Place of Birth

[ImogenDes]

Hi everybody,

My name is Imogen and I have a test day for Bournemouth uni regarding whether I am suitable to study and qualify as a midwife. For the test day I have been asked to research a topic from a selection of options - I've chosen to research place of Birth. I was wondering if you mums out there could tell me how you chose where you had your labour and your experience within the Birth place to help with my research.

Thank you

Honestly I think my hospital was not really on board with patient choice on place of birth... they would really have rather made their choice for me based on their view of clinical need.

I wanted midwife led alongside birth centre first time around. Learned about choices through apps such as what to expect and babycentre.

Second time around I wanted a home birth but turns out my chosen hospital didn't cover my area for home births - of course no way for patients to know this before you get to booking in appointment so unless I was prepared to rebook at a different hospital I was stuck.

As it happened it was all academic both times as medical needs on the day meant I eventually needed labour ward first time and planned section the second.

I chose to give birth on a consultant-led unit with access to all pain relief options, blood products, operating theatres, neonatal resuscitation, SCBU and people with the expertise to provide all help immediately should it be required.

Ended up needing 4 from the 6 things listed. I had a back to back baby, epidural, meconium, assisted rotational delivery in theatre, shoulder dystopia and PPH and a baby who required resuscitation (thankfully not SCBU). Would I have chosen anything different? No. Do I think labouring in a different setting would have changed the outcome? No, I'd have transferred in begging for pain relief or after being unable to push him out back to back.

Second time was advised CLU after previous PPH. Happy to do that, and had a trouble free SVD.

Hospital.

In labour 18 hours with first and they found the little monkey was flexed breech. (Discovered by junior doctor during routine internal) Tried vaginal delivery (gas and air - I love that stuff!) but he wouldn't come out. Consultant called - played hell with everybody. Emergency caesarian due to foetal distress. (Lovely anaesthetist). 5 pints of blood (me).

2nd baby. Head down (a girl - would never dream of putting her mother through what the other one did). Also gas and air. Successful vaginal delivery. Severe postpartum haemorrhage at home 4 days later (I had told the community midwife something was wrong and she said I was imagining it - blood clot was big as my fist like a lump of liver. Bled like a pig in the ambulance). Into hospital - scraped out and needed umpteen more pints of blood. Out again. 3 further haemorrhages and D&C's later they finally stopped it, otherwise it would have been a hysterectomy (which would have suited me by then. No further children for obvious calamity-related reasons.

Having said that, I had lovely care in hospital and don't blame anybody - it was one of those things - I'm not designed by nature for childbirth I think. I'm just grateful that I live in a time and place where the care was available

Chose ELCS (maternal choice). Wanted as much control over the process as possible. Agreed at 16 weeks. Consultant led care anyway due to IVF. Ended up under fetal med due to growth problems in baby. ELCS at 35 weeks. The birth was incredible. Couldn't have asked for more. If I have another I'll do the same.

I chose hospital for exactly the same reasons as Guess.

I actually didn't need any of the things she mentioned, though I was induced so couldn't have been on an MLU or anything anyway. Once the induction kicked in I laboured quite quickly and had a 10lb baby with only gas & air and no major complications. But having worked in obstetrics (I'm an anaesthetist) and seen the various ways things can go wrong very quickly, I wanted to be somewhere I felt safe. For some people home feels safer, for me it's hospital with all the funny smells and beeping machines.

I had the choice between a brand new birth centre, midwife led for most women but traditional labour ward and access to theatre etc. It is also all private rooms. Option 2 was midwife led unit which had a traditional labour ward upstairs.

I desperately wanted a water birth. I was concerned that option one was a popular location with only two birthing pools. I spoke to midwife about the availability of pools and she told me that they have never had a women not able to use the pool because it was in use. I went for option 1. I felt betrayed when I could not use the empty pool room as they did not have enough staff- apparently this is a regularly occurrence.

After over 50 hours of labour I had a crash section and horrendous after care which resulted in me being readmitted very ill with spesis after they repeatedly ignored me saying something was wrong.

In the future I don't know what I would do. I would want a water birth so I would be tempted by a home birth but I know a c section is more likely and I would not want to transfer for that. I did a difficult recovery from c section but if a c section was likely then I would prefer an elective one.

MLU located at the local hospital. Wanted a water birth and got it. Water birth was probably influenced by NCT classes.
Am hoping for water birth again but had complications delivering placenta last time so midwife may not accept me, there is 1 pool on the labour ward though.

