MLU - but what if there are problems?

[ChessyEvans]

I'm really lucky that where I live we have an MLU that seems lovely, I've been having all antenatal appointments there and they have an average of 1 birth a day (with about 4 or 5 midwives on duty) so feel like I would be well looked after.

However, have started to worry a bit recently about the number of stories I've read of people having to go for EMCS due to cord round neck or baby heartbeat problems etc. MLU have said that in an emergency you would go in an ambulance to the nearest proper hospital which is about 20 mins away assuming a clear run.

I originally was absolutely fine with the idea of the MLU as I am happy that I won't have the epidural option (which the midwives said was the only real reason for not starting out at the MLU) and it seemed the midwives could do most other things or there would be time to get to Bath. However, in the real emergency "we need to get this baby out NOW" type situations, am I putting my baby or myself at risk not having doctors etc nearby?

I will discuss this with my MW but they are keen for people to stay in the MLU if poss, they say on average 1 in 5 mums end up going to Bath but that most of these are mums who have decided they do want an epidural and so are transferred.

Any thoughts?

Is your home nearer the hospital? If so that could be a option.

This page on a homebirth website might help as it seems to deal with many of your concerns. Obviously a MLU would be slightly different in that they would have more available.g. pool, birth ball, pethidine and unlimited gas and air and a larger number of midwives/necessities.

With that level of midwife support I would be even further reassured, with my hospital birth I went in at a busy time and got an occasional check from a midwife and a dedicated midwife one hour before DD was born. DS was a homebirth but even then I only had a midwife for the last two hours and two for the last hour (and it was a 19 hour labour).

Obviously if this is making you very anxious then the main hospital would be a better place to have your DC. Good luck whatever you choose.

TBH I generally feel that the best thing for women who want a normal birth is to be as far away doctors as possible. They seem to have less patience that midwives and have no awareness of births that go right. This is my opinion of course, based on personal experience! Some people labour fine knowing that the doctor's clock is ticking and any deviation from the norm could end up with an unnecisary intervention.

I would tentitively add that very little goes wrong fast in labour, especially 1st time mums. You can see this by how few C sections are actually Crash- ie no time for a spinal or partner to get into scrubs, just a general aenesthetic.

Also, MLU's are being closed down fast, despite excellent results of natural birth and good outcomes for mum and baby. The more people use and rave about them the better! I would also place money on midwives in MLU's being much more supportive of active birth than midwives in hospitals, who may be more of a nurse at heart. A very different kettle of fish!

All the very best in making your decision- I know it's sometimes tough to weigh up pros and cons!

Also in hospitals you are left unattended for hours when something could go weong and the MWS remain unaware. But MLU have much more attendance in a MLU so they are more likely to pick up a problem sooner, which probably means you would get seen to in the same amount of time.

Thanks for all your replies and thanks for the link Dingalong, that's really informative and helpful. I definitely agree that I want to support the MLU and prefer their ideology re active birth and help with breastfeeding etc.

Was just having a bit of a wobble (must stop watching OBEM!!) as have had a few shocked reactions when I say I'm planning on using MLU which isn't actually based in the hospital. There are lots of "what if" reactions but my SIL recently had an emergency CS as they found out her baby was breech, and it took more than 40 mins for her to get into theatre (even though she was already in hospital). So not much difference really from being ambulanced straight there while hospital prepare for arrival.

Thanks everyone and will report back with hopefully a v positive birth story in about 10 weeks' time!

as if you haven't enough to worry about. I feel for you. I didn't have the choice of mlu but if everything straightforward in pregnancy then a good choice. The midwives in these units are so experienced and have more time for you, are more open to allowing you to labour in your own way and don't have more than 2 women in labour or the doctors breathing down their necks as may happen on a busy hospital unit.
I speak from experience having worked in a very busy hospital delivery suite. I would go with your gut feling however and do a birth plan. Not too specific but definately include things such as NO FORCEPS or VENTOUSE. NO CONTINUOUS MONITORING and moving around as much as possible.
Good luck

Sorry forgot to say, as a midwife, especially an experienced one there is always an inkling that the birth is not going to be straightforward and therefore a move towards hospital. You ask any midwife and she will tell you that often she knows how a delivery is going to pan out therefore would get you to hospital if any question.

Thanks needsatrim, they did seem very confident at the MLU that there would be plenty of time to transfer to Bath if there was a problem. Also have a couple of ante natal classes coming up there so I'm sure they'll go through it then and show us the facilities properly.

Re forceps / ventuose - I'm keeping an open mind as if they're necessary then I guess there's not much choice although I'd prefer to avoid them! Was surprised to see forceps on OBEM as I thought now the consensus was that ventuose is better? How much of a say will I have in refusing forceps? Didn't seem like any other options were discussed with the lady on the programme.

I'd say definitely give the MLU a go. They are really careful to monitor and transfer you as soon as they spot something that could be a problem. I had to transfer as there was meconium in my waters which can mean babies are distressed (mine had the cord around his neck but all was okay - I had to have monitors on though). The transfer was fine and there was still 4 hours to go before I had him.

If you do have to transfer to hospital, make sure you get back to the MLU for your postnatal care if you can, it's way better than being in a noisy hospital ward with no sleep and midwives who are rushed off their feet. I went straight back after the birth and stayed 3 nights, without this help I wouldn't have been able to breastfeed and would have been absolutely shattered after a long early labour.

