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 don’t think we should be dictating how women give birth and saying all births should be done a certain way or in a certain place. women should have access to better information, access to the birth support they want (be that hospital, MLU or home), ensuring all recommendations are evidence-based (as opposed to efficiency based) and support them in their birth choices.

I agree with your sentiment of providing better care, but I completely disagree with your assumption that medicalised antenatal and labour care is best and that all women should be made to have it. Homebirths aren’t hippy bs; they are a valid choice. Birth is helped massively to be natural and straightforward when and where mum feels safe and supported - be that at home or in hospital. Let’s support women to get better care, not dictate how and when they give birth.

tile both my sections (crash and elected) were performed by obstetrician consultants.

MLU wouldn't be for me, ours are about 40 mins from hospitals and I wouldn't personally take that risk. My first labour turned badly very quickly and I don't think my baby or I would have made it to the hospital but who knows. Was lucky I didn't have to find that out.

It's hard to know without all the data but I think things going wrong at MLU is rare but it does happen.

I'm sorry, but the statistics do not back you up.

1. Stillbirths are actually decreasing yearly, despite a higher uptake of women using MLUs and midwives at home.

1. The USA spends a lot more money on birth than we do (actually individual women do, as they do not have an NHS) and they have a doctor delivering the vast majority of births, yet their still born rate is significantly higher.

1. There is no evidence, anywhere, to suggest midwives making a mistake is what causes a still birth, anymoreso than a medic doing so.

1. Some European countries have lower rates than we do. However they also have much healthier lifestyles and less obesity. Obesity increases the chances of stillbirth exponentially, I believe its around 18% per every additional 5 bmi points.

MLU can be wonderful. And I agree the NHS should have more money to spend on birth. But that's not the reason for still births.

Freestanding MLUs actually have excellent stats as a whole, especially for second timers. They're safer and cheaper on average for low risk multips.

That said, some of them are very underused, which obviously is in pretty stark comparison to the hospital based facilities. I don't know how much these better stats are reflective of midwives there being much less stretched, nor whether the cost arguments factor in the relative underuse of the facilities. So there are obviously arguments about whether it would be a better use of resources to direct them towards more stretched services. Especially as FMLUs quite rightly only cater to lower risk women, and with the birthing population being increasingly older and heavier, that becomes a smaller percentage of women they're able to serve over time. It's a difficult one.

Our stillbirth rate is an international fucking disgrace though.

Our stillbirth rate is higher than most of Europe as we are older and fatter when we give birth, compared to most of Europe. We also used to implant more embryos, that sort of thing.

There is no evidence that MLUs are responsible for the stillbirth rate and the fact you are essentially proposing the US model, shows you haven't looked at their rates.

We could improve things by removing the cult like natural idea of pregnancy and birth, taking away the fear people might have for accessing health care. Feeling like a failure for making a more medical choice. If you were to introduce your system into our current way of talking about birth, you would just get people opting out of health care all together.

That's why homebirth in the US is so ridiculously unsafe... they cant work alongside hospitals, so a hospital would not be ready to immediately recieve you if there are any complications, they dont have the ability to bring a lot of the kit to the home like midwives do here.. in a lot of places in the states, qualified midwives cannot even get insurance to attend homebirths so any woman having a home birth is either doing it by herself or with a woman who is not medically qualified.

That the NHS funds midwife led units and homebirth, actually protects women massively.
Maternal death and stillbirth rates are ridiculously high in the US, akin to some countries we consider to be undeveloped!! And the US has a very medicalised approach to childbirth.

I've given birth in a MLU twice as in rural areas like mine that's the only option for many women without more than an hours travelling distance whilst in labour. It's not about being hippy dippy it's about not wanting a long car journey with agonising contractions only a few minutes a part.

I don't think transfer statistics are a good way of judging how effective MLUs are either.

I had two pretty much textbook births at two different MLUs, with no problems and no fuss, but on both occasions I was transferred after the birth because my blood type (rh negative) was different to the baby's blood type and the babies needed monitoring overnight to ensure all was well and the MLUs aren't staffed overnight for inpatients.

Similarly many first time mothers get transferred from MLUs after the birth for the same reason - an overnight stay is felt to be needed rather than any issues with the birth itself, or because they decide they want an epidural.

The problem where I live is not so much the MLU, but the absence of any paediatric services at the hospital. If there are any problems with your baby, you will have to be blue-lighted to the hospital in the next city, about 30 minutes but depends on traffic.

