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.

That book sounds like waffle, I’m afraid.
I was recently induced well overdue on a weekend as a last minute decision due to health concerns. Up to that point I was going to be deciding where I could have my baby.

I wouldn’t set your heart on a plan. Babies will come when and how they want. And often first births are the longest. Providing they arrive safely, I really can’t see why women get so caught up on this supposedly natural, wonderful, breathe the baby out births.

Hospital births are also Midwife led in most UK hospitals and you will be offered the same birth options, only with the guarantee of an onsite consultant and appropriate pain relief if you need them. Research all the options carefully.

I would take a sweep over being induced any day! I had a full on induction with DC1 and I will avoid it at all costs.

I had a natural water birth with DC2 in the midwife lead area England and it was lovely. I would say it was the birth I always wanted, very quick and less intense than being induced

Both my pregnancies were high risk, consultant led. However, I used hypnobirthing and TENS and had very supportive midwives for both births. First birth ended with interventions as baby was in danger, but most of my labour was natural.

Second birth I had waters broken as I'd been leaking hind waters for 24hours and there was increasing infection risk. I could have refused consent, and do watch and wait, but I chose the lower risk option. I had no further intervention, a calm, active labour with hypnobirthing (alone as my OH had suspected covid) and a very positive birth.

Intervention isn't 'bad'. There is often very good reason for it. The risks will be explained and your consent sought.

The thing that helped me the most was not having 'the perfect birth plan'. Instead, write several (best case, middle and worst case), so you can decide what is most important to you even if you suddenly need an emergency c section, or if you are exhausted after a long labour and the pain is getting too much. If you've thought out all the scenarios, then you're more likely to feel positive about your birth afterwards, rather than possibly making rushed decisions in a short time during labour.

In my area pretty much any intervention would move you to Labour ward instead of mlu.
The most common issue being going very overdue.
I was totally willing to go for the whole epidural route if I’d needed induction on the Labour ward but luckily I went into Labour naturally at 39+5 and birthed in water in the mlu.

I did a hypnobirthing course and really enjoyed it. However like PPs have said, don't get too into the mindset of thinking it must be natural and that it's your fault if it's not. I ended up with an EMCS and felt like SUCH a failure. Honestly it totally blighted the start of motherhood for me, I felt like I'd let my daughter down. I think if I hadn't bought into the hypnobirthing stuff quite so much I'd have felt a bit better about it. In fact even now I still feel a bit rubbish years down the line! I ended up with pre-eclampsia and felt so guilty that it was something I'd done/not done/eaten/not eaten.

I had my one and only at at a tiny midwife led unit, we were the only people there. All in all it was a very good experience, arrived at midnight, gave birth at 3 and home by 9. They also supported me every few days with breastfeeding till this was established and baby regained birth weight.
I did hypnobirthing course and used the meditations religiously from about 28 weeks, mostly cause I had terrible trouble sleeping during pregnancy but they really helped.
For a first baby it transfer rates are relatively high but as long as you do your research and as everyone says go into this in the knowledge that it’s not always straightforward an MLU is great.

I had DS at an MLU. Didn't expect it as I had gestational diabetes and was due to be induced but (after normalising my pregnancy) went into labour the morning of my planned induction.

The pool rooms were all taken so I was in a room with a low, comfy bed. By the time I was examined, I was already 8cm. It wasn't until I started pushing that my waters broke. Midwife and student midwife both amazing, hands off, let me do what I needed. DS born three hours after arrival with five pushes and i was home eight hours later.

I had both mine in a birth centre, personally I liked it. Overdue with both and was offered sweeps, had a sweep both times and it didn’t do much. They were pretty good with explaining everything and I had the option to turn down things.

Also had my second daughter in April last year, a month after lockdown started, and my husband wasn’t allowed to attend for the sweeps.
When I went into labour had to go in and get examined and then they went outside and got him when I was in active labour which was 4cm. They allowed him to stay for the birth and for an hour after the baby was born. But because of the situation they got me out pretty quick after. Obviously things have changed a lot since then.
I’m pregnant again (early on) and also hoping things will be better!!

