Realistically, am I likely to be able to use the MLU?

[NameChangeyMcChangerson]

Feeling a bit anxious at the moment and thinking a few things over. Have name changed as details are specific enough to be outing - so if you recognise from a previous thread please don't give my other username here!

Am 33+6. I was initially booked high-risk due to three previous miscarriages, but they were all early so plan was to downgrade me to low risk at 28 weeks. Unfortunately, at that point they found an irregular fetal heartbeat - which subsequently resolved itself, but they sent me for a fetal cardiac scan, which showed heart was perfect but baby was measuring on 10th centile. So referred for another growth scan - which I'm having a week today. Have been paranoid about movement as they told me to be particularly careful about this, so went in for reduced fetal movements a few days ago and then today.

SO, anyway - due to all this am currently still booked high risk. Obviously if scan on Monday shows anything sinister then I assume an intervention plan will be needed. But what if that shows all ok? Would I still be able to use midwife led unit? I'm developing this increasing fear of instrumental birth, and really wanted as low-intervention as possible to reduce (I know it can't eliminate) risk of this. But should I accept that this is off the cards already?

The reason I ask particularly is because my hypnobirthing classes at local hospital start tomorrow, and I think they might put a big emphasis on low intervention birth - I know they give you a tour of the MLU, but (I think) not the labour ward - and I'm worried that it'll all make me feel even crappier if it turns out that's not going to happen for me.

Sorry for v long and v detailed post. Obviously my big, big fear (which I guess I'm a bit trying to distract myself from with this smaller one!) is that scan will show IUGR in which case all this is academic anyway, but I've been fretting about it and thought some advice from other people might help!

Friends who had low growth babies still had vaginal births. I'd go to the class. The skills you learn will come in handy. I had a wobble when climbing on the table for my 3rd c section. The breathing and calming techniques I had been taught 5 years previously came in very handy.

Friends who had low growth babies still had vaginal births.

Vaginal - but presumably with constant fetal monitoring and probably induced? Again, obviously I'll do whatever's best for the baby, but I'm really quite scared of induction, and a bit scared of being forced to lie on my back with a CTG for the whole labour.

I had 3 early miscarriages and wasn't considered high risk for my 4th pregnancy (even though I also have a thyroid issue which meant I was supposed to have consultant led care). Also had growth scans and baby was smallish.

Had a normal delivery in birth centre, water birth, no monitoring whatsoever.

Of it helps, I was induced with a pessary then waters brokwn. I had 30 mind of monitoring and was then free to wander and Labour as I likes. Not in MLU just normal hospital. I had no cannula or anything else to keep me stuck in the bed.

Even if you are not allowed to use MLU that doesn't mean you'll have an instrumental or unpleasant birth experience.

I was induced and on a monitor, while I personally wouldn't recommend induction with a drip, being monitored didn't bother me and you can still move on the bed just slightly inconvenient with the wires but quite possible.

I'm in the middle of growth scans and on the reduced movement pathway and monitoring for PE.

What I learned from my first birth was that it was a bit pointless to plan meticulously for the kind of birth I wanted (MLU, pool, gas and air and no stitches). In reality, I was in for a week before and four days after, induction with rupture of membranes in labour suite tied to bed with continuous monitoring, diamorphine and a lot of stitches because she came fast and I didn't need to push- my body kind of expelled her very quickly. Horrible recovery with difficulty feeding, constipation and several types of blood pressure meds. I still feel though that I had a good birth, or rather the experience of giving birth was good and the other stuff was totally out of my control.

I put that down to having felt quite positive and confident in my ability to give birth. Turned out that once labour was well underway, the only place I could possibly have been was on my back with the CTG and hoovering up gas and air. I couldn't have been mobile if my life had depended on it. It was ok, really it was!

I think you should go to your hypnobirthing classes, because I really believe that if you go into this with the attitude that whatever happens, you will be calm and you will cope and it will be mostly fine regardless. The classes can only help with that.

Sorry for the long post. I hope you have a really positive experience whichever type of birth you end up with. Lactulose is your friend!

I wanted a waterbirth on an MLU....
I developed preeclampsia, induced at 37+4, monitored all the way through, had an epidural that failed, gave birth with no pain relief in stirrups.

And you know what? Wasn’t that bad. I’m pregnant again, and hoping to have a normal birth this time, but I wouldn’t worry about it. What’s coming is coming, and sometimes your perceptions of things are way off. For example, stirrups were my worst nightmare... until the midwife put me in them because I was tired, and the relief at having my pelvis opened properly while I lay back and rested was wonderful!!

Practice the breathing techniques, and try not to see any outcome as terrible. Ultimately, it’s one bad day, and it passes quickly.

I had one episode of reduced movement (actually just hours before I went into labour) and also had some investigations into my heart in late pregnancy which didn’t find anything, and still gave birth in mlu as neither had referral to an obstetrician which puts you on the pathway for a hospital birth. So may still be possible.

