Wash hands; Introduce self; ask Patient’s name and what they like to be called; Explain
Break the ice
Congratulate them on their pregnancy
Do they know if it’s a boy or girl?
Do they have a name? (If so, use it when talking about the baby.)
Find out what they know so far and what they hope to get from the consultation
First ask a few questions
‘We can talk through a variety of options today to determine which might be best for you and your baby. However, your and your baby’s safety is our absolute priority so I just need to ask you a few questions first to determine the most appropriate options…’
Risk factors (if present, hospital birth is usually recommended)
Previous births
Previous C-section
≥6 previous children
Serious post-partum haemorrhage
Current baby
Expecting twins
Breech/transverse presentation
Placenta praevia
Problems with baby
Maternal factors
Anaemia
Gestational diabetes
Pre-eclampsia
Age >40 years
Obesity (BMI >35)
Locations
‘What options have you heard about so far?’
‘Do you have any particular questions or shall we go through the options?’
‘Choosing the right place can have a really positive effect on your relationship with your baby.’
Hospital birth
Birth on the labour ward of the hospital
Advantages
Safest environment – there are obstetricians and paediatricians around if problems arise
Can have epidural
Disadvantages
Less personal
Midwife-run birthing centre
Centres separate from the hospital run by midwives specifically for labour
Advantages
More comfortable and homely
More likely to have a midwife you know
Disadvantages
May need to be transferred to hospital if any complications
Cannot have epidural
Home birth
A midwife will come to your home and guide you through labour
Evidence shows it’s as safe as a hospital/birthing centre if it’s your second or subsequent baby (slightly higher risk for first babies)
Advantages
Most personal, relaxed environment
Privacy
You can light candles
You can still pay for a birth pool
Disadvantages
May need to be transferred to hospital if any complications – how far is it?
Recommended if: multiple pregnancy, labour doesn’t progress, placenta praevia/accreta, 2 or more previous Caesarean sections, malpresentation (breech/transverse), cephalopelvic disproportion, pelvic cyst/fibroid, maternal infection (Herpes simplex/HIV), severe hypertensive disease, fetal distress
Disadvantages: major surgery, longer recovery, scar, will be more likely to need it again in the future
Patients can request one but, if they don’t need one, try to find out why – are they worried about pain?
Pain relief
‘Have you thought about pain relief?’
‘Pain relief is really important because if you’re in control of your pain, you’re in control of your labour.’
Options
Natural (none)
Paracetamol
Codeine
Entonox
Pethidine
Morphine
Epidural
Spinal (for C-section)
Water birth and hypno birth
Water birth
Water birth is available in any environment (although one will have to be rented privately if they decide on a home birth)
It is a large warm pool
It helps with anxiety, pain and muscle relaxation
Hypnobirth
Mother can be taught self-hypnosis and controlled breathing by a local practitioner
Concluding
Summarise
‘Is there anything else you’re concerned about or would like more information on?’
‘There’s no pressure to choose anything now. It’s a big decision so take some time to think about what you would prefer and discuss it with your partner.’
‘You can visit the local birthing centres to help decide.’
Suggest getting more information and making a birthing plan on the www.nhs.uk website
Give leaflets and contact details, and book follow-up
