Welcome to Ask a Midwife

[MumO'Three]

Hi everyone and to the on-duty midwife ,

I would like to know what are the differences between giving birth at a midwife clinic and at a hospital. My sister who is going to give birth for the first time with her baby girl and who is in her 30th week of pregnancy is still unsure where she wants to give birth in? I gave her advices and ideas how it feels giving birth to a hospital, yet she prefers in a midwife clinic.Please do enlighten us both.

Thanks in advance.

[ljmarsden]

Hi MumO'Three,

Whilst you are waiting for Jane (our wonderful midwife) to reply I thought I would share my experiences/knowledge with you on this.

I had my son in a midwife-led unit (it was called a 'birth centre') rather than the hospital ward and the main idea of this is to provide an environment where you could have as natural a birth as possible with minimal interventions. There were not doctors available at the birth centre but there were very experienced and skilled midwives. There were plenty of birthing pools - having a water birth can help a lady to relax so that the contractions are more effective and the labour is quicker. You could not have a an epidural or the use of forceps or the ventouse at the birth centre I attended as these are medical interventions. If you wanted or needed these during the labour you had to be transferred to the hospital (this would obviously also be the case if an emergency caesarian was necessary- although these rates are a lot lower if you have had midwife-led care in the birth centre).

If a lady has not had any complications during the pregnancy and it is not considered to be a high risk birth, then the midwife-led birth centre is a good choice to have a low-intervention labour where you are supported by midwives. If any unexpected complications did arise the midwives would arrange for a hospital transfer (but this is not common).

I hope this has been helpful.

Best wishes to you and your sister,

LJ

[MumO'Three]

A pleasant hello to you Ms LJ,

The information you gave is very much appreciated. Actually, I did remember that one of the reasons why I preferred to give birth to a hospital was because I was a high-risk patient. That was way ten years ago so I almost forgot the reason why I was brought in. I preferred to give birth to a birthing home or centre yet was advised to better be admitted to the nearest hospital. Anyhow, my little sister did prefer natural birth in a midwife-led unit because she was sure enough that full attention to her and her baby would be given. She has no history of having medical problems and that is one of the many reasons why giving birth in a center is what she wishes.

Once again, thank you for the information Ms LJ.

MumO'Three

[5Homebirths4Kate]

Hi MumO'Three,

LJ has given you some very good information on why a birthing centre attended by midwives is often a better choice for mums. I've had 5 homebirths, and I've attended 2 homebirths and a hospital birth so I have a good idea of the differences between midwife led care and doctor/nurse led care.

One of my midwives attended births in the hospital, and she also attended births in a birthing centre. One of the many benefits of a birthing center is that you can labour and deliver in whatever position your body needs to. Sometimes this may mean that you need to lunge during labour to bring baby into a good position or you may want to squat to give birth (a great position that allows gravity to bring baby down and out).

In a home or birthing clinic setting, often times you will be able to use comfort measures much more effectively. We know that when we are relaxed and not feeling stressed, the labour progresses faster and pain is less. In a hospital you can use some comfort measures, but all too often, the woman is placed on a "protocol" that they use for each and every labouring mum. The problem with this is that every woman is different, and every birth is different, so every mum should not be placed on the same "protocol".

One of the things that often happen to mums in the hospital is that they have fetal monitors strapped to their belly and/or inserted through their vagina and screwed into the top of the baby's scalp. Once this happens, many women are confined to bed and it makes it more difficult for labour to progress normally, without intervention.

In a birthing center, often times the midwife will monitor the baby's heart tones with a doppler. This is what the doctor or midwife uses at all of the prenatal visits to listen to baby's heart tones. The benefit of using the doppler is that it never interferes with the natural progression of labour. The drawback is only for the attending midwife or doctor in that that the she would need to be in attendance during many hours of labour. This means it takes a lot of her time and in a hospital setting, the staff finds that they can sleep longer or attend more patients if they just run in for the "catch" and nurses can monitor more patients if they strap a monitor on to each mom and then sit at their nurse's station and monitor more than one woman from there. My personal opinion is that in a hospital setting, everything is about convenience to the doctors and nurses, rather than comfort for mum. It's much more convenient for the doctor to sit on a stool and catch a baby at arm's level, but poor mum, has to lay on her back, pull her knees to her chest, hold her breath and push as long as she can before gasping for another breath. Most of the time this is not the most effective way to bring a baby down the birth canal. Squatting or giving birth on hands and knees can be more effective for mum, but it's not as convenient for the doctor or midwife.

