NCT believes that women should be able to make an informed decision about where to plan to have their baby.
Many factors will influence their decision including their previous experiences, what their friends and family tell them, the range of services available in their area, whether they live in a city, a town, a rural or remote area, what midwives and doctors tell them, and their health, age and obstetric history.
Options include planning:
• for a home birth,
• to go to a freestanding midwife-led unit or ‘birth centre’ (ie on a separate site from a hospital where obstetric service are available),
• to go to an alongside midwife-led unit or ‘birth centre’ (ie on the same site as a hospital where obstetric service are available),
• a hospital’s labour ward or ‘obstetric unit’,
• a specialist or tertiary level hospital taking regional referrals for women and babies with complex conditions and needing additional specialist care.
In a Spotlight on Research article guest editor Sarah McMullen looks at the new evidence-based NICE guidance which supports choice on place of birth.
The NICE Intrapartum Care Guideline (2014) makes recommendations for care during labour of health women with a straightforward pregnancies who give birth between 37 and 42 weeks of pregnancy. The recommendation on choice of place of birth has been identified as a priority for implementation. Read more about NICE guidance for women on choosing where to give birth.
The Intrapartum Care Guideline does not cover women:
• who give birth before 37 weeks or after 42 weeks
• who have conditions such as pre eclampsia (high blood pressure during pregnancy) or diabetes
• who are pregnant with more than one baby
• who have had a caesarean section before, or are having a planned caesarean section
• who are being induced
• whose baby is 'breech' (bottom down)
• whose baby is not growing properly in the womb (uterus)
• whose baby has an inherited condition that might need assessment and extra care at birth
• whose baby has died in the womb.
The updated guideline acknowledges that ‘Having a baby is an emotional, intense and life changing event.’ Healthcare professionals should ‘do everything they can to make the birth a positive experience’ for the women and her birth companions. This includes involving women in decisions about their care during labour and birth.
NCT calls for NHS managers to expand provision of midwifery-led services, based on a social model of care, to enable families throughout England, Northern Ireland, Scotland and Wales to get to know and be able to access a range of services. There should always be sufficient midwifery-led community services to meet the demand. Women and their partners need respectful professional support and evidence-based information relevant for their particular circumstances so that they can decide what planned place of birth feels right for them and their baby. NICE says to women: ‘Where you have your baby is your choice, and you should always be supported in this choice.’ Further information is available on each option for birth (home, midwifery unit/birth centre, and hospital).
Miranda Dodwell, founder of BirthChoiceUK, has been working in partnership with consumer group Which? to launch Which? Birth Choice, a new website to help women choose where to give birth.
In the Related Documents section of this page there are links to NCT reviews of evidence relating to birth centre care, articles on midwife-led care, home birth. and helping parents to choose where to give birth.