A musing on home births and MLUs....

some of the recent threads have prompted me to ask this now.

I had a MLU birth first time round. no complications. 'perfect'

Second was hospital/epidural/ventouse/worried about twin one's heartrate but all ok in the end.

As a result I would now never consider a home birth or MLU. I wanted a HB with my first and H said he would be really uncomfortable with it, I needed his support obviously so MLU was the compromise. Now I completely get where he is coming from - why would you want to be 20mins away from the medical facilities if you needed them? why would you delay getting you or your baby the necessary treatment, potentially putting both our lives at risk in the quest for the 'perfect' birth?

it strikes me as more and more strange - especially on here with all the threads about SIDS guidelines/RF carseats and how people are so militant about it (not saying that its wrong, just an observation) yet a lot are happy to go through childbirth an ambulance ride away from help.

if I am lucky enough to have another I would want to be at the hospital so everything was on hand should I/the baby need it, even though I haven't had a really bad experience/need of NICU/SCBU/needed a section etc. I now agree with my H, why wouldn't you want to be as close as possible to help in the event the worst happens.

just interested in people's rationale behind this. I know first time round I seemed to be in a blissful bubble that if I willed it to go how I wanted it would all be fine (luckily for me, it was) but I realise in hindsight how shortsighted i'd been.

Would love to hear people's thoughts.

 

 

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  • I've always quite liked the idea of a home water birth. I like the idea of being in my own home, having my own things when I want them, being (possibly) calmer and more relaxed.

    However, I don't think I would ever have one. We live too far from the hospital (over half an hour to one), my H would not be comfortable with it and also I got a nasty 3rd degree tear last time and I'm terrified of it potentially happening again in the future, so I would really want a lot of support and coaching in labour.

  • I couldn't put it better myself. Number one was prem, number 2 massive and back to back but even if I'd had straightforward deliveries I know of far too many people who've had major complications. Even 5 minutes could mean the difference between a healthy baby and a severely disabled child. Just not worth the risk IMHO.

    I understand that people who are phobic of hospitals might prefer it at home but it's one day out of your whole life.

  • I agree, I wouldn't have a home birth for the reasons you mention. M was induced so was constantly monitored anyway but was almost a forceps delivery. After a PPH after my ERPC I'm terrified of giving birth this time. As it is, midwife has planned that I will go straight to delivery and can't use MLU which is actually connected to the maternity unit in thehhospital. That's quite disappointing but at the end of the day I'm glad they are being cautious as I wouldn't want to risk mine or babys health.

  • I used a mlu but only because it was in the hospital on the floor below delivery. I would not want to risk it and having now gone through labour, I would not fancy being transported in an ambulance! The journey upstairs was bad enough!

    As for a home birth, it has never appealed to me and I have always wondered who cleans up afterwards?

  • I'd never consider a home birth, firstly the ambulance transfer, it might not even be a paramedic, it could just be 2 technicians (they don't cannulate or give drugs so I wouldn't be prepared to then have a transfer in an ambulance with very little medical input until I got the 10/15 mins to hospital)

    Secondly, although the ambulance crew/mw would call ahead to the delivery unit, I'd still have to wait on assessment, all taking time leading to delays

    Thirdly if anything were to happen then I'd want staff there immediately, when I laboured with L they put out a crash call and everyone was there within 2 minutes, if anything went wrong at home then the ambulance response time to an emergency is anything up to 8 minutes, by the time they get u on board and the 5/10/15/20 min drive to hospital then that's all taking time that u possibly haven't got!

    If something happens after delivery then u need an ambulance for not only you but also the baby which is a) devastating to know you are transported without your tiny newborn and b) IMO a bit of a waste of an ambulance.

