Hospital vs midwife led birth centre?

[faelavie]

Hi all. I'm having a real dilemma about choosing where to give birth and I'm wondering if anyone wants to share their views on these options with me.

I'm 36 weeks+1 with my first (and probably last!) child. I am low risk.
I live in a town with a highly rated and recommended midwife-led birth centre, which is a 5 minute drive from my house. The nearest big general hospital is around 20-30 minutes drive, depending on traffic.

The local birth centre has two private delivery rooms. My husband and I recently toured these when we attended an antenatal class there. Dimmed lighting, birthing pool, aromatherapy if you want it, comforting homely decor, just a really lovely environment. There is of course a bed but you are encouraged not to birth laying on your back and to try whatever positions are comfortable for you. All of the midwives and midwifery assistants were so friendly and welcoming. There are also private rooms for post natal care - double bed so partner can sleep over with you and adjacent kitchen where you can make tea and have snacks. Partners can stay with you 24 hours. Parking is free. I need to stay in for 48 hours for NAS observations due to medication I'm on, so this important. Breastfeeding support is offered and you can stay there longer if you feel you need more support. It's close to home and I'm familiar with many of the midwives there as I've been going for my clinic appointments.
No epidurals though - the options are oramorph, Entonox, and morphine injection.

Now, I know that the big hospital isn't really going to be like this. I used to work there (not in maternity but I am familiar enough with how it is there). Short staffed, midwives rushed off their feet. The parking is horrendous and expensive. I know several people who have given birth there and didn't have good experiences. However..... They have the epidural option. But I know I'm not guaranteed to get one if I ask for one, either due to stage of labour or availability of an anaesthetist. Also, if there are complications, you're already in the right place should an emergency c-section be required etc, whereas if you were elsewhere you'd have to go off in an ambulance.

I am anxious about birth and the pain involved, even though I consider myself to have a good pain tolerance, I have a fear of the unknown and have read so many horror stories about birth I'm pretty much terrified now. I'm reading about hypnobirthing to try and calm my fears.

I originally thought that if I had to give birth vaginally I'd definitely want as many drugs as possible and an epidural, so I had it set in my mind I was going to the hospital. But since viewing the rooms at the midwife-led centre and seeing how nice, friendly and comforting it was, I feel a bit stumped. I'm not sure what to do. Everything hinges on whether I feel I can manage without an epidural and I just don't know!

Any thoughts would be very welcome! What would you do in my position?

[IslayBrigid]

Hey @faelavie thanks for getting back to me! It sounds like you went through quite an ordeal and I'm so glad that you and baby are both ok!

I'm still unsure about what I'll go for, but I have 6 more months of pregnancy as I'm only just coming out of my first trimester, so I guess lots of time to decide!

I have a really good, experienced home birth midwifery team in my area who seem wonderful and would not leave it too late to get you transferred to hospital if anything seemed awry, so this is an option. The MLU, which is not free standing and is part of the hospital, also appeals to me as it's close if anything did go wrong.

As you say you never really know what could happen! Got to just do what feels best and trust that the professionals will know how to act if things go south.

[undead]

In my first pregnancy I felt uncomfortable about MLUs. I had no pre existing conditions and pregnancy was going well. I felt that I needed to go to MLU. I went over due and was induced in hospital. Second pregnancy was induced, too, with other reasons. I am happy that I didn't need to make the choice.

[happymummy12345]

I knew I wanted a birth centre, but it was within the hospital, so if necessary it would have been straight down the corridor, so I wasn't worried at all.

[hairyxmasturkey]

I did nct, fully swallowed all the hypnobirthing etc. Was dead set on a natural birth first time round. First baby in mlu- was awful (mainly because they were short staffed, surprisingly). Second in hospital and I loved it. The problem is I just don't think you'll know how you'll be in labour before you've experienced it. It's not like anything I could have imagined. So actually when it came down to it I felt much safer and confident in that medicalised environment, with the option of epidural. It's a tricky decision.

[faelavie]

I should also add - that I'm a nurse myself, hospitals don't scare me, I was much more comfortable in hospital and actually felt more anxious in my own home. I know this is unusual.

[faelavie]

@IslayBrigid

This might not be what you want to hear but I'll be honest with you.

I ended up opting for the low risk MLU at the main hospital, so the higher risk labour ward was just a short trip down corridor.

Unfortunately my baby ended up in a bad position and I was failing to dilate properly, in excruciating pain. Long story short - Baby got distressed, his heart rate dropped whilst my own skyrocketed, 3 failed epidurals. I ended up in theatre having an emergency c-section under general anaesthetic.
If I had chosen the local unit I would've been blue-lighted. I'm so glad I didn't choose it. Statistics don't matter to you when you're hearing that emergency bell being pulled next to you.
Calm lighting, aromatherapy and the birthing pool could all go hang as far as I was concerned at the time! My baby's life was saved thanks to the speedy actions of the surgical team (not the midwives in the MLU who kept wanting to send me home!)

