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

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

This was the topic at our November Positive Birth Movement Tunbridge Wells gathering.

Lots of people have asked for the info. so I’ve summarised it here.

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. 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!

I absolutely ‘get’ that wading through loads of info. is dull and time consuming – that ‘s why I’ve put this together … so you don’t have to!

Here’s a summary of the points we discussed. For all the research and a break down locally, 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!

I haven’t been able to compare homebirth stats locally but on the link above there are lots of national stats. and info. If you’d like more info. about homebirth in this area versus Pembury Hospital or the local Birth Centres let me know & I’ll try to track them down!

The Birth Place study of almost 65,000 women (on which new 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.

It’s crystal clear from the results that the best chance of avoiding unnecessary interventions & their consequences is to avoid obstetric units.

In what ways might my decision affect my care and choices?

Breast feeding support – ask me and I can tell you anecdotally the info. I have from many local mums and healthcare providers

Post natal care – as above

Pain relief available

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 many of the 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.

Who’ll look after you

Women who gave birth in a freestanding birth centre or had a home birth were more likely to have already met the midwives caring for them than women who gave birth in a maternity unit

Travel

Transfer rates: see later for stats. Transfer rates from Home or Birth Centre, especially for first time mums are 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 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!

Chance of medical intervention

Low risk women planning a first birth in hospital are nearly twice as likely to have an unplanned CS or assisted birth (with forceps or ventouse). Also more likely to have epidural, an episiotomy & to have labour speeded up

National average outcomes for 1st time mums at a Birth Centre:

Unplanned CS:                                     Hospital – 13%          BC – 6%

Assisted (forceps/ventouse):             Hospital – 22%         BC – 10%

Speed Up labour:                                  Hospital – 30%         BC – 13%

Epidural:                                                Hospital – 38%         BC – 18%

Episiotomy:                                           Hospital – 28%            BC – 16%

Normal Birth*:                                     Hospital – 46%            BC – 71%

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

Safety

What came out of this study is that in England birth is very safe wherever for babies

The study found that for first-time mothers planning a home birth there was a small increase in the risk to their baby over planning birth in a labour ward, but 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.

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.

However, women planning a home birth or birth in a birth centre were less likely to have major interventions during labour than women planning birth in a labour ward.

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

Poor outcomes for 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.

Dramatic difference in rate of interventions (which carry additional risks for mums) depending on place of birth – 10% of mums planning a HB will have intervention, even if they transfer, whereas over 40% will if planning on obstetric unit

Crowborough Birthing Centre

240 births in 2012/13

How will I be looked after?

You’ll see up to 4 different midwives for antenatal appointments and up to 3 different midwives for postnatal appointments.

You’ll see the same midwives throughout your pregnancy and after your baby is born, but different midwives when you’re in labour.

Antenatal and postnatal care is given by an integrated team of midwives working in teams of 3 or 4, so you will see up to this number of midwives. Integrated midwives work in the community and the birth centre. If you are planning a home birth you will be cared for by the integrated team.

Who can give birth here?

Any woman can come here to use the birthing centre from surrounding trusts outside of East Sussex. You can give birth here even if you don’t live in the catchment area

  • Women between 18 and 35 years of age
  • Women who are between 37 and 42 weeks pregnant
  • No complications in this pregnancy
  • BMI between 18.0 and 30.0
  • Baby must be head down
  • Women having only a single baby in this pregnancy
  • Women with a maximum of 4 previous babies.
  • You can discuss having your baby here, even if you don’t fit these criteria. Contact them for details
  • 2 birthing rooms
  • 2 birth pool(s)

 

Transfer Details

84% give birth without transfer to the labour ward (2012/13)

Approximately 15 minute(s) transfer time

 

Support during birth

You can have the following number of birth partners with you during labour: 2

You can have a doula as a birth partner

A doula counts towards the limited number of birth partners.

Tours of the maternity unit

Booking directly with the unit or via community midwife

Take a virtual tour

Amenity (private) rooms

Amenity rooms are available.

