Choosing the Perfect Birthplace: A Guide for Expectant Parents

Choosing where to give birth is one of the first decisions you’ll make when you are pregnant.

Having a baby is a big journey, full of excitement and perhaps some nerves. Where you give birth affects your birth experience, your safety and your wellbeing. This guide explains your options in the UK and shares findings from the Birthplace in England study to help you decide.

Your options

1. Hospital (obstetric unit): Hospital labour wards are led by doctors and midwives together. They can handle emergencies and complications, and offer the full range of pain relief, including epidurals, plus specialist care for you and your baby.
2. Birth centre (midwife-led unit): Birth centres offer a calm, homely environment, run by midwives who focus on supporting physiological birth. They are for women and people with straightforward pregnancies. Some are “alongside” units on the same site as a hospital labour ward; others are “freestanding” units, where transfer to hospital would mean an ambulance journey.
3. Home birth: A home birth lets you labour in the comfort and familiarity of your own surroundings, supported by NHS midwives. If you need extra help, you would transfer to hospital.

What the Birthplace study found

The Birthplace in England study compared outcomes for healthy women with low-risk pregnancies who planned to give birth at home, in a birth centre or in a hospital labour ward. Key findings:

• Birth centres: For low-risk pregnancies, planning to give birth in a birth centre (alongside or freestanding) was as safe for the baby as planning a hospital birth.
• Home birth for a second or later baby: Planning a home birth was as safe for the baby as planning a hospital birth.
• Home birth for a first baby: There was a small increase in the risk of a serious problem for the baby, from about 5 in 1,000 for a planned hospital birth to about 9 in 1,000 for a planned home birth. Around 45% of first-time mothers planning a home birth transferred to hospital during or soon after labour.
• Interventions: Women who planned to give birth at home or in a birth centre had fewer interventions, such as caesareans, assisted births (forceps or ventouse) and episiotomies, than those who planned a hospital birth.

Things to consider

• Your medical history: Any health conditions or pregnancy complications may affect which options are recommended for you.
• Your preferences: Think about pain relief, interventions and the kind of environment you would like to give birth in.
• Access to care: Consider how far you are from hospital and how quickly you could get there if you needed extra care.

Talk to your midwife

Your midwife is a valuable source of support throughout your pregnancy. Talk to them about your options, any concerns and what is available locally. You can change your mind about where to give birth at any time.

In the end, where you have your baby is a personal decision that should reflect your needs and values. Trust your instincts, lean on your partner and healthcare team, and go forward with confidence.

Birth workers: my Birth Place Decisions card sort is a ready-made activity to help clients explore their options.

Sources and further reading:

• Birthplace in England Research Programme (NPEU): https://www.npeu.ox.ac.uk/birthplace
• NHS. Where to give birth: the options: https://www.nhs.uk/pregnancy/labour-and-birth/where-to-give-birth-the-options/