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Pregnant woman discussing birthing options with consultant

What Are My Options When I Give Birth?

One of life’s biggest events, could be that of meeting your baby. Finding clear information all in one place can help you to make a start with the multitude of decisions that need to be made, and that’s what we at Kari Health aim to do here.

It can be reassuring to know that many of the choices that you make around childbirth are guarded by the principle of protecting birthing peoples’ autonomy and they have a strong foundation in human rights. This means that your choices are governed by law, laying strong guidelines for how you can expect to be treated by your maternal health care team.

Can I give birth for free in the UK?

All pregnant women are entitled to being treated by the NHS for maternity care. If you are ‘ordinarily resident’ in the UK you do not have to pay for NHS maternity care.

There are complicated rules around who is considered to be ordinarily resident in the UK. For example, if you are a British citizen, but not ordinarily resident in England, then you may find that free treatment is not available to you. There are also exemptions and differences between healthcare eligibility criteria in all four nations of the UK.

Scenarios apply to the different statuses of foreign nationals and those with overseas residence. You can get help from Maternity Action to clarify which criteria apply to you.

Feel assured that even if you cannot pay for your maternity care, you will still be given it even from early pregnancy. It’s really important to make sure that both you and your baby are safe and receiving the correct medical attention ahead of prioritising money worries.

Where can I give birth?

Giving birth is considered to be generally safe wherever you choose to have your baby. Most NHS births happen in a hospital maternity unit under the care of midwives and doctors with newborn care available. If there is more than one hospital in your area, you can choose which one to go to, here are some questions you can ask them when you visit.

#1: Can I go to the midwifery unit or birth centre?

Midwifery units can be separate or attached to hospitals, offering a homely feeling option. However, medical interventions such as ventouse or forceps, some kinds of pain relief or neonatal care may not be available to you, and you still may need to be transferred to hospital.

#2: Can I have a home birth?

A home birth can be an option if you have a straightforward pregnancy that is considered to be low-risk. It can offer a calming experience in a familiar environment. If you wish, you can pay for a private midwife for a home birth. 

Things that could prevent you from having a home birth can include twins, the baby being in a breech position, or certain medical conditions. If you choose to have a home birth then there are things you may want to consider, such as not being able to have an epidural for pain relief, and if something goes seriously wrong then you won’t have immediate access to the specialised care that is available in hospital.

#3: Can I have a water birth?

Water births can help with pain control naturally, and help you to relax during labour. If your hospital has a birthing pool that is available at the time of your birth, your pregnancy is considered low risk, and your midwife or doctor believes it is safe for you and your baby, then it may be possible for you to have a water birth. Hiring a pool for home use is an option you could consider.

Can I choose what type of birth I want?

You can choose what type of birth you have, this might be a spontaneous vaginal birth, a planned induction for a vaginal birth or a planned caesarean section. The recommendations for each of these will depend on your health, that of your baby, and where you are planning to give birth.

#1: Can I have a caesarean section?

Around 1 in 4 pregnant women in the UK have a birth by caesarean section. A C-section can be given for both medical and non-medical reasons and it may be planned (elective) or emergency.

You are more likely to have a baby by C-section if you are over 40. In 2020 the most common birthing outcome registered by the NHS was a ‘spontaneous’ birth across all ages, except for the over 40s, where the most common was caesarean section birth.

You can make a request for a caesarean section at any point including during labour, even if you don’t have a medical reason. Your hospital must listen to your reasons for wanting one. NICE (National Institute for Health and Care Excellence) recommends that you should be supported in this decision by the hospital if they are satisfied you are making an informed choice. If your hospital cannot get funding for C-sections without a medical need, you can ask to move to a hospital in a different area.

#2: Unassisted or freebirth

Intentional birth without assistance from a midwife or doctor is called an unassisted birth (UC) or freebirth. Because of the culture for strong opinions around childcare, there can be stigma surrounding this choice, but giving birth this way is a completely legal thing to do. You can choose to have some, no, or full antenatal care. By law, you have to tell a GP or local maternity services within 36 hours of giving birth.

How many people can I have with me when I give birth?

Your hospital may have a policy that limits the number of birth partners you can have, but you may have additional requirements that mean you need the support of more than one birth partner. If you need to have an interpreter or a carer, these individuals do not count as a birth partner.

If you have no birthing partner, you can ask your midwife what charity or support service can offer a free birthing partner to you, so that you don’t have to give birth alone.

You may wish to employ the services of a doula who is a person enlisted to offer practical and emotional support the family before, during, and after birth.

What are my options for pain control during birth?

Childbirth probably isn’t the time to adopt a ‘no pain, no gain’ mentality, so be mentally prepared to ask for pain control (or to plan for it and not use it!) so that you know you are equipped.

The ‘no drugs’ options include breathing and relaxation techniques; which can produce endorphins, help with controlling pain and help you to cope and feel in control. Learning hypnobirthing techniques such as positive words and affirmations may help to reduce fear and increase feelings of calmness. Complementary therapies (aromatherapy, acupuncture or reflexology), can help you to cope with the intense experience of birth by helping to increase the levels of the feel good hormone oxytocin. Whatever other pain control options you choose, and wherever you give birth, relaxation techniques are always available to you.

