The decision on where to give birth is a personal one and there is no right or wrong choice. As with any decision, you may find it helpful to consider your own preferences, and to weigh up the balance of benefits and risks for each option. (See Making decisions about your care). The information on this page is intended to help you do that.
Different names may be used for the same type of birthplace. Those where all care in labour and birth is given by midwives may be called Birth Centres, midwifery units or midwife-led units. Those where both doctors and midwives are available may be called obstetric units, labour wards or delivery suites. In this article we mostly use Birth Centres and obstetric units. But if we are talking about research we use the terms the authors used.
You have the right to choose where you give birth.
Your midwife should tell you about what options there are in your local area. You could also ask other local parents.
Think about what is important to you. Where will you feel safest and most relaxed?
Your options are:
At home with an NHS or private midwife. You also have the right to birth at home without a midwife or doctor. This is called ‘freebirth’. It is legal.
In a Birth Centre (where midwives give all care in labour)
In an obstetric unit in hospital (where doctors are available. Midwives give most of the care).
There is more about these birth places in the sections below.
If you and your baby are healthy, birth is usually safe wherever it happens.
A straightforward birth is more likely at home or at a Birth Centre. You are also less likely to have an unplanned caesarean. But you may need to go to hospital if there is a problem.
If you or your baby has a health problem you might be encouraged to birth in an obstetric unit. You still have the right to birth at home.
A Birth Centre will have guidelines about who can go there. You should not be refused unless there is a good reason why they could not care for you safely.
The AIMS Helpline offers information and support. Contact us if you are finding it difficult to get support for your choice. (helpline@aims.org.uk 0300 365 0663)
You may have particular reasons for preferring one type of birth place. If you have given birth before you may feel strongly that you want the same setting, or that you want a different one. You may feel that you will be more relaxed and able to labour effectively in your own home, or in a home-like setting, or you may want to know that doctors and medical equipment are on hand should you need them. There may be medical reasons why you are advised to give birth in an obstetric unit; however, you do not have to do this if you do not feel that it is right for you.
Your NHS Trust/Board should have information about local birthplaces on their website. Your midwife should also be able to give you information and answer any questions you have, to help you decide.
You may also find it helpful to talk to parents who have given birth in your local area about their experiences.
The sort of things you may want to consider include:
What birthplace options are available in my area and what facilities do they have?
Where would I feel most safe, confident and comfortable giving birth?
Are there any specific reasons why I might want or need to give birth in an obstetric unit?
What options for pain relief would I like to have available? For example a birth pool, or the ability to have an epidural?
What surroundings, equipment and support people would I like to have during labour and for any stay after the birth?
Are there any practical issues e.g. ease of getting to your chosen birth place?
What are the statistics for birth outcomes? For example, what are the chances of an unplanned caesarean or instrument-assisted birth?
What are the arrangements for transfer to the obstetric unit from home or a Birth Centre? How often does this happen locally and how long would it take?
Whether you are expecting your first baby, second, third or more, you have the right to choose where you want to give birth1 and should be supported in your choice2. The options that should be available are at home, in a Birth Centre or in an obstetric unit. These are described below.
In practice, depending on where you live, the options may vary. Birth Centres may be closed, often at short notice, or have guidelines restricting who can use them. You may be told that support for a homebirth is not available. If you have a medical condition, or there is some reason for concern about your baby’s wellbeing, you may find that your care team strongly recommends that you give birth in an obstetric unit, but it is still your choice.
If you are finding it difficult to get support for your choice of birthplace, please contact the AIMS Helpline (helpline@aims.org.uk 0300 365 0663) for information and support.
At Home: You can arrange to have midwifery care from NHS midwives or an independent midwife if there is one in your area. You can choose to birth without a midwife or doctor present (often referred to as freebirth3 or unassisted birth). You always have the right to give birth at home but in recent years there has been an increase in NHS Trusts/Boards restricting or suspending midwifery support for homebirths.
You can hire a birth pool or TENS machine, and use whatever self-help methods or alternative therapies you want for managing your labour. Entonox (“gas and air”) can usually be provided for homebirths. In some areas you can ask to be prescribed opiate drugs such as Pethidine or Diamorphine for your midwife to give you if you want them. If you decided to have an epidural you would need to transfer to an obstetric unit.
