Midwife-led unit or labour ward for birth: pros, cons and choices

[Shopaholic100]

Midwife led unit or hospital labour ward what are the pros and cons and which did you choose?

For my first baby I had no choice but to give birth in the labour ward because I was induced at 39 weeks due to gestational diabetes and an apparently big baby (he wasn’t actually big when he was born). Had a horrible experience with strong contractions with no breaks between them. I’d wanted a water birth with just gas and air but couldn’t move to get in the pool and ended up needing diamorphine to cope with the pain, which made me very sleepy so pushing was difficult. For my second I managed to avoid getting gestational diabetes and opted for the midwife led unit which was right next to the labour ward. I had the water birth with just gas and air that I wanted and it was a much better experience. Though I think it this was more to do with not being induced than where I was giving birth.

I wanted a midwife led unit but it wasn’t to be, DC1 because she was prem and DC2 because I had gestational diabetes which apparently requires extra monitoring & possibly drips etc during birth.

Be aware that there are about 1001 potential reasons why you might end up deemed unsuitable for the MLU. Any kind of risk factor seems to mean it’s no longer an option. So don’t set your heart on it!

However a decent labour ward ought still to be able to offer a pretty natural birth experience if you don’t have big risk factors, not water birth but everything else. And then at least all the options are on tap if you do need them.

Ds1 I started off in water in the midwife led unit but had to transfer to the labour unit because I was pushing for too long. Ds2 I had to be induced so straight to labour unit. I honestly found childbirth so painful if I was to have another (which I won’t be) I’d go for the epidural straight away. I think I’d be unlikely to have a successful birth in the midwife led unit.

With ds1 I’m afraid I was left to it until it was quite late. Women should not be left pushing for over 4 hours. It was barbaric. I was consistently told throughout my pregnancy that as a young woman with a low risk pregnancy I’d give birth easily in the water and be home within 2 hours. I’m very against that view now. Fortunately ds1 suffered no long term effects of their, frankly, laziness.

This is just as sneery and unpleasant as people who act superior for not having an epidural tbh.

Not having an epidural is not automatically less of a “smart choice” (nor is it more of one).

I don’t remember a choice, where I had DC - but I had high blood pressure/pre-eclampsia with my first DS. I would have chosen the labour ward, because I had an early epidural to keep my blood pressure down.

With twin DDs, there was no time for an early epidural - I had had so many Brixton Hicks, I didn’t think those contractions were any different! I only realised I was in labour, when I was 8 - 9 cm. They said the anaesthetist wouldn’t come, even if they called him. I just had gas and air and the breathing for two deliveries within 2.5 hours.

DDIL also had high blood pressure, and DS insisted on the labour ward, because sure enough, within half an hour of getting there, the staff insisted DDIL have an epidural to bring her blood pressure down.

There are plenty of statistics to show that epidurals increase interventions. It’s not a no brainer as you seem to suggest.

Also not everyone finds childbirth unbearably painful, I didn’t. If you are lucky and it’s not that painful then the risks of an epidural will outweigh the benefits. Most women won’t know how painful they will find it until they are in the process of birth.

(Unless you know you have a back to back or induction - I wouldn’t try either of those without epidural and tbh I’d pick C section over induction).

And for you i recommend you The Watch the Business of birth.

There are plenty of statistics to show that epidurals increase interventions
it really isn't quite that straightforward at all

OP, if you are interested in finding out more about the pain relief options it's worth looking at the labourpains.org website if you haven't seen it already - it's run by the Obstetric Anaesthetists' Association and contains lots of objective and reliable info re the different options.

@minipie I agree, I wish I had a C section for my back to back baby. But I didn’t know she was back to back until I was scanned in labour, and at that point she was so low down the birth canal that a section would have been risky.

Isn't that American? How does it apply to the UK when the systems are so different?

Yes I wish we had late scans as standard, for this and lots of other reasons. Many other countries do. Although to be fair babies can change position even very late in pregnancy.

Same thing different country.

we just pay with taxes as opposed to health insurance.

also check out Kemi Birth joy Johnson on Instagram.

If your local hospital is like mine then don’t get too hung up on the Midwife Led Unit (if that’s what you decide upon) as if the maternity department are short staffed, which they often are, the staff and you will end up on the main one anyway so they can shut the MLU and prioritise keeping one ward fully open.

I think it depends what sort of birth you are wanting but for me I wanted low intervention so would go midwife led - or homebirth.

My first was an induction, I was given diamorphine as I didnt feel able to cope and wasn't believed when I reached the pushing stage. I felt so out of it when baby was born and upset at the whole process.

My second birth was a homebirth, born 5 minutes before the midwives arrived. I felt so much more able to cope and calmer, felt so aware of everything my body was doing and the joy when he was born was amazing

I actually did have a late private scan at almost 40 weeks to check her position and she was not back to back!

All credit to the hospital, they did scan me twice when I was in labour and her heart rate started to show decelerations. The first time she was back to back and then she half turned.

Midwife if low risk though ideally in a hospital annex! I didn’t need pain medication, not all women do, the ball was sufficient

As a HCP myself I chose a midwife led unit attached to labout ward. I had easy births with gas, but we'll aware of risks and didn't want to need blue lighting to another hospital if baby or I were in a life threatening condition.

Planned C section.

All women are different and their choices will be different, too.