  • Looks like I'm alone on this... I gave birth at a MLU, I didn't like our local hospital - everyone I spoke to had nothing good to say about it! I also wanted as natural a birth as possible. I was assessed first, deemed low risk and then chose to go there. As it happens I didn't labour there but the care we received was amazing! Next time I'm going to hopefully go for a home birth, I live 5mins from the hospital. After labouring at home last time, it's where I felt calmest (I would've had him in the bath if it wasn't for H dragging me out) And I will feel happier and calmer as a result of being at home. If for some reason it doesn't feel right, or I go off the idea, I'll be heading to the MLU again. (Which is probably a worse option as transfer is around 20/30min)

  • I really can't type a long reply on my phone but to me labour/birth isn't a medical process so I don't need to be in hospital. I am healthy, not overweight, no risk factors and had an uncomplicated pregnancy, I was hopeful all would go well for an uncomplicated birth.

    The way your hormones work in labour means that things like going to hospital during labour can slow things down, if you're in hospital they're then more likely to intervene to get contractions going quicker again which in turn can lead to further intervention. I'm too tired and typing in a too small a box at the moment but I'll try and come back to this later.

    Oh and it wasn't messy, the midwives took the placenta and any medical waste. I gave birth at 9.55am and we were eating lunch in the same room by about 11am after a shower and clean clothes.

  • I had no desire for a home birth at all first time round. I didn't know how I would labour and after having a number of miscarriages, i wanted to do everything possible to ensure this baby arrived as safely as possible. As it was I was induced and ended up with a ventouse delivery. 2nd time, i was more understanding of why people would like a home birth, but after having intervention 1st time i wouldn't have risked it. As it was I had borderline gestational diabeties so wouldn't have allowed one anyway. That birth ended up in forceps and almost s c section after the labour progressed like a text book and the mid wife asked to have a student observe as it was going to be such a lovely, straighforward delivery, so it just goes to show what can happen. However, I have known people who have had lovely home births. Maybe as a mother you have a gut instinct about how things will go? I just knew I'd need to be in the hospital.

  • I agree. Number 1 was prem, emergency CS, so obviously a homebirth wasnt an option anyway. It made me realise how blessed we are, to have those facilities when we need them. Number 2 was a straight forward pregnancy, and labour, until his heart rate dropped. They had to draw blood from him, and it was very scary. I'd have hated to be at home in that situation. I laboured at home for as long as I could, but H was relieved once we got to hospital. The entire time we were at home, he was on edge incase something "went wrong".

    I'm obviously pleased for those who have positive homebirths, but for me, I just couldn't put myself or my unborn baby at risk of anything going wrong, and not being able to have instant medical assistance.

  • workinghard

    I understand that people who are phobic of hospitals might prefer it at home but it's one day out of your whole life.

    I don't really think it's fair to say that WH, it's not how phobias work is it? Not phobic myself (or I'd find it difficult to go to work!) but for me wanting a homebirth was about remaining in control and avoiding the cascade of intervention that happens so often in childbirth once you're admitted and on the hospital's clock. The criteria for homebirth is so tight that only the most low risk mothers are 'allowed' for want of a better word.

    Obviously low risk doesn't mean no risk but it's about weighing that up for yourself and your family and trusting in the midwives caring for you. Things can go wrong in hospital and often the midwife caring for you can have two or more women in her care at one time whereas at home you have continuous one to one care with two for the actual delivery, and in a hospital room on your own it could be awhile before it was noticed that something wasn't right and valuable time while that was acted upon. 

    I kept a very open mind on the whole thing and as I had to be induced was delivered in the birth centre pool. 

  • I feel very similar to the op and lots of the replies. I had a very straight forward birth (though 3rd degree tear afterwards), but was still so glad to be in easy reach of any medical intervention in case. Also, my lo had an infection which wasn't picked up until the next day, a few hours before discharge. He was already very ill and I dread to think what could have happened if it wasn't caught early, though I appreciate this scenario isn't common, I just wouldn't feel comfortable with any unavoidable risk, no matter how slight.

