Labour ward, midwife-led unit or homebirth - what’s the difference?
Choosing where you would like to birth your baby is an important part of building your birth preferences. It’s entirely your choice and you should weigh up the environment that is both comfortable and safe for you, working through the decision with your birth partner and midwife or consultant-led team.
Considering your birth options
Under the care of midwives within the NHS, you will automatically be ‘booked’ to birth your baby on either a Labour Ward or Midwife-Led Unit (MLU). You also have the right to request a homebirth if you wish to. This can be supported by the NHS or you could access a private/independent midwife to facilitate this for you.
It’s important to consider the facilities available at your local hospital as it can be worth booking at a hospital slightly further afield in order to access their MLU or home birth team if that is something you would like and your local hospital does not provide. Speak to your GP about your catchment area and which hospitals you are able to access.
The difference in birth settings
Each setting differs and suits different birth preferences. Below we have summarised the options you have and the support and flexibility provided.
Midwife led unit (MLU)
MLU’s are intended to be a ‘home from home’ environment, run by midwives. There are 2 types of MLU’s (Alongside and Stand-Alone). Alongside means that it is situated within a main hospital complex and is very near or adjacent to the Labour Ward. Stand-Alone means that it is based a short distance from the main hospital site and if a complication were to arise, you’d need to be transferred via ambulance to the labour ward.
1 member of staff in active labour
Intermittent Auscultation to monitor baby (heartbeat monitoring)
Increased likelihood of being able to use a birthing pool versus labour ward
A more relaxed home-like atmosphere
Availability of gas and air and pethidine
Reduction in rate of intervention compared to the labour ward
A short journey to labour ward, if required
Labour ward
Labour ward is aimed at those pregnancies that are deemed ‘higher risk’, usually where there is an increased level of monitoring recommended for yourself or baby during labour and birth. Labour wards are run by doctors (obstetricians), although it is a midwife that will be looking after you directly.
There are often birth pools available in these settings and something called telemetry (which is a wireless way to continuously monitor your baby), so while the environment may look more clinical, it is absolutely possible to adhere to birth preferences that may have been written for a lower risk setting. It is also important to note that you have choice in all settings and the right to decline or embrace anything that is offered to you.
1 member of staff in active labour
Availability of Continuous Electronic Fetal Monitoring (CEFM)
Direct access to obstetricians
Direct Access to Anaesthetists
Immediate access to Neonatal specialists and the NICU, if required
Availability of Gas and Air, Pethidine and Epidurals
More limited birth pool availability (but they should have at least 1).
You are likely to experience an increased level of intervention and therefore longer hospital stay if choosing to birth on a labour ward his is due to the fact that there usually are associated pre-existing or pregnancy complications for people who are recommended to birth in this environment.*
Homebirth
If you are thinking of giving birth at home, you will meet with your service provider and discuss all aspects of this option, including the most up to date evidence supporting the safety of homebirth. Homebirths are much less likely to result in intervention than MLU or labour ward births. This is partly due to the fact that ‘lower risk’ people are more likely to give birth at home but there is also more control over the environment and fewer interruptions.
Your team will discuss with you ambulance response times in your area, emergency care at home, the practicalities of how the service runs and things you might need to self-source, such as pain relief.
At home you are likely to have:
2 members of staff in active labour
Access to a birth pool (if you choose to hire/buy one)
Home comforts
The same clinical care as on the MLU (in terms of observations and monitoring baby, intermittent Auscultation)
Availability of gas and air and pethidine in some trusts (to be confirmed with your provider)
More birth partners, or the involvement of other family members/children
Remaining with your birth partner following the birth
More likely to know your midwife
How inductions impact your choice of birth setting
There are a number of aspects that might impact where your team advises you to give birth. There is often room for flexibility, so please speak to your team about your options. As well as the availability and provision of services in your area, your and your baby’s health, the size of your baby and the position of your baby will be taken into account. If you choose to accept an induction of labour, you will need to be on a Midwife-Led Unit or Labour Ward as your team will want to monitor throughout early stages of labour and the need for intervention can be higher.
Remember, only you can decide on the best setting for you and your baby. For positive birth stories taken from across a range of different settings (including the car!), head over to read some of our Positive Birth Stories on our blog.
Source: *(https://www.cochrane.org/CD004667/PREG_midwife-led-continuity-models-care-compared-other-models-care-women-during-pregnancy-birth-and-early)
