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 think maybe if you like the idea of midwife led etc, then make the hoepital/your midwife aware of that and plan for that HOWEVER be absolutely prepared not for it to happen.

My local hospital was exactly the same, with the right next door and I had planned a midwife led water birth etc in the birthing unit

At 41 weeks I was suddenly diagnosed with GD and was induced, laboured for 3 days with epidural and ended with an EMCS.

So basically, plan and make preferences, but also know that very few births go to plan

I love the idea of a mw led birth, with minimal intervention, however I work on NICU so I see births every day. I attend every forceps, ventouse, emergency cs, meconium, ill mum, ill baby, also 'everything is perfectly fine until it's not'. We also attend when they arrive from home in a state because things Went Wrong.
Therefore I could only ever give birth in a hospital where theres nicu, obstetricians and theatre. When it goes wrong its very very very sad and you remember snapshots for forever.
I've attended hundreds of instrumental deliveries just because the mums are too tired/fed up/cant be bothered/too much of a princess to push and they have to be dragged out. Honestly amazes me how you can just lie there and say its too hard, when you've had 9 months to realise the baby doesnt just fall out.
I digress.
If the unit is in running distance for a team of obs and paeds, then go with that. If not, it's a definite no.

@Megan2018 that's interesting, thanks. It seems to be such a lottery as to which ends up being best!

@SweetpeaOrMarigold
I've attended hundreds of instrumental deliveries just because the mums are too tired/fed up/cant be bothered/too much of a princess to push and they have to be dragged out.
I get you're giving us some sensible advice, (and personally I'm also planning for a MLU that's part of a hospital with all the emergency facilities also on site, but... you don't sound like a very sympathetic healthcare person I think I would rather have more sympathetic obstetricians at my birth

I would second the recommendation for the book Expecting Better by Emily Oster. I wouldn't stress too much about a birthing plan right now. I am now 33 weeks pregnant and just been told that my midwife will talk to me about a birth plan at 36 weeks! I've also been told that you can write a birth plan but be prepared to completely change it if necessary. My vague plan is to go to the birthing unit attached to the hospital, where each room has a pool, but I am totally open to changing it. Just as long as baby arrives safely!

@Umberta
you don't sound like a very sympathetic healthcare person sad I think I would rather have more sympathetic obstetricians at my birth
I honestly really am. I'm just telling you a fact, its amazing how many women just give up. I'm not an obstetrician, I work on the neonatal unit and attend deliveries where the instrument is purely because the mum has stopped pushing. I stand and listen to the baby's heartrate going down and down, preparing my resus equipment, listening to the obstetricians and midwives tell the woman she has to push, and I was stunned how often they say they just can't.
Caveat: obviously mostly the instrumental deliveries are for other reasons.

Sweet pea, sometimes women say they can’t because they simply can’t because they are knackered etc, I wouldn’t call it lazy

I work on the neonatal unit and attend deliveries where the instrument is purely because the mum has stopped pushing

This happened with my first. I had been in labour for 48 hours at this point, it took 36 hours to get to 3cm dilated despite having contractions every 1-2 minutes for 24 of those hours. I hadn’t slept in 36 hours and thrown up what I had eaten. I couldn’t push any more. Literally couldn’t. They had to use ventouse. Good way to make people feel like shit though .
Had fabulous second and third births though, long but relaxed and I felt in control. Second was midwife led, third hospital but only because I was induced at 2 weeks overdue. No tearing at all with second or third, and no pain relief other than gas and air for all three (maybe if I’d been allowed an epidural with my first instead of being brushed off by the midwife I’d have been able to get some rest and therefore been more capable of pushing 🤷🏻‍♀️ )

Find out what (if any) pain relief options are available at the MLU. Ideally you would have the option to use a birthing pool, gas and air, TENS machine. As PPs said, if you are pretty sure you want an epidural then it will need to be the maternity hospital.

I wanted to give birth in the MLU which was in the same building as the hospital. It is extremely easy to be transferred to the hospital delivery unit. On the one hand this is a positive when something significant goes wrong. On the other hand it can be a negative if they whisk you off to the delivery unit for something minor that could actually be managed in the MLU. It is obviously hard for a labouring woman to be able to make this call, and you have to trust the midwives.

It sounds to me as if you are nervous about possible outcomes... as you are considering going private, can I suggest that you consider staying with the NHS but getting a birth doula to support and advocate you? I was unhappy with my birth experience first time around so I have a doula this time. It is an expense but obviously nowhere near as much as going private for the whole thing!

@SweetpeaOrMarigold
"I've attended hundreds of instrumental deliveries just because the mums are too tired/fed up/cant be bothered/too much of a princess to push and they have to be dragged out. Honestly amazes me how you can just lie there and say its too hard, when you've had 9 months to realise the baby doesnt just fall out."

It's people with nasty attitudes like yours that give (some) HCPs a bad name. Disrespectful and judgemental. You should be ashamed to post something like that on a forum/thread for pregnant women and mothers.