Was induced with both babies due to low growth. Both pain R free. Was not strapped to the bed the whole time either. I gave birth to ds2 on my knees holding into the top of the bed. Was fantastic.

Thank you for the replies - am finding it calming. Harriet's post has made me think that I might be using terms incorrectly - my local area seems to use high-risk and consultant-led interchangeable, but perhaps I just mean consultant-led?

Monitoring isn't that bad. It's two paddles on your baby bump. Check if they have the wireless ones (this was available here in the US and in c&w where my friend delivered in April) so no cords to deal with.

If you are being monitored you don't need to stay on your back or even on the bed. I was induced with my first and the nurse had me on my knees leaning onto the bed. I got to 5cm very quickly this way and highly recommend it. If being induced try to avoid the epidural as it slows everything down. The pitocin drip gives you contractions which are very strong but let your body go with it. This is where the breathing helped me a lot. I had full on contractions for 7

Also, it's almost like it's a dirty little secret that CS's are not that bad. It hurts regardless of delivery method. You seemed focused on having a drug and intervention free birth. Thats great to have that as plan A but you need to be aware that there are plans B, C etc which might need to happen for your and your baby's safety.

Thanks supermum - it's nice to hear positive stories of inductions/closely monitored vaginal births, as all the good ones you read seem to be either entirely natural or elective C-sections. Just to clarify, I am really quite scared of a forceps birth, but that's the only reason I want to avoid an epidural if I can (and I know if you're induced that's often not realistic) - I don't have any sort of ideological commitment to natural/drug-free birth.

You are welcome :-)

I remember being apprehensive when pregnant with my first and slowly plan A ended up being plan B. The only thing I had in my birth plan was no forcepts or vacuum. If the baby can't make it out I wanted a CS. Luckily I had my babies here in the US and my obn group didn't use these methods.

What did help me a lot was relaxation. I had a massage and acupuncture before being induced. During my induction they came back twice for the massage and 3 times for the acupuncture. It really helped to relax me and I felt rejuvenated afterwards. I was in labor for 22 hours and found the heavy contractions extremely tiring.

I was the same at 33 weeks, very concerned about intervention. At 38 I just want to get the baby out safely. You may feel it's less important as time goes on.

Second what supermum says about not needing to be on your back. I had a small for gestation baby & preterm labour last time, they were keen to keep me on my back and i subsequently had epidural and ventouse (not the end of the world, but not what I had wanted). I’ve since had a birth debrief in preparation for this birth, and have been told that they can monitor me in any position I’d like, as long as they can get a connection. Unfortunately I don’t think any trusts have wireless monitoring, however!

Oh, and I def used my hypnobirthing through my last labour, so it’s still useful even in a labour with close monitoring / intervention

Firstly obviously fingers crossed for a healthy-looking scan.

I think you might be a little confused or are using terms a little confusingly. You say you assume an intervention plan would be needed if you can't go to MLU but being on the main consultant-labour ward does not necessarily mean you will have any interventions. There are plenty of spontaneous unassisted deliveries in consultant-led wards too. Having said that, it's true that epidurals (which can't be given in MLUs) have been correlated with higher rates of instrumental delivery; however it is not clear whether the epidurals are the cause of the instrumental delivery. It may also be that the same factors that make instrumental delivery necessary (such as a badly positioned baby or an exhausted mother after a lengthy labour) are also the same factors that increase the likelihood of requesting an epidural - a badly positioned baby can cause a longer and more painful labour, so more likely to request and have time to receive an epidural. You of course are free to decline an epidural if you prefer (but I adored mine).

If I were you, I'd talk through all the considerations and concerns with your doctor. Frankly, with your history in this pregnancy and with your history of previous losses, I would personally have a very low tolerance of any additional risk such as not having immediate access to the highest level of care. But that's up to you to decide but please make sure your decision is fully informed and taken in consultation with your doctor.

I've only ever given birth on a labour ward, consultant-led, induced, with epidurals, episiotomy and vacuum first time, second degree tear the second. Once my epidural was cited, I laboured comfortably on my bed, resting and reading. I had stirrups the first time. Stitches both times. Continuos Monitoring, IVs, bright lights, lots of machines that go ping, the lot. To many people on the Internet, that would be a horror birth story. For me, knowing that I was in the safest possible place with the best possible care for me and my baby seconds away was priceless. I loved both of my births. I was pain free, calm and able to focus on the moment and got vital assistance that my baby needed the second it was required.

I have no idea why blogs and antenatal classes seem determined to paint this picture of MLU bliss vs consultant-led horror. It does not in any way correspond with my experiences and has no evidence to back it up.

Best of luck with the scan, with your choice and for a safe healthy delivery, wherever or however is best for you.