Hospital vs midwife led birth centre?

[faelavie]

Hi all. I'm having a real dilemma about choosing where to give birth and I'm wondering if anyone wants to share their views on these options with me.

I'm 36 weeks+1 with my first (and probably last!) child. I am low risk.
I live in a town with a highly rated and recommended midwife-led birth centre, which is a 5 minute drive from my house. The nearest big general hospital is around 20-30 minutes drive, depending on traffic.

The local birth centre has two private delivery rooms. My husband and I recently toured these when we attended an antenatal class there. Dimmed lighting, birthing pool, aromatherapy if you want it, comforting homely decor, just a really lovely environment. There is of course a bed but you are encouraged not to birth laying on your back and to try whatever positions are comfortable for you. All of the midwives and midwifery assistants were so friendly and welcoming. There are also private rooms for post natal care - double bed so partner can sleep over with you and adjacent kitchen where you can make tea and have snacks. Partners can stay with you 24 hours. Parking is free. I need to stay in for 48 hours for NAS observations due to medication I'm on, so this important. Breastfeeding support is offered and you can stay there longer if you feel you need more support. It's close to home and I'm familiar with many of the midwives there as I've been going for my clinic appointments.
No epidurals though - the options are oramorph, Entonox, and morphine injection.

Now, I know that the big hospital isn't really going to be like this. I used to work there (not in maternity but I am familiar enough with how it is there). Short staffed, midwives rushed off their feet. The parking is horrendous and expensive. I know several people who have given birth there and didn't have good experiences. However..... They have the epidural option. But I know I'm not guaranteed to get one if I ask for one, either due to stage of labour or availability of an anaesthetist. Also, if there are complications, you're already in the right place should an emergency c-section be required etc, whereas if you were elsewhere you'd have to go off in an ambulance.

I am anxious about birth and the pain involved, even though I consider myself to have a good pain tolerance, I have a fear of the unknown and have read so many horror stories about birth I'm pretty much terrified now. I'm reading about hypnobirthing to try and calm my fears.

I originally thought that if I had to give birth vaginally I'd definitely want as many drugs as possible and an epidural, so I had it set in my mind I was going to the hospital. But since viewing the rooms at the midwife-led centre and seeing how nice, friendly and comforting it was, I feel a bit stumped. I'm not sure what to do. Everything hinges on whether I feel I can manage without an epidural and I just don't know!

Any thoughts would be very welcome! What would you do in my position?

[Babdoc]

I’d take the hospital every time. Complications in labour can be sudden, unpredictable and life threatening for either you or your baby.
To deliberately choose to give birth in a place with no medical back up, where the midwives can’t even do a forceps delivery, and there is no operating theatre or paediatric crash team, seems a crazy form of Russian roulette.
I should declare my bias- I’m a retired hospital doctor, (anaesthetics) who has had to rush obstetric patients to theatre with massive haemorrhage, placental abruptions, cord prolapses, severe fetal distress, etc. Having to start their journey half an hour away in possible rush hour traffic would have done nothing to improve their chances of survival.

[Savoretti]

I tried for the midwife led centre option. Apparently I was bleeding too much with each contraction so they wouldn’t let me in the pool otherwise they wouldn’t be able to monitor it. I was ambulanced to hospital which was grim and I wish I’d just started off there.
Honestly when you are in full labour you don’t really care about the decor....

[pimbee]

Midwife led centre every time for me. Hospitals are a horrible environment, although depends on how you feel. Facilities tend to be much better at a unit. It is very, very unlikely you will crash and need immediate care, you will be blue lighted to hospital if necessary. I'm from a very rural area, over an hour to hospital, I've not known one person have an issue that couldn't be resolved in time, a friend of mine had a retained placenta, she was blue lighted there immediately. I personally think hospitals are unnatural environments, I would only go to one if there was a high risk reason. But it all depends on how YOU feel, you will labour better where you are comfortable. I wanted to be at a hospital first time, I felt safer. However, I hated it, I was over managed and they caused issues. I wouldn't change it because at the end of the day I felt safer there. I had a home birth second time, it was perfect. I didn't have the option of a MW unit or I'd have done that.

