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.

The US has an obesity issue, that contributes to birth complications. There are also midwife led birthing centers and home births in the US, it’s a free market and all of these options are available. My cousins entire prenatal care in New York was at a midwife clinic at her choosing.

I think you are absolutely right about third trimester scans and friends who are midwives support this (have had them for their own babies).

My first birth was in a MLU many years ago and my GP was called out of bed at 3am to stitch me because in those days midwives weren’t allowed to stitch. I left with a healthy baby.

My second birth was in a highly medicalised setting as I had preeclampsia. My son was stillborn, having died minutes before birth because the placenta separated and I spent four days in ICU. No scans at all then and no amount of them would have made any difference, the two doctors present at the birth couldn’t prevent it either.

I'm not sure if you can blame everything on MLUs. It's a tricky one though - I was low risk, but retained the placenta and haemorrhaged badly. They did not deal with it well at the MLU. They couldn't get the oxygen to work, tissued my cannula (and then left it, even though they had noticed the swelling, and prodded it a couple of times), and then the ambulance wouldn't start. In the meantime, I lost 2 litres of blood.

Mind you, at the hospital, when I was on the High Dependency ward, they first forgot to remove a tourniquet after taking blood, and then cocked up my transfusion, so it's much of a muchness really.

I do think that there is too much pressure to have a vaginal birth though. I would be interested in a study on the use of pitocin and how often it leads to complications. It also seems to be 'preferable' for a woman to have a hideous labour, and suffer severe vaginal/bladder etc. damage, rather than have a c-section.

Op not been back?

My local hospital lost its maternity unit and was downgraded to a stand alone midwife unit. It has no obstetricians or paediatricians on site.
When things inevitably go wrong, it requires an ambulance transfer to the next hospital 25 miles away.
We have already had one baby die en route - a misdiagnosed obstructed breech presentation.
Mothers should be warned in advance that midwives cannot perform caesarian sections or use forceps, and are not trained to the level of a paediatric crash team in resuscitating neonates.
A stand alone unit may also not carry a full shock pack of O negative blood to handle massive intrapartum haemorrhage.
My own second child would have died if delivered in such a unit. Fortunately she and I were in a fully equipped and appropriately staffed hospital labour ward.
I would ban all stand alone units, and have them moved inside proper obstetric departments in hospitals, preferably not more than a short corridor away from the emergency facilities and staff. Women should not be playing Russian roulette with their own and their babies’ lives.

I think these units are fine if they are attached to a hospital.

I don't care if people choose midwife care, but I do wish I had the option to see an obstetrician. It feels like all the choices are for a less medicalised birth and I'd like one that was more medicalised.

The thing is, the risks of under intervention are very clear and obvious, the risks of over intervention are less so but just as real. It's not true that everyone would be safer if doctors intervened in their labour at the first possible moment. There are actual statistics on birth place safety that bear this out.

I had my baby in a mlu attached to the main hospital. I wouldn't have gone there if it wasn't. I had an easy birth with no intervention. My midwife at all my prior check ups kept suggesting i have a home birth. I would never have a home birth. Being at home wouldn't relax me, it would send my anxiety through the roof to know I'm not near doctors and a hospital.

Exactly Newaccount,hospital based births have their own risks which aren't accounted for in op's analysis. I recently had a homebirth, under op's logic they should be banned too. I did my research and knew that statistically it was the safest setting for me and my (2nd) baby. The environment you give birth in is so important, if you can't relax the risks go up. I feel the consultants I saw during my first birth (in a hospital based
mlu with consultants next door) slowed my labour down which led to baby's heart rate dropping. Hospital births are more likely to lead to interventions (c section, induction, instrumental) which have risks for mother and baby, it's not just about emergency situations but the impact of medicalisation on health including mental health, you need to take a holistic view. Mothers need to be able to have a free choice and given all the info they need to make their own decision. I wasn't playing 'russuan roulette' with my baby's life, I made an informed decision based on the evidence. No birth is risk free and if you know you will feel safer in a hospital of course you should labour there. I knew I would feel safer at home and had a fantastic second birth. Incidentally baby's shoulders did get stuck temporarily and midwives knew the change in position needed to get her out. I did my research on shoulder dystocia and the training midwives get in resolving it and accepted the very small increased risk if it hadn't been resolveable at home.

