Anyone managed to get a midwife unit led high risk birth?

[Toadsrevisited]

I had a blissful midwife unit birth a few years ago- gas, water birth etc- and then sadly had a really stuck placenta so had epidural and surgery. Now pregnant with number 2, and have been refused to register to have birth at MLU. Am threatening home birth but consultant said although it's my responsibility to right, it's risky and I would be better in a big obstetric unit hospital. Anyone managed to negotiate an MLU birth when high risk?

[thingymaboob]

I really don't understand why you would want to given the risks? It would be really silly to have a homebirth given your history. I'm a paramedic and have been to plenty of emergencies, even in very low risk planned homebirths. It is your right but I don't really understand the logic...

[Steeley113]

Why would you risk it? You have a higher risk of retained placenta again?

[Believeitornot]

@thingymaboob you haven’t seen all birth outcomes though. You’ve only ever seen emergencies? So that certainly skews things.

I was a “high risk” because I had a third degree tear and significant blood loss plus anemia the second time around. When I went into labour, there weren’t any spaces in the standard ward so I was in the MLU instead. As it was, I ruled out homebirth second time around because the consultant scared me with stories (which, on further research were rare) and I had a toddler at home.
Labour second time around was quick, intense and no complications except a second degree tear which healed quickly.

Is the MLU attached to a hospital? Can they let you labour there then transfer if need be? I would read the NICE guidelines and try and make a case.

But obstetric led units can be nice. I would have a look around and see what you think. The main thing is that you feel in control regardless of where you birth.

[Toadsrevisited]

Fair point. Local big hospital is twenty minutes in one direction and is very busy on maternity ward and very high rates of intervention, c section etc. MLU twenty minutes in opposite direction and very low rates of both, plus an average of two births per day, so more likely to get pool birth, overnight stay, bf help etc. Risk of retained placenta is marginally higher for me but not huge, and chances of rapid blood loss even if it does retain are small.

[Toadsrevisited]

MLU not attached to hospital but about 30mins or less from big hospitals.

[Toadsrevisited]

I'm really adamant I'm not going to the big hospital. Poor reputation locally and some more personal reasons to avoid it.

So really I need help on how to get the MLU to accept me as less risky than home birth

[Thinkingofausername1]

Nope.

[newtlover]

they probably won't though, they will have really strict criteria
If you insist in a home birth (as is your right) they will probably send a suprevisor of midwives to discuss this with you, and it MAY be that you are then able to negotiate what you want at the hospital
I would suggest you ask exactly what the increased risk is for you of a retained placenta.

[welshweasel]

Units will have very robust guidelines in place, both to protect you, but also the midwives. I'm afraid, whatever you argue, you will quite rightly be refused. If you went to the MLU, had a bleed and died (bearing in mind MLUs do not have access to blood to transfuse you and given that it is not unusual to wait over an hour for an emergency ambulance transfer) they'd be strung up at the coroners court for letting you birth there.

You're being hugely unfair on the staff and also sound like you're ignoring the very real risk of haemorrhage.

[FaFoutis]

Can you still choose which hospital you go to? I remember choosing mine a few years ago.

[Toadsrevisited]

3% of births have retained placenta.
Of those 3%, 1 in 4 will retain again. Some of those will hemorrhage. NHS guidance.

[Toadsrevisited]

No other choice of hospital sadly due to distance.

[CrazyDuchess]

So you have a 25% chance of a retained placenta.... again why would you take the risk??

[moreismore]

I am in the same situation and wondering how it will go (only 8 wks currently).

Things I have lined up in my head:
What is the absolute risk of this complication? (As opposed to the relative risk: ie twice as likely)
Interventions such as oxytocin drip are more likely in hospital- this in itself raises the risk of retained placenta
If chance of interventions overall is higher in hospital setting, what’s the absolute risk of each of those interventions to me. It’s weighing risk against risk at the end of the day.

I know of someone who recently had a hospital birth, had a retained placenta, was about to go into surgery and was delayed (rightly) by a crash c section. She haemorrhaged and ended up having general anaesthetic and transfusion. So being in hospital is no guarantee in itself that you’ll go into theatre exactly when you need to.

At the end of the day I’m not going to put myself or my baby at risk but I’m also willing to advocate for myself and my very individual situation.

[Believeitornot]

You might have to therefore accept that you’ll have to use that hospital and try and take more control.
Can you afford a doula? Or is your partner any good as a birth advocate?

That was what made my experience much better. I was able to listen to my body and get myself into a decent position etc for birthing.

[FaFoutis]

I wouldn't risk it. It isn't worth the risk in order to avoid a CS, particularly when the experience of a CS can be absolutely fine and lovely.

[mrsreynolds]

My last birth was at the biggest teaching hospital in my county

I went in at 4am
Had ds2 at 10.29am
Home at 8pm

No pain relief and natural 4th stage as I requested

Please don't judge all hospital births on tv shows!

[Steeley113]

MLU will not accept you. You are considered high risk. You can risk a home birth and a transfer into the same hospital you don’t want to go to in the first place if you retain again, with the added risk of bleeding out waiting for/during the transfer and having to have time away from your newborn. Or you can give birth in the hospital, have immediate treatment should you need it without fannying around with ambulances etc. You can still have a drug free, natural birth if you want one!

[moreismore]

Also worth considering-what caused the retained placenta?

[MyDcAreMarvel]

You are right location , location , location is the priority. Much more important than not bleeding to death.

[babigailwabble]

why on earth would you risk it. i think the developed world really has gone full circle on this one

[NerrSnerr]

I was high risk with both my children and had a section each time, I still had a PPH after the first but luckily I was in recovery and there were doctors very close by putting lines in and prepping me for theatre right away. The professionals are not trying to be awkward, they just don’t want you to die.

[ApplesTheHare]

OP the MLUs have such low rates of interventions, etc., BECAUSE they only take low-risk cases. Please don't risk your life and your baby's life I say this as someone who nearly died after PPH in a MLU...

[allthatmalarkey]

It will depend on their insurance (or so I was told).