pregnant woman with older child

You might have thought the type of birth you have is just chance. But there’s actually plenty of preparation you can do in advance…

Tip one: choose midwife-led care

With midwife care, you are more likely to go into labour by yourself and be more satisfied with your antenatal care (Hollowell et al, 2011; NICE, 2014). Here’s how it works.

You don't have to see your GP, even when you find out that you’re pregnant. Instead, you can ask in your GP’s surgery if a midwife works from there or, if they don’t, get a referral.

Alternatively, ask at your local health centre or children’s centre to be put in touch with a midwife. You can also contact your hospital’s head of midwifery. In some areas of the UK, both a GP and a midwife will look after your antenatal care.

Most women will choose NHS care but some women will choose independent care. Having an independent midwife increases the chance of continuity of care, which in turn reduces the chance of interventions.

When you have your first antenatal check, your midwife should discuss your preferences for care during pregnancy. They’ll ask where you might choose to give birth (Brocklehurst et al, 2011; NICE, 2014). They will also arrange any antenatal tests.

Unless you have medical issues or concerns, there is no need to see a hospital doctor (Hollowell et al, 2011; NICE, 2014; Li et al, 2015). You can have all your care from your trusty midwife (or your midwife and your GP). They’ll aim to give you continuity of care.

Tip two: plan to give birth at home or in a midwife-led birth centre

Evidence suggests that a midwife-led birth centre is as safe as a hospital for you and your baby. That is, if you’re both healthy and have a low risk of complications (Brocklehurst et al, 2011; NICE, 2014; Li et al, 2015). You’re also less likely to have interventions like drips or an episiotomy, forceps or a caesarean birth in a birth centre (Brocklehurst et al, 2011; NICE, 2014; Li et al, 2015).

Home births for first babies carry a very small increased risk of a worse outcome for the baby if there’s at low risk of complications (Brocklehurst et al, 2011; NICE, 2014). If it’s not your first baby and you have a low risk of complications, a home birth is as safe as a hospital (Brocklehurst et al, 2011; NICE, 2014).

Tip three: pick the right birth partner… it might not necessarily be the one you think

Continuous support from a good partner during labour has known benefits (Hodnett et al, 2011; WHO, 2018). Your partner or the father of your baby might be the obvious choice but it might not be what you want. Your choice might depend on what’s happening in your life or your preferences.

You might have a partner you feel comfortable around and able to express yourself without inhibitions in front of, whatever the situation. If so, being together when your child is born migth be a special experience for you both.

Yet if your partner is likely to feel anxious and uncomfortable, it might be better if they stayed outside with a cup of tea. At least for some of your labour while someone else supports you. A birth partner’s anxiety is likely to interfere with your labour hormones.

Perhaps a close female friend or relative who might be less anxious in that situation could be in there with you. Another option for a birth partner or a second birth partner is a doula (see our article about doulas).

When you’re thinking about birthing partners, it could be good to choose someone who is experienced in birth. Other characteristics that are helpful during the birth are someone calm and quiet. Try to choose someone who you can communicate with openly.

It’s useful to discuss roles and boundaries and what you expect of your birth partner before your labour starts. And remember: everything is your decision.

Tip four: get your baby to help you along with its position

Your baby’s birth is more likely to be straightforward if they are in the optimum position  (Hunter et al, 2007). That is, with their head down and the back of their head towards your front. Breech or back-to-back positions are not the optimum.

Very little good research has been done that can tell us for certain whether or not it’s possible to encourage babies into the best position (Hunter et al, 2007; Wallis, 2016). But you could try various things in pregnancy that might encourage the baby into that position.

See our page on helping your baby into the best position for birth. Also ask your midwife or antenatal teacher for more ideas and tips.

Tip five: relax and prepare your mind too

Ok, so your body is one thing. But your mind plays a major part in how your labour goes.

If you’re feeling anxious or worried, which is totally understandable and common, you can try out a few strategies (Glover and Barlow, 2015).

First, try to address any concerns you have by talking to your partner, family, friends or midwife, and build your social network (Bollen, 2015). Support and reassurance can make a difference to how you feel.

Dealing with any niggling issues like relationship problems before you give birth is a very good idea. You don’t want to be in labour with anything other than the baby on your mind.

Second, spend time relaxing before the birth. Maybe give yourself the time and space to sit quietly for a few minutes every day. You could also find your local pregnancy yoga class or antenatal preparation class that focuses on mindfulness or hypnosis.

Many women find attending antenatal classes helpful too. They give you a chance to try out positions for labour and your feelings about birth.

Tip six: you have the option to avoid induction

At the 38 week midwife appointment your midwife might discuss the option of inducing (starting off) labour if your pregnancy reaches 41 weeks (NICE, 2008).  Some women do not want an induction because it increases the chance of interventions (Jansen et al, 2013)

If you say no to an induction, your midwife should accept your decision (NICE, 2008). Instead, after 42 weeks you and your baby can be monitored with ultrasound scans and checks of your baby's heartbeat (NICE, 2008). You can accept or decline this (NICE, 2008).

