Mid-wife led / medicalised labour wards. What's the difference?

[aufaniae]

I have found out with only weeks to go that my hospital is losing its full maternity service and becoming mid-wife led only.

Can anyone explain what the difference is? I have to decide whether to stay there or go to another hospital 40 minutes away which does provide a medicalised approach.

Can you get an epidural in a midwife led unit? What if you have to be augmented / induced, do they transfer you to the hospital with the medicalised unit?

What if you have to have a section, or a crash section?

In my first labour I was high-risk, so was on the medicalised unit (in a different town to where I live now) so I have no experience of midwife led.

I'm really annoyed this has happened, it seemed like a good hospital to give birth in

DD2 was born in midwifery unit. There was no paediatric support, no epidural. There was a birth pool and gas-and-air available. Emergencies/complications inc CS would require transfer to another hospital 45 mins drive away. Think of homebirth but in a purpose-built building. that was my experience anyway - other midwife led units might be different.

As everyday said, there is no medical support so it is very much like a homebirth but not at home. I believe pain relief would be limited to gas & air, pethidine, codeine. You wouldn't be able to have an epidural. As you suggested, any kind of issues needing assisted delivery or emergency C would involve a transfer to the delivery suite, however far away that is.

The major benefit of the midwife led unit is the calm and relaxed atmosphere with some creature comforts. Ours had no beds at all, just mats on the floor, balls, stools and pool. We had a wonderful birth in the pool and if we have another baby I will be choosing midwife led.

I think it's an insane choice to have to make tbh. The midwife led sounds lovely but it comes with a risk having to be blue lighted while in extreme pain or denied proper pain relief if needed. Also it's my understanding that if you need an emergency section because the baby's showing serious signs of distress they have a matter of minutes to perform the CS. How is that compatible with a hospital being so far away?

The ward they're closing has a dedicated obstetrics surgery team, at the same time as having pools and balls etc available. You don't have to choose one or the other (like you did at the hospital I had DS at) Really annoyed about this

Agree with the others who've said that there's limited pain relief in an MLU but much greater levels of privacy and more like a homebirth (but without all the cleaning-up afterwards!). I believe there's research that shows that with a calmer, more relaxed and supportive environment there's a statistically much lower need for intervention and medicalisation - where I am there are at least two MLUs outside the city that aren't attached to hospitals. I used the MLU for both previous births and will be for this one, but it's not for everyone, and usually if there's any chance you might need a section they will send you to the normal delivery suite.

Is your current pregnancy high-risk too? If so you will probably be happier going to the other hospital.

It is your first baby? A slow first stage of labour will have you transferred to a hospital as a precaution from a MLU. As they do not have medical assistance on site they cannot take risks. In my case I opted for hospital as it was my first and I'm glad I did. I had a normal low risk pregnancy, and text book early stage, but needed very quick ventouse assistance when my baby's heart became erratic and the cord was found to be dangerously positioned. I am very grateful to the wonderful doctor who got my baby out safely.

Congratulations! DD was born in MLU... The one in Paddington which is attached to the hospital. Perfect birth of baby- well... You know! As perfect a birth can be! Still bloody painful... out in 10 hours (that's considered fast for first baby)... Did not get to the point where i asked for drugs, although i lost a lot of blood as she was so big (10.5lbs) and the chord snapped when placenta was still inside...3 jabs of syntocinon later in hope to get placenta out saw me climbing the walls like something out of the exorcist (seriously not a fan of this drug! Was like contraction pain X 10!) so was sent to theatre in the hospital next door and subsequently ended up with immobile epi to get it out... Point being i think MLU's are wonderful- as long as you are close/attached to hospital in case you need help. Hope this doesn't worry you to hear. It's very unusual circumstances but have taken to being more honest since being told off for sugarcoating...

It's my second baby. I had my first at a different hospital. I was high risk then and they gave me a syntocinon drip in the early stage of labour, and then throughout. They also tried 5 times to give me an epidural but it didn't work at all. I never knew pain like that existed. [Sad]

This time round I'm getting conflicting advice about whether I'm high risk or not. My usual midwife ssys I'll be augmented (induced once labour starts) but the one I saw last week said there's no reason to assume I will be .

Either way, this baby is back to back atm, which I hear is very painful. I wanted to avoid an epidural the first time round, but in the end I really needed one (just wish it had worked!)

I am very reticent about putting myself in the position of needing an epidural and not having access to one. Screaming agony with no pain relief is not my idea of fun.

"I had a normal low risk pregnancy, and text book early stage, but needed very quick ventouse assistance when my baby's heart became erratic and the cord was found to be dangerously positioned. I am very grateful to the wonderful doctor who got my baby out safely."

This is also what worries me. What would have happened if you'd been in a midwife led unit not in a hospital? Surely for some babies they're put at risk by being so far from help in an emergency?

My ideal would be a MLU in a hospital, it's crazy that we need to make these kinds of choices IMO. Basically if we want fast access to emergency assistance and proper pain relief we need to put ourselves in an environment which makes these outcomes more likely. Or we go for a MLU which means intervention is less likely but not there if we need it. What a crap choice.

I think if your labour needs to be augmented then you'd be transferred to a maternity unit anyway? So wonder why you'd be told MLU is an option if that was the intention?

I had my first at a MLU, they are great at recognising when something is not quite right and you'd probably get more personalised care so a problem would be spotted pretty quickly. Also you don't get to just go straight into theatre even if you're in a hospital, it can take 30 mins to prep for surgery.

How long before you have to decide? I'd play it by ear if you can, certainly if you're no longer back to back on D Day that might change things.

I don't yet know if they'll augment this time or not.

I've also only just found out about this. When I saw my MW a week and a half ago it hadn't been announced.

About CS, don't they sometimes need to do a crash section in a great hurry, no time to prepare? How does this work in a MLU I wonder?

I'll see my MW on weds and should hopefully know more then about when I need to decide etc.

Don't worry too much about back-to-back - both my first two were b2b and so is this one. It's perfectly possible with just gas-and-air and it's better with a second because they have more space to turn during labour.

BumbleBee2011 Also you don't get to just go straight into theatre even if you're in a hospital, it can take 30 mins to prep for surgery.

It can take even longer if there's lots going on & faff - but if it's a proper emergency i.e. Category 1/Crash Section then the target for 'decision to delivery interval' time is 15-20 minutes at lots of hospitals.

I'm paranoid (seeing too many crash sections will do that to you! Still in awe of one particular surgeon who got a baby out in about 5 minutes while I was scrubbing up..!) so definitely want to be in a building with the facility for this & seem lucky that all the local hospitals here seem to have MLUs alongside Labour Wards. But also think there's a risk of LWs over-medicalizing things... so tough decision to make.

Yes that makes much more sense! That's how it was in my last hospital. Although actually it did mean that for some reason they decided that only labouring women in the MLU needed access to pools, balls etc. There was no support of active labour in the Labour Ward.

That's why I liked this hospital - even though it was a Labour Ward rather than a MLU, it still had pools and balls etc.

Is it possible to change hospitals at all? Many people do, even late on.

The two next nearest hospitals are 40+ minutes away. If DD goes overdue, I am essentially being forced to change hospitals whether I like it or not (as even if I stay as the local one, the ward I chose won't exist in its current form).

I've pretty much decided I'm going to go for the medical Labour Ward as my last birth was extremely painful and I don't want to labour without knowing an epidural is a possibility if I need it. I don't fancy being bluelighted such a distance while labouring. Also I'm not happy about the extra risks to DD, not being near the crash section team, in case we need them.