I didn't choose - I had pre-eclampsia and needed an EMCS so all decisions taken out of my hands

I chose to have my second child at home.
I had a horrible hospital experience with my first baby and would never choose to give birth in a hospital ever again.
My home birth experience was a million times better than my hospital experience. I was calm and relaxed in my own environment, able to move around as I pleased, my husband was able to be a lot more involved.....and I was cosied up in my own bed eating a Chinese takeaway about 4 hours after my son was born

I didn't choose, I was told where I was going.

The place I wanted (midwife lead birth unit, 4 miles away) refused to take me because it was my 1st and they insisted I went to hospital, 20 miles away. So a very noisy busy maternity ward. I hated it and the staff were not at all sympathetic but very 'matter of fact'. They kicked my husband off the ward 10 minutes after we arrived due to visiting hours ending and then left me alone all night despite me asking for food/water which I had missed because I was in labour and because my husband had been sent home. I couldn't leave the ward either with or without baby so was starving/dying of thirst all night So that was an awful experience.

My 2nd I wanted again to go to the birth unit but because I was measuring large (huge in fact) they refused to take me and had to go to hospital. It was very noisy and dreadfully understaffed. I appeared to be on a conveyor belt of births so got no individual attention and even had to clean up my own sick off my bed while in late stages of labour because no one came to help me. Another dreadful experience.

My 3rd the midwife lead unit refused to take me due to complications with my 2nd. A similar story to the others, too noisy no individual care and being left to manage alone. No food due to giving birth at the wrong time of day and vising hours ending so no visitors allowed on the ward to bring me anything to eat. I really should have learnt my lesson with the others about that really. I walked out at 10pm and phone my DH to come back and get me and baby. No-one batted an eyelid with me walking out with a baby at 10pm. I felt very much that I was just another person rather than an individual.

Good luck with your course.

I chose mid-wife led care both times and as I was low risk this was the option they wanted me to go for. I had a water birth both times too.
Was very fortunate to have really good care before, during and after. Also for my 1st the mid-wife I saw through out my pregnancy was actually on shift the day I went into labour so delivered my DD. With my DS the mid-wife I saw through out pregnancy was on shift after I'd given birth so was able to do the newborn check and discharge me, so I had great continuity of care and familiar faces

I chose the local midwife centre, both times. Home birth wasn't offered to me so I'd have had to really push for it and I wasn't brave enough for that, but I knew I didn't want an epidural so thought the local midwife centre would offer the pain relief options I wanted in a more relaxed and 'less clinical' atmosphere than the main hospital, with the main hospital there in case.

I went to the local centre when in labour with DD1 but she had an irregular heartbeat so we had to hot foot it to the labour ward of the main hospital in case they had to intervene - they didn't luckily but I appreciated having the additional monitoring and intervention option in case.

When I went into labour with DD2 I tried to get into the local centre but all midwifes were busy so I had to go to the main hospital again (delivered in the same room as DD1!). This was not ideal but I appreciate just what happens in an underfunded NHS.

What was annoying was having to return to the main hospital the following day for the newborn check as 'that's where my notes were'. Why couldnt they just have been transferred to my local centre (who had staff available and would have been doing the check had I delivered there)? It was a 1.20 hour drive round trip and I was in a lot of pain from an awful lot of stitches - sitting in the car seat was excruciating and frankly not that safe, but I had no one who could take me. Seems like this was an unneccessary pain as I could have easily got to my local centre.

The only other thing that I feel relevant in terms of care is that it seems to vary so much depending on your midwife - this is much more influential on your experience than where you are. Fantastic midwife with DD1 - brilliant. Experienced, listened to what I was saying but clearly told me what I was going to do. Bad midwife with DD2, argued with me about how far along I was (she didn't accept that I was dilating fast then argued with me when I told her I was getting the urge to push, then she was a tad surprised when DD was born 10 mins later). It was really stressful having her not listen and I honestly think I'd have been better on my own.

Do these things help your research? If you give us a list of questions you might get more specific feedback.

Hi Imogen
If you have been asked to talk about this subject you're going to be expected to know something about Birthplace 2011 - a major piece of research which has shaped NHS guidelines on place of birth.

Here: Birthplace

I'd read it through from front to back before the interview.

