To think we should do away with midwife led birth centres

[Orangecandycane]

..let doctors lead the care for pregnant mothers and introduce third trimester scans for all? Maybe this could help reduce the high level of still births in this country compared to many other european countries.

Often as many as a third of women who are first time mums have to get transferred to hospital from a midwife led unit and the time taken for the transfer can be dangerous for mum and / or baby. I dont care if the majority of births at these places are okay or if they are cheaper to run, because im not talking about widgets im talking about human beings - babies and mums dying or babies suffering brain damage because mums are given the choice to give birth somewhere that has got neither the staff nor the equipment neccessary to save lives.

They should all get shut down imo, the sooner the better and midwives should not be given responsibility for overseeing what they deem to be low risk pregnancies...there should always be a doctor on hand to supervise who has the ability, if neccessary, to carry out an emergency csection.

I know doctors make mistakes too but so many women i talk to have been let down by rubbish midwives. Let the doctors assess the risk level of pregnancies, scan women in the third trimester when so many complications go undetected, let surgeons repair tears so women dont need to go back for painful revision surgery after a midwife has made a mess of stitches and ensure that all women give birth in a hospital with scbu or nicu...hippy BS like candles and home birth becomes meaningless if your baby ends up dying because i think as a nation we have forgotten just how dangerous child birth still is...and we should be reminding mothers to be that its dangerous and also considering the needs of the baby.

There isn’t any money. I agree with you but other services will have to be cut or the funds will need to be raised by charging women who give birth. Write up a comprehensive funding plan and get back to us.

What makes you think that MLUs are a major factor in the higher stillbirth rate? We do know that mum's emotional state/stress level contributes to the safety of childbirth, so actually the "hippy BS" is not meaningless if it serves the purpose of helping a mum stay calm and keeping the helpful hormones flowing, rather than stress hormones.

Most MLUs are right next door to a CLU anyway and many mums see them as a safer alternative to a home birth.

C sections have risks associated with them too, they aren't automatically safer than a vaginal birth, they are only safer than a complicated birth.

Doctors don't learn that much about pregnancy and birth during medical school. They would have to do extra training. Meaning the NHS spending more money and doctors either taking longer to qualify or taking longer her to train after medical school.

They need to have midwife lead centres attached to hospitals.

Also, doctors can't do C-sections. It has to be a surgeon. Again more training and money if every women needs a doctor and her own surgeon with her during birth.

I don’t know about other areas, but the MLU I gave birth in was in the same building as the maternity unit. If something had gone wrong (I was very minimal risk), I was literally a lift-ride away from everything needed in an emergency.

My first birth in the MLU was far better/easier/less painful than my second. I had a pool, ball, leaning chair, mat, bed, gas and air, surround sound system - it was everything you wanted for a straightforward birth. I had hours in a large room after to recover, learn to breastfeed in peace, use a toilet attached to the room (so barely leaving my newborn), brought food. Yes if we’d had to stay overnight I’d had to go to the ward, but that wasn’t the case luckily.

They don’t bring in doctors unless there is a real need, regardless of MLU or maternity ward. I think you’re doing midwives and women a great disservice in your post. Yes, giving birth is bloody dangerous, but panicking women just before/during birth by making it as medicalised as possible won’t help matters.

That should be maternity ward not next to the maternity unit.

All births are risky, it is impossible to entirely remove the risk involved, and the main thing we can do is manage that risk by giving women the knowledge they need to make informed decisions about their care. That, alongside adequate staffing numbers and comprehensive care, goes a long way towards improving outcomes.

I agree that MLUs should have to be within a certain distance of CLUs, ideally on the same hospital site/in the same hospital building as is the case at both of my local hospitals, but I don't think they should be gotten rid of entirely.

Also, I wanted to give birth to DC1 and the midwife lead center and was not allowed as there were not enough midwives. I hated those clinical hospital rooms. Not a very nice place to give birth in. Very unnatural.

DC2+3 were born at the midwife lead centre and it was bloody lovely. Music, candles and lovely warm pool, dim lighting my own private room that I was allowed to stay in for as long as I wanted.

Are rates of stillbirth any higher in MLUs?

Presumably home births should be out too by your reasoning?

I’m not disagreeing with you. My baby girl was stillborn at 40 weeks only a month ago. I opted for a hospital birth but my baby had died before I even got to the hospital. My understanding is that the majority of babies who are stillborn died before labour started.

