home birth or ML unit?

[quertas]

Hi All,

Wondered if anyone has any experience to help me make a decision. I'm having DC2 and would really like a homebirth if poss. However, where I live there is a very good hospital which has an all new small ML unit attached as well as a standard labour ward. I've been told that if I had to transfer in for complications obviously I'd be on labour ward not the ML unit. Fine, no problem.

The thing I need to make a decision about is this. I have far less confidence in the community midwives, who in my area do all the home births, than the hospital ones. When I was having DC1 the community midwives were by and large pen pushers and the hospital ones were without exception brilliant. There is also one midwife who works for our community midwife unit who DH has sworn will cross our threshold when hell freezes over as frankly we both think she's not competent (if we'd followed her advice with DC1, DC1 would probably have died a few days after birth, she seems to be clueless about even fairly basic matters, and we plain old don't trust her). This pg has been similar in the sense that the community midwives have been quite unhelpful and a bit ...meh, but since I've not needed them to actually do anything, its not really mattered.

Obviously things may be different on the day, and that's what I'm hoping for but I don't know if having to transfer in because you've lost faith in your attending midwife would mean that you'd automatically have to go to labour ward rather than the ML unit (where all the lovely birth pools are). To compound the problem, the opening of the ML unit has meant that the beds on standard labour ward are now very very clinical as they mostly deal with complicated labours and labours that need a lot of monitoring. So no bean bags, birth pools, any of that new fangled moving about . I can't think how to work out what to do, or even who to ask. Can anyone offer any advice?

[cathan]

I had a home birth with my second baby after ending up in hospital with my first planned home birth and I would thoroughly recommend it! For a start, you get to have most of your antenatal care at home, which is lovely. Then there is the relaxing effect of being in your own place which, for me, was wonderful. I was lucky in the midwives that attended me and I can totally see why you're worried about that, but it's possible you'll find personnel changes since your last labour. Also, midwives who chose to cover home births are usually pretty enthusiatic about it so you'd hopefully be happy with your attendant. As well, a lot of people think that asking for a home birth commits you to having one - it absolutely doesn't. If you change your mind (or if anything changes medically) at any time, you can change to a hospital or ML delivery. Why don't you have a chat with someone from the local ML unit and see what they say. They might have a protocol about would happen if you needed to be transferred in labour. I had a birth plan with my first delivery and, when I landed up in hospital, the midwives there were very nice about doing everything the way we wanted. Hope this helps.

[quertas]

Hi Cathan, thanks for the reply! Where I am I think they do it a bit differently so I'm 32 weeks now and I've yet to see the same midwife twice and they don't come out to me. I guess the thing I'm worried about is if I call the midwives out and then decide I don't want to stay at home because I don't have confidence in them then would this be treated as the same thing as transferring in for failure to progress or needing more pain relief or other complication? I don't feel like I can phone up and ask labour ward though. I mean I am basically 'dissing' their colleagues. I'd rather try for a home birth like you say but if this means that its all or nothing even if labour's straight forward then it's rather a gamble. I'm booked for a home birth but feel I'm running out of time .

[Bue]

Hmmm. Tough one. If you're stressed and worried then you're not going to be able to relax at a homebirth, so the lovely environment will be of no use to you. You need to be where you will feel most comfortable. However (this one midwife excepted) you should find that the midwives who come to you in labour are very good - community midwives generally do a brilliant job at HBs. If you DID end up with the one you don't like (which is unlikely) you could always just say you had changed your mind and transfer in. There would be no 'clinical' reason for the transfer so I can't imagine that you would have to go to labour ward. You would still be low risk. Good luck with the decision!

[Bue]

Also quertas, by all means ring labour ward or your local Supervisor of Midwives and ask what would happen in the event that you wanted to transfer. Better to find out than to endlessly worry about it.

[quertas]

Thanks Bue, you're right I'm probably overthinking this one! I'll just have to think of a diplomatic way to phrase it to labour ward . Thanks!

[HelloBear]

It sounds like you have had rubbish antinatal care, what a shame.

I had 2hbs. And it was made really clear to me that if at any point I wanted to go to hospital that was fine, not a problem. Also you do not have to give any reason, or you can lie, tell them you have suddenly had a panic about your cream carpet :)

If you get the right MW then I would highly recommend a hb, but I would have felt differently with mws I didn't like.

Good luck!!!!

[HelloBear]

Oh also there does not need to be a clinical reason, I asked to go to hospital while in transition to ask fir an epidural. The MWs found it slightly amusing and said that if I left then I would have the baby at side of the road they were right

But if I had said I still wanted to go in they would have arranged it, as it was I ended up with a head crowning instead.

