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 know doctors make mistakes too but so many women i talk to have been let down by rubbish midwives.

Well yes, if you've spoken to people in this country about issues they have had it will focus on midwives as the care is midwife led.

Equally, if you spoke to the same amount of American women they'd give you horror stories of doctor-led care because their care is led by doctors.

we should be reminding mothers to be that its dangerous and also considering the needs of the baby.

Oh and fuck off with this.

All we do is focus on the baby to the detriment to the human pushing the baby out. Maybe let women decide?

When the community MW checked up on my infected stitches in the tattered remnants of my undercarriage, she was horrified when I said that it was done in an operating theatre as it meant that it had been done by a senior member of staff. She said she was going to complain about the mess they made of me.
Senior isn't always superior.

MLUs are better if they have easy access to CLUs. Choices and maternal comfort are important. In the absence of other risk factors, being in a relaxed, comfortable state makes birthing more successful.

I felt very much like my pregnancy was doctorless. Even when I was transferred to a consultant led unit, I only saw a consultant once, when she tried to convince me to let her break my water to induce labour. (that's a story unto itself...) I do think midwife led units are best placed within a hospital environment where transfers can easily be made to consultant led units.

I don't know any of the other stats you talked about. But the MLU I went to was in the same building as the CLU. The transfer is via the lift in the hospital. There might be standalone birth centres but that's not the case in many urban centres.

I'm pretty comfortable with the risk of a transfer on a hosiptal bed, via a lift, to an operation room somewhere else in the same building.

My 2nd degree tear from my last birth was sewn up by the head/lead midwife. Took her over an hour.
She also noted the poor fixing of my previous episotomy and knew it must have (and did) cause me many issues even though it was 7 years ago. It had been done by a male surgeon. It was also a factor in the way I tore and the large blood loss.

She did an amazing job and I will be forever grateful. All previous issues disappeared.

My first baby would have been born at a birth centre. It was two towns away from the nearest maternity hospital. I went to the birth centre in labour 6cm dilated, got straight in the pool and the mw noticed little flashes of blood in the pool. They transfered me. Wouldn't let me push my baby out his head was right there but they said I had to hold on, they were worried I was going to haemorrhage I think. The contractions were unbearable as my body just wanted him out. Got to hospital and there was NO DOCTOR to come and check me so for almost two hours I was holding the urge to push, in the most intense agony imaginable, then my babies heart rate dropped significantly and there was just no medical response as back up for the midwives. She said just push your baby out and he literally came flying out with one push with the cord around his neck three times. It was the most horrific experience, but even of I'd been at the hospital to start the outcome wouldn't have been any different, just shocking how understaffed they were that day, my baby could easily have died and so could I. I was grateful to the midwife in the end for just making the decision and getting my baby out. My point is, I don't think the midwives take any chances, first inkling of a problem they are on it.

I pushed really hard for dd2 to be delivered at our mlu, my community midwife (although being very natural & 'hippy') was against it due to me haemorrhaging after ds 7years earlier, (although I had dd1 nearly 3 years after ds, & 4 years prior to dd2 & she was born into a birth pool, all very natural & a lovely perfect birth) but as the mlu is actually in the hospital & just across the corridor to the delivery suite etc.

When I got to the hospital & went to the mlu, after labour starting & contractions being 1min apart, I told the first midwife (who was about to finish her shift) that I hadn't felt baby move all night, she listened to her heart with one of the little metal ear things & said she was fine, she left, we got new midwife, & about 10 mins later all contractions etc stopped, the new midwife told me to bounce on the call & she'd be back soon, about two hours later she came back & wanted to send me home, no other checks or anything, I told them the baby had pooped, the midwife didn't seem concerned, but said she would take me across the hall to delivery suit, & put me on a monitor for a few mins, as soon as she put me on the monitor, she made me roll from side to side, then shouted that we were bradycardic, pulled all bells & pushed buttons, only then was I internally examined & they discovered all of my babies cord was prolapsed, & I was whisked off for emc!

If the mlu hadn't been in the hospital & taken all of 30 seconds to get there, dd2, wouldn't have made it, we were told her cord had started to thrombose, & we were about a minute away from losing her.

There is nothing wrong with mlu, but they need experienced midwives in them, the two we saw were early-mid 20s, there was nobody older or more experienced in the unit, which I think is awful, they were not experienced enough to know what was happening & thank god id noticed the baby poo in my pants, or I would have been sent home, with no body looking into why labour had stopped, & what was going on. The whole labour was a massive ball up from beginning to end, the midwives were incompetent & I very nearly lost my baby, I'm at massive risk of developing ptsd too,

BUT

I do not think they should be gotten rid of, just placed in hospitals, or somewhere with immediate emergency medical care, & women should be monitored better than I was. I'd love another baby, & I'm very broody, but I won't risk it, I've got three beautiful healthy children.
Sorry it's so long 😕

I personally would never ever choose a stand-alone MLU or home birth. Not worth the risk to my baby or me. However I understand the statistics and why some people chose it so I don't think they should be banned.

