What If the Hospital Guidelines Suggest a Labour Ward, but I Want to Give Birth in an MLU?

For many expectant parents, deciding where to give birth is one of the most significant decisions during pregnancy. While some mothers-to-be feel more comfortable in a hospital setting, others prefer the more natural, homely environment of a Midwife-Led Unit (MLU). However, what happens when the hospital’s guidelines recommend that you give birth on a labour ward, but you have your heart set on an MLU? This article explores the complexities surrounding this decision, the reasons why certain hospital guidelines might suggest a labour ward, and how to navigate the conversation with your healthcare provider to ensure that your preferences are respected while keeping both you and your baby safe. Whether you’re in the early stages of planning your birth or approaching your due date, understanding your options is a crucial part of antenatal care and empowering yourself during pregnancy.

1. Understanding Hospital Guidelines and Recommendations

a) Why You May Be Advised to Use a Labour Ward

Hospital guidelines are generally created based on your individual health, medical history, and the risk factors that could influence your labour and delivery. If your hospital has recommended that you give birth on a labour ward instead of an MLU, it’s likely because certain aspects of your pregnancy may require closer monitoring or additional interventions. Common reasons for being advised to use a labour ward include:

• Pre-existing health conditions such as diabetes or high blood pressure
• Complications in pregnancy, such as preeclampsia or placenta previa
• A previous caesarean section or other high-risk factors in past deliveries
• Multiple pregnancy (e.g. twins or triplets)
• Concerns about your baby’s health, such as growth restriction In these cases, a labour ward provides immediate access to obstetricians, anaesthetists, and other medical professionals, should any complications arise. There is also access to more advanced monitoring equipment, medication, and procedures like epidurals or emergency caesareans, which are not typically available in an MLU.

b) What is a Midwife-Led Unit (MLU)?

A Midwife-Led Unit, or MLU, offers a more natural and less medicalised birth environment, with midwives overseeing the care and delivery of your baby. MLUs are often seen as a good choice for women with uncomplicated, low-risk pregnancies who want to avoid interventions such as epidurals or continuous monitoring. The atmosphere in an MLU is typically more relaxed, and it can feel more like home than a traditional hospital labour ward. Some MLUs have birthing pools, which allow for water births, and they promote the use of alternative pain relief methods, such as hypnobirthing, gas and air, and antenatal massage to help reduce discomfort during labour.

2. Balancing Hospital Guidelines with Your Birth Preferences

a) Understanding Your Options

If your hospital’s recommendation is to give birth on a labour ward, but you are keen on an MLU, the first step is to have a detailed conversation with your healthcare provider. Attend your antenatal appointments equipped with questions about the risks and benefits of each option, and be open to their medical advice. This doesn’t mean that your preferences are irrelevant; it means you’ll need to carefully balance your personal birth plan with the medical considerations at hand. In some cases, it may be possible to plan for a birth in an MLU if your pregnancy progresses without complications and both you and your baby are healthy at the time of delivery. Alternatively, some hospitals offer combined care, where you begin your labour in an MLU but are transferred to the labour ward if complications arise.

b) Discussing Your Birth Plan

An essential part of antenatal care is creating a birth plan that outlines your preferences for labour and delivery. Your birth plan is a tool to help communicate your wishes to your healthcare team, but it’s also a flexible document that may need to change as your pregnancy or labour progresses. When discussing your birth plan, clearly explain why you prefer an MLU and listen to your midwife or obstetrician’s concerns if they believe a labour ward would be safer for you and your baby. Consider asking:

• What are the specific reasons for recommending a labour ward in my case?
• Is there any flexibility for starting labour in an MLU and transferring if necessary?
• How does my healthcare team support antenatal support in an MLU versus a labour ward?
• Can I still access midwife-led care in a labour ward setting?

c) Being Open to Compromise

While it’s important to advocate for your preferences, flexibility is key when it comes to childbirth. If your hospital strongly recommends a labour ward, consider how you can incorporate aspects of the MLU experience into the hospital setting. This may include bringing your own items for comfort, such as music, pillows, or essential oils, using techniques like prenatal yoga or hypnobirthing to manage pain, or working closely with a midwife to focus on minimal intervention whenever possible. Remember, even on a labour ward, you can often opt for alternative pain relief techniques, such as antenatal yoga or prenatal massage, which promote relaxation and help ease tension during labour. Maintaining a flexible mindset can help you feel more in control of your experience, regardless of the setting.

3. Safety Considerations: Why Medical Advice Matters

a) Prioritising Safety for You and Your Baby

At the heart of every birth decision is the safety of both mother and baby. While giving birth in an MLU can be a wonderful and empowering experience for many women, it’s essential to recognise when a more medicalised environment may be necessary. Your healthcare team’s recommendations are based on a wealth of research and experience designed to minimise risks during childbirth. A labour ward offers immediate access to advanced medical support, should you need it. This includes doctors, anaesthetists, and specialised equipment for emergencies. While no one plans for complications, having these resources available can be lifesaving in situations where things don’t go as expected.

b) Knowing When to Seek Further Support

If you feel anxious or stressed about your hospital’s recommendation for a labour ward, it’s important to address these concerns with your midwife or doctor. You can also attend antenatal classes to further understand the risks and benefits of different birth settings. These classes, often offered through your antenatal clinic, provide detailed education about birth environments, pain relief options, and medical interventions, empowering you to make an informed choice. Antenatal education can also offer insights into combining natural birth practices with hospital care, helping you prepare for all possibilities while feeling more in control of your experience.

4. Preparing for Labour: A Flexible Mindset

a) The Importance of Flexibility

Birth plans are a great way to outline your preferences, but it’s also important to remain flexible. No two labours are the same, and situations can change quickly. Whether you are placed on a labour ward or manage to give birth in an MLU, the most important thing is the safe arrival of your baby. Having a flexible mindset will allow you to adapt to any changes and feel more at ease. Additionally, integrating techniques such as prenatal yoga and relaxation practices from pregnancy yoga classes can help you stay calm and centred during labour, no matter where you give birth. These techniques encourage mindfulness, breathing control, and relaxation during pregnancy, all of which can be beneficial whether you’re in a hospital or an MLU.

b) Post-Labour Support

Once your baby is born, both MLUs and labour wards offer excellent postnatal care. However, if you have specific preferences about your care after the birth, such as immediate skin-to-skin contact, breastfeeding support, or the presence of your partner or doula, be sure to communicate these ahead of time. Both MLUs and labour wards are equipped to help you transition into parenthood smoothly, but making your wishes known during your antenatal checkups can ensure that your post-birth experience is as positive as possible. While the decision about where to give birth can feel overwhelming, it’s important to remember that your safety and your baby’s health are the primary concerns of your healthcare team. If your hospital’s guidelines recommend a labour ward but you would prefer to give birth in an MLU, start by having a transparent conversation with your midwife or doctor to understand the reasons behind their recommendation. By attending antenatal appointments, discussing your preferences in detail, and staying flexible, you can make an informed decision that balances your desire for a more natural birth experience with the need for medical support, if necessary. Whether you give birth in an MLU or on a labour ward, what matters most is the healthy and safe arrival of your baby.