What level of care did you received in hospital for labour/birth?

[Tangle]

My personal experience of labour and birth has been to use an IM, which has given me 1 to 1 care from a known MW throughout labour and birth. For various reasons, we might wind up planning a hospital birth if we have any more DC and I'm trying to get a feel for what I could expect if that were to happen.

I've read a lot of stories from women who seemed to barely see a MW from when they were admitted until they got their birth partner to call the MW as they had an urge to push (or until they called the MW as their birth partner had been sent home). But I'm also aware that people are far more likely to shout about their experience if it was bad - and particularly if they found it traumatic. I know that the level of care for any given unit will fluctuate with the number of women that walk through the door on any given day and how complex their births become. But what I'd like to get a more realistic sample of what level of care is "normal" in British hospitals in 2011.

My ideal hospital birth would be to be able to take my DH and IM (acting as a doula) with me for the duration. I'd like one MW who stayed, broadly, with me throughout to keep an eye on how labour was progressing and monitor the baby using intermittent auscultation. I would like to be left in peace and quiet - not interacted with (based on how I've laboured before). I'd like no VE's unless there was an indication of a problem.

I'd appreciate it if people could give me feedback on the level of care they received so that I could try and work out if what I would like is even on the spectrum of "possible" and, if so, how close it is to "normal".

TIA :)

I only have a sample size of 1 but I couldn't fault my care during labour and birth in a fairly run down maternity unit (no midwife lead unit, small rooms, no ensuite etc). I had a midwife with me almost all the time, although there was a change of shift towards the end of my labour so it wasn't always the same one.

They did a VE on admission, which I think all NHS units will do as there is no space to keep women in very early labour so they have to check you are at least 4-5cm dilated. Then they did one every 4hrs to check progress, which was fine with me but I expect you could negotiate on the frequency of these.

I also wanted intermmitant monitoring but BP was high on admission so it ended up being constant. I wanted to be as mobile as possible so they brought in a stool, bouncy ball etc so I could at least be upright and keep changing position. It all went wrong for me at the end as baby's HR plummeted and was rushed to theatre for spinal and assisted delivery. However despite all this I feel I received excellent care throughout labour.

I have no idea how they would have been if I'd wanted more than one birth partner as, as I said, the delivery rooms were very small.

One thing that I don't think people focus on much before the birth is care on the ward afterwards. In my experience, and that of several friends in a variety of hospitals, this is often pretty ropey. I found the ward to be so busy that unless you made a real fuss you got no help with anything. I had to practically beg a nurse to look at my episiotomy wound, another to help me with my first ever nappy change, and press the call button god knows how many times if I ever wanted help trying to feed DD. Oh and getting any sleep? Forget it!

I have a sample size of one too.

We booked for a homebirth but had to transfer.

When we were at home I had 2 VEs over the 14h to try to assess progress, because they were worried about meconium in teh waters. In the end, when we transferred, the midwife came with us & stayed with us - this was about 12pm till 4am. That was brilliant of her. DD ended up being a forceps baby, so yes, we did have interventions, monitoring & more VEs. But I didn't care by that stage! I do feel that I was "allowed" to labour on, nobody was getting worked up about how long I had been in labour iysim - DD was born after 26 hours of active labour. We are moving away during this pregnancy but I would book in with the same midwives again (& hopefully not have to transfer to hospital!).

I had minimal contact with a midwife when I was first admitted for induction with my son. I had an excruciating VE, and so was given an epidural when the syntocin drip was started. I had at least one midwife with me and sometimes two at all times after the epidural started as it only blocked on one side and then moved and blocked my chest. I subsequently had very poor pain control as the anaesthetist was really busy. The midwives were absolutely fantastic and really looked after me and made the best of a horrible situation. I was monitored constantly.

I had two midwives and two registrars there whilst I pushed as DS was big and it was lucky as he was born with the cord round his neck. The anaesthetist was also there which was lucky as i had a 3.5l pph and so was rushed to theatre. The midwives stayed after their shift to see me out of theatre and helped DP look after our baby. The care I received was amazing.

Post natal care a different story.....:)

I had my DD in a midwife led unit attached to a general hospital.

