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.

But sorry to go over the same thing, are you asking for better care IN LABOUR? That’s different, entirely different as a research and policy agenda from stillbirth.
Still birth is not equal to babies left sick or injured.
Most stillbirth happens for complicated reasons related to maternal health, placenta etc that would have no bearing on whether the mother birthed in a MLU or not.

You don’t like MLUs after your recent experience, I get that. What though does it have to do with stillbirth? There is some really excellent work being done to reduce stillbirth and not a SINGLE one of those involves a recommendation to close MLUs because there is no significant correlation between the two.

Also referring to the OP, afaik the stats about first time mums transferring to hospital from MLU- this figure includes all the mums who transferred for more pain relief. So not a medical necessity but a choice. So that does rather skew the stats

Third trimester scans are definitely something I think should be introduced. I live in Spain and it’s standard to have a third trimester scan. You also have appointments at the hospital at 39 and 40 weeks to be hooked up to an ecg machine for about 45 minutes to monitor babies heart rate and check they react to outside stimuli. This is then followed by an appointment with an obstetrician who again does a scan to check the cord, amniotic fluid and babies position.

Maybe if the U.K. invested in the extra scan/monitoring in the third trimester MLUs would be a less risky option as any issues that wouldn’t previously have been picked up would be seen and women would be able to make a more informed decision on where to give birth.

I was high risk in both my pregnancies, my midwife care in both of them was second to none, with the exception of one bank midwife who was a completely bitch. The registrars I saw with my second pregnancy were atrocious the midwives were amazing.

I complained about the registrars and complimented the midwives.

I had extra scans from 36 onwards so do think that would be an improvement.

I agree with OP. Just surprised it isn't only me who has this opinion. I've read a lot about how crap midwives are, how obstructive and even sadistic in their refusal to call doctor/give pain relief etc.

all the mums who transferred for more pain relief. So not a medical necessity but a choice

Think about that a bit more.

I work in my local maternity service - we have two MLUs, one adjacent to an obstetric unit and one in the grounds of a hospital with no obstetric unit. Over 50% of first time mums get transferred, usually for pain relief.

Home births and MLU births in our county are rarely ever a factor in still births - there’s only been a couple in the last few years that have been related to women who started out in these settings. The criteria are extremely strict here. I think women should have the right to choose them if that’s what they want.

I transferred for pain relief only. If I hadn’t had been there, there’s a strong possibility my daughter and I would be dead.

all the mums who transferred for more pain relief. So not a medical necessity but a choice

Think about that a bit more.

Yeap. I have. Not a judgement, just a fact.

If you are in more pain than you can stand pain relief is not a 'choice'.

(Sigh)

Please don’t try to make an argument where there is none.

A woman may start off in a MLU and then decide that she wants more pain relief (a perfectly valid choice) and transfers to hospital.

My point is that if that woman is counted in the same group as women who are transferred on medical advice because the Labour is not progressing as it should (when the woman would not otherwise choose to transfer) then it somewhat skews the statistics. That is all.

I have a degree in midwifery and I chose home birth twice because I knew it was statistically the safest option for a low risk pregnancy. More medical intervention does not equal lower risk. It merely increases intervention, which reduces mothers satisfaction in the experience. Countries with high levels of medicalised childbirth do not generally have lower rates of infant mortality.

(Sigh)

Labour is certainly not progressing tonight.

Canigetarefund - exactly.

I had one in a MLU which was a good 30 min ambulance ride to the nearest hospital. Lovely, calm water birth with the full attention of 2 midwives throughout. Stayed for 3 days just because it was so nice there, and because I didn’t want to go home and cook!

Second birth, at a hospital. They were short staffed and didn’t check me at all until a midwife was finally available, 3 hours after I’d got there. No pain relief, still fully dressed, standing there screaming in pain. Dd was born 12 mins later. Luckily she hadn’t been in distress or anything because they wouldn’t have had a clue.

The first option was definitely the safer one.

Anything can happen during birth, low risk or not. I totally agree with the op. And yes to third trimester scanning too.

And honestly I can't say a good word about the midwifery profession based on countless experiences of rudeness, being talked down to, eye rolling, judgements all the way across to sadistic and selfish medical practice. Two of my best friends are midwives and I am sure they'd be different but I can barely bear to hear about their work.

More medical intervention does not equal lower risk. It merely increases intervention, which reduces mothers satisfaction in the experience.

Doesn't that depend on the intervention and what you're comparing it to? If you for example compare women who had an ELCS with women who wanted an epidural and didn't get one, the former will have had more intervention but do you think they'll be more satisfied? Equally, a woman with a homebirth and no intervention is likely to be happier overall about the experience than a woman who was induced and had forceps.

Countries with high levels of medicalised childbirth do not generally have lower rates of infant mortality.

Depends on the ones you pick. The US and France both have pretty medicalised birth compared to other wealthy countries (countries with the least medicalised births also have the worst maternal and infant mortality, but that goes without saying) and their stats look very different to each other. But of course, so are their birthing populations. It's very difficult to make international comparisons.

But if there's not enough staff for the main hospital, how is it ok to take even more away for a unit that will only be able to serve a minority of women?

Particularly as then the women with more issues receive even worse care as opposed to extra support.

Would a scan pick up issues with the placenta btw? Asking as my placenta was in absolutely dreadful condition even though I wasn't past my due date.

I agree with you but it isn't a popular view.

I've never understood why MLUs arent attached to hospitals anyway. That way you'd be able to easily access intervention in a speedy manner if you needed it.

If your midwife uses the word 'medicalised' you are in trouble.

I think you're completely wrong. I had 2 MLU births both of which required ambulance transfer after the birth (so would be in the transfer statistics) however the midwives in my local MLU are second to none and far more experienced imho than those who rely on obstetricians to take all of the decisions. My care was absolutely first rate and a decision I would 100% make again. The number of conditions requiring an emergency c section with no previous warning signs are actually very few and incredibly rare. The midwives in an MLU absolutely have to recognise warning signs and hence must monitor women in labour much more closely than in a hospital situation when they can rely on whipping the baby out in a few minutes so in theory don't need to monitor you so closely. I know which I prefer!!

I think this is a difficult one, women should have a choice and your proposed closing of all MLUs would be terrible for women in my opinion. I'm sorry you had something terrible happen OP, but you are dismissing all of those women for whom the 'hippy candles BS' means they feel in control of their births and are more likely to give birth safely and calmly. Bad things happen of course, and my heart breaks for anyone who has ever lost a baby or had something terrible happen, but childbirth is inherently risky and you sometimes can't control what happens, even if you have 20 doctors in the room. It's the worst fact in the world but sometimes babies are stillborn or don't survive and I don't think the changes you propose would fix that.
I agree that third trimester scans are almost certainly a good idea, but otherwise I think you are unreasonable. If I was low risk and an MLU wasn't available I'd feel almost like I had to have a home birth, which would defeat the point of your idea of banishing MLUs and midwives and only having doctors supervising birth in highly medicalised settings.

I've never understood why "unmedicalised" childbirth should even be the goal.