Midwifery unit or consultant-led unit?

[KitKat1985]

Hello. Will try and keep this brief whilst including all relevant information. I'm in the first trimester of pregnancy with DC2 and have my booking appointment in a few days. I know they are likely to ask me where I would like to give birth. There are two options in my area:

1. Consultant led unit which is about 45 mins to an hours drive from my house (traffic dependent).
   
2. Midwifery unit which is about 20-25 minutes drive from my house.
   
   With DD I chose to go to the consultant led unit as I was hoping for an epidural and also I wanted the reassurance of knowing there were doctors around if needed. However my labour progressed quicker than expected, and I found the car drive to the consultant led unit awful (and that was with basically no traffic on the road as it was 2am). When I got there the midwife in the assessment unit kept insisting on telling me I was probably just having early stage labour pains, and didn't rush to get me transferred to delivery. By the time I got to the delivery suite DD was born 10 minutes later and I didn't even get time for any gas and air, let alone an epidural. DD got a bit stressed by the quick delivery too and there was some meconium in her waters when she was born, but thankfully although they said she needed to be kept in for 12 hours for observations she was well enough to go home that day. I never saw a doctor the whole time I was there. Also the postnatal ward was noisy (shared dorm with 4 other women, and so there was always at least one baby crying at any time, so sleep was impossible). It was also very busy and I didn't get an awful lot of support from the midwives there as they just had so many women to look after (I felt quite sorry for the staff on the post-natal unit to be honest as they were clearly very stretched).
   
   So second time around I'm thinking about going to the midwifery unit. It's much closer (which is important as also we need for my Mum to come over - a 30 minute drive away- to look after DD before we go anywhere), and there's a reasonable chance labour 2 will be quicker than labour 1 (so probably unlikely I'll get an epidural this time either). They are also a small unit (rarely have more than 2 women in at a time), and other people who have given birth there have told me how lovely and relaxed it is there, plus all the rooms are private and en-suite so no shared facilities. I am nevous though in case something goes wrong and there's no doctors around, although I am told in the event of any complications they will blue-light you the consultant unit, but that's a 20-30 minute drive away. I guess with DD being stressed during labout last time I'm worried in case anything goes wrong. I also know a mum who started her labour in the midwifery unit but needed transferring to the consultant unit, but unfortunately due to the time involved in the transfer the baby was starved of oxygen and ended up with brain damage.
   
   If you were me what would you do?

[KitKat1985]

Thank you for all of your comments and replies. Saw the midwife this morning. She seemed to be suggesting MLU as being the better option in my circumstances, but said that on the day if I decide to go to the CLU on the day if things aren't progressing that fast then I could do that too. I still feel a bit confused. Will talk to DH this evening.

[Artistic]

I had a very quick labour first time (couple hours start to finish), and second time round this was noted & highlighted in every meeting note & consultant meeting. In the end due to other personal reasons I chose to have a private consultant- led delivery, but am sure if I had gone the NHS way the speedy delivery would have allowed me to be admitted sooner than normal guidelines. That said, the second time round, my dilation went from non-started to 8cm in an hour - so yes it is likely to go very quick for you too. I was an hour away from hospital so I started from home at the first twinge and got there in good time before actual dilation could begin.
Go consultant led, and plan better on when/how to get there!

[RattieOfCatan]

Sorry missed the homebirth bit. Will be living with my parents so it's not an option unless it happens accidentally! Home and mlu are on opposite ends of the same road so pretty much the same distance from the hospital!

[RattieOfCatan]

That's what my midwife said but it still worries me. I'm booked to see a doctor to "discuss" it down here but her concern is that when I move they won't be able to refer me to a doctor soon enough and she's certain that they will want me to see a doctor there too. The mlu is apparently "strictly low risk" so goodness knows what will happen. I'm really against going to that clu though. They have an adjoining mlu which I will settle for but that mlu has a very high rate of transfers to the clu,and it's still quite far away. In an ambulance it's nearer 30minutes I'm told but that's still far.

[minifingerz]

"I'm already marked as high risk thanks to a recent referral to a cfs clinic and a mild chest problem so I'll probably be forced to go with the clu anyway"

Talk to the supervisor of midwives - I very much doubt those things would make you ineligible for a MLU.