Nitrous Oxide (commonly known as gas and air) works quickly and helps to reduce pain for the time that you are breathing it in, and you can use it wherever you are giving birth. It is safe for both you and your baby and can be used alongside other pain strategies.

You may feel that this is where you want to draw the line with pain control, however, if you need to have further assistance, a C-section, or if you aren’t coping with the birth experience, knowing about the options for stronger pain control in labour is useful.

You may be offered morphine and opioid drugs which are long lasting, effective painkillers that reduce pain, and which might help you to have a positive mindset about the experience.

If you are in hospital, you may need anaesthetics which are used for ventouse, forceps or caesarean section deliveries. Epidurals and spinal anaesthetics are both regional anaesthetics where you will be awake to experience the birth without pain, but with some sensation such as tugging or the feeling of the baby being born, and your birth partner can be present to support you.

With a general anaesthetic, it is unlikely that they will be allowed in the operating theatre, and you are most likely to meet your baby when you wake in recovery.

Becoming fully prepared

Just as you may train for a sports challenge, investing time and effort into getting tips and tailored knowledge (and for birth you may also wish to be in your best physical shape too!), it’s a good idea to be fully informed about your birthing options to be able to make choices.

Your individual situation may influence the preparation you wish to undertake. That extra detail can come from a variety of sources. You may wish to consider:

  • In person or online birth preparation courses (antenatal classes) offered by organisations such as the National Childbirth Trust (NCT), private practitioners or private midwives.
  • Finding out more about baby care, first aid or safety at home
  • Reading up on hypnobirthing techniques
  • Speaking to a lactation consultant if your pregnancy and birth are anticipated to have an impact on feeding
  • Taking part in pregnancy yoga
  • Finding out how to optimise your baby’s position for birth

How do I talk to my healthcare team about what I want for the birth?

You may feel like you’re swimming in a sea of the unknown when you go to see midwives, and consultants. After all, they have years of training and experience and you may feel completely out of your depth asking for what you want, or you may not know what you want except for knowing what your gut feeling is.

While your team should be equipped to help you, there is a lot that you can do to feel prepared to guide this conversation and get the response that you need.

Starting the conversation

  • Consider the medical and emotional reasons why you want a particular type of birth (perhaps you had a previous illness or a traumatic first birth and subsequent PTSD).
  • Speak to your midwife first about any concerns you may have.
  • Look at the NICE guidelines and read up on your individual scenario. You can ask the midwife what studies and guidelines are relevant to you. You could bullet point parts of the guidelines you may feel concerned about for friendly discussion. Listen to what their recommendations are for you.
  • Use firm, direct and clear language “This happened to me before and I really feel that I need/ want to have X”.
  • Take your birth partner, a well-briefed friend or relative with you to help you to articulate your points and to help keep you focused and absorb information. They can take notes and help you to relax.

If you feel concerned or unhappy after speaking with your consultant, you can speak to your midwife and get a second opinion. You can speak to your Head of Midwifery if you are unhappy with your current midwife.

Dealing with anxiety before birth

If you feel scared or anxious about your pregnancy and birth, speak to your midwife so that you can access perinatal mental health services or other emotional support. Tommys has a wellbeing plan for pregnancy and post birth which you may find useful.

Writing your Birth Plan

If you have never given birth before, it can be difficult to know what to put in your birth plan and how to answer the questions that the template prompts. There are different, personal considerations to make alongside the type of birth you want:

  • If you need an interpreter
  • If you have a non-birthing partner who is intending to breastfeed and needs to stay in overnight rather than being sent home
  • What you need if you have a physical or mental impairment, or long-term health condition
  • What pain relief you would like to try
  • If you want delayed cord clamping, or what you would like to have happen with the placenta
  • Whether you want interventions
  • If you want the screen lowered during a C-section

And many more. You may find that your well-considered plans change during labour and that in the moment you make different decisions, or that you don’t use it.

Expect the unexpected

Whether you want a spontaneous vaginal birth and an unmedicated labour, or a planned C-section and all of the pain relief; you may not get what you want, but hopefully you’ll get what you need.

In 2020-2021 NHS data gathered showed that 34% of labours were induced and 22 in 100 had an unplanned caesarean section.

It is the birthing teams priority to ensure your baby is delivered safely and they will do all that is required in order to protect you and your baby’s life. No matter what plans you put in place for your birth, as with all of life, unexpected events can happen and so it helps to be prepared for a range of eventualities.

Everyone’s birth experience is different, as is their recovery. Birth can be utterly empowering and fulfilling, and conversely, it can have lasting effects for either your body, mind, or both.

You are the best judge of what’s right for you. Do not think or be told that you shouldn’t ask for help if you find that you are not coping at any point during your pregnancy or post-birth.

This article has been reviewed by our Kari Health Experts and Editorial Board to ensure accuracy and reliability of the information presented. However, please note that the content provided is for informational purposes only and should not replace advice from your medical professional.

Did you find this article helpful this article? 

If so, you can read related Kari Health articles here:

Five Things to Expect From Your Body Postpartum

What is Post-natal PTSD, and how do you treat it?

Do I Need To Breastfeed? A Look at the Pros and Cons

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