A Birth Centre. All care is provided by midwives. Birth Centres are designed to support the process of labour and maximise the chances of a straightforward birth. They usually have a home-like setting to encourage relaxation and the flow of hormones that help labour to progress. Most have birth pools in all or most rooms. Most forms of pain relief are available apart from epidurals, although some Birth Centres do not provide opiates. Alternative therapies such as aromatherapy may be on offer.
There are two types of Birth Centre:
A Freestanding Midwifery Unit (FMU) is on a separate site and is not attached to a hospital with an obstetric unit. A transfer to an obstetric unit in labour would be via ambulance.
An Alongside Midwifery Unit (AMU) is on the same site as a hospital with an obstetric unit, often in the same building, but sometimes a separate one.
Not all areas have a Birth Centre. Some will only have a freestanding one or an alongside one, but not both. Birth Centres may be closed at short notice if there is a shortage of staff, or staff have been moved to work in the obstetric unit.
An Obstetric Unit (OU) is a maternity unit within a hospital. Usually care in labour is provided by midwives but doctors are available to provide medical care if appropriate. It’s possible to request an epidural, though it may not be available exactly when you want it. The availability of birth pools in OUs varies and there may be local guidelines on who can use them. The environment within an obstetric unit is usually more clinical and less home-like than in a Birth Centre, and this may inhibit the helpful labour hormones. On the other hand, some people feel safer having doctors, operating theatres and medical technology close by.
Occasionally if your chosen hospital is very busy you may need to go to another nearby hospital.
A large-scale study conducted in the UK (known as the Birthplace Study4) compared how planning to give birth in different settings affected the outcomes for mothers and babies when there was no reason to expect complications (referred to as “low risk”). It looked at how common it was for babies to be injured, be seriously ill or die during or just after birth when birth was planned in different settings.
The comparison was based on where the women planned to give birth even if they eventually gave birth somewhere else. It excluded women having a pre-term labour or a planned Caesarean birth.
The authors concluded that wherever it took place “birth is generally very safe” for babies of “low risk” women. For mothers who had birthed before, there was no significant difference in chance of death or other serious problems for their babies between the different types of birthplace. The majority (997 or 998 out of every 1000 babies) would be born healthy wherever the birth was planned.
“In each case, the green circles represent a baby born healthy, and the blue circles represent a baby with a poor outcome” ©2014 King’s College London
For first-time mothers who planned to give birth at home the study found a slightly higher chance of problems for the baby compared to a midwifery unit or obstetric unit. Nine babies in every 1000 had a serious problem following a planned homebirth and 991 were born healthy. For births planned in an obstetric unit or in either kind of midwifery unit, five babies in every 1000 had a serious problem and 995 were born healthy.
However, a more recent review5, suggests that homebirth is as safe as hospital for first babies, too. This review combined the results of 14 studies including about half a million planned homebirths. It found that, for ‘low-risk’ mothers, planning to birth at home did not increase the chances of the baby dying either around the time of birth or in the early weeks, or of being in poor health at birth, compared to planning to birth in hospital. This was the case for first babies as well as for later ones.
Some of the medical interventions that a mother might experience can also have an impact on her baby. For instance, when a birth is assisted with forceps or ventouse, the baby may experience bruising or small cuts on their face and head. These usually heal quickly but may mean that the baby is more unsettled for the first few days, which can make it harder to establish breastfeeding. Mothers who have had a caesarean or assisted birth may find it harder to feed and care for their babies in the early days, as well as probably needing longer to recover than those who had a spontaneous vaginal birth.
It is fortunately very rare for mothers in this country to die during labour and birth, so in this sense all birthplaces are safe.
However, the Birthplace Study4 showed that mothers with no complicating factors are more likely to experience medical interventions if they plan to give birth in an obstetric unit rather than at home or in a midwifery unit. In this sense, out of hospital settings are safer for the mother. Women with uncomplicated pregnancies who planned to birth in an obstetric unit had a higher chance of an unplanned caesarean or a birth assisted with forceps or ventouse than those that planned a birth at home or in a midwifery unit.
