Closing smaller maternity units

[Asosbabe]

Who is making this decision? Surely this is where tax £s are well spent?

Why are we making it midwife vs Dr? Surely the best outcomes are where both work collaboratively together, knowing their own skills and boundaries and respecting the others. Births led by midwives, with obstetrics and paeds available quickly if needed.

I had 1 birth on a hospital based midwife led unit, 1 on labour ward. Both looked very similar - calm, midwife led, well supported throughout, laboured initially in water with both. No interference from drs until midwife deemed necessary.

I was a 'low risk woman', but when I needed the obstetricians to get baby out quickly as in distress, then I was very thankful that my midwife led unit was right next to a fully staffed labour ward with a NICU on site.

Midwife led units are brilliant, but need to be co located with consultant led care for the safest outcomes.

@Bushmillsbabe I agree. Co-located is the dream. What’s happening right now isn’t that though. Even women in alongside midwife-led units are being transferred across to the obstetric-led units at the drop of a hat. We have women who spot after an examination being transferred for ? abruption. It is wild.

And the women on the obstetric-led units are often not receiving care from confident, competent midwives. The midwives are more likely to be junior, inexperienced or anxious. The senior team are constantly in the delivery rooms, making management plans, calling doctors in to do routine examinations etc. Those midwives never build the confidence. The women then have little confidence in the person delivering care at their bedside, oxytocin dips, fear rises, labour stalls, intervention rises, birth trauma happens. There is so much fear.

There should be no battle. But there’s no uniform call for the fundamentals at the core of physiology to be protected - warm, dark, private environments, feeling safe, trusting instinct, feeling listened to. I’d say this has all taken a nosedive in the last year.

Word from the staff is they purposely ran it into the ground to force it to close.

the outcry has lead to a desperate struggle to find consultants to staff it. Fortnightly meetings to review whether it is safe to open.

Women with reduced fetal movements having to drive up to 2 hours to Exeter, more when there’s road works/holiday traffic.

One then sent another hour to Yeovil when Exeter was unsurprisingly full.

its an absolute travesty. 7 babies born a day on average.

Our local one in Banbury has about 10 births max a month. What's crazy is everyone else has to drive to Oxford! Which is quite a way! But midwifes encouraged everyone to have the MLU as their first choice even though it wasn't suitable for most people. Everyone in my NCT class (except me as i have a health condition) was down for the MLU, no one had a baby born there. I think it's more common for second/third births when your outcome is more predictable.

I had some post natal appointments there and there were so many staff - must be a crazy waste of resources. My postnatal care there also wasn't great to be honest.

I think the whole system doesn't work - more investment in better quality midwife care I think would support more women to give birth safely in that environment.

We will all be put out into fields soon.
As long as the men keep getting funding for constant erections, who cares about childbirth and gynae?

This is exactly it.

Nobody is saying don’t react if needed, but the constant overreaction and ‘doing this just to be on the safe side’ leads to this relentless conveyor belt of induction, drips, lack of movement, epidural, then finally a c section or forceps. The latter with a higher risk of permanent pelvic floor damage needing further treatment.

I also saw a study that continuous fetal monitoring does not even provide better outcomes than using a Doppler, yet all these women are stung up like supermarket chickens with the pads all over their bumps, unable to move about. Madness.

I wonder if it’s linked to increased maternal age and that more women are deemed to be high risk? Also the delays impacting ambulances mean you can’t rely on one to go from a standalone MLU to a hospital if needed, especially in a time critical situation like a PP described.

It will be a combination of factors
Older mums,
Not so fit mums
Fertility babies
Bigger babies,
Risk of transferring mums and babies

Fear of being sued should things go wrong
Birth while its meant to be a natural process still has risks.

You don't know they're complicated till they are complicated.

It is the fact only 2% of NHS funding goes on pregnancy, childbirth, and female reproductive/gynaecological health, despite women being 51% of the population.

Are you sure midwife led care is statistically safer? It didn't feel like that. I don't see how it can be.

