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.

Putting focus on increasing the medicalisation of birth is just a red herring to detract from the real issues.

It is an understandable attempt to take away the uncomfortable truth that women need to blame others/ something other than themselves when things go badly wrong.

The odds are stacked so far against women having a normal delivery when their BMI is high and all associated problems due to this it is like an elephant in the room and it has become a too sensitive a subject to broach.

The threads on MN for women having problems conceiving and then having recurrent miscarriages and then stillbirths and premature babies and horrendous birthing experiences is unfortunately tied up with the uncomfortable fact that your high BMI and associated problems is likely to be a contributing factor, if not the main one.

Women need to take back responsibility for their health, fitness and wellbeing before, during and after childbirth if they want to improve their chances of a successful outcome.

There is no point flaming my post as it is the truth and I am sorry the truth is so hurtful and brutal.

I agree we need to look after ourselves but high BMI or not, standalone MLU dont have the experience nor equipment to deal with emergency situations and this is putting lives at risks. I think BMI is largely irrelevant here because if i recall correctly BmI forms part of the risk assessment for giving birth at MLU.

I do wonder about that. My DS has the scratch test on his head to look for distress, it showed he was okay, but the midwife hadn’t done it properly and she knew she hadn’t done it properly but she was prepared to that risk. One of the doctors had to badger her to redo it and he was in distress. Fortunately I wasn’t in a midwife led unit so I went straight in for a csection and it was touch and go. He had to be revived.

The threads on MN for women having problems conceiving and then having recurrent miscarriages and then stillbirths and premature babies and horrendous birthing experiences is unfortunately tied up with the uncomfortable fact that your high BMI and associated problems is likely to be a contributing factor, if not the main one.

ODFOD. There are plenty of other factors which affect this and one of the commonest causes of infertility actually causes women to have a high BMI while eating healthily but you’d know all that if you weren’t just posting snarky pseudoscience.

I certainly cannot see the issue with MLUs in hospitals. Surely they are a great idea, as they keep costs down, provide exactly what most low-risk women want and need, and everything else is at hand if it’s needed. As far as I am aware, the risk of giving birth is no higher (and perhaps actually lower) at MLU, partly because only low risk births go there.

I do wonder how the more remote MLUs are actually any different to HBs, in that you need to travel in an emergency, although I guess there is perhaps an advantage in truest remote areas.

FWIW, we had a HB for our first (no real MLU option) and had complications at the point of delivery. We could see the hospital from our home, and were there very quickly. We had a hospital birth for our second child and I never saw an obstetrician. I was fully managed by midwives and we just had a doctor to do the once over if our child. I would imagine it was much the same as giving birth at a hospital-based MLU, with medical assistance in hand if it was needed.

I do, however, agree that third trimester scans, and better tracking of babies kicks etc in the final weeks would be a huge improvement to current care.

Bejam - midwives don't do fetal blood sampling (the scratch on a babys head to look for distress).

Anyway the research for home birth (which can be extrapolated to midwife led units) is for people having their second baby who are low risk then it us safer than consultant led units.

But hospitals lead to higher levels of interventions which have their own problems.

If I remember rightly, the birth place study showed that for low risk, first time mothers, birth centres had the lowest rate of intervention and the lowest rate of adverse outcomes. For second time or more mothers, home was statistically the safest place.

I'll be having my baby at home. Not because of hippy BS as you suggest, but because statistically it's safer for me and for baby. I'll also have 2:1 midwifery care and will be more closely monitored it labour than I'm likely to be hospital.

I had two third trimester scans, one for bump not quite measuring enough and one whilst in labour for being over due. Both estimated ds bring much smaller and neither able to measure the head. His head was too big to be born vaginally.
When you’re in hospital you have to actually get a doctor to see you before it all becomes an emergency and some smaller regional hospital have to call out their peadatric (sp) consultants (also other consultants as well) out of hours and they don’t tell people that.
Women need to be informed of the risks of all types of birth and then allowed to choose. So for example go in the labour naturally and if laboured unsuccessfully for x number of hours go to c section

The vast majority of stillbirths are caused by factors other than labour. Growth restriction, placenta problems, maternal factors such as smoking. More money, research and time needs to go on the antenatal identification of babies at risk, and appropriate actions taking place when these factors are identified.

