Get the birth experience you want

A shake-up to maternity services that promises to give all mums-to-be in England the right to choose between a wider range of birth options was launched by the government last year. Getting a home birth, water birth or epidural should no longer be a postcode lottery. ‘By the end of 2009, all women will have choice in where and how they have their baby and what pain relief to use, depending on their individual circumstances,’ says a Department of Health spokesperson.

However, with over a year to go until this ‘choice guarantee’ comes into effect, getting the perfect birth is sometimes easier said than done. Staff shortages, financial constraints and variations in policy across the UK mean that not all hospitals offer the same services. So how do you work the system to get the birth you want?

How can I arrange to give birth at the hospital of my choice?

Most women give birth at their nearest maternity unit, but if there’s somewhere else you’d rather be, you may be able to book in there instead. Usually, the first step is to phone the director of midwives at the hospital (or, in the case of birth centres, phone the unit direct), who will tell you how to book in. You’ll probably need your GP or community midwife to refer you there.

Before you book, do your research. Don’t base your decision on hearsay. You should find out about facilities, such as whether it offers antenatal classes, has birthing pools or provide epidurals around the clock. It’s also worth checking out the unit’s philosophy on things like continuous monitoring of your unborn baby’s heartbeat during labour, active births or breastfeeding support. For quick statistics on intervention and c-section rates, visit birthchoiceuk.com or drfoster.co.uk/localservices/birth.

‘There are occasions when a hospital might decline your request, for example if you’re out of their catchment area or they’re already fully booked,’ says Miranda Dodwell of birthchoiceuk.com. ‘If you’ve been turned down, phone the hospital’s supervisor of midwives for advice, or the head of maternity services to ask if she would reconsider your case. Have a reasoned argument about why you want to go to that hospital, a bit of flattery doesn’t go amiss, either!’

What if I want a homebirth but my midwife says no?

According to the National Institute for Health and Clinical Excellence, all low-risk women should have the option of a home birth. However, there’s currently no legal requirement for Primary Care Organisations (PCO) to provide a home birth service, so in some areas, you may have a fight on your hands.

‘While some PCOs don’t offer home birth services, no one can force you to go into hospital,’ says Beverley Beech, chair of the Association for Improvements in Maternity Services (AIMS). ‘The Nursing and Midwifery Council obliges a midwife to attend if a woman decides to stay home in labour.’ In other words, if your contractions start and you refuse to budge, the hospital have to send someone to you.

In reality, few of us would willingly put ourselves in such a stressful situation, so try to have plans in place before your labour day. ‘If your request has been refused, write to the chief executive of the maternity unit stating that you intend to stay at home in labour and expect them to provide a midwife,’ says Beverley. ‘In AIMS’ experience, women who are determined to give birth at home and who make it absolutely clear, preferably in writing, that they have no intention of going into hospital are eventually provided with a midwife.’ You can find template letters at aims.org.uk.

Certain existing medical conditions or pregnancy complications may mean you’re advised to give birth in hospital in case you or your baby needs specialist help. But if you feel your home birth request has been unfairly denied, contact the AIMS helpline (0870 765 1433) for support and advice.

How can I make sure I get a water birth?

Labouring in water is great for pain relief, and according to recent research, 86% of maternity units have birthing pools. At the moment, you don’t have a statutory right to a water birth, but there are things you can do to boost your chances of getting one.

‘The most important thing to do is to find out what facilities are offered at your hospital,’ says Sue Macdonald of the Royal College of Midwives. ‘If there’s only one pool and someone else is already in it, you won’t be able to use it.’ Your midwife will be able to tell you what’s available. It’s worth asking how many midwives are trained in water births – if there’s only one, and she’s off duty when labour starts, you may end up staying on dry land.

Also, find out about hospital protocols for using the birth pool. ‘Some units allow women to labour in water but won’t let them actually give birth in the pool,’ explains Sue. Different units may have different eligibility criteria. Generally, if you have a condition that means you might need extra monitoring, the pool will be out of bounds, but some hospitals are more lenient than others.

If your maternity unit doesn't have its own water birth facilities, you may be able to hire your own pool to take into hospital. However, in some cases, this may not be possible, for example if there are space issues or if none of the midwives are trained to attend water births. There is also a chance that, if your labour is fast, you might not be able to assemble and fill the pool in time, unlike at home, where you can set it up in advance.

Arguably the best way to get a water birth is to consider having your baby at home. ‘This way, you can rent a birthing pool, removing the worry about someone else getting there first,’ says Sue. And the one-to-one care from a supportive midwife could help you fulfil your water birth dreams, too.

Can I book a c-section if I really want one?

Just as you couldn’t force a surgeon to remove your appendix without medical reason, you don’t have the right to a caesarean on demand. You do, however, have the right to request one, and psychological factors such as fear of labour may be considered sufficient medical grounds.

‘Some obstetricians don’t feel comfortable assessing a woman’s psychological need and refer her to a psychologist for assessment,’ explains Gina Lowdon of caesarean.org.uk. ‘If she can’t be helped to view labour more positively, a caesarean can be scheduled on the basis of psychological need.’

If you want a caesarean, make an appointment to see your named consultant obstetrician. ‘Prepare a rational argument about why you want a caesarean,’ suggests Professor James Walker from the Royal College of Obstetricians and Gynaecologists. ‘Generally, consultants are more receptive to a considered request than a confrontational approach.’

And if the consultant says no? Get a second opinion. ‘For the best chance of success, seek out the obstetrician with the highest section rate,’ Gina advises. ‘Ask your midwife or local NCT teachers if they have a feel for which consultants are most likely to be sympathetic.’ If you need help or advice on requesting a caesarean, contact AIMS or visit caesarean.org.uk.

How can I be sure of getting the pain relief I want?

Whether you want an epidural at the first twinge or are hoping to manage with massage, check that your maternity unit offers your chosen pain relief by asking your midwife or logging onto drfoster.co.uk/localservices/birth. You can also find out if they offer, or are supportive of, any alternative therapies you may want to try. You can then include your pain relief preferences in your birth plan, and bring them to your midwife’s attention when you arrive at the hospital in labour.

In general, there’s no reason why you shouldn’t get the pain relief you want. However, there are circumstances where your preferred painkiller might not be available. ‘If the anaesthetist is dealing with an emergency elsewhere, you might not be able to have an epidural precisely when you want it,’ explains Prof Walker. Likewise, if you’re very close to delivery, you might be discouraged from having an epidural (because it can affect your ability to push) or pethidine (which could cause breathing difficulties for your baby if given in the late stages).

In these cases, it pays to have a back-up plan – for example, if the anaesthetist isn’t free to set up your epidural, you might want to try pethidine instead. ‘Be open to the midwife’s suggestions, as they may help you to cope with the pain,’ says Prof Walker, ‘But no one will refuse you pain relief for the sake of it.’