Can a consultant dictate where you give birth?

[Westcountrylovescheese]

Had bad meeting with consultant which left me upset. I have a highish bmi (midwife says on the cusp of pct level so referred me to consultant to be safe) and also reasonably well controlled arthritis.

At 20 week scan sonographer said everything fine, baby growing normally. No worries.

Saw consultant who then said I needed to do a GTT with my GP but if that was fine she wouldn't need to see me again. I said was considering birthing on MLU. With my arthritis the calm atmosphere helps reduce stress and therefore pain and I am feeling that I can be more in control of birth and my position in MLU. I am doing active birthing classes already and am certainly not going into this with my eyes shut. I am happy to take constructive medical advice. MLU in our hospital in next door to CLU.

Consultant has told me that I have no choice (due to BMI not arthritis) and have to give birth in CLU. I asked why and she said because the doctors are close and there is an increased risk. I said that I had been thinking about the MLU. She again said no and that I have no choice. She has put on my notes that I will be giving birth in CLU.

I am getting prepared to discuss this with my midwife as I don't feel happy with this lack of choice/discussion. Can I be forced to give birth in the CLU?

Can't really be forced into giving birth anywhere, what number is this one? If you have previous experience they may take that into account. Keep chatting to your midwife.

The MLU will in all likelihood have fairly strict criteria about who can and can't give birth there. This will probably include women above a certain BMI and if you're above this then I'm afraid yes, they can refuse to accept you there.

You can still have a natural birth in a consultant led unit. Have you considered hiring a doula to support you? Or what about a home birth?

If your name is relevant to where you live I think you're booked in at the same hospital as I am. Fwiw, the CLU and the MLU are really no different. I gave birth twice at the old CLU before the birth unit was opened and tbh from what I've seen there is genuinely no difference. But I don't know if this supports your arguement or theirs tbh.
I'm booked into the MLU but am reassured to be so close to help should I need it. As regards BMI, I'm not sure what difference it makes in actual labour. My midwife told me there are certain things that are not recommended if your high risk status is down to BMI, for example they won't let you use the pool as there may be problems physically getting in, and especially out in an emergency situation. But there is a pool on the CLU, so I don't know if you'd be allowed to use that? If you have arthritis then perhaps mobility is an issue? The fact is, that the people who are attending you will be the same in whichever unit you give birth in, assuming no complications. Assuming you're under community care then it'll be a community midwife with you. Have you had a tour of the unit? You might find it reassuring for you to see that the units are essentially identical. The calm atmosphere you're after can be recreated whichever unit you're on imo. There won't be a consultant lurking in the corner, far from it.

This is my first... My midwife has already told me that with my BMI I would be fine on the MLU. It's 33 which in my area they don't treat you as high risk unless you are over 35, but would keep an eye on you if over 30. My midwife only referred me to be on the safe side and because of the arthritis.

I think the lack of discussion/reasoning/explanation about it has made me unhappy and concerned. If I could understand it I'd feel happier... She wasn't very open to discussion.

I live in a small flat so the option of a home birth scares me a little. It being my first too I am worried. I also see the point with being higher risk so can see that being in a hospital is safer for us both...

In that case I would speak to your midwife again and ask to be booked for the MLU. If your BMI is within their guidelines then there shouldn't be a problem being allowed to book there. It may be that this is a consultant who doesn't 'believe' in birth centres and thinks everybody should give birth in a CLU.

Unfortunately having a high bmi does make you high risk. You are at increased risk of needing instrumental delivery / caesarean and bleeding just to name a couple. In all likelihood you will probably have an uncomplicated birth, but it is inappropriate for you to use the mlu. In the event of you needing medical input, there will be a delay in help getting to you, and if it something like heavy bleeding or a serious drop in babys heart beat, minutes can make a real difference. Having said that, I do know of cases where women have contacted the head of midwifery and special consideration given to them. That may be a route you may want to take. I agree that having a doula and using the clu may be more appropriate.

Although the communication of this was poor - the advice which was being given was for the safety of you and your baby. I would go with the CLU

MLUs are funny, because they will turn people away and send them to a CLU, a lot of home births (especially VBACs) seem to arise from this, not being able to get "permission" for an MLU birth, but able to insist on a home birth. However, I have known women talk their way into an MLU with the support of the Supervisor of Midwives. A doula friend of mine had a client VBAC on an MLU who "don't accept VBACs" with a bit of persistence and the support of the midwives. So I would consider talking to your midwife, and maybe contact the SOM for support.