Midwifery Lead Birthing wards, pros and cons?

[Niki93]

Hi. Im 16 weeks pregnant and have chosen to have my baby at my local hospital just a 10 minute walk from my house (makes sense). Unfortunately due to cuts, they nearly closed the maternity ward last year. However, they’ve now decided to keep it open, but its only a MLB ward (only midwives, no consultants). At first i thought this is fine, so far im a low risk pregnancy so i dont mind. Plus, id like to support my local hospital, as they need to reach targets and deliver so many babys a year to stay open.

The question is, what are the pros and cons to a midwifery led birthing ward? My midwife has said that i can only go there if my pregnancy is low risk. (This is my first pregnancy, im 16 weeks today. Everythings new and a learning curve for me but so far everythings looking healthy). She said if i needed a c section for example, i would need blue lighted in an ambulance to the second option hospital down the road that my hospital has joined with.

Ive heard mixed reviews. Some people have said a ML ward are much better as theres less intervention from consultants meaning the birth goes alot more smoother and straight forward. Others have said its not the best as pain relief options are limited so you can end up having abit of a horrific time if birth gets complicated and no consultants are around to interject if needed.

As my first pregnancy im naturally slightly apprehensive around labour/birth. Im not agains pain relief, and im not being unrealistic thinking i wont need it. I plan on just going with the flow and doing whats best for me and baby at the time.

Can anyone give me any advice on midwifery led wards with no consultants? Just wondering on peoples experiences and if theres nothing wrong with midwives only/no consultants.

[Tableclothing]

The NCT class I was at last week reckoned that ML is as safe as a hospital birth for low-risk pregnancies (I'm pretty sure by "as safe as" they meant "same number of stillbirths").

With respect, I don't think you should choose a unit because you want to help them meet their targets. Look at all your options - Google their CQC reports, look at the data they publish. If you can, arrange for a visit. Consider post-natal facilities/care as well. You may want to look at the likelihood of being able to access birthing pools, private rooms etc too. What kinds of staff do they have? Will there be students there? Different people value things differently, so the right choice for your next door neighbour might not be the right choice for you.

[WBWIFE]

You are.more likely to have a normal birth on MLU ward. Which is an enough pro for me.

I had to go consultant led as high risk and ended in failed forceps and emergency section.

This time I should be high risk as previous emergency section but I've refused and I'm fighting to go on MLU ward as j want a normal birth. If I can't go MLU then I'll be.home birthing

[Niki93]

What are the limitations to a typical ML ward then? Are they all different or do they general have less options. Ie only gas and air? No choice for epidural?

Me and all my family have been born in this hospital with no complications. My mother and sister both said their births there were fine (but this was before the consultants were scrapped). It does have the choice of birthing pools and hypnotherapy rooms, which im open to trying. Generally, I personally have no issues with this hospital, we have some family friends who are midwives with 30 years experience on this ward which gives me reassurance. So im happy to go their. Il definitely take the advice and do some more research tho. They also have ‘open days’ for women to visit so il be doing that too. I just wondered the practicalitys really of whether il have the option of pain relief or not. Xx

[Tableclothing]

You are.more likely to have a normal birth on MLU ward

Isn't that because MLUs get all the low-risk pregnancies in the first place, though?

I'm sorry you had such a difficult time with your first and hope you get the birth you want this time.

[WBWIFE]

@17:39Tableclothing some low risk people have to go to delivery suite when MLU is full of no MLU nearby.

Just going off NHS statistics.

I was high risk due to apparently the size of the baby. No other reason.

They thought she was 11lbs and she was in fact 8 lbs 2 so no reason to be induced for 4 days or be high risk

[rottiemum88]

I started out in an MLU and asked to be transferred to the labour ward due to lack of progress after 19 hours in labour. When I was finally put on the monitor it turned out DS's heart rate had started to drop periodically and he was ultimately delivered by EMCS. The midwives in the MLU hadn't picked up on the heart rate issue because their monitoring was with a doppler, not continuous and I still believe to this day that DS might not be here if I hadn't made the decision - which I was told by the midwives in the MLU was unnecessary - to move to the labour ward. My pregnancy was low risk throughout too so that isn't everything. You have to weigh up the pros and cons and do what you're comfortable with and I know for many people MLUs offer exactly what they're looking for in a birth experience, but knowing what I know now I'd never recommend it.

[Lunafortheloveogod]

I’d check how long it actually takes to get to the next hospital.. blue lights or not it also depends on the wait time for the next available ambulance.

