Low risk women/better birth facilities - unfair?

[Glassofshloer]

When DD was a baby we attended a breastfeeding appointment at my local stand-alone birth centre and WOW! To say it was gorgeous is an understatement - double bed, huge whirlpool bath thing, fairy lights and bouncy balls in every room. Looked like the Ritz compared to the tiny, dimly lit room on the CDU where I gave birth. Just a bed and some wall stickers of flowers

AIBU to think this is unfair on high risk/Consultant led women? And that we all deserve equal facilities, high risk or not? Fully prepared to be told IABU!

@Franca123

At the NICU my son was in for nearly two weeks, each bay had a high backed reclining chair with adjustable foot rest. Not beautiful but perfectly functional to sit for hours following a c section. The beds on the postnatal ward also had them so the partners can get a half decent night's snooze.

Compared to my experience that sounds absolutely incredible and would have made all of the difference.

It certainly speaks to the point of "it doesn't take much."

@AngeloMysterioso

Not that it matters but what does CDU stand for? I don’t recognise it…

Sorry, Central Delivery Unit, I should’ve said

They also had a 'parents' room where you were eligible to recieve hospital meals. Tea making facilities, microwave etc...... I burst into tears in the corridor one day (from pure exhaustion if I'm honest) and was ushered into what was best described as a crying-room with a box of tissues. No complaints on the NICU. They were incredible.

Sounds fantastic @Franca123

That’s exactly it, the small(ish) touches - proper comfortable chairs and beds, plenty of natural day light, cots that can be pulled up to the mum’s bed so she can reach baby without getting up, enough peace to have a decent sleep after labour.

It’s all standard care when you think about it, not anything fancy or lavish. It’s depressing how many people on this thread think we are being selfish and precious for wanting it,

@Glassofshloer

It would be amazing if every postnatal room could be private however this would then mean less beds. Hospitals are at breaking point as it is, if there are less beds they would then have to accept less births. The only way around this would be to build new hospitals which isn't a realistic expectation

But there’s money to build fancy new MLUs with excellent facilities despite the fact less than a fifth of mothers give birth in them? There’s money for the emergency ambulance transfers for the 50% of first time mums that need to be taken to CDUs from stand-alone birth units? There’s money to staff these underused units 24 hours a day? What you’re saying makes no sense.

Do you mean less than a fifth of mothers overall or fifth of mothers who start on an MLU finish on there? My local hospital for example there are 5 rooms on the MLU and I believe 12 delivery rooms. So already only a 1/3 would be able to go on the MLU based on room availability reasons alone. Also not every hospital has an MLU, looking online at my 7 closest hospitals only 2 of them have an MLU so your figures of a 1/5 are probably about right, again based on capacity reasons alone. If you mean less than a fifth of those that start in an MLU get to deliver in there where did you get those figures from, I've had a look online and found info from NICE (based on 1000 births) where the % of transfers from freestanding units was 9.4% and for units in a hospital was 12.5%, far less than the over 50% that you have stated require ambulance transfers. If you have found information that disputes otherwise could I ask you to post the link please as I would find it interesting to look at. There is no evidence that units are underused, if anything I know people who weren't allowed into my local MLU as it was at capacity.

I said 50% of first time mums @mummyh2016

Overall transfer rate is 30% (first & second+ time mums, and that’s only transfers in labour, not afterwards)

Link here

assets.nhs.uk/prod/documents/Birth-options-first-baby.pdf

I agree, if you had a straightforward birth previously you are indeed very likely to have another straightforward birth, and this should absolutely be taken into consideration for subsequent births.

There is also the variable of are high risk women likely to have a harder and more complicated birth because they are not offered the facilities that can make managing the physical challenges of child birth easier.

Eg. The NICE guidelines say every woman should be offered a water birth as it reduces pain, tearing and improves mobility. The reality is that most high risk women won't get offered one because most delivery suites only have one pool and very few hospitals have waterproof wireless monitors so even though we KNOW laboring in water improves outcomes we don't have the facilities to provide it.

Of course they’re underused.

I follow Southmead hospital on Facebook.

