You have a number of choices available to you when the time comes for you to have your baby.

You might prefer hospital if

• you or your baby have medical problems - you will need interventions
  if you have certain conditions such as pre-eclampsia or placenta praevia
• you want an epidural
• you would be more comfortable with the technology hospitals have available
• you would like time away from the family to focus on your baby.

You might choose a home birth if

• you will feel more comfortable at home
• you do not want an epidural
• you want to give yourself every chance of a vaginal delivery.
• you want to be certain a midwife will be with you through your labour
• you don't want to leave other children

You might choose a birth centre or midwifery unit if

• you'd rather not see doctors
• you want a homely atmosphere
• you want to be with other women.

You can give birth

• on a bed
• standing
• squatting
• on all-fours (good for a breech birth)
• lying on your side
• half-sitting
• in the water
• on the floor

You might let your labour start on its own or use natural induction methods, eg sex, if you are overdue. You can leave your waters to break on their own or let your midwife break them for you. You may want to pick your baby up yourself after the delivery or you might prefer the midwife to wrap your baby up and give him or her to you

Your midwife will stay with you throughout your labour if you give birth at home, whereas in hospital, she will most likely be caring for other women in labour at the same time, and so will not be able to give you her undivided attention. Other reasons why people choose home birth are

• because you feel more relaxed in your own home
• you have had bad experiences in hospital
• you can eat and drink as you like
• you can move around as you like
• and make as much noise as you like
• you can learn to breastfeed in private
• there will be no less queues for the bath or toilet
• less noise at night
• no set visiting times

You can choose to have your partner, mum, sister, children or whoever you like with you and your baby will be born into a welcoming environment rather than the less personal atmosphere of a hospital. You might choose a home birth because you don't want any medical interventions in your labour or pain-relieving drugs. Women tend to need less pain relief as the pain is more manageable at home. Visit the Home Birth web site.

Nobody can make you go into hospital to have your baby and it is not against any law to have your baby at home. But, although the health authority cannot be forced by law to provide a home birth service (e.g. if there is a shortage of midwives they can get all the community midwives to work in the hospital) it is legally obliged to provide emergency care. So if a woman insisted on staying at home and called the hospital when in labour, then they must do their utmost to provide a midwife to go to her home to care for her. If you live in an area where you cannot get the maternity services to support your choice to have a baby at home, contact one of the supervisors of midwives from the hospital, or the community midwifery manager. In most areas, midwives will support a woman's choice to have her baby at home and try to provide a home birth service.

Many women are unaware that they could give birth at home, as they are offered a choice between local hospitals. Some GPs will attempt to talk women out of having home births. Sometimes they may believe that they have to attend the birth personally, or that they would be legally liable for any problems which might occur. However the Royal College of General Practitioners and the RCM issued a joint statement in 1995:

"Women wishing to arrange a home birth should be able to do so. General practitioners who do not wish to provide care for home births should refer women to a local midwife or the local supervisor of midwives (or to a general practitioner who does provide full maternity care)."

You can free to choose the hospital you would like your baby to be born at, so visit all your local maternity units. You can also choose how you would like to be cared for. Moving around in early labour and remaining upright appears to progresses labour and feeling confident and relaxed also has a positive effect. Good questions to ask are

• do I have to stay on the bed or can I move around during labour?
• is the baby's heartbeat monitored continuously during labour?
• can I give birth in whatever position I choose?
• will student doctors or midwives be present at my birth?
• what is your induction/caesarean section/forceps/ventouse rate and how does this compare with other local hospitals?
• how long will I have to stay in hospital after the birth?
• what are the visiting hours and can my partner visit me outside these hours?
• how many women are breastfeeding when they leave the hospital?
• are fetal scalp electrodes (the kind of monitor that clips onto your baby's head) used regularly?
• will you break my waters at a certain stage in labour?
• Ican I eat and drink what I want during labour or will I be only allowed water?
• can I wear my own clothes for labour?
• how many people can I bring to support me during labour?
• do you have a birthing pool and midwives experienced at waterbirths?
• are epidurals only available in office hours or all around the clock?