I don’t think I’d like to risk it personally. But that’s from my low risk pregnancy that ended with pre eclampsia, induction, baby turned the wrong way (facing into my hip), round to theatre for forceps which had to be rushed as the minute I was moved the cord slipped round his neck and his heart rate dropped... how that’d have went if I had a 30minute wait for an ambulance and a 15 minute journey might change the outcome dramatically. Fortunately he’s absolutely fine.

If it was maybe your second or third and you knew your previous labours were uncomplicated/managed with little pain relief I’d have a different opinion.

The hospital I was in have you in a room with a midwife where if all goes well she’ll deliver your baby there and you’ll stay there until a bed up on the ward is ready afterwards, if you don’t need to consultant you won’t see them same goes for anaesthetists etc but if you want an epidural or there’s a complication someone’s there in minutes. And you’re either dealt with in that room or quickly round to theatre. Honestly if the hospitals a similar set up it really was fairly stress free and not overly medical until the tail end when obviously it had to.

This time round I’ve been put as high risk due to previous pregnancy so I’ll be in the same place again.

[GrumpyHoonMain]

If the local maternity unit is failing then it’s likely the mw led unit might not have access to any procedures or pain relief stronger than gas and air. Including epiostomies / pethidone and may extend to NICU services too. Really ask your mw about the differences in care between hospitals because if your DC needed to be blue lighted to the other hospital, your DH / birth partner would be the one sent with them. This could seriously impact your MH even if things were okay in the end.

[LoisLittsLover]

At our mlu you can have gas and air or pethedine but pethedine means you can't get into the water for 4 hours. There is much greater breastfeeding support and more relaxed re visiting. However as pps have suggested, find out how long (at different times of dsy) a transfer could take as it could be life or death. It's an easy choice here as the delivery suite is across the corridor

[Niki93]

Ive got an appointment with my midwife this Thursday so i think i’ll have to fire a few questions at her while im there. A close family friend is a midwife at this hospital too so il have a sit down with her and see what she says. The next hospital is only a 10 min drive away if that, i can change my mind and choose that hospital to deliver if i wish, since the hospitals have joined they have all my infomation/pregnancy notes aswell just incase anything does require that hospital. With it being my first pregnancy I literally dont have a clue or know the difference/side affects of pain relief. So its all about daunting/out of my depth at the moment. Trying not to over whelm myself too early. Anyone recommend any reading that might educate me? Or give me some reassurance/what to expect some how? X

[GrumpyHoonMain]

The best thing I did was take a local NCT class. If you have ones where the instructor has actual experience of both hospitals they may be able to answer your questions / help you arrange tours etc.

[Niki93]

Can i ask what a NTC is? Sorry i have no idea haha im learning xx

[GrumpyHoonMain]

National Childbirth Trust. They offer antenatal classes. Can be a bit pricey but useful if you go to a highly local one.

[hammeringinmyhead]

In my NCT group of 8 women, only one managed to give birth in the midwife led unit and she was transferred to hospital after the birth for complications. All first babies. I think our transfer rate from midwife unit to hospital is something like 7 out of 10 first time mums.

I was low-risk, but had a precipitate (under 3 hour) labour and then had a haemorrhage. For me, the positives of being close to consultants, paediatricians etc. were worth it. I transferred to a midwife unit for postnatal care and breastfeeding help.

[mummyh2016]

I can't speak more highly of my MLU birth however it was attached to a hospital with a normal delivery suite, if there had been complications I would only have had to go upstairs in a lift. Unsure what I would've chosen if it was a stand alone unit.

[horse4course]

With dc1 I started out in a stand-alone MLU and got transferred to hospital with delivery suite due to lack of progress. I was at MLU about 24 hours.

Being blue lighted for a problem with the baby is one thing, being blue lighted for lack of progress meant I needed an ambulance but not urgently. I was packed up ready to go, having contractions for two hours before the ambulance came because we were low priority. Then I was strapped on a gurney and jolted around in the ambulance. I lost my shit and it was awful. Your experience might be different but basically being transported mid labour is no fun.

MLUs mean no epidural. I'd personally always want the option of one.

Relevant questions might be: rate of first time mums transferring (first time is important!), set up for transfer, pain relief available in MLU.

I think an MLU based within a hospital with a delivery unit is best, if there's one near you.

Also even though delivery units have consultants, you'll probably be midwife led unless there's a need for intervention. I had my second at a hospital delivery unit but only saw a midwife and trainee.

