I know this is a bit of a morbid topic but I need to weigh up my options....

[lunavix]

what would the worst case scenario risks be of giving birth in a midwife led unit as oppposed to a hospital?

My last labour was very long, and there was talks of an emergency ceasarean (don't get me started on why it was talked about and not done, but that's another post entirely) and eventually ds got stuck and had to be sucked out with ventouse.

Now I'm assuming there's no ventouse at a midwife led unit, and the doctors after the birth said there had been no chance of him coming out without... but having said that I'd much rather give birth somewhere friendly and accomodating. My midwife seems completely unphased by all this, she keeps trying to badger me into a home birth in fact, which I really don't want. But on the other hand, I'd like to know statistics of what could go wrong...

[Wordsmith]

I don't know anything about them, but I'd imagine a midwife led unit would have all the equipment on hand just in case. Even a theatre for a C section!

[lunavix]

I don't think you can get c-sections, I don't think they have proper doctors...

If I'm wrong I'll be racing to one with open arms!

[emkana]

I started a thread on where to give birth the other day and mears said that it depends really on your midwife-led unit - is it right next to a "normal" delivery suite, so that you could be moved very quickly if necessary, or is it stand-alone, in which case it'd be more risky.

The nature of a midwife-led unit as far as I understand it is to be low-intervention, so they wouldn't have all the equipment.

[nicnack2]

i would think that the worst case scenario is that you would be moved to a hospital under a blue light. Our midwife unit is within the maty hospital but all rural units are mw led and they do not have theatres for sections. the babes in the wood (sky TV) always seem to transfer complex cases to hospital. My first was long ending with a move form mw unit to labour ward, ending in epidural and ventouse, ds2 who is 3 months 4.5 hours gas and air mw unit. hth good luck

[Wordsmith]

I'm sure somepne more knowledgable than me will put me right. But if I was giving birth somewhere where, if everything went horribly wrong then there was no way of getting my baby out, then I wouldn't go, no way! Although I do like the idea of them in principle. (Even though there's no way I'm having any more kids!)

[SoupDragon]

It won't be any different to a home birth so you could look at the statistics for those. If there are problems, you would be transferred under blue light (you are from a HB). Very few problems happen without sufficient warning to transfer you.

[lunavix]

hmm.

The midwife units I'm looking at are a good 40 minutes in good traffic from any hopsitals, so I'm guessing they have no facilities for emergencies. I think I might sit this one out in my miserable and clinical local hospital and if it goes to plan have the third somewhere nicer :) I'm just not brave enough to risk it after last time I don't think...

[nicnack2]

thought of employing a doula to help you? Might bring some intimacy to a hospital birth

[AdelaideS]

My sister started off in a midwife-led unit, baby got stuck (big head, facing wrong way!) and she was taken by ambulance to the hospital for a ceasarean. I guess the journey took about 3/4 hr, and there was no sense of panic from any of the staff as decision was made with plenty of time to spare. Sis wasn't deeply traumatised after the event, just glad it was all over.
I plan to give birth in a midwife-led unit later this month.

[nicnack2]

good luck adelaide :)

[pupuce]

In my experience (as a doula) everytime babies were stuck in home births MWs use FAR MORE ingenuous techniques than in hospital where they will get the ventouse out at every corner. They will get women off their bed/back, walk up or down stairs, mnove teir hps.... and babies WILL come out!
My opinion is that if your MW feels a home birth is safe then she understand why your baby got stuck last night 0 don't forget that your baby actually went THROUGH your birth canal - so there is the room!

Lunavix - You do need to realise that most women (the vast vast majority) do not need an instrumentral delivery the 2nd time around. I did a mumsnet survey about 18 months ago on this and teh results were unbelieavbly conclusive.

At the end of the day you need to have confidence in where you are going to give birth and the practitioners who will support you... where ever that is.

And there is NO section, no ventouse , no epidural in a midwife led unit and they ALSO would never take you if you were medium or high risk... they must think you are low risk.

My next suggestion is to review with a midwife your last labour there was a reason why your baby was stuck: typical reasons : inductions and epidurals which often have badly positioned babies.... as 2nd time around most women don't get induced (or if they do they usually get going very quickly) and they tend to have far less epidural - there is generally far less problem!

[pupuce]

sorry for all the typos

[AdelaideS]

Thanks nicnack

[TuttiFrutti]

"40 minutes in good traffic from any hospitals"

Lunavix, in your position I would want to be at the hospital. What if you need intervention and it's the rush hour and the ambulance has problems getting through?

