Place of Birth – Where do you want to have your baby?

Place of Birth – Where do you want to have your baby?

This is often a big topic for parents at my Hypnobirthing Workshops, my NCT Antenatal Courses and at my free Positive Birth Movement antenatal gatherings.

Where will YOU feel safest? Hospital? Home? Birth Centre? … Why? We’re all different so it’s important that you make your OWN choice but in an INFORMED way.

As you read on you might think “Oh, she’s definitely bigging-up the Birth Centres over the Hospital.” Rubbish – I’m merely presenting the stats and facts to you here, but yes, when you see them the Birth Centres shine. I know that there’s no ‘right’ or ‘wrong’. However … in order to make a fully informed choice you really do need to give where you’ll have your baby a bit more consideration than, say, what colour highlights you’ll have next time you visit the hairdressers!

This is just a summary of the points I get asked about most. For all the other research and a break down locally and nationally, with lists of other considerations, booking criteria for each, as well as an online tool to help you figure out which place of birth will most suit you go here – This is a really fab resource!

Locally both Birth Centres and Pembury Hospital have birth pools, partners are welcome to stay over at all three – at the Birth Centres you can sleep in a double bed together (roll out mattress on the floor for partners at Pembury). Women having their babies at either of the Birth Centres or who have a home birth are more likely to have already met the midwives caring for them in labour. This is unlikely at the hospital. At the Birth Centres & Hospital you can have 2 birthing partners with you, obviously at home you can have as many as you like! You can visit & have a tour of both Birth Centres. Pembury Hospital doesn’t offer tours.

For info on breastfeeding support and postnatal care at each setting, please get in touch and I’ll happily share feedback from previous clients.

29% of women having their babies at Pembury Hospital were induced.

The Birth Place Study (2011) of 65,000 women (on which NICE Guidelines are based) compares like-for-like groups and counts ‘planned’ place of birth rather than actual place of birth (so if a woman planned a homebirth & ended up transferring her stats stayed in the homebirth category) which gives us a real idea of what the effect of place of birth has on the way the birth plays out.

Therefore, worth noting that those commentators who say homebirth stats look better because the group is lower risk are incorrect.

Whether you like it or not, it’s crystal clear from the results that for low-risk women the best chance of avoiding possibly unnecessary interventions & their consequences is to avoid obstetric units…

Types of birth in each setting

Unplanned Caesarean Birth:

Crowborough Birth Centre:      0%

Maidstone Birth Centre:         2.2%

Pembury Hospital:                    17%

Assisted Birth (forceps/ventouse):

Crowborough Birth Centre:    7.7%

Maidstone Birth Centre:          7.2%

Pembury Hospital:                    19%

Straightforward Birth:

Crowborough Birth Centre:  92.3%

Maidstone Birth Centre:        90.6%

Pembury Hospital:                      64%

*birth without induction, epidural, caesarean, forceps, ventouse or episiotomy

But, although most women do want a straightforward birth, there are many other factors to consider too which might mean that actively avoiding the obstetric unit isn’t the right choice for you…

Medical Pain relief available 

Crowborough Birth Centre: gas & air/sterile water injections/pethidine

Maidstone Birth Centre: gas & air/sterile water injections/pethidine

Pembury Hospital: epidurals/Remifentanil/gas & air/sterile water injections/pethidine

Home Birth: gas & air

The Birthplace study found that women planning to give birth in a labour ward were substantially more likely to have an epidural than those planning to give birth at home or in a birth centre. Of course some pain relieving drugs aren’t available for use at a home birth or in a birth centre. That said, the study found that even when a low-risk woman was transferred into a labour ward from home or a birth centre she was still less likely to have an epidural than a low-risk woman who had planned to give birth in the labour ward all along. For example, only one in five (21%) of low-risk first-time mothers planning a home birth had an epidural, compared with more than a third (38%) of those who planned to give birth in a hospital labour ward.

Safety

What came out of this study is that in England birth is very safe in all of these settings for babies.

The study found that for first-time mothers planning a home birth there was a small increase in the risk to the baby over planning birth in a labour ward, babies of women having a second or subsequent baby did not have this increased risk. Planning to give birth in a birth centre was as safe for the baby as planning birth in a labour ward for all mothers at low risk of complications.

Women planning a home birth or birth in a birth centre were less likely to have major interventions (with their own associated risks) during labour than women planning birth in a labour ward.

Why the increase of risk in homebirth for 1st time mums?

Poor outcomes for the baby rise from 0.53% to 0.93% – authors note that this low & still a very safe level & doesn’t apply to women having subsequent babies.

We don’t know why exactly – more research needed, suggested reasons are: demographic of HB groups (older mums for example) & also the way maternity services are set up across the country – dedicated HB m/w team where women know the m/w who’ll attend their birth, compared with no dedicated HB m/w team – less experience, some aren’t positive about HBs – puts mum & m/w in difficult position & of course will impact on the stats.

Travel/Transfers

First-time mothers planning a home birth or birth in a birth centre were more likely to transfer to the labour ward in labour or immediately after the birth than women having a second or subsequent baby.

Transfer rates (see below for local stats) from Home or Birth Centre, especially for first time mums look quite high. Midwives aren’t stupid and they don’t take risks! Often when we see transfer rates our immediate assumption is that this is the percentage of women who needed to be transferred emergencies or for necessary interventions … in some cases yes, but do bear in mind that for most they will have been transferred to err on the side of caution and then went on to have straightforward births without assistance … as I’ve said midwives at home and birth centres don’t take risks!

Crowborough Birth Centre Transfers:

18.9% transferred in labour

81.1% gave birth without transfer

Maidstone Birth Centre Transfers:

13.4% transferred in labour

86.6% gave birth without transfer

I hope this answers some of your most urgent questions when considering where to have your baby, but do go and have a look at Which? Birth Choice online for loads more info on each setting, and get in touch with any questions or thoughts.

 


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