[neonglow]

I think for low risk women you’re just as likely to have a good outcome, yet a lot less likely to have certain intervention like episiotomies or c-section. I’m not sure the stats on first-time mums though, may be worth looking it up.

[Willow4987]

I started in a MLU for my first baby, but due to several complications during labour (in a low risk pregnancy) I ended up on the main labour ward with forceps and a spinal, minutes away from a c section if things had gone wrong

Out of 8 first time NCT mums in my group only one had a ‘normal’ delivery in the MLU. Everyone else ended up on the ward for one reason or another

Going into the labour the first time, pros for me were: more natural, less intervention, quicker recover, ability to literally go down one flight of stairs to labour ward if needed

Cons: no pain relief

If it was a standalone MLU I think I’d have chosen to go to a normal delivery ward, but luckily for me the MLU is within the main hospital where I am

[horse4course]

The NCT website is good on different aspects of birth incl pain relief.

I also like Emily Oster book expecting better which has a bit on labour.

I'd download some sample birth preferences/plans to get you thinking about birth and the choices open to you.

[Niki93]

@horse4course thanks for that. Might look that book up.

I spoken to two midwives who work at the MLU over the weekend who massovely put me at ease. Its got some fantasict we’ll experienced midwives, the birthing rooms are so relaxed and lovely. They also have two breastfeeding consultant health care nurses who support with that too! I can still have pain relief, just not epidural, and if at any chance theres a tiny incling its becoming complicated, the blue light system is prioritsed to the women on the MLU so thats covered also. So all seems well for me to still go there.

If i happen to need to be induced I automatically go to the bigger unit ten mins round the road which again is fine. Thanks for everyones comments. Ive made my decision that il be stayingg at the MLU if i remain low risk. And i can change this option at any-point if feel differently at the time. Now i need to prepare for birth and look into some plans that might make me feel more in control :)

Thanks!

[NeverGotMyPuppy]

Hi OP - congratulations!

I went to a stand alone MLU for our first baby. I was transferred due to lack of progress. However the one main pro was that once we were discharged (10 hours after birth as I gave birth in the middle of the night) we went back to the MLU. The care was so much better. I will absolutely go again if we have number 2

[londonmummy30]

I gave birth in a midwife led unit in June.

My delivery was unusually quick for a first labour (also under 3 hours) and I too had a postpartum haemorrhage - I lost over 2 litres of blood due to retained placenta.

The birth itself was brilliant- I felt very empowered and the midwife was very experienced and reassuring throughout. I felt in very safe hands and I can honestly say I loved my birth. They're very very cautious as units and don't allow you to give birth within the unit unless deemed low risk.

As a previous poster said, I would keep an open mind. Nearly 100% of the ladies in my antenatal group wanted a midwife led birth and I was the only one out of 8 woman who was able to have it, due to complications arising. When we met at 30 weeks pregnant, we all had low risk pregnancies but things can change quickly - either before or during labour.

What I would say about my experience is that whilst the birth was brilliant, after my little boy arrived I suddenly started haemorrhaging. I fainted 4 times and the emergency button was pushed several times. In my case, I went to theatre so they could remove the placenta and stop the haemorrhage. Later that night I was given 2 blood transfusions.

It sounds dramatic, but it wasn't. My midwife realised there was a problem, and I was transferred from the midwife led unit to the labour ward, where doctors intervened. It took about 10 minutes to move me and I was taken to theatre within a couple of hours. The transfusions happened about 12 hours later. The reality is that labour can be calm but also labour can sometimes quickly change- but midwives are trained to detect when there's a problem and there a protocols for this.

It's really hard that there's no crystal ball to detect how your labour might go, but the midwives in midwife led units are often very very qualified- many have worked in labour wards previously and have seen emergencies occur first hand and know when risks might occur. Just as they don't take high risk ladies pre labour, they also don't take risks during labour (and after during the recovery), and if they think there's a problem, they absolutely will intervene and will look to transfer you to another ward.

Appreciate that it's not ideal that your labour ward is at another hospital, but if you are blue lighted, you would be prioritised for an ambulance. I was told by my midwife post labour (one week after he was born) that if I were to have another child, I might be better off having a home birth due to the speed of delivery and if I have another haemorrhage, I would be prioritised for an ambulance.

For the record, my sister had two deliveries in midwife led units and both were complication free and lovely births!

Hope this helps! Good luck and keep an open mind.