1st baby - midwife led or hospital?

[roarfeckingroar]

Hi everyone,

I'm early on with my first pregnancy. I'm 31, no health conditions or high risk factors, healthy weight and exercise (new to this - apologies if it isn't relevant but I've seen lots of mentions of BMI).

I've been advised to self refer and the options seem to be the hospital or the birthing centre. Where I am, the nearest two are next door so I assume if something went wrong I could be moved to the hospital from the birthing unit? On the flip side, I always thought I would opt for a Caesarian because there seems to be such a prevalence of tearing then poor after care for women in the UK.

Any advice would be hugely welcomed.

Apologies for silly questions - all seems a bit surreal

I opted for midwife lead unit , did end up doing it in hospital but the two where just on different floors of the same building.
Honestly there was nothing wrong with the birth it’s just I arrived fully dilated and ready to push when they asked what I wanted I just wanted the baby out ... so I stayed in the hospital side ... it was still midwife lead and a good experience overall.

Though the rooms are nicer in the midwife lead unit as they transferred me down after.

But when in labour it really wasn’t something I cared about. If it was a longer labour I may have

Choose what you fancy and just bear in mind that everything is changable.
Massive congratulations 🥳

For me I knew I wanted the birth centre. But in my case the birth centre was in the hospital, down the corridor from the delivery suite, theatres and NICU. So if anything did go wrong I could very easily have been moved.
If it wasn't within the hospital then I'm not sure what I'd have done

I had midwife led in the birthing pool. I had 1 graze and no pain relief. 31 yr old, first baby.

Depend on how you want to deal with the pain. No pain relief at midwife lead birthing centres some offer has & air.

If you want an epidural then it's the hospital labour ward.

C-section of course generally there should be a reason, but you can request it but you will need to very strong in wanting it.

I had both babies on the labour ward due to induction, as they didn't arrive in their own. First just gas & air, i thought I had a high pain threshold but not in the case of giving birth it was so painful. The second one with epidural and I can recommend, small tear all ok, a good birth.

Sorry regards tearing I had a slight tear my midwife was fab ... the tear was literally because the urge to push was so strong I couldn’t wait for the next contraction and ejected the poor bubba out.

A planned c section I understand though is much better than an unplanned one ... I haven’t had one but seeing my friend recover from one I think it’s harder to recover from or
Seems that way... but I was lucky in my labour and midwife

@mrsed1987 that's the dream!!

@Newmumma83 thank you! Early on so still between terrified and ecstatic. I just know I don't want to be on a conveyor belt then shoved into a ward with strange men and no peace afterwards. I might rinse my savings and look into private if possible. It's all rather new and daunting.

I was midwife lead but had to be induced at 39 weeks due to reduced movements. I delivered on the labour ward in the hospital but still managed to have the water birth with no pain relief that I would have had at the birth centre. It just meant I had a wireless monitor on my stomach during labour and delivery to keep an eye on baby which couldn't be done at the birth centre.

Congratulations! As you are fit & well it would be very reasonable to start with the plan for midwife led care in the birth centre. There is always the option to medicalise things if necessary but you will have the opportunity to discuss this with your midwife/midwives as the pregnancy progresses
I’m not sure where your info about tearing and bad after care has come from. As midwives we work very hard indeed to avoid problematic tearing. Many women birth beautifully with no issues at all and no need for any intervention. Good luck!

I would go midwife led especially as it is an alongside unit rather than freestanding, so very close to the hospital if required.

You are right about the prevalence of birth injuries. I would advise doing some research into your rights to refuse and question. Just because the doctor says you "need" forceps or "need" an induction doesnt mean you have to have them - you could opt for a c section instead in this case for example.

Maybe it's different in your area but here you go to the hospital initially then the decision of where to actually have your baby happens much further down the line (by 28 weeks or whatever you might find you do have a risk factor, although hopefully not of course). Do you definitely have to choose now?

