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!

@Glassofshloer

Can somebody please tell me what the votes are up to? I can’t see them for some reason.

51/49 YABU.

Actually I have seen a lot (by midwives ect) about the birth environment being important for labouring women and the progression of smooth labour. Labour wards can be very much designed with purely the healthcare providers in mind and convenience which is fine but often the bright lights, lack of privacy, noise, bed and stirrups as default place for the woman can be counterproductive to the process of labour.

I have seen many, many midwives and hcps say that a balance would be far more beneficial but I guess ultimately it’s down to cost.

I do think maternity care is very undervalued. Even many of the responses here are of the opinion that as long as a baby is safely (in the physical sense) delivered then that is the only thing that matters. I think the fact that 1 in 3 women leave hospital with a degree of trauma, and the statistics around mental health, depression, suicide in the postnatal period means more attention needs to be paid to how women experience such an important and vulnerable time.

I do think maternity care is very undervalued
I think that lack of decent maternity care is costing a shit ton later on in terms of dealing with complaints, trauma and PTSD.

Thanks @Blossomtoes

@Hamtonn

I do think maternity care is very undervalued I think that lack of decent maternity care is costing a shit ton later on in terms of dealing with complaints, trauma and PTSD.

Not to mention corrective operations, prolonged hospital stays & our bad stillbirth rate

Regarding the stats of births, I gave birth last October in the MLU (floor next to the medical floor at the hospital) which was definitely busy when I was there. This year due to staffing issues only the medical floor is open most of the time, as they only open the MLU to any women when they have sufficient staff - and they are severely short staffed. So the statistics make it look like they don't have (hardly?) any MLU births! If I was due this year my quick straightforward birth would be a different statistic, and a floor of "nicer" rooms are all sitting empty one floor away.
Btw I had neither a water birth or double bed but I did have my own room. I did see a pool in room adjacent but it certainly wasn't as "lovely" as I think some are possibly!?

We don’t have a bad stillbirth rate. According to SANDS it’s at a record low and it’s about in the middle of a comparison of European countries. It’s disingenuous to make a correlation between maternity facilities and stillbirth. If I’d been in the maternity equivalent of The Ritz, my baby would still have been born dead.

You can choose and MLU even if you are high risk.

You just need to ask for an appointment with the head consultant midwife in your trust and ask for an "out of guidelines care plan" to be written for you.

The AIMS and NICE guidelines reccomend giving ALL women a choice in where they give birth, home MLU or labor ward, and even theater for elective CS but women don't know they have a choice in the matter.

Know your rights and do your research would be my advice, and don't blindly agree to the first option you are presented with if it isn't what you want.

Healthy mum and baby isn't the only goal, the birth experience and environment does matter massively.

The only place of birth I actually picked was the homebirth.

The midwife led was because labour was full I wasn’t meant to be in there, the hospital pool birth was because there was no more community Midwife’s they could send out.

Midwife birth, the room was ok I guess, then shipped off to a shared ward still. Home birth was at home in a house I’d just moved into still surrounded by packing boxes. Pool birth I went home straight from the birth basically.

The pool birth room was nicer than the midwife room by a long shot but it made zero difference to my experience it’s the midwifes themselves that make the difference.

My first birth is what made me want a homebirth due to the attitude of the midwifes on ward.

There’s also a discussion to be had about the use levels of the different units. In our area an overwhelming number of people end up giving birth on the delivery unit rather than in the MLU. (They don’t offer info on how many people transfer because of medical emergency, need for pain relief etc.) Like elsewhere the MLU facilities are newer and offer substantially more in the way of space, comfort, privacy - and toilets!

I was considered high risk because of my weight and I was lucky that my MLU was in the hospital directly below the labour ward. I appealed for my delivery to be in the mlu and I was successful.
It was important to me because I had set ideas about how " non medical" I wanted my labour to be. (I know...)

But it was lovely and there was a definite difference in ambiance, mood and approach. I was very lucky to have the option for both of my pregnancies.

@HairsprayBabe

You can choose and MLU even if you are high risk.

You just need to ask for an appointment with the head consultant midwife in your trust and ask for an "out of guidelines care plan" to be written for you.

The AIMS and NICE guidelines reccomend giving ALL women a choice in where they give birth, home MLU or labor ward, and even theater for elective CS but women don't know they have a choice in the matter.

