Choosing where to deliver DC1 (sorry, long!)

[Daisybell1]

We live on the border of 2 (actually probably 3!) health authorities and so therefore have at least 5 options of where to deliver DC1. I've had some problems with pre-natal depression/anxiety which affects how I'm viewing the birth, and what I want in the way of care, but which also may affect whether some of the units will take me.

My options are:

1 Midwife led unit in hospital 35 mins away, low risk only, 1:1 care, very pro water birth and excellent post-natal care - 2 or 3 nights stay. If I needed to be transferred during labour then it would be to option 4, but if this unit refused me due to my 'head' problems, then I would have to go to option 3.

2 Midwife led unit in community hospital 40 mins away. Low risk only, pro water birth, 1:1 care. Chance (1/10) of my community midwives being on duty so having a familiar face at the delivery but no post-natal care - 6hrs only. If I needed to be transferred then it would be to option 4

3 Standard maternity unit 1.15hrs away, no 1:1 care, more pain relief options inc water but no epidurals unless EMCS needed. Busy wards, and post-natal care limited. If I was rejected by the MLUs then this would be the default option.

4 Standard maternity unit 1hr away, no 1:1 care but full pain relief options including water and epidurals. Busy wards, and post-natal care limited. If I started my labour in option 1 and ended up with EMCS or instrumental delivery, I might then be transferred back to option 1 for after care, but not if I ended up with a 'normal' delivery.

5 Home - would only have a 1/10 chance of having my community midwives on duty, and would be 1hr away by blue lights to nearest hospital (plus time for ambulance to reach us).

Argh, I'm soooo confused! My gut feeling is that I'd like option 1 as think I'll need the 1:1 care, and my 'head' issues lead me to wanting a lot of post-natal support/care/guidance for looking after DC1.

However, I've been told that I need to have a back-up in case they won't take me. I have no issues with having to go elsewhere in case of being higher risk, however I've been told that they may reject me because of the pre-natal depression. I'd be gutted if they rejected me on these grounds, given that they seem to provide just what I need post-natally.

It seems that the post-natal care being offered at No.1 seems to be the 'reward' for women having a problem free delivery - if I need any additional intervention/assistance/pain-relief, then I may be denied this aftercare, which doesn't seem entirely fair. Or am I being unfair?

Sorry this is so long

[vj32]

We have a lovely local birth centre, but it is over half an hour away from the local hospital. I decided this was too risky incase I or the baby needed a Dr. So I ended up starting giving birth in the midwife led unit in local hospital, and ended up in surgery having an emergency c-section.

Have you looked at the stats about how many women who start at the MLUs actually give birth there? If there is a long transfer time to hospital then they are probably going to be cautious and transfer you if they are in any doubt about you having a safe delivery. While the post natal care in hospital wasn't great, the staff during labour were amazing, and a transfer by ambulance while in labour would have been horrible. So I would go for 4, but then request a transfer to 1 for post natal care.

If you give the names of the hospitals/units then maybe people who have been there recently can give you their experiences?

[FutureNannyOgg]

How long would the transfers be from the MLUs?

Generally MLUs can't offer you anything you can't have at home, and I would go for home unless the transfer was considerably shorter, or you wanted a water birth but didn't want a home pool.

Your MH issues shouldn't get in the way of MLU, thats absurd. Actually I think you might be better off in MLU as calm, low intervention births in a homely environment have a lower incidence of PND, you will probably feel less anxious and more in control. If the maternity unit won't offer epidural, then they really don't have much over the MLU except in case of an emergency.

I think what it comes down to is where you feel most comfortable and the transfer issue. Most "emergency" transfers from HB or MLU aren't all that emergency (my DS was delivered by EMCS 6 hours after my transfer, but it still get called an emergency) midwives are very good at anticipating trouble, in most cases, it might be worth talking to your MW if this concerns you.

4 sounds much better than 3 to me if you were going down the hospital route.

If you wanted option 1, then you can push for it, make a case, write to the supervisor of midwifery

[nannyl]

I almost know the feeling

I have midwife unit 25 mins away (lovely), midwife unit in nearest (only feasible hospital) 45mins + away, Birth in the labour ward of said hospital (other side of corridoor to that midwife unit) or home.

I have chosen home. Unless major complications become obvious before labour, i WILL be choosing a home birth. I have a 2/5 chance of having one of my lovely community midwives present at my home birth.
I am happy that this is right choice for me

[Daisybell1]

Thank you for all your comments, and sorry for the late come back.

On the back of your comments I braved the Option 1, my first choice. And they were lovely! Yes, my anxieties mean that I am border-line consultant care, but the senior midwife told me just to keep emphasising how I needed their safe and secure environment for delivery and aftercare, and they'd let me deliver there (all other things being equal). She also said that they'd break their rules so that if I ended up delivering elsewhere, they would still take me back for post-natal care, as that would be best for my mental health.

And I have a referral for their mental health midwife (who my CMW hadn't even mentioned) to see her next week.

So, thank you for your comments and support, they gave me the balls to just turn up and ask the unit directly .

PS Option 1 is Helme Chase in Kendal, 2 is Penrith, 3 is Carlisle and 4 is Lancaster....