to consider going against consultants advice?

[TiredofYorks]

DS1 (2.4) was born by emergency C section.

I am 36 weeks pg with DC2 and have just been to see the consultant. He said because of previous CS I am high risk and need to be in the consultant unit.

I asked if I definitely can't use the Midwife led unit (it is across the corridor from the consultant unit) and he said no, so I asked if that ruled out a water birth (there is one on the Cons unit) and he said yes as I have to be monitored throughout.

I then asked if I would have to be immobile, he said that there is one mobile monitor but if that is in use then yes I will be immobile and will have to stay on the bed.

I asked exactly what the risk is and he said 0.7%.

I know this is a low risk and I do think I'll cope better if I'm left to it (well I think so anyway) and also I really wanted a waterbirth.

So would I be unreasonable if I considered going against the consultants advice and opting to use the Midwife led unit anyway?

Sorry for the long post.

Ina May whatserface and Ina May Gaskill - nice.

It's Ina May Gaskin. The Gaskin Manoeuvre used for shoulder dystocia is named after her for goodness sake. She is not some f*ing cowboy! She is a certified professional midwife who has delivered quite a few births including breech twins. She also has a 95+% successful breastfeeding rate. You do the Maths. Compare that to the hospital that I was in - 1 in 4 emcs. Say no more.

OP, do your research, make your decision. The more you know, the more confident you will be. Or, just leave it to the professionals and you will be none the wiser whatever happens. Chances are you will be fine.

Just re-read your message - so it is the continuous monitoring you are thinking about... well, there is a school of thought that suggests CFM is not that helpful... but again, some think otherwise. Best thing is to do your research and make an informed decision.

ToY just catching up on this thread and glad you have reached a decision you're happy with.

FWIW I was about to say that I was induced with DD and was monitored throughout and unable to use the MLU as I had wanted. But your midwife is right that the monitoring leads were long enough for me to be pretty mobile and I certainly wasn't lying on my back strapped to the bed or anything crazy like that.

Good luck with everything! x

Just seen that last message. Good Luck ToY .

From experience I would say to listen to your consultant - he is a consultant for a reason.

I had a very medical birth with DS1 and was under consultant care for the whole pregnancy with DS2. I was advised to have an elective section to avoid the complications with DS1. I followed that advice and the previous situation was avoided. Coincidentally DS2 was born with a VSD and needed SCBU after birth and if I had force the point about being in the Midwife led unit, he may not have received the instantaneous care that he did.

At the end of the day, you have to live with your actions and any risk, however small, is still a risk.

There is a hell of a lot of anger on here towards consultants. You do know they are EXPERTS, their job is to minimise risk to the baby and mother...as for them dissuading anyone from homebirth, i do not know a single consultant who would ever have a homebirth- the risks in their eyes are colossal. This whole idea of being 10 mins from hospital is fine if you're not in dire straits, but if your uterus ruptures, if baby is born blue (yes midwives do call for paeds to help in this situ as they are not always the expert you think they are), or you're bleeding out, you dont always have 10 minutes. In a hospital they can reach you in 30 seconds if they need to (4 of my friends are consultants on paeds/ neo natal wards and assist delivries often, being beeped to attend immediately), you cannot have this at home.

Now i know it feel like they're being controlling OP, and you're absolutely right to challenge the level of monitoring if it means your labour will be harder and avoidably so. But please do not buy into the them and us attitude so many people here have expressed...they are on YOUR side, they just err on the side of caution, and rightly so. Work with them, find a middle ground, and good luck in your labour,whatever you choose.

msrisotto

what a simplistic view of what a consultant does. They do not just hide in an office away from patients and learn from books, they learn through experience! My consultant friends are called to attend births that they were not scheduled to be part of (so seemingly straightforward labours) on a regular basis in their maternity units, due to unforseen complications the midwives cannot deal with alone. They are not working from books but reality. Yes we can all do our own research, but we will never make as rounded a decision when it comes to the medical safety of our baby and ourselves as a consultant who actually knows the medical risk and how quickly one would need to be addressed. Yes we can look after our mental wellbeing far better than they can, but this is one time in our lives we probably have to put our own desires aside and think "right, what is best for my baby"...

ideally consultant led units will morph into more homely feeling places, so women dont feel like they're in an overmedicalised environment. Sadly as we're NHS we have to make do with what we have for now, considering funding restrictions. If you go private you can achieve both homely comfort and consultant led care.

Also you do know a lot of doctors are women! so not quite the sexist stereotype you seem to portray.

Women can be sexist too. Easily in a traditionally male profession. I know a lot about the ethically and medically very questionable decisions made by the medical profession so I don't put them on a pedestal. I'm not saying don't listen to what they say obviously, but don't treat everything they say as gospel because they can and do get it wrong.