Fingers crossed that you can be supported for the whole thing!

The weekend thing doesn't even have any logic in it. The staff who are working the weekend are in regardless of whether the woman who came in on Friday morning has her baby by Saturday or not.
Sounds like BS.

Hypnobirthing can be great when it is about mindset but these books or courses that end up just being anti medicine are downright dangerous.

Midwives are there to help you have the best and safest birth possible, no one is making it worse for you so they can get a day off.

I agree with the recommendation of the positive birth company. The important message from this is that a positive birth is about mindset, a section can be a positive birth, an epidural or an induction can be a positive birth. A non medicated birth is cool if if it your choice, but it is not the only 'positive' birth.

Natural in birthing is overrated. I mean, a 10% risk of your baby dying in child birth or soon after is what you get without modern medicine and conveniences.

I went into labour at 1am on a Sunday morning. Trust me, no one had taken the weekend off..

@Tal45

This is my plan too. Did you find your private midwife through a company or independently, if you don't mind sharing that would be great?

When my friend went into labour in the middle of the afternoon and eventually wound up going in at 3am a labour ward staff member said I'm afraid you've only got one pillow because I'm too tired to bother to get you another one ...which really set the tone for her feeling uncared for and basically like an inconvenience.

I have also read about people being hooked up to machines and lying on their backs for the convenience of professionals too when ambulatory monitoring was available but it wasn't offered and the mum didn't know to ask until comparing notes later so I can appreciate why you're asking these questions. OP.

OP, only use a MLU if it is close to, or preferably inside, a hospital with a fully equipped, and consultant staffed, labour suite and operating theatre. Emergencies in labour are unpredictable and potentially fatal for mother or baby.
In my area (rural Scotland) the MLU is 20 miles away from the nearest proper obstetric unit, and babies have died during emergency transfer. Midwives cannot even perform a forceps delivery, let alone an emergency Caesarian section.
Rates of intervention are relatively high in the UK because of our higher proportion of obese and older mothers, who both have a higher risk of complications in labour. Obstetricians do not intervene for fun, they do so to prevent death or disability.
I think your book sounds foolish and biased, and is promoting its own agenda. Please give more priority to your and your baby’s safety than to minor concerns like environment, decor and wanting an unmonitored labour.

I should add, globally 800 women a day die from the complications of “natural”pregnancy and labour. I’m sure every one of those wished they could have had the standard of care of a UK obstetric unit.

My nearest hospital from midwives unit is 112 miles away fair to say we don't get many births up here now. I was induced with pessary for health reasons. Labour was fine no stitches no other interventions. I did the hypo birthing thing though I found it kept me calm rather than any actual help pain wise.

@babdoc it is worth bearing in mind that 99% of those women who die in childbirth are situated in lower middle income countries with no availability of skilled healthcare workers, medicines or intervention. In these cases it is 4 days walk to the nearest hospital not 20 miles down the roads.
I think you make some very sweeping uneducated statements here and it is down to the poster to do her own reasearch and weigh up the risks for her and her baby and not be dictated by your scare tactics.

Women have been birthing babies for centuries it is a natural process that sometimes necessitates medical intervention. Believe me if necessary the midwives would transfer at the first sign of concern.
I very much doubt the poster is driven by the decor but environment and being relaxed very much does contribute to an unmedicalised labour.

Like PP have said I expect a lot of that book is rubbish. As someone who had 2 radically different births I think a lot of what happens is outside of both your and the midwifes control and reflects what is needed at the time

I planned a home birth with my first. But he moved into the back to back position (despite me doing loads to get him into optimal birth position) and was very overdue so I ended up in hospital and had an epidural largely due to the length of the Labour (over 40hrs). With my second I planned to go to midwife led unit but delivered completely unassisted at home as labour progressed so rapidly and I barely noticed it! I listened to loads of hypno birthing stuff with my son, planned it to be so natural and all went out the window whereas with my daughter I don't actually recall planning much beyond midwife led unit and indicating desire to go for water (but fully expecting a long labour and epidural again) and it was beyond my wildest expectations in terms of lack of interventions.