Co-located MLU are amazing though.

My second baby would have been fine if I'd delivered my second wherever (straightforward delivery at full term and I was asked multiple times if I'd like a home birth). I, on the other hand, needed immediate surgery post delivery and I'm grateful the theatre was just through some double doors and not an ambulance ride away.

I agree we should have a third routine scan.

Or midwife training can be upped in intensity. In Norway midwifery is a two year degree that you take after you've qualified as a nurse. (I'm admittedly not sure how you do it in the UK, google says a 3 year bachelor which is pretty serious!) This makes them more than qualified to handle birthing in a respectful and knowledgeable fashion.

In Norway the vast majority of pregnancies (and indeed hospital births) are supported and dealt with by midwives. Doctors are only called in for serious medical issues. I think it's lovely, this way I'm seen by a specialist (the midwife) who will be experienced in how to keep me calm and how to keep my babies safe.

Midwives SHOULD be the ones in charge of the process in my opinion, give them the education and experience that they need to be the specialists they should be and the care will be excellent.

A study of 244,000 births in NZ found 'health outcomes for babies cared for by a midwife rather than a GP or obstetrician are significantly worse'

www.theguardian.com/world/2016/sep/28/births-led-by-midwives-rather-than-doctors-linked-to-greater-risks-nz-study

Doctor-led care resulted in a 55 percent lower chance of oxygen deprivation during delivery, a 39 percent lower chance of neonatal encephalopathy - which can result in brain injury - and a 48 percent lower chance of a low Apgar score, indicating an unwell baby.

www.radionz.co.nz/news/national/314359/babies-more-at-risk-in-midwife-led-births-study

At the end of the day it’s the right of the women. I don’t personally care if you give birth via csection/with a midwife or alone in a forest surrounded by deer. The point is it’s your choice. Don’t try and take mine away from me.

I was under the impression that evidence shows that women are less likely to have complications in MLU and at home because it was a less stressful environment. Obviously if they haven't had complications in pregnancy.

Personally I felt calmer knowing I was near all the things needed in an emergency. My first labour was meant to be in MLU in same building as the wards etc but they refused to take me because I'd had a small amount of bleeding...I don't think they take any chances. Ended up on a ward for my 2nd as well...both times I was monitored by a midwife and didn't see a Dr at all during my 2nd labour.

YABVU OP, I have given birth at both an MLU and at home. I have never seen a Dr whist pregnant or giving birth (3 DC), and always had faith in the excellent care I received from midwives. Why should you dictate where I choose to give birth? I was confident in my choices, which were based on research and personal experience.

Can you provide stats please because I don't think your claims are factually accurate?

I do think we have begun to romanticise childbirth as an 'experience'. Throughout most of western history, and in many places today still, birth is a situation women have looked to with fear as potentially perilous. Part of the very necessary response to the loss of women's autonomy and voice in childbirth that went hand in hand with its medicalisation involved a glorification of the birthing process per se and demonisation of 'medicalisation' that I think can be dangerous. I had 'medicalised' births in which I felt supported and listened to. It is possible.

But I also don't think that care will need, in every situation, to be provided by a doctor.

TFBundy but very little of that training and experience it with women who have vaginal births with no intervention nor is it throughout the whole of labour.

@Skincaresos
@Elisannah

Actually studies show Midwife led births have worse outcomes.
www.theguardian.com/world/2016/sep/28/births-led-by-midwives-rather-than-doctors-linked-to-greater-risks-nz-study

See my other link above also. Women should have choice, including easy access to doctor led care.

@Skincaresos
Also, really pleased things went well for you, doctors were present at the birth of my DS which i was very, very grateful for. The NZ longitudinal studies show midwife led births have worse outcomes.

Do you have a study based in the uk?

Good grief, I’d far rather have a midwife than a doctor.

The MLU IN our town is co-located. I started on there when I had my son but ended up transferring up to the CLU because my Labour was taking so long (DS was back to back and big!).

I really wish I had gone for the CLU from the outset because I felt really insecure on the MLU - left pretty much to my own devices.

That said, the midwives on the CLU weren't great either - didn't listen, were quite patronising and I just felt like they didn't care.

My only saving grace was the wonderful consultant obstetrician who came to see me when she came on duty. By this point, I still wasn't dialated and it was 36 hours since my waters had broken!
She was amazing - recognised immediately (without doing an internal!) That baby's head wasn't engaged and that the baby was big (I have a very small frame).

She delivered my son by emergency c-section and she couldn't have done a better job! Baby out, perfectly healthy in 3 mins and I have a very neat scar. He weighed in at 9lb 6oz so she was right when she said he was big!

I am thankful every single day for her knowledge, care and skill and if I ever had another baby, I would deliver by elective section. No way would I ever attempt a midwife led birth again. As it is, the experience left me so traumatised that I can't face it again.

@chillpizza, nope, do you? Midwives can operate independently in NZ so more like the midwifery led unit model rather than what you would experience in a hospital (midwife present but doctors also available). The study also found Maori and Indian babies were less likely to be resuscitated which is tragic.