Birthing unit versus hospital birth- thoughts on safety?

[Londonmrss]

Hi, sorry if this is something which has been discussed before, but I am looking for advice on the benefits of midwife led unit versus a hospital.
The NHS birthing centre near me looks absolutely lovely, with individual rooms, each with a double bed (so your partner can stay with you), pool, private bathroom. It?s completely midwife led and as such has gas and air piped in, but that?s it. You can only give birth there if everything is 100% uncomplicated at 37 weeks- no breech, no blood pressure issues etc.
My concern is not the pain relief, as the hospital is a 10 minute ride in an ambulance if you wish to transfer for an epidural or if the baby is becoming distressed. I?m just wondering what would happen if the baby?s cord was around the neck and it need oxygen or something similar. I assume they would have some basic facilities to deal with that, but obviously not a full neo-natal dept.
Basically I?m less bothered about my own safety as a transfer would be fine if necessary- I just want to be completely sure it is safe for my baby. Am I being super paranoid?
Does anyone have any experience / opinions? It looks like such a lovely place to give birth.

The hospital will have more medical facilities and staff available than the birthing centre, so if you are getting worried about emergency responses then I'd go for the hospital option.

Disclaimer: I'm one of those weirdos who actually feels safer in hospital because I know that all the doctors are there, so my opinion is somewhat biased :)

I have also given birth once (in hospital) and it was fine. I had a 3rd degree tear and so had to be stitched up in theatre immediately post-birth; they just wheeled me down the corridor and sorted me out, which was nicer than an ambulance ride I imagine!

statistically MLUs generally have absolutely no higher rate of 'sreious adverse outcomes' than hospital for babies.

and less than half the C/S and forceps rate for the mother.

this may vary from individual unit/ hospital obviously,

It sounds like this particular birthing centre doesn't offer C-sections, so I wouldn't be surprised if the rate is rather low!

The midwives role is to work closely with you to ensure everything is progressing as it should, so many issues are resolved with a run to hospital before it comes even to a problem. As for problems, it's well worth asking this of the unit you are considering, how they deal with such instances. The unit I went to had a resucitation area for the baby, and were well trained in such issues as cords wrapped around neck. It gave me a lot of reassurance after they explained what training and measures they had in place

I have to correct you here though Herrena - if the mother started at an MLU and was transferred for a CS it would still be included in the MLU stats. (This is also why you get CS rates for home births - it's not because anyone is doing a CS on the kitchen table.)

Herrera - the c/s rate for birth centres reflect the numbers of women who labour there but end up transferring to hospital for a c/s.

Whoops cross post!

Ah, I did not know that. You learn something new every day!

I had a midwife watching me carefully during labour... as DS came out rapidly with his arm over his head and I tore to the extent that I needed surgery. To be fair there wasn't anything she could have done. My point is that sometimes unpleasant stuff happens even if you are being closely monitored and when it comes to fixing you up afterwards, it's nice not to have to travel to far.

Just realised I missed the bit of your post that says 'issues are resolved with a run to hospital', littleweed10 - whoops!

I think I should get off MN for the evening, I am clearly too tired to have a rational conversation.

Hope some of this has been helpful op :)

Thank you for the advice ladies.

Included in their statistics are the percentages of women who do end up being transferred- about 25% for first timers (this is my first) and slightly less for second, third etc births. Those transfers are mostly for epidurals in the case of a long and tiring labour.

I think I will talk to them in depth at littleweed suggests. I really want reassurance that they are trained and equipped to cope with anything that might arise last minute, and that anything that would cause a bigger problem would be picked up by their monitoring process well in time to get to hospital (ie if the cord is round the neck, it's likely to be loose. If it's tight and causing a problem, the fetal monitor would pick that up before actually giving birth and in time to take whatever action is necessary).

Obviously the most important thing is safety, and if I don't feel absolutely safe then that 'perfect and relaxed natural birth' I keep imagining will be a lot more stressful, and I might as well not bother with the lovely birthing centre anyway.
Hmm, I love how these threads can clarify a thought process like this!

Thanks

The way a newborn would be resucitated is exactly the same regardless of location - so home, MLU or CLU - it's bag and mask. In fact at my local hospital the resucitaires used oxygen and this is now a no-no because it can caused oxygen toxicity.

The whole time a baby who needs this kind of help is being treated, the ambulance would be arriving to blue-light the baby to the neo-natal unit.

Most problems with a baby or mum become apparent during the labour and a transfer would be recommended.

The most recent piece of research about place of birth was unequivocal about the safety of birth in this country - with a MLU being the place where both mum and baby are safe and interventions are lowest for first time mothers. Home being the safe and the place of fewest interventions for second/third etc mothers.

London

re transfer - alot of ladies on the previous home birth thread have said they walked very easily to ambulance re transfer, when i was in labour - i couldnt even walk to the birthing pool even though it would have prob eased my pain a little! I couldnt even move my foot - i got stuck on this birthing ball and it somehow was going under the bed, and my foot was on its side - not only couldnt i move my foot myslf to make it flat - i couldnt even bear for my Dh to touch it to move it....There was no way I could have transfered anywhere in that pain, ( i had pethadine, gas and air - and homeopathy oils, massage....balls....and a 6 hour labour with 23 mins pushing, no interventions - textbook according to MW and more like a second labour according to consultant).

if you are getting worried about emergency responses then I'd go for the hospital option.

Midwives - whether they do homebirths, work on MLUs or in a hospital, all must be up-to-date in all emergency procedures including resuscitation of the newborn. They are not allowed to practice without being updated every 12 months (at least). And tbh MLU staff are likely to be even more on-the-ball about this stuff simply because they know they can't pull a buzzer and have a room full of doctors in 2 seconds flat!

A cord around the neck is very rarely a serious issue; the vast majority of babies deliver quite happily through the cord and, as you say, if the cord is very tight it will usually show up in the heart rate and necessitate a transfer anyway.

The Birthplace survey is very clear on the fact that MLUs are safe for first-time mums. Poor outcomes occur in hospitals too - going to hospital is not a guarantee of safety and your risk of intervention is higher than in an MLU. If you are low-risk and like the idea of an MLU, I'd say go for it!