I chose a homebirth with my second despite having a diagnosis of gestational diabetes and being known to be carrying a very large baby (predicted 10lbs+) because of my lack of confidence in the quality of care at my local hospital. I hired an independent midwife to care for me (the community team wouldn't do it). The birth was challenging but concluded with a healthy baby and a healthy mum and I was able to stay at home and not need any additional help beyond what my midwives were able to give me.

I feel very strongly that women should be made aware that their chosen birth setting may have a very significant impact on their likelihood of a normal birth. NICE does set this out in the guidelines on intrapartum care: here but I don't think women always really clock its importance.

Good luck!

PS: Try not to use the word 'allowed' - as in 'high risk women aren't allowed to have a home birth'. NICE recommends that women be supported in their choice of setting for birth. This is what NICE says on choice of place of birth: "Explain to both multiparous and nulliparous women that they may choose any birth setting (home, freestanding midwifery unit, alongside midwifery unit or obstetric unit), and support them in their choice of setting wherever they choose to give birth"

First time I wanted Mlu as I didn't want a medicalised birth. Ended up CLU due to meconium in waters.

Second time - home birth as first labour was very fast once established and again wanted to medicalisation.

I wanted a water birth in our local hospitals new birthing suite. It was a lovely room with a large pool which I got to use throughout my labour and only came out to be checked.

I felt relaxed and safe which is exactly what I wanted .

I went in at 9am and was 3cms had some gas and air but it made me feel sick so struggled on and had my daughter that evening in the water at 6.40pm and she was on the boob in bed with me by 7pm! I managed to escape any tears and stitches but put that down to using perineal massage throughout pregnancy and listening to every thing my midwife told me about pushing then breathing.

Feel lucky to have the birthing services I did as I felt empowered in all my decisions. Midwives were fantastic and kept to my birth plan which was that I did not want an epidural and they never ever mentioned it and even when I did they brushed it off.

Only shitty thing was that after a day being in labour and once I was cleaned up and baby measured and checked I was only given a cup of tea no food at all. I found that quite bad especially as I was breastfeeding as soon as my daughter was born.

Overall a very positive experience of my place of birth.

Wanted/needed CLU for epidural/spinal due to permanent injury from previous birth.
At booking in, midwife really tried to sell me on water birth, wouldn't take on board that this would be totally inadequate.
Eventually managed to escalate request, saw obstetrician and anaesthetists to write in comprehensive pain management recommendations, because epidurals do not provide adequate pain relief for my condition.
Every fucking midwife i saw said but you don't need to be CLU, you can start off on MLU and if you do need an epidural you can have one.
Gave birth on MLU, no epidural, only totally inadequate gas and air. Agony.
Horrible experience, which I cry every day about.
Am especially frustrated as I has tried so hard to ensure I would get the help I needed.
Good luck with your studies Imogen. Please, if you do become a midwife, listen to your patients, especially if they've given birth before.

Would have liked to have used the 1 birthing pool in the hospital. But ended up in a consultant led delivery room due to an induction for obstetric cholestasis.

Also would have liked to be able to move around but the mobile monitors were all being used too.

Staff during delivery were amazing. But wards were overcrowded with not enough staff. This was in Sheffield 2015.

I chose my local midwife led unit for 1st baby, reasons being that it was actually IN the maternity hospital so any complications it was just a lift down to the delivery suite. There is another slightly better equipped mlu in our area but it's not in a hospital so you'd have to be transferred in an ambulance. 2nd baby I'm planning a home birth because I was frustrated that I couldn't get admitted as early as I wanted. I wanted to be in the place I was going to give birth but my labour progressed very slowly

Fist birth at a MLU in a town about 20-25 drive away. Amazing birth and place.
Second birth was a homebirth and another amazing experience.

Hospital for me is a last option for emergencies only. It's about 20-25 mins from home or the MLU I birthed in the first time. Even though the Hospital in the city has a MLU attached to it, I still won't use it. Personal choice.

I was pretty clueless with my first, and just assumed I'd give birth at the local hospital (consultant led unit) and the midwives didnt make any other suggestions (very rural area and midwife team are known for being reluctant to offer home births etc). It was a horrible experience. Different staff in and out throughout my 14 hour labour. One was quite rude to me when I wasn't pushing correctly. Baby was born at 8pm, and my husband was told to leave at midnight. I didn't see another person until he was allowed back in at midday the next day. I was left alone all that time.

Second time I researched my options and chose the birth centre 30 miles away. It was lovely, I had a water birth, same two midwives throughout (labour was 2.5 hours). I left to go home three hours after delivery which was what I wanted, I didn't want to stay.