Birth choices - first timer

[duckling3]

Hi, I am currently coming up to 11 weeks pregnant. Had the booking in appointment with the midwife yesterday. She asked me if I'd decided where I want to give birth which tbh I wasnt expecting with it being so early. In our Area we have a midwife led unit not near the hospital, a midwife unit in the hospital & the hospital labour ward. I've only just started looking into the options, and have ages yet to make any decisions , but it's a bit overwhelming. The midwife unit not near the hospital looks the nicest ( by far) but then there is no option for epidural or doctors onsite if something were to go wrong.

I'm curious as to what factors people take into account when planning where to give birth...especially for the first time.

Hey there, first timer here also! we've also looked at these options as we have a midwife led unit not attached to hospital

Hospital pros and cons - you're at the hospital should you need emergency c section or want an epidural. Plenty more midwifes etc there if you need them. Downside for me is that it is very clinical, not very 'cosy' and can be louder as it's busier

Birth centre / midwife led unit - much more homely. Most of them have double beds so your partner can stay too. Usually have kitchen areas that you can choose. Most have birth pools and tend to be more relaxed. Downside is if anything goes wrong or you want an epidural you will need to be transferred to hospital. This is in an ambulance and a midwife will go with you (certainly in our area anyway). You have to basically be the 'perfect' candidate for this I.e not 2 weeks overdue, not overweight etc. you can usually visit these before your due date (this May depend on what's going on with CV19 tho atm)

Home births - usually not recommended for first time mums. Higher risk although tends to be more comfortable for you as you're in an environment you know. Again you would need transfer if anything went wrong. A lot of selected home births are not happening at the moment due to the virus also.

Plenty to think about and of course what you plan may not happen as babies do what they want 😂 think about the kind of pain relief you may or may not want as well

Hope this helps a little :)

Hello! I highly recommend The Positive Birth Book by Millie Hill, this will help you decide where you want to give birth. Also the Birth Place Study which took place in the UK a few years ago and studied c. 60K births is a great resource for balancing risk (to both you and baby) and your decision of where to birth. I'm also a first time mum, currently 18 weeks.

For me, I have opted to aim for a home birth. This is for many reasons but I'll set them out coz maybe it'll help you with your thinking and your decision :) There is not a MLU in my area (closest one is about 30-40 min drive away). I feel like a 40 min drive while having contractions every 5 mins is not a good idea if I can avoid it, but I do have the option of changing my birth place to the MLU later in pregnancy if I like. With a home birth, I can also decide to transfer to hospital on the day. You aren't locked into anything. The hospital isn't bad but the birthing rooms do not have their own bathroom. For me this is quite important because I know that to labour and birth well, its important to have privacy and be comfortable (more on this later). I don't want to have to go out to the main ward bathroom etc. With a home birth, I have the midwife come to me throughout my pregnancy, appointments at home, two midwives at the birth who are extremely experienced and who I will have met and know already, and they have the ambulances on call during the event if you needed to be transferred. The hospital is also only 15 mins away so feel pretty safe I would get there quickly. Hardly any transfers happen due to an emergency (I know this because of the books / resources etc I've read) it's usually if mum needs more pain relief or labour isn't progressing.

I am also happy with aiming for a home birth because I know I do not want to have an epidural (again due to the books etc! so useful to read up). I want to use birthing pool, gas and air and maybe pethidine if needed. I learnt that the hormone oxytocin is crucial to give birth and this is produced with your lizard brain aka your subconcious brain is at ease which happens when you can have dim lighting, familiar people, cosy environment. Basically when you feel safe but on a deep level, not necessarily an intellectual level. So a home birth or MLU setting is ideal for this.

What is the MLU at the hospital like? Can you dim lights? Does it have a pool and equipment for an active birth? Does it have your own bathroom? If all these things, this could be a good option, as you will have best of both worlds. :) Another thing to consider - could you transfer from the MLU to hospital if you found you needed stronger pain relief? How far away are they?

I think the risk balancing thing is very personal, but also nuanced, and a lot comes into it. For example, I've heard stories about the baby getting distressed and then being rushed to NICU as soon as it is born, or the mother being rushed to have a c-section, and this is obviously only possible in hospital, so it naturally puts the fear into anyone and makes one afraid to do it at home or at a freestanding MLU. BUT, who knows why the distress happened in first place? The distress may have in part been caused by being in a stressful hospital environment in the first place with stranges, bright lights etc preventing labour from progressing well. In stories like this people often denounce home births or free standing MLU. But it is sometimes hard to know whether the complications would have arisen in a different setting or not, if you see what I mean? It is not an exact science. But the birth place study says that MLUs are just as safe as hospitals for first time mums and babies, but also much less likely you will have interventions. Another thing to bare in mind is that midwives are very good at knowing if something is wrong and they will always blue light you to hospital as soon as it seems you might need to go - they won't wait till the last minute or put you at risk.

