Would Birth Centre turn me away if I just turned up?

[helgaw99]

Hi
I am going to be away from home from tomorrow until Sunday at my parents house. I am 38 weeks. I have looked online and there are two really good birth centres very close to where they live, or a Consultant Led Unit about 25 miles away. I wasn't allowed to book into my local birth centre due to my BMI being too high. I have had a very uncomplicated pregnancy and am still under midwife only care.
My question is, if I go into labour while at my parents house and then just go to the one of the Birth Centres, will they turn me away or should I just accept that I need to travel the distance to the hospital?
Thanks
H

They'll turn you away if their policy on BMI is the same (and I imagine it will be). With a raised BMI you're considered high risk in labour and need to be at a consultant unit. Sorry.

It really is better to be where the consultants, their equipment etc are just in case
The most important thing is your health & your baby's, it doesn't matter what birth you have, as long as you both get through it safely

I hate to say it, but how well you've been in pregnancy is no indication of how well your labour will go. For example, I had tons of risks factors and problems but had a 3 hour intervention free labour. My best friend sailed through pregnancy and had a difficult birth, her baby's life was saved by having a emcs.

I don't see that in good faith they'd turn you away tbh. But I agree if you're considered high risk then you'd be better off going to the consultant unit anyway. Tbh, and I know I'm really very lucky, our hospital has the midwife unit and the consultant unit literally doors away from each other, and there's very little cosmetic difference between the rooms. But even in my low risk pregnancy, knowing the better equiped unit is feet away makes me feel much easier than knowing it would be miles away if I couldn't cope with the pain or something went wrong. I don't think being away from home would allow you to skirt the rules tbh.

They'd turn you away because if something went wrong they'd be strung up in court for letting you through the door. If you sued a lawyer would make mincemeat of them for "allowing" a high risk woman to give birth where there's no doctors or paeds.

Whereas if you had to travel further to a consultant unit, they couldn't be found negligent for making you go there.

At our local midwifery led unit you wouldn't be let in. I don't even think they would allow a non booked person in due to not knowing their medical history, never mind the BMI issue.

Would this depend on how far on she was?

Something similar happened to a friend some years ago. She was considered to be at some risk because of high blood pressure. She went to her mother's for a couple of weeks to make sure she got some rest. She went into labour early and went to the local hospital to be checked out with the intention of making a sixty mile journy back to the hospital she was booked at. She was told to stay and gave birth a couple of hours later.

Wouldn't make any difference, they wouldn't examine her to see. Though I suppose if she was blatantly pushing they might let her in. But they'd also call an ambulance to transfer her to the obstetric unit and if the ambulance turned up before she had the baby they would transfer. They would where I am anyway.

In fact 2 good birth centres close,ish together and a consultant led unit25 miles away is our set up and I'm beginning to wonder if op is talking about my area.

So they wouldn't examine her unless she was blatantly pushing? If they sent her away and she delivered on the hard shoulder of the motorway and then something went wrong, would they really be able to wash their hands of the matter? I thought that midwives and doctors couldn't just refuse to attend when called to attend a woman in labour.

Hypothetical in my friend's case because it didn't happen, but it could be the situation facing the OP - although it sounds as though she is having her first so she should have more time.

"Wouldn't make any difference, they wouldn't examine her to see. Though I suppose if she was blatantly pushing they might let her in. "

That is a shit unit if it is really true. Surely a decent midwifery unit in that kind of situation would examine the woman to see how far she was on. They would look after her until a transfer had been arranged. Otherwise it is leaving a high risk woman completely and utterly unattended in labour.

A midwifery unit would surely have all the skills and equipment that a home birth midwife would have. They would have oxygen, gas and air and the ablity to put a saline drip in the event of a blood transfusion and a soncaid to check the heartbeat. I assume that midwives in a midwifery unit have some training and might have some ideas on how to keep a woman alive who is suffering from eclampsia until the ambulance arrives.

I think if you are high risk then you are better to go to a consultant led unit. 25 miles is a terrible trek.