    I guess also though I didn't feel uncomfortable in hospital, or restricted. I've seen it said on a few Hb posts lately that you aren't restricted on the position you give birth in - I wasn't in hospital, and that you are likely to get stuck in a cycle of monitoring, intervention, pain relief. I was monitored intermittently, which to me was only a good thing, I didn't require intervention but if needed I would have been thankful; I don't feel hospitals are trying to trick people into intervention if unnecessary. And lastly I had no pain relief and was never encouraged to - I was given informed choice and went with what was right for baby and I at the time.

    I think a lot of people - both hosp and Hb, have specific ideals for their delivery which influences where they want to be and the kind of labour they desire, so are passionate about home births or no pain relief or intervention for example. I honestly just had the aim of baby arriving safely so to me hospital was a no brainer as I had no other 'goals' for labour and delivery, I have always felt it isn't something that is completely within our control so preferred to just go with it, be it water birth, epidural or c-section.

    I also agree with AKs point, in that I feel very lucky to have the NHS, Doctors, and the potentially life saving equipment, intervention, etc. to hand should it ever be needed.

  • A very good question, I think everyone should have their own choice where they give birth and each person has to judge their own risk etc. I am very lucky to have 3 MLU and a hospital all within equal distance from my house, I chose the MLU attached to the hospital the reasons being this is my first child and I don't know how I will cope, what will happen etc. Another reason was if I needed transferring from a MLU I wouldn't want my husband to be driving himself behind and panicking I felt that was a risk also (as only 1 person in the ambulance with you being the midwife and as CP said not all ambulances are manned by a paramedic).

    The MLU attached to the hospital meant I could be transferred to delivery/theatre etc within minutes and H would be with me. As it looks I'm 11 days overdue and being induced tues so will be in delivery anyway, I am happy with this now as I will still try to do it without pain relief and can use a pool if I can get into labour without a drip.

    What I am surprised about in the answers so far is that people feel hospitals interfere or they would be forced into something they don't want, out of interest is it because women feel that they can not say no to the medical profession if they feel that strongly about something, they can't so anything without your permission or so people not want to be seen as being awkward?

  • Would never ever consider it.

    I can't understand why anyone would . I've read people's reasons for choosing a HB on lots of threads on here but it still wouldn't convince me. They are all valid reasons why it is a good thing, but surely the safety of your baby is more important than any of that.

    As working hard says, it's just one little day, but the wrong choice could change your and your baby's life forever.

    I can't understand people's thing about intervention. If you don't want any intervention you just say so. You can tell them you don't want any examinations, monitors , drugs etc. if you saw the midwives programme the other night the woman on there had absolutely nothing- hadn't even had any scans and was very definite about no drugs etc. they don't make you do anything you don't want.

    I feel extremely fortunate that W was born very healthy, but we did have to go to the neo natal unit for her to have a heart scan and I will always remember going past all the tiny incubators and seeing lots of worried parents looking helplessly at their babies, and me  feeling so grateful that wasn't me and knowing that those parents were thinking they would literally do absolutely anything to have their child be strong and well  but there was nothing they could do but wait days/weeks/months to see if it would happen. So if you are lucky to have had a healthy pregnancy, carried to term etc, why then risk it at the very end?

    Why drink no alcohol, caffeine etc,avoid unpasteurised cheese, raw seafood, lifting heavy weights, climbing ladders, etc etc the list goes on of all the things we avoid doing in pregnancy even though older generations insist they didn't do half of it and their babies were fine, but we follow it all to the letter so we know we have done everything we can to keep our baby safe and healthy, then at the end choose to give birth without hospital facilities and expert staff? Makes absolutely no sense to me!!

  • Isis and Estrellita have echoed my thoughts.

    I'm lucky that I don't mind hospitals at all, I have no fears surrounding them and so will not be an 'at any cost' type of homebirther. I do believe though that if you are low risk and IF you feel comfortable with the idea of homebirth then it is often the safest place for both mum and baby. It is essential that both parents feel 100% happy with the idea of homebirth though, because if you have any fears at the idea of being an ambulance ride away from hospital then that will cause tension and ultimately is likely to cause issues in labour.

