3.org/TR/xhtml1/DTD/xhtml1-strict.dtd"> Choice of Antenatal Care

Choice of Antenatal Care

There are options when it comes to choosing where to have your baby. These include not only home and hospital but also which hospital. There may be several hospitals in the area where you live, and different types of care, ranging from birthing centres to consultant-led units, may be available. The choice is about where to have your baby and who is to be the main provider of your antenatal care.

Whatever you decide, circumstances may change during your pregnancy which influence your decision. However, there is no contract to sign, so do not worry about changing your mind.

Midwife-led care

Where care is midwife-led, midwives provide all your antenatal care and, as long as your pregnancy continues to be straightforward, a midwife will also provide your labour and postnatal care. How this care is provided depends on where you live and what is available in the area.

Your community midwife can provide your antenatal checks, either in a clinic or in your home. You may see various midwives who are part of a team, or you may have one named midwife throughout your pregnancy. There may be a domino scheme, where your midwife accompanies you to hospital when you are in labour and discharges you home soon after the birth. Some doctors like to see women from their practice at some time during their pregnancy but, if you prefer, or are more comfortable, just to see a midwife, that should be quite acceptable. It is your choice.

Shared care

In this case, antenatal care is shared between the midwife, doctor and a consultant obstetrician at the hospital or maternity unit. This is usually recommended if your pregnancy falls into a'higher risk'category, for example, if you have a complicated obstetric or medical history, are pregnant with twins or have diabetes. Your midwife will explain why this recommendation is being made but, again, ultimately it is your choice.

Private care

Some women choose to employ an independent midwife to provide ali of their care. They like to feel that there is a guarantee that they will have the same midwife providing continuity of care throughout their pregnancy, birth and also postnatally. Statistically, independent midwives have a high proportion of homebirths. You could also pay to see an obstetrician privately for your antenatal care, or choose to give birth in a private maternity unit.

Home birth

Some women would prefer to give birth at home, where they feel comfortable and with their family close at hand, rather than in the unfamiliar, more clinical surroundings of a hospital. If your pregnancy is uncomplicated then statistically it appears to be just as safe to give birth at home as in hospital. The reality is that women who give birth at home need less pain relief, experience less intervention, are more likely to know the midwife who looks after them, and feel more in control throughout the birth.

hospital (consultant unit)

These units have obstetricians on their staff, as well as the facilities to deal with any complications during the birth. If your labour is straightforward you will have a midwife caring for you in labour and during the birth. However, if there are any problems, an obstetrician will be available to carry out an instrumental delivery (forceps or ventouse) or a caesarean section.

You will also have the option of a full range of pain relief, including an epidural, which is administered by an anaesthetist.

Midwife unit

This is usually a much smaller, often stand-alone, unit, or birthing centre, where midwives, and healthcare assistants, provide the care. Women are encouraged to have an active birth and a birthing pool is usually available. This type of unit is more suitable for women with uncomplicated pregnancies who do not anticipate any problems in labour as there are no facilities for administering epidurals and no special-care baby unit.

Birth Plans

Drawing up a birth plan makes you consider the options available and what is important to you and your partner. It acts as a communication tool between you and your midwife and helps to set the'tone'of the sort of labour and delivery that you are hoping for.

To make choices you need to have information, and it is never too early to start finding out what is available. Reading, talking to other women who have had babies, attending antenatal classes and chatting with your midwife should give you some idea of the sort of birth that you would prefer.

The best way of presenting a birth plan is in the form of a letter. This is far more personal than a form printed off a website, and will give the midwife caring for you some idea of your personality. Rather than just completing boxes, put something of yourself into the plan and explain what you and your partner feel is important and why. Some antenatal notes have a space for you to write a birth plan, but you can always write one up separately. Just remember to hand it over when you find out who will be caring for you during labour.

some points to consider;

  • Do you prefer to be cared for by women?
  • Do you have any preferences about pain relief?
  • What are your views on induced labour?
  • Do you want your waters broken only if necessary?
  • Do you want to avoid continual fetal monitoring which would stop you moving about during labour?
  • Do you want to be encouraged to move in labour?
  • Do you want the midwife to encourage you to push or leave you to push spontaneously?
  • Do you want to seethe sex of your baby for yourselves rather than be told?
  • Under what circumstances would you be prepared to have an episiotomy?
  • Does your partner want to cut the cord?
  • Do you want to put your baby straight to the breast?