Natural births in midwife led units - how natural are they?

[xxxIntergalacticxxx]

I’ve been reading up on hypnobirthing as many friends have recommended it to me as a good way to have a natural birth where medically possible. There is a focus in the book on world statistics showing that the UK has high levels of routine intervention (e.g. induction for the convenience of staff being able to take the weekend off, artificial breaking of waters to speed people up through the system etc.) and it made me wonder how “natural births” actually are in low risk midwife led units, which is probably the place I’ll deliver.

I’ve been reading that the “routine” cervical sweep acts as a form of induction too, which can lead to labour starting earlier but being more difficult and longer. This is the theme I’m getting from the hypnobirthing book, that unnecessary interventions for no medical reason are making labours more difficult and intense for mothers.

Obviously some circumstances require medical intervention if something is wrong. But if nothing is wrong, how likely am I to be able to convince the midwives I want a low intervention natural birth in my own time?

I’m a first time mum in 3rd trimester and currently researching to learn more.

Also, how likely do you think it will be that my partner can join me in the unit, are things changing for the better and will he be able to support me with hypnobirthing relaxation exercises in the early stages of labour, or will he be waiting in the car until the midwives decide I’m ready? I know it depends on each hospital’s policy but it would be good to have some first hand up to date info from anyone with current experience.

In my experience, midwives do not force you into anything. They give you recommendations based on their experience and it’s up to you what you want to do.

Nobody can force you to have a sweep or be induced, or have your waters broken. However a lot of women are happy for any of the above to happen because they want their baby to arrive quickly and safely.

Labour is very painful (hypnobirthing didn’t work for me, I completely panicked when it turned out to be extremely painful very quickly and I couldn’t breathe through the contractions so had an epidural at 5cm) and this shocks a lot of people when they’re actually in it. Some can cope and some can’t. A majority don’t want labour to take an extra 6 hours because they’re not up for having their waters broken.

Put it on your birth plan, speak to the midwife about it when you attend. They will respect your wishes as far as possible unless things get dangerous. Even then they still need your consent, but I’m sure if you were told you need a c section or your baby could die / be disabled, that it would be more important than your natural birth.

That said, I really really hope you have the birth you are planning for. Congratulations and best of luck x

Sweeps are offered when you go over your due date, you can turn them down.
Your partner will either be allowed in from the start of labour or from active labour, ie. from c.4cms, depending on your trusts covid policy. Don’t worry You will not be giving birth without him.
In your birth notes you can write that you want a natural birth- my advice is go with the flow, only once in labour will you know what you want (could end up screaming for drugs and an epidural), equally your baby could completely side teach your plans.
I will say you sound very negative about midwives, maybe that’s the fault of the hypno birth book, but my midwives in both my labours were fantastic!!! Couldn’t have got through either without them- superb. Ultimately they are the experts and the nhs aren’t trying to spend more money on medical intervention for fun.

You will have the right to say no to any interventions at all. Sweeps aren't mandatory or necessary if you want to wait for labour to start on it's own. However I would take the hypnobirthing with a pinch of salt. The breathing techniques really helped me. But as PP said labour is very painful and often first time births are long and drawn out regardless of whether you had a sweep or not. A midwife's job is to deliver baby safely, but ultimately you need to advocate for yourself to get the labour you want. It helps if your partner has a good understanding of this.

You know that they can't do those things to your body without your consent, right?

For consent to be legally valid it has to be freely given, informed and by someone who has capacity. Coerced consent is not legally valid.

Nothing can happen to you without your consent. Understanding your options and making sure your partner can advocate for you 'in the moment' is really important because things can change very quickly. You can almost always say 'can we take a moment' and discuss things on your own before agreeing to a procedure or step.

That said, a book that suggests women are routinely induced to allow midwives the weekend off would probably get short shrift in my house. Midwives are rota-d on a 12 hour, 7 day shift pattern. They don't get to go home if the unit is emptied out at 10am on a Saturday! Going in with a belief that the midwives are not 100% invested in your care and the care of your baby will cause stress and adrenaline that you don't need in the room with you.

Make sure to do your research to get a balanced picture. In most cases, a single book (maybe not by a statistician/researcher/scientists) will not give you that balanced view.

Looks at rates of intervention, looks at Caesarian rates, look at stillbirth and complication rates.

Then compare them to the same stats of 100 years ago.

This is why I don't have a birth plan, I don't want to set myself up for failure. I have a document with my preferences in various scenarios.

I think most women take the view that the birth process itself is when the vast majority of critical complications can happen (did in my case) and that really, a healthy baby is my end goal.

