Have you given birth in a midwife-led centre (that doesn't have a labour ward nearby)?

[MintyTea]

Hi,

DH and I are finding it really hard to decide where to choose to have our baby. It's our first, and likely to be only, baby, and we are anxious to get the choice right.

Our choices are:

• close-by community midwife unit - about 5 mins' drive away, with no obstetrics/labour ward attached
• further away community midwife unit - about 25 mins' drive away, with labour ward next door
• labour ward - as above, 25 mins' drive away

The close-by MW unit is lovely, feels like a private unit, and always seems to have enough room for everyone who needs it. I'd definitely feel more relaxed (to start with anyway!). If we need intervention, we would be transferred in an ambulance to the labour ward 25 mins away.

The further-away MW unit is also apparently very nice, but if we turn up there and there's no room at the inn, we would have to go to the labour ward and there would be no birth pool, dimmed lighting, privacy, etc. and you get discharged in six hours.

I think this is the most difficult decision we've ever faced and we just don't know what to do for the best. I'd hate to think any decision is going to make the baby suffer, but at the same time if we go somewhere pleasant and easy, my labour could be shorter and less stressful.

If anyone has any advice, or can share their experiences, we'd be so grateful.

For example, is there any problem with getting a quick transfer in an ambulance, or do they make the decision so early that you've got plenty of time to get to the labour ward and be treated safely?

Thanks!

They always told me that they would have plenty of time to transfer you because they could see problems coming in almost al l incidences.

With dd1 I started at the midwife led centre but when I got to the pushing stage my labour stopped! I was then put in an ambulance for the 20 minute transfer to the labour ward at the bigger hospital. They then put me on a drip to kick start the labour.

To be honest, by that point I didn't care - my birth wasn't great but to be honest it wasnt made any worse by the ambulance transfer

I guess what I'm saying is, if you think you really like the local one then dont let the transfer put you off!

Do you have particular hopes for a natural, intervention free birth?

I personally would go for the close-by MW unit. However, that's just my personal opinion. I planned a homebirth with my first. We had to transfer to hospital (10 minutes away) by ambulance after about 12 hours labour - there was meconium in the waters indicating baby possibly in distress. I was then monitored on the labour ward for another 12 hours before baby was delivered by forceps. So I am planning a second homebirth, but I am comfortable with the idea that true obstetric emergencies happen rarely & with a lot of lead time - ie signals that can be picked up - & that we have time to transfer if we need it.

I think you have answered your own question, of course we make the decision to transfer early so that you can be treated safely! Stand alone birth centres have an excellent safety record, much more so than an obstetric unit because they are self selecting. Do some reading around the subject to reassure yourself. Basicially, it is the same criteria as a home birth so ask yourself if you are happy to have a home birth and decide from there. No-one knows what is going to happen in labour, no-one can predict every possible complication but midwives (believe it or not) are professionals who care deeply about yours and your baby's safety. Risks are generally taken in an obstetric unit where a theatre is available for emergencies, not in a midwife led unit (they lose their jobs and get shut down - believe me).

I have pretty much exactly the same situation as you (other than hope to have another baby or 2 at some point)

My decision is a home birth.

My 2nd choice is the local midwife unit (10 miles away) but you can only go there if low enough risk, to the point where they are happy for you to have a home birth.

Unless baby is transverse or some other extreme complication ill be insisting on my right to a home-birth (but cant use the same insistance to use the birth centre i think)

I am in the same predicament with my second. I think we are going to give birth at the hospital rather than the midwife centre. We thought this was the best option for us as we would just feel better knowing that we were in the right place if a complication arises. My friend went to the midwife centre and had a complication and there were no ambulances and they had to wait beyond the usual time. I couldn't be doing with the worry of this happening.

Good luck in whatever you decide x

I went to a fantastic mw unit 20 mins from the hospital. They could only take 2 women in labour plus 6 post natal beds. I think the standard of care I recieved during labour and delivery was first class and probably better than I would have had in a busy hospital. It was relaxed, felt a bit like home from home. I think it also kept me focused on managing the pain and keeping calm as there wasn't much else they could offer other than entinox. If you are fit, healthy and problem free during pregnancy (that even means good iron levels) then I would say trust yourself and the mw team and go with the local unit. I recal the car journey in labour wasn't too much fun so 5 minutes over 20 would win every time.

I would still recommend that even when you consider that I had a massive PPH following the birth and needed an emergency transfer. The mw's did exactly what they needed to do to keep me alive until I got to hospital, brought my baby in the ambulance with me and were highly professional with no hesitation as to what needed done. As others have said complications like this are rare, but my experience shows that your mw team should cope fine.

