Making your birth plan

A birth plan is a record of what you would like to happen during your labour and after the birth. You don't have to create a birth plan, but if you would like one your midwife will be able to help. You may also want to discuss some things with the baby's father, and your friends and relatives.

Pack your bag for birth

Whether you're planning to have your baby at home, in hospital or at a midwifery unit, you should get a few things ready at least two weeks before your due date.

If you're planning to give birth in a hospital or midwifery unit, your midwife will probably give you a list of what you'll need to pack. You may want to include:

  • something loose and comfortable to wear during labour that doesn't restrict you from moving around or make you too hot – you may need about three changes of clothes
  • two or three comfortable and supportive bras, including nursing bras if you're planning to breastfeed – remember, your breasts will be much larger than usual
  • about 24 super-absorbent sanitary pads
  • your washbag with toothbrush, hairbrush, flannel, soap and other toiletries
  • towels
  • things to help you pass the time and relax – for example, books, magazines or music
  • a sponge or water spray to cool you down
  • front-opening or loose-fitting nighties or tops if you're going to breastfeed
  • dressing gown and slippers
  • five or six pairs of pants
  • a loose, comfortable outfit to wear after you have given birth, and to come home in
  • clothes (including a hat) and nappies for the baby
  • a shawl or blanket to wrap the baby in

Transport

Work out how you'll get to the hospital or midwifery unit, because you could need to go there at any time of the day or night. If you're planning to go by car, make sure it's running well and that there's always enough petrol in the tank. If a neighbour has said they will take you, make an alternative arrangement just in case they’re not in.

If you haven’t got a car, you could call a taxi. Or call your maternity unit, which can arrange for an ambulance to pick you up.

Home births

If you're planning to give birth at home, discuss your plans and what you need to prepare with your midwife. Think about where in your home you want to give birth. You're likely to need:

  • clean linen and towels
  • clothes (including a hat) and nappies for the baby
  • about 24 super-absorbent sanitary towels

Important numbers

Wherever you're planning to give birth, keep a list of important numbers in your handbag or near the phone. You need to include:

  • your hospital or midwife's phone number
  • your partner or birth partner's phone number
  • your own hospital reference number, which is on your card or notes (you will be asked for this when you phone in)

If you don’t have a phone, ask neighbours if you can use theirs when the time comes.

Some hospitals and midwifery units allow you to use your mobile phone. Check with your midwife. If you can't use your mobile phone, make sure you have a phonecard or change for a payphone.

Stocking up

When you come home, you won't want to do much more than rest and care for your baby, so do as much planning as you can in advance. Stock up on basics, such as toilet paper, sanitary towels and nappies. If you have a freezer, cook some meals in advance and freeze them.

Antenatal classes

Antenatal classes (sometimes called parentcraft classes) can help you to prepare for your baby’s birth and learn to look after and feed your baby. They can help you to stay healthy during pregnancy, and give you confidence and information. You can learn about the different arrangements for labour and birth, and the choices available to you. This can help you to make your own birth plan. You may also meet some of the people who will look after you during labour.

You'll be able to discuss your plans and any worries with professionals and with other parents. Classes are also a good way to make friends with other parents who are expecting babies around the same time as you. These friendships often help parents through the first few months with a baby. Classes are usually informal and fun. 

Choosing an antenatal class

Think about what you hope to gain from antenatal classes so that you can find the sort of class that suits you best. Places in antenatal classes can get booked up early, so it's a good idea to start making enquiries early in pregnancy so that you can secure a place in the class that you choose. You can attend more than one class. Ask your midwife, health visitor or GP, or contact the NCT, formerly known as the National Childbirth Trust. The NCT may charge for antenatal classes. 

Speak to your community midwife if you can't go to classes. The midwife may be able to lend you a video or DVD about antenatal care, or you may be able to rent or buy one. You can see if there are any available in your local library.

What happens in antenatal classes

You might be able to attend introductory classes on baby care early in pregnancy, but most antenatal classes start around 8-10 weeks before your baby is due, when you are around 30-32 weeks pregnant. If you're expecting twins, start your classes when you're around 24 weeks pregnant because your babies are more likely to be born early. Some units offer antenatal classes for women expecting multiples – ask your midwife about this.

You and your baby could benefit from a regular routine. It's easy to join a group near you or find online support on baby routines and more. 

Classes are normally held once a week, either during the day or in the evening, for around two hours. Some classes are for pregnant women only. Others welcome partners or friends to some or all of the sessions. In some areas, there are classes for single mothers, teenagers or women whose first language is not English.

