Choosing your birth setting

There are three different birth settings:

Homebirth – labour unfolds best when you are relaxed and confident and being in your own space can help. Women who have experienced homebirth have an overwhelming preference for homebirth for further babies and say they had an increased sense of control and confidence. 

Birth centres – (midwife-led units) are staffed by midwives and focus on creating a comfortable and calming ‘home-from-home’ environment, to help you feel more relaxed which will help your labour to progress more naturally.
Equipment provided in the birth centre includes birth pools, couches, and birth balls. birth centres are either within or next to a hospital which is called ‘alongside midwifery unit’ or are a ‘freestanding’ birth centre located elsewhere. Within Kent and Medway there are both alongside and freestanding birth centres. 

Obstetric units – located within a hospital, an obstetric unit (also known as a labour ward) is staffed by midwives, obstetricians and other specialists. An obstetric unit is essential for some women and babies for medical reasons.

Epidural pain relief for labour is an option for all women and is provided only in obstetric units. Equipment is high-tech including continuous heart rate monitors for babies and multi-position delivery beds. Many obstetric units have birth pools. Check the interactive map to see full details for Kent and Medway obstetric units.

Caesarean sections take place in an obstetric operating theatre, part of the obstetric unit. Assisted births (forceps or suction cup) take place within obstetric units when needed.

In Kent and Medway, all trusts have experienced homebirth midwives, as well as at least one birth centre and one obstetric unit. View our interactive map.

Which birthplace is safest depends on each mum and each pregnancy.

Homebirth and birth centres are safe:

• for healthy mums having healthy babies
• for those who have regular checks from a midwife during labour and birth including baby’s heart rate, mum’s blood pressure
• when an obstetric unit can be reached quickly for births started at home where the checks suggest more support is needed.

On average one in seven women who have had a baby before will need to transfer to a hospital for more support if they are having a homebirth or are giving birth in a birth centre, which is in or alongside the hospital.

This compares to less than one in 10 women who will need to transfer from a freestanding birth centre to hospital for support.

When having a first baby, up to half of the women will need to transfer during labour or just after the birth if they start at home, and around one third who start in a birth centre. Freestanding birth centres have slightly fewer transfers than alongside birth centres for first-time mums (36 per cent compared to 40 per cent).

Healthy mums with healthy babies can safely be supported at both home and birth centres. More than 99 per cent of babies will arrive safe and well. For mums who have had a baby before, both settings are equally safe. For first time mums, some will prefer to choose a birth centre (freestanding or alongside), where 99.5 per cent of babies do well, rather than home where 99.1 per cent of babies do well.  

Obstetric units are the safest place for:

• women with health conditions where labour could cause problems
• babies who are more vulnerable when the normal process of labour may be less safe, such as premature babies, or when a health condition is found during a scan.
• obstetric units are the only place for:
• caesarean section
• using an epidural in labour.

Obstetric units are not advised for:

• healthy women with healthy babies who wish to avoid interventions, where possible. The evidence shows that you are more likely to have an epidural, an episiotomy (cut to vaginal opening), an assisted delivery, or heavy bleeding if you birth in an obstetric unit.

Obstetric units are designed to help healthcare professionals provide close monitoring during labour and birth. This is essential for mothers and babies with conditions where there may be complications giving birth. Close monitoring can, however, interfere with the labour and birth process. This is why there is no ‘one size fits all’ approach to choosing your birth setting. 

Your NHS maternity team will have their own view on the choices they can safely support, as well as the choices they would advise against, for safety reasons. It can be difficult when there is disagreement, and your midwives and doctors will want to make sure you fully understand the evidence behind any recommendations. 

Every woman has the legal right to birth at home, and choosing an obstetric unit is available to all women. There may be some restrictions on the use of a birth centre depending on your or your baby’s health, but you can make the final choice that is right for you.

It is important that you feel you are being listened to, your views are respected and you have been given all the information you need to make the best birth choice for you.

Midwives and doctors are now working more closely together to improve the way your preferences are accommodated. 

If you have any concerns regarding your birth choices then you can ask your midwife to involve a Professional Midwery Advocate in discussions. If needed, you can escalate issues to the Head of Midwifery within the Trust you are booked with. To understand your rights in this situation, visit Birthrights.

In most cases, by working together, these concerns can be resolved, and an agreement reached.
 

Take a virtual tour of some of the local maternity units and what they offer.

Tunbridge Wells Hospital
Medway Maritime Hospital
William Harvey Hospital – Labour Ward
William Harvey Hospital – Singleton Midwife-led Unit
Queen Elizabeth The Queen Mother Hospital – Labour Ward
Queen Elizabeth The Queen Mother Hospital – St Peter's Midwife-led Unit
Darent Valley Hospital  - The Birth Centre

View the Bump, Birth and Beyond interactive map
 

More information about the chances of different outcomes in each setting is available from a large scientific study from 2011. The results are provided here:

Information if it’s your first baby

Information if you’ve had a baby before