The scans thing is an issue as my baby could have been saved if I’d had more scans later on. Everything was fine and then midwife even listened to her heartbeat two days before. We haven’t got PM results her but the chord was wrapped around her and a late scan might have shown this

At my hospital, the midwife led birthing centre is on site. It would take two minutes to wheel someone through to labour ward.
I wasn't actually aware there were units which were completely separate. That wouldn't be for me personally.
I had many scans during my pregnancies due to high risk and I found them extremely reassuring, but there's no funding as things stand.

I was “low risk” by the way but wouldn’t have opted for a MLU or home birth as I wanted to be in the best possible hands and for me that was the maternity ward in good hospital

Disagree. It's fantastic that we have the option (speaking generally), and women ideally have a choice in what location they feel is best for their birth experience.

Argh posted too soon, agree about extra scans though. We do need to invest more money in both antenatal and postnatal care

What's your opinion on home births? I had two, both far better experiences than the hospital birth with my first.

Our town's maternity ward was closed and converted to an MLU. We are now at least a 45 minute drive away from a maternity ward. Women and babies in danger are transported by ambulance from the MLU to the maternity ward at the other hospital but the route between the two hospitals is notorious for terrible traffic etc.
And yet our town is expanding in terms of housing etc. Madness.
I think MLUs are OK if a doctor is right next door but if not, it's a risk I wouldn't want to take.

MLUs are fine but they should be based in the hospital next to delivery suite. things can go wrong rapidly and unpredictably - MLUs in the community should be shut down.

They tried to close the MLU in our town (nearest hospitals are all half an hour away) and everyone was up in arms, there was a big campaign. Local women clearly wanted the choice. They are quite strict on low risk criteria (hence why I never got the option to go there) and they don’t guarantee it as it depends if a midwife can come from the hospital, especially if it’s out of office hours.

The midwife unit I have birth in twice was separate and 40 mins drive from the nearest hospital. They said it's quicker if you get blue lighted. I ended up in an ambulance to get me to the main hospital for stitches didn't feel like it took that long. Then DH drove.me back to the midwife.lead hospital and I stayed there for a few days. It's such a nice place to be during and after birth.

The postnatal ward at the hospital was horrendous and I was treated like I was on a conveyor belt.

I am ideal world all birthing rooms/including induction should be private rooms set up for birth, all have a birthing pool, ball and other equipment available. With private rooms for after care and lots of breast feeding support on hand.

In an ideal world (with money trees) there is no reason why this can’t be on a ward or in a stand along side midwife unit. I suspect in the long run it would be cheaper if every women had 1:1 midwife care in labour in a suitable room as the number of EMCS maybe reduced.

What's your opinion on home births? I had two, both far better experiences than the hospital birth with my first.

they are fine if it all goes well

last minute cord prolapse/shoulder dystocia at home = brain damaged baby
last minute cord prolapse/shoulder dystocia in hospital = decent chance of baby with a healthy brain.

I think maternity and birth care could absolutely be improved, 100% agree there, but that doesn't mean that MLU are the wrong approach for many women and many births. Midwives train for far, far longer than doctors in births. They are absolutely specialists and it's sexist that they aren't seen as 'better' than doctors in this area, IMO.

You would never have posted this about dentists, opticians or other clinicians who train solely in their specialism. I appreciate the stakes are lower in those areas, but it's the same model of training.

@AliceRR for you x

AliceRR I'm so sorry to hear about your little girl

YANBU

Midwife led units sometimes get a little bogged down in keeping a natural birth - they have lower c section rates and complication rates, but you have to remember that only the safest low risk deliveries are allowed there at all.

They can be good, but there are multiple local ones which are 15-20mins ambulance ride to the nearest obstetrics department which is neddlessly dangerous, mainly because they are trying not to waste parts of downgraded hospitals.

Some are separate, Princess Royal in Telford (MLU) and Royal Shrewsbury (CLU and SCBU) - who knows whether or not it contributed to the maternity scandal. Any slightly complicated cases go straight to Shrewsbury but I have lost count of the cases I've heard of where mothers are sent by emergency ambulance along the M54 from Telford to Shrewsbury because of things starting to go wrong.

Yanbu... I was high risk pregnancy and I was assigned a newly trained midwife who made many mistakes resulting in baby being distressed at birth