What are my Birth Options?

What are birth options?

I am going to talk a bit about the things that you need to know about when thinking about how your baby will be born. I am doing this from the perspective of a doctor, so it will be slightly different from your midwife. Midwives are the experts on normal birth, doctors only get involved when things go wrong. I am also going to bring to this my experience of being a mother. I have had 3 children. The first by forceps, the second normally and the third by caesarean section, so I have some lived experience in the mix; as well as experience of having looked after and delivered babies for lots of women. 

I am going to be really quite straight forward and I will say it as it is. This blog will go into the main different options to think about in terms of how and where to have your baby. More detail about individual topics are covered in other blogs, such as the one on planned caesarean section, the one on forceps or ventouse for example.

First things first, no matter how a baby is conceived, it has often struck me that the baby gets in there a WHOLE lot easier than it gets out. All routes out have the potential to be quite the journey. It is either vaginal, where the baby has to come through a space which is quite a tight fit or the baby comes out through a mother’s abdomen involving major surgery.  Ideally both can be positive experiences, but similarly, both can have difficulties and challenges and I hope that by talking about them in a straightforward and honest way (this is how it is!), people will find it helpful

Birth is one of those unique topics that can produce some polarised views, and politics and fashion have played quite a role over the years. I am going to steer clear of any of that I hope but I am aware that some people may not find the honest straightforward information here quite meets their expectations.

Vaginal Birth

Firstly, the way that babies were meant to be born, was vaginally. There is no getting away from the fact that this, if it goes well and without complication, is the safest way to have a baby, for both mum and baby. With the right care and support a normal birth can be a beautiful and positive experience. There is lots of evidence that it is safe, and that bonding and breast feeding tend to go better. Although it is painful at the time (pain relief options are available), you will experience much less pain afterwards and you will be up and about and back to your normal self quicker if you have a normal delivery. The biggest rub with planning a normal birth is that sometimes things don’t go to plan and no one has a crystal ball!

If you have a pregnancy which has been without complication, then you will have the option to discuss with your midwife where you would like to have your baby. These options are:

–          At home

–          In a midwifery led birth centre which is standalone

–          In a midwifery led birth centre which is attached to a hospital

–          In a doctor led delivery unit or labour ward which part of a big hospital

The main things to think about are access to pain relief, how you would like your baby to be monitored and how you feel about having access to doctors during labour.

Home Birth

I am no expert on home birth and you would be best to speak to a midwife about this. However, for many years most babies were born at home. The birth will be attended by two midwives and you will have access to some pain relief, usually gas and air and tens machines for example. You will not be able to use stronger pain relief like pethidine or diamorphine at a home birth. Some people think that being in the relaxed environment at home reduces the amount of pain relief you need. You can also arrange to hire a birthing pool. Your baby will be monitored by the midwife listening into the baby’s heartbeat regularly. Home births are associated with the highest chance of a normal birth but remember that women who are at higher risk of having a complicated labour are those who have had a complicated pregnancy, so would not be having a home birth to begin with. The main challenge with home birth is that, sometimes, labour does not go as planned and it is necessary to transfer to hospital. Sometimes this is for pain relief but it can also be for lots of other more urgent reasons, such as passing meconium (the baby has pooed inside), bleeding or a concern about the baby’s heart rate pattern. Remember to take into account how far you are from the hospital and how long it would take an ambulance to take you to the closest delivery unit. A large study, called the Birth Place study (www.npeu.ox.ac.uk/birthplace/results) reported a slightly higher increased chance of poor outcomes for mothers having their first baby at come compared to the delivery unit, but the risk is still low (9.3/1000 compared to 5.3/1000). The biggest issue is that 45% of women needed to be transferred to hospital either during labour or shortly after birth. This is nearly a 50:50 chance.

For women having a second baby, the transfer rate is much lower, at around 12% and there was no difference in outcomes compared to a hospital birth.

Types of hospital units

There are two forms of midwifery led units. These are labour wards, essentially a kind of hospital setting, but they are only run by midwives and there are no doctors present. Midwifery led units are either standalone, which means they are away from a hospital site or alongside, meaning they are usually part of the same building. Not all regions will have access to both, as unfortunately, a lot of stand along midwifery units have been closed down. Obviously, if there is an emergency in labour, you would need an ambulance to transfer to hospital from a standalone unit compared to an alongside unit where transfer may be along a corridor or in a lift. Also, doctors can also be called in sudden emergencies alongside midwifery led units so there is closer access to emergency support if needed. Transfer rates from standalone (or freestanding) midwifery-led units are 36% for first time mothers and 9% for women who have had a normal birth before.  Transfer rates are similar for alongside units at 40% for first time mums and 13% for women who have had babies before.

Compared to a hospital delivery unit, the two main differences are the pain relief options available and the way the baby is monitored.  On midwifery led units the baby will be monitored by the midwife listening in (called intermittent auscultation) regularly and there is no continuous monitoring (called the CTG). Also, there are more pain relief options compared to a home as the midwives can use some of the stronger pain relief options such as pethidine. However, there is no access to an epidural.

At a hospital unit, there are doctors and anesthetists present 24 hours a day, and there is access to continuous monitoring  for the baby and epidurals, as well as patient controlled analgesia systems (PCA).  Doctors will do ward rounds several times a day and there is ready access to emergency procedures and theatre, and there is a neonatal unit close by too. Delivery unit births tend to have more intervention but that probably reflects that women delivering there are the ones who have had a more complicated pregnancy and needed inducing for example.  Overall, for women having their second or subsequent baby and who do not have any complications of pregnancy, home births or midwifery led unit births are safe and offer benefits for the mother.  For women having their first birth, there is a reasonably high chance of needing to be transferred to an obstetric led delivery unit.

Caesarian Section

For some women, they choose to undergo a planned Caesarean section, or elective Caesarean section. Often this is because there is a complication during pregnancy which means this is the decision made between the woman and her obstetrician. I discuss elective caesarean section in another blog, but this is a medical birth which must happen in a hospital theatre setting.