BTW - I put no forceps/ventouse in my birth plan after everybody I know had problems with them (either themselves or the babies). They never mentioned them fortunately and I had a normal birth, but I think if you really don't want them, you need to make that clear at the start and brief your birth partner as well.

I had my first baby in a standalone MLU and cannot recommend it highly enough.

I was also a little bit fazed by some of the doom and gloom merchants who said things like: "you must be so brave!" "aren't you worried something might go wrong...?" etc

Just ignore any comments/worrying thoughts. Push them aside.

The fact is, MLUs are incredibly safe. I can't stress that enough. They simply would not be allowed to remain open if they weren't. The MLU where I delivered has never lost a baby or mother or had any serious problems with a baby in the entire 40 or so years its been open. Unfortunately the same can't be said for all hospitals - and I know in some cases, a bad outcome could not have been avoided anyway, but there are also dreadful cases where babies are damaged by forceps etc which may have been used because the mother had an epidural..... the classic cascade of intervention.

You midwives in the MLU will be experts at dealing with labour. You won't be interfered with by doctors, or encouraged to "hurry up" (wtf?!) or to have all sorts of interventions which aren't a medical necessity. Your midwives will be able to spot very early on if there is anything untoward in labour, but tbh, everything is highly likely to be absolutely fine, and you have a far greater chance of delivering your baby naturally than you would in a hospital.

The other thing to remember is that where women do transfer from MLU to hospital, its often because they decide they want an epidural (apparently this is the same with transfers where the woman had intended a home birth). The problem is that the statistics are just lumped together, so people end up thinking "Gosh, hundreds of women end up being blue-lighted to hospital, it must be so risky!" The reality is that most of these situations won't be a medical reason, and certainly not an emergency, it's simply that the woman has changed her mind and wants more pain relief. It would be far more helpful if information were more widely available about the reasons for transfer.

Honestly, I think you'll be so chuffed to have your baby in a non medicalised environment - it was the best decision I made with my first baby. Sadly I didn't have the option with dc2 and 3 (CS and VBAC) but at least I have my memory of a completely natural first time, just me, DH and the midwife.

I had DS in a MLU 11 days ago and can't recommend it enough. He was my second, DD born in the same place when it still had doctors on site. This time was so much better, everyone was so relaxed and confident that I never once felt panicked or concerned in anyway. The mw who was with me throughout was absolutely lovely and with me all the time which was fab, it just felt so much more natural, I don't know if being in the MLU made a difference but my labour took just 2 hours and I had no tears so no stitches and have and exceedingly chilled out little man.
Good luck whatever you decide.

Totally agree with Orange. I would put no forceps in MY birthplan and did both times, as would most Docs I know. Ventouse is ok when mum too knackered to push and baby just about there. Unless there is a dire emergency I would not let any person put those near my nether regions let alone on my precious little babys head/ neck.Totally barbaric unless a matter of life or death.

I was booked to have my first in an MLU, and had a very good experience. Was well looked after in a comfortable environment with very supportive mw. After several hours the mw's changed shift, the new mw did an examination, panicked, thought my baby was breech, and I was blue-lighted to the local hospital half an hour away. I say this not to frighten you, but to reassure you if that makes sense, because dd was born some 12 hours later (so wasn't in imminent danger) and wasn't breech after all. I think at the first signs of anything being untoward, you'd be transferred, just like if you were at home for a home-birth. I was upset/frightened/panicking was I was in the ambulance, because they wouldn't let dh travel with me, and I was convinced I'd be whisked to have a CS as soon as I arrived, but in actual fact it was very calm, dh arrived, I was examined, and it was decided that as dd wasn't breech after all, I'd carry on. Unfortunately the classic cascade of intervention happened, as I was offered syntocinon to 'speed things up' then couldn't cope with the pain. I found that labour very traumatic for those reasons, and for dc#2 and 3 would have loved to go to a MLU but wasn't 'allowed' because of concerns about PPH (ds) and Group B Strep (dd2). However, with a cast iron birth plan, and more realistic expectations, I managed to have my ds and dd (9lb 13 and 9lb 14 respectively) on the consultant labour ward with no intervention. So - go for the MLU, and don't worry, they will look after you. All being well you'll have your baby there, but if they do want to transfer you, try not to panic - they tend to be very cautious and will transfer you early on if things aren't progressing rather than wait until some last minute hitch. Good luck!

If there's any risk, they'll transfer you. It's extremely rare to go from no signs of there being anything wrong at all to needing a crash section. Most "emergency" CS's aren't crash sections and there is plenty of time to get you to the hospital (whilst prepping the theatre team) - or to prep the theatre team if you're already in hospital!

Here's what the midwife at my MLU told me when I had similar concerns:

If you're in hospital, or an MLU within a hospital, and they think something might be wrong, they'll monitor you for a while and it will take at least 30 minutes to transfer you to the consultant ward to find out what's up (if anything).

If you're at the MLU and they suspect anything's up, or your labour is taking too long, they'll transfer you immediately - 15 mins in the ambulance - and ring ahead to the consultant ward so you're already booked in when you get there.

Also, 1 in 3 babies has the cord wrapped around their neck at birth and it usually does no harm as they're still 'breathing' through the umbilical cord. MW just whips it off and it's fine.

If there was an unusually high incidence of women/babies dying or suffering avoidable complications in MLU, they'd have been shut down by now!

HTH and best of luck - hope you have the calm and lovely experience you're aiming for and a beautiful, healthy baby at the end of it