Consultant delivery unit rather than midwife led because of big baby - so disappointed

[EffinIneffable]

My midwife has just told me that because a growth scan showed my baby to be on the upper percentiles (97th), I have to deliver in the consultant led unit rather than the midwife led unit. I'm so disappointed, mostly as I was really hoping to use the birth pool which probably won't be available to me now.

She's emphasised that being on the consultant led unit means that if interventions are required they will be quicker/easier. But the midwife led unit is only just upstairs, and I feel that being on the CLU makes interventions more likely in the first place, just because they're more routine and available there.

When I had my growth scan initially, neither the consultant nor the midwives were concerned and happy for me to continue with plans for a water birth in the MLU and to transfer downstairs if complications arose. But after a consultation with the diabetes nurse, who took it on herself to 'double check' with a different consultant, I am now not allowed to even start off in the MLU. Obviously I don't want to put myself or my baby at risk, but I'm so disappointed to miss out on the birth pool - I'm just so happy and relaxed in the water anyway - and can just see this leading to interventions that may never have been necessary.

Is it worth arguing the point or trying to 'insist' on at least starting off in the MLU? Or should I just start trying to get my head around having a more medicalised birth?

[Brionius]

Hey lovely. How disappointing for you. I just wanted to say they can't make you do anything. You can choose whatever you like, they can only give you recommendations and advice. I'm guessing they want you on the consultant led unit because of your perceived increased risk of shoulder dystocia and postpartum haemorrhage? I would ask to speak to them again, get a proper run down on their concerns and make your choice. You're right there is a greater risk of their intervening if you're in the consultant unit, but they're also right that in an emergency being in the consultant unit is much, much easier and safer. There isn't a right and wrong option, there's only balancing risks for you and your baby. Do you have any other risk factors, eg diabetes, raised BMI, health conditions etc?
www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-shoulder-dystocia.pdf
www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-heavy-bleeding-after-birth-postpartum-haemorrhage.pdf

[Gobbolinothewitchscat]

Actually - when it comes to actual admittance - my understanding is that they can refuse admittance to the birthing centre. There is no right to turn up and demand to be allowed in.

This is disappointing. Can you speak to the supervisor of midwives and try and get a middle ground - eg there will probably be baths on the consultant led unit. Can you see if you can have access to them. Not the same but can help.

Separately, can they bring over some of the movable stuff from the birthing suites - bean bags etc.

Monitoring is really important - I would be making it clear that I did not want continuous monitoring unless there were excellent reasons (ie not routine) so speak to them now about it.

A lot of the birthing centre in the lighting - take your own LED candles, shut the curtains and ask for people to speak quietly in your room.

I was originally in the midwife led centre for my first birth. Stayed there far too long with a map-positioned baby and was carted off to the consultant led unit. I found the doctors very, very respectful of my wishes and it was the consultant who over-ruled the midwife when she tried to insist on continuous monitoring. He was keen to ensure I kept moving if possible. I eventually had to be put on syntocin bit it was agreed I would be given remiphentinol rather than an epidural as it has short half life and the hope was I would just need a bit of syntocin, reme would wear off and I could push naturally. This was all at the consultant's suggestion along with the anaesthetist. I did eventually have to have a forceps delivery in theatre but they did everything they could to try and help me give birth naturally.

My DH has a medical background so that helped a lot in speaking to the doctors etc. the key thing is prepping your partner to do the same too.

[Dildals]

The other posters have given some v good advice and I would definitely try and have the discussion with MWs / consultants.

I just wanted to say that you can make the CLU in to your own environment too. Take your own fairy lights/electric tea lights. Take your own linen (if you like that). Take some aromatherapy oils that make it smell less like hospital. Take your own ipod so you'll have the music. Take black out blinds (Gro Anywhere blinds for examepl), in case you labour during day time. Specify in your birth plan that you would like the amount of people in your room limited. Think about everything that would make it more like the MLU/home/a safe environment.

With regards to continuous monitoring. My hospital has mobile continuous monitoring units, so you can stay active during birth.

gob Could I borrow your husband, with medical background, for my labour please? Mine's a bit useless :-) (in the nicest possible way!).

[stopeatingbiscuits]

Is this your first baby?

I am sort of surprised that they are insisting on this on the basis of a (notoriously inaccurate!) growth scan. As far as I know this is not standard practice in the hospital I gave birth in (ie potentially big baby does not automatically mean high risk).

Have you spoken with the consultant about your concerns? If not I would ask to speak to him or her. I don't see why you cannot tell the consultant that you would like to try and have a natural birth / to use the pool, and ask whether you can at least start off in the MLU? You may be pleasantly surprised that the consultant is supportive of this!

