How do you decide whether you need an epidural in advanced?

[anniz91]

Hi

I have been asked by the midwife to start thinking about whether I would like to give birth in a midwifery led unit (no doctors but can be if needed / no epidural) or a delivery ward (doctors available epidural available). Since this is my first baby I am really unsure how to decide. Is it safer to have the first baby on a delivery ward with doctors in case I need an epidural? How do you guys decide such a thing?

I'm really overwhelmed and don't know what to look at.

Have you got any risk factors? I think I won't get given that choice as they have said since twenty weeks they want to induce early. A midwife led unit sounds lovely though and to me less scary.

How far away are they from each other? My local set up isn’t uncommon - they just wheel you across the corridor from one to the other if things start to escalate.

If you’re low risk go for the midwife led unit, it’s calmer, less medicalised and a nicer experience. I highly recommend the digital hypnobirthing pack by the positive birth company, it covers all options and teaches you techniques for staying calm, making decisions, etc.

Is your midwife unit inside the hospital, with easy access to transfer to the medically staffed labour suite if you develop complications and/or need an epidural? Or is it a “stand alone” unit miles away? Because that should influence your decision.
In my area, the MLU is over 20 miles away from the nearest proper obstetric unit, and babies have died during emergency ambulance transfer.
First labours are often more prone to complications than subsequent ones, and are usually longer and more painful. You would be wise to ensure that you at least have the option of fast easy transfer to receive an epidural if you decide you need one during labour.

My midwife led unit was opposite the delivery ward, so it was an easy decision of I'll start off in MLU, but I know I can get to delivery ward quickly if anything happens.

As it stands I need up being induced anyway, so didn't get a choice!

Having your baby in a birth centre/ midwife led unit is just as safe as a hospital setting for a FTM.

If you want an epidural and are at the midwife led unit, they will transfer you to the hospital if its offsite or to the delivery ward if it's in the same place so choosing the MLU doesn't rule out an epidural if you need one. You are also less likely to need one if you labour on a MLU than in a hospital because it is a calmer, less medicalised environment.

Is there the option of a tour of the MLU so you can see how it would be different? That could help you make your decision. On the day though you aren't obligated to go to the MLU anyway, if you're finding you aren't coping with the pain when latent labour starts you can just go straight to the hospital delivery unit.

What everyone else said. I was fully signed up to a whale-music-lavender-oil delivery but DS had other ideas and it ended up epidural and there was a very bad two hours between me realising i couldn’t manage and the epidural arriving and taking effect.
DD was induced, in a ‘normal’ maternity unit and it was all low lighting, relaxed, music on.
TLDR! You can have your peaceful, lovely birth in a big unit AND have emergency help on hand if necessary.

Hi OP, totally natural to feel overwhelmed. I'm a birth doula and also have a DD.

If you are currently unsure about what sort of birth you'd like I'd recommend doing an antenatal course e.g. NCT and/or a hypnobirthing course, and reading a book or two about birth. The Positive Birth Book by Milli Hill is absolutely excellent and will really give you a good idea of what birth is like, and what each kind of birth is like too including water birth, induction, cesareans etc. It also explains the hormones involved in labour and birth and how to protect these and get them flowing, and the pros and cons of various pain relief options - eg. having an epidural can remove the pain but statistically makes it more likely that you will tear or need an instrumental delivery, because you are not able to be mobile and often need coached pushing (as opposed to listening to your body and pushing with the contractions you feel). This is just one example. The hypnobirthing course I did also goes into much of this. I did the positive birth company digital pack - completely worth the small cost, so so empowering and informative.

I planned a home birth but ended up transferring to hospital (not an emergency but my labour was extremely long and I ended up needing some more help as I was very tired). I had an epidural at hospital which is what I needed at the time and absolutely glad I did it. I did tear quite badly, but through doing physio I'm completely healed. And yes people will say you can't plan your birth because who knows what will happen but actually, you're more likely to have a good birth experience if you do make some plans while remaining flexible (have a few plans up your sleeve! 😏)

So it's a good idea to educate yourself and figure out what feels best for you! I know plenty of women who have had wonderful birth experiences completely unmedicated so it absolutely can happen.

@User3568975431146 why are they horrible and rather dangerous things? Want to provide us with evidence for that vile statement?

Epidurals are safe and effective as pain relief in labour, yes there are risks and we discuss those. @anniz91 have a look at the OAA Labour pains website as a great source on information that is well researched and put together and gives the options around pain relief