My friend's second child (first child straight forward delivery, no complications during pregnancy) died due to complications during the delivery. She was told that if she had given birth in the hospital in the next city with paediatric care available, her ds would probably have survived. Understandably she chose to go to the next city to give birth to her third child.

The maternity unit in our town's hospital was built only 22 years ago with state of the art delivery facilities. 10 years later the children's ward was closed and the maternity unit was downgraded to MLU. This is for a town with a population of 116,000 (and growing rapidly) and which has experienced a growth in the number of births over the last decade or so.

We now only have one doctor led maternity unit, and one children's hospital for the whole county, population estimate 630, 000 and growing. We also only have one overnight A&E department for the whole county.

This is not down to rubbish midwives. It is down to cuts and due to difficulties in recruiting staff. Recruiting trained staff has already become more difficult since the Brexit vote and is likely to become even harder after we leave the EU. We are also likely to see further cuts to funding if the economy takes a hit after Brexit, not to mention the fortune that Brexit has already cost us.

These cuts kill

How about women making sure they have a healthy BMI and level of fitness before getting pregnant?

My sister was unconscious immediately after delivery and my mum was told to squeeze the milk out of her daughter onto a saucer so they could feed her new born daughter. Rightly mum refused as sister hadnt consented and couldnt and was told she would have to purchase formula off the premises (at the petrol station) and leave the premises before attempting to feed a 2 hour old baby who she was not the mother of. The gross lack of care and the abusive behaviour she encountered was horrific. And this is on the naice SE England. Imagine what more stretched trusts are like. I will be called a liar but that is exactly what happened. My sister was compensated after the case was investigated.

I see your point, but actually, having read the RCOG information on shoulder dystocia, it doesn't doesn't seem quite so clear cut.

An interesting thing to think about is why the USA, which has a very medicalised approach to childbirth, does not have the lowest rates of stillbirth and birth complications (for both baby and mother), if childbirth is truly much safer in a medical setting?

I did think seriously about my birth choices, and I accepted that a home birth would mean a greater delay if there was an emergency. However, the only one of my babies to be described as experiencing any distress during the birth process was the first one- when I was in hospital, in an environment I did not find remotely conducive to me relaxing, where the midwife insisted I could not stand, squat or get on all fours and tried to coach my pushing rather than let me respond to my body's urges. My third baby was born with a double nuchal hand and I honestly believe that being at home and confident enough to listen to my body and dictate the position I wanted to be in and push when I wanted rather than when someone else thought I would, etc, was massively helpful.

Tbh I just want women to have true choices- not to be scared into medicalised births they don't want, not to be shamed into home births they don't want. I want unbiased, full information and a true choice for pregnant women. That's it.

There are also some states in the US where you don't need to be properly qualified to be a midwife. You can just call yourself one. There's also something called a Certified Professional Midwife, where the training is nothing like as rigorous as our NHS midwives. Then they have the very well trained ones who are at a similar level to ours. There is just a massive variety in skill and training level for US midwifery as a while, much more so than here.

This is just one of the reasons I don't actually think making US comparisons is that helpful here. They're so different.

Their maternal mortality rates are much worse not just because they are more obese but also because there are so many of them don't have access to proper healthcare before they get pregnant. With the new reforms most pregnant women are covered now, though some still fall through the cracks, but if eg you have a pre-existing cardio condition that makes you higher risk in pregnancy, in the US you may well be going into pregnancy without it having previously been properly treated. Whereas in the UK you will have been able to access the NHS for it. Of course this is going to make a difference in mortality rates.

Uh, sorry, that was a response to dietcokemegafan!

I think the majority of midwives have more experience of pregnancy/birth than the J/SHO's that are floating around the delivery suites?

An interesting thing to think about is why the USA, which has a very medicalised approach to childbirth, does not have the lowest rates of stillbirth and birth complications (for both baby and mother), if childbirth is truly much safer in a medical setting?

That assumes that all women have access to full antenatal and delivery services, which everyone knows they don't.

Plus the huge swathe of the population who don't have access to full healthcare are also the most obese, badly-housed and under-educated part of the population, and all of these factors will have a big impact on their likelihood of stillbirth or neonatal morbidity

Living in the north of Scotland I feel your closing down of all standalone MLU's is going to leave a large percentage of ladies struggling.

Take the west coast of Scotland, there are places 4-5 hours drive to the nearest hospital. A MLU is MUCH safer for them than delivering at home, they have everything available for an emergency and facility for the air ambulance if required.