I only went to hospital when I was contracting every 3 mins. I did have a VE on admission, but I was perfectly happy with this (especially as I was 6cm and therefore allowed to stay!). I don't recall having any others. I had one midwife who stayed but did pop in and out. This was absolutely fine with me (in fact since I had my eyes closed for most of it, and was focussing intensly on the contractions, I didn't actually know - or care - if she was there half the time). She was only just down the corridor and I'm sure DH would easily have been able to call her, if we'd needed.

From my notes, I can tell that she monitored the baby's heart beat every 15 mins during this time. Again, I hardly noticed! She was very hands off - I clearly didn't need her, I was coping as well as might be expected, I just needed to continue labouring.

She stayed with me for the whole of the second pushing stage (pushing was 1hr 35min). My notes tell me that she was monitoring the baby's heart beat every few minutes during this time (presumbaly because the pushing was taking a while and she wanted to check it wasn't distressed). Again, she was using a portable monitor thingie.

During the pushing she was much more hands on (literally!) - this was fine with me as obviously I was desperate to get the baby out and the more help / advice / assistance to prevent tearing the better!

So based on my experience (2008, West Herts NHS Trust), I'd say that you could definitely achieve what you are looking for on the NHS.

Have you thought of a homebirth with an IM?

Thanks ladies - its good to know that I'm not completely off the radar on what might be possible.

Post natal care - if I wind up in hospital then, unless circumstances dictate otherwise, we'd plan on leaving ASAP after the baby was born. By preference I'd not go on the ward at all...

Wigeon - homebirth with an IM ticks all my "preferred care" options, its what we've planned twice before and it may be what we choose to do. But various things have happened that may change how we perceive the risks and how risk averse we are, such that we might prefer to be in a hospital environment. I'm currently under discussions with the consultant as to why she considers I'm too high risk for her to "let" me have a HB (don't even get me started :o!), but I thought it would be a sensible to get a more representative view on what "normal" care within the NHS is rather than focusing on the "I had an unattended hospital birth" style stories. I want to be able to choose home vs. hospital with my eyes open :)

Another sample size of one, but confirming the general tone of earlier comments. I had a hospital birth. Checked for progress on arrival via VE, and then every 3-4 hrs. Allowed to use birth pool, ball, etc, but of the two midwives that I saw, one was lovely and the other VERY set on how things should be done - continuous monitoring, VEs, and we had a blazing row about pethidine,which I absolutely did not want and she more or less insisted would be necessary. I was left alone quite a lot, but never for more than 45 minutes at a time, and once or twice DH did pop out and ask for some help / advice. But a friend we met through ante-natal gave birth at the same hospital two days later, and had a MW with her all the time. It was quieter day.

Can you refuse VEs on admission or the 'routine' 4 hourly ones? What happens if you do? Like the OP I wouldn't want one unless it was for a medical reason, certainly not ones for policy reasons.

I can't fault my care with either, I was only left once with my second, but this could be due to being 5 com's when I arrived with my first then going to 10 and pushing in 15 mins. And with my 2nd I arrived pushing. So I don't seem to have a big build up.

The only fault I have is that with DS I arrived 10 minuted before hand over and all the midwives have to attend so because I was pushing and babies arrival was immenent (didin't turn out to be but that's another story) they did the handover outside my room. I don't really understand why they all have to attend, I have worked in numerous jobs that require handovers and due to the nature of the jobs and the risks attatched at least 2 members of the previous staff had to stay on the ward and were not allowed to attend, can't see why this can't be done with midwives too.

Everything else I can't grumble about really.

workatemlife - see now you've encapsulated my concerns down to a T. Get the wrong MW on a busy day and you have an experience that is my version of a nightmare - but the same unit when they're a bit calmer and a different MW and everything would be fine.

peneleope58 - you have to give your consent for any intervention, including VEs. You can decline any intervention. The only way you can be forced to accept an intervention against your will is if you are sectioned under the Mental Health Act. If they perform an intervention that you have explicitly declined then, technically, it would count as assault. There's another thread running at the moment asking about VE's and the MN MWs commenting seem to be very chilled and happy at the prospect - but I'm guessing it would be very MW dependent. From my perspective, if I wind up in hospital, one of my birth partner(s)'(s) jobs would be to keep as much interference away from me as possible - including telling any over eager MW's where they can take their proposed VE's... But I'd rather that wasn't necessary.

so on admission you dont have to have a ve? but what if they send you home then?