Btw - I'm having my first also and am 90% leaning towards a c section. My reasoning is that I'm only planning one child and a lot of the advantages of having a vaginal birth is that it makes a second vaginal birth easier, and reduces chances of complications in a second pregnancy, which doesn't apply to me. I'm also worried about birth injuries. I've done some research and, for women over 35, there is a slightly higher risk of hemorrhaging with a c section vs vaginal birth, but also a slightly lower risk of baby ending up in NICU. That study only looked at women over 35 though so I'm not sure it applies to you.

I'd suggest having a look at the NHS birth statistics for the % of vaginal births needing forceps/episiotomy or ending with an emcs and see what you think..

Nb, study above was referring to planned c section, not emergency.

I am pregnant with my 5th. I have had babies in the hosp, in the midwife unit and at home. I'm now under consultant care and have to have this one in the hosp. I would say it honestly doesn't matter. What is more important is that you educate yourself as much as possible about birth. Read other people's successful birth stories (not the scary ones!). I tore (2nd degree) with my first child. Despite having done nct classes I allowed myself to give birth flat on my back. Try and work out in your head in advance how you want it to play out. Make sure your birth partner knows. I now know that for me on all 4's is most comfortable (and less traumatic for my body). It might be different for you and different labours are different - ultimately all any of us want is a healthy baby so you can't be too fixed as things can change. Also, for my second I wanted midwife unit but it was full so I had to go in the hosp and for my first it was so full I didn't make it out of the initial assessment room. If I had been rigid in my expectations of the birth that would have caused me a lot of anxiety. I didn't see a doctor for any of my births (except for stitching second time round)

I've refused examination in my last 3 births but in my first I wanted to know how dilated I was.

I don't write a birth plan anymore as I would rather let things progress naturally. And I don't want it used against me if anything goes wrong.

I had the most attention at my home birth - 3 midwives present and a set of paramedics downstairs just in case (I didn't even know they were there - my husband told me about them this week 5 years on!).

If the midwife unit is attached to the hospital I don't see you are putting the baby in additional danger. They would have to wheel you to theatre anyhow if you needed an emergency c section and the doctors have legs if they need to come in.

I had excellent NHS experience so don’t believe the hysteria. My 24hr hospital stay was necessary due to gestational diabetes but it was great.

I had to do hospital as I was too old for birth centre. I wanted an epidural too but didn’t have one in the end as labour too fast.

I’d opt for birth centre but you can change your mind.

After just having a baby in hospital and having horrendous postnatal care I'd opt for midwife lead if you can!

This is really really helpful thank you guys.

I've booked for a private scan two weeks today (Friday 13th - as you can imagine there were quite a few free slots!) and have a GP appointment next Friday. Joys of WFH.

Consensus and positive stories seem to be midwife led, which sounds right, but I'm going to take advice and do a sh*t tonne of research.

@shutupsteph I'm sorry to hear you had a terrible experience, I hope you're recovering and congratulations on your baby.

@memberofseven five!! Wow! Thanks for the benefit of your experience.

You are very welcome. I was a month off of turning 31 for my first so you have plenty of time 😂😂😂.

I gave birth in a midwife led unit attached to our hospital - nice and calm despite my birth plan going completely out of the window! I had a PPH and cervical tearing immediately afterwards so they needed to move me up to theatre very quickly to stop the bleeding. As soon as the placenta was delivered and they realised what was happening I was wheeled upstairs. Before the birth a PPH was really high on my list of anxieties (I’m not good with blood) and so I’m really glad we opted for the birthing centre instead of a home birth as I was originally weighing up.

I was on the recovery ward for 24 hours after surgery and then postnatal and both were fine. I had a private room on the postnatal ward thanks to the after effects of the surgery meaning I had to have extra obs and checks, also I think they took pity on me!

@memberofseven oh dear lord the thought that I could have 5 starting now... you're a braver woman than I am. I'm 32 in a couple of weeks and this pregnancy has been quite the surprise but I'm starting to come around to it, I'm in a good place with career, own flat, brilliant long term DP etc and I'm in London so not isolated at all. I seriously miss wine already and I'm a little tired but otherwise, I've always felt rather laissez faire about life and this is the next step!

