Labour ward or Birth Centre after PPH

[Lid88]

Hi all

I know this is quite a specific topic but I'm hoping someone can come along and chat with me.

I had my DD back in 2019 and had a gorgeous natural birth in the birthing pool on just gas and air, it was quick and honestly I was on a total high afterwards. I appreciate I'm super lucky to have had it go so quickly and smoothly. Afterwards I lost around 1.2ltr of blood which upon having a birth reflections meeting with the hospital earlier this year, have been advised was mainly down to my 2nd degree tear. I was kept in a few days but didn't have a transfusion.

I'm now 17 weeks pregnant with my 2nd and saw a consultant after my 12 week scan who basically railroaded me into having a labour ward birth, stating I need a cannula on admission and a drip straight after birth. I knew I would need these two things as I was told this would be prevention next time in my birth reflections meeting but was advised this is fine to do in the birth centre and fine for a pool birth again (if possible).

I reflected on the meeting with the consultant and contacted the hospital for a 2nd opinion and a lovely midwife rang me and said I can absolutely choose where I birth, and that yes I can have all those prevention's mentioned in the birth centre. It was my choice to weigh up risks v benefits.

Personally, I feel a birth centre birth will allow me to stay more relaxed and reduce the chances of intervention etc as it's less of a 'medical' environment. Our birth centre is actually in the main hospital and the labour ward is literally a set of doors across the corridor so if anything were to happen I can transfer straight over.

Am I crazy for wanting to push for a birth centre birth again? Has anyone also been advised for a labour ward consultant led birth changed this and birthed where they chose? I'd love to hear stories of this please.

Thanks in advance :)

I had a long labour (36 hours), ended up with hormone drip and epidural and pushed her out too quickly resulting in a nicked blood vessel, 2nd degree labial tear and 1.1ltr blood loss. Like you I didn't have a transfusion. I'm pregnant again now and at my meeting the consultant was more than happy to sign me back over to midwife-led care. She said if the blood loss had been to do with the uterus contracting then it'd be a concern and lead to labour ward care but blood loss from tears isn't necessarily going to happen like that again. So I would probably ask for a second opinion, don't see why you're not a candidate for midwife led care especially if your birth was pretty straightforward first time around! And if the birth centre is adjacent to the wards anyway. Im no expert though! X

I was going to say yes you are a bit unreasonable but if it’s attached to the hospital go for it! I would only say unreasonable if you’d have to rely on an ambulance transfer as there are such delays atm.

I'd go with the brithing centre as it's so close if there are any problems. I hemorrhaged after my 3rd with a retained placenta, enough to need 2 transfusions. I was in what they then called the midwife led unit, but just transferred straight across to the main hospital. They also packed me back to the midwife unit as soon as I was stable, which was much nicer than the main maternity wards.

I would definitely push for your preference of birth centre under midwife led care, they can provide the same prevention as the labour ward and there is no indication from what happened previously that baby will need increased monitoring during labour. Given that it's across the corridor, you are very near a theatre and a place that can provide enhanced care for you and your baby should you need it. You stick to your guns, and it sounds like the midwives there will be happy to facilitate this. You have every right to choose. Hope all goes well for you ❤️

I think given they’re adjacent and they are certain ish that they know the cause of the first pph (which hopefully won’t happen again) then I’d go for the birthing centre.

Thanks all for your opinions. I’m a generally risk-adverse person and I absolutely am weighting up the pros and cons of both scenarios. If the birth centre wasn’t in the same hospital as the labour ward I don’t think I’d even be considering this, but it just took me by surprise in the consultant meeting with the previous birth reflections meeting saying there was no reason for a labour ward birth next time.

I’ve got plenty of time to weigh it all up but I’m definetley swaying towards the birth centre again with the preventions suggested.

It sounds a bit like the consultant may be more concerned about uterine tone as a cause for PPH rather than the tear, hence the need for the infusion (syntocinon) after birth. I could be wrong, but I don’t think MWs can prescribe that infusion so there would need to be a medical presence to do that. Also don’t think they can prescribe drugs like tranexamic acid, which may also be used in a PPH scenario.

Everyone’s a bit twitchy about high-risk for bleeding cases at the mo (in all contexts, not just maternity) because of the nationwide shortage of blood products, so prevention of excessive bleeding is fundamental. Perhaps it’s worth having another conversation with the consultant about exactly what they’re concerned about, and the logistics of transfer from the birth centre to labour ward if there’s major bleeding again. HTH.