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October 10, 2022
The vast majority of babies are born in hospitals and for many people this is the default option that we give very little thought to. Labour starts? I’ll just rock up to my local hospital!
But you can of course give birth wherever you like. And there are likely to be many more pros and cons to each of your birth place options than you ever realised.
We often forget that all birth used to take place at home until it moved into hospital in the mid-20th century, as the medical-model of birth took over and it became more obstetric-led. But what might surprise you is that hospitals are not the safest place for all births and simply planning a hospital birth gives you an increased likelihood of unnecessary intervention. So what are your options for place of birth?
Broadly speaking, there are 3 places where most people give birth:
If you are local to Tonbridge, Tunbridge Wells or Sevenoaks then you will fall under the Maidstone & Tunbridge Wells Trust. If you are planning a vaginal birth then this means that your closest birth place options will likely be:
You also have the right to self-refer to a hospital in another Trust, so if, for example, you lived in West Kent you could self-refer to East Surrey Hospital if you didn’t want to attend Tunbridge Wells hospital (for whatever reason).
Everybody has a legal right to give birth either in a hospital or at home, and that applies regardless of whether it is your first, second, third, fourth (etc) baby and regardless of whether you are categorised as “high” risk or “low” risk.
The birth centres do have a power to refuse women in certain circumstances (usually women who are classified as “high” risk) and so you would need to visit the birth centre and discuss your specific pregnancy if you’d like to birth at a birth centre. It’s important to note though that you can appeal against a refusal to birth at the birth centre and so having a chat with the Trust’s Consultant Midwife can be really worthwhile.
If you have had a low-risk pregnancy it is safer to give birth in a midwife-led birth centre or at home than in a hospital. What is deemed to be "safe" in a pregnancy that is classified as "high" risk is less clear and very much dependant on the characteristics of your pregnancy.
Midwife-led birth centre
A large national study (the Birthplace in England national prospective cohort study, BMJ 2011) found that for women with a straightforward pregnancy, birth is as safe for babies in a birth centre as it is in hospital, with the added benefit of lower intervention and complications, including reduced rates of caesarean and instrumental births, episiotomy and severe perineal trauma.
In 2019, a large data review (Hutton et al, 2019) was published in The Lancet which considered data from 500,000 intended home births. The authors of that review found that “The risk of perinatal or neonatal mortality was not different when birth was intended at home or in hospital.” Ie,for “low-risk” pregnancies it is as safe to give birth at home as it is as hospital. Many people think that it is only safer to birth at home if it is your second (or a subsequent) pregnancy, however these statistics found no distinction between first and subsequent pregnancies.
In addition, birthing at home had many other benefits compared to planned hospital birth such as being 40% less likely to have a caesarean, 50% less likely to have forceps or ventouse, 70% less likely to have an epidural, 55% less likely to have an episiotomy, more than 40% less likely to have a severe tear, 75% less maternal infection, and more than 30% less post-partum haemorrhage.
These statistics on safety come from studies into birth place for “low risk” pregnancies, however it is important to note that there may be instances where you are classified as “high risk” and it may be that a) that classification is not appropriate, or b) you would still benefit from birthing out of hospital. It will be a personal decision based on the unique characteristics of your pregnancy.
In 2011, the Birth Place in England Study found that “low risk” first time mothers had a 61% chance of a straightforward vaginal birth (ie a vaginal, non-instrumental birth) when birthing in a hospital, compared to 82% in a stand alone birth centre (which Maidstone and Crowborough both are).
For “low risk” second (and subsequent) pregnancies, the National Institute for Clinical Excellence stated that giving birth in a hospital setting gave a 4 fold increase in caesarean birth and 3 fold increase in instrumental birth.
In 2016/2017, for women starting their labour at Maidstone birth centre there were the following birth statistics:
In 2016/2017, for women starting their labour at Crowborough birth centre there were the following birth statistics:
Both Crowborough and Maidstone birth centres are freestanding (in that they are not attached to a hospital labour ward) however in other Trusts there are also "alongside" birth centres - ie those attached to a hospital labour ward. What we see in statistics that compare birth outcomes between freestanding and alongside birth centres is that alongside birth centres have higher levels of intervention such as forceps and caesarean births than freestanding birth centres. So that is simply a case of proximity to a hospital; the closer you are to a hospital, the more likely that intervention is going to take place.
The majority of the statistics quoted above refer to “low risk” pregnancies. So are your options removed if you are classified as “high risk”? Well, yes and no.
It will very much depend on the characteristics of your pregnancy. Some pregnancies are unjustifiably classified as “high risk” (and indeed challenging this classification may lead to it changing). Some high-risk pregnancies still benefit from midwife-led environments or birthing at home.
One such example may be planning a home birth after caesarean (HBAC) – women giving birth at home were 39% more likely to have a vaginal birth after caesarean than to have another caesarean, compared to women having a VBAC in hospital (Bayrampour et al 2021).
So if you are classified as “high risk” but would like to explore your options, it's important to get to grips with the real issues that you face. What are the risks that are specific to you, and what are the statistics associated with those risks?
Its important that you feel informed when making decisions about your place but also that you feel safe in that decision! There’s no point opting for somewhere that you don’t feel safe as your body simply won’t relax and labour will not progress in the same way.
I cover place of birth in detail on my online hypnobirthing and antenatal course, as well as through the antenatal doula support that I provide, because it can be a big influencing factor in the type of birth experience that you have. Place of birth is also a topic which clients like to discuss in 1:1 Power Hours. If you would like further support when deciding where to have your baby, get in touch!
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