What’s wrong with a hospital birth?

[KO2018]

I’m first time pregnant, 18 weeks, and the whole idea of giving birth is starting to become more real.

There’s lots of things I don’t understand.

In my mind, it is a medical procedure - like having a major operation - and I was prepared for being surrounded by doctors and nurses and all the specialist equipment money can buy. Painkillers available as needed. For me this is a reassuring picture.

My local labour unit looks like a spa - it’s all ambient coloured lights, even actual fake candles?? The rooms are like hotel suites and they are always posting things about the power of your body, and how women know more than medical practitioners about what their body needs.

Come again? This is in complete contradiction to everything I have known and been told about medical care up until this point.

I guess I don’t understand - what is the problem about having a hospital birth or an epidural or frankly anything else that might make me feel safe...?

(This is a genuine question I am quite open to changing my mind but I feel like I am missing something)

Can you go to a different hospital where you feel safer and more comfortable?

I think there’s been a shift towards a more holistic approach to child birth and stopping “the ladder of interventions”.

When I gave birth there was a labour unit where you could get everything apart from an epidural that had water baths, candles etc. But then if you wanted a epidural you could be transferred to the next ward over because you’d need closer monitoring.

What I’m trying to say in a long winded way is fake candles doesn’t mean you can’t have an epidural

One potential problem is the risk of harm (to you or baby) from a medical procedure, which is a risk with any medical procedure. For some people birth in a very medicalised setting will be right, and for others it can lead to a spiral of interventions and side effects. Birth in a low intervention birth centre or at home also carries risks.

A good book if you’re interested that covers some of the different factors in a balanced way is ‘Expecting Better’ by Emily Oster. She’s an economist who summarises the evidence on various aspects of pregnancy and birth in a very readable way.

I felt like this too, especially when I watched my trust's antenatal videos and there was much talk of bringing your own music and fairy lights. Each to their own I guess but it did make me feel a bit abnormal for not prepping for birth in that way, I just didn't see the point to it. When my birth went south I was immensely grateful for the medical equipment!

I think the science says that anything which helps with getting oxytocin going will help with labour, so all the nice lights and music. You could look into hypnobirthing to learn more about it.

I personally wanted to have the reassurance of knowing that doctors were close etc if needed and I ended up needing an emergency c section so glad I did. However this happened during lockdown and I didn't have my partner with me initially so some people would say that it stopped the oxytocin flowing which may have led to the complications. For example I think there is some evidence to suggest that home births usually have less complications as you're relaxed etc.

Sorry I'm probably not being clear as I'm not an expert but I hope that made some sense!

Ultimately do whatever is best for you and makes you more comfortable. For some that's home, some it's a midwifery unit and some it is hospital.

Some women like the 'spa-like' rooms / MLU because it makes them feel relaxed and other women prefer being on the labour ward. Nothing wrong with women wanting / liking different things.

I actually wanted to be on the MLU but wasn't allowed as I'd had some extra scans and it was hospital policy. I ended up in a labour ward room instead and they were still able to dim the lights, give me a birthing pool and do everything else I wanted. I wouldn't have wanted an epidural due to the risks involved. My experience was a very birth-unit style experience which was what I personally wanted but 100% each to their own.

People are mammals and birth is based on your body’s ability to release certain hormones, hormones which are inhibited by adrenaline. Lots of bright light and a medical environment can cause a women to release adrenaline so prolong and even stall labour. Medical intervention in the past has often been women flat on their backs in bed which is not a good position to give birth in. A lot of things you talk about are based on medical knowledge. In midwifery women are not called patients because they are not ill.

There is nothing wrong with a hospital birth or an epidural but they are much likely to result in an emcs which obviously come with additional risks. Birth is a risky business so you need to decide what is the right option for you. I high recommend the positive birth company online hypnobirthing and the positive birth book - they are not in any way connected to each other.

Absolutely nothing! As nice as the candles and soothing music are lovely for a spa day i'd far prefer the medical surrounding and equipment on hand. No amount of candles are going to help if baby gets stuck half way out!

Ultimately the best birth for everyone is straightforward vaginal birth where everything is entirely straightforward. This isn’t possible for everyone and isn’t what is best for some individuals because they don’t want it. Your best chance of achieving it is when you are full of oxytocin and for most women this hormone is most effective when they are relaxed, have privacy and are comfortable. The idea of having as much oxytocin for any type of birth is a good one and individually that might mean all sorts of set ups from fairy lights to full medical. There doesn’t have to be a tension between the different options.

I also had a hospital birth and it was a really positive experience for me.

But I was afraid of lack of privacy, being vulnerable in a strange environment and strangers possibly not asking or respecting consent over my body during labour.

So I understand why some women feel uncomfortable about a hospital birth.
A solid birth plan made me feel a little bit more secure but I couldn't tell how the experience would be until it was over, obviously.

Having a hospital birth is quite a new thing really. Before the advent of the NHS most babies were born at home and only the very richest women would have a doctor present. During the 60s and 70s the shift started towards hospital births.

However, hospital can be a very scary place for some people and the big thing we need in labour is oxytocin and feeling secure and relaxed helps that.

Epidurals are great things, but they do come with risks.

I gave birth in a labour ward and a birth centre. I much preferred the birth centre, but then I'd also have preferred to give birth at home.

My hospital had both a midwife led unit (MLU) which is all low lighting and birthing balls etc, but the labour ward is next door (medicalised etc.) So if you're categorized as low risk you end up in the former, but if things go south, you're only feet away from the big guns. However I know some MLUs are freestanding, so if anything goes wrong you have to get an ambulance to hospital.

