Worried after booking in appt

[PomeralLights]

Hi all, I'm just worried and stressed after my booking in appt with the midwife yesterday so wanted to vent. I'm 9+4 with pfb.

I knew she was going to be a cow when she asked me if I had decided where I wanted to give birth and I said 'I think X, it just seems to have everything I want' and she said 'oh, I had assumed you wanted Y, I've got the forms for that here'. I'm not the kind of person to let easier admin put me off, normally, but I gave her my reasons for X and she countered all of them:

• birth pool in Every room at X - she said there are two pools out of 4 rooms at Y and 'in her experience working on the wards' (though didn't mention how long ago that was) the pools have never been too busy / unattainable. am I right in thinking this is probably bull and the fact there's only 50% pools at Y rather than 100% pools at X means it's more likely I won't get one?
  
• X does physiological placental delivery as default - she said 'every midwife knows how to do that' does that mean ill actually get it at Y tho?!
  
• double beds at X so DH can stay over with me if baby in middle of night - she said discharge times are so quick he'd probably be able to take me home straight away anyway really?
  

I didn't get the chance to ask about perineal massage and other things I know that X does as she was getting annoyed.

She said that Y has had the number of births in the last 6m that they expected in a year, so I'm guessing they must be stretched for capacity, that worried me but she said it like it was a good thing?

Also she pointed out that Y is a MLU attached to a hospital whereas X is a stand alone MLU, so she said 'most people feel safer'. Surely that is a bit misleading as the stats don't bear that misconception out, I thought?
She didn't offer me a home birth at all, which I didn't want but I feel not to even mention it is lacking in her duty of care to me... don't know if that's silly tho as I don't want one.

Also I have a history of MH problems, she said she would refer me to a consultant 'just for a chat' but said it wouldn't affect whether I could have MLU. Then later she dropped in that there was a chance I'd end up consultant led coz of the MH issues, but if I was, surely I would have to go to a hospital?!

She also said I wasn't allowed to change my mind later, as it takes them 2 hours to load my choice onto the system and I get a hospital number based on my choice. So now I feel that she pressured me into a place I didn't want with no chance to change.

I'm just feeling really scared that the rest of my appts will be like this and I'll end up one of those women in labour with no real advice, not respected or given choices and no idea what's going on - I know that still happens to so many people, has happened to friends, and I don't know what to do! :s

Sorry for length of post x

[squizita]

Please get the MH support. I did and am so glad. Being consultant led doesn't mean you give birth at a hospital at all! It depends on what your being consulted about - to put it crudely, your plumbing or something else! In fact, seeing a perinatal psychologist and getting it in writing that your 1st choice of unit would ease your anxiety is a great way of getting it.

You don't even finalise your birthplace choice till far later - it can change! E.g. if a woman's health improves or gets worse OF COURSE it will change (and you can self refer direct to the hospital or go via your GP). She won't do the paperwork twice, but that just means where you get scans done. The actual hospital can change for months.

Having said that, as someone with clinical anxiety expecting PFB after several losses, I'm sensing a desperation in your post to hold on to 'control' to feel safe. She does sound quite bossy but even from your account I don't see the level of fear you have as proportional to a slightly grumpy HCP. For example you seem to feel there 'will' be a problem with the new MLU because it is attached to a hospital - based on huge statistics not your medical care. In all honesty, there is so much you cannot control in pregnancy (let alone birth) that mindfulness and perinatal support might help you cope with that aspect.

[PomeralLights]

Thanks for your reply. Yes I am struggling with control - after all this is my baby and my body, that I need to look after and take responsibility for, therefore I feel I can't just say 'you do what's best' but equally I don't want to get to the point where I'm grasping for control for the sake of it and making bad decisions because I'm not taking advice on board.
My mum suggested that the midwife may have been trying in a 'softly softly' way to point out why her suggestion was best, but I don't really respond well to that, I like lists and clarity, so it may have just been a personality clash.
I've tried mindfulness but it doesn't work for me, I get stuck in repetitive thoughts.
I do need the extra support I think so I will see what the consultant says when I see her.

