I started the BigBirthas website for a number of reasons. One was because I wanted to give birth in the local Midwifery Led Units (MLUs) and was denied both times. I ended up having a home birth with my second, which was AMAZING, and I’d recommend the experience to anyone. But…
…would I choose home birth again automatically next time?
(There’s not going to be a next time! But hypothetically?!)?
I can’t say for absolute certainty that I would. I know (barring complications) that I don’t want another hospital delivery suite birth experience. And I don’t think there’s any NEED for someone like me to be there! I had two straightforward, ‘easy’, uncomplicated pregnancies and births. There’s no need for a more medicalised environment when it’s not a medical process…
But if the option was Midwifery Led Unit or Home Birth again… I’m not so sure which I’d choose!
The problem with Midwifery Led Units in 2025
Back when I was pregnant, the doors were firmly closed to anyone like me with a BMI over 30/35/40. (All a postcode lottery at the time, depending on local NHS Trust rules). This forced my hand. It was either home birth or hospital birth for me, and that was a no-brainer. Aside from other factors, I labour EXTREMELY quickly… It was entirely likely second time I’d have a home birth either way, so might as well plan one!
But there have been a couple of important changes since then. Firstly in 2018, the NPEU published the ‘Severe Obesity Study’… Terrible name, but interesting and valuable research.
This proved a few things:
Firstly, that SOME units were granting access to women and birthing people with higher BMIs. Units could no longer pretend that people like me ‘weren’t ALLOWED’ to birth in an MLU, because clearly in some places, they were!
Secondly, their results showed that for people in their second and subsequent pregnancies, birthing in a MLU was just as safe as birthing in a hospital setting!
Thirdly, it showed that even though the rates of emergency cesarean section for FIRST TIME mums was higher than the rate for people with lower BMIs in MLUs, it was significantly lower than you’d usually find with hospital births at the time, and the results for bleeding excessively after birth (PPH), again while higher than the general lower BMI population, were no worse that those seen for those giving birth in hospital settings.
Finally, and crucially, it proved that those units were absolutely right to offer the option for people with higher BMIs – especially for people who’d already given birth before!
The C word…
Another major change was brought about initially by COVID. For various reasons, many MLUs simply shut their doors 2020, and quite a few have never got round to opening back up again. So now, depending on where you live, you STILL might not have access – whatever your BMI!
There’s also seemingly been a loss of confidence in Maternity Led births? The numbers are definitely down in the MLUs that are still open. Without research into the reasons why, we can only guess the reasons… Is it that Trusts aren’t promoting them as much as they used to? Is it down to the high profile media coverage about failings in some maternity units? Or is it simply a word-of-mouth thing – fewer people know people who’ve had a MLU experience, and so don’t see themselves doing it either?
All we can see is that more people seem to be opting to birth in more medicalised settings. If you don’t use it, you risk losing it, and we’re in danger of MLUs disappearing from the landscape altogether. While MLUs are an extremely cost effective and safe option, they become financially unviable if they’re under used. Even if you wouldn’t want an MLU setting for yourself, I’d hope everyone can see that it’s preferable to have options!
The problem with Home Birth
Is there a problem with Home Birth? Well, it depends on your perspective.
Some people might be concerned about the mess… Frankly, I was faintly thrilled at the prospect of a blood spatter or two on the walls that I could proudly point out to potentially revolted guests that “Oh, that was from where I gave birth… would you like another biscuit?”, but in the event, I came down after a post-birth bath to find that my dining room was entirely back to normal! Everything had been tidied up and put away – even the pool was emptied and drying outside. It was (disappointingly to me!) as if nothing had ever happened… The midwives were quietly sat at the (now-reinstated to the middle of the room) dining table finishing writing up their notes, and that was it.
Another concern might be your travel time to a maternity hospital. I was extremely lucky in that I could have walked to my local delivery suite within 10 mintes (well, probably not while I was in labour, but you get the idea… it was close). There’s something very reassuring about knowing doctors are nearby, even if you don’t intend to use them, it’s helpful to know they’re THERE. Which is another reason ‘Alongside’ Midwifery Units (AMUs) can be so reassuring.
Lastly, there is sometimes a concern that you might be told “there aren’t any available staff free to facilitate a home birth right now, you’ll have to come in…” which could be extremely anxiety-inducing. In the event, people who say they’re staying put are almost always sent a midwife… But if ALMOST isn’t reassurance enough for you, then it’s not ideal.
Back to birthing in Midwifery Led Units
So, why do I want to hear from you about your experiences with Maternity Led Units?
Well, because I’m about to have a (very brief!) opportunity to speak to some influential people about why we should be maintaining access – and reinstating it where it’s been lost.
I can’t talk from the heart about what my MLU birth meant to me – as I never got the opportunity to have one! So thats where you come in. Please either email me via
thebiggestbirtha @ gmail . com (all split up to hopefully foil the bots and spiders from sending me even more spam than I already get!)
or post a comment under the thread about this in the BigBirthas private Facebook discussion group.
For a lot of people, a hospital birth is EXACTLY what they want. With others, home birth is clearly the way to go. For many, the more relaxed and home-from-home setting of a MLU is what they’re looking for. And some who’d want a home birth, but logistically and situationally, it just isn’t an option they’d likely want to consider, MLUs offer a good compromise. And that’s completely fine! Whatever style of birth YOU want is the RIGHT one for you. There’s pros and cons to all, and we’re all different in what makes us feel safe, comfortable, and happy. I’m hoping we can maintain a suite of options for ALL.
Please do get in touch with your thoughts!
x
Amber/Big Birtha