Make an appointment to see the rooms at the Delivery Suitee. Is this the place you would like your baby to be born? Check if there is a bean bag and birthing ball and whether there are comfortable chairs in each room. Decide whether the rooms are designed for the midwives, or for the women giving birth.

Women who labour in water often have shorter labours and many women find that the water itself helps them through contractions and they don't need another other form of pain relief. If you spend some of your labour in water you're less likely to need a forceps or ventouse deliveryand some studies show you're less likely to tear.

The warm water helps you relax and makes you buoyant so you can easily change position and it gives a sense of privacy and control. You don't have to give birth in the pool. You can simply use it for the first stage of labour and get out when you want to push. Most midwives prefer you the placenta to be delivered out of the water.

Most authorities agree that the baby does not start to breathe until it comes into contact with air so it's important to bring the baby to the surface of the water as soon as she is born. There is no sound evidence that the temperature of the water causes problems but it is best to keep the water between 35 and 37 degrees C.

If you are planning to use a birthing pool in hospital

• check the likelihood of tthe pool being available when you want it
• there is a midwife experienced in delivering babies this way
• check out the hospital's policy on pool-use.

If you are hiring a pool to use at home:

• ask your midwife or a member of the local NCT or Active Birth Centre who you should hire from
• practise assembling the pool, filling it and using it BEFORE you go into labour!

You might you need a caesarean because

• your baby's exit is blocked by the placenta (placenta praevia)
• your baby is large compared to your pelvis
• your baby isn't growing properly
• you have a serious medical condition.

Your consultant might well suggest an ELECTIVE CAESAREAN which means that a date is fixed for your operation before you go into labour if any of the above apply to you. You might need an EMERGENCY CAESAREAN if monitoring before or during labour shows your baby is in distress.

Before the caesarean, you will have to:

• sign a consent form
• remove any jewellery
• take out contact lenses
• take medicine to neutralise the acid in your stomach.

A couple of centimetres of pubic hair will be shaved off and a drip put into your arm, a catheter into your bladder and heart monitors attached to your chest. Your anaesthetic will either be local (spinal or epidural) which means that you'll be awake, or general (uncommon nowadays). About eight doctors, midwives and other staff will take part in your caesarean. A screen across your chest will prevent you from seeing anything. The surgeon will make a cut on your `bikini line' (the scar will be hidden when your pubic hair grows back). You will hear the clink of surgical instruments and sucking noises as amniotic fluid is suctioned out, you'll feel as if someone is rummaging around inside you (there should be little pain) and after about ten minutes your baby will be delivered. The paediatrician will check your baby and then hand your baby to you to cuddle while your operation is completed. It takes about 40 minutes.

After you have had a caesarean, remember that you have had major abdominal surgery and will be back to normal in weeks rather than days. During the operation you may have been given strong morphine-like painkillers. You will need more pain relief after the surgery and may be offered pain-killing injections and

• a small pump containing strong pain-relieving drugs you can operate yourself
• suppositories
• tablets
• a TENS machine.

If you are in pain, ask for more, or different, painkillers.

You will have a drip fitted during surgery which will be left in for some time afterwards and you will be monitored over the couple of days. A catheter will have been inserted to keep the bladder emptied and this may be left in place for 24 hours after the operation. You may have a lot of uncomfortable trapped wind. You may need iron tablets. You will find it difficult to stand up straight at first. Try standing bent over to begin with, gradually getting more upright day by day. You will feel tired and aching for some time but will be encouraged to get up and move around to improve circulation and recovery. Don't lift anything heavier than your baby for about 6 weeks and you will probably be unable to drive for about six weeks, depending on your insurance.

To get out of bed, wriggle to the edge and draw your knees up to your chest. Push yourself into a sitting position. When you feel steadt and are sitting on the side of the bed with your legs touching the floor, stand up.

Experiment with pillows to support you and your baby so that you're both comfortable. Keep the pressure off your scar with high-waisted knickers. Try peppermint tea (or ginger) to release trapped wind. Ring your bell and ask for help if you are in pain or whenever you need to reach or hold your baby.