The kinds of topics covered by antenatal classes are:

  • health in pregnancy, including a healthy diet
  • exercises to keep you fit and active during pregnancy
  • what happens during labour and birth
  • coping with labour and information about different types of pain relief
  • how to help yourself during labour and birth  
  • relaxation techniques
  • information about different kinds of birth and interventions, such as ventouse or forceps delivery
  • caring for your baby, including feeding
  • your health after the birth
  • "refresher classes" for those who've already had a baby
  • emotions and feelings during pregnancy, birth and after

Some classes cover all these topics. Others focus on certain aspects, such as exercises and relaxation, or caring for your baby.

The number of different antenatal classes available varies from place to place. 

Children's Centres

Children's Centres also support families with children under the age of five. They can provide:

  • easy access to antenatal care
  • health services
  • parenting and family support
  • drop-in sessions
  • outreach services (information and advice to remote areas)
  • early education and childcare
  • links to training and employment opportunities

Where to give birth

You can give birth at home, in a unit run by midwives (a midwifery unit or birth centre) or in hospital. Some hospitals have a separate midwifery unit. The choice you have about where to have your baby will depend on your needs and risks and, to some extent, on where you live.

Wherever you choose, the place should feel right for you. 

Safety of home versus hospital birth

Giving birth is generally safe wherever you choose to have your baby. However, for women having their first baby, home birth slightly increases the risk of a poor outcome for the baby (from five in 1,000 for a hospital birth to nine in 1,000 – almost 1% – for a home birth).

For women having their second or subsequent baby, a planned home birth is as safe as having your baby in hospital or a midwife-led unit.

If you are healthy and considered to be "low risk" you should be offered a choice of birth setting. If you choose to give birth at home or in a unit run by midwives, you need to be given information by your midwife or GP about what would happen if you have to be transferred to hospital during labour, and how long this would take. If something goes seriously wrong during your labour – which is rare – it could be worse for you or your baby than if you were in hospital with access to specialised care.

Women who give birth in a unit run by midwives or at home are less likely to need assistance, such as through the use of forceps or ventouse (sometimes called instrumental delivery).

For women with some medical conditions, it is safest to give birth in hospital because specialists are available if you need extra help during labour.

Sometimes the maternity unit you choose may not be available if many women are in labour at the same time and the unit is full. Ask your midwife what to expect if this happens to you.

Making an informed decision

It's important that you and your partner have all the information you need to make choices about where you would like to give birth. It is your choice and, even after you have decided where you want to have your baby, you can still change your mind.

Your midwife will discuss the options that are available in your area, though you are free to choose any maternity services if you are willing to travel.

As well as your midwife, you can get information from:

  • children's centres 
  • your GP surgery
  • local maternity units 
  • the NCT, which can put you in touch with other mothers
  • maternity services liaison committees (ask at your local hospital's maternity unit)
  • a supervisor of midwives, or SoM
  • the Birthplace study, published November 2011, comparing the safety of births planned in different settings (at home, in hospital and midwife-led units)

Talk to your midwife about going to have a look around the local maternity services. Don't hesitate to ask questions if you don't understand something, or if you think you need to know more (see a list of helpful questions). You may also want to get advice from your friends and family.

Home birth

If you have a straightforward pregnancy and both you and the baby are well, you might choose to give birth at home. In England and Wales, 2.3% of pregnant women (just over 1 in 50) give birth at home.

If you give birth at home, you'll be supported by a midwife who will be with you while you're in labour. If you need any help or your labour is not progressing as well as it should, your midwife will make arrangements for you to be transferred to hospital.

The advantages of giving birth at home include:

  • being in familiar surroundings where you may feel more relaxed and able to cope
  • you don't have to interrupt your labour to go into hospital
  • you will not need to leave your other children, if you have any
  • you will not have to be separated from your partner after the birth
  • you are more likely to be looked after by a midwife you have got to know during your pregnancy
  • you are less likely to have intervention such as forceps or ventouse than women giving birth in hospital

There are some things you should think about if you're considering a home birth:

  • You may need to transfer to a hospital if there are complications – the Birthplace study found that 45 out of 100 women having their first baby were transferred to hospital, compared with only 12 out of 100 women having their second or subsequent baby.
  • For women having their second or subsequent baby, a planned home birth is as safe as having your baby in hospital or a midwife-led unit. However, for women having their first baby, home birth slightly increases the risk of a poor outcome for the baby (from five in 1,000 for a hospital birth to nine in 1,000 – almost 1% – for a home birth). Poor outcomes included death of the baby and problems that might affect the baby's quality of life. 
  • Epidurals are not available at home.
  • Your doctor or midwife may recommend that you give birth in hospital. For example if you are expecting twins or if your baby is breech (lying feet first). Your midwife or doctor will explain why they think a hospital birth is safer for you and your baby.

