Midwife Unit vs Labour Ward discussion with Midwife

[BalvenieQuine]

Hello lovely ladies, hoping you can give me some advice...

I am 24 weeks with my first and had a midwife appointment yesterday. My usual midwife was off on holiday so I saw a different one who was covering for her. She was asking if I had though about where I wanted to give birth and I said I hadn't decided yet, but as I am thinking about an epidural it may be the Labour Ward. She looked at me quite disapprovingly and said, "The midwife unit is much nicer and if you NEED an epidural you can always be transferred to the labour ward". (NEED? What happened to it being my choice?! I wouldn't get a tooth removed without an injection at the dentist!). I didn't get into that though and just said, I am still thinking about it and haven't made my final decision.

I was looking at my Pregnancy Record last night and she has written in the comments, "Will go to Midwife Unit, may be transferred if requires an epidural". I am so angry and actually quite upset that already I am not being listened to. This doesn't set a good precedence for the actual birth if I am already being treated like an idiot.

I have pretty much decided now that I want to be in the labour ward from the start so that I am not tricked out of an epidural. I have a bad reaction to opiates so do not want morphine or pethidine. I also have a mild heart condition (which will not prevent me from getting an epidural), but want to avoid any added stress of being transferred in case there are any complications.

I am going to put a line through what she has written and write my own comment about this being a brief discussion only and that nothing was agreed. Should I make an adhoc appointment with my usual midwife though just to address this or can it wait until my next appointment? At what point are you "booked in" to the midwife unit or labour ward?

I'd wait until your next appointment, but definitely write in your notes that your MW didn't accurately record the outcome of your discussion.

AFAIK you can just turn up at the labour ward on the day and they'll accept you, so you don't necessarily need to 'book in'.

Thanks Flisspaps. I'm maybe just overreacting but I am really annoyed! Good to know you can just turn up on the day.

Do you know that an epidural contains opiates? So if you need or want to avoid them, you will need to avoid an epidural.

Did you know that the recent birth place study shows that for a healthy woman with a healthy pregnancy, stepping foot into a consultant led unit more than doubles the risk of having a c-section.

You may find that the pain of labour is nothing like the pain of having a tooth removed - contractions come and go, there are periods of rest and it is finite and there is a baby at the end!

I agree that the midwife should record your discussion accurately - they are your notes, change them!

I had my 3rd in a MLU & it was a lovely experience. That being said, however, it is entirely your decision re pain relief, & if you need to be in a labour ward for this to be an option, I would definitely go there.

I agree it is rubbish that she didn't record your conversation accurately. Mine used to tick the boxes saying we'd discussed things which we never had!!

She definitely shouldn't have written that in your notes, so I can totally understand why you're very annoyed.

Have you had a discussion about the impact of your heart condition on your pregnancy and any risks this may pose regarding labour?

Snowsquonk - I always worry about statistics like that. But that's because whilst I was given birth in a birthing unit I had to listen to the piercing screams of a woman trying to give birth "naturally" to a child who unexpectedly turned out to be breach.

Having had a midwife led delivery in a lovely labour ward and also given birth in a well respected MLU without a shadow of a doubt I would chose the hospital.

OP-Definitely get your notes updated to reflect your wishes. Don't rule out doing it without an epidural though, you might surprise yourself!

your epidural doesn't have to contain opiates. you can have a plain bupivicaine bag, but make sure that you discuss that with the anaesthetist and have it documented. although, as already said, you may find you don't need one.

that is appalling of the midwife and you should discuss it with either the head midwife or your own midwife. really, though, you shouldn't amend your own notes, unless it is agreed as part of your care plan/unit policy that you can write in them, as they do reserve the right to take your notes back to the base unit, if they are 'defaced' - (i know you would not be defacing them). if you do decide to cross it out, use a single line so that it is clearly readable underneath. let another midwife amend them and write why this has been necessary.

missing Just out of interest, who/what says you cannot write in your notes? There are regularly posts on here recommending that women add their own comments or point out errors in the notes written by the medical professionals, it's something I do regularly in mine and not one of the MWs has ever commented on me doing so.

completely your choice of course but you MIGHT NOT "need" an epidural at all.

I gave birth with just a TENS machine (on level 4).... I didnt "need" anything else at all, not even G&A....

Its not always as bad as you might imagine, though if you are certain in your mind that it will really really hurt, it probably will.

I was very lucky as my labour / birth really did not hurt much at alll..... breast feeding certainly did hurt though, much more than birth for me.

If you've got a mild heart condition will you not need to be consultant lead? I have epilepsy and the wouldn't let me go to a birth centre,
And being transferred during labour would be a nightmare, but it's 100% your decision they can't make you do what you don't want too, just advise what they think is best.
I didn't need anything during labour, so you might not need one, my midwife was extremely pushy and really opinionated. Twunt.

Lunarose - why do those stats worry you?

These are the findings of the Place of Birth study that's only just come out - it's a really well structured and comprehensive piece of research, and midwives should be referring to it when they have the discussion of place of birth with women like the OP.

KateSpade - transfer isn't usually a 'nightmare' at all! I've transferred in from a homebirth in labour, as have many women I know. It's very rare for women to regret their initial decision to opt to give birth out of hospital, even if they end up with a blue light transfer. And transfers from AMU are even less of a pfaff usually. In our local hospital a woman only has to walk/be wheeled 20 yards from the birth centre to reach the labour ward. Hardly a big deal!

OP - you need to decide what your priorities are: having a normal birth or having possibly easier and quicker access to an epidural. (not that you can guarantee immediate access to epidural on labour ward of course...)

If having easier access to pain relief is more important to you than having one to one care and a normal birth, then your best bet is the labour ward.

If having a normal birth is really important to you then you're about twice as likely to come through without needing surgery if you're in the birth centre.