If you feel unhappy about your caesarean, contact the enquiries line at the National Childbirth Trust on 020 8992 8637 or call the Birth Crisis Network on 020 7485 4725

Instrumental deliveries are carried out using forceps or ventouse.

You might be given help to give birth if

• you have been pushing for a long time
• you are exhausted
• your baby's heartbeat is irregular.

Forceps look like stainless steel salad servers and the curved ends that cradle your baby's head are called blades. You will be given a local anaesthetic to make sure you don't feel anything unless you already have an epidural in place. Your midwife will help put your legs in stirrups and the doctor will make a cut through the back of your vagina to enlarge the opening (episiotomy). He will then place the forceps gently around your baby's head. When you have your next contraction, you push and the doctor pulls to bring your baby into the world. Most doctors are experienced with forceps, but your baby's head might be bruised, and your bladder damaged and sex may be uncomfortable for some time after the birth.

The ventouse is a small silicone plastic cup attached to a vacuum device. Suction is gradually applied to remove the air from the cup so it adheres to your baby's head. Youdon't usually need an episiotomy for a ventouse delivery so it is less traumatic than forceps. However, it can take 7-10 minutes to apply the suction, the cap sometimes slips off the baby's head and must be reapplied and the top of your baby's head will be swollen for a few days after her birth. Not all doctors are experienced with ventouse.

Your labour might need to be induces (started) if

• you are 10 days or more overdue and the placenta is failing
• you have pre-eclampsia (raised blood pressure and protein in your urine)
• your baby is not growing well
• your waters break, but you're still not having contractions after 24 hours
• you have diabetes.

Methods of starting labour

The natural and most pleasurable methods (at home) include curry, a long walk and/or sex!

Artificial methods (in hospital) include

• prostaglandin pessaries or gel, placed in the vagina to soften the cervix to make it ready for labour
• breaking the waters round the baby, using an instrument like a long crotchet hook o a syntocinon (artificial oxytocin) drip.

There are some risks to be aware of when inducing delivery. Induction could make your labour very long or very quick and you may find it difficult to cope with sudden contractions. It might also stress your baby and is more likely to lead to a forceps or ventouse delivery than a non-induced labour.

If you have a syntocinon drip, your midwife will have to monitor your baby's heart constantly , but intermittent monitoring should be fine if you have had pessaries or your waters broken. Remember you don't have to be lying down to be monitored. You can ask to be monitored while you are sitting in a chair, or even kneeling on the floor.

Accelerating Labour
If your labour is very slow, you might be asked whether you would like to have your waters broken, or even a syntocinon drip, to speed it up. If you want to leave things alone and your baby is fine, tell your midwife that you are happy to continue as you are.

Twin births are unusual but if you are healthy and your pregnancy is normal, there is no reason why you cannot give birth vaginally without medical intervention if you wish. Your hospital may have policies on the delivery of twins such as on monitoring or inducing labour. Expecting twins does make high blood pressure more likely and twins often arrive prematurely. However, there is no evidence that inducing your labour (unless you have specific medical problems) is helpful. Monitoring two babies' hearts using a hand held sonic aid is just as appropriate as electronic monitoring, if everything is progressing smoothly. Being able to move around, stand up and following your body's instincts is as important when having twins as in a singleton birth.

Students and other medical staff may want to be present at the birth but three midwives (one for you and one for each baby) is all you need. If the babies are being born earlier than 38 weeks or may be unwell, you may need a paediatrician for each baby and if medical complications arise during labour, an obstetrician. With twins, the first stage of labour follows the same pattern as for a single baby, but possibly more slowly. You can choose all the pain relief options available. The babies will be born one at a time. After you have given birth to your first baby, the midwife will check the position of the second and if he is head-down you will be able to give birth again. If the second baby is in the breech position, you may be offered a forceps delivery to help this baby out quickly. On rare occasions, the second baby may be lying awkwardly and if it is not possible to manipulate him or her into a better position, a caesarean is the only option. If the twins are identical, there will be one placenta, but if they are non-identical, a placenta will be expelled after each birth.