Planning a home birth

Ask your midwife whether or not a home birth is suitable for you and your baby, or available to you. If it is, your midwife will arrange for members of the midwifery team to support and help you. Here are some questions you might want to ask:

  • How long would it take if I needed to be transferred to hospital?
  • Which hospital would I be transferred to?
  • Would a midwife be with me all the time?
  • How do I obtain a birthing pool?

Midwifery units or birth centres

Midwifery units or birth centres are more comfortable and homely than a maternity unit in a hospital. Midwifery units can be part of a general hospital maternity unit, in a smaller community hospital or completely separate from a hospital.

An adjacent midwifery unit (AMU) is attached to a hospital where obstetric, neonatal and anaesthetic care are available should they be needed in the same building or on a separate building on the same site.

The advantages of giving birth at a midwifery unit include:

  • being in surroundings where you may feel more relaxed and able to cope with labour
  • you're more likely to be looked after by a midwife you have got to know during your pregnancy
  • the unit may be much nearer your home, so it is easier for your partner and friends/relatives to visit
  • you are less likely to have intervention such as forceps or ventouse than women giving birth in hospital

There are some things to think about if you're considering giving birth in a midwifery unit or birth centre:

  • you may need to transfer to a hospital if there are any complications – the Birthplace study found that approximately four in 10 women having their first baby in a midwifery unit or birth centre were transferred to hospital, compared with approximately one in 10 women having their second or subsequent baby
  • your doctor or midwife may feel that it's safer for you to give birth in hospital

Planning a birth in a midwifery unit or birth centre

Ask your midwife if there are any midwifery units or birth centres in your area. There may be others you can use if you're prepared to travel.

Here are some questions you might want to ask:

  • How long would it take if I needed to be transferred to hospital?
  • Which hospital would I be transferred to?
  • Would a midwife be with me all the time?
  • Can I visit the unit before I give birth?
  • What facilities are available, such as birthing pools?

Hospital birth

Most women give birth in an NHS hospital maternity unit. If you choose to give birth in hospital, you'll be looked after by midwives but doctors will be available if you need their help. You'll still have choices about the kind of care you want. Your midwives and doctors will provide information about what your hospital can offer. The advantages of giving birth in hospital include:

  • having direct access to obstetricians if your labour becomes complicated
  • having direct access to anaesthetists (who give epidurals and general anaesthetics)
  • there will be neonatologists (specialists in newborn care) and a special care baby unit if there are any problems with your baby

There are some things you should think about if you're considering a hospital birth:

  • you may go home directly from the labour ward or you may be moved to a postnatal ward
  • in hospital, you may be looked after by a different midwife from the one who looked after you during your pregnancy

Planning a hospital birth

Your midwife can help you decide which hospital feels right for you. If there is more than one hospital in your area you can choose which one to go to. Find out more about the care provided in each so you can decide which will suit you best. 

Here are some questions you might want to ask:

  • Are tours of the maternity facilities available before the birth?
  • When can I discuss my birth plan?
  • Are TENS machines available for pain relief or do I need to hire one?
  • What equipment is available, for example mats, a birthing chair or bean bags?
  • Are there birthing pools?
  • How long will I be in hospital?

Find the right place for you to give birth using this Which? Birth Choice tool.

Wherever you decide to give birth, you can change your mind at any stage of pregnancy. Talk to your midwife if there's anything you're not sure about, or if you want to know more.

Birth questions to ask

Here are some questions you might want to ask if you're considering having your baby in a midwifery unit or birth centre, or in hospital: 

  • Are fathers, close relatives or friends welcome in the delivery room?
  • Are they ever asked to leave the room – if so, why?
  • Can I move around in labour and find my own position for the birth?
  • What is the policy on induction, pain relief and routine monitoring?
  • Are epidurals available?
  • How soon can I go home after the birth?
  • What services are provided for premature or sick babies?
  • Who will help me to breastfeed my baby?
  • Who will help me if I choose to formula feed?
  • Are babies with their mothers all the time or is there a separate nursery?
  • Are there any special rules about visiting?

healthtalk.org has women's stories of thinking about where and how to give birth

Also on NHS inform