As someone above said though it may be the MLU you have to convince of this. Even if you can't use the MLU (or the pool) I don't see any reason why you can't have a natural birth if it progresses well, using various props (birthing balls, bean bags, access to a bath perhaps).

FWIW I had consultant led care (privately, by choice) and have had two natural births with gas and air, #1 was 8lb 3 at 38 weeks and #2 was 10lb 11 at 40+5.

[Gobbolinothewitchscat]

dildas - I will happily lend him to you. He's not the most sympathetic but very practical.

To the extent that he was actually down at the business end with the obstetrician when I was having the forceps delivery. I had to chat to the anaesthetist!

[Gobbolinothewitchscat]

Sorry - spelled remifentanil wrong. Phone went mad on auto-correct.

en.m.wikipedia.org/wiki/Remifentanil

[Theboxtrollsareallowed]

Try & spin it in your mind so you are I control of the aspects you can be - music, own pillow, movement etc -

I was induced with DS1 but was only on the bed when I wanted to be - was on the birth ball, mobile etc a had music on & it was calm - had to have the heart rate monitor for the baby but just asked them rejig it when I moved.

Number 2 - also induced so had to be consultant unit, but again just had my music on, low lights etc - was not allowed in pool but had a long shower etc -

One thing for me was they wanted me in a medical gown and I refused so wore a shirt they could open/access but the gowns reminded me of being ill which I was not.

Now pregnant with no.3 & will have to be consultant led again - but just viewing it as a room, may not be as homely as the BC but a change in mindset & you can make it a positive experience.

[Momzilla82]

Ok. Don't give up home OP! They usually have at least one pool on delivery suite. Ask how many there are and whether you could be considered to use it. I had both of my babies on CL, having wanted ML and the midwives were so good at trying to make it the experience I wanted. First time, they put the bed in the corner and brought in birth balls and cushions from downstairs and agreed to intermittent monitoring. I was upright on a birth ball for as long as I wanted to.

Second time around they agreed to let me use the pool if I was labouring well alone and have the waterproof monitoring pads on. It didn't work out in the end. But they were very willing to accommodate my requests.

I also know one person who had a ELCS and requested that her doula be allowed to "cleanse" the energies in the operating theatre before they started and they all had a quick pray together in advance.

What I'm saying is - if regaining control is important to you- HCP will usually accommodate even quite bizarre requests.

[speak2me]

I have had two big babies ( 9lbs 8oz and 10lbs 9oz), i was not consultant led as they showed as normal size on scans and I wanted to be in a midwife-led unit, in a birth pool, but it never happened! Had both in consultant led delivery suites as for first birth there was no other option locally and for second birth the MLU was full. FWIW I only had gas and air for both and the only intervention was a small episiotomy with my first, and that was my decision.
I do know that my local hospital had one removable birth pool in the consultant led deliver suite, have you checked whether this could be an option?

[EffinIneffable]

Thanks all. Midwife just popped in to write up the change of plan in my notes in case I go into labour over the weekend (I'm 39 weeks) and very embarrassingly I just cried on her.

Apparently there is no room for negotiation for trying to start off in the MLU, the Supervisor of Midwives won't go against a consultant's opinion. I wish I hadn't asked questions now as the Day Assessment Unit was fine with scan results, it's only since they raised questions with the Diabetic Consultant that the plan has changed. But this is where we are now and apparently we can't go back, partly because whoever reviewed my scan on the Day Assessment Unit didn't write their name on my report.

It's so frustrating that I don't get to actually speak to the consultant, and it's so easy for them to make these decisions, and then the midwife basically has to guess what her reasons are, as they're not recorded and I don't get to discuss it. As Bronius said, apparently the main risk is shoulder dystocia, for which they want a specialist team available immediately.

There is apparently one pool on the CLU, which if it's available (not highly likely) I can use for first stage labour, but second stage will have to be out of the pool. I won't have to have continuous monitoring as a starting point though.

I know this is a bit stupid to think like this, but it seems almost inevitable that I will now end up with epidural, forceps/ventouse and wish I could just book in for C Section now.

I was reading some research a couple of days ago that suggested that it was actually healthcare providers' concerns about big babies, rather than actually delivering a big baby itself, that resulted in worse outcomes because of a rush to intervene and I feel that is exactly what is happening to me right now. Having been anxious about birth and spending a lot of time getting myself into a positive frame of mind, but open to possibilities, it now seems like I'm starting off expecting things to go wrong.

Sorry for super long post, just need to get this all out. My friends with kids already tend to say that I won't care about any of this when it actually happens but it's just so not the starting point that I would have wanted, even if it's where I would have ended up.