There is an argument that inducing everyone at 39 weeks would eliminate all stillbirths at 40 weeks and beyond. But thats not without it's own risks. Inductions are not safer for mum and baby that natural labour.

My MLU is in the same building as the consultant led birthing unit. It’s actually on the floor above. This for me was brilliant and reassuring that I was only a lift ride away from help but also got the midwife led birth I wanted.

I had 2 DC's. One in a hospitals delivery unit and another in an MLU. The MLU was by far a much better experience and I experienced a number of failings at the hospital. I think a lot of that is to do with the bed ALand staff shortages.

My birth at the hospital was my first baby. First I had 6 failed attempts at inserting an IV. One of those attempts ended up in them leaving it filling fluid in my hand as it was in incorrectly. They didn't realise until I bought it to their attention. I was left alone for most of my labour. No midwife came to check on me for 2 hours. In that 2 hours I had gone from 2cm to 6cm dilated. I had to send me DP out to insist things were progressing and I needed assistance and pain relief ASAP 3 times before they bothered to check on me. By this time it was too late for any pain relief other than had an air. When my son was finally born, he needed additional oxygen as he had been stuck in the birth canal and I couldn't push him out (he was back to back). They wouldn't listen to me and kept insisting I push (I pushed so hard that all the blood vessels in my face burst) before they finally bought the doctor in to assist.

At the MLU, I had a lovely room to myself. It was also part of the hospital so if anything happened and you needed to transfer it would be very quick. I had a bed, pool, some relaxing oils burning and a midwife present for the whole of my active labour. The whole experience was so much calmer and I can't stress how much of a positive effect that had on me in labour. They monitored baby's heart throughout as they would do in hospital. I felt much more in control and was listened to. My birth (although obviously painful) was fantastic. I had a midwife on hand to give me the gas and air when I needed it and guide me calmly through the labour. When my daughter was born they allowed me to hold her on my chest for half an hour and let her find the breast before they insisted on taking her to be weighed. That skin to skin time was amazing and I'd have loved to have been able to have it with my son. I ended up needing no stitches and just had a graze.

The midwife told me that the reason most women are me up needing stitches and having tears is because the hospitals try to rush the labour. They tell you to push constantly as hard as you can but that actually, you should be doing tiny pushes in between contractions (which she advised me to do during labour) to stretch the skin and help prevent tears. This makes sense to me.

All in all I loved my birth and I felt much more looked after the second time!

These assertions are simplistic and not evidence based. Consultant-led units and extra scans do not clearly improve outcomes. What you say underlines that people need to make I formed choices about what they feel is best for them.

OP, you n Ed to study statistics and look at midwife led births as opposed to highly medical “cascade of intervention” births.

I think you will get a shock....it’s why America has such high rates of neonatal mortality,

Third trimester scans yes.
Getting rid of MLUs no.
They can be brilliant places to have a low tech well supported birth when you are low risk and don’t want a highly medicalised environment

YABU. Totally unworkable in rural areas, and in any case there are not half enough doctors. And doctors already have too much to do.

I've had 4 children, my first in a midwife led birth centre, not attached to a hospital, and the other 3 at home. Not a hippy bs cabdkw in sight, but I was happy, calm and comfortable. I hate hospitals, and don't feel they are a place for natural child birth, I would incredibly stressed and anxious if I were made to have my babies in one, which is far more of an issue in my eyes.

I certainly cannot see the issue with MLUs in hospitals. Surely they are a great idea, as they keep costs down, provide exactly what most low-risk women want and need, and everything else is at hand if it’s needed

I think the issue is lack of funding. When the MLU opened at our local hospital they did not have enough money to staff it adequately. So midwives and HCA's were moved from the hospitals Maternity Unit, leaving their labour ward short staffed. So while they were as you say providing what low risk women want, this was to the detriment of women and babies who are high risk.

