Where to give birth: home, midwifery unit or hospital

You have more choice about where to give birth than many people realise. Here’s what each option means and who it usually suits.

Home birth

The NHS says a home birth is usually only recommended if you have a straightforward pregnancy and you and your baby are well. For a first baby, it says serious problems for the baby (including death) occur in about 5 in 1,000 hospital births and 9 in 1,000 home births. For later babies, a planned home birth is as safe as having your baby in hospital or a midwife-led unit. Epidurals aren’t available at home, but gas and air, a birth pool, TENS and relaxation techniques are. The Birthplace study found that about 45 in 100 first-time mothers who planned a home birth were transferred to an obstetric unit, compared with about 12 in 100 women who had given birth before. More on this in is homebirth the right choice for you?.

Midwifery unit or birth centre

Led by midwives and suited to people with a straightforward pregnancy. Some are part of a hospital, with obstetric, newborn and anaesthetic care nearby. Others are separate from a hospital and can’t offer epidurals or immediate specialist care, so if complications arise you would be transferred by ambulance. Birthplace found that about 36 in 100 first-time mothers planning a birth in a separate unit, and about 40 in 100 planning an alongside unit, were transferred to an obstetric unit, compared with about 9 and 13 in 100 for women who had given birth before. NHS inform in Scotland calls these community midwifery units (separate) and alongside midwifery units (on the same site as an obstetric unit).

Hospital (obstetric unit)

The NHS says it is safest to give birth in hospital if your pregnancy is high risk or you have certain medical conditions. It has direct access to obstetricians, anaesthetists (for epidurals) and newborn specialists. The NHS also notes people giving birth in hospital are more likely to have an epidural, episiotomy, or forceps or ventouse delivery.

Your choice, across the UK

England: the NHS says you can usually consider any of these, though what is available depends on your needs and risks and, to some extent, where you live. You are free to choose any maternity service if you’re willing to travel, and you can change your mind at any point in pregnancy.
Scotland: NHS inform says that for an uncomplicated pregnancy, a midwifery unit or home birth should be offered as options, and you can change your choice at any time.
Wales: NHS 111 Wales lists home birth, a midwifery unit or birth centre, and hospital, and says giving birth is generally safe wherever you choose.
Northern Ireland: nidirect says the choice depends on where you live. In some areas there is a midwife-led unit, and in others the choice is between hospital and home birth. Most consultant-led units have a midwife-led unit attached.

How to decide

Ask your midwife which options are available near you, what the transfer rates are, and what pain relief each offers. The NHS notes a midwife or doctor may advise a hospital birth if they think it is safer for you. You may also want to think about travel time and how you’d like to feel in labour.

Questions people ask

Can I change my mind late in pregnancy?

Yes. The NHS says you can change your mind at any point in your pregnancy.

Is a home birth less safe?

For a first baby, the NHS figures above show a small difference. For later babies, it says a planned home birth is as safe as hospital. Your midwife can advise based on your health.

Can I have a water birth in a midwifery unit?

Often, yes, but pool availability varies. See water birth.

What if I need to be transferred?

Midwives plan for this. If you give birth away from an obstetric unit, they will transfer you if you or your baby need extra care.