Hospital or CMU

[Jauralane]

Hi

I'm due for baby number one in May. Been really lucky and have had a straightforward pregnancy so far. I'm having a huge dilemma choosing where to have the baby though.

We have a freestanding community midwife unit nearby, it looks absolutely amazing and such a nice environment to bring baby into the world. I have every confidence in the midwives however there are no doctors there if something goes wrong. Then there is a big city hospital nearby which has a labour suite and an attached maternity unit, it's about a 40 minute drive from the community midwife unit, and while it's known for being really busy and overcrowded they do have doctors there.

Ideally I would like to give birth in the nearby community unit. It looks so comfortable, you have your own room as long as you like, and the midwives are so nice. BUT, if something were to go wrong I/ we would need to be blue lighted to the hospital which takes a minimum of 20 minutes. I'd never forgive myself if that time delay of getting to the hospital/ a doctor was the reason anything happened to my baby.

Phew! Sorry for the long post! Any advice would be appreciated.

Have you asked them what % of women have to be transferred?

Personally I wouldn't dream of having a first baby away from a hospital. My baby was nearly delivered then moved her head, got stuck, and started to get distressed very rapidly. She needed to be yanked out in a hurry, and I don't know that she would have survived a wait for an ambulance, transfer time and being brought to the right department.

Depending on the reason, the stats are:
Labour is slower than expected-37%
Baby needs to be more closely monitored in labour-23%
Baby needs medical attention at birth-3%
I need medical attention at birth 15%

I’m sure I read somewhere else that overall 1/3 first time mums who start in a community unit end up having to be transferred for one reason or another.

@OMGithurts That sounds terrifying, it's exactly the sort of thing I'm afraid of

They would move you at the first sign of anything going wrong. Probably long before you eould even be at the point of seeing a doctor even if you were in the hospital. It sounds a much nicer environment at the CMU, a more relaxed labour will hopefully be an easier one.

But that overall statistic is different per unit. I was ‘transferred’ with DD but in reality it was the same place and I did not move a mm but my care was transferred.

I would also look at the outcomes of both units for low risk births. Often low risk women have higher intervention rates in hospital due to a whole range of issues including lack of 1:1 skilled midwife care.

@Jackshouse In terms of what they deem an undesirable outcome at birth (including ongoing problems etc) the risks are 4.5 in 1000 from the midwife unit and 5.3 in 1000 at the hospital.

Sometimes things can go wrong very rapidly during labour. For that reason alone I would not want to be so far away. There isn't always time to transfer. I've worked in obstetric theatres, and a few minutes can save a mother or baby's life sometimes.

Have you thought of a home birth? If you’re up for a midwifery led unit, then why not a home birth? They bring all the same equipment to a home birth that they have in a MLU. Are you closer to the hospital if you need a transfer?

@BlueCookieMonster I'd be about a further 15 mins away from the hospital if I was at home, plus I'd need time for the ambulance to get here whereas at the CMU there are ambulances there and ready as it's right next to the local hospital (it's not a maternity one though so you can't get doctor/ obstetrician care there)

I think @Jauralane's statistics are interesting. Personally the 3% of babies who need medical attention at birth and the 1/3 of women who have to be transferred to hospital would mean that, for me, I would not consider a MLU. However everyone has different levels of risk they're willing to accept and it will have to be a personal choice. The risks involved are certainly not so high that the decision is clear cut.

I had DS in a hospital (was consultant led so no real choice) he got stuck, heart rate dropped and I was rushed down to theatre for emergency ventouse and episotomy after a very long labour. I also opted for an epidural (which didn't work but that's another story) because I had to be induced by drip at 37 weeks as my waters broke and he was back to back , the combination of which I was advised would be painful -it was. I couldn't have had that at the MLU. I had a complicated pregnancy so the water birth I wanted wasn't feasible, if I have another, unlikely as the whole thing was pretty traumatic, I will have a planned c section. However if I'd had a low risk straight forward pregnancy I would've opted for MLU ours looked lovely, but it's also on the hospital grounds, I think the distance of yours would really put me off.

I don't think you can assume there will be an ambulance there at the hospital, even if it's a dedicated maternity fleet what if there are emergencies just before yours? I would ask what the average wait time for one is. Even if it's 10 minutes, that's another 10 on top of your transfer time.

4.5 compared with 5.3 really isn't much lower given that all the higher risk cases will already be at hospital.

If you required an ambulance transfer from the midwife led unit, they call a 999 ambulance. The fact its a hospital and there may or may not be ambulances outside doesn't mean a thing.

It’s a tricky one, I chose a MLU for my first, and although I did end up being blue lighted I don’t regret it. We were the only ones in labour so had a midwife the whole time, dialating from 3cms to 10cms in the birthing pool with just gas and air and our own room (plus free to walk around and watch tv in the lounge etc). I found it so relaxing and felt very safe, checks were done regularly and monitoring was good. Unfortunately when it came to pushing someone flipped back to the wrong position, so they called an ambulance straight away and when I arrived after 20 mins in the ambulance I was taken straight to theatre where everything was prepped and ready to go. If I had been at the hospital would an issue have been picked up as quickly with less staff per person? Would the theatre have been prepped any quicker? Possibly, possibly not. I am aware that the outcome could have been different, but the chances of something happening are relatively low (they’ll transfer on the side of caution rather than risk it!), and the wheels are in motion from the time they make the phone call. You might have regrets either way, but think where you would feel most comfortable and confident.