[Blahblahblahnanana]

To make an informed decision based on facts rather than people’s options please read the outcomes from the birthplace study.

To summarise
Planning to give birth in a birth centre was found to be as safe for the baby as planning birth in a labour ward for all mothers at low risk of complications.

www.which.co.uk/birth-choice/using-birth-statistics/interventions-and-transfer-rates-compared#main-findings

[Blahblahblahnanana]

*To make an informed decision based on facts not people’s opinions

[EAIOU]

I was considered low risk and had to be given an emergency episiotomy due to fetal heart distress and I'm so glad that the consultant doctor was at hand to perform so. My labour was quick and I was only allowed a few minutes of actual pushing before they had to cut me. Thankfully all ok but in a few minutes, it all changed very quickly.

The midwives on the shift were great though and I felt very at home but left to my own comforts whilst I was there.

[Emmapeeler]

Could you do some post-natal care in the birthing unit if you gave birth in the hospital? I wish I had done this with my first (no choice here but hospital birth though as higher risk).

Also does your hospital not have a low risk birthing bit? Ours had a pool.

Tbh your anxiety makes me think you may be more reassured in a hospital but other people may think differently.

[negomi90]

If your baby needs NAS scoring than do it in the hospital where people are more used to that sort of baby and you have paeds on site in case there are any problems. On site paeds means that a slightly abnormal examination will get you a paediatrician to check the baby and say if ok or not. Birthcentre means you may transfer for paeds to say that everything's ok. They also won't be experienced in doing the NAS obs.

Plus you risk your low risk having an emergency.

[Mollie3]

Hospital if first baby as you never know how you birth until you do. Mine was long and difficult and I’m so glad of the consultant doctors who helped me by working with midwife and carrying out episiotomy. Knowing the option of emergency c section was there down the hall kept me reassured that I was in the right place.

On the flip side! I had to stay in an extra night and was shoved on a ward with c section recoverees where partners had to leave. Horrible experience where I was manhandled by breastfeeding ‘experts’ and took all day to be discharged the next day. Felt like a prisoner. Really awful!

Despite the above, reluctantly I advise hospital labour ward as this is in your and babies best interests. If for whatever reason baby need to come out now, it can. Midwifes can not perform emergency c section at birthing centre...

If u do choose Birthing centre this will probably be fine (although personally it would be my second choice). Midwives should be experts at anticipating difficulties before they arise and acting to arrange a quick transfer into hospital if necessary. Hugely convenient for you location wise too. I didn’t have an epidural just used tens machine and gas and air. I gave birth on my back so don’t let them chastise you if this is most comfortable for you!

I found the dilation of the cervix the most painful - like very bad period cramps. But once fully dilated just an overwhelming urge to push which can be tempered by gas and air!

You can do it whatever you decide, good luck! X

[Frizzy1986]

It really is a difficult choice. For me, it's birth centre each time.
When I had my first I looked around both and spoke to the midwives and health professionals about my choice. Both midwives and doctors showed no concerns for me choosing whatever I wanted.

I had a low risk pregnancy and felt the hospital to be sparse and too clinical for the birth I wanted. The postnatal care was also in wards with limited visitation. Delivery rooms only had beds, no additional birthing options except one room that had a pool. This was obviously a popular room so there was no guarantee it would be available when you needed it.

The midwife unit was 20mins away from the hospital and was lovely. Pools in each room, double beds to stay over with your partner, birthing balls, stools, different lighting options, music etc.
I specifically asked about emergency care and was shown the baby resus units they had there and how midwives deal with complications. Just like with home births they are on high alert for possible complications and never take a risk. At the first indication of anything the ambulance is called.
A friend of mine had even birthed at the unit in the pool and ended up having a pph. She was blue lighted in seconds and had no lasting effects.