Thanks ladies for your comments (and loving some of the usernames by the way :)). I have calmed down now after talking through with ranting at friends and family. Interestingly, a friend who has recently been in both the MLU and the labour ward at the local hospital described the MLU as 'minging' and found she actually got one to one care in the labour ward whereas she had been pretty much left to her own devices in the MLU.

I have neatly amended my notes and will talk it through with my usual midwife when I see her in a few weeks' time. Personally, I think I will be happier in the labour ward.

@Snowsquonk & nannyl - I appreciate where you are coming from but I am really not the 'grin and bear it' type! I'm pretty certain I want the epidural and I want to be 'in the room' rather than being completely out of it - as I know I would be on morphine. Perhaps if I have another child I will take a different path, but this approach feels right for me for my first birth.

@thefurryone and KateSpade - yes I have seen the consultant and have another ECG lined up so they are keeping a good eye on me. I suppose, depending on the outcome of that, they may well want me in the labour ward anyway. Funny that hadn't occurred to me .

good luck with you birth

i didnt grin and bear pain though.... i didnt have pain to grin and bare

I was a homebirth so only had G&A and pethidine avaliable but they wernt used cause it didnt hurt.... I had every intention of using them and my birth plan was to use them..... but actually it wasnt necessary for me at all.

I wanted to give birth at home and hire a pool, but that was a terrible idea according to the doctor.

I just would have thought being in the middle of labour and someone saying oh, right get up we're taking you somewhere else would be annoying, but clearly I'm bring crazy by thinking that

"I just would have thought being in the middle of labour and someone saying oh, right get up we're taking you somewhere else would be annoying, but clearly I'm bring crazy by thinking that"

Well - speaking as someone that this has happened to, it really wasn't that bad.

If things are going badly in labour NOTHING that's suggested for you to do to resolve the situation tends to be 'fun', where ever you happen to be.

Thanks nannyl. I'd be delighted if I don't need any pain relief...oh to have a crystal ball eh? :)

@KateSpade - I've heard of some transfers being a bit of a nightmare. At my hospital, the MLU is close by the labour ward so I don't think it would be a problem. I'm just not getting a warm glow about the transfer option or the MLU. I'd rather be in the labour ward so that if there is any drama I'm already there and don't need to be raced round the hospital!

flisspaps - that's why i said "unless it is agreed as part of your care plan/unit policy that you can write in them" because some places are fine with that, but some places, they are treated as medical notes (which normally, you have to go through quite a process to get to even read) and for passing info between hcp's; you carry them with you so you don't have to fanny on explaining things to every different hcp you see. mine actually say that on them. for the most part i think they wouldn't make that much of it. the sad thing i think here, is they should be an accurate record and it is dreadful that the mw couldn't do that, and they had to be amended in the first place. i'm shocked that the suggestion is they need to be amended so often by so many people.

That's what I thought, just incase your already their. Where I live the birth centre and the hospital where you can give birth in, are about an hour away from each other.
Now that would be annoying!

Depending on where you go you may not have a choice - I know at least one hospital where if you are low risk you go to the midwifery led ward (if you want an epidural you are transferred when you ask for one, but you can't start downstairs on the highrisk unit 'in case' you want an epidural - 1 floor down) that doesn't sound like that it is the case though as otherwise why would she have written it

iolas that's pretty much what they do at my hospital as well. The maternity unit has an MLU on one floor and a CLU a floor up. One of my ante-natal group friends expected to want every drug going but ended up with a very calm water birth.

Missing, two pregnancies I have had to change the due date on my notes coz the one they had decided on was just stupid.

OP, don't make the mistake of thinking that just because you are in a CLU you can ask for and get an epidural. Many units can only cope with x number at a time and you may not be one of them even if you beg.

Entirely up to you where you want your baby it's your experience. When I was pregnant I was adamant I wanted to be in labour suite so I could have epidural so when I went into labour and went to hospital I went to labour suite . I was admitted as I was in established labour at 9 in the morning. I asked straight away for epidural as I wanted to make sure I got one . I was told that I was only in admissions ward as labor suite was full so I would need to wait until labour suite had a bed! They gave me gas and air eventually after been giving 2 empty canisters first(long story) a doctor eventually put my drip etc in for my epidural and told I was 2 nd on a list!!!! At 9.15 at night I was still waiting for a bed and still no epidural and I had never been checked on again since 9am ! My partner insisted someone came to see me they told him I was doing fine but he insisted they checked me as he could see my discomfort . Midwife took seconds to check me and she realized I was fully dilated and ready to push . There was complete panic between me and my partner and the midwives I was put in wheelchair and rushed out the ward and straight to midwife unit where I delivered my son less than 15 minutes later!! I found labour suite midwives poor and uninterested whereas in midwife unit I was looked after from when got there until minute I left. However they are against epidurals and it's like they hold it against you if you would like one! So the choice is yours x

I live quite away from our labour hospital

a good 45min drive but (alot) more at peak time.
it has a midwife unit and a labour ward

our local hospital about 25min drive away has just a midwife unit and they transfer you by ambulance if you need / want anything else.

i have a midwife friend who works on the midwife unit in the same hospital as the labour ward.

basically if you are in the other midwife unit the 'head midwife' (or whoever it is) has the final say, and should you want / need anything you WILL be immediately transferred by ambulence to the labour ward, in other hospital

If you are in the same hospital, there is someone higher up who can over-rule and say "sorry no beds yet" and make you stay there for a while until they have space.

the reality is, (at some times), it can be much quicker to transfer by ambulence from a different location, than to take the lift up-stairs, because someone can say no to that.

just food for thought really

starlight - that is poor; why didn't you tell them that and ask them to change it to a more realistic date? and on what basis did they have the stupid one down?