Don't want to scare you at all, what happened to me wasn't run of the mill.
I'm still trying to process everything now as it was all quite traumatic.

But @Babdoc 's advice turned out to be prophetic. (thank you so much for your honesty @Babdoc)

[IslayBrigid]

Hi @faelavie really interested in what you decided?? How did your birth go?
I'm considering my options between a MLU, hospital or home birth with my first at the moment. No MLU in my area, but my midwife said she might be able to get me into one not too far away (about 30-40 min drive without traffic). Hospital is only 20 mins away and does have two birthing pool rooms, but I'm nervous about them not being free, as I really want a natural water birth. I'm kind of the opposite of you in that I really don't want an epidural or intervention!
I've also read a lot about oxytocin and how it's so important we can produce this and that MLU or home births make this more likely we will produce, and hospitals make it less likely as it isn't a cosy environment, so therefore more likely to NEED interventions like epidurals etc.
Please do let me know what you decided and how you got on ! x

[NotwhereIshouldbe]

I was in a similar situation to you and was debating birthing centre or hospital. Birthing centre is 15 mins down the road and hospital is 40 minutes. There’s another hospital near me that has a MLU and delivery suite down the corridor so I opted to go there in case anything should happen. Good job I did as although I was considered low risk (easy pregnancy) I ended up with forceps and an episiotomy. Baby was stuck and completely tangled with her umbilical cord (registrar said she had got herself in a right mess inside me!) and had I been at the MLU down the road, it would have been a 40 minute journey to the other hospital. The 10 minute trundle down the corridor in a wheelchair to the delivery suite was hard enough as it was when I was fully dilated and contracting every minute! So personally I would opt hospital for a FTM.

[Emmapeeler]

@faelavie

Barely any support with breastfeeding, noisy environment and rude midwives

That was my experience! (And I am SE) Would definitely look into being transferred after if you can. I’d do this hands down again for first (with second I just wanted to get home).

[notmyrealname37]

The biggest worry for me about stand-alone midwifery led units was the time it would take to get to the hospital in the (unlikely) event of an emergency. If a cat 1 emergency c section is required, this should be completed within 30 minutes so if it's 20-30 min to the hospital that's already too long - DH is a dr so he was very against using the local MLU for this reason. BUT plenty of women use these units and give birth with little-no complications and they can likely manage most "emergency" situations until you are transferred.

[Mintypea5]

Worth asking if they do hospital parking exemptions at the labour ward. I didn't know they did at my hospital until I was induced. They us like a scratch card ticket thing valid for 7 days ... labour is so unpredictable they don't expect us to pay parking every day at extortionate rates ....

[faelavie]

@Frizzy1986 Good idea, I'll ask about the transfer rates at my appointment on Monday. That might bring me some more perspective.
I do understand the reason for not allowing partners to stay over on a postnatal ward. But the reviews of the ward say the privacy and dignity is pretty much non-existant and you're just left on your own to deal with it. I don't know if I can deal with being on a noisy ward with a bunch of new mums and babies just left to fend for myself. I've had anxiety and depression this whole pregnancy, I don't have a clue about what to do and will need some support or at least some reassurance. Which is why the private room with my husband appeals to me more. I'll see if getting postnatal care at the birthing centre is an option if I end up in hospital for the birth.

[Frizzy1986]

@faelavie it's great that the responses have given you lots to think about.
There are positives and negatives to both options. All hospitals and MLUs have different procedures, rules, regulations etc and hopefully once you make a decision you will feel happy with your choice.

Have you asked about the transfer rates for your particular MLU? I know transfer rates can be high as I was one of them, but mine was post birth for a non medical emergency so it might be helpful to ask them to split the statistics if they can to emergency transfers and non emergency.
Its best to arm yourself with as much information about your particular options and then you can make a choice closer to the time.

My hospital also doesn't allow partners to stay over. The postnatal area is a ward with up to 6 women in each area who deserve privacy so visiting times are strict to ensure that people get that. I wouldn't want to be on a ward, going to sleep, with someone else's partner camping out on the floor.

[faelavie]

Thank you all for the replies. I really appreciate the advice and it's given me a lot to think about. I can't reply to all of you individually but I'll try to address a couple of things raised.


@negomi90 The midwives at the unit told me that they could do the NAS obs - for info the reason is exposure to a single tricyclic antidepressant - though I take your point. I will try and get some more information from them about this at my next appointment.

@Emmapeeler - Yes this is an option that I am considering. I thought I'd like to just stay in one place for continuity of care but it's definitely something I'd consider because the online reviews of the post natal care at this hospital are horrific. Barely any support with breastfeeding, noisy environment and rude midwives.

@Kam610 I am in South East England. It's such a difficult decision isn't it?

@WhoArtinHeaven @Em8725 The hospital does have an attached MLU but partners can't stay with you, but tbh if I'm having to go all the way there anyway and pay the huge parking fees I'd rather just go to the labour ward and try for an epidural! Unfortunately they don't do tours for me to have a look.

