birth plan - Stockport Birth Services

Where Can You Give Birth: Your Birth Place Options

Women and birthing people are supposed to be informed of their choices about where they can give birth and, crucially, are supposed to be supported in their choice. But we know this doesn’t always happen – according to the CQC Maternity Survey Results published in January 2023 a fifth of women said they were not offered any choices about where they can have their baby. Even if they are, the choices are often presented as a list rather than a proper discussion about them. How can you pick something as important as where to birth your baby if you don’t know what each option means?!

Read on for an overview of your choices of where you can give birth.

Home Birth

A home birth is exactly what it says – you give birth at home. Midwives come to you when you’re in labour and stay until you’ve given birth. They examine you post birth, help you with a shower, feeding, and tuck you into bed and go on their merry way. There is NOTHING like getting in to your own bed after giving birth and not sharing a postnatal ward with several other mums, partners and babies.

You’re supposed to be told that home birth is a good choice for ‘low-risk’ women as there’s a lower intervention rate and the outcomes for mums and babies is no different to in a hospital setting – there’s lots of evidence for this. You’re also supposed to be supported in a home birth if you’re ‘high risk’. You can choose to birth at home whether you’re low or high risk.

To hear more about what I’ve got to say about home birth, click here or here.

Birth Centre / Midwife Led Unit

Midwife Led Units (MLUs) are generally called Birth Centres. They come in two variations:

Alongside Midwifery Unit (AMU) – these are alongside the obstetric unit, ie on the same hospital site. Because they’re on the same site if you need extra support such as certain types of pain relief or necessary interventions, it’s a short trip usually taking a matter of minutes in order to receive it (and doctors do also have legs and can come to you if it’s really necessary!).

Freestanding Midwifery Unit (FMU) – these are on a separate site to the obstetric unit. Because they’re not in the same place it will take more time to receive extra help. If you needed that support you would need to be transferred to the local obstetric unit.

Midwifery Led Units are, as the name suggests, led by midwives rather than care being shared between midwives and doctors. They tend to be a little bit more ‘home from home’ like than labour wards and often have birth pools, twinkly lights and pretty murals on the wall. If it’s a particularly well-equipped one you might even find birth ropes, birth stools and other exciting birth equipment.

You have the right to choose to give birth at a Birth Centre if you wish, however sometimes this may involve a negotiation as your trust literally hold the keys and may encourage you to believe that it’s ‘not allowed’.

Labour Ward / Delivery Suite / Obstetric Unit

On Labour Wards care is shared between doctors and midwives. This is generally where those who are expected to have a complicated birth are recommended to give birth, however sometimes your definition of “expected to” may differ from your caregiver’s definition! It’s also where caesarean births take place.

The environment tends to be more clinical looking and less oxytocin-promoting than at home or in Birth Centres, which is a bit silly because people having complicated births are arguably more in need of oxytocin promotion! There is access to more significant pharmacological pain relief such as opiates and epidurals if you want them. By definition, more interventions happen here – because they can’t take place at home or on the Birth Centre.

You have the right to choose to give birth in a Labour Ward either vaginally or by planned caesarean section if you want to. However, you should be advised that unnecessary intervention is more likely to happen on a Labour Ward than either at home or Birth Centres.

So there’s your whistle stop tour of where you can give birth. Where you choose to give birth to your baby is a really important decision because even planning to give birth in one place but actually giving birth in another can change your birth outcomes. So make sure you really consider it and don’t dismiss any of the places until you’ve thought about them properly. And remember, you can change your mind at any point before your baby arrives!

Birth Plans (and Flow Charts)

Crack open your coloured pens, your pretty notebook and your laptop and make a start on your birth plan! Laminating is entirely optional

I’m still pretty furious that one of my clients this week was told she wasn’t allowed to write her birth plan yet. Errrr <— my actual face. Birth plans aren’t something that you write in a 10 minute appointment at 36 weeks.

The POWER of a birth plan comes from the knowledge that you and your support crew get from learning and reflecting. Of finding out what the biological norm is and what circumstances might arise that would throw you off that trajectory. Of what interventions you’d be happy to accept and in what circumstances, and which you will avoid like the plague. The piece of paper at the end is just a tiny part of the process; the really important bit is the work that’s gone into being able to write it.

