Birthing centre v's hospital

[Bebo1980]

I'm 32+3 and up until now have been certain that I would have my baby at the local hospital. This is despite wanting a very natural birth with as little intervention as possible. My primary reason was the 'what if something happens factor' as the birthing centre offers no pain relief or intervention. I would have to be tranferred by ambulance (10-15min journey)

I have just started hypnobirthing sessions and discussed this decision with the instructor. She was very supportive but did make me question myself. I called the local birthing centre, had a chat with a lovely midwife and have arranged a visit. They seemed to be offering the type of experience I'm looking for as our local hospital has a bit of a 'sausage factory' reputation. My main issue is that while I'm becoming won over by the birthing centre idea I can tell my dh is a bit horrified. He is very supportive but worries if something goes wrong and I feel he thinks I'm putting myself/our baby in unnecessary danger. Am I?

No, you're not. Home-births and stand-alone MLUs are considered to be as safe as hospital.

A transfer time of less than 30 minutes should not make any difference to safety, because it takes that long to prep a team for surgery in hospital (according to NHS and NCT advice) and if you're becoming higher-risk, they'll transfer you early, not leave it to the last minute anyway.

A birthing centre/MLU should also offer pain relief such as G&A, water births and possibly pethidine. Only epidurals and drips are not possible. If you decide you want an epidural, you can transfer.

Most first-baby transfers are for non-emergency reasons such as slow progress or wanting an epidural.

I think it depends on how your pregnancy has gone so far. if there have been no complications then why not. but if there are any risk factors, for a first birth my view would be go for the hospital. the most vulnerable time for me during my birth was when i was being taken from the delivery room to theatre (ended up avoidnga section thank God, but had to have a forceps delivery). the thought of that journey being any longer than the 2 minutes or probably less than it was is scary even now.

I think it depends on how you feel you would cope if you had to be rushed to the hospital, I think for me it would have been the final straw but from friends experiences you will get better 1:1 care and have less chance of intervention.

I would definitely go for the MLU.

IME of having my first baby in one, the fact that you are in a more supportive, home-like environment will make you feel better able to cope with the pain.

As japhrimel says, MLUs are as safe as hospital, if you're not a high risk case.

There is very likely to be pain relief on offer - I had gas and air while being stitched up, and my MLU also offered pethidine. You won't get an epidural, but that's a major intervention which presumably you're hoping to avoid through going the MLU route anyway?

Should've added the "if you're low-risk" to that first line!

The reason MLU's are so safe is that they will transfer you as soon as something "out of the ordinary" happens. This could be something as simple as a lack of progress (the reason I was transfered), or that you decide you want an epidural.

Another consideration is the after-care. My local MLU is so good that people often stay 5 or more days to get breast feeeding properly established and to generally recover. It was a world better than the hospital (I lasted about 12 hours before transfering back to the MLU!)

If your DH is worried, can he go on the tour and talk to the midwives? It might let him put his mind at rest.

"A transfer time of less than 30 minutes should not make any difference to safety, because it takes that long to prep a team for surgery in hospital (according to NHS and NCT advice)"

It really doesn't, if you are a cat 1 the baby should be out less than 30minutes after the decision has been made, sooner if it can be done safely.

Do you have a hospital near you that has both delivery suite and a MLU?

But Libra, if it really is an emergency, they will prep you in the ambulance on the way from the MLU to the hospital.

Also, with hospitals, you need to factor in the likelihood of a cascade of interventions, where one unnecessary medical intervention (eg excessive monitoring, inducing or speeding up contractions) leads to a whole series of interventions which in themselves present risks for mother and baby. A MLU is an excellent way of reducing this risk.

Reassure your DH that birth is not a medical procedure and, assuming you are fit and healthy, you will be as safe at home or in a MLU as you would be in hospital. Perhaps you could take him to the MLU for a chat with the midwives? They will be able to explain the emergency procedures to your DH and perhaps also the 'cascade' thing a bit better than I can.

If the MLU are happy to book you in - i.e. you've not had any complications, then definitely go for it!