Just imagine if refusing an intervention leads to a disability, or death (which is an unlikely but possible outcome)? I think this is why many women take the sweeps, the drugs, the interventions, because the result of something did go wrong is very difficult to process.

Lots of decisions when things do go wrong will be split second. I had a single midwife in the room. She pressed a button and with seconds there were about 12 people there saying 'this baby needs to come out now.' Who the hell am I at that point to argue with them after three days of labour and drugs that didn't work on me?

There is a very real possibility that if they hadn't used the forceps, my dd wouldn't be who she is, or even here. Was I going to risk that? Fuck no.

It's great that you're thinking about birth, but I also think your post sounds like you have many more books to read and research to do!!

Medical intervention isn’t always because the midwives want you in and out as quickly as possible - longer labours can lead to more serious interventions like forceps etc. If you’re exhausted because your labour is slow, you’re more likely to have to have help delivering the baby, so it makes sense for them to try and speed it up if it’s taking it’s time. I had a sweep of hen I was only 2cm 8 hours after my waters went, for example. Hypnobirthing helped me up until a point, but the fact that the course I did insisted on not focusing on any negativity at all while preparing for birth was not helpful. I had a major PPH immediately after delivery and was rushed off for emergency surgery, so didn’t hold my baby for 2 hours after he arrived. I blamed myself for this for a long time because I’d internalised that ‘bad’ births come from not trying hard enough. As PP have said, take it with a pinch of salt!

I would listen to all the PP. not sure where you got your information that the UK has one of the highest intervention rates, this is simply untrue. If you look at Brazil, Middle East, they have 70 -80 % CS rates. There are inteventions more than other low income countries, that’s because we have a lower maternal and neonatal death rates. Yes there is a 25-30% CS rate, up 10-15% elective rates for medical reasons.
Most units don’t want to intervene if they don’t have too but there are valid reasons for offering intervention. Please don’t go into the labour thinking HCP want to ‘do’ things to you, they are there to try and ensure the safest birth for you and your baby.

The midwives weren't that great in my first labour (emcs) but they were amazing in my second 3 years later, same hospital. I didnt have a birth plan second time because I'd booked a cs, labour started and I changed my mind. The student midwife was very kindly trying to ask me all the questions in between contractions. The relief when they broke my waters in my second labour were immense, the pain suddenly went down a few notches.

I found a tens machine really good, make sure you extra batteries and pads. A hot water bottle is great but they won't always refill it for you, I should have taken a flask! Standing under a hot shower works well but I stayed on the bed for my second.

I had my first baby in Ireland and my second in a midwife led unit in Scotland.

it works differently in Ireland but the experience prior to the midwives looking after me was not brilliant (doctor making decisions about me without discussing it with me or even telling me himself). Its only with hindsight though that I realised how bad it was and that I should have pushed back a bit. Anyway, the midwives that then took over. They were fabulous. Finally read my birth plan, guided me all the way through and were just brilliant!

My second birth was straihht to midwife unit which was lovely, a completely calm and welcoming space (dimmed lights, music, etc). I had a water birth (not planned, they recommended it, it was great). The midwives left me to get on with it, only took 1.5 hours from when we arrived at which point my waters broke and they had to rush back in cos baby was born 4 mins later. No intervention, no drugs and to be honest a bit of a doddle. Worth stressing that I had had a sweep 3 days before so in my experience it most definitively did not slow anything down.

The midwives I have dealt with in appointments/on wards etc have not always been brilliant. But the ones who have delivered my babies were God sent!

I considered a home birth this time round but the pool etc at home is too much hassle and I'm an hour away from a hospital. I will be very happy going to the midwife unit again and have no concerns at all about my wishes being listened to.

(Oh and I second the earlier opinion about an open mind... my birth plan was shredded about 5 minutes in the door before even my first contraction, babies don't read them unfortuantely).

I had my first birth in a hospital unit and second in a MLU and the second was definitely more 'natural'
First time there were some concerns re IUGR so I was hooked up to monitoring at all times, had regular VEs, had my waters broken, had a syntocinon drip, gave birth on my back, had some gas and air which I didn't much like. There was much discussion of my 'progression'. I mean it was fine and I had a healthy baby, no complications so I didn't care too much.

In the MLU I had no routine vaginal examinations at all. No-one checked on how dilated I was or seemed to care about progression which surprised me as I assumed it was routine.
I was offered a cup of tea and toast on arrival rather than nothing until after the birth. I seriously appreciated that at 5am
They didn't break my waters at all and in fact DS was born 'in the cowl'
I was not connected to any monitoring (the midwife just listened to the HB at intervals). I could move around, bounce on the ball, go for a walk off the unit even (this was encouraged when things slowed down a bit)
I gave birth kneeling up, caught him myself and breastfed straight away. The cord was cut with a delay.
No pain relief required although he was back to back.
I did find it much nicer and felt more in control but also I had done it before so was less scared.

