Midwife-led unit - how did it work out for you?

[CBear6]

Where I live I have the choice of three hospitals, one is completely out of the way so is ruled out entirely which leaves two. One of these is the big city hospital, a MW unit but with OBs, theatre, etc available 24/7 if needed. The other is a small local hospital, unit is MW led and for low-risk only as there are no OB staff or theatre on site.

I am booked at the city hospital, I had DS there two years ago too. I chose it because they have the doctors if needed and a birthing pool available. During my last delivery though they wouldn't let me use the pool (I'd had bleeds during the pregnancy) and I felt they were too quick to jump in and try to intervene - by the end of the delivery I'd been railroaded into stirrups with continuous monitoring, they told me DS was 100% stuck and had to be either a vacuum or forceps delivery, I delivered him naturally while they were off gathering up their toys.

The MW led unit at the local hospital is really attractive to me but they didn't have a birthing pool and I really want to try it this time. Last week they got one and now I'm really toying with the idea of changing hospitals as I think I'll have more chance at the pool and more chance of not being interfered with as much. Plus I'd get my own room post-delivery instead of being on a ward, one to one care, and the option to stay as long as I like (I don't plan to stay weeks and weeks but don't want to be pressured to get out after six hours either).

The only thing still worrying me is that there are no doctors on site, what if something went suddenly wrong? Has anyone delivered at a MW only unit, how was it? Did it all go to plan? Did they discuss what would happen if something went wrong?

I've got my 28w check tomorrow so going to talk about it with the MW but would love to hear experiences (advice appreciated too!)

interested to see responses as I am in a similar dilemma..

I had a tear with DS, second degree, and wondering how that would be dealt with if it happened again.

I can't speak highly enough of my experience. Amazing and much better than my hospital first birth experience. Nothing was too much trouble yet I knew they would have moved me if I had taken any longer to deliver dd2. No risks were taken. It was great.

Thanks nowwearefour :)

Am I right in thinking they'd be able to read the signs that maybe things weren't ideal and would make the transfer to another hospital while you were still low risk, before the situation became high risk?

Hi, I started off at a midwife-led unit with my first DD, but she was back-to-back and after a long labour, no sleep and being told I was still going to be hours as the baby had to turn round, I requested an epidural. Was transferred by ambulance and all turned out fine.

Second time round, I was in the same dilemma as you but chose to go to the midwife-led unit again as the other hospital is further away and also a lot less personal. This time, labour was very quick and by the time I went to the hospital there wasn't even time to finish running the pool.

A friend had a home birth and had a bad tear, and she was taken into hospital after delivery for it to be repaired.

I was told by my midwife that they can generally tell if everything is progressing normally, and if they have any concerns, they will get you transferred pronto by ambulance.

I went to my local MLW within the local general hospital, new unit, all lovely with birthing pools and great facilities, but near to the delivery suites upstairs. I had a reasonably quick birth but was transferred up because of bleeding issues and actually had my Boy in the main unit, but as was all straightforward afterwards I went straight back down after stitches. I stayed in for 24 hours monitoring due to blood stained meconium, it was great. Ensuite individual rooms, facilities for dh to stay all night and peace and quiet.

I was glad in the end that I chose the unit over another MLU without full obstetric facilities.

That's what's niggling at me, the MW only unit is 12 miles from the city unit. They have ambulances available all of the time because they do have an A&E so there'd be no waiting but I don't fancy sitting in an ambulance, you know? I know being low risk everything would be likely to be okay but it's so hard to decide!

On one hand I don't want to be in stirrups again with wires and doctors butting in every five minutes (I'm still convinced the stress contributed to my long labour) but on the other I'd hate for anything to go wrong and the transfer time to have been time better spent helping my baby/me if we had been in the city to begin with.

If things are going wrong you won't care that you have to be in an ambulance. Take a chance and go with the MW led unit, they are fab. Have posted my experiences many times on other threads

I had DS at a MLU 6 miles from nearest hospital. It was a wonderful experience even though there were complications. We had the place to ourselves because there were no other labourers that night, it was quiet, calm and peaceful - really felt I had the full attention of staff.