There are times when a VE might be the best course of action. If the hospital are really refusing to admit you because you won't allow one then, at the time, agreeing might be the best course of action - but I'd imagine that if you (in the collective of you and birth partner/s) made a point of taking the MW's name and NMC number and stated that you'd hold her personally responsible if the baby were born out of hospital and unattended because they'd not admit you when you stated you were in active labour then it would take a brave MW to send you packing...

This is one of the reasons I believe in continuity of care - I felt I got so much from having a MW with me in labour who'd got to know me before hand. She could do a much better job of reading my labour because she already knew me and so had a baseline for her observations. When DD1 was born I didn't have a single VE - the MWs could see I was in labour, could see progress was being made, could see no need to interrupt things to get a measurement that would become meaningless as soon as it was written down.

Tangle I booked a IM for the hospital birth of my second baby after the appalling care I received from a hospital during the birth of my first child. It was not one thing that was wrong - 2 days of labour and 4 days in HDU (with baby in SCBU) meant I saw enough staff to decide that only a handful of them had my interest at heart. I was concerned enough about what could happen that I wanted to be near to emergency facilities, but hoped to not need them, hence my using an IM. As it happened, second baby had other ideas and made his appearance at home, quite by surprise. So I didn't labour in the hospital. I did have to transfer in for stitches (very quick birth, big baby, hand by face and an undiagnosed vaginal varicosity - just about everything you can think of to make things tricky!)

What I can say is that my IM came into hospital with me for my VBAC specialist meeting at 36 weeks, chatted to the head hospital MW, helped me construct a hospital birth plan that would attempt to ensure the best labour I could hope for, and generally gave me confidence. She also came to the hospital with me after the birth and stayed with me until after I came out of theatre, gave me advice as to how to discharge myself and was at my house as soon as I got home in order to continue my one-to-one care. I cannot recommend an IM you trust highly enough if you can get one, whether you end up in hospital or not.

Compared to my first labour, the continuity of care made all the difference to my experience. My experience of 2 different hospitals still makes me want to avoid them though.

I didn't have a VE on admission- I didn't have one until transition, because my waters had gone and they were being careful about infection. Another sample size of one, but my experiences were very good- MW was fantastic, she left us more or less alone until I was ready to push, basically, then stayed on after the end of her shift to see us through.

I've had 2 hospital births and 2 home births and while all of them were straightforward deliveries the best part of the HB's were having no interventions, waters left to go naturally and no VE.

I guess this is because it was obvious everything was progressing quickly so no need but it meant I could keep myself in that quiet, focused space and just get on with it. I imagine it would be possible to have a similar experience in hospital if you have an IM to advocate for you and if everything goes to plan.

I had absolutely fantastic care for labour/birth, which involved 30 hours in hospital (first in MLU, then transferred to del suite once the anaesthetist was available, then theatre for ventouse delivery, and then some hours in special care for ds.

I had 2 VEs, but the staff were excellent about getting my explicit consent for absolutely everything. Must have been about 50 staff encountered in all, confusingly including identical twin consultants, but couldn't fault any of them.

I had MrNC and one or two other people to be interpreter throughout - it was a bit uncomfortable for them overnight as there was only one mattress so the other had a recliner. And only MrNC was allowed in theatre for space reasons.

I think a doula is a great idea. I'm considering having one when we have another as we found that it was really difficult for DH to deal with any issues whilst being with me.

I think the main thing to remember is that if you don't ask, you won't be offered help in many cases, both during labour and after the birth. If you want the MW to be with you a lot, say so.

But check beforehand what ratio of MWs to labour rooms your hospital has when maxed out - I know that the MW who was with me in the labour room at one point also had another labouring woman under her care. It didn't bother me as I wasn't progressing (failed IoL) but it might have done I suppose.