confused: labour ward or MW led birthing unit? Also: hands on / hands off midwifery?

[vezzie]

I'm 39 weeks pg with dc2.
dc1 was born at home, in water, and I had a 3rd degree tear (repaired in hospital, healed perfectly). dd was 9lb 1oz. This baby is scanning smaller (but we don't know when it will come of course)

I was told this time at the very beginning that following the tear I would not be allowed to have a home birth but it was suggested that I go to the MW led birthing unit attached to my hospital. This is what I wanted to do.

Today I had an appointment with a new doctor I hadn't seen before (standing in for the consultant I am supposedly "under" but have seen once for 5 minutes) who said things I had never heard before:

I should not go to the MW led unit because if the MW who attends me is trained to be "hands off" (as opposed to "hands on") I have a 50% chance of a 3rd degree tear again as there will be no doctors to intervene.

They will very likely want to give me an episiotomy (this directly contradicts what the consultant said: he said tears are preferable and heal better. This is the same hospital and he is this registrar's boss: )

this to me sounds like the sort of situation - lying down, feet in stirrups, ready to be managed by doctors - that leads to mothers getting distressed, babies getting stuck, forceps, maybe worse, etc. I really wish I could have a birth like dd's: calm, private, relaxed, one to one care, happy alert completely unscathed baby, agpar scores 10 and 10, feeding within 5 minutes.

It is my decision what I do but I feel that suddenly this very anti-MW led unit view has come out of nowhere and I am so confused. I don't want to tear again, or tear worse, and I think it would be stupid to go against advice on this; but on the other hand, a calm and happy birth, upright in control and with a strong happy serene baby at the end, would be so lovely. I found dd's early weeks a lot easier than some of my friends - no ventouse bruises, easy feeding, good sleeping for her; no weird infections for me.

Every time I go to hospital, people are missing, other people bark irritated questions at me about where people or things are that I can't answer, I never know anyone's name, I am always hungry or freezing or thirsty for hours, people barge in and out of rooms while you are taking your knickers on or off, I am immobile for some reason and completely lost. That is ok if you are just having stitches or something but I am not sure I can bear having a baby under those conditions. I'm afraid I'm going to freak out in some way, I am getting tearful thinking about it.

Now I have to decide fast!

Can anyone say anything that might help me see this more clearly? In particular can anyone tell me more about this "hands on / off" distinction with MWs because this seems to be extremely important to the doctor I saw today and I had never heard of it. She said if I go to the birthing centre I must ask the MW who attends me which she is and ask to go to the labour ward if I don't get a clear answer, or if she says "hands off"?

thank you for any help anyone can give

Have you heard of these?

here

Only a small study - effective?

Thanks everyone. I did phone the MWs today and talked it through with someone which has already helped and she has arranged an appointment for me next Tuesday - on my due date, so let's see if I make it! - at which she advised me to say exactly what I said to her and be very clear about what I want, ie a recommendation for my care which I understand and agree to written clearly in my notes.

It is actually very annoying and worrying that I don't have that already when the appointment I had yesterday could and should have been my last. I don't quite know how I allowed myself to be fobbed off like this.

Thank you to everyone for all your help. I am going to ask for:

MLU;
carefully guided pushing stage as explained by Viva;
Water as pain relief if possible but not a water birth;
No episiotomy except in case of foetal distress.

And ask for this to be written down clearly.

Spudulika - that looks interesting if scary but I don't think I will order one as it's a lot of money for a 2 - 5 day postage and I might have a baby by then! I'll be using the thumbs and the olive oil I think tho.

thanks again for everyone who contributed to this, it has really helped me to have people to go through it with.

Vezzle, coming late to the party, but I felt for you so much. I can't comment on the medical issue-am expecting my first-but I can relate to the mad doctor experience.

At 31 weeks, my community midwives sent me to see their consultant to get the go-ahead for a home birth, as my BMI is over 30. I was assured by them, and other women I talked to, that the consultant was extremely supportive of home birth and it wouldn't be a scare session, just routine procedure. I have SPD but have otherwise had a problem-free pregnancy.

I ended up seeing what I think was a registrar in the consultant's clinic and she was completely mad! I was lucky that I'd read up and knew what I wanted and what the facts were, because despite assurances I was prepared to defend my choice. She told me first that I didn't want a home birth, surely? Then said no, because as I have SPD, I'd have to have an epidural. I said that my understanding was that I should AVOID an epidural if possible with SPD and that labouring in water would be much better and safer. She replied 'ah well, you'll have to come to hospital then, as I couldn't have my baby in my bath. By this point, I was close to laughter and pointed out I intended to hire a birth pool. She had never heard of that possibility-this is an obs doctor at a leading teaching hospital-and asked how I could do that and what it cost. She signed me off for home birth in the end 'if it's really what you want'. Everyone I've told has been goggle-eyed, especially my midwife.

Sorry, very long, but point is that doctors don't know everything and if your consultant is happy, and you felt comfortable with that decision, don't let some other doctor upset you like this. Good luck next week.

Can you go and speak to the head midwife at the birthing centre? I'm sure he/she will be able to answer your questions, and hopefully more sympathetically than the consultant. Midwives are trained professionals - they're not going to do anything that would put you at risk.

Just wanted to say thank you to all who contributed to this thread, especially to Viva and Selina.

My dd2 was born on 15 April in the MLU. Absolutely brilliant midwife, one to one care from when she came on duty at 8 till when the baby was born just after 10. Gas & air, water, carefully guided pushing and a 1st degree tear - everyone home 5 hours later. And plenty of tea and toast!

Thank you so much to everyone who gave the confidence to follow my instincts and write a really clear birth plan based on them.

I'd call and ask to speak to the consultant and explain your worries about the opposing views given to you by the other doctor. He should be able to spare you 5 mins for a telephone conversation at late notice. Good luck x

Vezzie - congratulations on the safe arrival of your daughter. Sounds like a lovely birth experience :)

fantastic

thanks for the update and congratulations

Fantastic news! Vezzie Congratulations!
Really glad it all went so well for you!
S x