I cannot decide whether to give birth in Midwife-Led unit or in hospital. Would love some opinions on the matter.

[trulyscrumptious33]

Up until a week ago, my husband and I were fairly certain that we would go to hospital to have the baby, but after a recent trip to see the midwife, we're wondering whether the Midwife-Led Unit might be a better option.

Hubby is a hospital doctor so I am really surprised that in fact he is the one who is keen on the midwife-led option! We were told that we would have the undivided care and attention of two very experienced midwives, which in his opinion, could actually spell a much better outcome and quality of care than a rather busy (and caesarian-happy) labour ward.

We live in the middle of nowhere, and the services are therefore rather spread out. The local hospital is 40 minutes away, the midwife-led unit is 30 minutes away, but the distance between the midwife led unit and the hospital is greater being about an hour away from each other.

I'm concerned that in an emergency, the 60 minute transfer time would be too long. Firstly, I imagine that it would be a rather uncomfortable ride in the throws of labour, but of course secondly, if there were any serious complications and an emergency caesarian was needed, it would be at least an hour until I could be under the knife. I read that the national guidelines for the maximum amount of time in cases of fetal distress needing to be removed via c-section is 30 minutes!

Does anybody have any experience or strong opinions of either option?

This is my first pregnancy, and so far (28 weeks), I am at low risk.

I was booked into a MLU and arrived there after 8 hours in labour. It is a much calmer, nicer place to give birth IMO. However I had complications and had to be transferred to hospital - about a 20-30 min journey. My complications were not particularly urgent (DD not born until 26 hours later) but I was relieved the journey wasn't too long - a high speed ambulance ride whilst in full labour is no fun, I promise you apart from the gas and air which they gave me but shouldn't have
So I'm afraid I can't really advise because I have the same concerns as you! If I ever did the labour thing again I think I would opt for a MLU in a main hospital, which we also have nearby. Is that an option for you?

Oh and one last thing - I ended up needing an EMCS. I know that I would have panicked had I still been at the MLU towards the end of my labour and faced with the ordeal of transferring at that time.

An hour transfer time does sound long. Have you asked what they say the transfer time is?
I was booked into MLUs for both of mine, but they were both just part of the hospital anyway. I was transferred for DC1's birth. It was a ride in the lift to the next floor.
MLUs are more relaxed environments, but it certainly helps to feel relaxed if you know what plan b is.

would you consider a home birth and then you're only 40mins from hospital? still get care of 2 midwives etc? might be worth discussing with the midwives what is available at the MLU that you wouldn't be able to have at home.

I would go for the MLU every time. The one I went to for both my DCs was about 30mins away from hospital. I nearly had to be transferred post birth both times (placenta removal issues!) but luckily stayed at MLU in the end.

I found the MLU very relaxing with great facilities (incl. fab birth pool) and most importantly for me - lots of privacy (private room and bathroom, DH could stay overnight). Local hospital was horrible - big wards, no privacy, crap facilities - so a no brainer for me.

However you sound unsure, so I would be inclined to go with the hospital if you are going to find that more reassuring. You need to make the decision, not your DH.

My preference would always be the MLU and an intervention free labour but that transfer time would worry me. We are fortunate to have an MLU at the hospital. I did have one birth go unexpectedly pear shaped in MLU and had the full team there within a minute of the red cord being pulled.
For contrast, as I was 'high risk' for a repeat on birth 3, I was consultant led on labour ward and was pleasantly surprised - they moved the bed aside, got mats out and I gave birth kneeling, no intrusive monitoring, only one VE. If you are clear about your wishes the location may not make much difference.

Are you factoring in time for an ambulance to get to MLU? You can look up response times for your area, but it might be coming from a distance?

I would speak to the midwives at the MLU about your concerns- I'm sure it's something they hear a lot.

I had DD1 at a MLU, about 30 mins from the local hospital. It was such a lovely place, even more so I think because it wasn't attached to a hospital so was just so relaxed and calming.

I had similar fears and spoke to the midwives. They reassured me that first of all it is very rare for emergencies needing hospital transfer to just crop up out of nowhere. The midwives are very experienced at spotting any potential signs of things not going as normal, and they would always transfer you sooner rather than later. She also gave me some quite reassuring stats on the transfer rates and the reasons for transfer. For the vast majority it was either due to lack of progress (ie not dilating quickly enough) or for extra pain relief. The C-section rates for the people who transferred were very low.

Personally I felt the benefit of one-on-one care with a very experienced midwife outweighed the risks, particularly as our local hospital was very big and busy with not a great reputation.

Go and have a look round, ask lots of questions and then decide. Good luck!

Can you visit the hospital labour ward to give you an idea of the rooms etc? I was surprised by how nice the actual rooms were.

We're also lucky that our MLU is attached to the hospital - think it's bonkers that they don't build them together as it makes the decision much easier. Although I appreciate depending on locations it's not all that easy.

I was low-risk for my first and attempted a Vbac for my second. I had 2 emcs. I am not sure what the outcome would have been if we'd had to wait an hour before we made it to theatre.
Low-risk means nothing until the shit hits the fan.
Each case is different but knowing what I have been through, I would not want to be an hour away from medical intervention.

Many thanks for the responses.

The MLUs on hospital grounds sound ideal, unfortunately we don't have that facility where we are, so it really is a clear distinguished choice between the two.

I like the idea of exploring how different a home birth would actually be from an MLU experience.