    I also think people who wouldn't consider a hb (and therefore perhaps haven't looked into the research, had in depth discussions with others who have done it and/or medical staff) may not realise the amount of medical support that is available via their community midwives. The CMWs are also highly trained in homebirth (to them, hb is 'the norm' remember!) and are extremely quick to suggest transferring in loads of time - earlier than would be suggested in a MLU that is attached directly to the hospital, for example.

    I think prior experience (not just personal, but also of those around us) has a massive effect on how we feel about these things as well. It is totally understandable that the posters in this thread who've had bad experiences wouldn't consider a hb in future. For me, this is my first so I have had no 'bad experience' to influence my decision. My mum had 3 very easy labours (including a homebirth). One of my best friends, a nurse, began training as a midwife a couple of years ago and she had nothing but glowing praise for the CMWs and homebirths, and yet dropped out of training after one of her delivery suite placements as it was all so highly medicalised (frequently unnecessarily in her professional opinion - usually more to do with hospital policy and clock-watching) and she felt it was against everything she believed a midwife should be.

    If I thought I could be left alone with minimal intervention, allowed to birth how I wanted, using the facilities I wanted, with high quality 1:1 care in hospital, I would totally do it. Unfortunately due to budgets and understaffing, I know that wouldn't happen (in my local hospital at any rate) so I hope to avoid it.

  • Just to add, I'm not being critical of people who home birth as I know my reply sounds like I am. Every mother has the choice of how to give birth. It's just to me I can't understand it at all. None of the plus points people make for doing it at home outweigh the safety of a hospital. But I would never think soneone else's choice was "wrong". It's their body their baby their choice.

  • **jellytot**

    Would never ever consider it.

    I can't understand why anyone would . I've read people's reasons for choosing a HB on lots of threads on here but it still wouldn't convince me. They are all valid reasons why it is a good thing, but surely the safety of your baby is more important than any of that.

    As working hard says, it's just one little day, but the wrong choice could change your and your baby's life forever.

    I can't understand people's thing about intervention. If you don't want any intervention you just say so. You can tell them you don't want any examinations, monitors , drugs etc. if you saw the midwives programme the other night the woman on there had absolutely nothing- hadn't even had any scans and was very definite about no drugs etc. they don't make you do anything you don't want.

    I feel extremely fortunate that W was born very healthy, but we did have to go to the neo natal unit for her to have a heart scan and I will always remember going past all the tiny incubators and seeing lots of worried parents looking helplessly at their babies, and me  feeling so grateful that wasn't me and knowing that those parents were thinking they would literally do absolutely anything to have their child be strong and well  but there was nothing they could do but wait days/weeks/months to see if it would happen. So if you are lucky to have had a healthy pregnancy, carried to term etc, why then risk it at the very end?

    Why drink no alcohol, caffeine etc,avoid unpasteurised cheese, raw seafood, lifting heavy weights, climbing ladders, etc etc the list goes on of all the things we avoid doing in pregnancy even though older generations insist they didn't do half of it and their babies were fine, but we follow it all to the letter so we know we have done everything we can to keep our baby safe and healthy, then at the end choose to give birth without hospital facilities and expert staff? Makes absolutely no sense to me!!

    See midwives are 'expert staff' JT they are the experts in normal childbirth and are highly skilled practitioners trained to act on complications as they arise . It is assumed that in hospital doctors are the experts, but you may have a junior doctor on his/her first obs and gynae rotation where the midwives actually know more than them!  Laugh 

  • **jellytot**
      I can't understand people's thing about intervention. If you don't want any intervention you just say so. You can tell them you don't want any examinations, monitors , drugs etc. if you saw the midwives programme the other night the woman on there had absolutely nothing- hadn't even had any scans and was very definite about no drugs etc. they don't make you do anything you don't want.

