Midwife led units

So I'm 27 weeks tomorrow I'm it's finally starting to dawn on me that this baby is going to have to come out! I'm not worried about the actual labour (yet!) but my choices for delivery. The closest choice would be a small midwife led unit, with only midwives available during labour, no doctors at all. At my booking in appointment the midwife told me that the next closest would have doctors available but not lurking about everywhere, and then the next is a more doctor led unit.

I was fine with the midwife led unit, but now I'm starting to doubt my choice and am thinking of changing. I guess it's just nerves creeping in?

What I'd really like to know, is what the midwife unit can offer me. I know I couldn't have certain types of painkillers, like epidurals, but I don't want one so that's not a problem, but what about if I needed help with forceps, or they had to make a cut? Would that be something the midwives could do, or would they have to transfer me to one of the other hospitals.

This is my first and I'm classed as a low risk pregnancy, so I hope I won't need any of this. I have an appointment next week but I thought I'd ask in here first to put my mind at rest before I see my midwife next week. Sorry I waffle on a bit! Thanks. X

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  • Hi, congratulations on your pregnancy!

    I am 10 weeks pregnant with my second child and gave birth to my son in a small midwife led birthing centre - only 4 beds! I cannot rate the experience highly enough, they really were fantastic and I felt in the safest of hands.

    Of course I can't speak for your centre but at mine, anything classed as a surgical procedure including forceps, an episiotomy (cut) or obviously c-section would result in a transfer to hospital. Gas and air, water pools (which I totally recommend by the way!) pethadine and, I believe, diamorphine are available as pain relief. I had the same worries as you and one thing that put my mind at ease was learning that it takes around 40 minutes to prepare a theatre for surgery which is much less than an ambulance transfer to my nearest big hospital takes. Also, the midwives reminded me that they really are trained to know if labour isn't going as it should from early on - I think it's quite unusual that things are going swimmingly one moment and then you need an emergency section the next. Around 17% of women are transferred to hospital from my centre, and a large portion of them are ladies who decide themselves that they need an epidural, rather than a medical emergency.

    It's a case of weighing up whether the shorter commute, more 1 on 1 care that is usually available at smaller centres is more important than having doctors on hand for any what-ifs that might occur - its a personal choice.

    Sorry for the rambling response, I hope I've been able to help :-)

  • Thanks for replying. I had a tour around the midwife unit during my booking in appointment and I thought it was really nice, the rooms were cosy and homely, I was wanting to use the birth pool too but they only have one so I hope it's free when I arrive. At the beginning of my pregnancy I was really happy to just have the midwives, but after foolishly watching one born every minute, it appeared as though forceps were fairly common and a split second decision, and I was worried about baby waiting to come out but having to hold on until I got to a bigger hospital. And to be honest, the next closest hospital is a butchers yard so I'd want to go to the furthest of the three should I need to be transferred.

    I would really prefer the smaller midwife unit and I'm glad you said you'd had a good experience there as it's put to bed some of my worries. I think I'm just freaking out over nothing, it doesn't help that I'm studying the history of medicine as part of my degree and I guess I keep forgetting we've moved on since the eighteenth century!

    Thanks again for the reply! Congrats on your pregnancy x

  • I'm having my first baby at home at aged 36. The reason I'm not going for midwife-led centre is that I live 5 mins from the maternity hospital, my friend has a birthing pool and it's the nearest place to the doctors, should the midwives advise I need them. I'm training in hypnobirthing, which teaches that in normal circumstances, it is normally your ability to relax and allow your body to do it's work that determines whether you need stitches or forceps. This is because of the hormones you release: adrenaline (when you're scared) and oxytocin: which you really need to encourage in labour, which is present when you fall in love and orgasm and which is blocked by adrenalin. You also release endorphins which are hundreds of times stronger that other pain killers. Having been brought up on a farm, I kinda get this. It's sooooo rare that any other mammals need that kinda intervention. Can I say something? Maybe you should stop watching one born every minute? My best friend is a midwife and she advised me to watch more supportive helpful, positive real videos that are geared towards women who are pregnant and less towards selling a reality show. Best advise ever. I'm trying to really create a realistic, informed and accepting frame of mind, with skills to cope with the labour. Then, if it all goes to the wall, I'll be ready for whatever, as the most important thing for all of us is to have a healthy baby at the end. Have fun preparing xxx

  • Rjalmondo,

    I think you are right that your choice of birthing place needs careful consideration.

    However, as a statistician, I'm a little concerned on your information. Last time I looked at this in 2008/9 the stats for normal births in the UK, and it is births we are discussing, were 60% of all births, ie the majority. Just to be clear:

    The majority of births in the UK are normal and unassisted.

    A drop from 60% to 17% over 3 years would cause public and media outcry. I am sorry you suffered a the fairly rare (about 5 in 1000 in the UK) post-partum hemorrhage (pph). These are really traumatic and I'm sure that you were utterly thankful for the immediate consultant-led care you received. My sister had exactly the same experience with her second child. Thankfully, her third birthing experience was normal.

    I do think these are very valid questions to ask the birthing centre. What is the procedure if..? I think these questions help one to make an informed decision about all the stages of labour.

    So, Rachael, I hope that you can take away some useful questions to ask and also some reassurance that in most cases, women in the UK have a normal and unassisted birth, a figure that increases overall when you look at the cohort of women who choose to birth at at birthing centre. That's why the NHS funds the birthing centres.

    Good luck and I'm sure you'll make the best decision, regardless of where you choose, for you and your little one. xx

  • Thanks everyone for the feedback. My birthing centre is a bit strange really. It's based in a hospital, but the hospital only really does out patient things, so I'm not sure if in an emergency a doctor from another department would step in, these are all things that I plan to bombard my midwife with next week!

    I'd like to use the birthing centre as I want to have as natural a labour as possible, and after my tour around the facilities, I was very positive about being there. There are only six rooms, and they don't look clinical and intimidating, which I like.

    I guess as the time draws nearer, I'm going to start to fret more over little worries like what ifs, so it's nice to hear other people's experiences to help calm my nerves a bit! Xx

  • Sounds like you liked the place! It's great that you've got the midwife appt. coming up too.

    Well, we're having our babies at the same time, so I don't know if I'll be any use for pre-stories! I'm planning a home birth as I live literally a few mins from the Maternity Hospital, which has all the worst-case-scenario stuff there, so it's handier than the birthing centre really. My friend has a pool, which, all being well, we'll put in the kitchen and access to and from the flat is good if we need it.

    I just want to be as relaxed as possible and I figure home is best for me for that.

    If I change my mind or need to go in, that's all fine too.

    I'm going for natal hypnotherapy/hypnobirthing and I've got this cool book from the library called Birthing From Within to try and make it a natural experience, rather than the scary one-born-every-minute version. But really, I just want to be safe and healthy whatever :D

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