Their recent stats show only 3% of women gave birth at their freestanding Cossham unit and 87% in the CDU, despite the fact Cossham has 4 birth rooms and the CDU 10.

I’ve attached a photo for comparison of the rooms. Is this an acceptable difference for 2 women who both pay their taxes equally and deserve the same level of comfort and care?

You had just had major surgery, and needed to stay on a unit with doctors available. Which they aren't on an MLU. Add to this the only pain relief they can give on an MLU is gas and air/paracetamol/pethidine which I doubt would be enough for the after effects of an EMCS.

Standard pain relief after a section is bog standard paracetamol and ibuprofen, with a dose or two of oramorph if you're struggling. None of which you see a doctor for, and if your did, they are literally next door, in the situation we are discussing. Maybe have the first night on the hospital ward with more assistance on hand, but the second night, if still in, surely you could be in the MLU bit, as a transition before home.

I'm not aware of the postnatal facilities at our MLU as it was covid times when I had my son so they shipped us out 6 hours post delivery.

I do think it would reduce PND if postnatal facilities were more "family focused" with a lounge style area for visitors, more privacy between bays and a reasonable visiting policy so people aren't forced to deal with other peoples families on the ward when they are trying to recover.

Birth partner only visiting on the ward, any extra family who want to nose at the new baby could come to the postnatal lounge where they won't be annoying anyone who is trying to sleep!

@Moonbabysmum If you have an EMCS under GA they don't have time to give pain relief before surgery like a planned section, you get fentanyl (?) on a drip and you get to press the Magic Button every few minutes for a shot. I can't remember the interval, I was as high as a kite. After the first few hours, you revert to paracetamol/ibruprofen.

[quote Glassofshloer]I said 50% of first time mums @mummyh2016

Overall transfer rate is 30% (first & second+ time mums, and that’s only transfers in labour, not afterwards)

Link here

assets.nhs.uk/prod/documents/Birth-options-first-baby.pdf[/quote]
Thank you for the link. It states 36-40% depending on whether its a freestanding unit or one attached to a hospital. Higher than the figures I found yes but its not over 50%. Reading your previous post people would jump to the conclusion that you're more likely to get transferred whereas actually you're more likely to be able to stay on the unit.
Not every MLU unit is underused. Like I've said previously the one I use isn't and sometimes people are turned away as they are at capacity. Taking away the mood lighting/double bed/birthing pool for those that want to and are able to labour on a birthing unit doesn't mean it will then be available for those that are having to give birth on a consultant led unit. It will just mean the birthing units get used less than what they are and more pressure will be put on the consultant led unit. The NHS are trying to ease pressure on the busy labour wards and delivery suites by offering these things to entice people away. I was unlucky enough last week to end up at maternity triage in the middle of the night, and I was put on a two bed bay with a lady in labour, the curtains were closed but I could hear them say she was 7cm. She should not have been left to labour at 7cm on triage, it was completely the wrong place but they didn't have a bed for her on delivery, she ended up being moved around an hour after I arrived. I really felt for her, and the staff as they were clearly rushed off their feet. Can you imagine how long she would be left to wait if there were less rooms on delivery as people had complained they want a double bed and a birthing pool in every room? Which for the umpteenth time isn't necessarily available in every room on an MLU anyway.
I'm out anyway - no doubt this post won't get read properly anyway and you will pick and choose which bits you want.

@Moonbabysmum but if you're on an MLU and you need to see a doctor you get moved to the consultant led unit. Ours don't allow you to transfer back afterwards, and if for whatever reason you need to stay in longer than a few hours they will normally move you to the main postnatal ward.

I think better maternity care that isn't woefully underfunded and understaffed would be the place to start, rather than trying to make fancy MLU's to coerce women into thinking that the NHS allows them any kind of decent choice.

I don't personally like the thought of a MLU that isn't attached to the hospital. Things go wrong all too frequently.

