This information has been produced in response to the many enquiries we receive concerning options in maternity care.
Together with other sources of information, we hope it will help you to make informed choices concerning your care, as well as where you would like to give birth.
The information is available as a printed leaflet. (Single copies free of charge, bulk supplies for local distribution also available. See ordering details at the end of the page.)
This is the time to find out about and discuss the different choices available. Whoever you see for this initial consultation should give you information about your options, and you should then take time to consider these before making your choice.
Remember you can always change your mind; there is no "booking contract" involved in obtaining NHS maternity care.
Midwife-only: Home visits by local midwives, sometimes working in teams of various sizes. There may be some opportunity to get to know individual midwives who will attend you at the birth.
Midwife/GP: Visits to the antenatal clinic at the GP surgery. Care is shared between GP and midwife. Birth either at home or in hospital.
Shared care - Hospital/GP: Antenatal visits alternating between the GP surgery and hospital. (Some consultant clinics are held in local health centres). Hospital birth will be assumed, but the final choice of where you give birth is yours.
Hospital care: Hospital antenatal clinic visits during pregnancy, with care being given by midwives and medical staff. An obstetrician will be available if consultation is necessary. Hospital birth will be assumed, but the final choice of where you give birth is yours.
Independent midwifery: Total care by a midwife working outside the NHS, either alone or as part of a group practice. Antenatal care in your own home or in the midwife's consulting room. Birth at home or in hospital. Independent midwifery fees vary around the country. See contact address at the end of this leaflet.
Private Maternity Hospital: Care by midwives, doctors and consultants. Antenatal visits to the hospital, hospital birth. Fees vary.
There is ample evidence to show that a well-planned home-birth is safe for most healthy women enjoying normal pregnancy. You should feel able to trust your midwives, who should discuss your individual needs and give you full information of any condition which may affect your decision to give birth at home.
There are some genuine reasons for recommending a hospital birth, and it is in your own interest to take any contra-indications seriously. However, your choice of a homebirth should not be affected by reluctance on the part of the midwife, the doctor or the local maternity services management.
GPs may decline, but midwives, when called, must attend a labouring woman, wherever she decides to give birth, regardless of advice to the contrary. While there is no evidence that the outcome is improved by the routine attendance of a second midwife at the birth, this is now common practice. Midwives are trained to deal with most emergencies, and if necessary will call out the paramedic ambulance service to transfer you into a consultant obstetric unit.
You may wish to engage the services of an independent midwife. As described under 'Your Choices', these midwives choose to work outside the NHS, though their practice is regulated by the same statutory body as that of all other UK midwives regardless of where they work. Most of the births attended by independent midwives take place at home, though arrangements may be made to enable them to continue caring for you if you choose a hospital birth or if transfer to hospital becomes necessary.
These cater for 'low-risk' births, and are often situated alongside consultant units. Midwives, (who may also have provided your antenatal care), usually attend the birth, and sometimes also the GP. These units can offer continuity of care, but require the same obstetric back-up services as for birth at home.
These are usually part of a general hospital. At present the majority of births take place in these hospitals, in spite of the fact that they are designed to provide 'high-risk' care. Some women actively choose this option, though only a minority of women actually need the specialist care of an obstetrician.
When in labour, you will be admitted to the labour suite and be cared for mainly by midwives. You may or may not have met these midwives during the antenatal period. Your obstetrician may have a preferred set of procedures, which can influence the care you are offered. We suggest that you learn as much as you can, during pregnancy, about the hospitals in your area, their routine procedures, their intervention statistics, etc. This enables you to make an informed decision about which style of care to accept, which is much better than being faced by unknown factors when in labour. Your local consultant unit may have a website where you can access birth information.
It is never too late to change your mind, even if you have already agreed to a hospital birth. Talk to your midwife, and write to the Supervisor of Midwives.
Remember, it is your choice; you can change your mind at any time.
It is important that you learn about all the options before you need to make decisions. It is YOUR pregnancy, YOUR labour, YOUR birth, YOUR body and YOUR baby, and the hospital is at YOUR service!
Express your wishes well in advance, firmly and calmly, in writing, and discuss these with your midwife. Your letter should be placed in your notes, to be read by all those attending you.
6 Springfield Road, Birmingham, B14 7DS Tel. 0121 444 2257 Helpline: 01243 671673 Email: sarahmontagu@postmaster.co.uk www.midwifery.org.uk
1 The Great Quarry, Guildford, GU1 3XN www.independentmidwives.org.uk
(Midwives giving full maternity care outside NHS)
5 Ann's Court, Grove Road, Surbiton, Surrey, KT6 4BE Helpline: 0870 765 1433
Email: chair@aims.org.uk
www.aims.org.uk
(User group offering support and information)
Alexandra House, Oldham Terrace, London, W3 6NH Tel: 0181 992 8637.
www.nctpregnancyandbabycare.com
(Antenatal preparation, postnatal support, etc.)
8 Wren Way, Farnborough, GU14 8SZ Tel: 01252 543250
15 Mansfield Street, London, W1M 0BE Tel. 0207 312 3535
www.rcm.org.uk
Professional body for midwives. Monthly journal, library, archives.
Delivered at Home: Julia Allison. Chapman and Hall.
Who's having your baby?: Beverley Beech. Bedford Square Press
Obstetric Myths Versus Research Realities: Henci Goer. Bergin and Garvey
The Rough Guide to Pregnancy and Birth: Kaz Cooke. Rough Guides.
Birth Your Way: Sheila Kitzinger. Dorling Kindersley
Safety in Childbirth: Marjorie Tew. AIMS
Where to be born: Alison McFarlane & Rona Campbell. NPEU
The text above is reproduced from our leaflet "Choices in Childbirth". If you would like a supply for local distribution, please email your request to sarahmontagu@postmaster.co.uk . The leaflets themselves are free, but there will be a small charge for post and packing.
This page updated 2nd December 2004 IK