Where to give birth in the UK: home, midwifery unit or hospital

Three settings, and the choice is yours

The NHS is unusually direct about this. You can give birth at home, in a unit run by midwives (a midwifery unit or birth centre), or in hospital. Your choices depend on your needs, your risks and, to some extent, on where you live. If your pregnancy is high risk or you have certain medical conditions, the NHS says it is safest to give birth in hospital, where specialists are available in case you need treatment during labour.

Two things about that sentence matter more than people realise. The first is that it is a discussion, not an allocation: your midwife talks you through what is available in your area, but the NHS states that if you are willing to travel, you are free to choose any maternity service. The second is that nothing you decide is binding. You can change your mind at any point in your pregnancy, including in labour.

Home birth, and the figure the NHS publishes

Giving birth is generally safe wherever you choose to have your baby. But the NHS does not hide the one number that changes with setting. If you are having your first baby, home birth slightly increases the risk of serious problems for the baby, including death or issues that might affect the baby's quality of life, from 5 in 1,000 for a hospital birth to 9 in 1,000 for a home birth.

That is the honest version. It is a small absolute increase on a small number, and it applies to first babies only.

What changes if you have given birth before

If you have had a baby before, the NHS states plainly that a planned home birth is as safe as having your baby in hospital or in a midwife-led unit. That is a different conversation from the one a first-time parent is having, and it is worth making sure your midwife is having the right one with you.

There is also a benefit that runs the other way. If your pregnancy is low risk and you give birth at home or in a midwife-run unit, you are less likely to need assistance such as forceps or ventouse.

What a home birth actually involves

A midwife will be with you while you are in labour. If you need help, or your labour is not progressing as it should, she will arrange for you to go to hospital. Epidurals are not available at home. You can use gas and air, a warm bath, a birth pool, a TENS machine and relaxation techniques.

Ask four questions before you commit: how long would a transfer to hospital take, which hospital would you go to, would a midwife be with you the whole time, and how do you get hold of a birthing pool.

Midwifery units: alongside or freestanding

This is the distinction that catches people out, and it is not cosmetic. A midwifery unit or birth centre can be either part of a hospital maternity unit, where obstetric, neonatal and anaesthetic care is available, or separate from a hospital, and therefore without immediate obstetric, neonatal or anaesthetic care.

Both are called birth centres. Only one has an anaesthetist down the corridor. Ask your midwife directly whether the unit you are considering is part of a hospital or completely separate, because in a unit that is completely separate you will not be able to have certain kinds of pain relief, including an epidural.

What you gain is a setting the NHS describes as more comfortable and homely than a hospital maternity unit, a greater chance of being looked after by a midwife you got to know during pregnancy, a unit that may be much nearer home, and, if you are low risk, a lower likelihood of forceps or ventouse.

Hospital: the obstetric unit

Most births in the UK happen in an NHS hospital maternity unit. You are looked after by midwives, with doctors available if you need them. The advantages are the ones you cannot manufacture elsewhere: direct access to obstetricians if labour becomes complicated, direct access to anaesthetists who give epidurals, and specialists in newborn care with a special care baby unit if there are problems with your baby.

The trade-offs are real too. You may be looked after by a different midwife from the one who cared for you in pregnancy, and you are more likely to have an epidural, an episiotomy, or a forceps or ventouse delivery. If there is more than one hospital in your area, you can choose which one to go to.

Freebirth and the 36-hour rule

You can choose to give birth at home without a midwife present, sometimes called freebirth or unassisted birth. The NHS asks you to talk to a midwife first so the choice is informed, and points out that you can change your mind at any time in pregnancy or labour.

There is a legal consequence people miss. If you have an unassisted birth you must notify the NHS and local child health services that your baby has been born, because by law every birth in England must be recorded within 36 hours. Your baby gets their NHS number once they have been checked by a midwife, health visitor or GP.

What we cannot tell you from here

What is actually available near you is a local question, and no national page can answer it. Freestanding units open, close and suspend home birth services at short notice depending on midwife staffing, and that is a service-level decision rather than a national entitlement. Your midwife, your GP surgery and the local maternity unit are the three places the NHS names for finding out what is running this month.

Questions worth asking on the tour

Are tours available before the birth? Are there birthing pools? What is the policy on induction, pain relief and routine monitoring? Can you move around in labour and find your own position? How soon can you go home? Who helps you if you breastfeed, and who helps you if you formula feed? If you are looking at a birth centre, add the transfer questions: how long, which hospital, and would a midwife stay with you.

Booking, and changing your mind

Your midwife will discuss the options available in your area, and can arrange for you to look around local maternity services. Some hospitals offer virtual tours on their websites. Ask questions if you do not understand something, and ask again later if your circumstances change.

Whatever you decide, the NHS repeats the same point at the top and the bottom of its guidance: you can change your mind at any stage of pregnancy. A birth preference recorded at 20 weeks is information for your team, not a commitment you owe anyone.