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.

I would love to see all the data on this. I don't disagree that we need to prioritise and spend more money on maternity care, but I'm not convinced the high stillbirth rate is caused by too few doctors. Midwives are highly skilled and tend not to patholigise pregnancy/birth. Women need to feel comfortable with their environment for best outcomes for both mother and baby.

Deepest sympathy to anyone who has lost a baby.

I delivered bot mine in a MLU and it was fab. On site at the hospital 'just in case' so I had reassurance but more relaxed and calming than a more medical space. I think they have their place and I found the staff in mine to be fair, able to listen, and supportive.

Not RTFT

I don't know that the MLUs are the problem, but I can't think of any good reason why women receive so few scans in the British system.

My pregnancy had some risk factors, so I had more scheduled scans and was quite alert to anything feeling usual. That's the only reason I was referred to get an extra scan at 36 weeks, even after two different midwives had told me baby was turned and in position.

Actually she was breach and with too little fluid around her. After that extra scan I was seen by a consultant. Long story short they kept me in and scheduled the Caesarean for the next morning.

Seems obvious to me that there should be more scans / medical oversight in the last trimester.

Have you seen the mortality statistics for the US - a country with an extremely medicalised approach to pregnancy and labour? They are shocking for a 1st world, wealthy country. I don't believe that swapping midwives for doctors will magically make everything better. In some cases, it will do the complete opposite.

Oh, and I didn't choose a home birth for my second because I'm into "hippy bullshit", I chose it because its statistically less risky for second time, low risk mothers.

I don’t think there is any data that midwifery led care contributes to stillbirth. There is emerging research on this. It shows us that decreased foetal movement and the size of the foetus are often two of the biggest factors in predicting stillbirth. (There is an additional piece of research that shows a correlation between sleeping on the left and preventing stillbirth I believe). I agree about the additional scans but those would be useful to measure growth etc. And I believe that we now do measure foetal growth on a personalised chart in pregnancy (certainly in London they do) and there is a push for a 36 week scan. I think those measures rather than getting rid of MLUs would be far more effective.
Also remember that something going wrong during labour is not always the same as stillbirth. As far as I know most stillbirth happens before the start of labour.

In the (big) town I lived in when I had DD there was only the option of a MLU offered. I chose to go to the next town to give birth in a hospital maternity unit. So glad I did as I ended up with an emergency section. If I'd have had to endure an ambulance journey to the hospital on top of everything else it would've made the experience even more stressful and terrifying.
Having said that, if the MLU is situated in a hospital offering maternity services, then that sounds like the best of both worlds. Great for women to have the choice.

Yes. I had my first baby in the U.K as it was my first I was with a cross community team in the the North of Ireland, I had 5 midwives in the team, one older lady who took my bloods and arrived an hour late to deliver DD.
I had no movement the last trimester but a heart beat, DD has horrendous muscle tissue, she was stuck on my left side for 3 months as my hips leg length has a 1,5 inch difference., they only discovered it after 12 hours waiting on her to arrive. She took mine and DPs blood to check negative and positive, I got the result of B negative, had a horrendous birth, thankfully didn't need a transfusion, thank god as she added DPs blood into my chart.
Hopefully she was one if a kind.
I had my second in Dublin, which I had heard horror stories, it was excellent, I had a consultant lead care on each visit, the consultant done a scan. I made them do bloods 3 times insisting I was B neg, I wasn't I am O neg.
I know midwives are great, but they are not doctors. My midwife in Dublin was amazing too.

@itsabongthing @Primarystress @Moonatron thank you

I think this “low risk” / “high risk” assessment can be slightly artificial. I’m sure in some cases there are reasons to classify pregnancies as higher risk but having being in contact with other women who have lost babies (still birth and neonatal deaths) it seems many of them were low risk. Many of them gave birth in a hospital maternity unit and had issues due not receiving the right care. At the moment I don’t think there was an issue with the care I received and forgive me if I’m seeing this as a very personal thing.

Many stillbirths happen in low risk pregnancies.

Many that happen due to medical negligence seem to happen in matberitrh wards

I say this based on what I’ve heard anecdotally, from women who have lost their babies like I have, and not based on all the actual figures

I think people need to be more informed. No one talks about the things like what happened to me and I feel a lot of women almost don’t realise it’s a possibility. I had a perfect pregnancy and the day before my due date my baby died. By that stage I didn’t really think I had reason to worry. It might not have mattered where I was but women might make different decisions if they knew what could happen. My husband was shocked. He didn’t seem to realise things like this could happen.

Do you mean standalone midwife-led birthing centres OP? Because if so, I think I’m probably with you. But I see no problem with MLUs alongside CLUs.

I do also agree with you that doctors should do stitches. I can’t imagine a situation where men would suffer severe injuries in that area and wouldn’t be stitched up by doctors.

I’m quite happy with a co-located MLU and that would be my preference assuming I’m low enough risk come the time I go into labour. I wouldn’t touch a stand-alone one. It seems like a daft idea to build some on separate sites in the first place knowing a number of women would need blue light transfers etc instead of just being able to wheel them down a corridor. I’d rather have a home birth than be in a stand-alone MLU because of the high ratio of staff, extra monitoring, caution and continuity of antenatal care and birth.

Absolutely agree with you OP. But to say so is not the done thing. Especially in professional circles!
I'd not choose to birth anywhere other than a consultant led unit. I'd also pay for extra third trimester scanning and checks on fetal wellbeing.