Your midwife might offer you a 'membrane sweep'. This involves a vaginal examination to stimulate the cervix and produce hormones that trigger birth naturally (NICE, 2008).

If your baby isn’t doing well, an induction will be suggested again. Read more about what happens with induction of labour and other ways to start labour.

This page was last reviewed in February 2018.

Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.

Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.

The Royal College of Midwives Campaign for Normal Birth website includes stories, research and video clips of birth positions.

 

Bollen A. (2015) Supporting women in the transition to motherhood: a research overview. Perspective. 26:16-20, Available from: https://www.nct.org.uk/sites/default/files/related_documents/Bollen%20Supporting%20women%20in%20the%20transition%20to%20motherhood-%20%20a%20research%20overview%20pp%2016-20%20Mar%2015.pdf [last accessed 12th March 2018].

Brocklehurst P, Hardy P, Hollowell J, Linsell L, Macfarlane A, McCourt C, Marlow N, Miller A, Newburn M, Petrou S, Puddicombe D, Redshaw M, Rowe R, Sandall J, Silverton L, Stewart M. (2011) Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. BMJ 343:d7400. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22117057  [last accessed 12th March 2018].

Glover V, Barlow J. (2015) The impact of stress in pregnancy, Perspective (28). Available from: https://www.nct.org.uk/sites/default/files/related_documents/Glover%20and%20Barlow%20The%20impact%20of%20stress%20in%20pregnancy.pdf [last accessed 12th March 2018].

Hodnett ED, Gates S, Hofmeyr GJ, Sakala C.(2011) Continuous support for women during childbirth. Cochrane Database Syst Rev. (7):CD003766. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23857334 [last accessed 12th March 2018].

Hunter S, Hofmeyr GJ, Kulier R. (2007) Hands and knees posture in late pregnancy or labour for fetal malposition (lateral or posterior). Cochrane Database Syst Rev. (4):CD001063. Available from: https://www.ncbi.nlm.nih.gov/pubmed/17943750 [last accessed 26th  February 2018].

Li Y, Townend J, Rowe R, Brocklehurst P, Knight M, Linsell L, Macfarlane A, McCourt C, Newburn M, Marlow N, Pasupathy D, Redshaw M, Sandall J, Silverton L, Hollowell J. (2015) Perinatal and maternal outcomes in planned home and obstetric unit births in women at 'higher risk' of complications: secondary analysis of the Birthplace national prospective cohort study. BJOG. 122(5):741–753. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4409851/  [last accessed 26th February 2018].

NICE. (2014) Intrapartum care for healthy women and babies (CG190). Available from: https://www.nice.org.uk/guidance/cg190 [last accessed 30th  January 2018].

Further reading

Altman DG, Bland JM. (1995) Statistics notes: Absence of evidence is not evidence of absence. BMJ. 311:485. Available from: doi: https://doi.org/10.1136/bmj.311.7003.485 [last accessed 2nd February 2018].

Guittier MJ, Othenin-Girard V, de Gasquet B, Irion O, Boulvain M. (2016) Maternal positioning to correct occiput posterior fetal position during the first stage of labour: a randomised controlled trial. BJOG. 123(13):2199-2207. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26806596 [last accessed 30th January 2018].

Gupta JK, Sood A, Hofmeyr GJ, Vogel JP. (2017) Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database Syst Rev. (5):CD002006. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28539008 [last accessed 2nd February 2018].

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. (2013) Maternal positions and mobility during first stage labour. Cochrane Database Syst Rev. (10):CD003934. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24105444 [Last accessed 2 February 2018].

Wallis S. (2016) Does baby’s position matter in pregnancy and can we do anything about it? Magicalbirth. Available from: https://magicalbirth.wordpress.com/2016/01/20/does-babys-position-matter-in-pregnancy-and-can-we-do-anything-about-it/ [Last accessed 2 February 2018].

NCT. (2010) Normal birth as a measure of the quality of care Evidence on safety, effectiveness and women’s experiences. Available from:  https://www.nct.org.uk/sites/default/files/related_documents/NormalbirthasameasureofthequalityofcareV3.pdf [Last accessed 30 January 2018].

NCT, RCM, RCOG. (2007) Making normal birth a reality Consensus statement from the Maternity Care Working Party,.Available from:  https://www.rcm.org.uk/sites/default/files/NormalBirthConsensusStatement.pdf [Last accessed 30 January 2018].

NHS Digital (2017a) NHS Maternity Statistics. England 2016-2017. Available from: https://digital.nhs.uk/catalogue/PUB30137 [Last accessed 12 April 2018].

Ryan A. (2013) Interventions to reduce anxiety during pregnancy: an overview of research, Perspective, June. Available from: https://www.nct.org.uk/sites/default/files/related_documents/Interventions%20to%20reduce%20anxiety%20during%20pregnancy-%20an%20overview%20of%20research%20Ryan%20%282013%29.pdf [Last accessed 12 March 2018].

WHO. (2018) WHO recommendations: intrapartum care for a positive childbirth experience. Geneva: World Health Organization. Available from: http://apps.who.int/iris/bitstream/10665/260178/1/9789241550215-eng.pdf?ua=1 [Last accessed 27 February 2018].

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