I chose a maternity unit within a general hospital, staffed mostly by midwives but with doctors and a crash team onsite.

For me, it was the right choice. a long slow labour, then they lost ds heartbeat, maternity theatre wasn't available, so all I remember was crash team arriving seconds after they hit the panic button, needle in the hand, and ds was delivered with ventouse shortly after. We both came home OK.

I'd rather travel and know there is a doctor/surgeon available if needed.

Exactly this - an uncomplicated pregnancy does not always mean an uncomplicated birth and the best laid plans can change at the last minute, hence the need to have those options nearby.

Im in Scotland and my son was born prematurely in the back of an ambulance because the city i live in doesn't have a maternity unit, the local hospital doesn't even have an A&E.
Its a complete joke and costs lives but they keep making things worse and worse

I don’t think we should close them, I think we should be encouraging women to use them! I gave birth in one and loved the experience. Calm, supportive, no interventions, baby born and home 6 hours later. Absolutely brilliant midwives

Yes, lovely when everything goes right, but plain dangerous for mum & baby when things don't.

If baby is starved of oxygen, you have three minutes......

Very valid but oxygen deprivation is about 0.2 - 0.4% of births. I think women are encouraged into medical settings where they don’t need to be. Obviously we are allowed a choice, no women should be denied c sections etc, we should be able to labour as we want. My friend was a midwife and she believes hospitals induce too quickly which results in more interventions later on. She left to become a doula as she had a million horror stories. I think we should be allowed midwife led units as an option and women should be encouraged to consider them. My son was born in a hospital and the experience was so awful and different so I’m probably more invested than others!

Here we go again. I have lost count of how many babies we managed to salvage who would have been dead by the time their mums reached the next hospital. The majority of the surviving small hospitals serve isolated communities. Talk about the ultimate in post code lottery if they close them all.

Also got to factor in that some of the women who do meet the criteria for a freestanding birth centre won't want to have their baby there because they'll want epidural access.

I think there are mums who expect the experience to be how they imagined. I just wanted ds & I to get home in one piece. I expected it to be painful and pretty unpleasant. It was. But we came home safely.

I'm less worried about 'midwife led', I think the priority here is to ensure that all mums or at least 99%, have a maternity unit of some kind within 30 miles, and to be offered a choice.

Isn’t it due to falling birth rates?

big drive for CSections apparently

It is literally true and I actually signposted to the research, but here’s the link:

https://www.npeu.ox.ac.uk/birthplace

Oxford University, 64,000 low risk births. It’s actually cautious in the summary, but when you look at the breakdown of numbers you can see benefit with nearly all outcomes by being in midwife-led settings. The only difference between adverse perinatal outcomes being higher for women having a homebirth with their first child.

The problem now being that women are losing their ‘low risk’ status very easily. At the time of this research it was far easier to be considered low risk.

The difficulty is that so much of the Birthplace data comes from a time when we had a functioning ambulance service. Anecdotally, at least some low risk women would be more interested in freestanding birth centres if they felt confident speedy transfer could be relied on, which of course it can't in 2026. I don't think the fix to that can lie solely within maternity.

Painful yes but I think it’s all heightened by the awful hospital environment.

Animals don’t seek bright light and spectators to give birth, they often crawl somewhere dark and familiar and quiet.

The link between your emotional state and your body isn’t some woo woo hippy fiction. Think how your bowels feel when you’re nervous, or how your headaches ramp up when you’re stressed.

Giving birth is no different. The body is complex but ultimately in harmony so long as you aren’t interfered with. I absolutely appreciate there will always be women who need interventions but I feel nowhere near enough weight is given to the beginning of labour, and setting it up right, rather than stringing women up with drips, lying them on a bed, monitoring them so much it becomes stressful and then wondering why things aren’t moving along nicely.

For comparisons sake, in the 1960s, maternal death was 19 per 100,000. Now it’s 12 per 100,000. So it’s decreased yes, but given the sheer expansion of maternity services and interventions (and a c section rate going from 3% to nearly 50%), it’s not the massive difference one would expect.