Midwife led unit or consultant led unit? I haven't a Danny La Rue!

[ChineapplePunk]

Yesterday at my 12 week scan, I was asked to think about whether I would like to have my baby in the midwife led or consultant led unit. Even though I will be 41 when the baby is born, everything else indicates that I am in the low risk category (obviously this may change as the pregnancy progresses), therefore, the midwife who I saw said it was my choice. She pointed out that epidurals were not available at the midwife unit and that everything was geared towards as little intervention as possible, and making everything "normal" and relaxed. Now I have absolutely no problem with that and i can understand that it would be a much more pleasant environment if the birth is straightforward with no complications. But how do you actually make that sort of decision? I have no frames of reference and it's my first pregnancy. I am presuming that if I decide to go with the midwife unit then I will have the option of being moved to the consultant unit if things don't go to plan? Both units are in the same hospital, however, I don't know if that wouldn't definitely happen (I will clarify this at my next appointment). How do I know if I won't get to the point where I will be screaming down the building for an epidural? I'm thinking, sod it, I'll just go with the consultant led unit.

Any thoughts, comments or advice?

Mmm can't see why you wouldn't go consultant led - you get highly trained medical pro, plus midwife. I went private in order to get a consultant (I am 30, gave birth 6 weeks ago to first child) as I wanted the most expert person I could get at the birth! I had an amazing experience, natural birth (gas and air only) with v limited intervention - I had oxytocin as contractions were not long enough to help get baby out after 2 hrs of pushing. Oxytoicn made them longer and more powerful. No ventouse or forceps needed (afterwards cconsultant said ha I had epidural I probs would have ended up with forceps due to short contractions). I had a v minor 1st degree tear inside which had two stitches.

The midwife assisting was also lovely :-)

Will you be able to meet consultant before?

Not sure. I will have to discuss further with midwife at next appointment to clarify all this. However, I think you're right. I can't really see a downside to the consultant led unit. If things get complicated then I will have a safety net without the worry of being carted about from one unit to another. And if the birth goes without a hitch then all the better. :)

I started off in the mw led unit and ended up in the consultant led. As it was in the same hospital the transfer was v straightforward. In theory the mw led unit was more homely - but tbh being left in a hotel type room with a mw coming in only once an hour in early stages didn't feel very homely or reassuring to me, so I actually felt more comfortable in the consultant led room anyway, it was big, white, bright, and I had at least one member of staff with me constantly. of course your local mw led unit may be much better staffed...

You need to ask exactly what level of medical assistance is available in consultant led unit. In my hospital (Lewisham) consultants are only on-site 9-5. There's only one medical, ie doctor led, team on the labour ward and usually about 30 women on the ward at any one time. The MWs in the Birth Centre have all undertaken advanced training and are actually more highly trained than the MWs on the consultant led unit. I originally wanted to go to the consultant led unit but changed my mind once I realised how thinly spread the medics would be - in the birth centre you get one to one MW care which is another big plus in my book. It's a personal decision of course - just make sure you ask the questions about medical cover etc and what level of care you can expect if you are not a high risk case.

Consultant-led means you have access to ALL drugs (including epidural) and assisted delivery (forceps, cap and c -sections). Some even do water births. You're more likely to see 2 or 3 MWs during labour.

Midwife led is a home-from-home. Usually with 1:1 MW care BUT if you need help, travel to a consultant-led unit is likely, which, in the case of emergencies, can mean a long drive - of course depending where you are.

Both have their +s and -s - you have to decide which is better for YOU!

My friend was (unknowingly to her) trying to convince me that MW-led was better - even though she had to be transferred the 10 min drive when her son was in distress. I even had to S.P.E.L.L. it out to her that where I live (village) it is a 40 minute drive to my NEAREST consultant-led hospital and the MW led unit was 15 minutes away BUT 30 minutes away from the hospital you're taken to if necessary (and in the next county, across a river and down 2 motorways!)- therefore for ME (being my 1st and going into the unknown) it was best to go straight to the consultant-led unit. As it turned out, I have placenta praevia and am B- so it was best for me to be in a consultant led unit. I did not know this until further into my pregnancy. Obviously, not ALL situations are like this - I live in a county where hospitals and maternity units are few and far between.

Try leaving decisions like that until later on into your 2nd trimester (if you can) as you need time to research, visit (informally), get people's opinions of your choices and to see how your pregnancy progresses.

Mw led for me.

Mw led for me all the way if everything is normal and we are both healthy in pregnancy. One to one support fom midwives (the experts in normal birth), pro normal approach, no unnecessary intervention, homely relaxed environment. Perfick :)

Chat to your midwife at your appointments about the pros and cons and go for what feels right for you. I know our local midwife led birthing unit wont accept women of 40, as they are automatically consultant led care.

If both are in the same hospital, go with the midwife-led and if for any reason they are concerned, they'll move you to the consultant-led unit immediately.

I went to the Princess Anne in Southampton and went to the ML unit but because DS was 42w0d and there was meconium in my waters and my contractions were not regular, I was risked out and tranfered down to the CL unit, were I rarely saw a doctor and was under midwife-care all the time until the inevitable c-section.

Personally I don't know why you would choose a consultant for a low risk birth (unlike the first respondent). Consultants are experts is abnormal births, that's what they are trained for, it is what they do. You'd probably have to go back to their training days to fine a string of 'normal' low-risk births that they attended. Midwives, on the other hand, are experts in low-risk births. they are individual practitioners which means they are all qualified to go out and deliver children without needing a doctor overseeing them. But they know when things aren't going to plan and a low-risk pregnancy is no longer a low-risk birth and will transfer you to a more medicalised setting if needed.

I think the reason I am thinking consultant led is because, rightly or wrongly, I am not expecting a straight forward birth. Taking into account that this is my first pregnancy and I am of "advanced maternal age", I have just built up this mindset that it's not going to be without complication. In saying that, I totally appreciate that I have no way of knowing how the birth is going to pan out, and that lots of women my age, and older, have problem free birth experiences. He or she may may just pop out without too much of a song and dance. To be honest, I think I'm probably concentrating on all the horror stories. I know this is silly, but I think it's natural to freak out slightly and be somewhat irrational about the whole thing. :(

How close are the two units? I too was at the PA in Southampton, the official transfer time between the 2 units was something like 10 minutes - but I'm not sure what route they could have taken for it to take that long!

I started off ML and then transfered to consultant led - where 2 very clinical Drs did tests, repeatedly did internal exams, repeated tests later, and eventually decided I had to go to surgery. Actually, I think they did a very good job, but they were very cold and dispassionate and factual - whereas the midwives were more friendly, talked to me about baby, what we had decided to call him etc. I had pethidine in maternity led unit - so you can have some strong pain relief, just not an epidural/spinal. It was a bit more homely - was ensuite and had a radio. MW was in and out until I got to about 8cm at change of shift, then it was 1:1. I was transfered when the MW thought there might be complications - before the problem got bad, so I wasn't screaming down the halls and the transfer wasn't uncomfortable/awkward.

I also thought better to be safe than sorry - but if you are only five minutes from the consultant led unit you will be close in case anything does go wrong, and the MW will get you tranfered when they think they might need help - they will be cautious.

Both units are in the same hospital. :)