YANBU. I completely agree with the OP.

Check out the stats for America, more interventions, more epidurals, more c sections! Midwives are birth specialists and I can't believe you're trying to blame them for high still birth rates and assuming doctors would do a better job!

The problem is that you can’t just take budget and costings out of the equation. Regardless of what the reason is for the stillbirth rate, it will take money to fix it. The “doctors” who are needed for c-sections, complicated tear or episiotomy repairs etc etc are surgeons, they are incredibly expensive to train and the time taken to train them is an absolute age. It also relies on there actually being any of them! It’s all well and good saying that all care should be done by obstetricians, but if there aren’t any then what do you do?!

Scans perhaps could be offered more often, but again it costs money and people that the NHS doesn’t have. I know my ultrasound department are absolutely stacked out- if you then add in a third routine scan then that increases their workload by 50%. That would need not only another sonographer but also more equipment, more space and more cash, that just isn’t available. I think you do women and midwives a massive disservice by making such sweeping generalisations. The whole point of midwife led care is that a woman has the opportunity to take control of her care alongside a health care professional who is an expert in their field. Woken may fail to advocate for themselves, they may take poor advice from friends and relatives regarding reduced movements etc, but none of that is the fault of the midwife and would often be the case even with an obstetrician. You only have to look at the number of threads on here where women say “baby is moving a lot less, what do I do? Mum says it’s normal at 39 weeks?” To realise that some women aren’t getting the messages that are clearly conveyed to them. I don’t imagine that would change if the information had been given out by an obstetrician rather than a midwife.

@tessabelle74 - that’s true but it isn’t quite as simple as midwives = fewer interventions. The issue in the US is that a) doctors are paid for interventions and b) they have an extremely litigious culture so doctors are more risk-averse and likely to intervene.

tiles

Obstetricians do the c-sections don’t they? The same people who treat women delivering vaginally?

I think most midwives do a fantastic job, though I can’t see the advantage of a stand alone unit as opposed to one attached to a hospital.

AliceRR I am so sorry

The key is that mother’s have a choice surely? I loved giving birth twice in MLUs and hated the 20 mins I spent on the labour ward waiting for a birth centre room to become available.

Buddytheelf85 unfortunately we're going that way over here too! I'm not suggesting midwives are perfect but birth is all they do, day in, day out, even consultant obstetricians don't attend as many births

I certainly agree with third trimester scans for all. My assistant is Polish and got pregnant at the same time as me, and was horrified that we only get two scans here - at home, they get 5 or 6 as a matter of course (not sure if they have to pay for them though!).

Not sure about abolishing midwife-led centres. I'm not into candle and whale music, hypno-birthing and massage etc... but it does work for some women, especially low risk second time mothers.

I think YABVU
I had a home birth planned as I was deemed low risk. I was very happy with my plan to have a homebirth. Felt completely supported. Had the midwives round to my house and they ent through everything.. from where the ambulance would park if we needed one.. to light sources and flat surfaces for the resusc equipment... they brought a box full of blood clotting drugs, stuff for stitches etc etc they were planning on bringing gas and air and even a morphine substitute. I had two dedicated midwives who visited me at home... it was great..
And hey were so risk averse that I had constant checks on my blood pressure etc... in the end one of the midwives was worried about some slight swelling to my hands so I had a scan just before my due date... they were slightly worried about the size of my baby in the scan so they said no, you have to have her in hospital right now.
So in the end I got induced and was on the labour ward with an actual doctor...
And there was nothing whatsoever wrong with my daughter in the end... she was not even low birth weight. Completely straight forward 4 hour delivery with just gas and air...

So in my experience they are completely risk averse and constantly checked me.
I dont know of it's just the area I'm in... but I was amazed at quite how risk averse they were tbh.

I dont think birth centres or home births should be done away with as they can be extremely safe...
It's the amount of check ups on women that are lacking in some regions it seems.
I do think anyone having a birth in a midwife led unit or a home birth should be scanned at term to make sure everything is still low risk.

My pregnancies have all been high-risk, and I've been under the care of a fetal medicine consultant and scanned throughout, so I have a skewed view of people who are totally blasé about risks

BUT, we, and by we I mean the NCT, have fetishised natural birth in this country SO much, and demonised consultant-led deliveries, c-sections and interventions to the extent that many women are terrified of giving birth in hospitals.

If MLU weren't available and homebirths weren't offered, it is almost inevitable that there would be rise in 'freebirthing' or under/uninsured private midwives doing homebirths.

It is alarmingly regular to see threads on here from women who have been told they are too high risk to get the homebirth they wanted, and 50% of the replies will be 'just refuse to go in, and they are legally required to send midwives to you'
Putting aside that this information is completely wrong, I shudder to think what impact it would have on morbidity and mortality rates if it became more widespread due to women not having a MLU option

Our MLU is great I've used it twice and it made a scary painful experience more bearable. However we are lucky that our unit is right next door to the delivery suite so if there is any problems they can have you down there in seconds!
Choice is the key many women don't like the more ridged clinical approach of a delivery suite.

they get 5 or 6 as a matter of course (not sure if they have to pay for them though!)
My friend was similar she had her first in Poland regular scans and internals, though she could only have an epidural if you pay, she couldn't afford it on her first.

@tenon I agree with that totally! I hadn't even thought of that angle.. you are so right... if the option to do it safely wasnt there women would just end up doing it very un safely!
Some women are terrified of hospital or have been traumatised by over medicalised first births...