The two main choices when it comes to your birthing options are the where and the how. Usually having a good idea about the second will help you make a decision on the first. While depictions of birth in films and tv land these days are almost always hospital births, or births on the way to hospital, as an expectant mum you do have other options. You could give birth in the maternity unit of a hospital, in a community maternity unit or at home.
Your doctor will be able to provide you with the basic information on what options are available in your area. After that it will be down to you to decide what kind of birth you want and to find out more about, and visit, the various maternity units open to you.
Your birthing experience in a hospital will be managed by either a consultant unit, under the supervision of obstetricians and midwives, or midwife-led unit. Obstretricians are specialists in complications in childbirth, and in consultant units you will have the full panoply of medical technology at the ready should it be necessary. If you opt for a consultant unit then it's unlikely that you'll have much contact with the consultant supervising your birth during your pregnancy.
Whatever hospital unit you're considering make sure to ask about their approach to childbirth and intervention, their c-section rates and so on, so you can be sure their approach sits well with your own preferences.
Midwife-led maternity units are often run alongside consultant units in hospitals, and offer a 'low-tech' approach that favours natural birth and less intervention (see community maternity units, below), but with the option available of transferring to the consultant unit if necessary. Depending on the unit, you may be able to develop a relationship with the midwife who will oversee your birth during your pregnancy.
Community maternity unit / birth centre
Community units or birth centres occupy the middle ground between a home and a hospital birth and are usually NHS-run. They may be GP or midwife-led and do not usually offer options such as epidurals and c-sections. They may be situated near a hospital, so that you can transfer if complications arise, or they may be located in areas where the nearest hospital is some distance away.
Similar to midwife-led maternity units in hospitals, these units are small and intimate, giving mothers some of the advantages of a home birth including lower intervention rates and a cosier atmosphere. Rather than the wide range of medical pain relief on offer in hospitals, maternity units may provide more options in the way of natural pain relief and support during labour, such as birthing pools, birthing balls, birthing stools, the opportunity to use aromatherapy and massage and a more flexible approach to moving around in labour and birthing positions.
Births in these units are only suitable for women with a good chance of giving birth without complications.
When you opt for a home birth you make a conscious decision that you'd like a natural birth in familiar and comfortable circumstances with a midwife you have come to know during your pregnancy. If you choose a home birth then you need to be comfortable of the idea of experiencing labour without a wide range of medical technology and pain relief on-hand, and be comfortable with the possibility that you may need to transfer to a hospital if complications arise.
Among the advantages of a home birth are lower intervention rates and the ability to completely control your birthing environment. There's plenty more information on the advantages and limitations of home births here.
Home births are only suitable for women with a good chance of giving birth without complications. While there's no reason why a first-time mum shouldn't be able to have a successful home birth, some doctors and midwives will be reluctant to give first-time mums the opportunity, so be prepred to stick to your guns if it's what you really want. If you do go for a home birth and book a midwife you can still change your mind at any point.
How to decide
You might already have a very strong desire to give birth in certain surroundings, but if not, before you start thinking about where you will have your baby it will help to have thought a good deal about the kind of birthing experience you would prefer to have, and the options you would like to be open to you.
Do you have any special medical needs or problems which will require specialist attention during birth?
If your answer is yes to this question then it's most likely that you will need to have a hospital birth. If you have a particular medical condition then it's worth looking into whether there are specialists in the feild at the candidate hospitals, or whether it's an area they have plenty of experience in.
Are you comfortable giving birth in a low-tech environment or would you feel happier having full range of medical technology on offer?
If you've already decided that you want an epidural or c-section, or think it's unlikely that you'll be able to get through birth with only gas and air, then a consultant unit will probably be the place for you. If you're keen on a fully natural birth but want to keep your options open then you might want to consider a midwife-led unit in a hospital. Other birthing centres or home births may suit those who are convinced that they want little or no intervention.
How much do you want to be able to control your birthing environment?
Generally speaking you'll have more control over your environment in small birthing centres and at home, but practices in hospitals can vary widely, so make sure you ask about privacy, using aromatherapy, having family present at the birth and so on.
Would you like a water birth?
More and more hospitals and birthing centres are offering birthing pools, but these may be limited in number and be quickly booked up, or you may miss your slot when the time comes. Attitudes to water births also vary: some units will be happy to let you labour in water, but will want you out of the water for the birth itself. If you're having a home birth you can rent a pool for home use, or buy one that can later double-up as a paddling pool.
Will you be happier recovering at home after the birth, with full medical care in hospital, or just somehere other than home?
This is a difficult question to answer before you know what your birth experience will be like. But if you think you'll recover more quickly far away from home and that waiting pile of washing or the needs of other children then you might want to consider a maternity unit. On the other hand some women can't wait to be back home, and the thought of being settled in their own bed within moments of giving birth is a huge plus.
Once you've narrowed your options down in accordance with the kind of birth you want, be sure to visit the maternity units you're interested in, or speak to midwives, and ask lots of questions about how they approach childbirth. It's important that you're comfortable with the environment you select, and that you're confident that their approach sits well with your own concerns and priorities.