Have you been on a tour of your local hospital? Most of them run tours for expectant parents so you can make a decision about whether it's the right environment for you, and many of them now have choices between highly clinical delivery rooms and "home from home" environments with bean bags on the floor, CD players in rooms, etc so you might be able to get the more homely atmosphere you want within a hospital building.

[KateF]

I had my second baby in a midwife unit within our local hospital. I was not low risk as dd1 had been a difficult birth and needed SCBU but the consultant said that as the second baby seemed fine and as long as I accepted transfer to the labour ward at the first sign of any problem he would ok it. dd2 arrived in 4 hours flat, no intervention, 2 stitches, home after six hours. Do any of your hospitals have such a unit? It might be just the thing for you - after dd1 I was not a candidate for home birth and would have been too anxious but what I had with the next two was perfect. Good luck!

[pucca]

Lunavix...I had a problematic first birth too and i am now pg with no 2, i haven't got any choice about the birth i have this time (elective c-section) but if i did, i feel i wouldn't want to be at home or LED unit, just in case there were probs again, even though i know you can be tranfered if an emergency arose.

LED unit, all they have is midwives no doctors, and you can have a water birth, pethedine or gas & air so in affect it is just like having a home birth really.

Godd luck with your decision

[pupuce]

Morethan1: "flat babies" ie still births
No a flat baby is not a still born !!!!

[peachyClair]

Hi

I had a very complex birth in the gen hospital ist time, and a MW led second. Mainly coz I blankly refused to got back to the original hospital- I did deliver DS3 there, but only due to no other options as my home birth plans collapsed with an electricity cut and very mild anaemia.

Now, had the symptoms of the Pre eclampsia developed before then obv I couldn't have delivered there, but my BP did rise a little at the MW unit. They were worried (DS2 was also posterior) and I know they thought that I would have to transfer to the main unit (about 50 miles away- I had gone out of my NHS region to avoid the first place) but they fought for me, with every bit of skill they had. A romatherapy, exercises *to shift ds2)- I had them all. And it worked, the results being the most beautiful birth I could have imagined.

I know if I had gone to the place ds1 was born I would have freaked out, I was quite badly traumatised by it. So taking the gamble to move out of area was worth it for me and kept me much more relaxed and confident.

(I did bump into one of the original Obs though as he had transferred, but he was pretty much thrown out by MWs who understood. He clearly ahdn't improved- after reducing me to a gibbering wreck first time round, he stared at me and said 'what is THIS woman doing in this room?'- the MW stared him out and said, its a labour room, she's in labour, go figure.

[Snafu]

A 'flat' baby is one that requires a level of resuscitation after birth - it's not a stillbirth. It's a slang term that really shouldn't be used because it can mean anything from a couple of puffs of oxygen to full-on resus. 'Flat' babies can and do happen anywhere at any time - hospital, mw-unit, birth centre, home - and even if you were having a homebirth the midwife would carry basic resus equipment.

Anywaaaay, slight digression there. Lunavix, I can only echo what pupuce said in her first post - you have to do what you feel most comfotable with. There is no point you going to a mw-led unit if you feel worried and unconfident. Equally, the mws there may well be more adept at sorting out problems without recourse to surgical intervention. Do you know exactly why you had the ventouse with ds? It would be a good idea to go over your old notes with your mw and discuss exactly what the issue was.

Confidence is the thing, though, it really is. Try not to focus too much on what's happened to other people - get the information you need from your mw, then look at your own situation and gut feelings and take it from there

[LucyJones]

I am in the same situation as you Lunavix. Where I live they only offer a midwife led unit with no epidural, c-section ect and the nearest hospital offering those services is 40 minutes away. My midwife has tried to persuade me to go there but there is no way! I loved my epidural last time and don't want to go in an ambulance to get one!!

[pupuce]

The thing is Lucy... want to bet you won't have an epidural this time ??? It's quite common NOT to have time to have an epidural 2nd time around as labours are that much faster !

[morningpaper]

Is your hospital that bad Lunavix?

When I arrived at mine (in the night) there was soft lighting, music on, lovely midwives, warm birthing pool ... it was all VERY chilled. Honestly, all they were missing was draught beer on tap. I wouldn't have had it any other way.

[pupuce]

Morethan1- fair enough but as a doula I have experience of 2 stillbirths IN hospital.... that is NOT a guarantee ! I also know women who had more interventions than they needed because in hospital. Both hospital and midwife-led unit have their pros adn cons... one is not better than the other and MW-led units have excellent results (partly becasue you DO get one to one care!)