The alternative is that all women due to deliver stay at a hospital until they go in to labour? We are talking about exponentially higher costs for hospital stay, more likely to use intervention to get people discharged quicker, intervention is proven to be more likely to result in tears and C sections. Not even beginning to think about the cultural side of women being hours away from home for weeks, separated from older children in a busy overcrowded ward with likely no visitors as too far. That's not going to contribute to a positive birth/postnatal experience!

I personally was low risk but went overdue and switched to consultant care for induction. I had a 3rd degree tear which was stitched by a doctor. In a support group for severe tears many of the girls are choosing home birth for subsequent children because consultant care is more likely to result in intervention which hasnt served them well the first time round.

How about women making sure they have a healthy BMI and level of fitness before getting pregnant?

Healthy BMI here and 4x a week swimmer. 5 days of stop start back to back labour, emergency c-section, sepsis for baby and I. HTH.

The natural birth lobby lot have a lot to answer for IMO. Yesterday I was at the hospital having an internal scan for some gynae issues. The doctor doing the scan asked if I had given birth. I said yes - well, I've had a c-section. He said "Oh, you cheated!"

Yes, it was sooooooooooooo easy going through a 5 day labour, having my stomach sliced open and nearly dying.

tenbob I am going to have to go and so some work (so unreasonable of my employers to expect me to devote time to work rather than mumsnet...) now so won't have time now, but much later I'm going to have a look for more than just headline stats on US birth outcomes. It will be interesting to see whether the groups without high levels of medical intervention /management etc have significantly worse outcomes in that country.

I agree with you OP. If a doctor had assessed the risk level of my first pregnancy instead of a midwife, I maybe would not have lost my son in the later stages of my first pregnancy.

But if a woman CHOOSES to be midwife-led, then let them 🤷🏼‍♀️ Baby delivered at mother's own risk.

I absolutely disagree. My MLU was attached to a hospital which was my perfect situation but it was better for my baby's birth than the hospital would have been. We were able to birth in water without drugs and therefore recover very much quicker, not requiring any painkillers afterwards either. I strongly believe that if i'd had continous monitoring or a drip or no access to the pool I would have needed an epidural which we all know leads to more instrumental deliveries and drugs etc.

I know i was VERY lucky but it was good that i didn't require a doctor or full nursing afterwards. After i was discharged I had to go up to the postnatal recovery ward to wait with ds for his coombs test result as the first one was inconclusive. The women up there were unwell and/or injured, requiring monitoring and painkillers and 24hr nurse and doctor care. I did not need that and should rightly not have taken up those resources.

I needed quiet and dark to sleep and knowledgeable breastfeeding support which is exactly what the MLU offered.

Actually if you go the other way and look at midwife services like One to One midwives here in the North West, you get better one on one care, more scans, weekly and fortnightly checks and your own dedicated midwife 24hrs a day up to several weeks after birth. They come with you to all antenatal appointments if you need them and use private scan centres within NHS units.

Their stats are better than hospital births afair and the dedication of the teams and midwives is awe inspiring.

They are the model that should be being looked at. Their funding comes from the same pot as the NHS maternity units and they are free at the point of use like NHS mu's.

They know your file, your case history, everything about you. They are fabulous. If we have more children I would only ever use them.

I'd rather give birth in a bush wrapped in barbed wire than EVER give birth at our women's hospital in Liverpool. It's an absolute shambles of a place and was bad enough just being transferred in after birth to get stitched up (2/3 degree tear that would've happened there or at home).

I'd trust an experienced midwife over a dozy young male consultant (which I experienced there, several times) any day.

I certainly think there is a somewhat evangelical attitude in some midwives, in that they seem to resent and discourage any involvement by obstetricians.

A family member was affected, when a very long and painful labour was unnecessarily protracted because 'we thought you wanted to do it naturally' - having failed to inform the mother that they knew the baby was facing the wrong way. The obstetric unit was only just downstairs, but they apparently didn't want to 'give in'.

That mother was profoundly grateful for the eventual epidural and forceps delivery of a healthy baby, but she was left with damage resulting from an avoidably long period of the baby bashing its head against a brick wall, so to speak.

I'm still angry about it.

I don't understand some people's antipathy to obstetric units. It's decades ago now, and midwife units weren't offered, but both my labours were difficult - though not predicted to be - and I was only too glad of expert help quickly available once it became clear that it was not going to be straightforward.

I opted for a home birth as I wanted the best care. Where else in the uk do you get two! Midwife’s all to yourself who are only and constantly monitoring only you.

I’d rather not have a midwife or doctor who’s monitoring 3 other women at the same time and miss something important.

YANBU