[missismac]

Go to your Midwifery led unit. Wait until a Midwife a is free and ask to talk over your concerns.

If your MLU is anything like ours then if you transfer in to hospital from home by maternal request then, as long as you & baby are still low risk, you'll go into the MLU. YOu only go to the labour ward if something has happened to make you/baby high risk (fetal heart rate irregular, too low, too high, bleeding, waters going and meconium in etc. etc.)

[TurquoiseTranquility]

Tough choice.
Lots of things to consider beside your key point, I suppose the main one is - why do you want a HB in the first place?
I want one for two reasons. First, we're a bit stuck for childcare (we have daytime options but no one close enough we could bother at night) and I want to be back with DS as soon as I can. The second reason is tied in to the first, if it all kicked off at night DH would have to stay with DS so I'd be on my own. But not just that, we'd have to turf DS out of bed, drive to hospital, then pull him off me and DH would go back home with him. All in all, a nightmare scenario.

However if it wasn't for DS, I'd happily go to MLU.

I think it's of utmost importance where you feel the safest. If staying home means you'll be freaking out because you don't trust the midwives, any benefits of a homebirth fly out of the window IMHO.

I think supervisor of midwives is a good person to ask as it's part of their job to deal with questions of incompetence. In fact you don't even need to voice your concerns, just ask what the procedure is if you were to decide to go to hospital for non-medical reasons, would you still be allowed to go to MLU.

However if you decide to try HB and see who turns up, my concern would be this. Since 2nd labour can go much faster than the 1st, and it can take the midwives a while to get to your house (I was told, up to an hour in my area), you could be running the risk of getting a pants midwife BUT being stuck with them because it's too late to transfer. So, maybe you should be cheeky and call them out early in labour. You could always say your contractions were 5 mins apart and painful but slowed right down just before they turned up

The worst thing that can happen, you get nice midwives but because you're not in established labour they'll give you their mobile numbers and leave. At least that's what I was told would happen if I called them out too early.

Whatever you decide, best of luck and hope your labour is quick and easy!

[quertas]

Thanks all, yes Bear I do feel a bit shortchanged on the whole antenatal care front, though to be fair I've not had any major problems (touch wood) and I'm on a second pg so I guess they are rightly prioritising those with greater needs. I just wish I could have confidence that all will be well when I do need them. I'm in the same boat Turquoise, we have day time care for DD but if anything needs to happen at night it'll be a huge drama, one of the reasons I'm hoping for a home birth. Well that and I really really don't want to be kept hanging about the hospital while they fill out forms (last time I had to stay an extra night as there was no-one available to discharge me :-() I hadn't thought about the speed factor at all though. Hmmm you're right that does put a different complexion on it. aargh!

[Lesley1980]

I was forced to go to the MLU as it was my first child & I was having a text book pregnancy. My baby was back to back, after a long labour & hours of pushing they had lost the heart beat for 10 minutes, 3 midwives were called, there was panic, my husband (a Dr with nothing to do with women,children or childbirth) had to sign for a drug(midwives can't prescribe some drugs), confirm dosage amount & even prepared the injection because there was no time to move me. Baby was born almost black with cord around her neck. I believe if I had been consultant lead they would have tried to turn the baby, used forceps or given me a c-section. The MLU were totally unprepared for difficulties & sometimes you don't have 5 minutes to move to another section of the hospital even if it is "just upstairs". They didn't even tell me it was back to back & give me the option to move to consultant led.

I'm not a fan of MLU.

[syl1985]

I've 3 sons and I've given all 3 times birth in the hospital.

If I hadn't done that my last child might not be alive anymore today. Everything was ok. The pregnancy, everything.

Then at all went wrong in a second when he had to come out. He didn't make the turn, because he was to big. He also had the umbilical cord around his neck.

Very soon there was a team of, I don't know how many people, in the room. A couple of them helped to get him out. When he finally came out. 4 others worked on him to get him back. He has been unconscious for about 2 minutes.
He came back and they quickly put him on machines and in an incubator.

The first 48 hours they couldn't tell me how he was. Then we got the news that he seemed to be ok and functioning well. He went of the machines and a day or 2 later he was with me. After a couple of more days we were allowed to go home.

It was horrible and yet we were so happy and lucky that we gave birth in the hospital.
If we had been somewhere else. Help might have been to late for us.

If everything goes well there's nothing wrong with having your child at home.
But it can go wrong in seconds.

