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Philosophy of Care
Antenatal Care l Home Birth l Birth Centre Birth
Hospital Birth l Postnatal Care
The UK health system is built on a principle of choice. Every woman has the right to choose every aspect of her maternity care, from the person caring for her to the location of that care. However healthcare providers have to operate within the resources available to them and so it is a constant juggling act to meet the requirements of the local population within limited financial resources.
In your local area there might be an abundance of excellent maternity services and you feel overwhelmed with choice, surrounded by supportive midwives and doctors. However in some areas it might not feel like there is much choice and so informing yourself of your options is a good way to start talking your local healthcare providers.
This section is intended to give an overview of some of the issues parents may want to know about. Talk to other parents, healthcare professionals and look at other specialist websites to continue developing your thoughts.
Antenatal Care
Every woman needs to be cared for by a midwife during her pregnancy. Midwives provide information and support on physical, mental and emotional wellbeing. Some women may also need to be cared for by specialist doctors whose expertise and experience is vital for high risk women.
NICE guidelines suggest first time mothers should receive 10 antenatal appointments and other mothers should receive 7 appointments. During the course of your antenatal care you will be offered scans and screening tests. These are often presented as ‘routine treatments’ but you have a choice whether or not to accept them. In making that choice, you should inform yourself of the implication of having the scan / test – and the implication of not having them. And you should ask yourself what you will do with the resulting information; your main aim in pregnancy should be to minimise stress because research (link to Michel Odent website) suggests stress is bad for your health and the health of your baby.
For more information about the care ‘officially’ on offer, read the NICE guidelines on antenatal care.
Home Birth
Every woman can choose to have her baby at home. For healthy women who have experienced a straightforward pregnancy research suggests home births are safe, more likely to result in a natural vaginal delivery and less likely to result in intervention (e.g. episiotomy, forceps, caesarean section). A variety of pain relief options are available at home, most obviously the ability to move around freely and make yourself comfortable in your own environment. Additional facilities such as birthing pools can easily be hired into the home.
At home you are most likely to have one midwife who cares for you throughout labour. This is likely to be a midwife who has cared for you during pregnancy. Continuity of care, as this is called, is known to have a beneficial effect on labour because you are more likely to be relaxed and confident in the presence of a professional you know and trust. A second midwife will be called to assist during the actual birth.
Midwives are specialists in normality. This means that if something looks abnormal they are trained to pick it up immediately. Midwives are trained to provide basic emergency care, such as suction for a newborn or administering oxygen but in the rare event of an emergency a hospital transfer will be necessary. Strict protocols exist for such occasions so you will be transferred quickly and given immediate attention in the hospital according to your needs.
Birth Centre Birth
For women who do not want to deliver at home or in hospital a birth centre provides a ‘home from home’ environment. It is low-tech and relaxing, just like home. Birth centres are staffed by midwives and offer similar pain relief as you would get at home but cannot offer pain relief such as epidurals which you can only get in hospital. Most birth centres have a birth pool and other active birth facilities such as birthing balls, birthing chairs etc. Some have a few more bits of technical equipment (e.g. a resuscitair for babies who need assistance clearing their airways at birth) and some are nearer a hospital than home might be. Birth centres are also safe, more likely to result in a natural vaginal delivery and less likely to result in intervention.
In a birth centre you are likely to have one midwife who cares for you throughout labour. This is likely to be a midwife who has cared for you during pregnancy. Continuity of care, as this is called, is known to have a beneficial effect on labour because you are more likely to be relaxed and confident in the presence of a professional you know and trust. A second midwife will be called to assist during the actual birth.
Midwives are specialists in normality. This means that if something looks abnormal they are trained to pick it up immediately. Midwives are trained to provide basic emergency care, such as suction for a newborn but in the rare event of an emergency a hospital transfer will be necessary. Strict protocols exist for such occasions so you will be transferred quickly and given immediate attention in the hospital according to your needs.
There are different types of birth centres; stand alone which are situated in the community and alongside (also known as ‘co-located’) which are attached to the main consultant led unit. All birth centres offer the same philosophy of care.
Hospital Birth
For women who need, or want, to be near a consultant when they give birth large hospitals offer high tech facilities with highly trained staff. The scientific and technological advances in medical knowledge means that high risk mothers and high risk babies can now be very well cared for despite all sorts of complications. For those that need this level of care hospitals are the safest place to be.
In hospital midwives will still be a core part of the care team. If you are labouring on the delivery suite you will be cared for by midwives. However, you will not necessarily have one midwife who is with you the whole time and it may not be a midwife you have met during your pregnancy. However, all midwives are trained professionals able to inform and support you as you require. If a caesarean-section takes place midwives as well as doctors will be present in the operating theatre to support you.
The more informed you are about your needs and choices before you go into hospital, the more you will be able to benefit from the knowledge and skills of those caring for you. For example, if you want an active labour (which is known to help women cope with pain, assist with fetal positioning and can speed labour) learn about what you need to do. Learn how to use birthing balls, birthing mats, which relaxing music helps you, if you have a birthing partner ask them to practice massaging your back etc. You can then ask hospital midwives to produce the relevant materials (most hospitals have these facilities) and if there are enough staff midwives may even be able to support your movements.
For women wanting a normal labour the pressure of a hospital environment can unnecessarily complicate the labour and so for this reason, and others, it is worth thinking carefully about the location of birth.
Postnatal Care
For women who have delivered in a birth centre or a hospital you may want to spend a few days in the birth centre. This gives you time to recover, build your confidence and establish breastfeeding. Postnatal care is described in the NICE guidelines as being “about the provision of a supportive environment in which a woman, her baby and the wider family can begin their new life together.” Ref:
Postnatal support is to ensure the physical, mental and emotional wellbeing of the mother and baby. The amount of postnatal visits will vary depending on the local policy and the mother’s need but between 4-7 is a common number. Postnatal care extends up to 6-8 weeks after the birth of the baby when care is provided by the Health Visitor and GP. There should be plenty of opportunities to talk to the midwife or healthcare professional providing postnatal care. In particular midwives are assessing the physical recover of the woman, her mental wellbeing and the physical progress of the baby. There are a number of publications that should be given to the mother, if they have not been received antenatally. These include the Department of Health booklet ‘Birth to five’ and the personal child health record.
For more detailed information about the care ‘officially’ on offer, read the NICE guidelines on postnatal care.
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