Just to counterbalance what IslayBrigid said about episiotomies and tearing... I was advised by my gynaecologist (who is an expert in her field) that in my particular case, she recommended an that an episiotomy was likely to be advisable as it could prevent severe tearing and it would heal better because it would be a "cleaner" cut. In my case this was partly because of my physiology. She explained that during the pushing stage of labour, the midwives usually have a good idea of whether you would tear or not and if so how severely, and if it likely to be a first degree (small) tear only there would be no need for an episiotomy, but if a bigger tear seemed likely then an episiotomy would be advisable.

So my "birth preferences" list was all about minimal intervention if possible with a bonus episiotomy thrown in I did have an episiotomy and it turned out to be very necessary because DS got stuck on the way out (shoulder dystocia) and they had to do a manoeuvre which was presumably slightly easier thanks to the episiotomy.

Do read all the positive birth books and try hypnobirthing (I did a course myself and was completely sold on it all) but please don't get too hung up on it all in case it doesn't work out that way.

I had my first on the MLU which is right next to the hospital. I had a PPH and was whisked off for urgent care. The transition was immediate and seamless.

I'm due my second any day and have had to fight tooth and nail for the consultant to sign me off for the MLU, but have no doubt that I've made the right choice. It's so much more chilled. Low couch beds to labour on, less medical equipment, ambient lighting, pools in every room.

For me, the environment is very important to a calm birthing experience. I wanted a home birth until I saw DH's poor traumatised face and agreed that the MLU is the compromise.

Also, when in labour, get your birth partner to remind you to try for a wee hourly. They think my full bladder caused the placenta to tear on delivery which led to the bleed.

It seems a few people haven't read the whole post as usual!! I needed an instrumental birth because my baby was in distress, I had the entire team present and theatre was prepared for me. Everyone is different. Usual MN replies that don't realise everyone isn't like them! Its well recognised but of course not spoken about.

@sweetpeaormarigold
How can you tell if a woman is genuinely physically exhausted or just "too much of a princess to push" (if that is even a thing)? Answer: you can't. So I would hope that HCPs would be compassionate and not dismissive and judgemental I hope you don't work in the hospital in south london that I'll be giving birth at

@sweetpeaormarigold my baby wasn’t in distress, I was physically too exhausted to push. So I’m one of the women you’re describing in your nasty post.
I knew I’d have to get the baby out of course. I didn’t realise that would be after 48 hours of labour with no sleep, no food and no pain relief.

"It seems a few people haven't read the whole post as usual!!"

Yet more dismissive arrogance. We don't like your nasty post so we can't possibly have read it!

And actually sweetpeaormarigold, in my second two labours, which were handled correctly, where I wasn’t left in screaming agony for 2 days with eye rolls and tuts and remarks like ‘you’ve got worse to come’ from the midwives, and where I wasn’t forced to lie on my back, I barely even had to push. It was calm, relaxed, I knew what my body was doing and with some downward pressure the baby came out (no pain relief). So if my first birth was me just being a ‘lazy princess’, then so be it.

It's people with nasty attitudes like yours that give (some) HCPs a bad name. Disrespectful and judgemental. You should be ashamed to post something like that on a forum/thread for pregnant women and mothers

My thoughts exactly about @SweetpeaOrMarigold's post. And yes I have rtft.

@SweetpeaOrMarigold, wow.

Listen, im an A+E nurse. I know exactly how it feels to see through peoples bullshit but have to play along with what they're saying when its causing them harm, whilst quickly getting emergency drugs/equipment ready for when they eventually crash.

However, I find your comment appalling. I know you probably say things like this to your colleagues, but to truly believe a woman just doesn't want to push anymore at the detriment to her babies life is ridiculous.

I think you need to explore why you think like this. Write an honest reflection maybe, or chat it through to someone impartial, or something.

I choose the hospital because I wanted an epidural. But that meant I was induced to fit in the schedule of the anesthesiologist who would give me the epidural. It was a good experience but I am not in the UK and personally if I were in your position and wouldn’t want an epidural I might choose the birthing centre. Seems more like a cozy and nice environment to give birth then a hospital.

@SweetpeaOrMarigold fellow doctor here with three years experience in O&G. I ended up with forceps after ten hours of full on active labour including a two hour second stage with my large direct OP baby. I was exhausted and struggling to push by the end. Thankfully the midwives and doctors who cared for me were supportive and caring.

I find it very sad that you judge women for being “too lazy” or “too much of a princess” to push. It’s a rather misogynistic and old fashioned attitude that assumes all pain in childbirth is “natural” and “normal” and women should put up and shut up. I always find it sad that so many women on here are anxious about childbirth and distrust doctors and comments like yours really don’t help. So glad you are not an obstetrician.

All comments taken on board thanks very much for your help and support in showing me the enormous error of my ways.
Just to point out, being exhausted after hours of labouring does not mean being lazy or a princess. Maybe its just the geographic area in which I work.

Just to point out, being exhausted after hours of labouring does not mean being lazy or a princess

Unless you’ve been in the room for the whole of the woman’s labour, you have no idea why they feel unable to push any longer.

Please can people stop having a go at @SweetpeaOrMarigold . She gave her honest thoughts and I appreciate them; piling on really isn't in the spirit of the thread or Mumsnet.