Birth Doula Blog

PROM (Waters Breaking Before Labour): Should I Wait for Labour or Have an Induction?

Sat, 26 Sep 2026 13:01:43 GMT

If your waters break after 37 weeks, but before labour starts, NICE recommends offering you a choice between induction of labour as soon as possible and waiting for labour to start spontaneously for up to approximately 24 hours. If you choose to wait and labour has not started after around 24 hours, NICE recommends offering induction.

But why 24 hours? And does the evidence actually show that something important changes at this point?

Despite PROM being common, we still do not have good evidence that allows us to give women a precise risk of their baby developing an infection at different time intervals after her waters break. NICE's 2026 review found that the risk of early onset neonatal infection increases as the time between rupture of the membranes and birth increases. However, the evidence was not strong enough to identify a specific point at which the risk suddenly increases, or to tell an individual woman exactly how much her risk changes with each additional hour.

This means that discussions about waiting for labour after PROM often involve balancing incomplete evidence against individual priorities, preferences and circumstances.

If you're reading this after your waters have broken, you're probably wanting the answers to questions like:

How likely is it me/my baby will develop an infection?
Will my baby become seriously ill if an infection develops?
Does induction reduce that risk?

This article aims to answer those questions and many more as honestly and accurately as possible. Please note that any figures have the research they are quoted from hyperlinked throughout and references are given at the bottom of this article.

What does "waters breaking" actually mean?

At the end of pregnancy, the amniotic sac contains fluid which surrounds your baby. The baby’s head often divides this fluid into two parts: the forewaters, between the baby’s head and the cervix, and the hindwaters, behind the baby’s head.

At some point during labour or birth, the membranes will usually rupture, allowing the amniotic fluid to be released. This is what is meant by your "waters breaking".

Sometimes the membranes rupture before labour has started. This is called prelabour rupture of membranes (PROM). It is relatively common, occurring in around 8–10% of pregnancies . Anecdotally, as a doula, I feel it happens more! And if you are reading this article then it may well have happened to you.

We don't really know why sometimes the membranes rupture before labour begins, and sometimes they don't. Towards the end of pregnancy, the membranes naturally undergo changes that make them more likely to rupture. Pressure from the baby's head and contractions may also contribute, as well as rising prostaglandin levels as the body prepares for labour.

How do I know if my waters have broken?

This is not always as obvious as it sounds! Some women experience a dramatic gush of fluid, while others notice only a slow trickle that they initially mistake for urine or increased vaginal discharge. You may experience a bigger, more obvious leak if the forewaters break.

Signs that your waters may have broken include:

A sudden gush or a continuous trickle of clear, pale pink or straw-coloured fluid
Fluid that continues to leak even after you've emptied your bladder
Fluid that you cannot control in the same way as urine
Fluid loss that soaks your underwear or sanitary pads

What if I only had one gush?

A one off gush of fluid doesn't always mean your waters have broken. Other possible explanations include:

Urine, which is very common towards the end of pregnancy.
Watery vaginal discharge, which often increases as pregnancy progresses.
Cervical mucus or secretions, particularly as the cervix begins to soften in preparation for labour.
Fluid that has collected in the vagina and is released all at once when you stand up or change position
The amniotic sac is made of two layers with a small volume of fluid in between them, so it is also possible that the outer layer can rupture whilst the inner layer remains intact. There is no way currently of identifying if this has happened.

However, a one off gush can also be the first sign that your waters have broken. Some women continue to leak afterwards, while others experience only intermittent leaking, particularly with a small hindwater leak. Many midwives therefore suggest putting on a clean sanitary pad and seeing whether any more fluid leaks over the next hour or two. Ongoing leaking makes PROM more likely, but the absence of further leaking does not completely rule it out.

If you're unsure and want to, you can contact your maternity unit for advice. They may ask you questions about the colour, smell and amount of fluid, and invite you in for an assessment.

How long will it take for labour to start after my waters have broken?

The evidence on exactly when labour will begin after the waters break is based largely on older studies, and estimates vary. NICE quotes around 60% of women going into labour within 24 hours . Other published evidence suggests around 70% will do so within 24 hours, 85% within 48 hours and 95% within 96 hours .

In other words, somewhere around 30–40% of women may still not have started labour after 24 hours. For many women, waiting beyond 24 hours would therefore be necessary if they wanted to allow labour to start spontaneously.

These figures are averages across all women with term PROM. Your individual likelihood of labour starting spontaneously within a specific time frame may be influenced by factors such as whether this is your first baby, whether your cervix is already favourable, and the circumstances surrounding your PROM.

How likely is my baby to develop an infection once my waters have broken?

NICE estimates that the risk of serious neonatal infection following term PROM is around 1%, compared with around 0.5% when the membranes remain intact until labour begins . It is worth putting these figures into context: “serious neonatal infection” is a broader term than culture proven sepsis (which means that bacteria have actually been grown from a sample of the baby’s blood - showing that there is a bacterial infection in the bloodstream). It therefore should not be read as meaning that 1 in 100 babies will develop confirmed sepsis after the waters have been broken for 24 hours. It is also a figure for women with PROM at term as a whole, rather than the risk associated with any particular length of time after the waters break.

One of the important sources of evidence is the TermPROM trial, a large international randomised trial involving more than 5,000 women . The trial compared immediate induction with waiting for up to four days for labour to start, with induction if complications developed or if labour had not started after four days. The rate of neonatal infection was similar in the induction and expectant management groups: it was around 2–3% in all groups, with no statistically significant difference between them.

Researchers subsequently carried out a more detailed analysis of the TermPROM data. Seaward and colleagues looked specifically at factors associated with neonatal infection and found that the risk of neonatal infection increased as the interval between rupture of the membranes and the start of active labour became longer. In absolute terms, around 2% of babies were classified as having definite or probable neonatal infection when active labour began within 24 hours of the membranes rupturing, compared with around 4% when the interval was 24 hours or longer. However, the study found no significant difference in infection rates between those whose active labour began between 24 and 48 hours and those whose interval was longer than 48 hours.

It is also important to understand that these figures represent babies with "definite and probable" infection, not babies with confirmed sepsis.

What happens if my baby does develop an infection?

As well as feeling worried that your baby might develop an infection, you might want to think about what that infection might mean for your baby. Will they become seriously ill? Will they need intensive care? Could they die?

Infection in a newborn is taken seriously because, in a small number of cases, it can become severe. However, it is important to understand that being treated for suspected infection is not the same as having a confirmed, serious infection.

What might "suspected" or "possible" infection actually mean for babies?

A recent international study followed 757,979 late preterm and term babies born in 11 high income countries. The researchers looked at babies who received intravenous antibiotics because of suspected early onset sepsis . These figures were not specific to PROM, so they cannot be used to calculate the infection risk after PROM. They do, however, illustrate the important difference between suspected infection, broader clinical definitions of infection and culture-proven sepsis.

They found that:

Around 22,000 babies received intravenous antibiotics because infection was suspected.
Of those babies, 61% had negative blood cultures and antibiotics were stopped within five days.
A further 37% also had negative blood cultures, but clinicians remained concerned enough to continue antibiotics for five days or longer.
Only 375 (1.7%) of babies had culture proven early onset sepsis. In other words, around 58 babies received antibiotics for every one baby with confirmed sepsis.
12 babies with culture proven early onset sepsis died

Newborn babies can deteriorate rapidly, and the early signs of sepsis are often subtle and non specific. Doctors have a deliberately low threshold for starting antibiotics while waiting for blood culture results. Many babies who are treated because infection is suspected will therefore turn out not to have a confirmed infection.

One important limitation is that this study was designed to examine antibiotic use and culture proven sepsis, rather than longer term outcomes. It does not tell us how many babies required neonatal intensive care, how many developed meningitis, or whether there were any long term developmental effects among babies treated for possible infection. Those outcomes were simply not measured.

How likely is the mother to develop an infection following PROM?

In the TermPROM trial and subsequent Seaward analysis , maternal infection (chorioamnionitis) was around 4-5% when labour began within 24 hours of PROM and around 8-10% when labour did not begin until more than 24 hours after PROM.

Beyond 48 hours, the evidence becomes increasingly limited. Availab le studies have not demonstrated a clear further increase in maternal infection risk, but nor can they exclude smaller increases in risk. Some of this increased risk in maternal infection may be related to factors that can accompany prolonged PROM and its management such as more vaginal examinations and more interventions, rather than the passage of time alone.

What happens if the mother develops an infection?

Where there are signs of chorioamnionitis (for example, a raised temperature in labour) there are two things to consider. The first thing to consider is that, if untreated, the concern is that if an infection is present it could progress to maternal sepsis. Studies of term PROM have generally focused on outcomes such as chorioamnionitis and other maternal infectious morbidity, while serious outcomes such as sepsis, intensive care admission and maternal death have been reported much less consistently. In one Cochrane review of 23 trials, serious maternal morbidity or mortality was reported in only three trials, involving 425 women, with no mothers experiencing these adverse outcomes.