“In these diagrams, women who have a caesarean birth are shown by a dark blue figure. Light blue figures represent women who have births assisted by ventouse/vacuum or forceps. Green figures represent women who had a straightforward vaginal birth.” ©2014 King’s College London
For instance, first time mothers were about twice as likely to have an unplanned caesarean if they’d planned to birth in an obstetric unit rather than in a midwifery unit or at home (16% vs. 7-9%).
For mothers who had given birth before, the chances of a planned caesarean were much lower than for first-time mothers, but they were still five times more likely to have one if they planned to birth in an obstetric unit compared to other settings (5% vs. 1%).
Mothers planning birth in an obstetric unit were also more likely to have the birth assisted with forceps or ventouse.
Overall, around 80% of first-time mothers who planned a birth at home or in a midwifery unit had a straightforward birth, compared to only 60% of those that planned a birth in an obstetric unit.
Women who planned to birth in an obstetric unit also appeared to have higher rates of problems like severe tears and blood loss requiring a transfusion, although these were rare in all settings.
The outcomes for those mothers that chose an alongside midwifery unit (AMU) were not quite as good as for those choosing home or a freestanding midwifery unit FMU, but still significantly better than for an OU
Two more recent reviews had similar findings to the Birthplace study. The first of these6 combined data from 26 studies comparing outcomes by place of birth among women in high-income countries who were classed as ‘low risk’. It found that women who planned to birth in hospital had a significantly lower chance of a spontaneous vaginal birth than those planning birth in other settings. Those planning birth at home were less likely to experience severe damage to the perineum (a cut or severe tear) or heavy blood loss.
The second7 review combined data from 16 studies including about half a million planned homebirths and concluded; “Among low-risk women, those intending to birth at home experienced fewer birth interventions and untoward maternal outcomes.”
In the Birthplace Study4, about one in three first-time mothers transferred from a Birth Centre to an obstetric unit. This included transfers during labour or just after birth. Of those who planned a homebirth just under half transferred. However, only about one in ten women who had birthed before needed to transfer.
A follow-up analysis of the Birthplace Study data8 found that the most common reason for transfer from home or an FMU was so that a labour that was going slowly could be speeded up artificially. The other main reason was that a midwife had picked up signs that the baby might not be coping well with labour. Midwives are trained to spot these warning signs early, so it should usually be possible for transfer to be done in plenty of time and in a calm way. This analysis did not look at transfers from an AMU to an obstetric unit but it’s likely that the reasons for transfer are similar.
It was uncommon for mothers to have transferred in order to have an epidural – just under three out of every 100 first time mothers who planned to birth at home and just over two out of every hundred who planned to birth in an FMU. For those who had birthed before the numbers were much lower – four out of every thousand for homebirths, and three out of every thousand for FMUs.
If you decide to transfer from home or an FMU, your midwife will usually accompany you (if it’s by ambulance) or follow you to the hospital (if it’s by car). If you are transferring from an AMU, you might be able to walk or might prefer to be taken in a wheelchair.
You may be advised to give birth in an obstetric unit if there are concerns over your health or that of your baby, or if there are any factors that might make complications in labour more likely. You may be happy with this. If not, you still have the right to choose a homebirth, but may find that your Hospital Trust is reluctant to provide midwifery support for it. (You may find our template letter Booking a Homebirth helpful if you are having difficulty with this.)
Birth Centres have criteria for which women they will accept, but they vary from place to place, and it’s sometimes possible to negotiate a care plan that enables you to labour there even if you are classed as “high risk”. According to Birthrights1 “The birth centre must only refuse to allow you to use the centre if they feel they cannot provide you with safe care. The centre must have a good evidence-based reason that shows you or your baby are at high risk of harm when giving birth without the support of an obstetric unit. The centre must be able to show that it cannot safely manage that risk. They should consider the risk on a case-by-case basis, looking at what the risks are in your personal situation”.
There has been limited research on outcomes by place of birth for women who have been categorised as ‘high risk’ - perhaps because they are usually encouraged to give birth in an obstetric unit.