Is your home nearer the hospital? What about a homebirth?

[RattieOfCatan]

I'm wondering about this too. I'm pregnant with my first and had my booking in 2 weeks ago. I'm actually relocating at 32 weeks so my midwife couldn't really help that much with advising me! My mlu would be 2 minutes from my house whereas the main consultant unit is 45minutes with no traffic, easily an extra half an hour in traffic though. I'm really against going to the hospital as I've heard horrid things about it (6 bed dorms, discourage you "disturbing" others in the ward, ie try to keep you in bed, try to keep you on the ward as long as they can, one friend had a 'roommate' crowning before they actually believed the poor woman who was insisting that the baby was coming right now) but the risk of being that far if something goes wrong worries me. I'm already marked as high risk thanks to a recent referral to a cfs clinic and a mild chest problem so I'll probably be forced to go with the clu anyway

[bamalamlam]

Thanks minifingers that's really useful info.

Ultimately I wish they could get to the bottom of what causes those higher rates in CLU and address that. Then women and babies could have the best of both worlds. Knowing there was a consultant there if required but not increasing the risk for a c section. That's where we need to get to with maternity services. Please tell me one country somewhere has managed it?!

[minifingerz]

The stats for mums having their second/subsequent baby are actually:
(CLU - consultant led unit, FMU - freestanding midwife led unit)
Forceps
CLU: 1.9%
FMU: 0.7%
Emergency c/s
CLU: 4%
FMU: 0.6%
Normal birth (ie no episiotomy, no drip, no instruments, no c/s)
OU: 79%
FMU: 94.7%
Using birth pool
OU: 7.1%
FMU: 41.2%

Outcomes for baby the same

[minifingerz]

" in that stat you give about c sections are they comparing emcs only and for low risk women in both places? Or are they comparing all women who birth in hospital (including high risk women and planned or ELCS) with those at MLU?"

Comparing only women who are low risk at the start of labour according to their chosen (as opposed to eventual) birth setting.

[bamalamlam]

minifingers in that stat you give about c sections are they comparing emcs only and for low risk women in both places? Or are they comparing all women who birth in hospital (including high risk women and planned or ELCS) with those at MLU?

[mummytobecabz]

Im in the same situation, i want the MLU but im scared im going to need the consultant who will be 45mins away!

[MabelSideswipe]

MLU all the way in my opinion.

Meconium with your first labour dies not mean baby was distressed by the way. 20% of babies pass meconium either before or during birth. There is not actually much research to back up the need for transferring and treating the labour as high risk.

[bittapitta]

Obviously people posting here will be biased by negative experiences. To me you sound low risk and like you'll have a quick birth, so MLU sounds ideal! I had two births at MLU and they were both absolutely fantastic.

[megadude]

Can you have a tour around both units before you decide? I really don't understand why there would be a MLU without a CLU right next to it if the birth stops being straightforward.

[minifingerz]

"but it was risky and shocking"

But nationally outcomes for babies are no worse in free standing MLU's, and are MASSIVELY better for women themselves.

[minifingerz]

According to the Birth Place study you're about 5x more likely to need a c/s (for second babies) if you choose to labour in a CLU compared to an MLU, and no more likely to come home with a well baby...

Higher rates of forceps too.

[bamalamlam]

One important thing is not to buy into the idea that all MLU births are xxxx and all hospital births are xxxx. People have good and bad experiences in both settings. Therefore this decision has to be about you and where you are likely to feel most comfortable, safe, supported. This will help you feel happier with the experience no matter what happens. You could sign up for the MLU and then see how you feel in labour and how fast it's progressing? If you turn up at the hospital instead they can't turn you away so you would have the best of both worlds that way? You could also ask about signing up for homebirth so that a midwife would come to you but transferring in if you want to and you have time?

[Icecappedpinetrees]

I fully planned MLU with my first. Luckily I was so late I needed to be in CLU. This probably (though who can say) saved my son's life. Everything was absolutely fine - think yoga, soft lights, gas and air until...he fell back to back, wouldn't turn, became stuck with the cord around his neck. It went from fine to an emergency so quickly and the staff were just fantastic. Son was delivered back to back and needed resus. He suffered no long term effects but had we been in the MLU with a transfer of 30 mins for us...who knows. It might never have played out that way but I'm due my second baby in 4 weeks. Put it this way, there is no way I'd consider going anywhere else but CLU.