£65 per night

 

Birth equipment

  • Aromatherapy service -no
  • Bean bags
  • Birth balls
  • Birth mats
  • Birthing couch
  • CD player
  • Dimmable lighting – no
  • iPod dock
  • Reclining chair
  • TENS machine
  • Other: Birthing stool. Floats for holding in the water

 

Coping with pain

  • Birthing pool
  • Entonox (gas and air) & pethidine
  • Overall transfer rate: 16% (84% birthed at CBC)
  • Transfer 1st time mums: 29% (71% birthed at CBC)
  • Transfer 2nd+: 7% (93% birthed at CBC)
  • Type of women: 34% 1st time 66% subsequent

 

Maidstone Birth Centre

560 births in 2012/13

How will I be looked after?

You’ll see up to 3 different midwives for antenatal appointments and up to 3 different midwives for postnatal appointments.

You’ll see the same midwives throughout your pregnancy, labour and birth and after your baby is born.

 

Who can give birth here?

  • Maidstone and Tunbridge Wells and their surrounding boroughs
  • Women who are between 37 and 42 weeks along
  • Women between 18 and 40 years of age
  • No complications in a previous pregnancy
  • No complications in this pregnancy
  • BMI between 18.0 and 35.0
  • Baby must be head down
  • Women having only a single baby in this pregnancy

You can give birth here even if you don’t live in the catchment area

Facilities

  • 3 birthing rooms
  • 3 birth pool(s)
  • Out-of-hours access to food Kitchen and dining room to make drinks and
  • Facilities available if you arrive in early labour
    • You’ll be seen by a midwife who will check the progress of your labour
  • This is flexible depending on your needs
  • Communal area or living room Kitchen and dining room. Living room area for breastfeeding.
  • Outside space available to women in labour Small garden

Transfer Details

79% give birth without transfer to the labour ward (2012/13)

by road – approximately 40 minute(s) transfer time

Support during birth

You can have the following number of birth partners with you during labour: 2

You can have a doula as a birth partner

A doula counts towards the limited number of birth partners.

This is flexible depending on your needs

Tours of the maternity unit

Telephone the centre to organise a tour.

Take a virtual tour

Amenity (private) rooms

Amenity rooms are not available.

Birth equipment

  • Aromatherapy service
  • Bean bags
  • Birth balls
  • Birth mats
  • Birthing couch
  • CD player
  • Cushions
  • Dimmable lighting
  • iPod dock
  • Reclining chair
  • Rocking chair
  • Supporting rope or sling
  • TENS machine
  • Other: Some midwives trained in aromatherapy and reflexology.

Coping with pain

  • Birthing pool
  • Entonox (gas and air)
  • Pethidine

Type of birth: Unplanned CS: 5%, assisted: 7%, straightforward: 89%

Overall transfer rate: 21% (79% birth at MBC)

Transfer 1st time mums: 13% (87% birth at MBC)

Transfer 2nd + baby: 26% (74% birth at MBC)

Waterbirth – 66% (34% didn’t birth in water, may have laboured)

Type of women: 38% 1st time mothers, 62% subsequent

 

The Delivery Suite at Tunbridge Wells Hospital

4700 births in 2012/13

Facilities

  • 15 labour rooms, of which 5 are home-from-home rooms
  • 3 birth pool(s)

Tours of the unit – not available

Take a virtual tour

Birth equipment

  • Aromatherapy service
  • Bean bags
  • Birth balls
  • Birth mats
  • Birthing couch
  • CD player
  • Cushions
  • Dimmable lighting
  • iPod dock
  • Reclining chair
  • Rocking chair
  • Supporting rope or sling
  • TENS machine

Other: Woodland view, ensuite rooms. Some midwives are trained in aromatherapy and reflexology. Women at higher risk of complications are able to use the birth pools here.

Coping with pain

  • Birthing pool
  • Entonox (gas and air)
  • Pethidine
  • Epidurals are available 24/7.
  • Support during birth
  • You can have the following number of birth partners with you during labour: 2
  • You can have a doula as a birth partner
  • A doula counts towards the limited number of birth partners.

Type of birth:

5% unplanned CS, 14% assisted, 81% straightforward

Induction: 7%

Medical interventions: 45%

  • Compared with national average: more likely to have labour and birth with medical interventions
  • as likely to have natural birth but with epidural
  • less likely to have natural labour and birth without epidural

 

 


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