What to Do If You’re Moved from a Midwife-Led Unit to a Ward in Labour.

Many expectant parents look forward to a calm, natural birth in a midwife-led unit, where interventions are minimal, and the focus is on a more holistic, mother-centred experience. The environment of a midwife-led unit is often quieter and more relaxed compared to a traditional labour ward, and this setting is particularly appealing to women who want a less clinical birthing experience. However, sometimes during labour, complications or unexpected events arise, and your midwife may recommend transferring to a labour ward, even if you had hoped to avoid this.

This situation can be anxiety-inducing, especially if you had carefully planned for a natural birth without medical interventions. Understanding why a transfer might be necessary, what your options are, and how to advocate for your wishes during labour is key to feeling empowered during this process.

1. Why Might You Need to Be Moved from a Midwife-Led Unit to the Labour Ward?

There are several reasons why you might be transferred from a midwife-led unit to a labour ward, even if everything seemed to be progressing smoothly at first. The decision to move is typically based on the health and safety of both mother and baby. Although this can be disheartening, it is important to remember that your midwife’s primary goal is to ensure the safest outcome for your birth.

1.1 Common Reasons for Transfer

Some common reasons why you might be moved from a midwife-led unit to a labour ward include:

Slow labour progression: If labour is not progressing as expected, or if you are experiencing exhaustion, the midwife may suggest moving to a labour ward for stronger pain relief or interventions like oxytocin to help move labour along.

Foetal distress: If there are signs that your baby may be in distress, such as an abnormal heart rate, your midwife will likely recommend moving to the labour ward where more advanced monitoring and interventions are available.

Maternal health concerns: High blood pressure, excessive bleeding, or other complications that could affect your health may prompt a transfer.

Assisted delivery: If an instrumental birth using forceps or a ventouse (vacuum) is required, or if an emergency caesarean section becomes necessary, a transfer to a labour ward will be required.

While these scenarios are not always part of your birth plan, they are often recommended to ensure both you and your baby are safe.

2. Your Birth Preferences and Control Over Your Labour Experience

It’s natural to feel disappointed or even upset if your birth plan changes, especially if you had envisioned a natural birth in a midwife-led unit. However, it’s important to know that even if you are transferred to a labour ward, you still have rights, and your preferences can still be respected wherever possible.

2.1 Communicating Your Birth Preferences

During your antenatal appointments, you likely discussed your birth preferences with your midwife, and these preferences should be documented in your birth plan. This birth plan acts as a guide for your healthcare team, but it’s important to remember that it may need to be adjusted as labour progresses, especially if medical intervention becomes necessary.

If you’re concerned about the possibility of being transferred to a labour ward, it’s a good idea to have conversations with your midwife or obstetrician ahead of time. Ask questions about what might lead to a transfer and what your options are in those scenarios. Make sure your birth partner is also familiar with your preferences, as they can help advocate for you during labour if you’re feeling overwhelmed.

3. Advocating for Your Preferences During a Transfer

If your midwife suggests transferring you to a labour ward and you are unsure or uncomfortable with the idea, it’s important to ask questions and understand why this decision is being made. Remember, you have the right to make informed decisions about your care during labour, and your midwife is there to guide and support you.

3.1 Staying Informed and Asking Questions

If you’re faced with a recommendation to transfer, take a moment to gather information. Here are some questions you may want to ask your midwife or doctor:

Why do you recommend moving to the labour ward?: Understanding the specific reasons behind the recommendation can help you feel more informed and in control.

Are there any alternatives?: Ask if there are other ways to manage the situation without needing to move. In some cases, you may be able to stay in the midwife-led unit with close monitoring.

What are the risks of not moving?: Understanding the potential consequences of staying in the midwife-led unit can help you make a decision that prioritises safety.

What will happen when we arrive at the labour ward?: Having a clear understanding of what to expect can ease anxiety. Will you need to be hooked up to monitors, receive an epidural, or have other interventions? Make sure you’re comfortable with the plan moving forward.

3.2 Enlisting the Support of Your Birth Partner

Your birth partner plays an important role in advocating for your preferences during labour, especially if you are feeling emotional or overwhelmed. Make sure your birth partner knows what’s most important to you, so they can support you in communicating with your healthcare team. If a transfer becomes necessary, your birth partner can help ensure that your voice is heard and that any decisions are made collaboratively.

4. Balancing Your Preferences with Medical Advice

Many women who plan for a birth in a midwife-led unit do so because they want a more natural birth experience, with minimal interventions. This is entirely valid, and your preferences should be respected as much as possible. However, it’s also important to stay open to the possibility that medical intervention may be necessary to ensure the safety of both you and your baby.

4.1 Trusting Your Midwife’s Expertise

Midwives are highly trained professionals who specialise in normal pregnancies and births. When you are under the care of a midwife in a midwife-led unit, they will monitor your progress closely and will only recommend a transfer if they believe it is in your best interest. Trusting your midwife’s expertise, while also staying informed and asking questions, is key to feeling confident in your birth experience.

4.2 Understanding the Labour Ward Environment

If you do need to transfer to a labour ward, it’s important to understand that this does not mean your birth plan is completely out of your hands. The labour ward is staffed by obstetricians, midwives, and anaesthetists, and while the environment may be more clinical than a midwife-led unit, you still have a say in how your labour progresses.

For example, you can still request minimal interventions where possible, such as maintaining mobility, using antenatal massage techniques or antenatal yoga positions for relaxation, and opting for natural pain relief methods. Your midwife will still be there to support you, even in the more clinical setting of the labour ward.

5. Preparing for the Unexpected: Flexibility in Your Birth Plan

One of the most important aspects of preparing for birth is understanding that labour can be unpredictable. While it’s important to create a birth plan that outlines your preferences, it’s equally important to remain flexible and open to changes.

5.1 Staying Flexible and Open-Minded

While no one wants to imagine their birth plan changing, it’s helpful to approach labour with an open mind. By preparing yourself for different scenarios, including the possibility of being transferred to a labour ward, you’ll feel more empowered to handle any changes with confidence.

Attending antenatal classes or pregnancy yoga classes can be beneficial in helping you prepare mentally and emotionally for labour. These classes often cover techniques for managing pain and stress, as well as what to expect in various labour scenarios. Many classes also include discussions about antenatal care, so you can ask questions about what happens in the event of a transfer and learn relaxation techniques for remaining calm during unexpected moments.

5.2 Debriefing After the Birth

If you do end up transferring to a labour ward and feel disappointed about how your birth plan changed, it’s important to talk about your feelings afterward. Many hospitals in the UK offer postnatal debriefing sessions, where you can discuss your birth experience with a midwife and raise any concerns you have. This can help you process any emotions and provide closure.

Conclusion: Balancing Your Wishes with Safety

Being moved from a midwife-led unit to a labour ward is not uncommon, but it can still feel disheartening if you had hoped for a natural birth with minimal interventions. The key to navigating this situation is to stay informed, ask questions, and understand why the recommendation is being made.

Ultimately, your midwife and healthcare team want the safest outcome for you and your baby, and sometimes that may mean making adjustments to your original birth plan. By remaining open to changes while advocating for your preferences, you can maintain a sense of control and confidence in your birth experience, no matter where it takes place.