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.

I've had both and would say they were both midwife led.

My first I arrived at hospital fully dilated got into the pool in the midwife led unit and gave birth within the hour. I was grateful that it was in the same building as the maternity ward as I have birth to a rush of drs and nurses coming into the room. The midwife had pushed the emergency button as her shoulder was stuck, she was able to free it and she was born without issues. I had 2 paracetamol in early labour and some gas and air for the delivery.

My second was an induction on the labour ward. I had one midwife looking after me during the induction. She read me quite quickly and realised I'm a "quiet one" so even when I wasn't showing obvious signs of things getting too much she listened to me. She removed the pessetry after 4h as I was at risk of hyper stimulating and I was moved to the labour ward once the paracetamol I had had wasn't quite enough. I then had gas and air through out the labour. I only saw the Drs when they came for ward round. I asked about some blood results they were monitoring which had led me to be induced and didn't see them again. I had 4 midwives over the course for 6h. The majority of the time it was a student midwife and midwife 1 except when they went on their lunch break, midwife 2 covered the lunch break. Baby went into distress as midwife 1 came back from lunch break so the head midwife joined them for a bit. They determined baby was ok but needed to be born quickly and that this was likely. The head midwife left and the student and midwives 1 and 2 stayed until he was born.

I had 2 stitches with my daughter and none with my son. I had a shower, tea and toast with both and then went to the ward. The only difference between the two really was one was in a pool and the other on the bed. I would only give birth in a midwife led unit if it the hospital ward was readily available, both my labours were on the edge of needing intervention. My son was born blue and with the cord tightly around his neck which was causing the distress and a friend's son was born full term but not breathing and was whisked off to the NICU before she could ask if she has had a boy or a girl.

Pesky indecisive babies 😆

I gave birth at St Georges in London and they ran a study where everyone got a 36w scan as standard. It massively reduced surprise breeches and other issues. NICE were supposed to be looking at it to consider implementing it in the guidelines but ive no idea when they will make a decision.

First was hospital ward - chaos, noisy, dirty bathrooms, horrible ward.

After that mw led unit all the way. Calm, peaceful, birthing pool, quiet.

I had two inductions and two water births - first in the MLU, second on labour ward (because my waters had broken early so they wanted to do continuous monitoring).

So just to counter some things that have been said on the thread - labour ward doesn’t automatically mean no water birth (obviously check your hospital) and inductions don’t always mean an epidural is necessary (albeit I just had gel both times - I think drip is much worse).

My actual birth experiences were almost identical. I had gas and air both times, smooth fast labours, being in water was amazing. The difference was that post-birth the MLU was SO much nicer. I got to stay in the delivery room overnight as it wasn’t needed, so DH and I had a large double bed and en suite, vs the hell of the post natal ward second time round.

At my hospital the MLU is essentially next door to the labour ward, so everything was on hand if there was an emergency. I wouldn’t have gone for a stand-alone MLU I don’t think, but I’d always opt for it as a first choice if given the choice and if the labour ward was close by.

Totally agree with you. This is my friend’s first baby and although low risk, we both have reservations with the midwife led unit as it is based in a hospital rated inadequate in the latest cqc inspection. As someone who specifically said she only wanted gas and air and then went for every pain relief available, I know first hand how you just have to do what’s right for you at the time.

Thanks for sharing your stories and please continue to share as I’m sure it will be helpful to others too. The midwife led unit is in the the same hospital, so under normal circumstances it would have been worth a try, unfortunately it had a CQC inspection recently and was graded inadequate. One of the issues was that calls were not answered by the maternity triage in an adequate timeframe, putting mothers and babies at risk. My friend had to call them this week and tried for 50 mins no one answered even after this. It has left her feeling quite concerned. We had to call maternity triage in a hospital in another part of the country previously whilst on holiday and they had a dedicated person to answer calls and they were outstanding. I’m not sure if you can change hospitals later in pregnancy as a nearby city has a good rated hospital.