Hospital putting me in midwife led unit so no epi available-worried!

[Manc451]

Hi, I found out this week that I'm low risk so going into the midwife led unit rather than the consultant led bit. They slipped in that that unit doesn't offer an epidural, which I was determined to have (my sister had a horrendous time and I'm terrified!). I'd at least like the option? They said that if I said so on the day they could then move me to the consultancy led bit and try to get me one then. But what if a bed isn't available at that late stage, or they try to convince me to leave it? Maybe im being a fuss and it will be easier than i think? What do people think?

I have had two epidurals and think thank god we live in an age of science. Personally I would only go to the labour ward where epidurals are available especially as key word is available so you don't have to have one there but it is the option. Don't be fobbed off with being told you can ask for this on the day if this is what you want because during labour it is hard to fight your corner and they always try to persuade you that you can cope rather than do what you actually want. So I'd say fight for the labour ward now or change hospital to one that will do that for you. Perhaps email head of midwifery saying this is what you want.

You shouldn't have to go to a midwife led unit if you don't want to. I had a low risk first birth, in a birth pool for most of it with no pain relief except gas and air in a consultant led unit, which I and my dh (who's a doctor) insisted on, despite being continuously talked out of it. However the last hour was an emergency situation and I was very very glad to be with a consultant with a pediatrician waiting for my baby to come out to look her over.

Second time around my midwife is still looking at me like I have two heads for wanting a consultant led unit, but I want an epidural if I end up in some of the horrific situations that my friends have gone through but most importantly I want fully qualified doctors around if things go wrong, and things go wrong even for the most low risk of people.

Don't be bullied.

Polkadot - there isn't a SHRED Of evidence that CLU's have better outcomes across the board for the babies of low risk women, and WEALTH of evidence that low risk women are much more likely to end up needing emergency surgery (with all the risks entailed in that) If they choose it as a setting for birth. I'm surprised your DH wasn't aware of this given the fact that it is widely acknowledged in NHS patient information on choice of place of birth

Obviously if you want an epidural or you need additional monitoring (because you are considered 'high risk') then you head for the labour ward, but it needs to be acknowledged that there is no evidence it is safer for healthy mums than a birth centre.

Would add, just checked on Birthchoice site. According to the Quality care commission survey only 2.5% of women gave birth in birth centres in 2010. Fewer than had home births. The OP's situation isn't common.

Polkadot, the irony is that when it comes to childbirth, having doctors around somehow appears to make things go wrong.

It depends whether the OP values a pain free birth over a straightforward birth. You are about twice as likely to have a birth that doesn't end with you lying on an operating table if you go to a birth setting which provides midwife led care and where epidurals require transfer.

The reason things went wrong in my dd's birth was due to the midwives. I was just very glad to have doctors there who took control of the situation and meant a positive outcome for my dd. I totally accept that this is not everyone's experience, but this is what happened to me.

It's about choice, not being bullied into something. I choose to give birth where I feel safest. Everything I have experienced tells me that low risk just means nothing bad has happened yet, and if something goes wrong I want to be where I can get help.

Polka - if you have a birth attended by midwives in an MLU - whether freestanding or attached to a hospital you CAN get medical help if things become difficult. It is wrong to suggest that this is not the case. If it weren't so then outcomes for babies whose mothers labour in these settings would be worse than for babies whose mums opt to go to a CLU.

I accept though that many people feel safer in obstetric settings, despite the being no evidence to suggest that they actually are.

Do low risk women report a better experience in MLUs or CLUs?

Only I would never go to a hospital MLU again.

It's not all bad surely? Just seen this theconversation.com/weve-become-blind-to-the-risks-of-having-babies-by-caesearean-14067

The term low risk isn't that helpful. Being "low risk" is just a physical categorisation based on age and health statistics. It doesn't take into account how women think or feel. If a woman feels more comfortable and safe in an obstetric unit, I think she's more likely to have a positive birth experience than if she's feeling scared and in pain in a MLU.

I am the opposite to you, I am desperate to stay 'low risk' and get a place in the MLU attached to my local hospital.

I would be very pissed off if I ended up on the labour ward because somebody like you who WANTED to be in the labour ward is taking a MLU place.

It should be about choice so talk to them again and tell them you want an epidural (if that's what you want).

My, very personal, choice is that I do not want an epidural unless I have either an induction or bad positioning.

OP How are you getting on? Have you had any luck?

Have you read the Birthrights leaflet that Mumsnet have put at the top of the links?

You have real grounds for complaint if you are forced to go to an MLU. Why don't you write to the hospital with a letter of complaint to Patient Liason?
Here is the link: www.nhs.uk/Service-Search/Patient-advice-and-liaison-services-(PALS)/LocationSearch/363

Good luck and stick to your guns - gut instinct is usually right

These things are always about evidence and what complicated studies suggest. Sometimes it's just about common sense.

Low risk can turn to high risk without warning during childbirth, and some women will prefer to be where they can get immediate help. They a right to make this CHOICE.

CLUs have a higher rate of CS for a number of reasons including the fact that they get high risk referrals, which MLU don't get.

I would be more concerned about the comparative rates of perinatal mortality instead of the rates of CS.

Many women will not care about a higher risk of ending up with a CS if they can get proper pain relief in labour. Different women will make different choices.

It is inhumane to deny a labouring woman pain relief if that is what she wants.

I meant these things are NOT always about complicated studies suggest. Sorry.

Peace and hope "Many women will not care about a higher risk of ending up with a CS if they can get proper pain relief in labour. Different women will make different choices.