This suggests that severe maternal complications are uncommon, although the available research is not large enough to give us a precise estimate of how often they occur.

The second thing to consider when the mother shows signs of infection is that it increases the risk of the baby developing an infection. In the Seaward analysis , the biggest risk factor for babies developing an infection after PROM was signs of infection in the mother, with 16% of these babies having a "definite or probable" infection.

What factors might you want to take into account when considering your individual infection risk following PROM?

These factors are not a checklist that can give you a personal percentage risk of infection. Instead, they can help you think about what is happening in your own pregnancy and whether there are any signs that make infection more or less concerning. Some factors are particularly useful for spotting signs that infection may already be developing, while others provide context when you are weighing up your options around waiting or induction.

GBS status
If you are known to carry GBS (Group B Strep) in your vagina, then NICE guidance is to offer immediate induction if your waters break and you are not in labour. There is an increased risk of infection to babies born to mothers who are GBS positive and experience PROM (7% in the Seaward analysis). You will also be offered IV antibiotics during your labour.
Maternal temperature and pulse
A raised temperature and/or pulse can provide useful information about whether your body is showing signs of infection. A raised temperature is particularly important, but a normal temperature does not completely rule out infection. As above, if you have signs of infection after PROM, then the risk of your baby developing an infection may significantly increase.
Colour and smell of the amniotic fluid
Clear or pink tinged fluid is generally reassuring. Foul smelling or unusually coloured fluid could be an indication of infection and the recommendation is to seek medical advice
Fetal movements
Your baby's usual pattern of movements remains important. A noticeable reduction or change should be assessed promptly, regardless of whether you have PROM.
Other signs of infection, such as uterine tenderness or feeling unwell
These may be more meaningful when considered alongside your temperature, pulse and other observations. If you feel unwell or develop symptoms that could indicate infection, you should contact your maternity team.
Whether the leak appears to be a hindwater or forewater leak
There is no good research showing that the type or location of the membrane rupture changes the risk of infection after PROM. The studies we have do not distinguish between forewater and hindwater leaks. However, it is possible for a small opening higher up in the membranes to cause a slow trickle of hindwaters rather than a large gush. One possible consideration is that bacteria would have further to travel from the vagina to reach this opening, and a small leak may sometimes seal itself again. This is biologically plausible, but it has not been established in research, so it cannot be accurately used to try and estimate your individual infection risk.

Does induction increase or decrease the risk of infection after PROM?

This is the big question, isn't it?

The honest answer is that we don't have good evidence comparing induction with a physiological spontaneous labour after PROM. Often we are comparing one medical route with another.

There is quite a lot of research comparing planned early birth with expectant management. “Planned early birth” is a broader term than induction, although in the studies it usually means induction of labour, using oxytocin or prostaglandins. In the expectant management groups, women were given more time for labour to start spontaneously, but could go on to have an induction or other intervention if it didn't.

The Cochrane review found that planned early birth was associated with fewer maternal infections and infection-related complications. There was also a reduction in the combined outcome of "definite or probable" neonatal infection. However, there was no clear reduction in definite neonatal infection , and the overall quality of the evidence was rated low.

A more recent analysis of the original TermPROM data found that maternal infection and some neonatal adverse outcomes increased as the time from PROM to birth became longer. It found fewer adverse outcomes among women induced at particular time points compared with women who were still waiting. However, this was a secondary analysis rather than a new randomised trial, and it still wasn't comparing induction with physiological spontaneous labour.

So the fairest conclusion is something like:

The evidence suggests that, after term PROM, giving birth sooner rather than remaining pregnant with ruptured membranes for longer is associated with fewer maternal infections and possibly fewer neonatal complications. But we cannot say from the research that induction reduces infection risk compared with spontaneous physiological labour.

Other factors that influence infection risk

The time between your waters breaking and giving birth is one factor that can affect the chance of infection developing. But it is not the only factor that matters.

If you are deciding whether to wait for labour to begin spontaneously or accept an induction, it is worth looking at the whole picture. Induction is a medical intervention and can change the course of labour and the range of interventions that may be offered. NICE specifically advises women that induction may involve vaginal examinations, oxytocin, continuous fetal monitoring and epidural analgesia, and that an assisted vaginal birth may be needed.

If you are comparing waiting for spontaneous physiological labour with choosing induction, it is reasonable to consider how the two pathways might affect the rest of your birth, as well as considering the changing infection risk associated with remaining pregnant with ruptured membranes.

Factors that may be relevant to consider include:

Number of vaginal examinations . One of the strongest predictors of maternal infection after PROM is the number of vaginal examinations. In the Seaward analysis, maternal infection rates increased from around 2% in women who had fewer than three vaginal examinations to around 20% in women who had more than eight. This finding is consistent with the recommendation to avoid unnecessary vaginal examinations after PROM. You may like to consider whether you think induction is likely to involve more vaginal examinations compared to your original birth plan (again, no-one has a crystal ball and can tell you for sure!).
Internal fetal monitoring. Procedures such as a fetal scalp electrode involve placing equipment through the cervix and onto the baby's scalp. This is an invasive procedure and carries a small risk of infection.
Catheterisation and epidural. An epidural commonly involves urinary catheterisation, and catheterisation is another invasive procedure that can potentially introduce infection. Epidural analgesia also has an interesting relationship with infection risk: women who have an epidural are more likely to develop a fever during labour. This fever is often not caused by infection, but it can be difficult to distinguish epidural related fever from infection in the moment. As a result, a raised temperature may lead to antibiotics for the mother and/or investigations and antibiotics for the baby, even when no infection is ultimately found.
Instrumental birth. Forceps and ventouse births are associated with a higher risk of maternal infection than uncomplicated vaginal birth. WHO specifically identifies operative vaginal birth as a risk factor for maternal peripartum infection.
Caesarean birth . Caesarean birth carries a higher risk of maternal infection than vaginal birth, which is one reason antibiotic prophylaxis is routinely used for caesarean sections. WHO identifies caesarean section as a risk factor for maternal peripartum infection.

None of this means that these interventions should be avoided when they are clinically useful or necessary. You may want an epidural, an internal monitor may occasionally provide important information, and an instrumental or caesarean birth may be needed for safety.

My point is that infection risk is not determined by the clock alone.

If you are weighing up waiting for labour to start spontaneously against induction after PROM, it is reasonable to consider not only how the risk of infection changes with time, but also the likelihood of the interventions that might follow and how those interventions and the eventual mode of birth may affect the overall picture.

This is one reason why the decision is more nuanced than simply asking, “How many hours can I safely wait?”

If you decide to go into hospital immediately after PROM, what might you be offered?

Current UK guidance recommends that women are offered assessment after PROM (within 12 hours, if all signs are reassuring), to monitor you and your baby which includes looking for any signs of infection. As with all recommendations, the choice is yours. You may decide to remain at home, you may decide to go in and come home again, or you may decide to go in and accept an induction or caesarean. You may wish to monitor some of the signs below yourself before deciding what to do. To help you make your decision, it can be helpful to understand what healthcare professionals are actually looking for.

Logically, the concern is not simply how many hours have passed since your waters broke. The aim of assessment is to try and determine the overall well-being of you and your baby and if an infection may already be developing.

Measurements that can be taken to monitor this include:

Your temperature.
Your heart rate
Your baby's heart rate
Whether the waters have become offensive-smelling or changed colour.
Whether you have uterine tenderness (pain when the uterus is touched).
Whether you feel generally unwell, for example with shivering, flu-like symptoms or increasing abdominal pain.
Your Group B Streptococcus (GBS) status, if known.
The overall clinical picture, including your gestation, medical history and any other risk factors.

It is worth remembering that none of these signs is perfect on its own. A raised maternal pulse, for example, can occur because of pain, anxiety, dehydration or simply being in labour. Equally, a normal temperature cannot completely exclude infection.

Will my birth plan need to change if I am not in labour within 24 hours?

If you choose to wait for labour to start spontaneously and your waters have been broken for around 24 hours, then your maternity team will recommend changing some aspects of your birth plan.

NICE recommends that if labour has not started after approximately 24 hours, induction should be offered. If you choose to continue waiting, NICE recommends that you give birth in a setting with access to neonatal services. The guidance specifically mentions labour ward or an alongside birth centre . It also recommends continuous CTG monitoring in labour for women with prolonged ruptured membranes if you are not in established labour at 24 hours. However there is currently no good evidence that routine continuous CTG solely because of PROM, in the absence of other concerns, improves neonatal outcomes.

This means in practice that a planned homebirth or birth centre birth are unlikely to be recommended by your maternity team once the membranes have been ruptured for longer than 24 hours if you are not yet in established labour. However, a recommendation is not the same thing as saying that you have no choice. The decision about whether to continue waiting, where to give birth and which forms of monitoring to accept are yours to make.

In my own work as a doula, I have supported women who have chosen to wait longer than 24 hours and gone on to have a home birth or a birth centre birth. I've also supported women who have waited a length of time they were comfortable with and then had a caesarean when labour did not begin, and others who have been induced. The choice really is yours.

