Been told I can't use birth centre (previous PPH/retained placenta)

[ShushBaby]

I had a retained placenta (went to theatre for manual removal) and post partum haemmorhage (no transfusion) after my first birth 2 years ago.

This followed induction, and a syntocin drip to speed up contractions when things slowed to a halt. I can't help but think that the retained placenta had something to do with this, but what do I know....

I'm now pregnant and due in November. I don't have any other risk factors and am young, in healthy weight range, iron count fine, blood pressure fine, previous pregnancy fine etc.

Inititally I wanted a homebirth, but have been told I shouldn't- and I do accept this. Presumably the risk of having another retained placenta/PPH is higher (though I need to confirm this with consultant)- and I'd hate to have to go to hosptial after delivering at home if it did happen again. So I accept that a homebirth is not going to happen.

However, I've also been told I can't use the birth centre which is based at the hospital (Wythenshawe in Manchester), because of my previous experience.

I am very disappointed. For me, delivery suites are not environments conducive to labouring effectively and smoothly. I really feel that the ethos and atmosphere of the birth centre would benefit me and my labour/birth.

I honestly can't understand why, when the delivery suite is metres away and the doctors etc on site, I can't use the birth centre. Surely if something did happen (and like I said above, the actual increased risks have
not been made clear to me), medical help would be immediately at hand.

I don't feel I'm being irresponsible in wanting to push for this- am I?

I have an appointment with the consultant in a couple of weeks. What I need to know is, how exactly do I approach this? What questions do I need to ask and what do I need to say to get my point accross?

Any help/advice would be much appreciated. I don't want to be difficult, but equally I don't want to be forced down a road away from the birth I want, just because it's protocol...

Bumping in case anyone comes along later with experience/thoughts...

they can advise you not to use the birth centre, but they can't force you.

if you want to use it, then tell them (in writing if you need to) that you are going to use the birth centre as you believe it's safest and your reasons etc on the hospital being right there!

but, they cannot stop you.
(human rights and all that)

actually, if you want a homebirth they can't stop you from doing that either!

you tell them you're registering for a HB, and write in your notes that you're planning one.

then when you go into labour (perhaps get a strong-willed friend to do this part), you ring them an tell them that you are ready and need a MW to come out to you.

birth centres aren't any safer than home births unless they are within bigger hospitals so unless that is the case with your birth centre then everything you said about home birth still applies (like needed to be transered etc)

(and no, you're not being unreasonable - it sounds like you believe the intervention is what caused the problems, and you want to avoid that this time)

this also might help

I had DD1 at a lovely birth centre in London. I fully intended to have DD2 there also (in the pool), only to arrive on the day and be told it is full - so delivery suite it was. No pool available as not enough staff on duty. I was strapped to a monitor and had DD2 on my back on a bed. NOT what I imagined or wanted at all. Just as well it was all rather fast.

I hope you get what you want, but I'm just saying even if they green light the BC doesn't mean you'll have your baby there sadly.

that's true.

the homebirth option is much less likely to fail
(like we had to "I don't care if you don't have enough midwives, we're not going anywhere")
(don't let them try that excuse either - we had a sudden plethora of midwives as soon as we got my friend-who-works-at-a-different-hospital to get permission to come to the birth and assist. She was actually quite disappointed in the end)

Thanks for all the advice. I think I will put something in writing after I have met with the consultant. I am not a pushy person in general, but feel quite strongly about this. I would even consider changing hospitals if need be. I just can't see the rationale.

I've been totally put off homebirth tbh- would not be able to relax throughout labour, fearing that something would go wrong afterwards. Which is a shame- but it would now feel counterproductive to opt for lovely relaxed homebirth, and then spend it fretting!

HipHop yes, totally see your point. My last birth started in a birth centre- it was fantastic. But I had to shift to delivery suite when contractions slowed. Then it was monitors/drips/catheters etc. The best laid plans and all that...

monkeymoma the BC is in a big hospital, part of the maternity unit, so I wouldn't need to be transferred should complications arise.

Also- I didn't realise that I had the right to go to birth centre. This is useful info!

You have the right to give birth anywhere, just remind them of this. I'd say that to make out you're having a HB then agree to meet them in the middle - the birth centre.

Should work.

Yes I had the right but there was no room at the inn!! They just said NO at the time, we have no room for you! Big shock!

I had a PPH last time but no retained placenta, so not exactly the same circumstances. I'm due 1st October, and was initially told no, a MLU was probably out of the question in case it happened again. I've since had a chat with my MW and she's said as I'm otherwise fit, healthy and have no high risk factors, she is happy for me to go to the Unit as I planned. Assuming they're not full, I'll be gutted if they are :(

Hmm yes someone else in 'real life' suggested I tell them I want a home birth... and they will be more likely to meet me half way.

CaptainHetty that is really encouraging!

Indeed there is always the risk it will be full... Having had to move from birth centre to delivery suite last time, and having had things go a bit awry in terms of intervention (and, er, a massive bleed and surgery...), I'm aware that a birth plan is just that.. a plan. But important to have, I think! Otherwise you almost certainly won't get it...