Birth plans, or birth preferences, or birth flow charts (trademark pending ) come under criticism from some people (yes Adam Kay and other misogynistic folk I’m looking at you). Or rather, they’re another tool to mock and throw scorn down at a woman. As one fabulous OB said on Twitter ‘the longer the birth plan the longer caesarean scar I’ll make’. It’s funny how threatened an empowered woman can make some people feel, isn’t it? Because this is what it’s all about. When you learn and grow in confidence in your body’s abilities you start to question the autocratic policies that you’re told you have to abide by. You start to ask how it relates to you and your own unique situation. You start to ask for evidence and transparency of conversation. You start to demand that you’re treated as a person and not a statistic. And boy, does that throw the system into disarray.

Policies and procedures exist to protect hospitals and staff, and are created (often with little evidence) to give a guideline at population-level. But YOUR birth plan is just for you. It’s for YOUR situation, reflecting YOUR needs, YOUR desires, YOUR experiences, YOUR medical history. It’s the piece of paper that says ‘I am mine and my baby’s biggest advocate and I will make the decisions that I believe will keep us healthiest’. There is NOBODY who has more of a vested interest in you and your baby’s wellbeing than you. Nobody.

The biggest tip I give to pregnant people asking about birth plans – apart from booking my classes – is to read, read and read some more. It’s why my post-class emails are so link heavy! The more you read, the more scenarios you come across, the more different views you hear the more able you are to get a feel for what you’d do if that scenario happens to you in labour. Because with the best will in the world we can’t predict what’s going to happen to you on the day. But we CAN predict your reaction to it.

The second tip is to make sure your support crew know what you want. Don’t keep it secret. Get your birth partners on board, make sure they understand. Because in labour they’ll be advocating on your behalf.

A nice way of creating the final piece is a visual reminder for you and your team is the Positive Birth Movement pictures, available for free download here: http://www.pinterandmartin.com/vbp

Birth Plan Stockport Antenatal Preferences

The System Is Broken…And It’s Breaking Women

Now, I preface this with the fact I love the NHS. I really, really do. It’s a hundred times better than any privatised, corporate system could ever be and it has some of the most dedicated people working for it I’ve ever come across.

So why am I so angry with it?

Because it’s failing women.

Just some examples, from one single class yesterday.

One woman told me her midwife had told her she wasn’t allowed to write her birth plan until she’d been to her NHS antenatal class.

Not ‘you’ll know more after you’ve been to class’. Not ‘the appointment is scheduled for X weeks and you’ll have been to your class then so we’ll discuss it together after’. Not ‘get started now and we’ll go through it together after class in case there’s anything else you want to add to it’.

Not. Allowed.

Not allowed to have an opinion about HER birth at the time of HER choosing. Not allowed to exercise her absolute right to think, plan, decision-make over one of the biggest events of her life. Not allowed to create a tool that connects her to her baby, to her birth.

Language. Fucking. Matters.

And then, a conversation about augmentation of labour. A second-time mom asked why the NHS hadn’t given her this information, the information she needed to make her decisions. This is a mother who HAD BEEN THROUGH THIS PROCESS. She’d HAD the drip and ARM. And she hadn’t known why or what might happen. She asked me why she hadn’t been told this.

She actually wanted an answer.

What could I say?

I spend 9 hours officially (12 hours realistically) talking about it and many many many hours guiding them on top of that, and I barely scratch the surface. The new NHS parentcraft programme has a 2 hour session on labour. Two hours to learn how your body works, what medical assistance there is, to learn what might help you birth your baby.

‘Why don’t they tell us that accepting things has consequences?’

I don’t know. I know they SHOULD. I know I WANT them to. I know I’m glad for each and every woman who comes to me because they get those 12 (18…20…22….24…) hours of me repeating it’s your choice, you have the control, what are the benefits, what are the risks, what might it lead to, what if you say no, it’s your choice, IT’S YOUR CHOICE over and over and over and over and sometimes some of them believe it.

