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The Midwife Led Birthing Unit: Is It Right for You?

What is a Midwife Led Unit (MLU)?

The MLU is a place where you can give birth to your baby which is managed by midwives, rather than midwives and doctors. An MLU, sometimes known as Midwifery Led Birthing Unit (MLBU) may be in the same building as the labour ward, in which case it’s often called an Alongside Midwifery Unit (AMU) or in a different place – sometimes even in another town to the main hospital – this is called a Freestanding Midwifery Unit (FMU). Not every region has an MLU, although the NHS is required to ensure that women have the choice to access one.

Midwife led units usually have birthing pools, and the space is laid out to support women to easily move around in labour (active birth). They may have slings hanging from the ceiling to lean on and sway comfortably, or birth couches to kneel on or over. Typically, the spaces are not clinical like a hospital, and feel more homely. All of this helps our bodies to trigger one of the most important hormones of birth: oxytocin. Stress and worry can stop oxytocin flow, which is why so many women find their labours slow or stop when they arrive at hospital to give birth. In contrast, women often report that they walk into the midwife led unit and immediately relax, they feel safe and nurtured, and their oxytocin flow increases, pushing labour on. At the same time, this amazing hormone triggers our natural pain relievers, endorphins, and so we can feel less pain at the same time!

If we have a pet cat who is pregnant, when she goes into labour we might have two options:

1) Give her a warm, soft, cosy box that’s dark, carefully watch for problems and only intervene if necessary, or,

2) Whisk her off to the vets and put her on a table with bright lights, people watching her and see how well she performs then!

Of course, we know that option one would be most likely to support her body to birth safely and quickly, with minimal distress. So how do we do the same for ourselves? Once we remember that we are also mammals, who need a calm, safe space, lowered lights and people around that we trust, we can understand why a midwife led unit would be a way to give us the best chance of a straightforward birth.

What, No Doctors? Is That Safe?

For many women, yes! Some women or their unborn babies have a specific medical need that can only be supported in the main labour ward of a hospital, or they are at higher risk of a complication which could only be dealt with in the hospital, and so they may decide that that’s the place they’d want to give birth.

However, one of the largest studies ever done on the safety of birth in the UK, ‘Birthplace 2011’, found that for women who didn’t need to be in hospital, the safest place for them and their baby to give birth was in a MLU. The actual reasons for this are unclear, but it seems likely to be based on the fact that the MLU environment supports the human body to birth as efficiently as possible, whereas the labour ward environment can sometimes cause problems which then leads to a need for medical intervention (like augmentation).

Many midwives in obstetric units are recognising the need to create a cosy space, with dimmed lights and hiding, where possible, equipment that makes some people nervous, like bleeping machines. However, there is still very often a more clinical atmosphere, and fewer pieces of equipment to support normal birth, compared to the MLU.

Pain Relief Offered at an MLU

Most MLUs offer most types of pain relief other than epidurals, which need a doctor to do, but it is worth asking in advance if you have a specific type of pain relief that you want to have access to. Most MLUs have a birth pool, which gives powerful pain relief to many women – and of course, if you don’t like it, you can just get out! Moving and being active in birth helps to reduce pain, because some of the sensations of labour are your baby telling you how they need you to move so that you can help them to be born, and this can be far more effective than lying on a bed with pharmaceutical pain relief, as well as making it more likely that your labour will go smoothly.

What Happens If Something Goes Wrong?

Midwives are highly skilled clinicians with the knowledge and experience to deal with most emergencies. The midwives who will care for you at an MLU will be experts in recognising when a birth isn’t going to plan in a way which needs input from a doctor, or from medical equipment only available in hospital, and they will recommend that you transfer to hospital usually well in advance of an emergency, so that it can be as calm and comfortable as possible.

If you decide that you want an epidural, you can also choose to transfer to the obstetric unit whenever you like, and this will happen in a calm manner.

Who Is Able to Use the MLU?

Although there is no law which states that hospitals can restrict who gives birth in an MLU, there will usually be guidelines on who they say may or may not be able to attend. These are not legal rules and they can be negotiated. If you are told that you don’t fit the criteria for an MLU birth you can ask for the reasons in writing, together with the evidence that they are based on (if any), and then research whether or not their reasons are supportable. Volunteers on the AIMS helpline (a charity which campaigns for better maternity services) will help with this (helpline@aims.org.uk), and the charity Birthrights has a useful factsheet on your rights to choose where to give birth.  

Women and their partners can go to visit their local MLU and see what they think for themselves. Simply ask your midwife to arrange this, or phone the MLU yourself and make an appointment. Remember, even if you book in to go there, you can always change your mind at the last minute (even if you’re in labour) and go to the hospital labour ward. What have you got to lose? Answer: nothing – and you may have a huge amount to gain!!

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