@BadCatDirtyCat I felt exactly like you, I was really close to opting for ELCS as I was 41 and terrified of birth injuries as had friends who had this.
In the end I opted for vaginal and was convinced it’d go tits up and end up in a EMCS. My DH booked a month off as I was sure I’d need him and had everything prepped at home for section recovery.

As it goes I had a lovely fast birth (6hrs) no episiotomy, no epidural (No time!) and didn’t even need as much as a paracetamol afterwards. Back to normal in hours. In contrast my friend who opted for ELCS a month after me is still struggling terribly. Having seen her struggle I am so glad I didn’t choose it.

My NCT leader was a huge help and actually helped me reconcile my worries. I’m not knocking sections and make whatever choice is right for you-but I am someone that always looks for the negatives or worst case scenario and actually am glad I was challenged on it. My body astonished me.

I think recovery from c-section is so dependant on the woman. Ive known people struggle with it, but equally ive known people recover really quickly. The rub of it is you wont know how you recover until after you've had one, but thats the same as everything in life.

Be aware that encouraging vaginal birth isnt just about making the birth of a second easier. Theres also some evidence to say that microbiotic transfer from vaginal birth to baby is key for gut health. I think in my trust they're now artificially transferring vaginal microbes now if a csection has happened.

Im 33, am 37 weeks pregnant and opting for a vaginal birth as I want to avoid major abdo surgery, and on balance it seems better for the baby. For me the negatives are far worse than the positives could ever be.

Im also not making a birthing plan as PP has said, I very much have a lessaiz faire outlook to life and what will be, will be. If theres a need to medicalise things, then so be it. That said, ive chosen to labour at an alongside birthing centre, so im covered if anything needs to happen. I think this has played into my very loose 'plan' quite a bit.

Good luck!

Wow @Megan2018 that sounds like a dream birth! Congratulations

Hey @roarfeckingroar I'm also early on in pregnancy and considering my options! I highly recommend The Positive Birth Book by Millie Hill, Expecting Better by Emily Oster and Ina May's Guide to Childbirth. All are excellent resources for impartial, evidence based advice on childbirth.
Regarding tearing, I've read when they perform a cut it is often much harder to heal naturally and can actually make you tear more. I would avoid allowing a cut unless absolutely necessary. Have a birth plan - the positive birth company has a great birth plan resource. Know your rights.

You need to ensure you feel relaxed as poss at a primal level (not just reassured coz doctors nearby, it needs to be deeper than this) - this is a crucial element missing from so many people's birth stories esp in hospital due to bright lights, constant examinations, strangers etc. All of this reduces the body's ability to produce oxytocin. You need oxytocin to give birth, full stop. And this is produced when you feel cosy and loved. Barring emergencies, we are generally well developed to give birth vaginally and in the right environment we can do it easily. The books I recommended are so informative about this, but also give all the info about more medicalised routes with no judgement and it's impartial and super interesting. They just give the facts.

Also, you can do perennial massage, keggel exercises to help prevent tearing, and use evening primrose oil capsules in your vagina in the weeks up to labour, all of which help!
C-sections sound like a horror to recover from generally, I would definitely do a lot of research before trying to have a c-section without good reason. They are a miracle resource when necessary for whatever reason, but the idea that it is easier is a false one IMO. It's also beneficial for baby to have a vaginal birth because of the good bacteria they are exposed to in the birth canal.

I'm considering a home birth as like a PP said, I will have 2 midwives at least, highly specialised, be comfy in my own home so better for oxytocin, and hospital is nearby in event of emergency. If I had a midwife led unit nearby I would definitely do that but it is about 40 mins away so i'm not sure. Luckily the hospital also has some nice rooms and birthing pools. I recommend looking at the birth place study which looked at 60 thousand odd women giving birth and assessed the risks with home, MLU and hospital births. For first babies, risk to baby was same in MLU and hospital, but risk to mother was reduced in MLU. Good luck. xx