High risk pregnancy, Is there any way I can still to go to midwife led unit for delivery?

[Lucinda15]

I am 26 weeks pregnant with 2nd pregnancy. First pregnancy was classed as high risk in third trimester due to baby measuring large. In the end I had a normal vaginal delivery with epidural and episiotomy. But I felt really uncomfortable and anxious on the high risk Ward, I felt there was very little in the way of birthing aids and support. Consequently my labour slowed down as soon as I got there, it ended up being very long and was a bad experience during and postnatally. I also lost 800mls of blood through the episiotomy.

Due to the blood loss with first labour, and subsequent 4 miscarriages since that pregnancy, I am back under consultant led care. But I really dnt want to go to the high risk Ward for labour. I would so love to have a nicer environment for labour, and go to the midwife led unit. I did discuss it briefly with one of my midwives for previous pregnancy (miscarried so never got to discuss in detail but she mentioned if I wanted midwife led, I could put my foot down and get it?!)

I will discuss with consultant/midwife next fortnight when I see them but wondered, has anyone been in a similar situation and managed to go to midwife led unit with a high risk pregnancy? Of course I want what is best for me/baby but I really feel midwife led could help me manage my labour better without need for intervention. Also, where I'm based, the high risk Ward is literally across the hall!

Interested to hear others experiences. Thanks.

I was going to say that a midwife led unit wouldn't be a good idea if you're at risk of a big bleed, it would be really quite dangerous to risk a transfer to hospital when bleeding. Then I read it's just across the hall! I'm not sure there's any reason not to in that case, it's not like you need constant monitoring through labour or anything. Best see what the professionals say when you see them but I don't think your suggestion is unreasonable.

Hi there, I suppose it just depends on your hospital and their policy.
I'm currently 30 weeks pregnant, and have an high risk pregnancy. I had pprom at 18 weeks any now my cervix is open. I'm both midwife/ consultant led. However I don't think we have an high risk ward so that might not apply to me.Hope that helps. I would certainly ask for what makes you feel comfortable. All the best. X

In going to follow this. I'm down as a high risk pregnancy due to GD but so far I've managed to control it with diet and they've reduced how much I have to test significantly. I really want to push to go on the midwife led ward rather then the consultant led. Like the OP they are only across the hall from each other. I just know I'll be so much better in a midwife led unit rather than a room with all the clinical equipment around me.

JUST DON`T!!! go for all the bells and whistles, you could die or your child could or both you also have another child to think of. After DIL and grandson almost died which affected everyone, son had ptsd, do not put them through that because some pie in the sky idea that you want a natural birth.

It really does depend on your hospital. At ours the midwife led unit is in the hospital, literally down the corridor from the delivery ward, so it makes no difference.

With a previous PPH I wouldn't want to be too far from the delivery suite, and I say that as someone who had two home births because hospitals make me anxious.

I wasn't high risk but I was consultant led because of hypothyroidism and miscarriages.

I opted for the midwife led unit and really regretted it. I pushed for four hours (two of those so called 'purple pushing) before the senior midwife found out, went crazy and told them to get me a doctor. DD was back to back and stuck and I needed a ventouse delivery. Thankfully I only needed to go up three floors in a lift. Labour was 8 hours from very first twinge to birth.

The midwife had been so determined I was going to have a 'normal' birth. I dread to think what would have happened if the senior midwife hadn't popped her head in the door.

My advice would be don't have any concrete plans and have a birthing partner who understands what you've been through, what the risks are but will also fight your corner in terms of staying mobile and not being made to lie on the bed etc

Thanks everyone, interesting advice and experiences.

I have to add, welshmist that this is not some pie in the sky idea for a natural birth. I'm taking it seriously, I've lost 4 babies before this one, and I'm not going to risk this one.

I just feel that the high risk Ward I was in last time actually made me more anxious and did very little to support my labour. My contractions slowed right down as soon as I arrived, my labour was prolonged and I therefore needed an epidural and the episiotomy which is how I lost the blood (rather than a uterine bleed). I am keeping an open mind, I wld happily have an epidural if needed or c-section or whatever the midwives/consultants advise.

But I do want to know if I could start at the midwife led unit to try and encourage a smoother, less prolonged labour if I am more comfortable. And as I said, the high risk is only across the hall so I would be very close to everything I need if things went that way.

After the first labour, I know better than to have any 'ideal' in my mind and have not made any concrete plans. I am accepting that I may just be best placed in the high risk side, but I appreciate the advice and shared experiences. Has given me something to think about.

You sound very intelligent and well informed, as well as having a good understanding about what 'went wrong' last time. I'm sure you'll make a good balanced judgement on what's right for you, you're clearly not daft or got any pie in the sky ideas.

Thanks redjumper - the encouragement means a lot. x

The high risk bit being across the hall doesn't mean they'd have an empty room waiting for you in case you needed to move.
I'm consultant led as lost 3 litres of blood during last birth and it's never entered my head to ask not to be. You'll be costing them more as consultant led so doubt they would have you there unless they thought it was in your best interest.
Do you know for definite that being in the high risk bit was what caused your labour to slow down? Could be coincidence. It could have been specific people too and chances are you'll have a different team this time

No that's a fair point, I had wondered about availability of high risk room if it came to it.