The idea behind a home from home, dim lights, music, spa type vibe is that women's bodies are best placed to give labour and give birth when they're relaxed. Anything that feels stressful (hospital, doctors, bright lights) can make your body unsure whether it's a safe place/time to give birth and can slow things down leading to more issues. But I absolutely think that every women should go for the birth option that makes HER feel safest and happiest. Hopefully in your labour unit you might get the best of both worlds - a calm environment with all the painkillers you might need and all the medical care you could possibly need if it comes to that.

I felt, and feel, exactly the same. Make sure you know whether your unit offers epidurals. Midwife-led units normally don't, and your description of candles and "empowering" posters sounds very much like the MLU that I rejected, in favour of the common-or-garden labour ward next door. I found I just did not care about all the things that most people who talk/blog/pursue a childbirth-adjacent career (doulas, yoga, NCT) care about. It's just that they're the only ones you hear from, because people like me just want it over with and then to move on!

Birth isn’t a “medical procedure” it a natural bodily function that may require medical assistance.

I m 38 weeks pregnant with my first baby and I m hoping to use the midwife unit in my hospital rather than the labour ward.

I don't have the best feelings about hospital wards after the NHS doing their best but they weren't able to save my dad and a few other relatives unfortunately when I was quite young, I feel I ve healed as much as I ever will from that trauma but I know I won't be as calm as I could be if I was on a ward unless absolutely necessary.

Being near a lot of medical equipment and the sounds of monitors makes me a bit uncomfortable when I ve been in a lot of pain in the past rather than feeling reassured. The midwife unit has the option of all the pain relief that I d like to try and if it does turn into needing more help or medicines than the midwives can give me the labour unit is in the same building so a transfer doesn't take more than a few minutes.

If a hospital birth in a very medicalised environment is what you want and what makes you feel safe, fine. It's not what a lot of women want. I had one hospital birth and two homebirths and found the latter far, far better. But you should be able to choose. You're the one giving birth, it should (the obvious caveats around specific risks aside) be up to you.

Thank you - I also have no idea about complications from epidurals? I haven’t spoken with the midwife about any of that, plus I’m not going to any antenatal classes due to the pandemic.

So yes please book recommendations would be great! I am really nervous! And don’t know anything. Thanks all

Had an epidural and didn't feel any pain during birth. I did have a nasty second degree tear and to this day I still wonder if I might have pushed out DC too hard and too strongly because I couldn't feel any pain with a nasty scar as a result.

In my mind, it is a medical procedure - like having a major operation - and I was prepared for being surrounded by doctors and nurses and all the specialist equipment money can buy. Painkillers available as needed. For me this is a reassuring picture.

Just to note that even if you give birth on the labour ward you won't be 'surrounded by doctors and nurses' unless there are suspected complications - you'll have one midwife. And painkillers aren't always available as needed; if you want an epidural you need to wait for an anasthetist to be available. I'm not saying either of these things to scare you but to make sure you're being realistic - the NHS doesn't treat straightforward births 'like a major operation', it very much tries to do the opposite.

It is nothing like a major operation unless you have to have a Caesarian. I wouldn't really call giving birth a medical procedure but I suppose that depends on your definition; it's a perfectly natural thing and there will be a midwife or two and maybe a doctor to assist you in hospital.

If I had my time over, I would opt for a home delivery as long as there were no complications. However my hospital experience was straightforward and pleasant so no complaints. I hope all goes well for you.

Btw a lot of people will tell you that an epidural increases the risk of interventions/C-section, but my consultant told me that it's not certain whether that's causation or correlation. Ime some professionals believe it's true based on their experiences, others don't.

The thing about privacy and dignity... I always feel like such a weirdo on this, because when I was in hospital I just didn't care at all. The staff were all very kind indeed, but I knew they saw dozens of naked birthing bodies every day and wouldn't remember me, so I felt quite liberated by that relative anonymity. Bring the classic "troupe of medical students" loathed by Mumsnet into my room please! I could do with the novelty and distraction!

Personally, unless you're dead-set on an epidural (which is perfectly reasonable) I don't know why you'd choose labour ward over midwife-led if they're alongside, ie both in the hospital (I can see why you wouldn't choose a standalone MLU), but that might be because I'm still a bit annoyed about not being allowed to use the MLU because I was 'too high-risk' and then not being admitted onto labour ward until I was pushing, so getting none of the extra monitoring. If it's easy to move between them then I don't see why you wouldn't want the more comfortable one to begin with, and they have options that aren't there on labour ward, like birthing pools.

As others have said, it's all about keeping as relaxed as possible to keep that oxytocin flowing. There are also studies that suggest intervention is more likely if you're on a ward (im not totally convinced by this, but you should be given a copy of/directed towards the results of the birth places study).

It's not a medical procedure, unless of course intervention is required.

Personally, I felt most relaxed knowing that medical assistance was nearby. So for me an AMU or labour ward were my options, I wouldn't have entertained the idea of a stand-alone MLU (and don't even mention home births 😂).

Your midwives will probably encourage you to go for an option where intervention is least likely to occur, and that includes pain relief option. Your midwife will discuss pain relief options with you but in my experience not until the 36 week appointment.

I had a hospital birth and a home birth, and the latter was 1000% better. Each to their own of course, as PPs have said.

"I’m not going to any antenatal classes due to the pandemic."
You really must educate yourself, there are online antenatal classes. Check out the Positive Birth Company (also mentioned by a PP). Also see if your local maternity hospital and/or NCT are offering online antenatal classes.