I don't think it's much for women to expect a delivery room that allows for necessary medical equipment when necessary, but can also be a bit more relaxing with lower lighting, a bit of space to move around or whatever. Women would have better experiences with constant 1-1 care with a caring, competent midwife, throughout their labour and birth, and immediate access to consultants etc when required. Women would have better experiences if they were listened to and taken seriously, and offered proper pain relief at an appropriate time. And if they were given a proper choice about how they give birth- ELCS when requested without having to jump through hoops (and no bloody forceps unless there is no other option). Women and babies need proper postnatal care with the option of a single room and with no partners/visitors allowed on the ward at ridiculous times- there needs to be far more support from staff rather than women relying on fathers and visitors.

I don't see what is unreasonable about any of that. It just actually reads like a reasonable expectation to have in 2021 in the UK. Maternity care is not good enough and if it were men you can bet it would be much better.

Maternity care is not good enough and if it were men you can bet it would be much better.

The first part of that sentence is absolutely correct. I don’t think the second is, you should see the standard of care on wards for the elderly.

@HairsprayBabe

I'm not aware of the postnatal facilities at our MLU as it was covid times when I had my son so they shipped us out 6 hours post delivery.

I do think it would reduce PND if postnatal facilities were more "family focused" with a lounge style area for visitors, more privacy between bays and a reasonable visiting policy so people aren't forced to deal with other peoples families on the ward when they are trying to recover.

Birth partner only visiting on the ward, any extra family who want to nose at the new baby could come to the postnatal lounge where they won't be annoying anyone who is trying to sleep!

Fully agree with all of this.

At my hospital’s MLU you stayed in the delivery room until discharged, with your birthing partner, with en-suite facilities, beds that can actually be slept in.

The “normal” post natal wards were absolute hell. 4 bays, separated by curtains. Perhaps it just seemed like it, but visitors seemed to be allowed all the time. One toilet shared among those 4 patients. Their visitors were not supposed to use it but the fucking arseholes visiting the women in the ward I was on did. People sometimes behave like curtains are walls. They are not. I felt extremely vulnerable. It was just horrible.

Clearly the expectation is that mothers and babies are discharged from the MLU more quickly, if it’s more than a day they’d be transferred to postnatal. I would never have been a suitable candidate, it’s not bitterness. But some kind of medium ground where “high risk” mothers aren’t written off as failures who should be happy with paint peeling off the walls and waiting 2 days for shower would have been nice.

I am both eternally grateful to the doctors that delivered both of mine safely and insanely jealous of friends and family who gave birth in a water pool with relaxing music and somewhere nice to recuperate afterwards. Doesn't have to be either or. Op is correct that we could do much better for high risk women.

@Blossomtoes

Maternity care is not good enough and if it were men you can bet it would be much better.

The first part of that sentence is absolutely correct. I don’t think the second is, you should see the standard of care on wards for the elderly.

I disagree with this blossomtoes- elderly care is an entirely separate and depressing situation within the NHS. I've seen from the care both male and female elderly relatives have received to see how good, and how bad it can be. I think there are very separate issues at play.

I think that there is inherent sexism within the NHS and that maternity care suffers because of it. These articles make for interesting (and blood pressure raising) reading:

https://www.google.co.uk/amp/s/amp.theguardian.com/commentisfree/2021/jul/04/as-long-as-sexism-lies-at-the-heart-of-childcare-babies-and-women-will-continue-to-die

https://www.independent.co.uk/healthandd_wellbeing/women-pain-underestimated-male-stereotypes-b1828978.html

@emeraldcity absolutely, high risk shouldn't mean you have to put up with unpleasant conditions, it would cost very little to install controlled lighting, somewhere for music to play from and include active birthing resources like balls ropes and stools.

Birthpools are more complex because they take up more space but at the very least every hospital should be able to offer everywoman a shower for pain relief, and waterproof wireless monitors if needed.

Additionally more antenatal education is needed, what will happen in an induction and why. What your choices are and the pros and cons of accepting or declining. We are disempowering women from the get go because we are told "we will induce you on this date because of x" rather than "we can offer you an induction if you would like to choose one, we have these dates available, your other options are xyz here are the risks and benefits of induction, here are the risks and benefits of your other options" and actually giving women time to make a fully informed choice.