Frequently asked questions when your waters break before labour starts (PROM)

A final thought

If you have read this far(!), you will probably have realised that the decision about what to do if your waters break before labour has begun is not straightforward.

There is some evidence that the risk of infection increases with time after the membranes rupture, but there is no simple point at which waiting suddenly becomes "unsafe". The evidence around induction and waiting for labour to begin spontaneously also has its limitations, and the outcomes of a physiological birth following a period of waiting are simply not known compared to waiting and then, for example, having an induction or caesarean.

How can I decide what to do?

Only you could and should work out the answer to this! One question you may wish to ask yourself, or your healthcare providers if you have sought their support, is:

"Based on my observations, do you think I have evidence of infection now, or are we discussing the possibility that my risk may increase if I continue waiting?"

Those are two different conversations. The first is about whether there are signs that infection may already be present. The second is about balancing the potential benefits and disadvantages of continuing to wait for spontaneous labour versus choosing induction or caesarean before any signs of infection develop. I hope this article can help you hold those in balance. Many families find PROM a difficult situation to navigate, and my doula heart goes out to you.

One of the things I value most about my work as a doula is having the time to sit with families, look carefully at the evidence, acknowledge where there is genuine uncertainty and help them prepare for conversations with their healthcare team.

My aim is never to tell anyone what decision to make or to persuade them down a particular path. It is to help you understand your options, ask good questions and make a decision that feels right for you, your baby and your circumstances.

If you're pregnant in South West London and looking for evidence-based, non-judgemental support throughout your pregnancy and birth, you can read more about my doula services here.

About the author

Lisa Harris is a birth and postnatal doula based in Wimbledon, South West London. She supports families across South West London and has attended births in hospitals, birth centres and homes across the region. She is passionate about helping parents understand the evidence, navigate uncertainty and make informed decisions throughout pregnancy and birth.

References

1. NICE. Neonatal infection: antibiotics for prevention and treatment. Evidence review D2: Timing of prelabour rupture of membranes to birth and risk of early-onset neonatal infection. 2026.

2. NICE. Intrapartum care (NG235).

3. RANZCOG. Term Prelabour Rupture of Membranes (Term PROM), C-Obs 36. 2021.

4. Hannah ME, Ohlsson A, Farine D, et al. Induction of labor compared with expectant management for prelabor rupture of the membranes at term. N Engl J Med. 1996;334:1005–1010.

5. Seaward PG, Hannah ME, Myhr TL, et al. International multicenter term PROM study: evaluation of predictors of neonatal infection. Am J Obstet Gynecol. 1998;179:635–639.

6. Dimopoulou V, Klingenberg C, Navér L, et al. Antibiotic exposure for culture-negative early-onset sepsis in late-preterm and term newborns: an international study. Pediatr Res. 2025;97:1629–1635.

7. Edwards SE, Grobman WA, Lappen JR, et al. Existing models fail to predict sepsis in an obstetric population with intrauterine infection. Am J Obstet Gynecol. 2010;203:573.e1–573.e8.

8. Middleton P, Shepherd E, Morris J, et al. Planned early birth versus expectant management for prelabour rupture of membranes at term. Cochrane Database Syst Rev. 2017;CD005302.

9. Melamed N, Berghella V, Ananth CV, et al. Optimal timing of labor induction after prelabor rupture of membranes at term: a secondary analysis of the TERMPROM study. Am J Obstet Gynecol. 2023;228:326.e1–326.e13.

10. NICE. Inducing labour (NG207). 2021.

11. Jansen S, Lopriore E, Naaktgeboren C, et al. Epidural-related fever and maternal and neonatal morbidity: a systematic review and meta-analysis. Neonatology. 2020;117:259–270.

12. NICE. Evidence review for prophylactic antibiotics for birth with forceps or ventouse. Intrapartum care (NG235), Evidence Review J. 2023.

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Reduced fetal movements: Will I have to be induced if I go to hospital?

Mon, 22 Jun 2026 16:09:00 GMT

A really common worry I hear from pregnant women, particularly towards the end of their pregnancies, is this:

"I don't know if I'm worrying about nothing, but my baby's movements don't quite feel the same today. I'm scared that if I go in they'll just tell me I need to be induced."

It's a genuine and valid concern, and unfortunately one that can put you off seeking assessment altogether.

This is such a common doula conversation with a client, so when the updated RCOG Green-top Guideline on Reduced Fetal Movements was recently published (February 2026) I wanted to sit down and read it carefully myself. I wanted to understand what it actually says, where there is good evidence, where there is uncertainty and how women can approach these conversations with confidence.

As always, this article is intended to help you understand the evidence and have informed conversations with your own healthcare team. It is not a substitute for individual medical advice.

Babies should not move less simply because you are near your due date.
There is no set number of movements that is considered "normal", your own baby’s pattern is what is important
If your baby's movements feel different, seek assessment.
Going to hospital for assessment does not automatically mean induction.
If assessment is reassuring the RCOG guideline states there is no indication to expedite birth simply because of a single episode of reduced fetal movements.
Assessment and intervention are two separate decisions .

What are normal fetal movements?

There is no universally agreed definition of normal fetal movements. There is no magic number of kicks per hour and there is no particular pattern that every baby should follow. The guidance encourages women to become familiar with what is normal for their own baby. That is one of the reasons the UK no longer recommends counting a particular number of kicks within a certain period of time.

By around 28 - 32 weeks, most babies have developed a recognisable pattern of movement. Those movements might be kicks, stretches, pushes, rolls, swishes or flutters. One of the most important messages in the guideline is that the frequency of movements should not reduce simply because you are approaching your due date. Many women notice that the nature of movements changes. Sharp kicks may become more rolling or stretching movements as the baby grows, but this is different from a genuine reduction in movement.

Babies have sleep cycles, usually lasting around 20 - 40 minutes and rarely more than 90 minutes. During these periods they do not generally move, which is one reason there may be short spells where movements are not perceived. It is also worth remembering that you won't perceive every movement your baby makes. Studies suggest women detect somewhere between around 37% and 88% of fetal movements, with longer movements much more likely to be noticed than brief ones.

There are also lots of perfectly normal reasons why movements may feel easier or harder to notice from one day to the next. Lying on your side and quietly focusing on your baby tends to increase awareness. Exercise, anxiety and mealtimes may also increase perception. Being distracted or busy can reduce it. An anterior placenta can make movements harder to feel, particularly before 28 weeks, although a change in movements should never simply be attributed to placental position.

Trust yourself, but don't live in fear

One thing I have become increasingly aware of is how many women spend the last weeks of pregnancy expecting that something is about to go wrong. It is understandable. Stories of tragedy stay with us, and campaigns encouraging women to seek help if movements change are important and have undoubtedly had a positive impact. At the same time, it is equally important to remember that the overwhelming majority of pregnancies end with healthy mothers and healthy babies.

It is also a particularly difficult stage of pregnancy emotionally. By this point you desperately want your baby safely in your arms, and yet one of the only people who can judge whether their movements feel normal is you. I think many women carry quite a heavy burden because of that. They don't want to ignore something important, but equally they don't want to overreact or spend the last weeks of pregnancy in a constant state of anxiety.

My hope would not be that women spend the last weeks of pregnancy constantly monitoring and worrying, but that they gradually become familiar with their own baby's usual pattern and feel confident recognising when something genuinely feels different. I would never want somebody to dismiss a genuine concern. Equally, I would never want somebody to stay at home because they were frightened that seeking assessment would automatically lead to interventions they did not want.

What happens if I go to hospital with reduced fetal movements?

The broad aims of assessment are actually very straightforward:

To confirm that your baby is alive (overwhelmingly likely!)
To try and identify any evidence of fetal compromise.
To try and identify pregnancies that may be at increased risk
To avoid unnecessary intervention

Interestingly, this fourth aim is one that many women find does not always reflect their own experience of maternity care. I'll come back to that later.

If you are beyond around 26 weeks, this will usually include a CTG (cardiotocograph) to assess your baby's heart rate pattern, together with your routine antenatal observations such as blood pressure and urine testing.

Like every medical test, CTG has limitations and should not be interpreted in isolation. ( I would highly recommend reading some of Dr Kirsten Small's work if you are interested in understanding CTG in more depth. )

Will I automatically have a scan?

No.

This was one of the parts of the updated guideline that I thought deserved much more attention. Routine ultrasound for every woman presenting with a single episode of reduced fetal movements is not recommended.

Instead, ultrasound is generally recommended where:

reduced movements persist despite a normal CTG;
there are additional risk factors for fetal growth restriction or stillbirth; or
there are other clinical concerns that make further assessment appropriate. These should be explained to you.

When ultrasound is performed, it should include assessment of fetal growth (abdominal circumference and/or estimated fetal weight), amniotic fluid volume and umbilical artery Doppler.