In the hospital help is just a scream or a push on the emergency button away from you.
At home you first got to wait on the ambulance. If they can't help you then the quick ride to the hospital.

It all takes more time then if you'd already be in hospital.

You should do that what you feel most comfortable with. My very personal advice is to have your baby in hospital.
That's because of my own experience of unexpectedly nearly loosing my child.

Sylvia

[TurquoiseTranquility]

Gosh Lesley and Sylvia, you really did have horrific experiences! Makes me want to rethink the whole thing. DH isn't mad on the idea of homebirth precisely because of the "what if anything goes wrong" factor
I do think though, Lesley, the case with your MLU is the lottery of who you get I can quote 3 stories where things went wrong on a delivery suite (i.e. the doctor-led unit). In one case, a MW finishing his shift left a woman with a rubber band round her arm after taking her blood pressure, that despite her already being at high risk of blood clots. And the MW who took his place didn't notice either!

In another case, a lady who'd just had a C-section was feeling really weak, had 3 MWs looking after her but not one believed her. Finally her DH had to go out, grab the first person in a doctor's robe and drag them back to his wife. Turned out she was having a massive internal bleeding and had it been left another 3 minutes she'd have been dead!

On another occasion, a lady was told she had to have an episiotomy and the doctor who did it butchered her.

So TBH no matter where you are, it all depends who you get and crucially in the current climate, how overstretched they are!

Proximity to resus fascilities is a major factor though. Even though the recent Birth Place study showed that for non-first time mums, there was no difference in risk between those who laboured at home, in an MLU or on a delivery suite, you still don't want to be in the tiny percentage of those it went wrong for!

Lots to think about

[TurquoiseTranquility]

quertas, as for the speed of a non-first labour, the MW who led my parenting course said that often you can have a long 1st stage, but once you're in active labour things can really speed up. So I think so long as you call them out early you should still be fine?

[quertas]

Thanks all. I take your point turquoise , and you're right things may go fine if I can get someone out earlyish. Sorry to hear your stories ladies, that's rough! There seems to be no risk free option here. Home births are great if there's no last minute drama but that's a risk. Hospitals birth risks excessive intervention, giving birth in the car and MRSA. Still not sure which way to go but if labour is expected to be uncomplicated then it's either home or mlu here. Labour ward is for cases mlu can't / won't handle and epidurals here

[TurquoiseTranquility]

I'm with you quertas,
doctor-led labour wards freak the hell out of me, the only way I'll go there is if it's an emergency!
still rather more inclined towards homebirth, but much will depend on how it goes on the day.

Best of luck with yours!

[quertas]

Hi Turquoise,

Yes good luck for you too! I guess ultimately I'll just try and keep an open mind and hope for the best !

[Ilovestackingcups]

Hi OP, it sounds like the thing that's really holding you back from choosing a HB is the MWs you might get. I was just thinking (as I face my own second labour) that at least this time I won't feel so reliant on the MWs, as I've been there before and I know/my body knows what to do. I don't know if you feel the same, but perhaps the stranger kneeling for hours beside you won't be as important to you whilst you are labouring. Both you and your DP/other birth partner will know what you want or need.

Also, I've heard tell that a MW at a HB is much more hands off. In my area at least, they don't even stay in the room with you unless you want them to, so if they annoy me but I feel otherwise fine, I can ask them to go to the kitchen to do their paperwork whilst I labour in the living room.

Also, as others have said, unless there is a medical emergency behind your transfer to hospital, you can I'm sure go to the MLU. They will be set up to accept arrivals at any stage of labour.

[slhilly]

Honestly quertas, I'd go to the MLU under the circs you describe. The setting is less important than the carers. If the comm MWs are rubbish, being at home will just feel unnerving.

[tomatoplantproject]

I would have seriously considered a home birth if dh had not been dead set against it. He was right. I was signed up for the mlu instead, but meconium in the waters so I ended up on the labour ward (which was actually fine and I had a lovely midwife who was supportive of helping me have an active birth). Dd was breech - it ha been missed by every midwife who had seen me, including one v experienced one who had done an internal examination. A dr picked it up when they were doing the rounds, and within minutes we were being prepared for c-section. If we had been at home and midwives continued to miss it we could have been in for quite a scary experience and who knows whether dd would have survived - but we definitely would not have midwives experienced in breech births with us. Dd's birth ended up being a relaxed, surreal affair and dd came out unscathed and perfect.

I'm pretty relaxed normally but when I think what could have gone wrong it makes me shudder - and makes me grateful for medical interventions. If in doubt be in the hospital with the big medical team nearby rather than 20-30 minutes away.