geburts abc

Options where to give birth

Home, Birth Centre or Hospital?

Where you give birth is an important choice that deserves a lot of thought to make the choice that is best for you. No matter what you decide, you will be most comfortable with a choice that you took the time to consider.
If you have a healthy, normal pregnancy you can consider giving birth at home or in the hospital. However, if you have complications or medical issues, the hospital might be a better choice because of the availability of specialists who can care for your complex medical needs.
Another option some women have is a birth centre that is located within or near a hospital. Birth centres are a middle-solution between home and hospital, and for some women can provide the safety they need (or want) by having the hospital nearby but also ensure that they have the optimal chance for a physiological birth.
The keys to safety in home birth are having an experienced, knowledgeable and well-equipped midwife with you and having a reliable way to get to a hospital if needed. This is not possible in all health systems, so make sure you speak to your midwife about all your options in advance.
Home birth
Having a home birth is safe for women who are having a normal pregnancy and their babies. If there are problems in your birth, your midwife will transfer with you to a hospital. Women who are giving
birth for the first time more commonly need a transfer, usually due to exhaustion or for wanting pain relief. Having a transfer of care is not a failure - it is getting the best care that you need, when you need it - and if you start your labour at home and transfer later, that is ok. Home births are attended by midwives (doctors only attend home births in a few countries) and it’s important that the same midwife also cares for you in pregnancy. The advantages of home birth include having a midwife with you who knows you well, knows your health and your family, and whom you trust. If you have an older child, having a home birth means that you can stay home with them instead of leaving for a few days to a hospital birth.
Medical pain relief is not used at home births (so no epidurals or pain medication), so discuss with your midwife what measures you can use at home. You should also have support available for after the birth in your home, especially if you have older children.
You might need to transfer to a hospital if there are any complications and might not be able to bring your midwife with you. Discuss this with your midwife in advance. Also discuss her experience
and statistics for birth with midwives in your country/region, but also her personal statistics regarding home birth outcomes and transfers.
No matter what your choices, birthing alone without a trained midwife or doctor to support you is not ideal.
Risk in pregnancy is often considered a binary – either you have it or you don’t. In reality it is more like a continuum – at certain times you may have a certain risk, which may or may not affect all aspects of pregnancy and birth at all times. Risks are not always related and do not always affect each other. For example, if you had spotting in the first trimester that does not mean you will be at risk for bleeding during and after birth.

Birth centres
More and more women are choosing to have their babies in birth centres (sometimes they can be formed as midwifery-led units, alongside units or freestanding midwifery units). Birth centres are
a place where physiological birth is encouraged with all the things you need to make it easier (privacy, dimmed lights, home-like surroundings, birthing tubs). Birth centres also offer the benefit
of easier transfer to hospital in case of need. That said, there is no standard way birth centres operate and it’s important to get all the details in advance. Before choosing a birth centre, check out their statistics on transfers and caesarean section rates - these will vary and it’s important to be aware of them when choosing a facility.

Hospital birth
Most women still give birth in hospitals. Every hospital is different and it’s important to choose the hospital that best fits your needs and offers what is important to you. The main advantage of a hospital birth is that if you need specialised care, it is usually easy to get (although there are no guarantees as to speed or availability). Medical pain relief is also often available, although epidurals may not be available twentyfour hours a day or on weekends.
During your labour and birth, staff will change over shifts (usually every 12 hours) and you will have different midwives, nurses and doctors. Some of them will have different practice styles, although the hospital should have a general routine or protocols that everyone adheres to.

Research has shown that women giving birth in the hospital are more likely to use epidural, have an episiotomy, vacuum or caesarean birth.

Before choosing a hospital to give birth in, research their episiotomy, induction and caesarean section rates. Look at the facilities they offer birthing families and the number of support people that can be with you during labour and after birth. Many hospitals say one thing in their marketing materials but their statistics tell a different story – one that is closer to the way they actually practice. Check if there’s an independent maternity hospital guide available in your country/ area.