I had an amazing birth there. Water birth but serious tearing. An ambulance came and I was taken to the hospital for surgery (no blue lights)
My stay in the post natal ward after surgery was the worst bit of the whole experience.

I'd choose the birth centre again this time, but it's closed for refurbishment works. Thankfully we now have a centre attached to the hospital so I'll be utilising that this time.

Its very much a personal choice about weighing up risks. Yes, a standalone unit means you are away from emergency care should you need it, but firstly it's unlikely you will and from what I know the more relaxed and supportive nature of a midwife unit in turn leads to less need for intervention.

[Lozsmith]

I’m only 12 days post birth and I didn’t have the option of the midwife led unit due to pre-existing medical conditions. I thought I had a high pain threshold too but it’s pain like nothing else.
I don’t want to scare you as I was terrified before and looking back, yes it was painful, but the things I worried about weren’t half as bad as I was expecting. And it’s true what they say about forgetting when your baby is in your arms.
Even though I was in the consultant led care part, I was looked after mainly by midwives, with checks by drs. My midwife was fantastic! But I had an epidural and I don’t think I would’ve coped with the delivery without it.
I would still choose the hospital given the choice again. You don’t know how it’s going to play out and trust me the last thing you’d want is being transferred when you’re in enough pain that you want an epidural!!
Good luck xx

[Kam610]

I am in exactly the same predicament! The set up seems very very similar to my local area actually... are you in north east Scotland?

[WhoArtinHeaven]

I had my second baby at a midwife-led unit which sounds almost identical. It was AMAZING!

I wanted to have my first there too, but due to PROM and other minor complications, this was not possible. I do think I may have ended up transferred first time as I struggled to expel the baby (although all it needed was a cut to get him out, so maybe not).

My hospital birth was an induction, and positive on the whole. Although compared to the midwife-led birth at the centre, we are talking night and day.

I myself had concerns about transfer, but talking to my midwife put me at ease that the midwife won't delay in arranging a transfer if they feel it's necessary.

It's a very personal decision and obviously there will always be someone with an awful story, but many women birth at home or in midwife units without issue.

Just checking your local hospital definitely doesn't have an internal MLU? Some do and then you get best of both worlds...

[Em8725]

My MLU was in the hospital, next door to the general labour ward. With one child, I was in MLU. I had no drugs and a water birth. With my second, I was in the labour ward as MLU was full, and had no drugs and a water birth. I was in exactly the right place both times because my second child got stuck and we needed the full team in the labour ward. I’d have a proper look at the hospital and see if they offer an MLU, if not I’d choose the hospital.
I recovered in the MLU both times. It was fantastic but I don’t think I’d have chosen it if it wasn’t in the hospital already.

[WhoArtinHeaven]

Everything hinges on whether I feel I can manage without an epidural and I just don't know!

No, you don't know. So I think you have to consider if you want to try, or not, and go from there.
I have had two drug-free births (one drip induction as mentioned above) and it's definitely not a walk in the park... but I used alternative methods (hypnobirthing, TENS, water) and enjoyed the experience. I was relatively resolved to do things my way.
I wasn't totally anti-epidural, but I did want to try without, hence made choices to facilitate this. But with the knowledge at the back of my mind that things may not go to plan, so ultimately I was open-minded.

I do get fear of the unknown, but in a way it's wasted energy. It has to happen, and being scared of it doesn't change that. Best focus energy on other - positive - things. At least that was my approach!

[Newtothis213]

I went to midwife centre, never again. Wont go into details but there no good with any sort of complications. Wish I'd went to the labour unit

[hammeringinmyhead]

I gave birth in hospital and the next day transferred to the local midwife-led unit for post-natal care.

Out of 8 of us in my NCT group, all 30s and most low risk, we had 4 emergency c-sections, 2 inductions, 3 ambulance transfers. Only one of us managed to give birth in the MLU and then had to be transferred anyway. The choice was taken away from me as my waters broke and I had to be induced, but I would also have been transferred. I was all for it until I saw the stats on the wall that 6/10 first timers ended up transferring anyway!