    Isn't it funny how people can watch exactly the same thing, and interpret it in such different ways! The couple you are referring to declined a certain amount of intervention; the 'no drugs' etc is the easy bit to decline in a way. However, she was in the pool, labouring well, just entering transition and then she was hoiked out of the pool and transferred, stuck on her back in a bed with a monitor, and 'forced' to labour in a way that should never have happened. Their reasoning was possibly meconium in the waters (possible!) and as soon as they examined her and realised how far gone she was, they understood why and had no concerns. There was no reason why they couldn't have examined her in her room and allowed her back into the pool for 2nd stage.

    She did very well managing to continue with that birth without it stalling and without needing pain relief given the interruption and interference, which probably made it look like a much smaller deal to the viewer than it actually was.

    One of the things that often crops up in these types of threads are people saying - quite accurately - their baby would have died if they hadn't been in hospital. What about viewing it from the other side though - obviously excluding the prem babies and those women who have had high risk pregnancies (and so would probably choose to be in hospital anyway - I certainly would!) - what about the 'normal' pregnancies that have gone to hospital, and then ended up with complicated, medicalised births? They may have ended up with a healthy baby, and we all agree that is the MOST important thing but it is not the ONLY important thing. These situations leave women and their partners traumatised and fearful of future births, can affect bonding, can affect relationships etc.

    I prefer to look at the wider picture, with the health of my baby being of the utmost concern, but also my health, the mental health of me and my husband, and the relationships of us all as a family playing an important part.

  • some interesting responces - i'm glad i'm not the only one who feels as I do!

    yes I agree midwives are experts in their field and I would want my labour and birth under a midwife if possible - but they cannot perform a C-section if required.

    I appreciate some feel that they have more control and less likely to have intervention - well of course, because those options aren't available! but nothing was forced on me in hospital, I was free to say no but as things were explained to me (by MW and docs) I felt that constant monitoring was in my babies' best interest (it was as one was having decels), that forceps was the right choice (she was stuck). nothing was done without my consent and I knew what was happening and why.

    In the same way people say ' I couldn't live with myself if something happened and they were in their own room pre 6 months' I couldn't live with myself if something happened which could have been prevented was I in hospital. I would rather have all the intervention in the world and have a healthy baby than risk the alternative - which is a complete 180 from my stance pre my first labour. strange that my positive birth experience actually changed my mind about it!!

    my hospital has a MLU one floor up from the main delivery suite and I think I would feel comfortable there, its only a lift ride down should it be needed.

    I also agree with another poster - couldn't imagine H having to drive to a hospital if things were going wrong.

    jellytot - i'm now like you, cannot understand the willingness to take the risk.

    Mrs 50s - I think this stems from far to much focus being on the 'experience' of our labour and birth when the focus should be on healthy mum and baby. I feel we get to caught up in the 'ideal' birth and forget that in the end it is one day, the rest of yours and your baby's life is the most important and the whole labour/birth thing should fade into the background of it all.

  • Estrellita- I have upmost respect for midwives, they do an incredible job. But there is a reason why there is MW led care for uncomplicated pregnancies and labours, and then consultant led care for higher risk. Midwives are very knowledgable and experienced, but there is so much they are not allowed to do, so many reasons why people get moved mid labour from mlu to consultant led. That is what I meant.

    Mrs 50s - to me the health and safety of my baby is The most important thing. I don't try to imagine the long term emotional damage to mothers who have problems with birth, but I would have thought all mums would say the safety of baby is most important and whatever had to happen to them to get baby out safely is the most important thing. For example my worst nightmare would be a GA for a CS . Lots of women on here have had to go through that, I can't imagine how hard it must be to deal with having no memory of your baby being born or not being able to hold them, it must emotionally scar them for life, but I'm sure they are thankful that they were in a hospital and got to theatre in time for everything to be ok with baby.  That was the only option to get baby out safely and so as much as it must be hard for them, I'm sure they would rather that and have a healthy baby.

  • Another point to consider is that at a homebirth you have 2 midwifes attend who are totally dedicated to you & your baby, no nipping off to check on another lady etc

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