DC3... opinion: midwife led unit (no drugs) or hospital??

[Thirstysomething]

Having DC3 in a new area. Had previous two in birth centres with water births and entonox... Long hard births, but straightforward and it was reassuring that the centre was right next door to the main hospital.
This time the unit is 20-30 mins in ambulance from the hospital.

Midwife unit:

• PRO water birth available
• PRO much quieter and more relaxed
• PRO much more one on one attention
• PRO they are v careful and will send for ambulance to take you to hospital at first signs of trouble
• CON have to get in ambulance for 20 mins plus if anything goes wrong - scary??
• CON no doctors for stitching (I tore previous times and was badly stitched by midwife so consider this a downside)
• PRO much nicer recovery unit and can stay in for a few days
• PRO closer to home

Hospital:

• CON no water birth facilities
• CON crowded and frantic
• PRO obviously much better facilities if anything goes wrong, theatre is in maternity unit
• PRO can have epidurals etc if necessary
• PRO midwives and doctors who will stitch tears
• CON further from home
• CON wards crowded and not v relaxing

sorry, didn't mean to post without saying, anyone have any thoughts? Just love some feedback and thoughts, it is going round and round in my head and I am due any time now!
thanks

I think its up to you. The recent research shows that for non-first low risk births the most dangerous place to be is hospital, however....

really? interesting...
mainly worried about the baby's health actually -- suddenly paranoid, what happens if he gets stuck? or his heart rate suddenly drops totally etc, and we aren't at a hospital... scary! oh idon'tknow, idon'tknow idon'tknow... going round in circles!

How far is each from your home?

Hi, I had very similar with DD2 - had DD1 in MW led unit with full hospital back up and v nice waterbirth so no need for back up - but liked knowing it was there. We moved before DD2 was born, so choice was MW unit without back up and transfer in the event of problems (you don't live in Bucks, do you?) or go to MW unit at hospital with back up but run the risk of it being really really busy and not have a positive experience.

I went for a homebirth in the end - was a bit dubious about it but it made the logistics easier and it was great - am planning the same for DC3 in March. Part of the decision though was that it is probably quicker to get to the main hospital from my home than it is from the birthing unit - and I also thought that having a MW with me throughout would mean that any potential problems would get spotted more quickly. They monitor you very closely. I had stitches from MWs with both labours and they've been fine both times.

Not sure if that helps or confuses you more, but that was my experience. I do have to opt for one of the hospitals this time though and am going for the MW led one - there is always a chance of having to go in if there are no MWs available but I think, based on my HB, I'd be quite comfortable with that.

Good luck to you!

thanks, that is helpful. Now I am considering the whole home birth thing, but think I have just left it too late - my due date is before Christmas and I was early with the other two! So think it is a choice between the two away from home places. Midwife led unit is about 20 - 25 mins away and hospital is about 35-40 mins.

I was going to suggest homebirth too! As long as you aren't contracting, you've got time to book one! Just get on the phone now and get them round to do a visit. Rotas, etc are no excuse!

Home to hospital sounds about the same transfer as MLU to hospital (remember, they'd blue light you in a major emergency).

On the stitching, homebirth midwifes should be good because they are used to not having a doctor to call on!

brettgirl2 is right.

For low-risk women having a second (or subsequent) baby, the least safe place to have your baby is hospital, followed by MLU and home is the safest place.

For low-risk women, the chance of having intervention is lowest at home, followed by MLU, followed by hospital = "Planning to birth in an obstetric unit (hospital delivery suite) results in a 40% chance of delivering with obstetric interference ? including C-section and instrumental deliveries, this chance decreases to just 10% in homebirths" (quote from Four Mums blog based on Birthplace Study data released last month).

Certainly something to think about.

And it is never too late to decide you want a homebirth - some women don't make the decision until they are actually in labour and on the phone requesting a midwife come out to them rather than them travelling to the MLU/CLU. There is no need for them to do a home visit to see if your house is suitable, nor do you need to 'request' a homebirth and get permission to have one.

However if you are certain it is MLU or CLU, I'd go for MLU every time. The MWs are trained to deal with emergencies and will be well versed in transferring women to hospital in the unlikely event that you would need to go.

Fliss - totally agree with your post. Just to be clear, what I meant is that, if you were in labour, you wouldn't be 'booked' for a homebirth. Obviously waiting until you are in labour would be possible, but definitely inadvisable as you stand a greater risk of pressure to come in/staffing issues because they aren't expecting you/them saying they will send an ambulance, etc etc. Not something you want to argue over if you can avoid it!

With your history you're definitely better off with the MLU. I really can't see a single advantage to hospital for you except maybe the better suturing! But no, definitely not too late to consider home either!

thanks! as you can probably see from my first post I was leaning that way (MLU I mean)... just having a wobble because feeling paranoid about what happens if something goes wrong, eg baby stops breathing, gets stuck etc...

Absolutely Secondtimelucky - it was a X-post :)

Anyone wanting a homebirth should get on the blower sooner rather than later so staffing etc can be sorted if possible, but I just wanted to illustrate that even an on the spot decision isn't too late

Fliss - Great. I do sometimes worry that I post things and they aren't as clear as they should be. Tis not unknown for me to talk utter gibberish .

Thirtysomething - is there an opportunity for you to go & look around the MLU & have some of your questions answered by the MW's there? They must have protocols that they have to follow for all of the scenario's you mention. It might make you feel better if you knew that they had plans in place 'just in case', and what those plans were?