This selective approach exists for a reason. Studies looking at offering ultrasound routinely to all women with reduced fetal movements have not demonstrated a reduction in stillbirth, while increasing rates of intervention. ( I'll link separately to the AFFIRM study for anyone who wants to read more. )

Many women are surprised to learn that routine ultrasound for every first presentation with reduced fetal movements is not what the national guidance recommends. Ultrasound is recommended in particular circumstances, but not simply because somebody has attended once with reduced movements.

Will I be induced if I go to hospital with reduced fetal movements?

There is one sentence in the guideline that I think deserves to be quoted in full:

"Where there is no objective evidence of fetal compromise (no CTG abnormalities, no evidence of reduced fetal growth, oligohydramnios or abnormal umbilical artery Doppler), there is no indication for expediting birth."

That is quite an important statement.

It means that a single episode of reduced fetal movements, in the absence of any concerning clinical signs, does not automatically mean that induction is recommended. The purpose of assessment is to identify the babies who need intervention while avoiding intervention for those who do not.

The reality in practice

I also think it is important to acknowledge something that many women will recognise. The guideline itself is measured and repeatedly refers to individualised decision-making and avoiding unnecessary intervention. Real life experiences can sometimes feel rather different.

Some women are offered investigations that they weren't expecting or that appear to go beyond what is routinely recommended in the national guidance. Some are strongly encouraged towards induction despite reassuring investigations. Others come away feeling that uncertainty has been presented as certainty or that they have not had enough opportunity to understand the evidence behind a recommendation.

One point that I think is worth emphasising is that going into hospital for assessment and agreeing to an induction are two separate decisions. If you are worried about your baby's movements, my advice would always be to seek assessment. If, following that assessment, induction or another intervention is recommended, you are entitled to understand why, what evidence supports that recommendation, whether there are alternatives and what the risks and benefits are in your own particular situation. It is entirely reasonable to ask questions.

For example:

What exactly is concerning you?
What is your estimate of the absolute risk in my situation?
Which findings are you basing this recommendation on?
Is this recommendation based on national guidance or local policy?
What evidence is there that induction is likely to improve outcomes in my particular situation?
What would happen if I chose to wait?
Is there any additional information that would change your recommendation?

Those are sensible questions, not difficult ones. You do not lose your right to ask questions simply because you have accepted an assessment.

Reduced fetal movements after 39 weeks: what does the guidance say?

The guideline states that, after 39 weeks, expediting birth following reduced fetal movements does not appear to be associated with increased risk to mother or baby. That is not the same thing as saying every woman should be induced.

Nor does it mean induction has no disadvantages or trade offs. Research findings about induction and women's lived experiences do not always feel aligned, particularly when it comes to induction of labour in first pregnancies. I have written separately about induction because I think it deserves a much fuller discussion than can be given here .

What if everything is normal?

This is another part of the guideline that I find reassuring.

Healthcare professionals can reassure women with a single episode of reduced fetal movements that they are unlikely to experience an adverse perinatal outcome if the basic assessment offered, CTG and routine antenatal checks, is reassuring.

Reduced fetal movements are associated with an increased risk of stillbirth when researchers look across populations as a whole. However, observational studies where women are encouraged to report concerns promptly and are managed according to structured protocols have not demonstrated an increase in stillbirth among those managed women.

This is perhaps the part of the guideline that may surprise you the most. It isn't saying "don't come in". Quite the opposite. It's saying "come in, be assessed, and if everything is reassuring, you should be reassured."

What if I have more than one episode of reduced fetal movements?

Repeated presentations for reduced fetal movements do change the conversation.

The evidence here is much less clear-cut than many people realise. The guideline cites observational studies suggesting that women who present on two or more occasions with reduced fetal movements after 28 weeks appear to have higher rates of adverse outcomes than women who present only once. However, these are observational studies rather than randomised trials, so they can demonstrate an association but cannot tell us with certainty whether one thing causes the other.

The guideline also notes that ultrasound abnormalities are more likely to be found in women with repeated presentations, which is one reason ultrasound assessment is generally indicated in that situation.

For practical purposes, the UK has adopted a consensus definition of recurrent reduced fetal movements as two or more episodes occurring within a 21-day period after 26 weeks of

pregnancy. This definition is based on expert consensus rather than direct evidence that this exact timeframe represents a proven threshold of risk.

Perhaps the biggest uncertainty is what to do if everything is then found to be normal. There are currently no studies demonstrating exactly what the best management is when growth, amniotic fluid volume and CTG remain reassuring. In other words, there is evidence that repeated presentations deserve further assessment, but much less evidence about what should happen if those assessments are all normal.

It is important not to overstate what the evidence actually tells us. Equally, it is important not to minimise recurrent concerns. The fact that we don't have a clear evidence based answer does not mean they should be dismissed.

The guideline therefore does not recommend a routine approach in this situation. Instead, decisions should be individualised, taking into account the whole clinical picture and the woman's own preferences, rather than assuming there is a single evidence based answer that applies to everyone.

What is the cerebroplacental ratio (CPR) and why might it be measured?

If you've never heard of this before, don't worry. It isn't something that has traditionally formed part of routine conversations in pregnancy.

One thing I have noticed in recent months is that additional ultrasound measurements, such as the cerebroplacental ratio (CPR), are increasingly becoming part of discussions in some maternity units, particularly when women present with reduced fetal movements.

This is an area of active research and one where the evidence is still evolving.

Recent studies suggest that, in some women presenting at term with reduced fetal movements and an otherwise normally grown baby, using CPR as part of decision-making may reduce some adverse neonatal outcomes, such as low cord pH, low Apgar scores and emergency delivery for fetal distress.

However, it has not been shown to reduce stillbirth, and it should not be interpreted in isolation. Like every other piece of information in maternity care, it needs to be considered alongside the whole clinical picture and the woman's own circumstances.

For those who enjoy reading the research for themselves, I'll include links to some of the relevant studies below.

Do reduced fetal movements mean I can't have a home birth or use a birth centre?

Many women assume that an episode of reduced fetal movements automatically means they have lost those options.

That is not what the national guidance says. Reduced fetal movements do not, in themselves, automatically mean that a home birth or birth centre birth is no longer possible.

If you are told that you now need continuous fetal monitoring in labour or that your planned place of birth should change, it is entirely reasonable to ask:

Is this recommendation based on national guidance?
Is it based on local policy?
Is it based on my individual clinical circumstances?
What is it about my individual situation that means you think a different place of birth would be safer?

If this is something you are navigating, I would highly recommend looking into the work of Dr Kirsten Small on CTG monitoring and intrapartum fetal surveillance. It provides a thoughtful and evidence based perspective on an area that is often presented as much more straightforward than it really is.

Ultimately the decision where you give birth is yours.

Lisa's doula thoughts

One of the reasons I wanted to write this article is I don't think women should have to choose between ignoring their instincts and feeling that seeking assessment means giving up all control over what happens next.

The evidence suggests women should become familiar with their own baby's normal pattern, trust themselves if something genuinely changes and seek assessment promptly - while also remembering that the overwhelming majority of pregnancies end with healthy babies.

Get to know your own baby's normal pattern. Build self trust and confidence that you know your baby best.

But don't dismiss a genuine change because someone told you babies always move less near the end of pregnancy. And don't avoid assessment because you are frightened that walking into hospital means giving up control over what happens next.

Going in for assessment and agreeing to an induction are two separate decisions.

You can have the CTG. You can ask questions. You can ask what the evidence says and whether a recommendation comes from national guidance or local policy. You can ask for time to think if the situation allows, and you can ask for a second opinion. You can also choose to have monitoring without speaking to a doctor if that is your preference and your clinical situation allows.

And if your assessment is reassuring, it is worth remembering that the current RCOG guidance explicitly states that, in the absence of objective evidence of fetal compromise, there is no indication to expedite birth simply because of a single episode of reduced fetal movements.

Seeking assessment does not take away your right to make informed decisions about your care.

Frequently asked questions about reduced fetal movements

A final thought

If reading this article has made you realise just how nuanced some of these conversations can become, you're not alone.

My aim is never to tell anyone what decision to make or to persuade them down a particular path. It is to help them understand their options, feel confident asking questions and make decisions that genuinely feel right for them and their family.

If you're pregnant in South West London and looking for evidence-based, non-judgemental support throughout your pregnancy and birth, you can read more about my doula services here.

About the author

References

Royal College of Obstetricians and Gynaecologists (RCOG) Green-top Guideline No. 57: Reduced Fetal Movements (2026)

Norman JE, Heazell AEP, Rodriguez A, et al. Evaluation of the AFFIRM intervention package to reduce stillbirths in Scotland (AFFIRM): a stepped wedge, cluster-randomised trial. The Lancet. 2018 .

Molina FS, et al. Cerebroplacental ratio-guided management in women with reduced fetal movements at term (cERPa trial). European Journal of Obstetrics & Gynecology and Reproductive Biology. 2025.

You might also find these helpful:

Waters broken but no contractions? Understanding PROM (coming soon)
Where can I give birth in South West London?
The best birth centres in South West London

This Is What It Actually Looks Like to Have Me as Your Doula

Wed, 08 Apr 2026 10:06:30 GMT

It is very natural to have questions about what a doula actually does. It can still feel like quite a niche thing.

