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.

Yes brilliant let’s go with the American model of obstetric care. One of the highest morality and morbidity rates in the developed world.

"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."

There is money. It's just being spent on it's citizens.

Also, this isn't going to be popular, but you've got to question the risk Women are taking, now that the age of first time Births and Births in general, has risen.

Even older Celebrity Mother's are having stillborns and they are paying for the best care.

I suggest people read the full article that @pollyname has linked to so they can see how misleading the title of the article is and how incomplete the info is that she has referred to.

I'd rather have a midwife who's sole job it is to deliver babies than a doctor who is on a 6 month rotation in obstetrics a day doesn't know much about it!

@Gabriella - I haven't been intentionally misleading. Here is the conclusion from the research:

Conclusions
There is an unexplained excess of adverse events in midwife-led deliveries in New Zealand where midwives practice autonomously. The findings are of concern and demonstrate a need for further research that specifically investigates the reasons for the apparent excess of adverse outcomes in mothers with midwife-led care. These findings should be interpreted in the context of New Zealand’s internationally comparable birth outcomes and in the context of research that supports the many benefits of midwife-led care, such as greater patient satisfaction and lower intervention rates.

journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002134

If people insist on making comparisons to the US, it's worth pointing out that their perinatal mortality rate isnt that bad considering how far back they start in terms of maternal health, and they report births differently to a lot of other countries too.

I would need to see cast iron evidence of the direct proven causal link between midwife led units and stillbirths before you could persuade me not to protest outside hospitals planning this sort of thing. For high risk births yes maybe doctor led is best but i would be looking first at all the other links that could explain it. Poor antenatal care in some regions, obesity rates etc before blanket saying you should ban midwife led units. What you May have a point on is the quality of care and management of those units - midwives are overstretched massively and really looked down on. If there are issues would start looking at funding and management.

Ireland 2011.

bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-2393-11-85

England 2015

www.england.nhs.uk/wp-content/uploads/2015/07/npeu-report1-safety-of-birthplace-and-implications.pdf

There is a reason for risk assessing women before allowing them to deliver in MLUs. The NZ study includes high risk women, who would have been cared for by a consultant in the UK system, having been cared for by midwives alone and this skews the results towards poorer outcomes for women.

There is no evidence in the UK that the stillbirth rate is related to MLUs and for a number of women, MLUs are a fantastic place to deliver. The real disappointment to focus on is that the consultant wards which usually operate on the same site are being shut down so for many, it is further and further to travel when medical attention is needed. This is what needs to be funded.

I have had 2 babies on MLUs - one in a large hospital where the labour ward was across the corridor if intervention were needed, and another in a standalone MLU where the nearest doctor was a 5 minute ambulance ride away. Midwives at both have been absolutely fantastic and the standalone one in particular, had a very low threshold for transfer to hospital. If there was the slightest chance that things were not right, it was an immediate transfer. Fortunately, being low risk and having straightforward labour meant I didn't need to be transferred and the care was fantastic. I had the same 3 midwives from booking appointment, through pregnancy, in labour and then visiting me at home.

I do agree that women should be offered growth scans in third trimester as routine

Agree absolutely. 7 years of med school, a few years of core medical training, specialism in obs & gynae and a few years as a registrar should do it. We could call them, ooh I dunno, maybe "consultant obstetricians"?

Are you seriously suggesting that all women, no matter how low-risk and how well the birth itself is going should give birth under the direct supervision of a consultant? That would be astonishingly expensive (and unnecessary) and never, ever happen - if all women gave birth under doctor care then the same number of women would have their babies delivered by a consultant as currently, it's just that the rest would have them delivered by much more junior doctors, most of whom would have much less direct experience of birth than midwives currently do.

Sorry but I think you are wrong. I want the choice of MLU or hospital. As it is I found the postnatal care at my local MLU amazing compared to the hospital ward. I would opt for MLU everytime. All for more scans but let's not take away more choices from women.

Midwives in freestanding, out of hospital units are actually quite a bit less likely to be stretched. Some units are actively underused. There are often attempts to get more women to use them.

Just read thread. AliceRR so sorry for your loss.

Agree with OP and you about availability of late scans.

Also I do think it would be useful if people talking about their experiences and views could clarify whether they mean hospital or out of hospital MLUs. I thought it was obvious OP was only talking about the latter, but she didn't specifically state that and now people are conflating the two. But they're very different.