Our bodies are designed to do this but we’ve created these wonderful intervention techniques that help when our bodies don’t work perfectly or our babies need help and then we hold it secret so nobody knows what it’s really about. But then nobody trusts their bodies either because if they worked we wouldn’t have all these interventions would we and so these women, these poor, poor women are left with TWO HOURS of information and then they come out the other end lost and broken and feeling like they’ve failed because how could they possibly win if they’re not even in the same race?

I’m sure the new NHS programme has merit. It sounds like it’s a huge step forward, weaving in attachment and mental health and other vitally important things. But it’s not enough. And that needs to be recognised and if there’s no money to invest in preparing women for something that can impact the rest of their lives, their attachment with their baby, their relationships with their partners, family and friends, their own wellbeing (don’t forget that maternal suicide is THE most common cause of death after childbirth), their future family plans…if there’s no money to protect all of that then why the hell are we not making it commonplace for women to get this information from alternative sources? Why are we giving out fucking Bounty bags instead of educational resources? Why are we allowing Emma’s Diary to fill the screens of antenatal clinics instead of using them to signpost women to information that could save their mental and physical health? Why are we letting down some of the most vulnerable people we have in society?

I’m so angry about it. And so sad for them. It’s a horrendous, stupid broken mess of a system and it doesn’t get any better.

I’m an antenatal teacher because of this shit. Because I desperately don’t want people to go through what I went through. Because I want to stop women being too scared to have more babies, too scared to go back into the hospital that traumatised them, too scared to even THINK about their pregnancy because after pregnancy comes birth and I’ve done my very best to block out any thought about that because of the panic attacks it makes me have. I volunteer with the NHS in two different capacities to try and work within the system, to make it better, to stop breaking women, to stop failing them. I’m not a big corporation. I’m not a profit-making business or well-known monopolising charity. God (well, HMRC) knows I don’t do this for the money, I give away too many free places to women for that! I do it because you deserve better.

Home Births

It’s interesting that this blog post popped up this morning as I had a little chat with my current class about home births yesterday. Thanks to Chilled Mama for sharing so I can pass on and Live, Love & Birth for writing.

The number one reason I hear about not wanting a home birth from those who are pregnant is that they think it will be better to be in hospital ‘just in case’. (The number one reason from dads is the mess )

The research tells us that planned home births are as safe as hospital settings in low risk, not first time pregnancies. For first time moms the chance of a serious negative outcome happening is elevated slightly but the absolute risk is still very low.

We also know that women have better outcomes the longer they stay at home and for those that stay at home for the full event there’s less chance of needing interventions, less chance of getting an infection, less chance of baby being admitted to NICU and more chance of achieving a vaginal birth after caesarean (vbac).

We know that women who feel safe, secure, loved, respected, listened to and in control birth with better outcomes and with a more positive experience than those that don’t, and we know being in a home environment provides those things in a greater capacity than a hospital.

We know that when women are able to choose the position and movements they feel best with in labour they have better outcomes. We know that in hospital women feel restricted to their rooms in labour and those rooms are often quite small (but conversely when rooms are large they feel too clinical and cold).

We know that there’s stupid rhetoric among people who have no clue whose immediate response to people discussing the idea of having a home birth is ‘ooh you’re brave’ which is neither helpful nor accurate but goes a long way in affirming the idea that home birth is risky business without any basis in fact.

There are a multitude of resources for people who are thinking about a home birth including meet ups at most of the local hospitals to discuss other people’s experiences, and the fabulous Greater Manchester Homebirth (morning tag fail, find them on Facebook!) who also run an active support group.

Ultimately, this is YOUR choice and not that of your partner, mother-in-law, Janet your work colleague, Martha on the till at Tesco, your midwife or your consultant. YOUR CHOICE, as everything to do with your care in pregnancy and birth is.

Oh, and dads and partners? There is no mess and you don’t need to clear it up anyway. Your job is to support your partner and your baby and before you even realise it everything has been cleared away. There’s probably more mess from your Friday night takeaway tbh.

*side note: when I refer to hospital I mean an along-side unit of delivery suite and birth centre, as that’s what we have here in Stockport

Risks discussed: https://www.nhs.uk/…/births-at-home-or-in-hospital-risks-e…/

And: https://www.nct.org.uk/…/giving-b…/home-births-are-they-safe

And: https://www.tommys.org/…/midwives-answ…/are-home-births-safe