It is inhumane to deny a labouring woman pain relief if that is what she wants."

Brilliant, brilliant post. But why is such a simple, obvious, ethical, humane, message so widely ignored?

I just don't understand it and I do hope the Birth Rights campaign that MN are supporting will have some effect.

Have you seen your local MLU and CLU and asked about procedures for getting from one to the other?

I started off in the MLU, which I don't regret at all, but when my medical issues meant an epidural became a good idea, they alerted the anaesthetist just as if I'd been downstairs, and I was wheeled down when he was on his way - I couldn't have got it any earlier by being there waiting.

If that's the case for your place, consider where you may be more comfortable.

notcitrus was it the midwives who suggested you have an epidural though?

I have heard a couple of stories from our local MLU where they assume you want a natural birth (cos that is why you chose to go to the MLU) and keep 'encouraging' you to resist epidural. It is very difficult to be forceful if you are in agony and it does not feel like encouragement when you have requested a transfer and it does not happen.

Not only that but it must be awful being transferred when you are absolutely out of your mind with pain i.e. being loaded in an ambulance etc.

The OP doesn't want MLU and neither would I so I hope she gets what she wants.

Hi, thanks for the advice. I've got a midwives appointment in a couple of weeks so I'm going to bring it up and see where I get to. But it is the community midwife rather than the hospital one so not sure if they'll be able to help?

Thought the idea of emailing the head midwife was a good one, so I might do that afterwards. I'll happily stay on the mlu (and not take a valuable place on the labour ward) if they have a way forward with it. Think ill have another word with my other half too-don't want him to be easily persuaded!

I wouldn't be persuaded to stay on the MLU if I were you. They may tell you now that there is a way forward, but when you're in the throes of labour you won't be in a position to argue if the midwife on call isn't sympathetic to a transfer request.

Furthermore, places on a MLU are equally valuable. Let someone who wants an all-natural birth occupy that place. If you know you want an epidural, there is absolutely no sense in going to the MLU first.
So don't let them guilt you into thinking that you're using up a 'valuable' space on the labour ward. You have a right to pain relief, and some other lady will get her request to be on the MLU.

Insist on going straight to the CLU. Don't ask them or request them. Tell them they are harassing you and inform them that you want the epidural and will go to a CLU.

End of story.

I've only had one baby, 12 weeks ago, and maybe the hospital is unusual but the care was fantastic and I doubt a MLU could've been better.
I had 2 midwives with me throughout who never left the room, even when there was a shift change the 2 new midwives plus the head MW came in and did the handover in the room.
It was nothing like on telly where they pop in and out to see how you are.

I too based my choice of hospital vs MLU on the fact that I was very nervous and wanted an epidural and I am so relieved I did as she was back to back and took 30 hours.
Tens machine was pants and did nothing and I kept asking if the G & A was switched on as it didn't make a scrap of difference, the midwife told me that both of them are more to give women a sense of some control and focus during contractions than pain relief.

I also had pethidine after 22 hours which took the edge off but nothing amazing then at 26 hours they recommended an epi as they were going to give me a drip to speed things up as she was getting into distress.
The relief was amazing, yes I could feel it but nothing like before hand, I'd been physically shaking and my teeth chattering because my body wasnt coping with the exhaustion and intensity but after the epi it was a fantastic experience, I finally felt 'with it' and now 3 months on it's the only 4 hours I can really remember as the other 36 were just a blur of pain.

Dogs good the epidural worked but what a shame you had to go through hours of torture first. I had exactly the same experience of epidural - absolute bliss
Hope you are ok after what happened - sounds traumatic xx

It does sound great doesn't it - a painfree birth. But there are consquences as always in life. If you have an epidural I believe you can't get into good positions to help baby turn - the hormones, released with the pain that help to push on labour, are reduced so labour slows down...Some women feel detached from the birth process.

Any woman who asks for pain relief should get it. I'm with this 100%.

But both unmedicated and medicated labours have costs/benefits to be weighed up by each labouring woman. I think if you choose a CLU you almost certainly will end up having an epi. But whatever you choose, you almost certainly will end up with a healthy baby. However, a minority of women end up feeling unhappy or traumatised with the birth (med or unmed) so thinking about these things beforehand can only help.

What helped me was to think about pain as part and parcel of labouring - it's a positive thing that moves labour on. However, my labour wasn't extended and there were no complications. I was happy with my choice. Whatever you decide, I hope you'll be happy with yours.

If you request an epidural on arrival I can't see how they could justify sending you to the MLU.

If they do, you can ask 'but I thought you weren't allowed epis there?'

'CLUs have a higher rate of CS for a number of reasons including the fact that they get high risk referrals, which MLU don't get.'

This isn't true. The studies that show higher risk of CS were purely based on choice of place of birth for low risk women. So the studies are balanced. All things being equal, you are more likely to have a CS if you START in a CLU as a low risk woman than if you start in a MLU.

What the studies don't seem to show is the level of satisfaction with these outcomes however. An epidural might have increased my risk of CS, but that was a risk I NEEDED to take. Being in a MLU and fobbed off for hours means I suffer from PTSD, and I believe, caused my ds' to develop autism.

Unfortunately, not everyone can look at pain as positive thing simply because it involved birth. Pain is pain and is processed by the body in exactly the same way. If someone doesn't want to suffer that pain for an indefinite length of time, then that is her choice to make.

It disgusts and concerns me simultaneously that even in 2013 we have agendas that push women to suffer the pain and policies that restrict the use of pain relief in labor.