Choosing a birth place

More information Choosing a caregiver Professional caregivers Choosing a caregiver is the most important decision that you will make. Questions to ask It is quite acceptable to "shop around" for appropriate health care, and interviewing potential caregivers can be rewarding.

The environment in which a woman labours and gives birth has a major effect on the birth. Your partner's physiological responses will be affected by her surroundings and the result can either speed or delay the process. Her main need is to feel safe and protected from danger or harm, since during the hours of labour she will feel particularly vulnerable. (See "The pain of labour - A feminist issue" by Andrea Robertson).

Many expectant parents assume that their baby will need to be born in a hospital. The World Health Organisation states that normal, healthy pregnant women may wish to consider a number of options, and that for these women, giving birth in their own home is the safest option. In choosing a place to give birth, the availability of suitable caregivers to assist you will be a major factor. You may find that some birth places are impractical because there is no caregiver able to provide the necessary service in that location.

It is also possible to arrange several alternatives and make a final decision on birth place during labour. For example, you could make a booking at the hospital, but choose a midwife who can assist you in either your home or at the hospital, depending on how the labour develops and how you feel at the time. Keep you options open for maximum flexibility!

Home birth

The availability of home birth depends largely on the availability of midwives who provide this service. In some places, home birth is provided through the local health authority, and in other areas engaging the services of an independent midwife will be necessary. Doctors rarely provide home birth services, since they are primarily required to manage problems in appropriate hospital settings.

You may need to make extensive enquiries to determine the availability of home birth where you live. You can ask at your local hospital, community health centre, women's health centre, Family Planning Agency or check the telephone book for listings of midwives and home birth support groups.

Advantages

• Freedom to "do your own thing" in the privacy of your own home.

• No need to make special arrangements for other children.

• A woman feels naturally in charge, since this is her own place.

• You may invite anyone you wish to attend and participate.

• Reduced risk of medical technology or drugs being used routinely - you will be asked to consent to every procedure.

• Reduced risk of infection.

• The baby will be welcomed into its own home and family with little chance of separation or disruption to the mother/baby bonding process.

• No need for hospital visits to see the baby - the midwife will provide post natal care in your home.

Disadvantages

• Your home must have basic equipment - telephone, plenty of hot water, ready access, and should be within 20 minutes of the nearest hospital.

• If there is a complication with the labour, transferring to the hospital may be traumatic.

• Although the midwife will carry basic medical equipment for most situations, if there is a problem with the baby, emergency transfer to the nearest hospital may be necessary.

• Extra help in the home following the birth will be necessary, as a woman needs to rest with the baby for the first days, even weeks.

Hospital labour ward

The majority of women give birth in a standard hospital labour ward. Care in the hospital is usually free. However, if you have private insurance you may be asked to pay, particularly if you elect to use better facilities, such as private rooms, reserved for those who can afford the extra fees.

Labour wards vary in their facilities and the degree of privacy they offer, and a visit during the pregnancy will help you to decide if this is where you want to be for the birth. During this visit, you may wish to raise the following issues:

• Are there any restrictions on whom we can invite to the birth?

• What are the hospital policies regarding:

• Position for labour and birth? Is giving birth on a floor mat acceptable, if requested?

• Procedures that are routinely performed, unless specifically refused?

• What equipment do you have to enable women to get comfortable during labour: extra pillows, armless chairs, floor mats, bean bags, birth balls hot packs? (See "Making labour as comfortable as possible")

• Do you have showers or baths available for use during labour to ease the pain?

• Breastfeeding - is the hospital accredited as being "Baby Friendly" using the World Health Organisation's guidelines? (See "WHO Baby Friendly Hospital Initiative")

• What are the hospital's rates for Caesarean section, forceps, epidurals, episiotomy and induction?

• What costs will be involved in using the hospital? Can I pay for additional services?

• What facilities do you have for the support people?

• Where do I park the car?

• When do you suggest we come to the hospital in labour?

Birth Centres

Some hospitals have additional facilities, called Birth Centres, that are designed to be as home-like as possible. These units are usually set up as a separate unit and have their own staff of midwives to oversee the pre-natal care and the birth. They aim to enable women to give birth with as little intervention as possible, however, should the woman require medical assistance or the use of pain relieving drugs, she can be transferred to the labour ward, which is usually nearby.

Since a Birth Centre operates as a separate facility within the hospital it is important to register for their program as early as possible. They are very popular and often set strict limits on the numbers of clients that they can take. As they are part of the regular hospital services there is usually no charge made for care in a Birth Centre.

In some places, free standing Birth Centres have been established to provide home-like births for those who wish to pay for a private service. These units are usually staffed by independent midwives, who have back up arrangements with local obstetricians and hospitals. Ask for full details of the services they offer and the costs involved.