Deciding on an induction date/timeline isn't a particularly time sensitive activity, if it was they would be reccomending and immediate EMC, but so few women are given a chance to actually think about what is best for them and make a choice without being pressured one way or another.

Surely you understand why you couldn't go back to the MLU though? You had just had major surgery, and needed to stay on a unit with doctors available.
I didn’t want to go back to the MLU. I wanted to stay on the doctors unit and have the same standard of room that I had in the MLU. My need for those facilities was not lesser because I was being attended by a doctor instead of a midwife.

It would be amazing if every postnatal room could be private however this would then mean less beds.
Well then by that token there shouldn’t be private rooms in the MLU either. Because that means fewer beds. If they’re going to offer private rooms they should be for everybody or nobody.

I think that there is inherent sexism within the NHS and that maternity care suffers because of it

If that were true maternity care would always have been poor. There was a time when it was properly staffed. Women stayed in hospital for a week for post natal care and returned home properly rested. There were enough staff for women not to need to be supported by their partners.

So because it was better at one time, it means that sexism isn't one of the causes for why maternity care is poor today?

What reasons would you give for an area of medicine that solely affects women being so terribly underfunded, if not sexism?

I thought those articles summarised a lot of the issues very succinctly.

@Hamtonn

I'm not sure how long women stayed at the MLU in your trust after giving birth but in ours you don't get a MLU postnatal stay, you get 6 hours in the room you deliver in then either home or to the normal postnatal ward if they need to keep you in for any reason. It is the same on the L&D ward, 6 hours recovery in the room you birth then either postnatal ward or home, so there is no double standard in terms of vaginal deliveries for postnatal stays, but the MLU rooms are just generally nicer for those 6 hours. Admittedly I don't know what the process is for a csection though.

I agree private recovery rooms should be open to everyone, but you don't get one for "recovery" on an MLU they clear you out as soon as they can - especially with covid.

I don’t class the things you’ve listed as ‘better’ facilities I think women have been duped into thinking they now have some wonderful, holistic birth option in midwife led units.

What’s actually happened is government have massively cut costs and fooled you into thinking that you’re having a better experience with candles, aromatherapy etc when you’re actually dicing with death for you and your baby….giving birth without immediate access to an obstetrician and paediatrician…..for the majority of low risk women it’s probably fine for the few where themselves and / or baby requires emergency care you’re relying on an ambulance getting you to a doctor in time….a midwife does not have the skills to help.

The point being you have no idea if you’re really ‘low risk’ until you’re holding your baby in your arms after a safe, uneventful delivery.

Talk to some of the newborn emergency transfer doctors / nurses or the doctors in nicu and you will often get a different view on midwife led units, in my experience.

@CupcKes10

I don’t class the things you’ve listed as ‘better’ facilities I think women have been duped into thinking they now have some wonderful, holistic birth option in midwife led units.

What’s actually happened is government have massively cut costs and fooled you into thinking that you’re having a better experience with candles, aromatherapy etc when you’re actually dicing with death for you and your baby….giving birth without immediate access to an obstetrician and paediatrician…..for the majority of low risk women it’s probably fine for the few where themselves and / or baby requires emergency care you’re relying on an ambulance getting you to a doctor in time….a midwife does not have the skills to help.

The point being you have no idea if you’re really ‘low risk’ until you’re holding your baby in your arms after a safe, uneventful delivery.

Talk to some of the newborn emergency transfer doctors / nurses or the doctors in nicu and you will often get a different view on midwife led units, in my experience.

All of what you've said is something I agree with.

It just wouldn't take much to help higher risk women feel more empowered and comfortable, that's all.

I was high risk throughout my pregnancy and began my induction/labour on a high risk ward. I have to say the rooms were massively spacious and had different lighting and birth balls in the room, as well as facilities to play music and things. However I developed complications during labour and was moved to a sepsis risk room and It wasn't nice at all, I was small and cramped and bright and a bit scary tbh. I didn't particularly care at that exact moment because I was terrified but thinking about it it is strange. I'd have disagreed with you if I hadn't had seen the other birthing rooms on the ward but I suspect like everything on the nhs it's pretty much a postcode lottery 🤷‍♀️