I had a 2nd degree tear which was stitched by the midwife while DH held DS, but unfortunately I bled a lot and had high BP so was transferred to hosp for post-natal care. We went in an ambulance and care was excellent. Cannot recommend MLU care enough

Thank you all so much for your input. I'm going to speak to the midwife tomorrow, she'll love me because I was registered at the MWU but the community MW was really vague when I asked her some questions so I changed to the city hospital because I was a bit afraid of the unknown. Hopefully the MW doing my appointment tomorrow will be the MW who actually works at the MWU so I can get a better picture.

We have both in our area - MLU is about 9 miles from where we live, no docs on site. The main hospital is 13 miles away from the MLU, and has a consultant ward and an on site MLU next door. The transfer rate from our local MLU during or after labour is about 1 in 5 (20%) but 75% of these transfers are in first-time mums if that helps. The ambulance transfer time is estimated at 20 minutes including waiting for it to arrive. If you deliver on the consultant unit or the adjacent MLU, you can transfer back to the local MLU within hours if you need to stay in for a bit, but you need to be off drips/no catheter etc.

Incidentally, my first labour was very medical but my second was much calmer - I had a fab MW who kept the doctors away from me and let my body do it's own thing, and I think that MW's working independently on an MLU have a huge amount of experience. The evidence shows that people who labour on an MLU have lower rates of pain relief, intervention and complications and shorter lengths of stay, although some of that is to do with patient selection.

I wanted to go for our local MLU this time but DH is paranoid about intra-labour transfer so I have gone for the MLU next door to the consultant unit. (We are both medics and I work at the bigger hospital too) I just hope I can make it to the MLU 20 miles away in labour without killing DH if he is driving!! Good luck with whatever you choose.

I'm a first timer and I've chosen to go to the MWL unit 2 miles away because of the continuity of care, the one to one labour, the fact that if you do have to get transferred to the hospital then your MW goes with you - I've just heard very very good things about the MWLU and prefer their approach. I think staying calm and relaxed will make for a much safer birth for me and I cannot stay calm and relaxed in hospitals.

Too tired to talk more, but it's the right choice for me.

Well I spoke to my MW today and I think I'm going to change hospitals and have baby at the MWU :)

She told me that my current hospital have opened a MW led unit which got my interest because it's MW led but on the same site as the medical unit, however you can only use this brand spanking new MW led unit if you're willing to go home after just six hours! I don't expect to stay a fortnight but I do expect to at least be allowed to stay overnight just to make sure everything is settling down, etc.

My MW told me that the staff on the unit at the other hospital are very experienced and they would know really quickly if there was something not quite ideal, at which point I'd be transferred. Transfer is by ambulance and there is always an ambulance on site because of the A&E next door. I can have any pain relief I want excluding an epidural and they can repair anything up to a third degree tear. No risks would be taken and I'd be transferred at the point of "this might not go to plan" rather than "this isn't going to plan".

I'm trying to book a tour of the unit so I can go have a nose round check it out.

I'm all excited now!!

Yay - so pleasd for you. My MW told me they need another 80 births a year at ours in order to maintain funding. Seems sad that something so good for women is suffering from a shortage of women.

Absolutely the right choice if you're excited about it.

Went on the tour this afternoon, was just us and one of the MWs so right from the get-go we've had the personal touch. She showed us the delivery rooms, one of which has a huge pool, and their other equipment including long thick cords on a hook/bracket that you can pull or lean on - I really wanted something to pull against while I was pushing with DS to help me bear down (if that makes sense?), it was like a compulsion and I was really out of sorts for the lack of it - not so at this unit, supposedly I can pull away to my heart's content. They also have birthing balls, chairs, etc.

I was really impressed and all of my doubts have been put to bed - they can suture anything up to a second degree tear, can offer gas/air and opiates for pain relief, and they have set policies on when to transfer (basically at the first sign of risk) but I can be transferred back for my post-natal care. They also support both feeding methods and will give impartial advice and assistance no matter which I choose (my last hospital was very judgey and non-supportive of "wrong" choices).

I'm definitely transferring to the unit and if anyone else reading this is in two minds I really recommend arranging a tour of your local unit, seeing mine really has helped me to decide. At worst I end up transferred to city hospital, but best case scenario is that I get the peaceful one-to-one non-medicalised delivery that I want :)

Thanks to everyone who responded for your advice!

Had DD2 in MLU - it was fantastic. But our MLU is attached to the main hospital - so very quick transfer if necessary.

Good luck - hope it all goes smoothly for you x

CBear - that sounds wonderful and just what I'm hoping for too. Good luck with it all :-)
x