BUT - most of my friends have laboured in MLU and had really good experiences. My friend recently had a brilliant water birth. It's such a personal choice. (My other friend delivered in MLU and was blue lighted to CLU, baby was left with dad at less than an hour old - no skin to skin with her, no initial feed etc...).

For every horror story for one venue there will be another wonderful experience. It's such a hard choice. Good luck.

[holaguapa]

I would go consultant led.

I had my last (second baby) in the MLU and we had to be transferred. My baby is fine, but it was risky and shocking. Wish I'd gone consultant led from the beginning.

[ThirtyNineWeeks]

I started off at MLU 2 yrs ago with DD but had to be blue-lighted due to meconium. The rest of my Labour was a car crash...how I wish we could've stayed at MLU.

Eleven weeks ago I gave birth at MLU and it was just brilliant. Giving birth under water was amazing and managing on just gas & air (i got to 6cm at home - worth sticking it out for as long as possible at home) and gave birth 40 minutes after arriving at MLU. Go for it, OP, you won't get a better birthing experience (unless you hire a pool at home, which is exactly what I'll do next time).

[Jenijena]

I've just had my second in an mlu, having had my first in clu after meconium in the water and an erratic heartbeat.

Check what the transfer protocol are from the mlu to clu. Ours says 9 minutes between the two in an ambulance (if I were driving it would be closer to 25, I think).

My mlu birth was so, so, so much better than my first, I feel completely different.but it is an understandable desire not to choose it.

[pocketsized]

I am in a similar position Op. I had a quick first labour and am an hours drive from a major labour unit. I think I have decided that a midwife led unit, with the possibility of an ambulance transfer feels safer to me than the possibility (not an insignificant one) of delivering en route to the hospital with no medical assistance. If nearer the time the circumstances of my pregnancy suggest there are any additional risk factors I will reconsider, but at the moment that's my plan...

[KitKat1985]

I think having read your posts I'm leaning more towards the consultant led unit. I want to talk to the community midwife on Friday though as the problem I had with my first labour is that the hospital weren't even open to the possibility of me coming in before my contracions were 3-4 minutes apart, and I think if I have to wait that long second time around it might be too late, and I really don't want to end up giving birth on the side of the road.

To be clear I don't expect the hospital to be like a 2-week spa break. But I was quite tearful after giving birth with DD1, and I was struggling to breastfeed, so I found the lack of privacy or abilty to sleep quite hard in the post-natal ward, hence why I mentioned the private facilities in the MLU.

I'm afraid I don't know the details of the mum whose baby ended up being starved of oxygen. She was a Mum I met at a baby group rather than a close friend, and the group no longer runs, but her little boy had obvious brain damage, and she did tell us once (we didn't ask) that unfortunately there were complications in her labour and she needed an emergency C-section, but by the times she was transferred to the consultant led unit her little boy had already been without adequate oxygen for too long and suffered brain damage. I'm assuming there were no warning signs of potential complications before labour started or else I think they would have made her go to the consultant led unit in the first place.

[jojocoxy]

I would go for the consultant-led unit every time. I went to a midwife led unit but the baby got stuck and lots of complications and ended up with me being rushed over to consultants. It was touch and go and this time they have told me they would prefer me to be at a consultant led unit due to what happened before. I know the midwife birth units look amazing and calm and in theory they should be but for me, its the 'what if' scenario that doesn't sit well. I agree with nectarini1983.

[boomboomchickaboom]

Tbh I had to transfer from a MLU with DC1. I sensed a reluctance by the midwives to admit that it was no longer a straightforward labour (despite multiple signs) and to transfer. I had to be very persistent and then the transfer process was a shambles. It took over an hour. Hospital staff were lovely on arrival and although my concerns were confirmed, we had the right people around us to ensure no long term harm came to either of us. My advice with MLU is to ask someone who had a complicated labour how well it was handled. If they handle these things well then it's a lovely safe place to birth. Also if you have already had 1DC without issues you are much less likely to have complications.