I love it most when people enquire with me because they’ve heard of others having a good experience with a doula. But there are many different paths to reaching out, and wherever you find yourself, I want this post to give you a sense of what it actually feels like to have that support there.

I work as a birth and postnatal doula in South West London, and this is what it actually looks like to have me alongside you through your pregnancy, your birth, and those first days afterwards.

What does a doula actually do?

A doula supports you through pregnancy, labour and the early days after birth, offering continuity, information and experienced support throughout.

In lots of ways, having a doula is a very old idea. It’s how women have always given birth — around other women who have had babies, who understand birth, and who know how to be there without making it something clinical or managed. Our modern maternity system has really lost sight of this, and that is one of the major reasons birth has become so medicalised. At its heart, birth is a physiological event, not a medical one.

One of the most important things a doula brings is that sense of confidence — that birth is something humans do, and have been doing for a very long time. We offer consistent support in a system where you might otherwise be seeing different people, hearing different opinions, and trying to piece it all together yourself.

If you’re looking for a birth doula in London and want this kind of support, you can find more about my birth doula services here.

During pregnancy

You can use me as much or as little as you want.

For some people that looks like lots of conversations, messages and questions as things come up. For others it’s quieter, and that’s completely fine too. You set the pace. I’m very available and quick to respond, so you’re not left sitting with questions.

What I notice with most of the families who choose to work with me is that they don’t just want to go along with everything automatically. They’re aware that maternity care is quite medicalised now, and they want to feel more in control of what’s happening. That doesn’t mean saying no to everything. It just means understanding your options properly. I have a health science background, so I’m very comfortable talking through evidence, risks and benefits where that information exists. But a lot of pregnancy and birth involves nuance. There is often no clear yes or no answer.

Birth also asks something more of us than just facts. At its heart, it is a deeply intuitive process. As quite a type-A, modern, slightly anxiety-driven woman, I’ve found that one of the biggest challenges of motherhood — but also one of the greatest gifts — is learning to trust that instinct. Fourteen years in, I know my gut is my superpower when it comes to my children, and I really enjoy helping you tap into that too.

“She helped us feel prepared, informed, and confident about the whole process.”
— SH

Getting ready for birth

When I come and spend time with you antenatally, we go into quite a lot of detail about what birth actually looks like.

If you’re hoping for a physiological birth, we’ll talk about how labour might unfold, how it can feel, what’s normal but intense, and what it might look like from the outside — because that can be quite different to what people expect.

We would have no idea what to expect otherwise, would we? We don’t live in communities anymore where we see birth or hear these stories in a natural, everyday way. I love the work of people li ke Rachel Reed and Natalie Meddings , wh o have helped put words to the great mystery that is labour and birth. I often say I did things the wrong way around — I had my babies physiologically, and only afterwards learned what my body had actually been doing from these wise women, among others.

By the end of that time together, I want us to feel really clear on your birth preferences. That does include thinking about what you might want if things change — not because we expect them to, but because it’s much easier to make decisions when you’ve already thought things through.

A lot of birth preparation is about getting to a point where you understand enough that you can then let go and trust the process.

When labour starts

Once I’m on call, you are my top priority. That means I’m available whenever things begin, even if that means dropping plans or stepping away from normal life. This is where a big part of the doula commitment lies.

With a first baby especially, there’s often quite a long period at the beginning where things are happening, but you’re not yet in established labour. This is also the stage where there isn’t really any support from the NHS. It’s why so many people end up going into hospital, being sent home, and feeling a bit unsettled by that. So we’ll be in close contact at this stage. You can expect a good pep talk as the night comes to help fortify you both.

You might be messaging, calling, checking in about what you’re feeling. Often you’re looking for reassurance — that what’s happening is normal, that you’re on the right track, that you’re not missing something.

I often say that a lot of labour is about stringing yourself out and just keeping going. If you can do that, a baby will eventually come out of your vagina!

Sometimes I say that a lot of my work on the day is done before I even arrive, and I do think that’s true. Then when you feel ready for me to come and be with you, I will. Usually we’ll spend some time at home first. That familiar environment can really help labour deepen before you go into hospital, and we know that going in later is often linked with fewer interventions. But it is always your choice.

“Without her expertise I would have arrived at the hospital far too early and, instead, was able to labour at home, making myself as comfortable as possible.”
— EL

During labour

When I’m with you during labour, I’m responding to what’s happening moment by moment.

Sometimes I’m in the background — making sure you’ve had a drink, noticing small things that might help, keeping the space calm and steady. Sometimes I’m more hands-on — supporting you physically, helping you move, offering touch or comfort, or showing your partner how to do this so they feel confident.

And sometimes there are decisions to be made. When they do come up, I help you slow things down enough to understand what’s being offered, what your options are, and how that fits with what you wanted.

The more preparation we’ve done beforehand, the less those moments tend to feel rushed or overwhelming.

Your birth partner

Your partner is a huge part of the birth experience, and often they feel a lot of pressure. Dare I say it — if your partner is male, birth is such a feminine process that it can feel quite unfamiliar territory.

As labour deepens, you’ll often go somewhere quite inward. You’re not really engaging with the room in the same way — you’re focused on what your body is doing. Your partner, though, is right there in it. Hearing everything, watching everything, trying to work out what’s going on and how best to support you. Having someone alongside them who understands birth can make a big difference. Someone who can quietly reassure them, explain what’s happening, and help them feel confident in what they’re doing. It’s really important to me — and I think to you as a family — that you come through this experience feeling strong together.

“She also gave my husband the strength and space he needed to take care of his own needs and be the best version of himself for me through it all.”
— OJ

After your baby is born

I stay with you until your baby is here, and if you’re planning to breastfeed, usually until that first feed is underway.

Those moments after birth can sometimes feel quite busy within the NHS, and it’s a priority for me that they feel steady and calm for you and your baby.

Then there’s usually a natural moment where things feel settled, and it feels right for me to leave you together as a new family.

Early postnatal time

We stay in touch after the birth. And in many ways, this is where I see the biggest difference.

Those early days can feel intense — physically, emotionally, just the adjustment of it all. Having someone you already know, who understands your birth and your baby, and who can offer calm, steady support, can make that feel much more manageable.

Compared to my own experiences, it’s one of the things I value most about this work — seeing families settle into life together feeling supported and confident, rather than overwhelmed.

What people often say

Women sometimes say to me that they couldn’t have done it without me. But that’s not really how I want you to feel.

I want you to look back and know that you did it — in your way, on your terms — and feel proud of that forever.

I often describe having a doula as being a bit like a Sherpa. You’re the one climbing the mountain, but it helps to have someone there who knows the way and can carry some of the load.

“Getting Lisa on board was the very best decision we made as we embarked on our journey to have our first baby.”
— MG

If you’re looking for this kind of support

I support families across Wimbledon, Merton, Kingston and South West London.

If you’re looking for a doula in London and this feels like the kind of support you want, you can find out more about working with me here.

Behind the Scenes of a Newborn Photoshoot

Wed, 01 Oct 2025 16:46:13 GMT

Welcome to this guest blog from the fabulous S hal my talented friend and fellow South West London female business owner! Here is what she has to say...

Capturing the first precious moments of a newborn’s life is a unique and rewarding experience. As a Newborn photographer based near Wimbledon, I get to create a safe and comfortable environment where both the baby and parents can feel at ease, resulting in beautiful, timeless images.

Here’s a glimpse behind the scenes of a newborn photoshoot, detailing the preparation, process, and care that go into each session.

A Newborn Photoshoot in my Natural Light Studio, near Wimbledon

Setting the Stage
The Newborn Photoshoot
Post-Production

Setting the Stage

Communication with Parents

The journey begins well before the actual newborn photoshoot. I start by having an in-depth consultation with the parents, sending over guides and information to assist in preparing for the shoot.

I can also have a phone conversation if more questions arise!

I also provide a detailed client guide that outlines what to expect, what to bring, and how to prepare their newborn for the session!

Studio Setup

Creating a warm and welcoming newborn photo studio environment is crucial. At my professional natural light studio, the temperature is regulated and is heated to a comfortable level, as newborns are more sensitive to the cold.

Soft natural light is used, avoiding harsh flashes that could startle the baby.

All props, blankets, and outfits are prepped and sanitised, ready for use and are especially purchased for baby photography.

Safety First

Safety is my top priority during a family photoshoot. I always have a spotter and never leave the baby unattended (often one of the parents) close by to ensure the baby’s safety during poses.

I also make sure that all props and equipment are secure and that the baby is never placed in any unsafe positions.

With my professional newborn training, correctly and safely posing babies was part of the course.

The Newborn Photoshoot

Patience and Timing

Newborns have their own schedules, and it's important to be patient and flexible. The best time for a photoshoot is typically within the first two weeks of life when the baby is sleepier and easier to pose.

However, every baby is different, and I adjust the session according to their needs, allowing for feeding and soothing breaks as necessary.

