midwife led unit doesn't provide aftercare - how soon would the community midwife team see me once discharged?

[pastabest]

I'm 31 weeks with my first and considering my options for the birth. I'm low risk at the moment and have been offered the choice to give birth at the local stand alone midwife led unit which is around 40 minutes away (it also happens to be my closest option - we live rurally).

I've visited and it is really appealing, modern, private ensuite rooms etc . I am really concerned though that as far as I've been able to work out you are pretty much discharged as soon as possible after the birth. The unit is only staffed 8am - 8pm and if further care is needed you have to be transferred to one of the consultant led units a further 45 minutes/hour away.

It's my DM really who has put doubts into my mind, she's worried that a quick discharge (hours after birth) will mean that there will be limited breastfeeding support and time to rest. I'm moving house in the next few weeks and so will be under a completely different community midwife team than I have been so far.

It all just feels a bit messy and like there is huge risk of quite disjointed care. Has anyone experienced a similar set up and found it to be ok and can reassure me?

[Saku]

For me .. 14 hours of labour...DS1 born in morning 8 am ... I was discharged next evening... and the day after next day .. midwife visited home...

I asked all breast feeding, baby umbilical cord, baby puking .. sleeping.. feeding position.. food I am taking ... how much walking .. and tear stitches.. all related questions I asked to her...

if you want only breastfeeding support.. there are always some children centre and all GP's give support on this

just one tip from me as no one told me in my first preg. to clean/rub gently nipple's front part with some cotton soaked in warm water.. before you feed first time......... it removes any dead skin and open milk pores

[pastabest]

Thanks Saku my understanding is that in your scenario I would be discharged later the same day not the next evening. If I couldn't be discharged home I would be transferred to one of the consultant led units.

We are really rural, there are no children's centres.

[HopeAndJoy16]

There might be a peer support service which runs in your area which may at least have a phone support service in the evenings. La Leche League have a support line too!

I'd be very surprised if you were discharged if breastfeeding wasn't established, midwives would need to make sure you and your lovely baby were going to be OK until your visit. The community midwives generally visit the day after discharge. You should also be able to contact the hospital for support overnight too ☺

[PossumInAPearTree]

If it's not staffed till 8pm what happens if you're in the throes of labour at 8pm? Do they stay late or transfer you? Because I wouldn't fancy an ambulance trip at 9cm!

[McBaby]

I would be planning on going somewhere which is open 24/7 first labours can take a while and the majority of people I know seem to have gone in to labour at night.

if you are that far from the mlu what about a homebirth?

[didireallysaythat]

The midwife visits the day after you've been discharged. If you're unlucky, she visits at 6am....

[GoofyTheHero]

I've got 2 DD's (3 and 17 months). Both low risk, both born in a MLU. DD1 was born at 4.13pm and we were home at 9pm, DD2 born at 8.45am, home for 2pm.
It was lovely. I got to rest at home with DH (from what I've heard about postnatal wards you get little or no sleep). I BF both, and the MW came to the house within 24 hours with both and checked latch etc.
If there are no complications I don't think there's a better place to be than home.

[GoofyTheHero]

With regards to BF being established... we just had to show one successful feed before being discharged so they had no idea if it was established or not really. We had the MW round the next day though.

[Oysterbabe]

TBH many people want to be discharged asap. A noisy ward isn't somewhere you can rest, I've never had less sleep than those nights in hospital post birth, it was like torture.

[pastabest]

possum I think once you are there you can stay and the on call midwife takes over.

By open 8 - 8 they mean fully staffed with admin etc, the rest of the time it's just on call staff only and if the on call staff are already busy with other people you have to go to one of the consultant led units by default.

goofy your posts have been really reassuring thanks, sounds like it's a bit more organised than give birth then your out on your own!

McBaby DP has vetoed a homebirth. He gets enough action at lambing time!

[AWaspOnAWindowInAHeatwave]

Both times I was booked to give birth at MLU, and both times I ended up in the hospital birthing suite - first time was a Sunday evening and the on-call midwife was attending a home birth so there was nobody at the MLU. Second time was 3am and the on-call midwife had phoned in sick and they hadn't been able to get cover. Both times I couldn't fault the birthing suite, or the midwives who gave guidance and reassurance over the phone before I went in. Just saying, please be prepared for this eventuality and try not to be too disappointed if it happens - the main thing is that you're getting the correct care wherever you end up.

[GoofyTheHero]

I didn't feel like we were abandoned or out on our own at all. It was more a case of baby was born, no complications, we were all well and happy... so we went home. One of my best memories ever is getting home with DD1, snuggling up (Nov birth), FaceTiming our parents (we lived a long way from both sets) and spending our first night together. It was lovely.

[MuppetsChristmasCarol]

I gave birth in hospital at 7am and was discharged at 3pm (at my request). I preferred to be in the comfort of my own home while I recovered. I had a 2nd degree tear, but otherwise an ordinary 15hr birth with some pain relief.

My midwife came in the morning the next day, and was great. I had a few problems breastfeeding but they sent out daily support until I was happy.

Next time, if all is well with baby. I'm going for a home birth. The community midwives in my area are awesome.

[Becciilouisex3]

I really wanted to go into my midwife unit as I was low risk. It seemed a fine option to me as if there were any issues they transfer you via ambulance to the hospital 2 minutes away.

However, if your hospital is far ish away I would personally advise against it. Midwifery units have no doctors on site and anything unpredictable can happen during birth.

Lucky for me I ended up having a hospital birth because my waters broke first and it was over 12 hours before my contractions started so I needed antibiotics. Long story short, I had a very difficult labour with back to back baby and had to have an instrumental delivery. DS' heart rate dropped a hell of a lot when I was pushing and he came out purple for lack of oxygen. As it turns out, I had extra fluid and a DS growing along/just below 10th centile which meant unneeded a hospital birth anyway but this wasn't picked up until he was born.

I'm not trying to scare you at all and you know what you think is best for you. Go with whatever makes you comfortable. Just offering the advice that with something as unpredictable as labour, personally I would only go into a midwifery led unit if it was very close to the local hospital.

Good luck whatever you choose! x