[mumofone234]

I chose a birth centre and it really suited me - much quieter and more pleasant than a busy hospital. I found that I could get on with it all well, without being interrupted much or interferes with. The midwives at the birth unit seemed more familiar with low-intervention birthing than hospital midwives who are used to epidurals etc (but I may be being unfair there). For me, it actually helped knowing that I didn’t have the option of an epidural - I just got on with it and managed the pain because I didn’t have a choice. Plus, the birthing pool helped!

[lauryloo]

Hospital for me. Ds had his cord wrapped around his neck and wouldn't be here today if we were in the mlu. I was knocked out and he was delivered in less than 10 mins from his heart rate dropping

[forkfun]

Had both mine in midwife led units and both experiences were very positive. After first baby we had to be transferred to hospital, for a minor complication. It was still great to have the baby in a very comfortable space. Second baby we stayed in the unit and it was fabulous. Having husband over night with us in private room with or bathroom was heaven compared to bring with newborn in a busy ward.
Also, get yourself a hypnobirthing app. I found training my brain to be calm and relaxed, and experiencing the pain as temporary yet necessary really helped me stay focused on giving birth rather than the pain. I know this doesn't work for everyone, but having a positive attitude will never be bad.

[Xitt]

I tried the midwife centre. Had to be transferred to hospital for emergency cs when it all went drastically wrong. Thank god the hospital was next door on the same site. I wouldn’t go to a midwife centre if the hospital was more than five minutes away.

[PanamaPattie]

What would you do if both rooms at the centre were occupied?

[lifeinthedeep]

I was low risk and ended up with an emergency c section after 26 hours in labour and 5 hours of pushing a stuck baby. Ended up with temporary kidney failure and was on a drip for 2 days feeling quite nauseous. I didn’t care about the decor or interior of the medicalised delivery suit- I just wanted the baby out.

The post-natal care sounds much better in the midwife led unit but I think I’d rather the security of the hospital. Also, most hospitals allow partners to stay for as long as they like. Dp slept on the floor next to my bed on the maternity ward! I don’t know how they expect most women to care for babies on their own straight after giving birth tbh!

[1300cakes]

It's such a personal choice. Personally, I would go for the epidural every time over lighting and aromatherapy. It's such a cliche at this point - seems like everyone who goes for this option later laughs about how naive they were, and says the candles/oils /music etc didn't even come out of the bag.

Actually most people I know who chose a birthing centre never even entered the door as they ended up being induced. So you may not get the choice anyway.

[faelavie]

Thank you all for the replies. I really appreciate the advice and it's given me a lot to think about. I can't reply to all of you individually but I'll try to address a couple of things raised.


@negomi90 The midwives at the unit told me that they could do the NAS obs - for info the reason is exposure to a single tricyclic antidepressant - though I take your point. I will try and get some more information from them about this at my next appointment.

@Emmapeeler - Yes this is an option that I am considering. I thought I'd like to just stay in one place for continuity of care but it's definitely something I'd consider because the online reviews of the post natal care at this hospital are horrific. Barely any support with breastfeeding, noisy environment and rude midwives.

@Kam610 I am in South East England. It's such a difficult decision isn't it?

@WhoArtinHeaven @Em8725 The hospital does have an attached MLU but partners can't stay with you, but tbh if I'm having to go all the way there anyway and pay the huge parking fees I'd rather just go to the labour ward and try for an epidural! Unfortunately they don't do tours for me to have a look.

@lifeinthedeep Unfortunately this hospital is very strict about how long they let partners stay with you.

@1300cakes I think I'm also concerned about being refused the epidural anyway, I've heard of this happening so many times from friends and also threads on MN. Most of the time due to an anaesthetist not being available which again is something you just don't know until the day I guess.
Of course if I end up needing to be induced this whole question would be entirely academic, I'm just going on the current situation.

@PanamaPattie Then I obviously wouldn't be able to birth there anyway and would have to go elsewhere.