A follow-on study9 using the Birthplace Study data showed that for women with medical or obstetric risk factors, planning a homebirth actually reduced the chances of the baby being admitted for hospital care in the first few days after the birth, compared to planned birth in an OU. There seemed to be no significant difference in the likelihood of other serious harm to the baby; however the number in this study was too small to be certain about this. For these women a planned homebirth was associated with an increased probability of having a straightforward birth compared with planned birth in an obstetric unit.
More recently, a number of studies have looked at the outcomes for women who were admitted to an AMU despite being classed as ‘high risk’ for one of a number of reasons, compared with a group of women who did not have that risk factor. Note that these studies only looked at women who were accepted as being suitable to birth in an AMU, rather than the whole group of mothers with that risk factor. They do not cover women with these risk factors who birthed in an FMU or at home.
The first of these studies10 compared women with a Body Mass Index (BMI) over 35 kg/m2 with a group who had a BMI less than or equal to 35 kg/m2 . It concluded that birth in an AMU is a safe option for women with a BMI over 35 kg/m2 who have birthed before, if they have no other complicating factors. Some risks may be higher for first-time mothers with a BMI over 35 kg/m2, including needing to have an urgent caesarean (12.2% compared with 6.5% of the lower BMI group) and having a blood loss of 1500 ml or more (5.1% versus 1.7%). Very few women in the sample had a BMI over 40 kg/m2 so we can’t be sure if the findings would be the same for them.
Another of the studies11 looked at women admitted to an AMU who had previously suffered a blood-loss of over 500 ml after birth (post-partum haemorrhage or PPH). They were about twice as likely as women who had birthed before with no PPH to have a blood loss of over 500 ml (22·7% versus 11·1%). About 80% of these cases in both groups were successfully managed in the AMU, but slightly more of the previous PPH group had a PPH after this birth that required transfer to an obstetric unit (4·2% versus 2·4%).There was no difference in outcomes for babies.
A third study12 was of women admitted to an AMU who had gestational or pre-existing diabetes. Though the sample was too small to be certain, it showed no significant difference in the chances of the women with diabetes experiencing a poor outcome for mother or baby compared to women admitted to the AMU who did not have diabetes. The authors concluded that “selected women with well-controlled GDM [Gestational Diabetes Mellitus] may safely plan birth in an AMU.” Almost all the sample had gestational diabetes so outcomes for women with pre-existing diabetes may not be the same.
If you have been advised to birth in an obstetric unit but want to consider other options, or if you’ve been told that support for a homebirth or access to a Birth Centre is not available or cannot be guaranteed in your area, you can ask to discuss this with your midwife or doctor. If you are not happy with the outcome of the discussion, you could ask to speak to a Consultant Midwife or the Head of Midwifery. Contact information for all of these people should be available on your NHS Trust or Board’s website or from the maternity ward in your local hospital. You can just phone them up and ask for the information without giving out your name, or the reason why you want their details, if you would prefer not to discuss your situation with anyone else.
It might be possible to transfer your care to another Hospital Trust or Board that offers the services you want.
If you are keen to have a homebirth and your Trust/Board is reluctant to support you, another option is to hire an independent midwife to provide your care. You will usually need to pay for this but many independent midwives will accept payment in instalments and sometimes reduced fees in special circumstances.
You have the right to give birth at home without midwife support (sometimes known as freebirthing). This is legal. It is also legal for a relative, friend or paid supporter such as a doula to support a woman who is labouring without a midwife present, as long as they are not acting in the capacity of a health professional or giving medical or midwifery care12.
There is more information about freebirthing here Freebirth, Unassisted Birth and Unassisted Pregnancy.
Although in most places homebirth services were resumed after the coronavirus pandemic, it appears that there are often still restrictions on the hours of operation or the number of women being booked for homebirths in a given period13. Even when homebirth services are operating, women may be told that due to staff shortages there is no guarantee that a midwife will be available when they go into labour. This can mean that a woman in labour is faced with the choice of going to a Birth Centre (if available) , going to an obstetric unit or staying home and birthing without medical assistance. If you are planning a homebirth you may want to think about what you would want to do in this situation.
