Milton Keynes University Hospital (MKUH) Maternity Services consist of various antenatal assessment and treatment units, the community midwifery team (this is who you’ll have appointments with at your GP surgery), a postnatal ward, and an obstetric (consultnant-led) labour ward. The labour ward has 2 rooms with pools available, but it’s luck of the draw as to whether there’ll be one available for you on the day.

Milton Keynes does not have a midwife-led Birth Centre or dedicated homebirth team.

If you’re not sure about having a homebirth, you can ask to give birth on a midwife-led birth centre in a nearby trust, such as at Stoke Mandeville (Aylesbury), Barratt Birth Centre (Northampton), Acorn Suite Birth Centre (Bedford), or Luton & Dunstable Hospital’s Birth Centre.

This page includes:

• Inductions at MKUH

• Pain Management at MKUH

• Homebirth at MKUH

Inductions at MKUH

If you’ve been offered induction, make sure you understand why it’s being offered to you and what the risks of it are (including the risk of cascading interventions). You can always opt for a “watch and wait” approach and discuss this with your care providers. There can be a tendency for HCPs to present induction as straightforward and low risk, but it comes with a lot of risks that you may feel do not justify its use in your case (even if you have other risk factors). Read up on any risk factors you may have, question HCPs, explore your options, and make absolutely sure that it’s the right choice for you.

Membrane Sweep: Yep, you read that right! A “stretch and sweep” is a form of induction, designed to start labour before your body would begin it naturally. The HCP inserts a finger into the cervix and “sweeps” it around, between your cervix and the amniotic sac. “This action should separate the membranes of the amniotic sac surrounding your baby from your cervix. This separation releases hormones (prostaglandins), which may start your labour. Some women find the procedure uncomfortable or painful. You may get some cramping and vaginal bleeding afterwards.” (NHS) It’s often presented as risk-free, but it isn’t, and some question if there’s even decent evidence about them (Wickham 2022). You can read more about that here to help you decide if a membrane sweep is right for you.

Prostaglandins: An artificial version of the natural hormone that prepares the cervix for labour, this is usually inserted as a pessary behind your cervix. Sometimes (and usually if your body was getting close naturally anyway), this will be enough to get contractions started. Sometimes, it won’t, and more doses may be suggested. They may also suggest breaking your waters. This can help as it allows baby’s head to make better contact with your cervix, which in needed for effective contractions, however it comes with risks such as infection. (For more information on artificially breaking the amniotic sac, here’s a great article by midwife Dr Rachel Reed.)

Syntocinon: An artificial version of one of the main birth hormones, oxytocin. Often given after breaking the waters or other induction methods have failed, it’s given via a drip in your arm. This comes with continuous fetal monitoring, so while technically you can be mobile in labour with the drips, the monitoring may restrict your movement. many women find the intensity of the synthetic contractions caused by syntocinon far more difficult to handle than natural contractions, so it’s something to bear in mind.

Dr Rachel Reed says: “Oxytocin (syntocinon/pitocin) administered via a drip is not released in waves [like natural contractions] and an individual woman’s oxytocin receptor response is unpredictable. This may result in contractions that are too powerful without an adequate gap between them leading to a hypoxic baby” - and a struggling birthing woman!

As always, you can decline; for example, if you were comfortable accepting pessary induction but it hasn’t worked, your HCPs may suggest a syntocinon drip. If you decline, discuss alternative options with them. Can you continue to watch and wait? What are the risks of that? Do you have a time limit on how long you would be comfortable with that? Would you prefer a c-section instead of the risks of syntocinon? Use the BRAIN acronym and work with your care providers to find the right choice for you.

Mechanical Method: This method doesn’t involve artificial hormones. A “balloon” is inserted into your cervix and slowly inflated (this is sometimes only suitable for women who have birthed before, as the cervix of a first-time birthing person may be too closed.) Benefits of this method include no artificial hormones (though they will be offered if the balloon doesn’t work), a reduced risk of hyper-stimulation of the uterus (which causes fetal distress), and reduced risk of scar rupture if you’ve had a previous belly birth.

This method is often used as part of a plan to break your waters after, and if it’s not successful you’ll be offered hormonal induction instead, so it’s important to think about this before accepting. It may be, for example, that you’re comfortable trying this but not hormonal methods. Discuss this with your HCPs and always plan for options that you feel comfortable with and informed about.

Coping With Pain in Labour

All non-medical pain management tools can be transferred to a hospital environment. If you’re planning a homebirth, plan for how you would take those tools with you in case of transfer.

You personal coping toolkit is your first “line of defence” to stay within your window of tolerance and feel that you are coping during labour and birth.

