Elcs vs Stand Alone MLU vs Homebirth

[BirthChoice]

Tried posting in Childbirth but there doesn’t seem to be much traffic (though I appreciate my situation is pretty unique).

Background: Gave birth at stand alone MLU in area ‘A’ (half an hour from home) in summer ‘19 and had a 3a tear. Had to be transferred to hospital around half an hour away for a repair under local anaesthetic after the birth. Tear repaired by Dr in theatre and subsequently healed very well (I suspect I had a better repair job than lots of people do with bad second degree tears, a bit of gas and air and a midwife). I had a ‘birth reflections’ meeting a few months later and was told that next time I would be advised to give birth at the main hospital, under supervision from a senior midwife to try and prevent another 3rd degree tear or I would be offered a c-section. No real reason found for the tear other than long labour and spent a lot of it in the water.

Fast forward to now and I’m pregnant again. I’ve booked in with ‘MLU A’ again. I had planned to opt for a c-section as I didn’t want to give birth on the labour ward of a busy hospital (I could hear women screaming whilst I was being repaired previously blush ) and wanted to avoid interventions that could lead to an instrumental birth (tearing risk). My midwife, however, thinks I will be fine to give birth at the MLU again.
Which has got me thinking about a homebirth. To my mind it has the same positives and negatives as a stand alone MLU (home comforts, birth pool, less intervention vs not being close to hospital if something goes wrong, no strong pain relief) except with the homebirth I can guarantee a pool will be available, I might not need childcare and I don’t have to worry about when to drive to MLU (half an hour drive in labour).

All that being said, if I want a homebirth I would need to transfer my care to hospital B. I’m reticent to move to a different trust when I’m happy with the care received by area A.

Or I ‘just’ go for the section in area ‘A’. I’m under no illusion that the c-section will be the easy way out but If I have a worse tear which causes long term issues (incontinence) will I kick myself for not having a section?

Option A) give birth at MLU in area A
Option B) ELCS in area A
Option C) homebirth (I would have to move to a different trust and I was very happy with the care I received in first pregnancy)

Shameless bump

Tldr: following 3a tear

Option A) MLU 30 minute drive from home (30 minute drive from home + 30 minute transfer to hospital)

Option B) elcs at hospital 1 hour from home

Option C) homebirth with a 30 minute transfer to hospital (would require me to change trust but I like trust that I’m currently booked with)

Not C and I'm not sure you'd get the support for a home birth plus you would still need childcare.

I think A is a good compromise.

@Crockof thanks for replying! What would the difference be, risk wise, of a stand alone MLU and a homebirth? I’d assumed that if I could give birth in the MLU I would be ‘allowed’ a homebirth.

I have four children all home birth. The third was a big baby and third degree tear (mild shoulder dystocia) having had no tears with my first two births. I went for another home birth for my fourth as I felt it was going to be a smaller baby than my third (it was). I ended up with a small second degree tear. Marginal worsening long term of sensation in my bum, but nothing that affects my life at all. I am a midwife so knew my choices well. Had the baby felt big to me, I would have opted for a section due to the shoulder dystocia. I had a very nervous newer midwife (I knew she had no need to be nervous!) and a very experienced midwife who was not worried at all.

@LabiaMinoraPissusFlapus obviously you can’t speak for all trusts / situations; but, generally speaking, if somebody was low risk enough to give birth in a stand alone MLU would they also be low risk enough for a homebirth?
(Am aware that technically anyone can say they’re having a homebirth)

Its been a while but when I was pregnant it seemed to be a tiered approach, with hospital most risky, then MLU then homebirth, however thinking about it MLU was much closer to the main hospital than the large village I lived in at the time so that may have been why. How have you healed? I've been having a think about this and now I'm leaning more toward elcs. Although obviously it has its own risks plus the dreaded shelf.

Just to add I can't see the difference in risk of MLU vs home birth if there aren't any other risks. You can't not be allowed a home birth, it is your choice even if you have someone disapproving and telling you otherwise.

In fact there are many women who opt for a home birth because they are too high risk for an MLU. MLUs have strict criteria for who can give birth there, especially at standalone MLUs, whereas they can’t refuse you a home birth if you request one. Personally, if I were too high risk for an MLU there’s no way I would have a home birth but I understand why people make a different decision.

Do you have any alongside MLUs in your area? That would be my ideal scenario if I had another as the labour ward is right next to it in my trust, so no worries about transfer. However I previously had an EMCS and that would rule me out of many MLUs.

I started in the MLU with my first and ended up with episiotomy and forceps in the hospital. It wasn’t fun and I was so disappointed that it didn’t work out. No birth reflections, pretty shitty care and no anaesthetic for the episiotomy repair, just gas and air. All pretty traumatic.

My second birth was a dream, and I really wish it had been in the MLU cause it would have been perfect. It was still good in the hospital but the water would have been lovely.

So in your shoes I would give the MLU a go again. How long is the transfer to the hospital?

@Crockof I’ve healed very well. My bladder control probably wasn’t what it was pre birth and labour but I used to not wee all day at work! I certainly wouldn’t worry about leakage / running / trampolining or anything now. Aesthetically everything healed perfectly, which is more can be said than for many women. If anything I feel that I got incredibly lucky and I’m a little worried to put my undercarriage at risk again!

@LabiaMinoraPissusFlapus thank you! That’s what I thought but wanted to make sure I wasn’t missing an obvious risk factor.

Sorry I just read it again properly and can see it’s 30mins.

@Planning3457 transfer time for both MLU and homebirth would be 30 minutes in normal traffic. Potentially quicker for homebirth in an emergency as there is a dual carriageway for part of the journey but it’s B road only between MLU and hospital.

@TammySwansonTwo There IS an alongside MLU if I give birth at the hospital I would have a homebirth ‘through’ (would need to change from trust I’m currently booked with) but I don’t want to give birth vaginally in a large hospital. Firstly, I’m just not keen on the environment even if it is an MLU and secondly, I’m concerned that they would be more likely to transfer me mid-labour leading to various interventions if it was only a case of wheeling me next door. In an ideal world if I was having a homebirth and they wanted to transfer me in I would like to have a csection when I got there (though am aware that may not be practical).

Have you seen the alongside MLU? You might have and have decided it’s not right for you, but the ones here are absolutely lovely and don’t feel like being in a hospital. You don’t hear the labour ward either and many are discharged straight from there so no need for the postnatal ward.

Worth considering anyway - lots of trusts have video / virtual tours online now.

Good luck with whatever you decide. Whatever your choice, so long as you have made it with all the information needed, then it will be the right one for you!

Your labour is going to be low risk. The risk is following birth that you have a higher risk of an extended rear (scar tissue does not stretch as easily).

The choice of an elective v vaginal birth is only something you can decide. The birth is likely to be straight forward and quicker than your first. However, if you have another 3rd degree - you'll need a spinal (like a temporary epidural) for suturing.

If opting for a vaginal birth - I would be cautious re homebirth, not for the birth itself but as its far more difficult to suture a complicated tear with poor lighting/soft bed/no lithotomy poles - the end of the bed comes off on a hospital bed and it's much clearer and easier to suture someone this way.

Also - the last thing you want after giving birth us to be transported in the back of an ambulance with the baby to a consultant led unit.

I would consider the alongside MLU - you'll have a relaxed birth environment, equipment to support suturing if required and quick facilities for extensive repair if you had another 3rd degree.

I've worked in many health boards, staff do rotate around different hospitals - midwives and doctors move between trusts.

As long as you have a caring and experienced person to look after you - it doesn't really matter where you give birth.

Hope all goes well.