They really wouldn't, they'd direct her to the consultant unit. As far as they're concerned they don't exist at all for high risk women. Not allowed through the door.

Just out of interest (truly ignorant about this) why does a high BMI make for a more risky labour (vs. pregnancy and assuming no other complications)?

Thanks all, kind of confirmed what I thought anyway. Will just head to the consultant led unit of it all kicks off.

Re question as to why BMI stops me using birth centre. It's just one of the boxes that if ticked exclude me. I become a higher risk with a high BMI. Since I have no other risk factors then I could maybe argue my case if I wanted to, but would rather not get everyone's backs up before I turn up to deliver!!

I'm a bit shocked by Viva's statements - although perhaps I shouldn't be!

It makes me question what 'high risk' really means if someone is really expected to risk delivering on the hard shoulder of the motorway because their 'high risk' status makes them unacceptable for a nearby MLU.

Not blaming Viva for this - blaming whoever makes daft rules and insists they are applied rigidly instead of being able to use judgement, and the whole tick box culture.

The problem is the fact that the chief execs of hospitals don't give a shit about individual care. If someone delivers on the hard shoulder en route to hospital and has a bad outcome the hospital trust can deny any responsibility. They will say it's not their fault there isn't a consultant unit at town x but only at town z.

If a woman hasn't been examined the trust can argue she wasn't in labour. Remember you have to be 4cm dilated to be in labour. If you haven't been examined then you can't possibly be in labour. Ha ha.

If a high risk woman has a bad outcome in a midwifery led unit the unit would/could be sued, there would be serious repercussions for staff who let them in.

OP, if you would really prefer to be able to give birth in a MLU then perhaps it's worth a conversation with your current midwife. I am considered 'high risk' because of a previous pph but after some very friendly and informal chats with consultants and the supervisor of midwives (very informative, gives you information on the associated risks) it has been written in my notes that I am aware of the associated risks but would prefer to be able to birth either at home or at the MLU. For me, the MLU is attached to the hospital, so I guess for you it would depend on the distance between MLU/CLU and how confident you were.
You can be surprised by the supportiveness of people if you take it one step further than the whole 'ticked a box on a form' thing. I think most HCP want women to have the best and safest birth and are happy to provide you with the right information for you to decide yourself.
In the experience of some of my friends, if you 'threaten' (I hate that word, so agressive!) to insist upon a homebirth, which is your complete right, then they will often 'allow' you to use the MLU as a compromise.
It really does depend on your individual level of risk and that is in no way determined or understood by your high bmi being recorded on a form.

FWIW, to be admitted to our local MLU birth centre you need to have passed their 36 wk assessment (to confirm that you are low risk and that you understand that they are limited in what they can offer medically). Even if you pass the assessment (and with a high BMI, they will probably want a written letter from the consultant to say he is happy for you to use the MLU), there's no guarantee you can use the birth centre if the suites are already occupied by other labouring women. They will send you to the hospital instead.

You can even get turned away from the hospital's consultant led unit if they are full to capacity, and you will be told to go to another hospital or MLU (if low risk) under your own steam. My nearest is probably 30-60mins drive away. It happened last month to my local hospital.

Re LaVolcan's comment, they would expect you (knowing that you are a higher risk) to go straight to your consultant led unit and not to chance the MLU.

Your midwife/consultant should have explained why BMI makes you a higher risk (increased risk of diabetes, high blood pressure/pre-eclampsia etc) and what they see as your options. Of course, whether you choose to follow their recommendations is your choice (and your outcome to deal with) but you should at least have been given the information. They should also be able to enquire on admittance policies for the MLUs. I suggest you chase them for it if not.

I'm going to be in a similar situation around my due date and miles from my booked-in place of birth.

I found the local birth centre where I will be and asked them if they would accept me.

They told me they would if I met the following criteria:

1. i met Their admittance criteria
2. had my notes with me
3. had some evidence that I had already been accepted by another MLU
4. they had space on the day.

They asked me to phone them just before I set off to remind them I coukd be one of their numbers and to inform ST Johns ambulance who will be on the site I am camping on.