Thinking about where and how to give birth

Ideas about where and how women should give birth are constantly evolving. Many women, midwives and doctors feel strongly that the natural process of birth has become too medicalised, with most births taking place in hospital and rising caesarean and induction rates. Others stress that having the chance to have good pain relief and use interventions such as caesareans has made birth easier and safer for many women. The reality is that each labour and birth is an individual experience for each woman, and it is impossible to predict how it will turn out.

Birth is a time of transition and change, especially for first-time parents. What happens during birth can help them feel empowered and confident, or it can leave them feeling abused, ignored and disrespected. An important factor is how parents are treated, whether they feel listened to, and whether they feel that any intervention was used for a good reason, with discussion and choice. Some of the learning disabled mothers we talked to felt that they were not listened to or given a choice in how to give birth which was upsetting (see Learning disability and pregnancy).

Some women emphatically wanted as natural a labour and birth as possible. One employed an independent midwife and planned a home delivery to help achieve this. Doctors and midwives supported her choice, but her family were doubtful. She really wanted a home birth, but was reassured to know there was a hospital nearby.

Most women wanted to have a hospital birth, and some were able to choose a community hospital or midwife-led unit. One woman felt she was not given enough information and support by her GP to help her choose which hospital to go to.

Most women's main priorities were having a safe birth and a healthy baby, even if they had clear ideas about their ideal birth. Some women had been clearly advised to think of their birth plan as a guide, and not to be disappointed if things turned out differently. On the other hand, one woman felt angry that some pregnancy books created unrealistic expectations that everything would go according to plan and made people feel a failure if it didn't.

Another woman who knew she wanted an epidural felt others at her antenatal class disapproved of her choice. (See 'Antenatal classes and preparation').

Views were mixed about whether a written birth plan was a good idea. Some felt it was unnecessary or 'a waste of time', but others felt very positive about it and valued the discussion it generated with their midwife. One woman was particularly impressed with the way her community midwife discussed evidence with her about clamping the umbilical cord. Some people felt more in control with a written plan, even if the birth did not turn out as they hoped. A birth plan can help staff who may not have met the woman before know more about her original intentions. On the other hand, it can be difficult to use a birth plan effectively when the midwife present at the birth has not seen the woman before and so neither of them has had the chance to discuss worries and expectations in advance.

One mother went through a birth plan questionnaire with her community midwife but could not make real choices about things that were important to her. For example, she was told she could not have all the people she wanted to come with her for the birth; being able to choose their birth companions mattered to most women.

Another woman was unsure whether to make a plan and would have liked more discussion with her midwife. In the end it did not matter because she knew what she wanted and the midwives present at her baby's birth listened to her. She thought a birth plan might be especially helpful for women who did not speak English.

One woman who had recently come from Pakistan had got most of her information from the pregnancy book her GP gave her, but would have liked more information and discussion.

Some people were happy to accept that intervention might be necessary, but worried about being rushed into a decision during labour without having discussed it and thought it through beforehand.

Another worry for some people was feeling pressured into having an induction if they went overdue. Two mothers from families with a history longer than average pregnancies had contrasting experiences. One felt supported in waiting for labour to start naturally, but the other felt under pressure to have her labour induced.

She would have preferred a caesarean, but agreed reluctantly to an induction. She had a long and very unsatisfactory labour, and in her next pregnancy employed a doula (independent birth companion) to help support her choices.

Doing things differently another time was important for other women, even when there were good reasons why their first birth had not been as planned. Some women who had an emergency caesarean section wanted to try a vaginal delivery next time. Others preferred (or were advised) to have another caesarean.

For some women who discovered the baby had a serious health problem, giving the baby the best chance of survival became the overriding factor in making birth choices. (See also Healthtalk sites on 'Antenatal screening' and 'Parents of children with congenital heart disease').

For more information see our pregnancy resources.

Last reviewed May 2017.
Last updated May 2017.


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