Where to give birth? Why is hospital not as highly recommended?

[AlZi]

Hi,

Just wondering if anyone else has found this strange. When my midwife told me my options for where the give birth she said the best options were home birth or one of those midwife run birthing centres. The third option was hospital. She also gave me a flyer to read where they explained that obviously with a home birth and birthing centre there are no doctors or drugs available - but if something goes wrong I’d have to be taken to hospital by ambulance. My question is my the hell wouldn’t I want to give birth in a hospital where everything I could need is available, and give me peace of mind?? The flyer also mentioned that birth success rates were higher for home birth and birthing centre than hospital, but I believe this is because more high risk births happen in hospitals. It very much felt like home birth or birthing centre was being pushed on me, and I suspect the reason has nothing to do with success rates etc but rather with saving the NHS money. Maybe I’m just being paranoid, but as this is my first I’d feel a lot more at ease being in a hospital.

I know it’s 100% my choice where I do it, just feel very suspicious about their motives.

[Chwaraeteg]

Some midwives are just obsessed with natural birth to the point where they will claim all sorts of nonsense e.g pain during childbirth os caused by fear, contractions aren't painfull - they are just waves of intense pressure, it's impossible dor a babies head to be too large to fit through a birth canal ( it's what are bodies were 'designed' to do after all (you can't pick your baby up for eight weeks after a c-section, epidurals slow down labour (debateable), of you do your pelvic floor excercises you won't suffer incontinence etc. I've heard all kinds unscientific, judgemental crap from midwives 😣

My advice - wherever you decide to give birth is this: read the nice guidelines, educate yourself about consent, be specific in your birth choices, have someone assertive be your birth partner and photocopy your birthnotes.

[Babdoc]

There has been friction between midwives and obstetricians forever, OP - it’s a constant power struggle. Midwives promote home births and stand alone midwife units, as they are in sole control of them.
They also need to keep up numbers of deliveries at their units, to avoid risk of closure.
If you are concerned about safety, and access to emergency facilities like blood transfusions, operating theatres, and rapid instrumental delivery (forceps or Caesarean section) in the event of unexpected complications in labour, then choose a hospital delivery. None of that is available anywhere else.

[HereForTheBiscuits]

I gave birth in a birth centre. It was mainly because I really didn't want to go to the hospital maternity ward nearest me. One reason being, the birth centre is 15 minutes from home, the hospital almost an hour. Plus, bad experience at the hospital.

I just wanted to give you the flip side of the coin from other pp's. I really loved the experience in the birth centre. It was more homely and you get more dedicated care. At one point, baby's heart rate was dropping so they called an ambulance who were there in about 3 minutes (luckily not needed, turns out I was fully dilated and she decided to grab onto the cord ready for the drop - it happened a bit quick!). We could then stay, in a private room, for as long as we wanted. DP had a bed - some rooms had double beds in but they were taken so we had 2 singles. We had our own bathroom and there was a little kitchen where we could make drinks/breakfast etc.

If they feel you might need any treatment that requires a hospital then they send you early on to be on the safe side, it's not like they wait until it's too late and shove you in an ambulance.

That said, it should be absolutely your choice and shouldn't be forced upon you. At the end of the day, giving birth is scary and you need to do it where you feel most comfortable. If that's the hospital then bugger what the midwives think.

[8dpwoah]

I'm hoping to get into the midwife unit this time but only because it's physically attached to the rest of the hospital so any complications is a wheel down the corridor not a go in an ambulance...I'm completely with you OP I was glad I was in a hospital last time and I want to have access to all that immediately again this time. I'd just rather have a go at a nice low risk experience that will let me into the MLU this time, but you have to go with what you've got don't you!

[Babdoc]

If the midwife unit is inside the hospital, or next door, then the transfer time is not likely to cause a dangerous delay.
My local midwife unit is over 20 miles from the nearest hospital labour suite, and we have had at least one baby die in transit.
My own second child would not have survived delivery outside hospital, despite being a full term normal labour.
I wouldn’t want to gamble with my child’s life, OP. The stakes are too high.

[lemorella]

I'm a another vote for a MLU attached to a hospital or directly to hospital.

With my first I went to a stand-alone midwife unit and was rushed to the hospital by ambulance when things didn't go to plan - longest 20 mins of my life.

With my second I went to the MLU attached to the hospital and baby ended up needing some urgent attention and a short stay on the neonatal ward up the corridor.

With my first I really bought into the idea that the more natural the better (including environment) but by my second I wasn't taking any chances with being far away from the best medical help.

[Historytoo]

If you want the research rather than a string of anecdotes then this is the best place to start. Happy reading www.npeu.ox.ac.uk/birthplace

[8dpwoah]

Great link @Historytoo and I'll have a proper read later but I always wonder if they account for the fact that you have to tick a load of boxes to be allowed anywhere near an MLU so they are inherently low risk births in the first place- I forget the criteria but I remember there being lots of common problems that could get you allocated to the ward instead.

[FakeTanandProsecco]

There have been RCT's which have shown that for low risk women, giving birth on a midwife led unit is more likely to lead to a spontaneous vaginal delivery than giving birth on an obstetric unit. The link above is good. They specifically compare outcomes for low risk women- not a mix of high and low risk.

I'm a midwife. I work with both high and low risk women. I have no ulterior motive when advising women on their options for giving birth- I want what is best for the women in my care. Most women (not all!) Want a spontaneous vaginal birth. That is more likely to happen on a midwife led unit. Some women want to be close to the obstetric team so therefore a FMU wouldn't be appropriate (there isn't one where I work though). Some women are so against intervention they will birth at home whether it is recommended or not, but as long as they are fully informed it is their choice to make. Some women are dead set on an elcs and I will help them with that.

I think most of my colleagues are similar in their thinking and don't have an agenda, they just want what is best for the women in their care.

[8dpwoah]

That's good to know @FakeTanandProsecco
Personally the only thing I've ruled out both times is a home birth as the thought of that absolutely terrifies me! I didn't think I wanted epidural and forceps etc at all last time (possibly a little NCT influence there) but actually worked really well for me with good recovery so I'm glad I took the view of the experts and let them guide us through safely.

[porridgeface]

With my first I was induced in the maternity ward and moved to MLU for delivery. Like you I wanted to be close to the hospital incase anything went wrong.

My second I had a homebirth in the middle of lockdown 1 (I had considered homebirth from the start but Covid cemented my decision). I thought you couldn't have anything other than gas and air at home but my GP prescribed me morphine to keep in the house that the midwifes could inject if required.

[EezyOozy]

Another vote for a MLU attached to a hospital .

[Historytoo]

@8dpwoah the 64000 women in the study were all low risk so all would have been eligible for a MLU. It was a like for like study which is why it's so useful.

[AlZi]

Thank you all for your replies! It’s given me a lot to think about, and I’ll definitely do some independent research.

Anyways, I would definitely not want to have a home birth as we live in rented accommodation with thin walls 🤣

Where I’m based the hospital is actually the closest (15-20 min drive except in rush hour), and unfortunately no MLU attached - it’s maybe 30 mins away...

[BigGreen]

I wanted to stay away from our local hospital at all costs as it was chronically understaffed and at the time had a low rating from the CQC. I chose the standalone birth centre (although a ride from the hospital) as I knew a midwife would spend far more time with me. In the end I had 1-1 support.

The standalone birth centre was a wonderful experience and I was sad not to have DC2 there due to complications. I had him in the hospital attached birth centre which although absolutely fine was nowhere near as caring and lovely as the standalone birth centre which didn't feel hospital like at all. Good luck with whatever you decide.