There is also an increasing tendency for staff from Birth Centres to be called on to cover the obstetric unit if there is a shortage of staff, resulting in them being closed, often at short notice.
Your Trust or Board should be making information on the current state of their maternity services available in a readily accessible form. Some are proving better at this than others. You might want to ask your midwife to keep you up to date.
The AIMS helpline (helpline@aims.org.uk 0300 365 0663) can provide information and support for negotiating the choices that you feel are right for you.
If you are finding it hard to get support for a homebirth please contact the Helpline . Our Volunteers will do their best to help you.
If you are considering freebirthing, there is information and a list of resources here Freebirth, Unassisted Childbirth and Unassisted Pregnancy.
For more on your right to choose your birthplace see our book AIMS Guide to Your Rights in Pregnancy & Birth (principal author Emma Ashworth.)
The Scottish Government’s Children and Families Directorate has developed a guide to help with birthplace decisions Birthplace Decisions, Information for pregnant women and partners on planning where to give birth - gov.scot.
Birthrights factsheet Choice of place of birth
NICE Guideline 2023 Intrapartum care
AIMS Birth Information page Freebirth, Unassisted Birth and Unassisted Pregnancy
National Perinatal Epidemiology Unit “Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study” BMJ 2011;343:d7400
Hutton E.K. et al “Perinatal or neonatal mortality among women who intend at the onset of labour to give birth at home compared to women of low obstetrical risk who intend to give birth in hospital: A systematic review and meta-analyses” EClinicalMedicine 2019; 25:14:59-70
Scarf L.V. et al “Maternal and perinatal outcomes by planned place of birth among women with low-risk pregnancies in high-income countries: A systematic review and meta-analysis” Midwifery 2018 Jul:62:240-255
Reitsma A. et al “Maternal outcomes and birth interventions among women who begin labour intending to give birth at home compared to women of low obstetrical risk who intend to give birth in hospital: A systematic review and meta-analyses” EClinicalMedicine 2020 5:21:10031
Chapter 5 in Hollowell J. et al “The Birthplace in England national prospective cohort study: further analyses to enhance policy and service delivery decision-making for planned place of birth” Health Services and Delivery Research, No. 3.36 2015
Study 5 on the National Perinatal Epidemiology Unit (NPEU) webpage www.npeu.ox.ac.uk/birthplace/birthplace-follow-on-study
Rowe R., Knight, M. & Kurinczuk J.J. “Outcomes for women with BMI>35 kg/m2 admitted for labour care to alongside midwifery units in the UK: A national prospective cohort study using the UK Midwifery Study System (UKMidSS)”, 2018 journals.plos.org/plosone/article?id=10.1371/journal.pone.0208041
Morelli A. et al “Outcomes for women admitted for labour care to alongside midwifery units in the UK following a postpartum haemorrhage in a previous pregnancy: A national population-based cohort and nested case-control study using the UK Midwifery Study System (UKMidSS)” Women and Birth Volume 36, Issue 3, May 2023, Pages e361-e36 www.sciencedirect.com/science/article/pii/S1871519222003481
Morelli A. et al “Outcomes for women with diabetes admitted for labour care to midwifery units in the UK: a national prospective cohort study and survey of practice using the UK Midwifery Study System (UKMidSS)” BMJ Open vol.12 Issue 14, December 2024 bmjopen.bmj.com/content/14/12/e087161
Birthrights factsheet “Unassisted birth”
Birthrights, “Access denied: Restrictions to Homebirth in the UK” 2025 birthrights.org.uk/campaigns-research/home-birth-restrictions
AIMS Guide to Your Rights in Pregnancy & Birth (principal author Emma Ashworth)
Why Home Birth Matters by Natalie Meddings
Freebirth, Unassisted Childbirth and Unassisted Pregnancy, AIMS
King’s Birthplace Decision Support leaflet
Written by: Nadia Higson
Reviewed by: Claire Cousins and Ryan Jones
Reviewed on: 22/10/2025
Next review needed: 06/01/2028
AIMS does not give medical advice. Our website provides evidence-based information to support informed decision-making. The AIMS Helpline volunteers will be happy to provide further information and support. Please email helpline@aims.org.uk or ring 0300 365 0663.
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