Plan for birth: Healthy Pregnancy

The options for giving birth should be discussed early, reports Heather Welford

The keynote of maternity care today is choice - and that's official. The Department of Health's maternity policy is outlined in the document Changing Childbirth, published three years ago to whoops of glee from campaigners for woman-centred care. They had argued that when it came to decision-making about care or place of birth, mothers should have the last word.

Changing Childbirth supported a new outlook on maternity care. The job of the health professional should be to share information, and offer advice, without pressure. The midwife's role was to be enhanced, and pregnancy was to be seen as a major social and emotional event, in which the woman is in control, and not merely a medical one.

Three years on, and initiatives, pilot schemes and projects reflecting this new culture of choice are everywhere - though women themselves may still know very little about it, something the National Childbirth Trust hopes to redress.

An information campaign is launched in October run jointly by NCT and the DoH-backed Changing Childbirth team. NCT's head of policy research Mary Newburn says, "our research shows first-time mothers, especially, aren't aware of what questions to ask when discussing maternity care, and how to find out about getting what they want. After the birth, they say 'if only I'd known'."

The leaflet How To Get The Best From The Maternity Services is one part of the campaign, encouraging women to talk to their GP and their midwife about the kind of maternity care they'd like. "We don't want to present pregnancy as an obstacle course," says Mary Newburn. "The aim is to point out that health professionals are there to offer a service, and to listen to what women want."

The major choice for most women centres on the place of birth:

t Hospital, in a unit headed by one or more consultant obstetricians, though midwives carry out most of the care. You may have a choice of more than one unit in your local area. A consultant-led unit is usually the place of choice if you expect to need medical help. Over 90 per cent of woman give birth here, not because they need any extra care, but because the units are everywhere, and, as a MORI poll found, for most women this was the only option fully discussed with their advisers. MORI also discovered 72 per cent would have liked other options.

t Hospital, in a midwife-led unit. Likely to be increasingly available to all mothers who expect a problem-free birth. MLUs aim at a less medicalised approach to childbirth.

t At home. Only about 1 per cent of babies are born at home, and this figure includes the surprise deliveries of mothers whose babies pop out after 10 minutes of contractions. Yet the MORI poll found 22 per cent of women would like the choice of a home birth - while Changing Childbirth reported that professionals often greeted this request with "a lack of interest or hostility". There is no clear evidence that a planned home birth is less safe than anywhere else for women with uncomplicated pregnancies, and studies show a high level of satisfaction.

t Domino delivery. A domino means the community midwife cares for you at home in early labour, accompanies you to hospital for delivery, and then comes back home with you some hours later. You need to check how seamless this continuity actually is in your area - once in hospital, midwives there may deliver you and you return home by yourself, visited the next day by (possibly) a different community midwife.

It's usual to "book" your place of birth near the beginning of pregnancy, but you can change your mind later. You have the statutory right to midwifery care, wherever you choose to deliver, even if health professionals advise against your choice.

Much ante-natal care today is community-based. This means you'll be seen at a GP or midwife clinic, or at home, for most appointments, rather than at the hospital - good news, on the whole, as hospital clinics can mean long waits and little continuity of care.

Consider making a birth plan. The very idea was once considered by some health professionals as a piece of nonsensical self-indulgence from the bossier sections of the middle class. Now you're likely to be encouraged to make one, in discussions with your partner and a midwife.

Thinking about your options for birth - pain relief, positions for labour and delivery, type of monitoring - is worthwhile. It helps your carers get to know you, and focuses your mind on what's right for you.