[JamesAndTheGiantBanana]

I realise you're 39 weeks but if funds allow could you arrange for a homebirth with an independent midwife? I did this at 39 weeks when I realised the hospital didn't support my decisions and were actively lying to me to get me to submit to their "care" - I struck a deal with my nearest IM, she covered the (lovely) birth for a few hundred, with a couple of pre and post natal visits too.

Do you have gestational diabetes or not? Are the "big baby" predictions based on head or abdomen circumference? Any other risk factors going on?

[JamesAndTheGiantBanana]

You could try putting a bat signal out on the Independent Midwives UK group on Facebook, they'll probably be able to advise and/or put you in contact with your nearest IM if you're interested in doing that.

I reckon if you said you were thinking of having a hb they'd probably let you go to the midwife led unit, all these "rules" they impose seem to be usually pretty arbitrary. They certainly went back on loads of things they'd said when I said I was doing it at home...

[Brionius]

Oh my god. I'm so mad. Supervisors of midwives do NOT just go along with the consultants opinion. They support you, even if that is against consultant opinion, as long as you have considered the risks. Ring them! Please ring them!

[Brionius]

I wish I were your midwife. We'd tell em.

[Brionius]

sits in a corner having a little steam with annoyance

[EffinIneffable]

I haven't been tested for GD but don't have any other signs indicating it's likely like sugar in urine, etc. Apparently it's too late to accurately test now, though they will test baby's blood sugar when he's born if he is, in fact, a giant.

Size predictions are based on head circumference and femur length on 97th percentile and abdominal circumference above that. I know weight estimates are notoriously inaccurate, but don't know how accurate these measurements are.

I think I've been sufficiently scared not to request a home birth at this stage, but I've found a local independent midwife who I may try to arrange a consultation with. And perhaps the SoM might be worth a call. I think I'd just be happy to at least know that I can start off in the MLU and have a better chance of using the pool even if I need to transfer later.

[bakingtins]

I was high risk and consultant led with my 3rd baby having had PPH with 2nd. The first 2 born in MLU. Apart from no access to pool, the CLU was no different, I never saw a doctor, had MW caring for me, didn't go on the bed, stayed mobile and gave birth kneeling on mats, intermittent monitoring etc. I think if the units are at the same place it's a bit daft, I can testify they can get a team there PDQ if they pull the emergency cord but they are within their rights to only admit low risk women. As others have said, try to focus on what elements you can control. Best of luck!

[beckworth]

Try not to worry too much about it, although I know that's easier said than done. Due to bleeds during the pregnancy and the fact that I bled on arrival during labour, I was swiftly sent away from the MLU, and was very disappointed. But, actually, the level of care in the delivery suite was amazing - I had a midwife who stayed with me the entire time, and honestly, I was so focussed on getting baby out I couldn't have given a toss about candles or music. Although if I had, I had my own room with birthing ball etc and so could have set it up how I liked. My labour did end up in intervention, in theatre, but when I had a massive bleed as baby was arriving, I was very glad that a doctor was there immediately and it took no time to transfer me to theatre, and I didn't have to wait even the short trip downstairs from the MLU.

My friend had a baby on the MLU the month before me. On arrival they refused her gas and air on the basis that she 'wasn't in established labour'. Her contractions were a minute apart at that point. They then left her in the room on her own with her husband as 'it was her first, it was bound to be ages'. Midwife appeared again when the baby was crowning. So she tore badly. She did finally get the gas and air when they were stitching her up....

What I'm trying to say is not that MLU or delivery suite is inherently bad, but that you can have good and bad experiences on either, and the most important thing is that you are given the care that is appropriate to the risk level of your birth.

[Pinksuitcase]

I had a very medicalised delivery for DD 2years ago, (theatre forceps full spinal, massive pph) and was advised to have a labour ward delivery for #2. I had DS last week, really fast natural delivery, was walking around until 5 mins before he arrived, had to get on the bed as his cord was round his neck, but minimal pain relief and intervention. All births are different, just relax and embrace the experience.

[UniversalTruth]

OP just to say I had dc1 on MLU - all the pools were busy so didn't get one. This time likely to be CLU due to pph but I see no reason why I will need/be encouraged to have anything more than g&a like last time. It's a nervous time (being 39weeks I mean) but try to be relaxed and go with the flow

[UrethraFranklin1]

I just wanted to say they can't make you do anything. You can choose whatever you like, they can only give you recommendations and advice.

I've seen this a lot on here and its just not true. You can't choose the MLU if you've been told you are not suitable, they do not have to and will not admit you. I'm not sure where the idea comes from that you can choose whatever you want, but its not the case. They can't make you do anything, but they can certainly stop you doing a lot of things (and quite rightly).

OP, I know its disappointing but its for your and your babies health. Bigger babies do create certain risks, and consultant led is where the experts think you should be. I was transferred in the pushing stage from MLU to CLU, I didn't want to be but it was for the best.