Sorry this is very long but I hope helpful! I've done tons of research :) I would also recommend Expecting Better by Emily Oster xx
In the age of COVID who knows what will be possible by the time my baby is due and I'm happy to go to hospital if needed. The best thing about reading some good books is that you can feel confident you know what you want, what the risks are, and you will then be able to manage most eventualities well :)

@2020firsttimemum hello! I just wanted to say that it isn't that home births are not recommended, it is just that not many first timers do opt for a home birth. If you are low risk, home births are fine for first time mums. My midwife said she has a lot of first timers and I was almost encouraged to consider it :) The Birth Place study shows that there is a very slight increase in risk for first time home births rather than second time home births. For second time home births, the risk of something serious going wrong for baby is approx 4 in 1000 (this is the exact same risk as at the hospital). For first time home births it is approx 9 in 1000. For a hospital first time birth, risk is again approx 4 in 1000. So, very slightly more risky, but you need to balance it all out and it is still a very very tiny percent of risk.
For a first time birth at MLU, risk is just the same as for hospital :)

One other thing I would say is that the main draw card for MLU or home birth is the risk of interventions (e.g. instrumental delivery/c-sections) is much much lower. So if this is important to you, it's important to factor that into your decision making xx

Hi, I'm pregnant with my first too :) 5/40. I've always known I wanted to be in hospital, ideally with as little medical intervention as needed (although I'll have pain relief, yes please). However, I want to be somewhere where doctors, anaesthetists and an operating theatre are close at hand in case it all goes south as when it does it can do so quickly!! (I'm a doctor myself so always thinking about the worst possible outcomes, kind of spoils it a bit really as I probably think about it more than I should. My friends SIL's first baby died on NICU after a disastrous home birth and that sort of thing haunts me)

@emerald89
So sad to hear about your SIL's baby :( do you know what happened with your SIL's birth at home which made it disastrous?

I didn't consider anything other than a hospital birth. I like hospitals. I find them reassuring and interesting. I was advised to go for a homebirth with number 2 due to fast labour with number 1 and dismissed the idea out of hand.

Birth is messy! I have zero desire to have all of that mess and disruption in my own home and I have no desire to put myself or my child out of the reach of medical professionals in case they need it.

@IslayBrigid fair enough! My MW has advised against it - particularly at the moment and I'm pretty sure they're not allowing home births and a 'choice' due to the need for midwifes / ambulances elsewhere. I suppose that can all change by the time op is due.
Having said that, I'm due 3rd July and still weighing up options depending on advice from MW

@2020firsttimemum yes many areas are cancelling home births at the moment due to COVID. I would be happy to go to hospital as well and am not entirely sure about a home birth yet, just aiming for it at this point :) You must be excited about baby coming so soon! I'm due end of August.

@IslayBrigid excited and nervous. Ideally I'd like to be in the birth centre and have a water birth - i don't really want an epidural or anything either so seems like the best choice for me provided it can all still go as planned. I'll check with MW at 28 week appointment. Is this one your first? It's exciting isn't it however I'd like to be out and about - isolation is not ideal haha

@IslayBrigid

All I know is what my friend told me. I think it was a straightforward pregnancy, she went into labour at home, there was a midwife present (maybe 2, do they give you 2 for a HB?). There was meconium in her waters, they couldn't pick up a heartbeat on doppler and she delivered in the ambulance, paramedics resuscitated baby successfully and he went to NICU. He was severely brain damaged and they withdrew treatment after it was clear he had no prospect of recovering. Absolutely horrific. Not a nice thing to talk about on a pregnancy forum but it just serves as a warning how wrong things can go and how quickly, even if you think the hospital is only a short ambulance ride away.

For me I knew I wanted the birth centre. It was within the hospital so I knew any problems it was straight down the corridor. Not sure if I'd be happy in a free standing birth centre though.

That does sound horrible @emerald89. I wonder if the outcome would have been different if she had been at hospital when they discovered the meconium/heartbeat. It might be that it sadly wouldn't have changed much, but then I guess if the ambulance takes longer than being wheeled into the emergency suite it would have an impact. I know from my midwife that if there was merconium in the water, they would transfer me straight away to the hospital. They also monitor the heartbeat regularly and she said if any change, again, they transfer. They are very cautious. From what she said the emergency situations are usually always perceivable earlier on BEFORE it is an emergency, if you know what you are looking for. HB midwives are often more experienced too - my one seems that way anyway! I think I just really trust her judgment. Having said that, I may still decide to opt for a hospital birth. There is always a risk ... I just think it's good to read up on the options and you have to go with your instinct

@2020firsttimemum yes I would love a water birth and don't want an epi either :) from what I have read, they seem to have more risks than benefits... don't like the idea of being paralysed after baby born either... but yes who knows if the pain is bad maybe I'll take one. I think I would rather try pethidine though, if any drugs at all. Yes it is my first. I would ideally have wanted to go to the MLU but there isn't one that is really close to me. How far is yours?

@Emerald89 I’m also a doctor and am opting for hospital delivery for the same reason as you! We’re trained to think in worst case scenarios for so long, it’s difficult to turn it off!

