What are my choices?

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

But for women having their first baby, home birth slightly increases the risk of serious problems for the baby – including death or issues that might affect the baby’s quality of life – from five in 1,000 for a hospital birth to nine in 1,000 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. 

It’s rare but, if something goes seriously wrong during your labour at home, it could be worse for you or your baby than if you were in hospital with access to specialised care. 

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 go to hospital. 

Advantages of home birth:

• Being in familiar surroundings, where you may feel more relaxed and better able to cope. 
• Not having to interrupt your labour to go into hospital. 
• Not needing to leave your other children, if you have any. 
• Increased likelihood of being looked after by a midwife you have got to know during your pregnancy. 
• Lower likelihood of having an intervention, such as forceps or ventouse (suction cap), than women giving birth in hospital. 

Things to consider:

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. 

Epidurals are not available at home, but you can use gas and air, a warm bath, a birth pool, TENS and any relaxation techniques you’ve learned. 

Advantages:

• Being in surroundings where you may feel more relaxed and better able to cope with labour. 
• Being more likely to be looked after by a midwife you have got to know during your pregnancy. 
• Lower likelihood of having an intervention such as forceps or ventouse than women giving birth in an Obstetric Unit. 

Should you require obstetric or neonatal support, during or following birth, this can be provided quicker than if you give birth at home. 

Things to consider:

You may need to be transferred to the Obstetric Unit if there are any complications. The Birthplace study found that approximately four in 10 women having their first baby in a midwife led unit were transferred to an Obstetric Unit, compared with approximately one in 10 women having their second or subsequent baby. 

Whilst the unit is alongside the Obstetric, you will still not be able to have certain kinds of pain relief, such as an epidural. 

Advantages:

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

Things to consider:

• 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. 
• Women and birthing people giving birth in an obstetric unit are more likely to have an epidural, episiotomy, or a forceps or ventouse delivery. 

You may be encouraged to have OU (labour ward) birth if during your pregnancy you have complications which indicate that this is the safest option for you and your baby. 

Benefits of labouring or giving birth in water: 

• Increases privacy and the mother’s sense of control. 
• Improves relaxation. 
• Reduces tension and anxiety. 
• Reduces the need for drugs and interventions. 
• Floating in water supports your body weight easing movement and conserving energy. 
• Reduces the length of labour. 

All birth centres and labour wards in our area have at least one birth pool and most have several. If you plan to birth at home, you can buy or hire a birth pool (ask your midwife about local community schemes). 

This stands for transcutaneous electrical nerve stimulation. Some hospitals have TENS machines. If not, you can hire your own machine. 

TENS has not been shown to be effective during the active phase of labour, when contractions get longer, stronger, and more frequent. It’s probably most effective during the early stages, when many women experience lower back pain. 

TENS may also be useful while you’re at home in the early stages of labour or if you plan to give birth at home. If you’re interested in TENS, learn how to use it in the later months of your pregnancy. Ask your midwife to show you how it works. 

How does a TENS machine work?

Electrodes are taped on to your back and connected by wires to a small battery-powered stimulator. Holding this, you give yourself small, safe amounts of current through the electrodes. You can move around while you use TENS. 

TENS is believed to work by stimulating the body to produce more of its own natural painkillers, called endorphins. It also reduces the number of pain signals sent to the brain by the spinal cord. 

There are no known side effects for either you or your baby. NHS information about TENS machines. 

This is a mixture of oxygen and nitrous oxide gas. Gas and air won’t remove all the pain, but it can help reduce it and make it more bearable. Many women like it because it’s easy to use and they control it themselves. 

You breathe in the gas and air through a mask or mouthpiece, which you hold yourself. The gas takes about 15-20 seconds to work, so you breathe it in just as a contraction begins. It works best if you take slow, deep breaths. 

Side effects:

• There are no harmful side effects for you or the baby. 
• It can make you feel light-headed. 
• Some women find that it makes them feel sick, sleepy, or unable to concentrate – if this happens, you can stop using it. 

If gas and air doesn’t give you enough pain relief, you can ask for a painkilling injection as well. 

This is an injection of the drug pethidine into your thigh or buttock to relieve pain. It can also help you to relax. Sometimes, less commonly, a drug called diamorphine is used. 

It takes about 20 minutes to work after the injection. The effects last between two and four hours, so wouldn’t be recommended if you’re getting close to the pushing (second) stage of labour. 

Side effects:

• It can make some women feel woozy, sick and forgetful. 
• If pethidine or diamorphine are given too close to the time of delivery, they may affect the baby’s breathing – if this happens, another drug to reverse the effect will be given. 
• The drugs can interfere with the baby’s first feed. 

An epidural is a special type of local anaesthetic. It numbs the nerves that carry the pain impulses from the birth canal to the brain. It shouldn’t make you sick or drowsy. 

For most women, an epidural gives complete pain relief. It can be helpful for women who are having a long or particularly painful labour.

An anaesthetist is the only person who can give an epidural, so it won’t be available at home. If you think you might want one, check whether anaesthetists are always available at your hospital. 

How much you can move your legs after en epidural depends on the local anaesthetic used. Some units offer “mobile” epidurals, which means you can walk around. 

However, this also requires the baby’s heart rate to be monitored remotely (by telemetry) and many units don’t have the equipment to do this. Ask your midwife if mobile epidural is available in your local unit. 

 An epidural can provide very good pain relief, but it’s not always 100% effective in labour. The Obstetric Anaesthetists Association estimates that one in eight women who have an epidural during labour need to use other methods of pain relief. 

How does an epidural work?

• A drip will run fluid through a needle into a vein in your arm. 
• While you lie on your side or sit up in a curled position, an anaesthetist will clean your back with antiseptic, numb a small area with some local anaesthetic, and then introduce a needle into your back. 
• A very thin tube will be passed through the needle into your back near the nerves that carry pain impulses from the uterus. Drugs (usually a mixture of local anaesthetic and opioid) are administered through this tube. It takes about 10 minutes to set up the epidural, and another 10-15 minutes for it to work. It doesn’t always work perfectly at first and may need adjusting. 
• The epidural can be topped up by your midwife, or you may be able to top up the epidural yourself through a machine. 
• Your contractions and the baby’s heart rate will need to be continuously monitored. This means having a belt around your abdomen and possibly a clip attached to the baby’s head. 

Side effects: 

• An epidural may make your legs feel heavy, depending on the local anaesthetic used. 
• Your blood pressure can drop (hypotension), but this is rare because the fluid given through the drip in your arm helps to maintain good blood pressure. 
• Epidurals can prolong the second stage of labour. If you can no longer feel your contractions, the midwife will have to tell you when to push. This means that forceps or a ventouse may be needed to help deliver the baby’s head (instrumental delivery). When you have an epidural, your midwife or doctor will wait longer for the baby’s head to come down (before you start pushing), as long as the baby is showing no signs of distress. This reduces the chance you’ll need an instrumental delivery. Sometimes less anaesthetic is given towards the end, so the effect wears off and you can feel to push the baby out naturally. 
• About one in 100 women gets a headache after an epidural. If this happens, it can be treated. About one in 2,000 women feels tingles or pins and needles down one leg after having a baby. This is more likely to be the result of childbirth itself rather than the epidural. You’ll be advised by the doctor or midwife when you can get out of bed. You may find it difficult to pee as a result of the epidural. If so, a small tube called a catheter may be put into your bladder to help you. 
• Your back might be a bit sore for a day or two, but epidurals don’t cause long-term backache.

NHS epidural information.