There are just so many unknowns, particularly as this is my first pregnancy, and even though an MLU birth appeals so much more, in the back of my mind it would be plaguing me that if either I or the baby were in need of any emergency care, we wouldn't be able to receive it immediately. I would hate to put either of us at risk.

DH agrees with you avocadogreen, in that the parameters for transfer are met way before things get serious. But surely there are some circumstances which creep out of nowhere, rare though they might be.

The hospital does have two really nice and recently refurbished birthing suites with pools, balls, etc, but the hospital is renowned to be quite jumpy for intervention because again, it is quite far away from a big, important hospital. (As an aside- DH also met one of the gynae registrars once when he was called to assess a women who was 'psychotic post-partem with visual hallucinations'. DH pointed out that she was just suffering from a migraine! Doesn't fill him with the most overwhelming amount of trust. )

What happens if when you get to the MLU you don't fit their eligibility criteria anymore? Just that we have a MLU attached to hospital where we are, and while pregnant with DD I must have met a dozen women at various antenatal classes (plus probably ten women since at postnatal nct things) who planned to have their babies there. Only two actually gave birth there and most of the others were turned away on arrival for various concerns, most minor (eg me- too much blood in my show). Obviously I completely agree with why they turned us away - they have to keep things low risk - but it was just a trip up in the lift to the labour ward for me. I would not have liked an hour in the car with contractions 2-3 mins apart. (Would you get an ambulance if it wasn't an emergency situation?)

Just worth exploring what happens in various situations. It may be that your MLU are more relaxed about things - obviously it is easier for mine to say no to women in labour when they know the hispital is right next door.

OP, I would go to hospital. It is all nice to hear about how great MLU is, but if you are the type who worries I would say it is not worthy. You will always have this on the back of your mind and you dont need that. At least in hospital it might not be so pleasant but you can be assured that the care of you and your baby in unpredictable situation will be on hand. And that is what matters at the end of the day, that the baby is safely delivered and you and baby are well.
Pool, lighting, balls, music are just nice extras.

You're absolutely right moggle, I may not even be eligible. We do already have links with the hospital as we've had scans and one appointment, so we are registered there.

DH has green emergency lights on his car so if we weren't offered an ambulance as transport to the hospital that could be an option, but at the end of the day, it would be hell being transported for an hour whilst in labour....

The joys of living in rural Wales!!

Well I think it comes down to how willing you personally are to take the small risk of something going horribly wrong because you weren't in the hospital.
Personally I've had 4 dc in a normal labour ward and found it fine. ( there was no MLU locally for the first 3 and I had to have an induction for dc4). Reassuring to know all help was on hand if needed - altho all 4 labours were straightforward anyway.

My first birth was at a MLU which was upstairs from a labour ward. I really liked the facilities and it was very reassuring.

Second birth was BBA with paramedics so let's ignore that got this.

This birth was a choice similar to yours, birth Centre was on a community hospital grounds so if any issues would need to transfer to a larger hospital. The hospital with labour ward was in the opposite from my house so it would be a transfer longer than journey from home.

I decided on a home birth. It went well but I think it is easier to choose as a third baby than a first.

We actually transferred after baby was born, it was unnecessary but MW was being cautious and wanted baby seen by paed. He was fine just a bit small (i had HG but they hadnt noticed how small he was). It was a bit annoying but I reckon they tend to be very cautious and don't want to take risks.

Have you considered a home birth?

I would go with the hospital if the MLU is an hour away from it. Especially in a first birth, you just don't know what's going to happen, and in childbirth problems can arise very suddenly and sometimes with tragic consequences.

I was another one classified as low risk, but had to have a crash c-section. I heard the doctors saying "we've got 5 minutes". If we hadn't been next door to an empty operating theatre I don't know what would have happened.

Thanks for all of your advise, it's really helped me towards making a decision.

I don't think I can take the risk with this being my first pregnancy...for me the risks would far outweigh the benefits of a ML birth this far away from a general hospital.

Have a very merry Christmas everyone!!

I think that's a good decision op. I went to the midwifery led unit and had a long labour and baby was back to back. I really wanted/needed an epidural. They were not keen on transferring me to labour ward to have one. In the end I needed drip as was pushing for two hours with no luck. In the end had a natural delivery but I think I will be choosing the labour ward this time as for me the mlu was more stressful. The pool, lights, music didn't really help me.

Another here who had her pfb dd in a MLU located in a hospital. Excellent care, couldn't have felt calmer or better taken care of.
Whats most important is for you to feel at ease and what should help is that your dh is a doctor! What better person to have on hand to make sure interventions don't escalate unnecessarily!!
I was dreading hospital, tell me to be calm and I'll do the opposite. I told my dp all my fears in advance - top among them was being at the mercy of escalating unnecessary medical interventions, followed closely by stirrups... So he knew to question everything and make decisions knowing my areas of concern. (Obviously, if baby had been in any danger and interventions really had been needed we'd have gone for them but I just didn't want to feel like someone was working through a call centre script and that I had to fit their expected schedule). As it was, we had a very quick birth in the pool, using hypnobirthing techniques and gas & air. I was low risk despite my age (baby arrived day after my 45th birthday). Based on that experience I would love to have had the chance of a home birth but it would still depend on whether or not they classed me as low risk when the time came.
Do speak with the MLU about your concerns then go with what makes you feel the most confident. Ultimately your body and baby know what they're doing and we just have to go along for the ride! Wishing you a safe and happy birth whatever you decide