In terms of people, we were pretty much left to it on the high risk side. Weren't monitored regularly until the end. After we arrived in the early stages we were left in a very clinical room with no birthing aids at all to help. I spent hours walking around and around (or hanging on to) the bed as nowhere else/nothing else to use. Even the bathroom was being used as a storage room, I managed to have a bath but it was difficult working my way around it all to get to it! And it felt dirty and DH cldnt really sit with me. It just wasn't very nice at all and I truly believe being in those circumstances had a negative effect on my contractions and went towards the prolonged labour and everything that followed.

But I spose that's the luck of the draw, and cld be an entirely different set up and different staff this time.

It would just be nice to have some cushions/birthing ball/seat/accessible bath to try different positions with or something. Perhaps I can discuss this with midwife/consultant. And be a bit more assertive about getting these in high risk if we are there for some time.

Could you take anything with you? I don't think I had any if those things but we played our own music on a tablet and had a midwife with us for a fair bit (tbh I was a bit out of it so can't remember it all). I certainly didn't have a bath nearby.
It'll be the same for me next time (am 25 weeks so similar to you)
I think you just need to try and make the best of it, take some of your things and just go knowing you're in the safest place
X

So realistically, we can't actually tell you what you can't and can't do. You say you had a pph, well there's a vast difference between 500ml and 3000litres in terms of risk and management. What you need to do is book a meeting with your local supervisor of midwives and get a documented plan in place, there could have been reasons why you bled last time that may be nagivatable. They'll look through your previous birth notes and give you a better idea of what went on and how it applies to your next birth. Give it a try, you never know.

Sorry you've had such a tough time.
I don't know if this will be a helpful point of view but are you sure you will be more comfortable on the MLU?
I delivered DC3 last year on a MLU. I was very very anxious due to some issues with the pregnancy and a terrible birth with DC2.
The midwives couldn't have been nicer and the set up was very calming and relaxing but I was so afraid my body kept shutting down, so labour was very stop-start.
I agree with pp suggesting you book a meeting with the supervisor of midwives. Maybe your focus could be on what you can do to make the high risk unit more tolerable to you?

Thanku, that's a good idea. I will discuss with them in more depth. To be honest I never really considered myself to have had a haemorrhage until it came up last year during one of my booking in appointments for previous miscarried pregnancy. They never made an issue of it during the labour at any rate, although we obviously knew there was a lot of blood and I was prescribed iron tabs etc. But all of a sudden it became an issue during the booking in appt and I was down as high risk again. And then I am now consultant led due to recurrent miscarriages. Perhaps I could discuss all this with them further.

I'd be happy to go high risk, if I cld take some things to help the labour as there was nothing to help me last time. Birthing ball/cushions/music from home should be do-able! To be fair we didn't think of this last time. I did toy with the idea of music but it was all so beyond me when things kicked off and we were quite unprepared at hospital. Thanks for the tip. I'm beginning to think perhaps we can make the most of this and make high risk much more manageable than last time. Thank u xx

I gave in to high risk consultant led birth, but maintained I had to control 1 thing, and that was dp told me the sex of the baby.
I wasn't allowed any of the things I wanted, but hearing dp say 'it's a boy' was amazing! And my little boy is alive and well because of their interventions

My second birth was consultant led. I asked for a birth centre type birth but in the labour ward. I refused constant monitoring so I could move around. I had to stay in but was allowed to move to the birth centre and a private room for the night after the birth.

It is worth explaining and discussing your concerns. You can ask for minimum interventions and as few people present as possible.

It will depend on your hospital but I have had consultant led care for all of mine and still been able to use birth balls/birth pool/move about etc

I've been consultant led for 3 of my 4 pregnancies and have always used the midwifery led unit. Like you it's just upstairs so they can move you if they need to.

So the miscarriages don't stop you from being on a MLU and the fact you lost 800mlnfrom an epis doesn't make you at risk of PPH. Therefore, I can see no reason why you would need to be on a CLU. If you are advised against it I would suggest contacting a supervisor of midwives (although they are becoming redundant very very soon so you may need to see if you have access to a consultant midwife for normality). Good luck, you should be fine 😊

I was high risk with all 3 pregnancies. Was told I couldn't go to birth centre on any circumstances. When I did go into labour (3rd baby) I was taken through to normal delivery ward. Got myself comfy etc & was told I could be monitored in birthing centre if I felt comfortable enough.
I went and had absolutely no assistance (midwife obviously checked baby's heart rate every 15/20 minutes) and I had a very successful unassisted birth.

Ask your midwife if it's a possibility. I was always told no until the actual moment!

Its up to you to weigh up risks for yourself but I would be cautious if part of your decision is based on thinking never mind HR is across the hall. i second caipirinhas comment that across the hall does not mean available or indeed optimum. They have a set number of beds and staff and women who chose to be there from outset. Even then, I would think being settled in there from the start and being monitored is still more controlled and easier for staff to manage than shit right hurry up over to high risk. If you feel lack of birth aids was a problem taking your own seems a quick win.
I notice you mention taking an epidural if midwife advised - the info pack for my hospital said epidurals are not available at the midwife led unit. Yours may be different but if not checked might be worth it.

Best wishes