Frequently Asked Questions

What is meant by choice of place of birth?

Choice of place of birth refers to the options that should be available to women when deciding where to have their baby. The options accepted by health professionals and policy-makers are:

• Home birth with care from a midwife;
• Birth centre (also called midwife-led unit, or community maternity unit, this can be alongside an obstetric unit in a hospital or standalone in the community);
• Obstetric unit in a hospital.

Each has its pros and cons. Home births, for example, have been shown to reduce interventions during birth, reduce women’s recovery times and increase satisfaction. On the other hand, they are not able to provide some of the facilities, such as epidural or caesarean section, that are available in hospitals.

Birth centres, similarly, are designed to be more home-like, thus allowing women more comfort and control over their environment, meaning that they tend to have quicker, easier births, and are more satisfied with them. Again, some of the facilities that are found in obstetric units are not available.

Obstetric units have much technology available, so are particularly well suited to women with greater risk of complications during labour. They do tend to increase the use of interventions, so reduce the rates of straightforward births, even for low-risk women.

Hasn’t the government promised that these will be offered to every woman? Why do we need a campaign on this?

The government has promised, in Maternity Matters, that these options should be offered to all women in England by the end of 2009. The NCT has looked into whether this promise could realistically be said to have been met, by looking at the reasonable access to these options for women throughout the UK – we believe it is as important for women in the devolved countries as it is for women in England. The research shows that we are a long way from being able to say women have reasonable access to these choices.

What research was done?

The research, commissioned by the NCT, looked at physical access to obstetric units and birth centres by journey time. It was decided that a journey time of approximately 30 minutes or less constituted reasonable access to either type of unit. For an area to be defined as providing choice, there had to be at least one obstetric unit and one birth centre within this journey time. The area also had to have a home birth rate of above 5%. This cut-off suggests that home births are being presented as a realistic option to women, and are not only being used by those women who absolutely insist on them.

What are the results of the research?

The results show that 95% of women live in areas without access to the choices of home birth, birth centre and obstetric unit. The main factor in keeping so many women from having access to these options is the low use of home birth. With more support of this, many more women could be said to have access to the three choices.

Why is access to home birth defined by a rate of 5%? 

There will always be a number of women who insist on home births, no matter what. These will account for some of that 5%. We know that when home birth is presented as an option, it is used much more than this rate – the Albany practice, for example, has a home birth rate of over 40%. So it could be argued that 5% is rather small. Though in order to measure any amount of choice at all, this figure could not be any higher, as there would be no case for any amount of choice in the UK at all.

Why is the NCT concentrating on choice of place of birth?

We are focussing on this, as it is something that has been promised, and the promise will not be fulfilled in time. There are, however, some simple steps that can be taken to address this, short, medium and long term.

Choice is vitally important for giving women the best birth outcomes possible. Having choice empowers women, gives them more control over their birth and leads to greater levels of satisfaction.

We are not ignoring other factors though – we campaign on a number of issues, including being members of coalitions, such as End Child Poverty.

Will this benefit all women?

This is a campaign for all women. Every woman in England has been promised the choice of where they have their baby, and every woman in the UK should have realistic access to the three options mentioned before.

How is this going to be funded? In a recession don’t we have more important things to concentrate on?

The NCT are only campaigning for things that have already been promised, and that should have been accounted for in funding for trusts and boards. Numbers of midwives employed have already been laid out in previous work, such as Birthrate Plus. We believe that the changes we would like to see in order to provide choice to women in the UK can be cost-neutral. 

Why are you so against technology and interventions? A natural birth is not always the best kind?

There are situations in which technology and interventions are appropriate. Straightforward births, however, tend to result in greater satisfaction in women, and reduced recovery times. Therefore, the NCT recommends that interventions are only used where necessary, in order to promote better health and satisfaction.

Shouldn’t women be able to choose interventions just like you want them to be able to choose location?

If a woman is presented with the full range of options and objective information about those options, it is her choice which of those she selects. She must be supported in this decision.

Are there really too many interventions?

It is an unfortunate state of affairs that there are more interventions in births than there could be. This is not necessarily because of any individuals insisting on performing interventions, but it has been shown that births in hospitals lead to greater rates of interventions. Hence, birth centres and home births, with much lower rates of intervention, are often preferable for women at low risk of complications during birth.

In guaranteeing the small numbers of home births for the women who really want them, isn’t this taking midwives away from birth centres where potentially they could help more women?

Not in the least. With the numbers of midwives employed as per government targets, there will be sufficient midwives to provide all these services. Besides which, Maternity Matters, the government report setting out the choice guarantee, states that care should be provided to all women by one named midwife throughout her pregnancy, so whichever setting is chosen, there should be enough midwives to provide this care.

What about women who don’t feel comfortable at home?

It’s about informed choice. So long as women have the information and support to back up their decision, this is what is important. As well as this, home doesn’t have to mean your home it could be a parent or friends home, anywhere you and your baby can feel safe and supported.

Is home birth safe?

Yes. For women with low-risk pregnancies, the three options of home birth, birth centre and obstetric unit are as safe.

Where can I learn more?

There is more information available through a variety of NCT’s channels. The website is a good place to start – www.nct.org.uk/choice. This has more information, including the campaign report and the research report available for download. NCT’s other communication channels can provide further information – look out for articles across the range of NCT’s publications.

Any further questions?

Please email campaigns@nct.org.uk.