@FredFlinstoneMadeOfBones of the 1/3 who are transferred, 3% are transferred because the baby needs medical attention at birth, so roughly the equivalent of 1% overall.

OP I would ask what their transfer statistics are for first time mums rather than all mums and make a decision from there.

You need to remember when considering the statistics that the two groups of women (hospital vs midwife unit lead birth) are not directly comparable. The women who are offered Midwife units have been screened and are already lower risk, hence they may seem to have more favourable outcomes. The hospital group are composed of those who chose hospital AND those who are recommended a hospital birth because if their higher risk of complications.

If you want a fairer way to decide, look at the risk of complications in all first time mums and then make your decision.

Statistics may help,you a bit, but can be unreliable (eg in some places, poor outcomes for babies transferred into hospital from the community unit are counted as poor outcomes for the hospital rather than the other unit)

The absolute risk to your baby, as part of the population of low-risk births, is low

The risk of something serious happening (rather than something more minor that triggers transfer) is lower

However, for your specific baby, something will happen or it won't

It's all about your perception of risk

I started off in the MLU near us. It's only 10 - 15 min from hospital. I can only say a couple of things - the transfer was very unpleasant. Bouncing around in the back of an ambulance, without my husband, was scary and uncomfortable and I was very upset. Also it's actually unlikely you'll get there in the first place. I know so many people who were signed off to go there, that didn't even set foot there. Throwing up in early labour - go to hospital. Waters broke more than 24 hours before labour starred - hospital. Baby may be large or small (even when measurements were OK just been plotted on graph wrong) - hospital. Going into labour 36+6 - hospital. Pain was on one side of her back rather than spread evenly - hospital. That's just people I know.

However on the other side the one or two people I heard of who did give birth there found it truly amazing (though one had to fight tooth and nail afterwards to be stitched up there rather than sent to hospital), it was so much cleaner and nicer than the hospital and I imagine having my own room post birth with my husband there would have made an absolute world of difference to the couple of days post birth where I was kept awake by people watching tv and all the babies on the ward woke each other up and I was still hooked up to cathater etc and couldn't lift the baby properly and it was all a bit of a nightmare. They turn so many people away that it's so quiet that you would get loads of help with breastfeeding etc

Do they have any stats at all about just how many issues are caused by women giving birth there rather than hospital?

Also I would ask, when midwives give birth, where do they prefer to go??

See if you can visit the hospital too.

I didn't have any choice because of a medical condition on my part but actually we had a private delivery room, ensuite bathroom, 1 to 1 midwife care. The only thing I couldn't have had there compared to the MLU was a water birth which wasn't a possibility for me anyway
(and in the end I did need the obstetrician and paediatricians etc.)

I had my first in what was pitched as a midwife led unit but where consultants were next door, and were called in as soon as there were concerns about 'faIlure to progress' l. For me they just slowed things down as i was less relaxed and just wanted to be left to get on with it. Just had second baby at home. I decided not to have a honebirth with my first due to high transfer rates. Having done a lot of reading and thinking about place of birth it's worth bearing in mind that there are risks attached to a hospital/ consultant led birth in terms of increased chance of intervention that potentially mean poorer outcomes for you and baby. The best environment is where you will be most relaxed and for many that will be cmu and for others it will be a hospital. You sound quite clued up on the stats but look at the Which place of birth website if you haven't already, this suggests a mlu has the best outcomes for first births. You would be monitored v closely and transferred at first sign of trouble. And do hypnobirthing to help you relax and make sure your birth partner can advocate for you in terms of preserving your environment and being cautious about interventions. I'd also highly recommend a doula which is also very effective at improving birth outcomes and experiences, wish I'd had one for my first.

If you required an ambulance transfer from the midwife led unit, they call a 999 ambulance. The fact its a hospital and there may or may not be ambulances outside doesn't mean a thing

Also because the midwife led unit will be considered a ‘place of safety’ by the ambulance service you may not be a priority for an ambulance. Personally I wouldn’t risk it

Stats can be misleading.

Actual labour wards deal with high risk patients as well as low risk who suddenly become high risk so of course the hospital stats of an "undesirable outcome" will look worse? And quite honestly - comparatively - the numbers you give really don't do the CMU any favours?

I'm lucky in that my labour ward and birthing centre were a floor apart. Have done the whole shebang.... DC1 birth centre but moved to labour ward, DC2 birth centre, DC3 labour ward and then neonatal

Was glad there was only a lift journey of seconds with DC1 and DC3

Also I would ask, when midwives give birth, where do they prefer to go??

Can't answer this, but all the paediatricians I know have had their babies in hospital, whether consultant unit or midwife-led unit with medics available.

My community MW's smuggly all seemed to deliver each others baby's at home.