Third trimester scans would be good. I am guessing the UK has so few because the only ultrasound machines are in hospitals and those are the ones which need to be used for every instance of ultrasound, meaning it's hard to get an appointment. I didn't realise until I came abroad just how much ultrasound is used here compared to the UK - every GP surgery has one and many specialists (gynecology, urology) have more than one. I find it quite puzzling actually - they can't be that pricey surely that we have to restrict them to hospitals? Most of the machines here seem to be computer software on a standard desktop computer. Perhaps it's the cost of training for a sonographer?

OP, you n Ed to study statistics and look at midwife led births as opposed to highly medical “cascade of intervention” births. I think you will get a shock....it’s why America has such high rates of neonatal mortality

That's a pretty big claim.

I'm afraid I haven't the time to respond in full to your post op. However look up the word 'iatrogenesis'

“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”

I think you’re making sweeping judgements based on your individual experience OP.

I attended NCT classes and found them great. They unapologetically had a focus on breathing, relaxation and non invasive pain relief methods, but I found that very balanced views were given and also as the course progressed, our teacher was very much led by the group members. So, one member who had had a previous birth with epidural was quite keen to discuss epidurals as she thought she may want one with her second birth too. So, one session there was quite a focus on more medicalised hospital birth, with anaesthetist there.
I had my first baby in a stand-alone MLU and although it was obviously very painful, I could not have been better supported. It was a safe, empowering environment.
If I had booked into hospital from the outset (which for me was a lot further from home then the MLU) I may not have bothered with NCT classes as I suspect I might have assumed I would have a more medicalised birth and less of a benefit from the breathing and relaxation; Although having said that, hopefully it would have still been useful. I don’t think you can blame the NCT though for acknowledging that many women do want as few interventions as possible and want to birth in a homely environment. I needed a CS second time round and then a VBAC for third baby (obviously in hospital this time as I was now higher risk.) consultant care and hospitals have their place, absolutely, but the MLU was undoubtedly the most supportive environment for a low risk situation

You say "I'm not talking about widgets, I'm talking about human beings"... This is the NHS. The staff on the ground (doctors, nurses, midwives) care tremendously, but the people making the budgets don't give a shit. And there's less and less money, and the system is gradually getting worse. There's no way they would make a change like this now, no matter how good it would be for patients. It's all about the money I'm afraid.

I just hope that first time mums who are classed as low risk and choose to give birth at these standalone units really understand that if they get into an emergency they are potentially putting themselves and the life of their baby at risk and there's no guarantee they will get to hospital in time. Emergencies can and do happen to anyone, even those classed as 'low risk' and not just people with a high BmI. Nobody who has had a good experience could ever understand that and will find it easier to accept a more utilitarian approach to the availability of good maternity care in this country but for many people who have had babies who have needlessly died or become sick / injured because the level of care at these places isnt good enough its a bitter pill to swallow. Knowing what can and does happen at these places makes me worry about other mums going to them,i cant just say well it worked for me so it'll work for most other people and tough luck for the rest because that's not the experience i had. Even many of the emergency staff i encountered expressed similar opinions about these units and their dismay at just how far the government is cutting levels of care. I just hope that people are as informed as they should be before choosing to go there and really consider how they will feel if their midwife gets it wrong and they are suddenly faced with a life or death scenario and realise they arent in the best place.

patients. It's all about the money I'm afraid.

Today 14:00 Orangecandycane

‘I just hope that first time mums who are classed as low risk and choose to give birth at these standalone units really understand that if they get into an emergency they are potentially putting themselves and the life of their baby at risk’

Nasty scaremongering post

I researched all the options with my dc1

It was either local MLU, big regional hospital 25 miles away or home. Information about all options was available. The stand-alone MLU had an exemplary safety record.
I did come across a few other first time mums- to-be at the time who raised their eyebrows at me and said ‘you’re brave’ in a slightly sceptical way. However, that was clearly to do with them choosing to be in hospital and wanting access to more pain relief options (entirely their choice) Not anything to do with actual fact.

No way would I have put any of my children at risk. I needed a cs for dc2 so hospital it was. And VBAC for dc3 - so again, hospital. The best birth experience by a mile was the MLU