I disagree. I think they are brilliant and I loved being able to give birth in one. They offer a much more relaxed atmosphere. The one I went to was within a hospital. I would think twice if I had to go to one that wasn't though

First time OP hasn't been back to the thread. Funny that...

@Waspnest PRH Telford has both a MLU and Maternity unit with SCBU and has done since 2012. The new Maternity unit was purpose built along with an assessment unit, new children's ward, maternity out patients and Children's out patients. The MWL unit is still in operation, Shrewsbury has been updated slightly and still fully functional.

*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."

Why does the job title make a difference? Surely it's a matter of ensuring that there's decent training. I've been suturing perineums for 15 years and think I make a really good job of it. Never had anyone that I've sutured had to come back for refashioning that I know of. I know I can suture better than a lot of doctors I see.

Also the comment someone made about shoulder dystocia/cord prolapse at home = death. Not in my experience. For a start the chances of a cord prolapse at home are very remote because you need an unengaged head for there to be a cord prolapse and if someone was labouring with such a high head the community midwives would advice transfer into the unit because of the risk. Midwives are proactive as well as reactive!

As for shoulder dystocia we're very well trained in resolving them. Will attend yearly simulation updates which interestingly enough in every hospital I work at is mandatory for midwives but not doctors. Its very rare for a doctor to attend such updates as they're" too busy"

I've never known a baby die of a shoulder dystocia at a home birth (I'm not saying it never happens but it happens in hospitals as well). I've known plenty be resolved by community midwives.

The 2 worst shoulder dystocias I've ever seen - the worst one the Reg and the Band 7 midwife took it turns doing maneuvers to resolve it and it was actually the Band 7 midwife who got the baby out in the end. The other bad one I got out after the senior Reg tried and failed and asked me to do it - I have smaller hands and could get to where I needed to be to get the posterior arm out whereas he couldn't.

I am very interested in third trimester scans though and think there's a good argument for them. Other European countries do them routinely I believe.

I'm so sorry alice .

It's difficult to answer your question OP without saying "well my MLU birth was lovely" / "My MLU birth was shit". But I'd argue that they have a place.

Agree absolutely. 7 years of med school, a few years of core medical training, specialism in obs & gynae and a few years as a registrar should do it. We could call them, ooh I dunno, maybe "consultant obstetricians"?

We have 7 midwives per shift on labour ward. We don't even have 7 consultants working at the hospital, never mind having enough to do 7 per shift, 3 shifts a day, 7 days a week, 365 days a year! We'd need 50 consultants instead of 6!

Plus another 6 consultants to do all the stuff they should be doing like gynae and clincs.

And I don't think they'd be happy about spending significant amounts of their time (90%) giving emotional support, checking obs, monitoring FH, helping mum mobilise, etc. The actual birth part is a tiny part so yes although you could get them to come in at the last minute for that we do that anyway if we have a problem and most intrapartum deaths don't happen because of something going wrong in that last little bit. Its to do with things going wrong much earlier on in labour which may have been missed. So in your argument you'd need the consultant present for the whole 16 hour (or however long) labour. And of course when things do sometimes (sadly) get missed it isn't just the midwife who misses it, registrars and even consultants miss things sometimes.

The MLU and CLU were next to each other in the same hospital where I have birth. I was consultant-led due to pregnancy complications, but except for the epidural, I was looked after exclusively by two amazing midwives (both called Emma).

I had a baby in a stand alone midwife unit. It was pretty awful physically, about as wrong as it can go from a mum perspective (baby was fine). I had to be transferred to a hospital post birth and the whole process took hours during which I was in agony the entire time.
Women are usually having to choose between the kind of environment that is best for a natural birth and the back up of doctors.
Ideally we wouldn’t have to choose.
However I’m very lucky in some ways as I had a good surgeon. I can’t imagine how awful it is to have a third degree year badly repaired.

The problem is that you are right but also very wrong. It’s scientifically the case that women give birth easiest and safest in a calm, quiet, darkened room with someone they know and trust.
It’s also true that Csections save babies and mums lives.
If we were men we wouldn’t have to choose between these things.

@NicoAndTheNiners my dc had a shoulder dystocias the male doctor tried several times to free him but failed. There was alarms going off and people running into theatre it was a midwife that saved him. She removed the forcpe blades used her hands to free him then guided him out while 2 other midwives pushed down on my stomach, she saved his life. She acted just as quick to to resuscitate him he did end up with a dislocated shoulder but I absolutely believe that was cause by doctors technique

Figaro88 Forceps does increase the risk of a shoulder dystocia.