Neither time did I felt pressured by midwives or anyone into going down a route I didn't want. At one point during the massively long labour with my son the midwife wasn't as nice but then the shift changed and I had someone lovely. And in fact when I went for an induction appt I was turned away due to not enough space so in the end it started on its own. By that time I was very uncomfortable and over being pregnant and wanted to be induced.

I also am not sure if the cycle of intervention things is necessarily true for everyone. If I had refused the epidural with my son I would have been too tired to push later on and may have ended up with foreceps or c section. Though it wasn't on my plan it was the best thing at the time.

Juju Sundin's book birth skills has some great techniques for dealing with labour but is also very pragmatic and has a whole chapter with positive stories of more medicalised births which really help to counter the impression that a natural birth is the only good outcome. I think there are many reasons to try for a natural birth but the way it is pushed sets so many women up for disappointment and a completely unjustified sense of having failed. I was so glad I had read her book prior to my EMCS, as doing so helped me feel so much more positive about the experience.

We did Hypnobirthing with our first, we stayed home for all the early parts of labour and went to the birth centre when I was having very close contractions. Our midwife followed our birth plan. completely, she left us to it, she sat out of sight in a corner and did minimal checks and we had a lovely birth experience.
You have the option to turn down interventions if they’re not right for you, read up on BRAINS which can help make your mind up about interventions, if one is needed

I gave birth in a mlu in August.
My waters went at 38+5 at midnight on a Sunday morning. I went in to maternity triage to be checked to make sure that it was my waters and to book an induction for 24h after my water broke due to infection risk. It was clear from the puddle on the bed that my waters had gone so they didn't do an examine in the end. I was offered a sweep (they had to get Dr approval as I was less than 40 weeks) to help things get moving because of the 24h clock but they didn't as the ctg monitoring started to show regular contractions although I couldn't feel them. They seemed keen to do as few examines as necessary as I guess they can stress some people out whilst explaining clearly what they were wanting to find out.

I went home to wait for it to happen and they arranged to call me at 6pm to check on progress and to see if I needed an induction. Contractions started in the early hours I went in to be checked once they were 3 in 10 and 60 seconds in duration. I had my first examination and I was 2cm and was sent home with some cocodamol. About an hour and a half after we got home it was getting too much so I phoned back. The midwife that did my examination was now running the MLU and was happy to have me there even though I was high risk and was expecting to give birth on the ward. She was happy that my risks were in pregnancy and post birth but not during labour. At the time I could have my partner with me at any point in the MLU but only in active labour on the Dr led ward (now both allow partners in) so we turned up and she had filled the birthing pool for me. She gave me my second examination on my arrival and to everyones surprise I was fully dilated. I got into the pool and I gave birth in the pool with a little help from gas and air less than an hour after we had arrived.

At no point the weekend was brought up in discussion its a 24h 7 day a week service. Even when we were back home we had community midwives visit us on Saturdays and Sundays

I’m for one grateful for the intervention.

My body went into spontaneous labour after a long time wedged in my vagina my babies heart rate dropped to, quite frankly, frightening levels.

With intervention I am here and my baby is here. I’m sure many other women can say a similar story.

I echo what everyone else has said about not having to consent to interventions (such as sweeps). Obviously everyone is different and it's all about making informed choices having been given all the detail you need to do so.

My experience of a midwife led unit birth was very natural. Labour started by itself & I stuck it out overnight before calling the hospital the next morning. Went in & they offered me an examination which I accepted as I wanted to know how things were progressing. If I'd have said no that would've been my choice. Turned out I was 5cm so got in the pool. Monitored HR (both me & baby) & my temp but aside from that there was zero further intervention, exams or anything. I had gas & air & the midwives just supported me in whatever I chose to do - like get in or out the pool, move around. I breathed my way through as many contractions as I could, felt I wanted to push & they encouraged it. Delivered my baby underwater & got out of the pool & placenta followed shortly after. In my mind it was about as natural as I could have imagined.

Good luck for when the time comes