I think it also helps that I’m very comfortable and ‘at home’ in a hospital environment after working in them for so many years, so it’s not as alien or intimidating

@2020firsttimemum and yes, the isolation is making it all a bit more stressful! Have you joined the bumps on lockdown FB group? x

Firstly, congratulations! Birthing choices is such an emotive subject for many. There will be those who are massively pro-homebirth, zero intervention, positive birthing etc and then there will be those who have maybe had a scary experience, or someone close to them have, and are very pro hospital birth. I think it's great that you are getting opinions from across the board to make an informed decision, but just be aware that due to the nature of how emotive the topic can be, at the end of it all it is whatever you personally feel most comfortable doing. And that decision will probably change between now and when you give birth!

Congratulations again!

I’d love to go to a midwife led unit this time, but unfortunately I’m not allowed because of my last labour! It also means I’m not allowed a home birth and HAVE to go to hospital. I had considered it last time but wasn’t sure on the protocol as even though it was actually closer to home than either hospital I could go to, it wasn’t offered by the midwife at the booking appointment, she only offered home or either hospital (both are about 40-60 minutes away).

If I were to choose again I’d choose a midwife led unit.

I think I would look once the coronascare passes, to seeing the MLU. Our local hospitals do guided tours :) Some have virtual tours. Disagree that labour ward has to be clinical or too busy- some labour wards have rooms with pools for water birth.

I wanted MLU (there was a unit within the hospital on a different floor to labour ward), ended up on the labour ward and would not change that for anything, second we straight away said we want labour ward. For MLU you need to fulfill certain requirements and it's not suitable for everyone, so it may be you may find further down the line this option may be limited.

I personally found that births are so unpredictable, while it's nice to have a plan, don't get too focused on it and don't feel disappointed if it does not work- especially as you were asked so early about it. Mine went down the drain, none of my friends really stuck to theirs. When it came to the actual birth, it does not matter as much where you are as long as you have great care and feel supported.

I live in Belfast and had my first March 2019 and due my second September this year.

MLU is attached to my local hospital and I was able to have gar and air and water birth, It was a really good experience and I definitely felt safe and at ease.

Does the MLU in the hospital have facilities such as private rooms, bathrooms, birthing pools? If so I would choose there as you've the best of both worlds.

My friends sister went to a MLU separate and had to get an ambulance to the nearest hospital as the baby got stuck in the canal, I'm sure this doesn't happen that often but still something to consider.

Also be open minded as even if low risk now things may change along the way, my friend was breach throughout her pregnancy and it gave her time to get her head around a planned c section.

I assume you don't want an epidural but it's always good to have the option, I hate needles so the thought of it terrified me more than the thought of the birth itself!

I had my first at a MLU attached to a hospital which made the 3 minute trolley ride to the theatre when he was stuck much quicker and easier. I wouldn't have wanted to wait for an ambulance at that stage of labour. The MLU itself was very nice and I laboured in the water for most of the time.

A friend of mine had hers in a standalone MLU but tore badly so still had to go to the big hospital to get stitched up.

I'm on #2 but planned a home water birth for #1. I wouldn't discourage it but what I would say is this. Make sure you have 100% faith in your MW. My waters went and I was with One to One. My MW was off on annual leave and my buddy midwife kept in contact via phone but didn't once come out to check me in 26 hours (I trusted she knew what she was doing). The lack of reassurance stressed me and things never progressed. I ended up having an EMCS after taking myself off to the hospital because there was possible merconium and it had been more than 24 hours (although my MW kept telling me it was okay we could just monitor it for a little longer). Turned out baby was breech. I wouldn't have minded the prolonged early labour if I'd had some reassurance and monitoring to let me know everything was okay and would even have considered it this time. I could never see myself giving birth in the hospital but equally can't see myself at home, especially now given I've had a previous section so I'll be opting for an elective this time round. Whatever you choose just make sure you have a plan A, B and C (aptly named for csection) and be open to deviate from the lot of them. I know a lot of people beat themselves up when the birth doesn't go to their plan but ultimately there is absolutely nothing they could have done differently.

I’m pregnant with my first as well.

I am 95% sure I want a water birth after hearing so many good things about it. My hospital has a midwife led unit then the labour ward next door so I can opt for an epidural if it gets too much, which makes me feel calmer about it.

I'm pregnant with my first, I'm hoping to use the MLU attached to the hospital as I'm not wanting an epidural or pethidine, just gas and air and I'd like the option of a birth pool and I'd like to have the private space to move about in.
The MLU doesn't move you to the ward after birth unless they have to which makes me feel more comfortable than ending up on the ward and DH getting kicked out.

It's really interesting hearing all the different opinions.
I shall continue researching probably until I go into labour and have to decide.
The MLU at the hospital has similar facilities to the separate MLU, the biggest thing which I don't like about it as much is that they don't have ensuite bathrooms like the separate one does. At the minute that feels important but that's probably not the most important thing.