Know your rights and do your research would be my advice, and don't blindly agree to the first option you are presented with if it isn't what you want.

Healthy mum and baby isn't the only goal, the birth experience and environment does matter massively.

As lovely as that will be I can’t imagine they will accept me under any circumstances as I will need to be induced

@Hamtonn

I got tea and toast on the ward (after c section) after I’d given birth. I thought everyone did. It was the middle of the night, they obviously couldn’t be arsed. I wasn’t fed until 15 hours after my c section. If my husband hadn’t brought me food I’d have become seriously unwell.

Me too - I was told I couldn't eat for 6 hrs post emcs as it wasn't safe given the internal rummaging which had occurred! 🤢

In an out of guidelines care plan you can ask for a minimal intervention induction.

It would go something like pessary in then you can go home till contractions start, if they don't start after 24hrs you can ask for another pessary and a wait or ARM and wait 24hrs. Once your waters are broken you have less flexibility though however - as long as you aren't on the syntocinon drip there is no need for you to actually be on the labor ward. If you have the pessary/ARM and are getting a good pattern of strong contractions you can absolutely go on the MLU.

Also depending on why you are being induced you can absolutely safely decline continuous monitoring as long as you aren't on the drip as the evidence doesn't suggest it leads to improved outcomes for mother or baby, some desels are normal in labor but they can make consultants more twitchy.

Speak to your head consultant midwife, see if this is something they would be happy to support in your case - the NICE guidelines also reccomend individualised care plans for all women you have options.

@HairsprayBabe

In an out of guidelines care plan you can ask for a minimal intervention induction.

It would go something like pessary in then you can go home till contractions start, if they don't start after 24hrs you can ask for another pessary and a wait or ARM and wait 24hrs. Once your waters are broken you have less flexibility though however - as long as you aren't on the syntocinon drip there is no need for you to actually be on the labor ward. If you have the pessary/ARM and are getting a good pattern of strong contractions you can absolutely go on the MLU.

Also depending on why you are being induced you can absolutely safely decline continuous monitoring as long as you aren't on the drip as the evidence doesn't suggest it leads to improved outcomes for mother or baby, some desels are normal in labor but they can make consultants more twitchy.

Speak to your head consultant midwife, see if this is something they would be happy to support in your case - the NICE guidelines also reccomend individualised care plans for all women you have options.

Thank you that’s very interesting.

With my first pregnancy I didn’t pay too much attention and went with the ‘doctors know best’ attitude. But looking back there’s a lot that makes me

I really don’t see why after ARM, regular strong contractions and going from 1-4cm dilation in 4 hours they decided to hook me up to the drip because there ‘wasn’t enough progress’. Looking back I think they were just trying to hurry things up to free the room up. This makes me quite cross now as I ended up with the inevitable lying on the bed/epidural/long pushing stage etc which I think could’ve been avoided had they just left me to it and had more patience.

Now I’ve had one VB I feel more confident that my body knows what to do, and hope next time I can insist upon a gentler approach because the drip was, quite frankly, evil.

I think that they aren't staffed 24/7 and empty, MLU midwives are pretty much constantly called back to cover labour wards and so the units close really frequently.

Considering you have had one "successful" induction you are very very likely to have another birth with good maternal and infant outcomes.

You are right, and your HCP did not follow guidelines last time as syntocinon management should only be considered after ARM if contractions are not strong and established after 6 hours, and even then you are absolutely able to wait longer if that is what you want. A 1cm per hour dilation rate is bang on what they would expect so you were in established labour and they should not have augmented with the drip.

Unfortunately some trusts just do their own thing that make life easier for the HCP and not the mother. This is largely due to being underfunded.

If you want an MLU birth you might have to fight for it but it doesn't mean it is totally out for you.

Good luck!

P.s regardless of how long ago your last birth was I would put in a complaint about them not following the IOL guidelines because the more often it is recorded the more likely it is to change!

@TheWayTheLightFalls

The other point I don’t see being made here, unless I missed it - crowded, chaotic wards -> stress on women in labour -> less likelihood of things progressing naturally -> higher risk of interventions and ultimately CS. I expect it’d be a lot cheaper to make wards more amenable than to staff the doctors, consultants, anaesthetists etc resulting. No I don’t have stats but I’ll happily go dig around for them once I’m off the sodding postnatal ward!

This is a really good point.