I think it will be as natural as you want in an MLU within the confines of safety. Midwives who choose to work there are signed up to promote less intervention.

Some of us are chatting through our induction experiences on another thread and they are quite a range of views and opinions.

But I haven't posted here to say that- wherever you have got the idea that people are induced so staff can have the weekend off is a ridiculous statement so I'd not take anything else from that source with a pinch of salt.
I went in at 10am on a Sunday (pre-arranged! Fancy that) to a very busy and full ward. Had DD on the Thursday and was discharged on the Saturday when postnatal was just as busy and full as antenatal had been the previous weekend. Guess what, the staff work shifts and although they have to follow a timeline and protocol there is no way there were less staff on shift over the weekends than in the week when I was there.

The book sounds like bullshit tbh. No, in the UK midwives don't induce you so they get the weekend off.

Medical interventions take place either for the health of the baby or the health of the mother.

I was induced with DD because I was 12 days overdue and getting increased anxiety about it as my niece was stillborn 8 months earlier. I was given a pessary and told that I would get another one each day until day 3 then a rest day then possibly c section. I had 1 pessary and went into labour a few hours later. DD born naturally (ie vaginally) with only gas and air less than 12 hours after pessary inserted.

DS was induced via rupture of membranes on due date. His presentation was unstable (footling breech swapping to oblique) but he shifted to head down and they induced while the going was good. I was out on a syntocinon drip and had gas and air. He was back to back so I happily had an epidural. Natural (ie vaginal) birth.

My SIL went into birth 17 days overdue. She just kept refusing induction. She lived v close to the hospital though.

Midwives work with you and afaik are happy to go with hynobirthing. Any interventions are down to medical need and not for the midwife benefit.

(I also believe that hypnobirth teachers can give an unrealistic view of child birth to expectant mothers. Women I know who followed it and ended up with either a hospital birth with interventions or a c section told me they felt like failures because they couldn't perform this holy trail of natural birth. Birth isn't an experience to monetise, it's a means to an end of getting the baby born safely and with mother safe too. Please don't be blinkered into thinking the NHS want to force you into a c section or what have you.)

Just maybe talk to your midwife about the labour and birth unit and what they look like, how you can labour and birth options. Ask about pain relief available and how they can support hypno birth.

I had both my DC in the midwife led unit and had really great experiences both times. Privacy, soft lighting, water birth (2nd time), freedom to move around/get in a position that worked for me, double bed so DH could stay over... The midwives were pretty unobtrusive, just monitoring heart rate with a Doppler. I had some gas and air but couldn’t really get into the swing of it.

So from my experience I would recommend it, and am hoping to use it again if all goes well with this pregnancy, but really depends on risk factors and your actual labour. Think there’s a 25-30% transfer rate to the labour ward at my MLU. I’d echo what others say to keep an open mind - the most important thing is that you and baby are safe and well.

I never got far enough along to need a sweep and not sure about specific covid restrictions so can’t help on those, but good luck (and probs take hypnobirthing doctrine with a pinch of salt).

As @DanielODonkey said it's a means to an end. You wouldn't have a tooth removed without pain relief. Plan for all eventualitys that's my advice.

The weekend thing does smell of bullshit and an agenda

Anyone who works in an acute sector of the NHS (I do) has really no concept of a weekend because we've worked rotating shifts all our working lives.
Now I have school aged kids it's nice to have weekends off with them sometimes but I still love a weekday off with no-one around and pre-kids I actively preferred them. Nice and quiet in the shops.

You cannot know what your childbirth experience will be like.
The book author definitely cannot and of course they want to sell their method and their books. Everyone is so different. Of course we want to control it and make plans but it's one of those things in life that ultimately you cannot control however hard you try. It's good to think of your preferred strategies etc and do all you can to prepare sensibly but in the end what will be will be and if you have too rigid a plan it's bound to lead to disappointment.

It's good to be informed but please try to be flexible and open to different views.

I really recommend the positive birth company online course. It left me feeling empowered snd if I hadn’t done it I wouldn’t have felt like I could decline a VE a second time. I really enjoyed giving birth in the midwife led unit. There was a senior midwife, more junior one and a student and they coached me through my water birth telling me when to push, when to hold off etc.