I was supposed to give birth at a MLU but had to transfer to hospital as there was meconium in my waters. It wasn't an emergency and the transfer was okay, quite comfortable actually. My DS was fine, I think midwives at MLUs are always very careful and transfer you as soon as they spot something to be even slightly concerned about.

As soon as I could, I got straight out of the hospital and back to the MLU for postnatal care which was just like a hotel, I stayed for 3 nights which there's no way I'd have done in hospital, it was far too busy/noisy. It really helped me with breastfeeding - I hadn't expected to be able to do it and carried on for 10 months, I put this down to the help I received in the MLU after the birth.

If it really is an emergency then you don't want to spend any time in an ambulance, and there is very little prep to do.

I am not against MLU (even tho I think they should be attached to hospitals) and whilst I agree that hospitals are more likely to lead to a cascade of intervention I think in most cases this is because the mother is not educated in how to say no and doesn't have a supportive (or again labour educated) partner.

You cannot prep in an ambulance!!!! prep can only be done in a sterile area i.e. in theatre.
In an emergency they have 9 minutes to get a baby out 3 minutes before they decide to opt for EMCS and prep theatre, 3 minutes to get you into theatre and intubated, then 3 minutes to get that baby out. I know this from going through my own notes and discussions with senior nidwives.
Realistically if its an extreme emergency your baby would not survive an ambulance journey to hospital.
Thats not to say there are plenty of safe transfers to hospital from birthing units for non-emergency reasons (im talking extreme emergency here)

I dont agree with stand alone birth units, fine if they are attached to a hospital and can get you upstairs.

"if its an extreme emergency your baby would not survive an ambulance journey to hospital"

or you, c-sections aren't always done for the baby.

exactly libra

It's extremely extremely rare to get to the threshold of needing an EMCS or other major intervention within a few minutes without there being ANY warning signs beforehand.

A 9 minute transfer to surgery is only possible if a surgical team is on standby. 30 minutes is the time quoted to organise and prep a team from having had no warning.

With home-birth or MLU, they will transfer you at the first sign of things not going well. So then you are already in hospital, possibly with a team on standby, when you get to the stage of needing a 9-minute-transfer.

sorry japh i disagree, its not always possible to have warning signs.
they lost ds2's heartbeat with no prior warning, everything was ticking along fine then one massive contraction must have floored him. What would have happened in an MLU in that situtaion??
Luckily I was in the hospital and theatre was prepped for me at 3 minutes, but he recovered shortly after that.

It does not take 30 minutes to organise a surgical team in a busy maternity hospital there should be a surgical team there day and night, inc anaes.

"I dont agree with stand alone birth units, fine if they are attached to a hospital and can get you upstairs"

Current advice from the RCM and the RCOG is that stand alone MLU's are as safe for low risk mothers an babies as a consultant led unit and are associated with lower rates of morbidity for mothers.

Perhaps you'd like to share the evidence on which you base your belief that stand alone MLU's (and homebirths I presume) are linked to poorer outcomes for mums and babies?

My MLU is the floor below the labour ward within my local hospital. Do you have that option within any of your local hospitals?

"Current advice from the RCM and the RCOG is that stand alone MLU's are as safe for low risk mothers an babies as a consultant led unit and are associated with lower rates of morbidity for mothers."

What are the stats for MLU attached to a hospital?

That makes a lot of sense. As well as midwives possibly being less experienced in handling the delivery all the way through, i would imagine transfers in attached units are more frequent for non- emergency reasons such as mother wanting more pain relief. It's easier to decide on an epidural if it's only a walk along the corridor; harder if it's an ambulance ride away. So, the risk of the cascade of interventions would be greater

Thanks to everyone for their opinions, I've been away so unable to respond. just thought I'd update everyone on my decision. We went to look round the birthing centre and my DH was the first of us to say I really think this is the best place for our baby to be born, which was an incredible turn up for the books.

We asked about the statistics for transfer, complications etc and were very reassured by the information we were given. This along with the ethos of the centre and its midwives has made me very excited about the birth.
Thanks again for all the opinions and advice

I had both of mine in Birth Centres and both times I had very experienced midwives who were fab and both times I had one MW from start to finish which I'm sure really helped too.