Looking back at my own birth, I’m fairly certain I had the syntocin drip to hurry me up & get me out of the room. But the drip meant I asked for an epidural, so then needed use of anaesthetist & I believe once you have an epidural a midwife has to stay with you 24/7 as well.

It just all sounds like paying double later to avoid paying now, if that makes sense.

@Hamtonn

I was admitted to a lovely midwife centre with individual rooms, private shower and toilet, double bed and a sofa for guests that pulled out into a sofa bed for the father, my own tv and music system, and access to a shared kitchen with coffee facilities and free ready meals to use as required.

They rushed me out of there for a c section. After I left the theatre they put me on a ward with 15 other women and their partners, only separated by curtains. No privacy or safety. Constant noise. A single hospital bed and chair, nowhere for my husband to sleep. No tv, no music, no sofa. A single shared toilet and shower which meant I had to repeatedly make the walk of shame past strangers whilst wearing a hospital gown and leaking blood. No kitchen facilities, not even for a cuppa never mind food.

I gave birth at 1am and my husband said to the nurses if you can’t provide food and drink can you at least take me back to the midwife centre to use their kitchen and get a ready meal? They said no. He had to go out and fetch me a takeaway!

Honestly I see no reason why I couldn’t have been taken back to an equally lovely private room after my c section. I felt like a second class citizen. I’d understand if the NHS didn’t provide that level of care for anyone, but they are clearly able to offer it in the midwife centre. It’s incredibly unfair.

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. 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. 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. MLU's can offer facilities such as birthing pools and double beds (although can I add at my local MLU they don't have double beds and only 3 out of 5 rooms have a pool) purely down to cost reasons. A birth on the MLU is cheaper for the NHS so they want to try and attract as many people to give birth on there as possible. My main reason for choosing the MLU is because I didn't want to go on a ward afterwards. If those on an MLU don't have access to these things, and it is exactly the same as the consultant led unit and I would have to go on a ward afterwards there is nothing to incentivize me to stay on an MLU - I'd be opting for the consultant led unit where to be frank the drugs and the doctors are.

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.

Many MLUs aren't open at the moment at all due to funding and staff shortages, so some MLUs are not being used because there is no staff.

The problem is two fold, firstly far too many women are labeled high risk unnecessarily and "can't" use the MLU but then go on to have a perfectly normal uncomplicated vaginal delivery. Secondly the maternity system is underfunded so too many women aren't getting the care they need at the right time and end up transferring when they might not want/or need to.

I have a LOT of feelings on this topic.

I gave birth in a trust with an absolutely glorious new MLU (well, it was new at the time) which they were quite right not to let my high risk self anywhere near, no question.

However, it would be neither obstructive nor difficult for the clinical sterility of the labour ward to be softened a bit. They couldn't even get me a birthing ball to sit on. I wasn't asking for the moon! If there's anything that made me feel less "in control, respected, and capable" (a quote from a MLU patient they use in their marketing copy) it was how the labour ward was so clinical. And don't get me started about the special care baby unit -- you can visit your baby but it's made as uncomfortable as possible. Recovering from an emergency c-section and hauling myself down there, to sit bolt upright in a horrid little plastic chair while I tried desperately to hold my newborn while in severe pain is not one of my finest memories.

I do not wonder why PND was so very, very bad after the birth of DS2. I absolutely believe the conditions contributed.

By contrast I have also given birth abroad twice, both times with the same risks, and both times in labour wards that are nowhere near as disempowering as the UK. It really is as simple as changing some visual aspects control of the lighting, different furnishings, etc. and considering the mothers giving birth in these circumstances as human beings and not clinical cases first.

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.

@HairsprayBabe

Many MLUs aren't open at the moment at all due to funding and staff shortages, so some MLUs are not being used because there is no staff.

The problem is two fold, firstly far too many women are labeled high risk unnecessarily and "can't" use the MLU but then go on to have a perfectly normal uncomplicated vaginal delivery. Secondly the maternity system is underfunded so too many women aren't getting the care they need at the right time and end up transferring when they might not want/or need to.

I wonder if rather than focussing on medical conditions/age/BMI as an independent precluding factor, they should take an overview of previous births and how they went, etc.

Like I said, it seems mad that a first time mum with a 50% chance of transferring can use the MLU, but a mum with previous straightforward births but a high BMI can’t.

But I’m just playing amateur hospital manager again!

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