@lifeinthedeep Unfortunately this hospital is very strict about how long they let partners stay with you.

@1300cakes I think I'm also concerned about being refused the epidural anyway, I've heard of this happening so many times from friends and also threads on MN. Most of the time due to an anaesthetist not being available which again is something you just don't know until the day I guess.
Of course if I end up needing to be induced this whole question would be entirely academic, I'm just going on the current situation.

@PanamaPattie Then I obviously wouldn't be able to birth there anyway and would have to go elsewhere.

[1300cakes]

It's such a personal choice. Personally, I would go for the epidural every time over lighting and aromatherapy. It's such a cliche at this point - seems like everyone who goes for this option later laughs about how naive they were, and says the candles/oils /music etc didn't even come out of the bag.

Actually most people I know who chose a birthing centre never even entered the door as they ended up being induced. So you may not get the choice anyway.

[lifeinthedeep]

I was low risk and ended up with an emergency c section after 26 hours in labour and 5 hours of pushing a stuck baby. Ended up with temporary kidney failure and was on a drip for 2 days feeling quite nauseous. I didn’t care about the decor or interior of the medicalised delivery suit- I just wanted the baby out.

The post-natal care sounds much better in the midwife led unit but I think I’d rather the security of the hospital. Also, most hospitals allow partners to stay for as long as they like. Dp slept on the floor next to my bed on the maternity ward! I don’t know how they expect most women to care for babies on their own straight after giving birth tbh!

[PanamaPattie]

What would you do if both rooms at the centre were occupied?

[Xitt]

I tried the midwife centre. Had to be transferred to hospital for emergency cs when it all went drastically wrong. Thank god the hospital was next door on the same site. I wouldn’t go to a midwife centre if the hospital was more than five minutes away.

[forkfun]

Had both mine in midwife led units and both experiences were very positive. After first baby we had to be transferred to hospital, for a minor complication. It was still great to have the baby in a very comfortable space. Second baby we stayed in the unit and it was fabulous. Having husband over night with us in private room with or bathroom was heaven compared to bring with newborn in a busy ward.
Also, get yourself a hypnobirthing app. I found training my brain to be calm and relaxed, and experiencing the pain as temporary yet necessary really helped me stay focused on giving birth rather than the pain. I know this doesn't work for everyone, but having a positive attitude will never be bad.

[lauryloo]

Hospital for me. Ds had his cord wrapped around his neck and wouldn't be here today if we were in the mlu. I was knocked out and he was delivered in less than 10 mins from his heart rate dropping

[mumofone234]

I chose a birth centre and it really suited me - much quieter and more pleasant than a busy hospital. I found that I could get on with it all well, without being interrupted much or interferes with. The midwives at the birth unit seemed more familiar with low-intervention birthing than hospital midwives who are used to epidurals etc (but I may be being unfair there). For me, it actually helped knowing that I didn’t have the option of an epidural - I just got on with it and managed the pain because I didn’t have a choice. Plus, the birthing pool helped!

[hammeringinmyhead]

I gave birth in hospital and the next day transferred to the local midwife-led unit for post-natal care.

Out of 8 of us in my NCT group, all 30s and most low risk, we had 4 emergency c-sections, 2 inductions, 3 ambulance transfers. Only one of us managed to give birth in the MLU and then had to be transferred anyway. The choice was taken away from me as my waters broke and I had to be induced, but I would also have been transferred. I was all for it until I saw the stats on the wall that 6/10 first timers ended up transferring anyway!

[Newtothis213]

I went to midwife centre, never again. Wont go into details but there no good with any sort of complications. Wish I'd went to the labour unit

[WhoArtinHeaven]

Everything hinges on whether I feel I can manage without an epidural and I just don't know!

No, you don't know. So I think you have to consider if you want to try, or not, and go from there.
I have had two drug-free births (one drip induction as mentioned above) and it's definitely not a walk in the park... but I used alternative methods (hypnobirthing, TENS, water) and enjoyed the experience. I was relatively resolved to do things my way.
I wasn't totally anti-epidural, but I did want to try without, hence made choices to facilitate this. But with the knowledge at the back of my mind that things may not go to plan, so ultimately I was open-minded.

I do get fear of the unknown, but in a way it's wasted energy. It has to happen, and being scared of it doesn't change that. Best focus energy on other - positive - things. At least that was my approach!

[Em8725]

My MLU was in the hospital, next door to the general labour ward. With one child, I was in MLU. I had no drugs and a water birth. With my second, I was in the labour ward as MLU was full, and had no drugs and a water birth. I was in exactly the right place both times because my second child got stuck and we needed the full team in the labour ward. I’d have a proper look at the hospital and see if they offer an MLU, if not I’d choose the hospital.
I recovered in the MLU both times. It was fantastic but I don’t think I’d have chosen it if it wasn’t in the hospital already.