Posing and Comfort

I start with simple poses, gently transitioning the baby into various positions. The key is to handle the baby with care, ensuring they are comfortable and secure at all times.

I also use soft, plush blankets and gentle props to enhance the aesthetic without compromising the baby’s comfort during a family photoshoot.

Capturing Details

Beyond the classic poses, I focus on capturing the tiny details that make each newborn unique. Close-up shots of tiny toes, delicate fingers, and wispy hair create a beautiful and intimate portrait of the newborn's first days.

These details are cherished memories for the parents and add depth to the photo gallery.

Parent and Sibling Involvement

Including parents and siblings in the family photoshoot adds an extra layer of emotion and connection. I guide them on how to hold and pose with the baby, capturing candid moments of love!

These family portraits are often the most treasured images from the session.

Post-Production

Selecting the Best Shots

After the session, I carefully review and select the best images, ensuring a variety of poses and expressions. Each selected photo undergoes meticulous editing to enhance colours, remove any distractions, and highlight the newborn’s natural beauty. To view an example gallery of images for one of my newborn photoshoots, click here!

Editing with Care

Editing newborn photos requires a delicate touch. I focus on maintaining the baby’s natural skin tones and textures while smoothing out any temporary blemishes or redness. The goal is to create timeless images that are both realistic and visually appealing.

Presentation and Delivery

Once the editing is complete, I present the final gallery to the parents, either through an online viewing platform or an in-person reveal session. This is a special moment where parents get to see their beautiful newborn captured in a series of stunning images. I also offer a range of high-quality products, from prints and albums to wall art, allowing families to cherish and display their photos for years to come.

Book Your Newborn Photography

Behind the scenes of a newborn photoshoot is a mix of preparation, patience, and passion! As a newborn photographer, my goal is to create a safe and comfortable environment where both the newborn and their family can relax and enjoy the experience.

The journey from preparation to final delivery is so important to me.Get in touchand let’s book your newborn photos.

Best Birth Centres in South West London

Tue, 18 Mar 2025 10:29:40 GMT

Hoping for a water birth in a birth centre? Kingston, St. George's, Chelsea & Westminster, St Thomas’ and St. Helier all have them – but what do you need to know?

First things first… how to access a birth centre!

When I chat to potential doula clients in discovery calls, I always ask what kind of birth they’re hoping to have. Probably 75% of the time, the answer is “a water birth on a birth centre.” So I thought it would be helpful to share what I tell them: first about how to maximise your chances of a water birth in a birth centre, and then some inside intel on the different birth centres near you in South West London.

How to Access a Birth Centre for Your Water Birth

Most parents I speak to during pregnancy are worried about whether a pool will be available when they arrive at the birth centre, but I always explain that it’s really more important to focus your energies on getting onto the birth centre in the first place! Most hospitals don’t discuss birth choices with you until 36 weeks, but it’s good to be preparing and working out your options earlier on in pregnancy so you can advocate for what you want at this appointment. You can sometimes watch virtual tours of the local South West London birth centres online, or even better, go and visit on an in-person tour (offered routinely at St George’s and St Helier), or ask to be shown around.

If your pregnancy is “low risk,” then giving birth on the birth centre would be supported by your hospital. However, it’s not unusual for “risk factors” to be identified in your pregnancy. In my experience, many of these come up near the end of pregnancy, not giving you much time to consider them. It would be impossible to go through all scenarios now, which is where the support of a good doula can help – so you don’t feel like you always need to be one step ahead! But there are many sources of quality information out there for you to research yourself. I would really recommend the work of Dr. Rachel Reed , Sara Wickham , AIMS , and the podcast The Great Birth Rebellion .

Local Birth Centre and Water Birth Statistics

Using data from the National Maternity Dashboard and individual stats from each birth centre, here’s what you can find:

St Helier (April 2026) : 16% of all babies were born on the birth centre, 7% of all births from the trust (Epsom & St Helier together) were water births on the birth centre
Kingston (March 2026) : 15% of all babies were born on the birth centre, 8.5% of all births were water births on the birth centre
Chelsea & Westminster (March 2026) : 12% of all babies were born on the birth centre, 5% of all births were water births on the birth centre (slightly educated guess as C&W and West Mid report their total number of births together)

We can also see from the statistics that you are more likely to use a birth centre for a second or subsequent birth rather than for your first (about 30–40% of mums giving birth on the birth centre are first-time parents).

Therefore, the hospital published statistics suggest that around 15% of women birth on the birth centre, and around half in water. I always make it clear that I say this to encourage, rather than discourage: this knowledge is power. It makes it clear that to aim for the birth you want, you can’t just go with the flow of NHS maternity care, because the flow is taking you in a different direction – onto the labour ward (NB: some labour wards also have pools, but there are no published statistics on how often women have water births on labour ward).

Understanding Water Birth Use in Birth Centres

In terms of having a water birth specifically, we can see from the statistics above that less than 50% of women using a birth centre actually give birth to their baby in the water (although many still use the pool for pain relief). In some cases, this is due to maternal preference, or simply because there wasn’t time to fill the pool. Or you may be told that you can use the birth centre but not the birth pool; in these cases, you would need to look into the evidence for this recommendation during your pregnancy.

There are some reasons why you may be asked to get out of the pool during labour, and this NHS document has a helpful list:

To use the toilet
For additional pain relief
If there is any evidence of meconium staining
If there is difficulty in hearing your baby’s heart rate or any irregularity in the baby’s heart rate
For internal vaginal examinations
If your blood pressure, pulse or temperature becomes abnormal
If your labour does not progress as expected
In order to deliver the placenta

These are all topics you would need to research and decide what you think about (remember, in birth, all care and recommendations are offers, not orders!). It’s best to do this in advance of your labour for the greatest chance of making an informed decision at the time.

Birth Centre Access When You’re “Out of Guidance”

Each birth centre in South West London has its own policies on who meets the criteria to use them. If you meet the criteria, you wouldn’t usually face any barriers to going to the birth centre in labour – although it still may not be proactively offered, so make sure you know what’s available so your birth partner can ask for what you want at the time. You may be asked or may choose to transfer to the labour ward during your labour, and the points listed above about reasons to get out of the pool are also the kinds of things you would want to know about when making a decision on this.

If you don’t meet the criteria, you may be told that you’re not allowed to birth on a birth centre. However, the reality is much more nuanced than that. This article from BirthRights gives an amazing explanation, but the simple answer is that we have a right to choose where we give birth. The only reason you can be refused access to a birth centre is if there is a good evidence-based reason that you or your baby cannot be provided safe care there.

One major reason for being discouraged from using a birth centre is a recommendation for continuous fetal monitoring (CTG) in labour. However, there is very little evidence that this improves outcomes for babies, and only in very specific circumstances: I recommend reading some of the amazing work from Dr. Kirsten Small on this topic. Therefore, if you are comfortable with declining the offer of continuous monitoring in labour, this alone would not be an evidence-based reason to deny you access to a birth centre.

If you want to birth on a birth centre near you when you don’t meet the criteria, ask to speak to a consultant midwife to make an “out of guidance” birth plan to use the birth centre. This must be done before you go into labour to ensure a smooth and well-supported journey for you and your baby when you arrive at the hospital.

Reviews of Local Birth Centres in South West London

It’s finally time to have a chat about the ins and outs of our local birth centres! Here are some of my observations after supporting women as a doula at all our local birth centres:

Location of the birth centre relative to the labour ward

Kingston, St. George’s, Chelsea & Westminster, St Thomas’ and St. Helier all have alongside birth centres, meaning they’re in the same hospital building as the labour ward. This gives you easy access to obstetric care if you need or want it during your labour. At Kingston, St. Helier and St Thomas's, the birth centres are literally adjacent to the labour ward; at Chelsea and Westminster they’re on the same floor but across the corridor, and at St. George's they’re two floors apart. I wouldn’t say any of these factors has a major impact if you decide to transfer in labour.

Staffing levels

Most of our local South West London hospitals are able to reliably staff their birth centres, although unfortunately in the past few months (March 2026 update), I have known all the local births centres to be closed on atleast one occassion, and multiple times in the case of Chelsea and Westminster & Kingston. The situation is often not that the birth centre is physically full, but that the hospital does not have experienced midwives to allocate there so they prioritise labour ward staffing. Hopefully as both Chelsea & Westminster & Kingston have started to limit postcodes they will take referrals from, this may improve.

It’s always sensible to ring in early labour, so you know what availability is like and in some cases can make a decision about your timing of going in. They can sometimes open the birth centre for a woman who comes in labour and wants to use it – so this is always worth asking - again, I’d ask on the phone in early labour to give them time to prepare. It is also sensible to have a plan for birthing on the labour ward if the birth centre is closed or at capacity, and making sure your birth partner can advocate for the type of care you wish to receive there.

On reliable staffing, St. George's have longstanding issues with staffing the birth centre. However the update as on May 2026 is that the Trust is now very committed to keeping the birth centre open and reliably staffing it, which is such an exciting development!