[peeapod]

i know il get jumped on for this but hey.. used to it.

my midwife seemed to equate my mh probs as an incapable mother (crystal ball because i wasnt a mum then) so that might be where shes coming from. midwifes tend to think they know best for women and that culture is changing slowly.

saying that, the one positive with my mh label was that i was able to take more control over where and how i wanted to give birth. Although for me that was by c section, id imagine it would work equally well in your situation.

when you speak to the perninatal team, link your mh probs with your birth choice (its a more relaxed environment et. but also being aware of the risks (the need to transfer to hospital.

the mh team are better placed to advocate for you than your community midwife..

[squizita]

That's awful Peeapod, from a HCP as well!

Mine weren't like that at all. I wonder whether I've been lucky and had less stigma because to MW etc' my clinical anxiety triggers are "what they're used to" IYSWIM? I.e. post trauma, to do with lost pregnancy, exaggerations of anxieties many pregnant women feel ... MH issues make people uncomfortable but they can perhaps empathise a bit more because mine seems to fit in their world?

Mind you the rest of the world still treats me like I'm crackers.

Having said that having seen someone seems to be the best way to secure the care we needed, so OP might find it incredibly useful for that!

[ViviPru]

I had a similar experience, Pomeral, in that when I expressed a preference for a small MLU some distance from a maternity hospital, I felt pressurised into accepting the MLU attached to a large hospital in the city, with the midwife extolling all its virtues etc (I didn't point out that I had done extensive research into both as I suspected this would get her back up).

In the end I just dropped it as she was a locum and she did say that it's never set in stone and can always be changed during the pregnancy. (Besides it's all a bit of a moot point anyway as after this conversation it transpired I would need to be placed temporarily under consultant care at the city hospital for a condition which I don't believe will have any bearing on the final decision)

Anyway I just played them lip service and resolved to push through my preference the next time it's brought up. Have courage of your convictions, OP!

[Rockchick1984]

To answer a couple of the points in your OP:

Pools - no guarantee of getting to use one at Y, particularly if they are busy.

Physiological third stage - you can choose to have this no matter where you deliver baby unless there's a specific medical reason for you not to.

Staying over - most hospitals and MLUs offer 6 hour release subject to everything going well with you and baby following labour. Often you wouldn't even leave the delivery room until going home. Of course, if you have to stay in for any reason then DH could only stay at X with you.

Stand alone MLU vs attached to hospital - is it your first baby? I don't know the stats for MLU transfers but for home birth for first time mums it's about 55% transfer into hospital. I'd imagine its similar for MLU as they don't offer anything different to a home birth, so if you're at one that is attached to hospital it'll be far easier if you find you need additional pain relief or if (for example) you need an assisted delivery.

Is there a reason you don't want a home birth? I know they aren't for everyone but with some of the points you seem keen on about X, you would get those and so much more if you birthed at home. I had DD at home and it was incredible - plus afterwards I was able to do what I wanted mcdonalds breakfast rather than sticking to schedules!

[Hazchem]

MLUs have better outcomes then hospital units for first time mums. Also the transfer rate isn't 55% it's 45%. The place of birth study is worth checking out for correct information about birth place choice. quick bbc breakedown

PomeralLights I would contact the supervisor of midwives and ask for some help to negotiate with the booking midwife. Midwifes have a duty of care to you which means they need to support your decisions rather then make you make decisions they want you to make. It sounds like you have done lots of research and are making decisions from an informed and empowered place.

[Gennz]

Pomeral can you change your midwife? I know I would react really badly to someone trying to tell me "what's best", especially at this early stage. Like you, I like lists and clarity and it's been really important to me to be able to choose what I'm doing (though I'm going in the other direction from you - obstetrician, hospital, ELCS) and it's been really good to just discuss risks and outcomes with my ob and be left to make the decision myself.

I chose an ob for this reason as I wanted the range of "medical options" available to me - I didn't want to battle for a C section, or an epidural for example, which I know is a risk with some (not all) midwives. It's been really positive for me so far as I have felt listened to and my wishes respected, not just a womb on a conveyor belt. I don't think this is because I have an obstretrician btw, it's just his personality suits me. Sounds like your MW is a bossy cow.

If you have a certain kind of birth in mind, don't let someone override yoru wishes (within sensible reason of course).