Oh I'm sorry girl, I must have misheard all those women saying that they are left alone or left to it when in labour in hospital then?

Anyway I'm off to skip around on Planet Iggly.

sorry alibaba just saw your post. When I say they are there for the whole labour, I mean just that - are they there from when contractions start, do they see how things progress etc etc from first stage to pushing? They may well turn up in active labour and see it through to the actual delivery at the end but I don't think they're there for the whole thing.

TiredofYorks I'm glad you've come to a decision that's great. Good luck with your birth.

I had emergency c-section first time round, for the second, two doctors would not leave my hospital bed until I agreed to have another. I had high blood pressure and previously escaped death by having c-section because of pre- eclampsia. Had second one, lovely calm experience compared to first and I had a bouncing healthy baby.

will the midwife unit take you if the consultant says no?

You could hire an independent for a home water birth, but as minxie says just be aware that you have to accept the consequences if something did go wrong. If you do this then you can change your mind and transfer to hospital and use the NHS at any stage during the pregnancy or labour.

why not ring an independent midwife for her opinion on this question? she'd be in a better position to give you safe advice :-)

enjoy planet iggly, igglybuff

Maybe read the RCN's position statement on independent midwifery and insurance before having that chat...

thanks ruby, I will

As a midwife it saddens me that women feel they are 'not allowed' to have certain labours. Mobility is the best way to achieve a vaginal birth. Continuous monitoring can be difficult to achieve when someone is mobile and then the woman ends up being asked to lie down in order to get a good tracing.

I have looked after a number of previous CS women using the birthing pool. An initial CTG is done to ensure all is well at the outset. Then we listen in intermittently. The risk of uterine rupture is low when there is spontaneous labour with no drugs involved to strengthen contractions.

If I was attempting a VBAC it would be in a pool. Our consultants agree to women using the pool in the midwifery unit. So sad that other units 'don't allow it'

here is another unit that has VBAC in water

Tired, hope the tour round the CLU is reassuring.

Snow, do you mean the RCM?

For all the people who see this in very black and white, 'consultants are Gods and women who want to give birth with as little intervention as possible are stupid and irresponsible' terms... worth bearing in mind that even IN a hospital you can be left alone for long chunks of time.

Happened to me in a MLU - only one midwife on duty to seven women in established labour. And she couldn't transfer me to the hospital labour ward on the other side of the corridor as there was only one midwife there, too (with another seven women).

I'd have been better off with a homebirth, frankly. And probably have avoided a third-degree tear as there would have been a midwife around when I felt the need to push.

Amongst the people I know who have discussed their experiences of labour, I can immediately think of half a dozen who have been left alone in CLUs.

No single approach is risk-free or guarantees a good or safe delivery, I'm afraid.

edam, sorry, the reason there was only one midwife there was probably because the others were off attending homebirths!

That's the thing a lot of you don't seem to grasp - my mum worked in a maternity ward and for every woman who wants a homebirth, it takes a midwife off the ward, unless she hires an independent one.

'No single approach is risk-free or guarantees a good or safe delivery, I'm afraid.'

well said edam.

Edam: true indeed (and yes, I should have reread my post...)

I think a reliable birthing partner is so important, particularly someone who can tell staff that you're 'not right'.

girl - nope, the reason was the midwifery department was short-staffed. And the trust bosses get away with it. They know perfectly well it's dangerous - was later told by a community m/w that trust is known for being 'lucky' as they've not managed to kill anyone despite m/w shortages.

Iggly - yes. As part of training, even a registrar who is doing an obstetric rotation as part of their general training will be present for whole labours as you describe.

I laboured for hours with DS through the night, it wasn't until it was all over that we realised that his heartbeat had been decelerating for hours without any midwife picking up what was going on. They never called a Dr to come and look, and it didn't occur to me to ask to see one because I trusted the midwives who were caring for me.

More bloody fool me.

The Dr who stuck his head in was horrified that I had been left so long and that the consultant hadn't even been called to look at the trace of DS' heartbeat. He stayed with me for an hour to monitor progress and then ordered a section. It saved DS' life. If it had been left to the midwives god only knows what would have happened.

So you'll forgive me if I don't buy into the 'Drs are crap, midwives are all wonderful'.

Ali I don't think midwives are wonderful, doctors are crap. I have a friend who was labouring in hospital and supposedly being monitored by consultants and midwives. It took her husband to point out that his son's heart rate kept dipping during contractions.

I only have an issue with the general idea that woman cannot give birth without significant medical intervention and that they all need to be in a hospital - the attitude I came across when pregnant.