Chelsea & Westminster, St. Helier and Kingston all have dedicated teams of midwives who have chosen to work on the birth centre and are therefore motivated to support women to have low-intervention births there. Others may allocate staff depending on availability at the time.

Triage

When you arrive at the hospital in labour, you’ll first be assessed by a midwife to see whether they recommend you stay at the hospital or go back home and labour a bit longer. Now this is a whole topic in itself, but when I’m supporting families who want to access a birth centre as a birth doula, I much prefer if we’re able to be “triaged” on the birth centre itself, rather than go to general triage and then be allocated to the birth centre. This is because the facilities are usually nicer (a single room rather than a bed on a bay), and the midwives will be more used to choices on your birth plan that you may have made to support physiological birth – for example, no routine vaginal examinations or keeping the lighting low and external disturbances to a minimum. They also don’t offer a routine CTG, which means you have to be restricted to the bed and unable to move around freely. As above, an admission CTG isn’t evidence-based to improve outcomes.

This element is a little hard to plan because maternity units sometimes offer a different route to triage depending on their capacity at the time, but clients booked with Chelsea and Westminster and St. Helier can ring the birth centre directly, if it is open, at any time and be triaged with the team there. The other hospitals I’ve had different experiences with depending on the day – but it’s always worth asking on the phone to be directed straight to the birth centre and your reasons for preferring to do this.

Birth pool availability

Although this is a common fear of parents, it usually isn’t a problem to access a birth pool once you’re on the birth centre. Sometimes if you go in a little earlier but decide to stay in, you may be encouraged to remain in a smaller room without a pool – but as long as you’re managing well, this tends to be completely fine. I always recommend clients wait until the last moment to access the “next” coping strategy, so in many ways, getting in the pool for the pushing stage is ideal. But it’s not set in stone at all.

Kingston, St. George’s, Chelsea & Westminster, St Thomas’ and St. Helier all have birth pools available. The only notable difference is St Thomas’ don’t have them in the main birthing rooms, but in a separate room (a small internal room with no windows) within the birth centre. So you move rooms to use the birth pool. I genuinely can’t decide what I think about this – in a sense, it’s unsettling, but in another, mammals love to give birth in small, cosy, private spaces!

Postnatal care

A lovely benefit of giving birth on a birth centre is that they’ll do their best to keep you there postnatally, which means you’ll get your own room. There’s generally a much higher staff ratio of midwives to families, and so more support with breastfeeding and postnatal care. This is never guaranteed, as it depends on who they’re supporting in labour at the time. There isn’t really any difference between the South West London birth centres on this, as all have postnatal rooms and would try to accommodate you if they can. And you can always ask what’s possible!

Birthing out of guidance

As mentioned above, sometimes you’ll need an out-of-guidance plan to access a birth centre. These are possible to arrange at any birth centre, but it will involve talking to the right person to support you. As a doula, I have lots of experience in supporting clients to do this, and if you’d like information about helpful contacts or ways to go about this at the hospital you end up choosing, just let me know. Interestingly, the local birth centres have different criteria on automatic eligibility (for example, some “accept” women with gestational diabetes on metformin, and others don’t). I can also help you navigate this and let you know what some of the local policies are. Feel free to contact me here or fill in the form at the bottom of the page.

Next Steps and Support

I hope there’s plenty of information here to help you understand how to maximise your chances of a birth on a birth centre near you in South West London! Of course, homebirth is also an option…

Do contact me on the form below or check out my birth doula services here.

Where to Give Birth in South West London

Wed, 07 Feb 2024 14:36:36 GMT

A guide to maternity at Kingston, St. George's, Chelsea & Westminster, St Thomas’ and St. Helier hospitals

Do I Have a Choice Where to Give Birth?

This guide will help you compare maternity hospitals and birth centres in South West London. The first thing to be clear about is that it is your choice which hospital in South West London you want to be linked to for maternity care and to birth your baby (if, indeed, you want to use hospital based care at all!). BirthRights is an amazing charity to keep up to date with your rights in birth, and this link explains how you can refer yourself to any hospital you wan t: [click here to find out more] .

Once this article has helped you decide, you can complete a self-referral form for Kingston, St George’s, Chelsea and Westminster, St Thomas’ or St Helier online. There is no need to visit your GP first.

NB As of October 2025, Chelsea and Westminster are limiting self-referrals from certain areas, all details here :

As of February 2026, Kingston are limiting self-referrals from certain areas, all details here

How to Choose the Right Hospital for Your Birth

There are lots of factors to weigh up to decide the right hospital for you out of Kingston, St. George’s, Chelsea & Westminster, St Thomas’ and St. Helier. If you are particularly interested in having your baby in a birth centre, you may also like to read my article specific to South West London birth centres: [click here to be taken through] .

Here are some other factors to help you decide where to have your baby locally:

Location of the Maternity Unit

South West London is a big place, so you will be closer to some of these hospitals than others. If you plan to birth at the hospital, you may want to think about how long it will take you to get there, rush hour traffic, ease of parking, etc. (see my top tips below!).

You can find your local hospital matern ity unit [here] .

Your antenatal care will be coordinated through the hospital. If you live close by, you’re likely to have your appointments at the hospital itself or in a clinic near you. If you live further away or across boroughs, you will probably need to travel further for your antenatal appointments too. Although, as someone who grew up in Cornwall, I can tell you the distances aren’t huge, so you still have choices!

How Homebirth and Postnatal Care Work

It’s worth knowing that if you would like a homebirth, the teams cover specific geographical areas. You can ring the hospital and ask about this, click here for a map , or send me a message and I can help you know which catchment area you’re in. If you know you want a homebirth from the start, it makes sense to book with the corresponding hospital that provides this service in your area. If you decide later in pregnancy, you may need to transfer, but this is not an issue.

Your postnatal care will also be delivered by community midwives according to geographical area, and so this will be fixed. If you choose the hospital closest to you, it’s more likely that some of the midwives you meet antenatally will also visit you in those early postpartum days, which can be a real boost. Regardless of which hospital you birth in, your postnatal care will be arranged automatically with the correct team before you go home.

CQC Reports for Maternity at Local Hospitals

A bit like Ofsted for schools, the CQC (Care Quality Commission) carries out regular inspections of maternity departments and awards ratings for different aspects of care, along with a report detailing what they found. The latest reports are linked below, along with the maternity department’s current overall rating (click on the rating to read the full report):

Kingston Maternity (December 202 2) : Good
St George’s Maternity (August 2024) : Requires Improvement
Chelsea & Westminster Maternity (May 2023) : Good
St Thomas’ Maternity (December 2022) : Good
St Helier Maternity (June 2026) : G ood

As with any reports, you may want to delve into the details to see what the inspectors had to say about the areas that feel most relevant to you.

Comparing Hospital Policies & Approaches to Care

You may have some elements in your pregnancy that you need additional support with, such as a medical condition. For example, I was diagnosed with gestational diabetes in my first pregnancy and moved from St George’s Hospital to St Helier Hospital, where I discovered that the two hospitals had different target thresholds for blood sugars. My friend had a similar experience with testing positive for GBS in a previous pregnancy and learning that the recommendations for antibiotics in labour for subsequent pregnancies varied. If there’s an issue that’s likely to come up for you and you’d like to compare hospital policies, you may be able to find this information on their website or email them directly to ask for a copy.

Comparing Maternity Care in South West London

As a doula, I spend time regularly at all these South West London hospitals, and here are some of my favourite things about them to help you decide:

Kingston Maternity - My Favourite Things

Kingston’s delivery suite, birth centre and home birth teams all have their own Instagram accounts, so it’s easy to find information about birth outcomes in each location (they vary quite a lot!), read birth stories and see up-to-date photos. The overall maternity culture at Kingston really stands out, with midwives consistently seeming happy and well supported.

In my experience, staffing of the midwife led birth centre and home birth teams is reliable. There is a birth pool available on the labour ward.

There are a good number of single rooms on their postnatal ward, particularly for mums who have had a caesarean birth, which can really make a difference to your experience afterwards. At other hospitals, if you birth on the birth centre you will have a single room but otherwise you are likely to be in a shared bay.

The staff also take a special interest in biomechanics and have produced a really helpful leaflet , whi ch shows their motivation to support physiological birth if this is what you want.

St George’s Maternity - My Favourite Things

St George’s is the largest hospital in South West London and has some amazing facilities for fetal medicine and NICU, offering specialist care before and after the baby is born.

The early pregnancy unit at St George’s operates on a walk-in basis, so if you have any concerns early on, or you’re not sure when you might have conceived, you can head there without needing to see your GP first, which can be really helpful.

St George’s is also good at offering tours of their birth centre. They have recently added a birth pool room to their labour ward.

St George’s also facilitated a maternal assisted caesarean recently. If this is something you might be interested in, message me for more information.

Chelsea and Westminster Maternity - My Favourite Things

The birth centre at Chelsea and Westminster is lovely (although see note about capacity below). If you are booked to have your baby there, they have a special number to call them in labour so you can go straight onto the birth centre and receive all your care there. They also have an active Instagram account with lots of birth stories, monthly stats and opportunities to meet some of their staff.