I had both my babies in midwife units, both were very straightforward deliveries - I felt that the midwives gave me space and were quite hands off apart from listening to the baby with a stethoscope. I think if you are going to be able to have a ‘natural’/hands off birth, they will stand back and let it happen, but if you are going to need intervention, they obviously want to identify that - that’s sort of why they are there...

My second was born during the first lockdown and DH came in with me on arrival, he went home before us but this was to look after our toddler rather than because he got kicked out! This was probably because we were in our own room in the birth centre, rather than on a ward with others.

I had my first in an MLU and literally all the midwives did was offer me gas and air (I declined as didn't like it), check my dilation, run the birthing pool for me, and verbally coach me through the delivery. Midwives in the MLU are aiming for a "normal" vaginal delivery. However, birth has risks and things do go wrong. The point at which you intervene is a very tricky issue. I think there are times we do now overmedicalise birth and intervene unnecessarily. But the stakes are high and it's very difficult to know what might have been.

You can consent or not consent to any procedure or intervention. Do your research but try not to be wedded to any one plan of action.

The thing with intervention is that it's a no-win situation really in terms of timing. If they didn't recommend something when there were early signs but it could work out okay, there would be questions asked if god forbid the outcome was not good- ie well why wasn't the woman offered x earlier? On the other hand, if it's offered too late, then the risk has likely increased which is more dangerous for mum and baby.You can refuse them if you like, but they will be made based on research, policy, medical knowledge etc, they aren't thrown out for a bit of a laugh or because it makes their jobs easier, because it doesn't.

Read a selection of research to form an informed point of view, for example re: induction, there is research that shows a reduction in blood passing across the placenta to baby, which obviously is not ideal. Others will say your body knows best blah blah, so do read around it rather than just follow the one book that paints midwives as some sort of surgical fiends.

On the whole in a MLU, all being well, you are left to it generally!

I had a traumatic first birth with a heamorage and vonteuse delivery. It was a very very very long labour.

I'm doing hypnobirthing this time because I think I made the early labour harder for myself as it went on for so long (5 days) and I had no coping strategies in place. I am in no doubt though that I could not have hypnobirthed my way through the full labour. I was in unbelievable pain with the labour (back to back) and after 15 hours of full labour and a lot of drugs I finally got the epidural I wanted. Before labour I was adamant I wouldn't have one.

I like hypnobirthing but it does annoy me the idea that every woman can avoid intervention or an epidural. I would have died without intervention and I was actually begging for a c section but thankfully the midwifes put me off long enough for me to reach full dialation and I changed my mind.

My advice is learn the techniques, think about you want but be flexible to change as every labour is different

The MLU I went to was amazing but my waters went at home the night before and my labour was incredibly straightforward. My best friend advised me to stay at home as long as possible and for me this was excellent advice, I had my baby within a couple of hours and was home within 6. I had the pool and a small amount of gas and air in the final stages at my request so not completely ‘natural’ but pretty close. The midwife was very experienced and excellent, she didn’t push anything on me at all, in fact quite the opposite!

I wouldn't get your heart set on the MLU without checking their policies op. At the hospital I had ds in, I wasn't allowed in the MLU purely because I'd had more scans than the routine 2. Very low-risk pregnancy and nothing wrong with baby or me (the scans were always false alarms / being on the safe side) so I'd always assumed I'd be an ideal MLU candidate because I was happy and healthy. Never assume is my advice!

For what it's worth I ended up in a lovely room on the labour ward which had dim lights and a nice birthing pool so it was identical to the MLU in my opinion

Also you never know how you're going to be on the day. I was adamant that it would be no internal examinations unless essential but I actually arrived at hospital itching to know how far along I was and was over the moon when it was more cm than I'd thought so that gave me a real boost mentally. Try to have an open mind as you just don't know what will happen.

Having said that I do recommend hypnobirth. Every single bit of it didn't suit me but I definitely cherry picked some techniques / information and it helped me massively. Good luck

I was supposed to give birth in a midwife led unit. They didn't let me in the end because I went over my dates. I only went over because they wouldn't go by my date of ovulation (I charted), only on my LMP and I have long cycles and my scans weren't far enough out. When I went to look round there was a woman shouting out obviously in a lot of pain, the midwife said 'we don't like people shouting out it just tires them out and is pointless', I was really shocked and upset tbh. They told me I'd have to go to a hospital an hour and a half away from my house because that was the hospital they'd booked me in to.

It was all so awful I got a private midwife, the care was so different it was unbelievable. I'd really recommend it (although expensive) or at leasts a doula to advocate for you. I found NHS midwives really over worked and disenchanted x