Comfort measures are so important, and as LJ mentioned, you can labour in the water (or even give birth there, as I did with two of mine) and you can have an active birth with slow dancing.

Here's a wonderful little video that shows some of the comfort measures that can be used to manage pain and encourage a shorter labour and birth.

[raish]

Hi aussie,

Its me raish its been a while i have successfully born my 1st baby now i'm having a problem since my baby is almost 2months is it ok for her to use pacifier? Because most of the time even she is not hungry she wants me to stay by her side and suck my nipples for her to be able to sleep but i cant stay always beside her i have work need to be done so i just wondering if its ok for her to use a pacifier because someone told me that its not ok...so i will be happy if you can help me

Looking forward for your reply

Thanks

Raish

[ljmarsden]

Hi Raish,

I'm sure our midwife will reply to you shortly but I just wanted to give you some information on using pacifiers and breastfeeding. The main disadvantage of this is that using a pacifier can lead to decreased milk supply (which could then lead to you giving your baby formula and missing out on the benefits of exclusive breastfeeding). This is because milk is produced on a supply and demand basis and if your baby is not sucking on your nipples for milk then your body will not produce enough. There is a useful forum post explaining the advantages and disadvantages of pacifier use here.

Another potential disadvantage of using a pacifier is that it can lead to 'nipple confusion' and affect how well a baby latches onto the breast. Some healthcare professionals advice waiting until you have been breastfeeding for 12 weeks in order to minimise this risk.

I would recommend baby wearing as a gentle parenting method of staying close to your young baby but still getting some jobs done (if you have the energy!). At this age, it is important for a baby's social and emotional development and well-being that they are close to you and baby wearing allows you to bond in this way. It is also possible (with a little practice) to breastfeed whilst the baby is in the carrier - I found the ring sling easiest for this although I sometimes breastfed with my baby in a soft wrap sling (Kari Me or Moby sling).

Finally, I would say be kind to yourself! Your baby is still very young and you are adapting to having a new baby. Rest when you can and try not to worry if the household jobs slip for a bit. Try and eat a healthy balanced diet and drink plenty of water and fruit juices.

I hope this is helpful for you but please post back if you need any further suggestions.

Best wishes,

LJ

[5Homebirths4Kate]

Hi Raish,

Congratulations on the birth of your daughter! I'd love to hear how your birth went.

When you fully breastfeed your baby there will be times when baby seems like she's always at the breast, and all you do is sit on the couch. Those times would be when she's going through a growth spurt and increasing your milk supply to keep up with her growth, or when she is sick and not feeling well, and if she has fever, she would need more fluids, so suckling at the breast would not only soothe her but would also increase milk supply so she has more fluids during her fever.

But other than that, if you truly feel like your baby is constantly at the breast, even while she sleeps, she may not be getting a good, full feed.

You can use breast compressions to help baby feed faster and become full without "nibbling" at the breast all day. By using compressions you can even give a baby a full feed on one breast at one feeding, and then offer the other breast at the next. This can give painful nipples a break so they can heal too (I had very painful nipples with my first baby).

Here's a video by Dr. Jack Newman that shows you how to keep a baby awake during a feed. It also shows how mum uses compressions to help move milk down into the baby's milk so the baby gets a good mouthful rather than just "nibbling".



If your baby's desire to nibble at the breast is not due to being hungry, but is more about wanting the breast to simply pacify, then you could offer a dummy (pacifier) only in a very limited capacity. You really need to keep in mind what LJ shared about. Using a dummy can cause nipple confusion and it can also cause you to have less milk for your baby. But if needed, you can use it a little, and the way I would do this would be to give your baby a really good, full feed (using breast compressions if needed). This shouldn't take more than 10-20 minutes.

Then, if baby has not fallen asleep yet you notice she is tired, you could offer the pacifier, swaddle her tightly, put her in a swing or in a front pack and start running the vacuum or a hair dryer.

When you do all of these things, you are replicating the environment in the womb, which she was used to for 9 months. The swing or front pack gives her movement, similar to the movement she experienced when you moved around and she was in the womb. The sound of the vacuum or hairdryer or running water is similar to the sounds she heard when she was in the womb "white noise", the tight swaddling is similar to the confines of the womb, and the dummy allows her to suck, which is similar to the sucking of her thumb that she may have done in the womb.

Take a look at this video to see a 21 week baby in the womb who was caught on tape (ultrasound) sucking her thumb. Amazing!



Please write back and let us know what you think. We're here to make mothering life much easier on you so let me know what it is you want to be able to accomplish, and if you need more ideas.

Warm regards,

Kate