[Gennz]

Also - I don't know if this is helpful - but I think it's good not to try to get attached to a certain idea of how your birth will go. Of course it's great have a plan in mind (birth pool, drug free etc) but I've seen friends who've planned for that and ended up in a hospital with interventions, EMCS etc ... Quite apart from the recovery, the feeling of failure and disappointment is really hard for them. If you're not hung up on one ideal, I think you're less likely to be disappointed.

I guess my motto is hope for the best and plan for the worst eeyore

[Bellyrub1980]

I'm 20 weeks and my midwife hasn't even asked where I'd want to give birth yet. It literally hasn't been mentioned. Do you even need to make this decision now?

[noblegiraffe]

Nonsense that it can't be changed. How many women have even thought about where they want to give birth before 12 weeks? I hadn't, so they put me down for the default, then later I asked to change and it was fine. They must get it all the time.

[beanynamechange]

I changed my choice of hospital at 32 weeks.. Trust me when I say my mw wasn't happy, had to have a 45min appt to change all of my notes, but I'd gone with the default suggested option at my booking in appt and after research I wasn't happy... Do what you want, if you want to go somewhere then push for it and I would Deff be pushing for your option and not hers..

[bronya]

Just wanted to say that you need to prepare yourself for birth not going quite as you imagine it. It might, but your waters might go and contractions not start so you end up unable to have a water birth and on a drip, or you might go overdue or have to be induced, or baby could get a little stuck and need some help... Birth (esp first births) is an unpredictable thing. It is better to be totally informed, then take it as it comes. You will still be in control of what is done to you, so think of it as using that control to get the best outcome for your baby, whatever might happen on the day! Here, I am booked into my preferred hospital, but if baby decides to be super fast, I'll end up at the other one as it's closer!

[PomeralLights]

Thanks all, I'm really feeling empowered now to challenge the decision at my next midwife appt. I'm considering getting a doula for the birth so I can be 100% happy that I am aware of what is going on and making the right decisions.

I know I can't control the birth and that interventions or even an EMCS might happen. My mum had a EMCS with my sister, my SIL had EMCS, my best friend had ventouse... I know these things happen. I also know that for me, with my MH issues, stress is probably the biggest risk factor for the birth so I owe it to myself and the babe to do everything I can to understand birth and try and remain calm, whatever happens. However I strongly feel I can only achieve that if I feel respected by professionals and have everything explained to me properly. I also feel that choices that are MINE to make, like where to give birth, should NOT be taken away from me like this (excluding genuine medical reasons like needing a hospital birth).

The more I think about that appt the more angry i get, there were other things she said like casual racist comments that upset me (me and DH are white so presumably it's OK to say 'its great that you're white and not anything difficult' to us?!) I just think she was not a nice person and I will make sure I don't see her again.

[ohthegoats]

I'm nearly 24 weeks and have only just yesterday had any conversations about birth options.

[peeapod]

there are ways you can remain in control of your labour and birth whatever changes. Focus on the bigger picture as it were such as being kept informed of changes and being told why they are needed so you can decide yourself whats happening. sometimes its best to think worst case scenarios and have them planned so your not pannicing. I had an elcs and the mw thought it strange I had considered what would happen if baby went to scubu but ineeded to have it planned so i could think in advance...

[Poycastle]

I didn't have any discussion whatsoever at my booking in appointment about the birth plans, so can't help with that, but, regarding MH issues, I had a dreadful time with infertility and ended up having IVF. The whole year before I got pregnant, I suffered terrible insomnia and anxiety and ended up seeing a nurse at the GP practice (I was actually given them impression that she was a counsellor). When I told the midwife about this honestly, and answered questions about antidepressants (which incidentally I did not take) he referred me to the MH team in the hospital.
I was terrified in case they said I was too anxious to look after my IVF twins, especially as I am now single.
But actually when they evaluated the case they were very fair and assessed my situation well. (They did make one error which I received a formal apology for, but that's another story!) They did not want to see me personally, it was sent to me in a letter. No more was spoken about it ever again.
Obviously it will depend on the severity of your MH issues but please don't worry too much that it will automatically be a major problem.