Thanks so much for all your insight and thoughts on this. There are some really good recommendations of MW units and this is definitely our preferred option, all being well.

iskra - yes, we do hope for an intervention-free birth and I'm trying to do as much now to plan for it, eg natal hypnotherapy. I guess it's just that because I haven't had experience of this, I don't know how I'll cope but I hope I'll be relaxed and strong.

diddygirl - we did think the same as you but we had serious second thoughts when we heard we could be turned away from the further-away MW unit if there's no room - and we wouldn't then be able to go back to the closer MW unit, it would have to be the labour ward.

heavenstobetsy, reikizen and notasausage, your comments are reassuring as it reaffirms what everyone says about the midwife units - how they are so professional and helpful, yet much more relaxed.

nannyl and reikizen, at what point are you assessed to check whether you would be a suitable candidate for a MW unit birth?

Thanks again.

PS. I am 35w+4.

Good luck whatever you decide.

I had 3 babies at the local midwife led unit, each was a fantastic experience with caring midwives who had plenty of time to stay and help. The post natal care was (possibly) even better.

Don't want to rain on your parade and I'll probably get flamed on here, but I personally wouldn't go for a unit without a labour ward attached.

If you do decide to go for it, I would recommend that you do a fair amount of reading and discussion with your midwife, as ime there can be a lot of responsibility put on you and your partner about if/when you want to transfer if things aren't going to plan and one of the reasons that delivery complications can be risky is because of the speed with which things can get serious. So I've known circumstances where the message to the parents was fairly low key and "if you want to, you can, or you can stay here" but then things deteriorated rapidly. So I guess I'm saying that there's a lot of judgement and you may be asked to make the judgements so worth being prepared.

im not sure about the midwife unit where you are...
but for me HERE, they assess if we are low enough risk to be recommended a home birth at 34 / 36 weeks. (and then birth stuff is delivered at 37 weeks, and they prefer baby to be born by 42 weeks)
For our midwife unit (along way from the hospital) you have to be eligible for a home birth to be eligible to birth there. (ie low risk)

The difference is you can insist on a home birth (regardless of their opinion of your risk), but i dont think you can insist in being allowed into their unit, if for some reason they arnt happy you fit their pretty strict criteria.

If at home they can not stop you from getting in your own birthing pool... in a midwife unit, if you dont meet their criteria they can not allow to use their pool.

I had DS at our MW unit in January, 20 odd miles to nearest labour ward. It was a brilliant experience. The only midwives they allow to work there are really experienced so everything was very relaxed. I ummed and aahed about it when pregnant for the same reasons you are but was very reassured by their policy and confidence about spotting trouble quickly enough. Can you visit the unit and talk to them in more detail about it?

We live between 2 hospitals, one with MWLU + labour suite + theatre.
One with just MWLU, 20 mins or so from yet another bigger hospital.

Went to hospital with labour suite as it is marginally closer and there are no speed cameras on the way! Can't say what the labour facilities are like anywhere, as I went straight to theatre (undiagnosed breech). Will be inspecting them again in October....

A couple of my friends who went to the other hospital say that the ambulance tranfer was the scariest and most uncomfortable 20 mins of their life. And one ended up giving birth in the ambulance, so they can't always see problem far enough in advance to transfer you in plenty of time.

Goodness, so many different stories - but all really useful, thanks so much.

nannyl, It's interesting the difference between being able to insist on a home birth but not so for a midwife unit birth.

BikeRunSki, that is also an interesting story about your friend giving birth in the ambulance! I think that is our main worry, that perhaps things could progress so quickly that they could take us by surprise!

Fuzzywood, yes, I think we need to visit both units asap:

• the farther away one to ask if we would get turned away if too busy, or to ask could we phone ahead on the day to check availability
• the closer one to find out about their transfer rates and how people find the transfer in general

itsatiggerday, appreciate your honesty, it's all helpful in getting the balance right :)

Have my 36-week midwife appointment on Monday so will discuss further with the midwife then.

Thanks again.

Not sure if you'll check here again, but it would be worth asking whether they have stats on the proportion of deliveries started in the unit that were then transferred and what the outcomes were after transfer. They may claim they don't know the outcomes as those are recorded by the hospital but it would be a better reflection of things than just their stats on the deliveries that started and stayed on the unit, which are obviously the ones that went smoothly. If they can't answer, you could try asking the hospital for their stats on the number of admissions they take from the unit and what their outcomes are for those deliveries. May just be a fuller picture. Good luck.

Thanks, itsatiggerday - we have our 38-week appointment next week so I'll ask them about the stats then. Much appreciated.