than one hospital in your area you can choose which one to go to. Find out more about the care provided in each so you can decide which will suit you best.

Here are some questions you might want to ask:

• Are tours of the maternity facilities available before the birth?
• When can I discuss my birth plan?
• Are TENS machines available for pain relief or do I need to hire one?
• What equipment is available, for example mats, a birthing chair or bean bags?
• Are there birthing pools?
• How long will I be in hospital?

Find the right place for you to give birth using this Which? Birth Choice tool.

Wherever you decide to give birth, you can change your mind at any stage of pregnancy. Talk to your midwife if there's anything you're not sure about, or if you want to know more.

Birth questions to ask

Here are some questions you might want to ask if you're considering having your baby in a midwifery unit or birth centre, or in hospital:

• Are fathers, close relatives or friends welcome in the delivery room?
• Are they ever asked to leave the room – if so, why?
• Can I move around in labour and find my own position for the birth?
• What is the policy on induction, pain relief and routine monitoring?
• Are epidurals available?
• How soon can I go home after the birth?
• What services are provided for premature or sick babies?
• Who will help me to breastfeed my baby?
• Who will help me if I choose to formula feed?
• Are babies with their mothers all the time or is there a separate nursery?
• Are there any special rules about visiting?

healthtalk.org has women's stories of thinking about where and how to give birth.