Creating Your Personal Toolkit: Coping with Pain in Labour

Your toolkit & birth preferences may, for example, include:

• Environment: fairy lights or a salt lamp for low lighting, chosen aromatherapy, cushions and blankets from home, strong tasting snacks, a portable/bluetooth speaker to play your chosen music

• Movement: your birthing ball or a rebozo to help with positioning and activity in labour

• Comb or TENS to utilise Gate Theory and distract your body’s pain receptors

• Using gas & air, with a plan to try pethidine if you feel you need it at any point

• Using a birth pool

Medical Pain Management in Hospital: MKUH

Paracetamol

In early labour, you may be advised to take paracetamol to ease the pain you may be feeling with your contractions. However, new research shows that paracetamol actually inhibits prostaglandins - the hormones needed for your cervix to soften and dilate to birth your baby! - so many now consider it to be counter-productive. That being said, if you’re struggling to cope and it will bring you back within your window of tolerance, it may make you more relaxed and cope better having a positive effect in the long haul. Every person will feel differently about this balance. You may want to use other coping tools at your disposal first, but find paracetamol helpful in avoiding more medical pain management further down the road. As always, you know what’s right for you!

“Gas & Air” (Entonox/Nitrous Oxide)

The archetypal birth drug! Breathed in through a mouth piece, the effect is similar to being a bit drunk. Your body and mind may relax, helping you to cope and your body to do what it needs to do.

Pros:

• Wears off quickly, so if you don’t like it, it’s easy to stop!

• Easy to use (and you control how much you use)

• Does not effect baby

• Does not affect freedom of movement

Cons:

• Some women find they hate it and feel “out of control” on it

• Can make you feel/be sick

• Can make you feel dizzy

Pethidine

This is given as an injection into the muscle of your thigh or buttock. “It takes about 20 minutes to work after the injection. The effects last between 2 and 4 hours, so would not be recommended if you're getting close to the pushing (second) stage of labour” (NHS). This because pethidine - in the opiate family, along with codeine and heroin - acts a sedative, and can cross the placenta into baby’s bloodstream, making them sleepy too. This is a particular problem if baby is still sleepy and woozy once born, as they may struggle to adjust to being earth-side and need some help or resuscitation.

As with all medical opiates, it’s a pain medication for when you needs something extra strong!

Pros:

• Strong pain relief

• Can help you rest (make you sleepy/able to sleep through contractions) if you’ve had a long labour

Cons:

• It can make you feel “out of it”/woozy

• You may feel sick or be sick

• You may feel forgetful

• “If pethidine or diamorphine are given too close to the time of delivery, they may affect the baby's breathing – if this happens, another medicine to reverse the effect will [need to] be given” (NHS)

• Baby may be sleepy and this may interfere with initiating breastfeeding

Diamorphine

Diamorphine is medical-grade heroin, a super strong opiate painkiller. It’s similar to pethidine, and administered the same way, but less commonly used. The side effects are the same as for pethidine.

Epidural

Considered by many to be the holy grail of pain relief in childbirth, it’s important as ever to consider the pros and cons of the procedure.

In essence, and anaesthetist will inject a local anaesthetic into your spine to block the nerves carrying pain signals to the brain. Some hospitals can offer “mobile” epidurals, where you can retain some (if not all) movement in labour, which is great when it’s available. More commonly, you’ll be lying down in bed from the administration of the epidural onwards. You can read more about them in detail on the NHS website, but here’s a summary for quick reading.

Pros:

• Most effective pain relief (usually complete, and can be extremely welcome in a long or difficult labour)

Cons:

• Lack of mobility has a knock on effect on labour progression, which can impact other outcomes such as baby coping, perineal tearing, increased risk of instrumental or assisted deliveries, and increased risk of c-section.

• Coached pushing may be needed if you can’t feel your contractions, which can come with an increased risk of perineal tearing

• Hospital policies say they’ll need to do continuous fetal monitoring after an epidural is administered; even if you have a mobile epidural this may impede your freedom of movement. They may use a fetal scalp electrode to monitor baby’s heart rate (look out for the phrase “we’re just going to pop a clip on baby’s head”; what this means is that a “fetal electrode will then be placed by screwing a tiny wire into the top layers of the baby's scalp” (Weiss, 2021). This means you can move more freely if you’ve got a mobile epidural, but does cause tissue damage to baby’s head and has its own risks, as does everything!

• Longer labour and pushing stage

• 1 in 100 people get an “epidural headache” (decribed by many as the worst pain they’ve ever felt). Easy to remedy, but unpleasant to experience.

• Difficulty urinating

Other, rarer risks are listed on the NHS website.