I am a virtual doula who supports women around the UK to make informed and empowered choices about pregnancy, birth and postpartum.
Choosing where to give birth might not be on your to-do list when you first get those two blue lines, but maybe it should be.
Here, The Smart Doula, Charlotte shares why you have more options than you may think – and why making decisions early can set you up for an empowered pregnancy and birth.
Yes, nowadays most people in the UK will choose to give birth in hospital. In fact, based on recent data (2023-2024), about 73-75% of births happen in hospital, 22-25% in midwife-led units and 2-3% at home.
In the 1900s the overwhelming majority of births happened at home with midwives; however government policy started to actively encourage hospital birth in the 1950s. By the 1970s, over 80% of births were in hospitals.
We grow up hearing birth stories from hospital and only see hospital births in the media. It is no surprise that many people don’t know there are other options.
In the UK your right to choose where to give birth is protected as a Human Right (article 8). There are several different options including:
People choose homebirth for many reasons. Some people believe that birth is a normal physiological event that works best when undisturbed. The main hormone that creates contractions during birth is Oxytocin.
Oxytocin works best in calm, unobserved and undisturbed environments, where the mother feels safe. For a lot of women, the easiest place to create this environment is at home.
For other people, especially those who have given birth before, if their previous births have been fast, giving birth at home removes the fear of having to rush to the hospital. It also removes the risk of giving birth in the car at the side of the road.
Giving birth at home if you have other children makes childcare arrangements easier too. If birth happens at night, often the older siblings can stay asleep upstairs, or you can arrange a family member to watch over them whilst you and your partner are with the midwives.
If you give birth at home and the birth Is uncomplicated, you can skip the stay at the postnatal ward in hospital, instead you simply return to your own bed after giving birth and can eat your own food or get a takeaway.
If you choose an assisted homebirth, a team of homebirth midwives will come to your house to support you during birth and provide clinical care.
The structure of the homebirth teams differs from area to area. With some, once you choose a homebirth, you will be transferred over to the homebirth team for the remainder of your pregnancy. In other areas you may stay with your community midwife until around 36 weeks of pregnancy.
When you go into labour you will inform the homebirth team and they will send a midwife out to assess you, if they feel you are close to giving birth, they will call a second midwife to assist.
You could also choose to hire a doula, a virtual doula or birth keeper to support you and your partner as well.
In 2019 a large review of available data, 14 studies and 500,000 births concluded that there was no difference between home births and hospital births in terms of outcomes for mum and baby.
There is also data suggesting that if your aim is a vaginal birth, this is nearly three times more likely at home. (Scarf et al 2018).
The same analysis found that severe perineal trauma (tears) and bleeding happened at lower rates at home when compared with hospital birth.
The midwives who attend a homebirth have the same skills and training that hospital midwives have, they carry a lot of the same equipment and medication. Through observations, midwives are skilled at spotting warning signs and will arrange an ambulance transfer to the hospital if more medical assistance or monitoring is required.
Yes! Although many women find the peaceful environment of a homebirth makes it easier to deal with the sensations of contractions, there are still pain relief options you can use at home.
Hypnobirthing, breathing and massage are tools that can be utilised at home before the midwives arrive, alongside things like a shower, bath, birth comb and TENS machine.
You can hire or buy a birth pool to use at home, and when the midwives arrive, they can bring with them gas and air and some pharmacological pain killers as well.
If you require stronger pain relief such as an epidural, you will be able to transfer into hospital.
No! Technically you can give birth at home without buying anything, but there are things you buy to support you and make clean up easier.
If you want the option of birthing in water or using a birth pool you can buy or hire kits online, some areas have a subsidised birth pool scheme.
Incontinence pads and a few plastic shower curtains can protect your carpet and furniture.
Plenty of old towels to help with clean up but also drying you and baby if you get in and out of the pool.
Other equipment like TENS machines or birth combs are things that people buy regardless of where they are planning on giving birth.
Some conditions or risk factors may mean that you are told that it would be best for you to give birth in hospital. You should work with your midwife, doctor or a doula to determine where you feel safest and what the evidence says about their recommendations. If you still wish to birth at home, you can request an out of guidance plan.
Although all NHS Trusts are expected to provide a homebirth service, there are circumstances in which your hospital may not be able to do this. You can work with the Birth Rights organisation to help your Trust get their service back in place or offer alternatives, like an independent or private midwife.
You can choose to hire a private or independent midwife upfront to guarantee access to a homebirth.
I am a virtual doula who supports women around the UK to make informed and empowered choices about pregnancy, birth and postpartum.