Advice on Midwife unit vs Hospital for birth of DC2?

[katherine2008]

Any advice greatly appreciated here. I am 40 years old, low risk, 24 weeks pg with dc1. I live 30 minutes drive from a midwife led birthing unit and 45-50 minutes drive from the delivery facilities of a brand spanking new hospital. My midwife is the manager of the birthing unit (she comes out to see us here in the sticks) and is quite militant anti-epidurals and pro natural birth - and obviously has a quote to fill at the midwife unit. When I was booked in she actually told me that I had two options - a home birth or the midwife unit, and when I said that surely I had the option unit she said that they might turn me away if they were busy (!) -which she later totally rescinded.

My first birth was reasonably straight forward but long and obviously enormously painful. I asked for an epidural but was told I had to wait, then the anaesthetist was busy and by the time one was available I was ready to push. Without going into too much detail I did find it all quite traumatic and it took me quite a long time to get over it - but I know that this is the case for a lot of mums. I felt unsupported by the midwives and was in terrible pain by the time I was allowed onto the labour ward - and felt a bit like I was being a nuisance - I had pethidine on the maternity ward which didn't touch the side about 4 hours before I insisted on being admitted onto Labour.

I do quite like the idea of having a focussed midwife team on a midwife led unit and hopefully being supported properly during my labour. However, I equally like the idea of being able to ask for an epidural in hospital and for their to be medical assistance if I need it (it's about 25 minutes in an ambulance from midwife unit to hospital). My age is obviously considered irrelevant by everyone, apart from me, but I wonder if I should take it into account. I am admittedly a bit of a wimp with pain but did give birth without major relief last time. Can anyone offer advice or experience that might help me make up my mind.

It seems to me that if I go to hospital too soon or too late in either scenario it's not going to make all that much difference.

thanks for your help.

[phlossie]

It's your choice - you should go where you feel most comfortable. I had a long (induced) labour with DC1, but DC2 was gloriously easily and less painful. Obviously it's impossible to predict how yours will be, but I laboured happily at home for most of the time, and then went in at 5cm and DC2 was born 45 minutes later. I'm going for a home birth with DC3 - but I know I can do it, plus I live in the city so I have plenty of choice and 4 minutes to hospital by ambulance!

IME second baby labour is a speeded up version of the first.

My experience was that midwives in the delivery suite take you more seriously the second (and subsequent) times round because they know your labour will probably be quicker than the first, so they'd be more likely to admit you earlier.

I think that you need to think about what you want and stick to your guns. If you're uncomfortable and scared in the midwife-led unit, then you're not going to labour so well.

Um, and you're not a wimp! Giving birth is bloody, fecking agony! I begged for an epidural the first time, but was told the anaethitist was busy, and was pushing by the time he arrived. (I told him to f*k off, you're too f*king late!)

[Tangle]

Its hard to proffer advice as its such a personal decision.

Personally, I'm not impressed with your MW (however pro "natural birth" she might be, her job is to support the woman in front of her in their views. That's not to say she shouldn't suggest alternatives the woman might not have considered, but not by denying them information about choices )

That said, I am quite in favour of well-supported natural birth. I had DD1 at home with IMs and DD2 in hospital after induction (plan was HB with IMs again but things went a bit wrong - IM there for support). I found being supported meant I felt able to cope with labour without chemical pain relief - and I found DD1's birth much easier to cope with than DD2's (partly because I knew the MWs and didn't have to try and communicate as we'd covered all the "what if's?" already).

My only thoughts from what you've said is that if you go to the hospital you've no guarantee they will be able to give you any more support, or that you'll be able to have an epidural this time round. If you go to the MLU you do so knowing you'll not get an epi - but you should be much better supported, which may well make it much easier for you to cope without the epi in the first place. Would you find it easier to know that you couldn't have an epi in the first place, or to get to the point of asking for one and then (potentially) discover that is not going to happen again?

You should be able to ask the hospital (and the MLU) what their ratios are when the unit is operating at max load - ie how many women/MW will they admit? That might give you an idea of how much support you could expect to receive on a busy day.

What's the relationship between the MLU and the ambulance service - IIRC in some areas, if there is a birth in progress there will be an ambulance stationed nearby just in case. Does the 25 minute transfer include time for an ambulance to reach you? How long did you spend in labour at the hospital last time without seeing a MW? How do the 2 compare? Usually once you get to the 2nd stage you'll have someone with you regardless - but a lot (not all, but a lot) of problems can be prevented from becoming "emergencies" with more support and awareness from the MWs...

Re. age, my understanding is that although increasing maternal age has been identified as a risk factor, the risks tend to be more to do with problems that will be picked up ante-natally rather than emergencies during labour (see here for more details).

There are pros and cons to either option. Ultimately I think you need to do whatever you feel most comfortable with - which is absolutely no use whatsoever and something I think you knew already .

[katherine2008]

Thank you thank you for all your advice. Yes, I know that it's a very difficult decision, but believe me, your words to make it much clearer. I totally agree that knowing I will be supported would make me much more relaxed, and it is more likely that this would happen in the Midwife led unit. For DC1 my waters broke and I started contracting fairly frequently straight away so had to go straight in. The hospital I had DC1 in was actually about a 40 minute drive away and has since closed down, so once I was there and had been checked we went and did some shopping and moved around for about 4 or 5 hours or so until it got very painful.

Some good questions to ask - especially the ratio. The new hospital won't allow tours due to norovirus etc, but I think I can have a tour of the MLU quite easily.

I'd also like to know how many women get transferred from the MLU to the hospital (in my post natal group for DC1 of 8 women, all but 2 who had started at the MLU ended up in hospital).

Thanks again for your words of widsom, as I said, it does help a little.