If you’re lucky enough to live in the catchment area of the Sunflower Team , you’ll receive true continuity of midwife care, with the same team providing all your antenatal and postnatal care and coming to support you in labour at home or in hospital, depending on your preference.

The hospital is modern, and the facilities for intrapartum (in labour) care are good. There are also two birth pools available on the labour ward and wireless CTG monitoring and bluetooth in all rooms.

St Thomas’ Maternity - My Favourite Things

St Thomas’ is a large teaching hospital, like St George’s, with all the specialist facilities that go along with that. This probably shouldn’t sway your decision too much, but the views from the maternity unit on the 7th floor are amazing – you can give birth with a view of the London Eye!

The rooms on the labour ward and birth centre are lovely and big, with plenty of room to move around. They are all en suite.

St. Helier Maternity - My Favourite Things

St Helier is often the lesser known maternity choice in South West London, which means you can benefit from a more relaxed atmosphere and less busy antenatal clinics and facilities when you’re in labour. The more I doula, the more this stands out as being a lot less busy, which in my experience means you receive very responsive care. For example, if you choose to have a medical induction or request a caesarean birth later on in your pregnancy, this is likely to be subject to far fewer delays and scheduling issues than at other local hospitals.

Their birth centre is fabulous. It has a n active Instagram account tha t gives an insight into their approach to birth, and around 15–20% of births at St Helier take place there, which is consistently the highest of all the hospitals featured in this article. They have also just revamped the rooms (January 2026), so they are looking very nice. If you’re interested in a birth centre birth, this is a hospital you may want to consider. There are two birth centre managers who are wonderful and supportive of women wanting to make informed choices, including birthing outside of guidance.

Almost all of the rooms are en suite, although in the birth centre the toilets are behind a curtain, which most women in labour don’t mind too much.

On the postnatal ward, it is the only hospital locally that still lets you pay for a private postnatal room for approximately £150/night (subject to availability), if this is suitable for you clinically.

Things Worth Knowing About Each Hospital

As well as the upsides, here are some of what I see as the downsides of each hospital:

Kingston Maternity - Potential Downsides

Kingston is a good unit, and as such very popular. This means it is pretty busy and so there can be long waits in e.g. the induction process / the birth centre can be at capacity at times. This also means if you want to use the birth centre the triage process is unpredictable, as sometimes you can go straight onto the birth centre and sometimes you have to go through main triage which many women find disruptive. Parking is limited and crowded (but better than at more central London hospitals!). Although it’s very busy for maternity, it’s only a small hospital and doesn’t have the same amenities as some of the others in terms of food outlets, etc.

There is a high level of intervention on their delivery suite, but this is comparable to the other local hospitals too.

St George’s Maternity - Potential Downsides

If you read the CQC report above, you’ll see that St George’s has some issues at the moment, particularly with staffing. Some families report that a lack of staff on the postnatal ward can mean they feel unsupported at this stage. It's also a very busy ward.

As a doula, my least favourite thing about St George’s is the labour ward rooms are not en suite! If you’re having a caesarean or want an epidural, this won’t be an issue as you’ll have a catheter, but if you’re hoping for a more active birth, a toilet can be really helpful in labour (it’s nicknamed the “dilation station!”), and having to walk across the corridor to a shared facility is not appealing.

Chelsea and Westminster Maternity - Potential Downsides

Make sure the location really works for you—it’s the other side of the river and traffic can be terrible, especially during rush hour. It also has very limited parking, so most people take a taxi.

With the changes to the postcodes they will accept referrals from from October 2025, Chelsea & Westminster is seeking to ease pressures on capacity, which I think is wise. Even in labour, care has felt extremely busy in my experiences lately. This could mean longer waits for beds following induction, long stays on triage before you’re allocated your own room in labour, and on one occasion, they had to close the labour facilities as they were so busy, though this is very rare.

Some women find the postnatal ward crowded, and a lack of private rooms means you’re often in a shared bay, although this is common to most hospitals.

St Thomas’ Maternity - Potential Downsides

St Thomas’ services cover a wide area and it’s the furthest from the South West London boroughs, so consider carefully whether the location really works for you. Being in central London means entering the congestion zone and parking is not easy. If you’re having a planned birth, such as an induction or caesarean, this may be fine, but think about it carefully if you’re planning to head to the hospital in labour.

Another thing to know about St Thomas’ is that in their “home from home” (midwife-led) unit, the main rooms are more like labour ward rooms with a bed as the focal point. To access the birth pools and more active birth equipment, you have to go into another room that has no windows. So you could end up being in three rooms before you actually birth your baby: triage, a room on the ward, and a pool room!

The final thing about St Thomas’ is that for some reason, it’s unbelievably hot. Consistently.

St. Helier Maternity - Potential Downsides

I’m not going to lie to you, visually, St Helier isn’t the most attractive place! Someone told me recently that the hospital is built back to front, and the side of the site that faces the main road is actually the back of the hospital, which makes a lot of sense! Situated on the edge of the large St Helier estate, it doesn’t have a modern central London vibe (mind you, neither do any of the others apart from Chelsea & Westminster). I also once saw a bucket collecting drips in the labour ward corridor! Honestly though, I would encourage you to look past these aesthetics if you want a quieter, more laid back vibe, as the maternity rooms are all adequate. It doesn't have wireless CTG monitoring which is available, atleast in some rooms, in all the other hospitals.

St Helier, along with Kingston, has the least specialised NICU facilities of all the hospitals in this article, which will be no issue at all for a healthy mum and baby, but may be good to know if you’re anticipating a more complicated journey.

The antenatal and postnatal wards are also quite old and can be hot and stuffy too.

FAQs About Giving Birth in South West London

The Preparation You Do Is More Important Than the Maternity Department You Choose

I hope some of the above has helped you feel more informed about your options for birth in South West London.

Kingston, St George’s, Chelsea & Westminster, St Thomas’ and St Helier all have strengths and limitations, and many women go on to have positive births in all of them. However they all also have high rates of induction, interventions and unplanned caesarean births.

In my experience as a doula, how you prepare, and the support you have around you, matters far more than finding a “perfect” hospital. This is also the element you are most in control of, which I hope feels reassuring.

The most important thing is engaging with your pregnancy and birth, working out what matters most to you, and making the decisions that feel right for your family.

I am obviously biased, but having a birth doula can massively help with this.

Birth Doula Blog

PROM (Waters Breaking Before Labour): Should I Wait for Labour or Have an Induction?

In this article

What does "waters breaking" actually mean?

How do I know if my waters have broken?

What if I only had one gush?

How long will it take for labour to start after my waters have broken?

How likely is my baby to develop an infection once my waters have broken?

What happens if my baby does develop an infection?

What might "suspected" or "possible" infection actually mean for babies?

How likely is the mother to develop an infection following PROM?

What happens if the mother develops an infection?

What factors might you want to take into account when considering your individual infection risk following PROM?

Does induction increase or decrease the risk of infection after PROM?

Other factors that influence infection risk

If you decide to go into hospital immediately after PROM, what might you be offered?

Will my birth plan need to change if I am not in labour within 24 hours?

Frequently asked questions when your waters break before labour starts (PROM)

A final thought

How can I decide what to do?

About the author

References

You might also find these helpful:

Reduced fetal movements: Will I have to be induced if I go to hospital?

In this article

Key points

What are normal fetal movements?

Trust yourself, but don't live in fear

What happens if I go to hospital with reduced fetal movements?

Will I automatically have a scan?

Will I be induced if I go to hospital with reduced fetal movements?

The reality in practice

Reduced fetal movements after 39 weeks: what does the guidance say?

What if everything is normal?

What if I have more than one episode of reduced fetal movements?

What is the cerebroplacental ratio (CPR) and why might it be measured?

Do reduced fetal movements mean I can't have a home birth or use a birth centre?

Lisa's doula thoughts

Frequently asked questions about reduced fetal movements

A final thought

About the author

References

You might also find these helpful:

This Is What It Actually Looks Like to Have Me as Your Doula

What does a doula actually do?

During pregnancy

Getting ready for birth

When labour starts

During labour

Your birth partner

After your baby is born

Early postnatal time

What people often say

If you’re looking for this kind of support

Behind the Scenes of a Newborn Photoshoot

A Newborn Photoshoot in my Natural Light Studio, near Wimbledon

Setting the Stage

Communication with Parents

Studio Setup

Safety First

The Newborn Photoshoot

Patience and Timing

Posing and Comfort

Capturing Details

Parent and Sibling Involvement

Post-Production

Selecting the Best Shots

Editing with Care

Presentation and Delivery

Book Your Newborn Photography

Best Birth Centres in South West London

How to Access a Birth Centre for Your Water Birth

Local Birth Centre and Water Birth Statistics

Understanding Water Birth Use in Birth Centres

Birth Centre Access When You’re “Out of Guidance”

Reviews of Local Birth Centres in South West London

Location of the birth centre relative to the labour ward

Staffing levels

Triage

Birth pool availability