The US doesn't use midwives, it's all doctors and the mother and baby mortality rates are awful!!!

The US absolutely does use midwives, of varying types.

YABU

Drs do not guarantee good outcomes. A midwife is a specialist and often is far better trained than the drs she calls for assistance during difficult births, it's just they aren't currently licenced to do certain procedures. I chose midwife led care in a full service hospital, best of both worlds

By the way the higher rate of still birth is correlated to higher maternal age, obesity levels and (particularly relevant in certain locations with high levels of cousin marriage) genetic conditions. Some still births have no obvious cause or are cord related but alas some are lifestyle related.

Pur MLU is 15 min away from hospital. They turn most people down in pregnancy then turn 40pc of people away after they've got there / started labour there and then send some to hospital afterwards for stitches etc.

It's lovely but as a result of the above, it's completely dead. There are 3 rooms and every time I've been (4 or 5 times) it's either empty or one room in use with loads of midwives sitting around.

It doesn't seem right given the hospital nearby turns women away sometimes for being full (was built for 3000 births per year and now deals with 7,000)

I think it makes more sense to have them on hospital site or very near so they can accept more people to start with and share resource more easily between the MLU and ward

@AliceRR

I agree that stand alone ones can be dangerous. For DC1 I started off at a MLU 30 mins from a hospital as was deemed low risk, We drove to a Labour ward after a few slow hours as thought I’d want an epidural at some point.
I thank my lucky stars that I did as in the end my placenta came away and I had an emergency section under GA followed by a hemmorage and a few days in intensive care.
DP says My section was performed in less than 10 mins of the emergency buzzer being pulled.
If I had still been in a MLU, I dread to think where me and my daughter would be today.

The US doesn't use midwives, it's all doctors and the mother and baby mortality rates are awful!!!

The US does use midwives. My friend gave birth at home with a midwife 3 weeks ago in the States.

Stop using the US as am arguing point, it has serious issues but midwives vs consultants isn’t the primary one. France also has highly medicalised birth and has better outcomes than the US.

YANBU. I’m not a fan of stand alone MLUs but can see how in remote areas they are important. I attempted to give birth in a MLU attached to a hospital but when it became apparent that DS1 needed continuous monitoring it was easy enough for me to get out the birthing pool into a wheelchair and be wheeled next door to the delivery unit. The thought of being blue lighted 40 minutes down the road whilst 10cm dilated and pushing terrifies me.

A friend of mine recently had a fantastic experience with her first baby in our local MLU (also attached to a hospital) - water birth, no gas and air or any other form of pain relief other than controlled breathing. All 3 of them stayed the night in the room, discharged the following day, never saw the postnatal ward. The dream

@Primarystress I think we live in the same town!!

Thanks for your views all. @alicerr im so sorry thank you for sharing.

It is the standalone units i would like to see shut down not the ones attached to a hospital where you just need to be wheeled down the corridor to have access to a doctor. Sorry for not being clearer on that.

I think its shocking that some towns only have a standalone MLU and are so far from NICU units especially the Scottish situation.

After having a terrible experience myself im just so concerned that giving birth these days is indeed made out to be an 'experience' and this is an agenda really pushed by the likes of the NCT and that some women have no idea of the horrors that could await them, and this in turn is allowing the government to get away with providing substandard care to save money in the form of the standalone MLU. Just my opinion though.

But a terrible experience of labour is not the same as a stillbirth. It may result in one but I would really like to see the statistics on that. Some babies who are v unwell in utero die during labour but it is my understanding that the vast majority of stillbirths are not related to labour.
So I still don’t understand how a more medicalised process of labour would solve the stillbirth issue?

It might result in less injuries for women, fewer oxygen deprived babies or whatever but I am puzzled by the link between stillbirth and MLUs.