If the birth centre was a remote unit I would understand the reasoning more. But it is in. the. hospital. This is what I simply do not understand. I would also get it a little more, if I had other risk factors which would mean I need monitoring throughout the labour or similar. But I don't believe that's the case. As I understand it, it will be like any other labour- it's just that if I have a PPH/retained placenta afterwards (which, chances are, I won't!) I'd need medical help. Which will be available. In. The. Hospital.

Bangs head on desk

ShushBaby I'm due to give birth at Wythenshawe in October and am currently gearing myself up to try an push for a VBAC in the midwife led unit. All current indications are that they won't let me in there but, after a fairly shit experience at Wythenshawe the first time round, I'm feeling pretty feisty at the moment.

(Booked in for ELCS due to breech, turn up, they look blankly at me as somehow my booking was crossed off the list and so I was sent home because they've given my spot to someone else, waters break and go into labour half an hour after getting home, go back in, they strapped me up to monitor for half an hour but don't check my downstairs for 2 hours and when they finally did I was fully dilated with DD's hand and knee presenting - cue EMCS due to risk of cord prolapse. This was after failing to book me in for a pre-op and a pathetic token gesture appointment with a consultant re ECV. Needless to say, I am less than happy with my previous experience there).

So, every conversation with a midwife so far has started with the words "You had an emergency C-section last time" as if last time was a huge disaster of my own making and hence will be a huge disaster this time. I intend to make as much of a fuss as necessary to try and ensure that I'm not just shoved down the tick box conveyor belt process that I was last time.

I agree that, given Wythenshawe's layout, it seems crazy not to let us use the midwife led unit when it is just as close to the operating theatres as the consultent led delivery ward. My friend was actually told by a midwife there that there is no more risk in being in the midwife led unit if an emergency arises and you have to be transferred than if you are on the delivery ward.

I'd be interested to hear how you get on at Wythenshawe. Who is your consultant and when are you going to see them?

I had a retained placenta with no. 1 (in a midwife-run birth centre which was not related to a hospital, and not in the UK) and had to transfer to get it removed, but no hassle - baby was well, I wasn't in any distress. When it came to no. 2 I tried a different birth centre because we had since moved, and they refused me for that reason. I wasn't convinced it was a real enough risk and tried another centre which was happy to take me, because the midwives there were very experienced and we would be very near a big hospital. In the end it was a great water birth, very quick, and placenta came after a bit of persuasion - we were able to leave for home after three hours, which is ideal for me. I'm convinced if I'd gone to a hospital the technological approach would have put me off from believing in my own body - hospitals are essential for medical difficulties of course, but not the best option when you want an active medication-free birth.

As someone who was high-risk for my second birth (induction, forceps, third degree tear, retained placenta, 700ml PPH treated with 9 boxes of iron tablets first time round) I am fairly certain that actually, you can be refused access to the MLU/birth centre. There was a thread not too long ago where someone asked if they could just turn up at the MLU when in labour despite having been told they couldn't use it, and the advice from MWs on that thread was a resounding no, you'd be refused access and told to go to the CLU. Insurance or something - if you don't step over the threshold, they can't be held responsible if something does go wrong.

However, you are within your rights to have a homebirth (which you no longer want) or go to the CLU (which you don't want)

As said upthread, unless the birth centre is attached to the CLU then there is nothing that can be done there that cannot be done at home. A PPH can be treated at home with syntomentrine (and you can transfer in if necessary)

FWIW I planned a homebirth for DS, and ended up transferring after 17 hours of contractions and no sign of DS after 2 hours of pushing, with eventual forceps birth and 1500ml PPH (no transfusion, sent home with 2 boxes of iron tablets!)

The labour itself was fabulous and I wholeheartedly think that was because I was at home and there was no way he would have shifted without assistance due to his position and my knackeredness.

However, if you tell them you want a homebirth because you cannot have access to the birth centre, you may find that you are offered the birth centre as a sort of compromise (meaning you actually get the place you wanted anyway)

The alternative is to stay at home as long as physically possible, and then transfer in for second stage so that if you do have another PPH, you're in the hospital.

Can't remember consultant's name soozle - sorry. My appt is week after next- will update here when have had it. Your experience sounds awful.
FWIW, I went to Stepping Hill last time and it was great. If I really hit a brick wall I may transfer there (am only not booked in there this time because of geography- it's quite far to go from where we live)

And yes- Whythenshawe's approach does seem very black & white- 'you can't' right from the off, instead of opening a dialogue.

And yes, I'm pretty sure they'd be quick to reassure pregnant women who were umm-ing and ahh-ing about using the birth centre that it is just as low risk as the delivery suite!

that's the problem with the Birth Centre - it does rely on the number of rooms available - you don't have that problem with HBs, although, if you are higher risk, then you have the worry of what if you have to transfer.

But no, they can't refuse to book you in for a BC birth, but if there aren't any spare rooms, you'll have to use the labour suite.

have you looked at your labour ward?
I had a look in ours, and the room we were shown was actually not that far different from the ones in the Birth centre.
It had a pool and everything.
(other rooms didn't have pools, but there were bathrooms that birhting mothers are encouraged to use)

I chose HB because I couldn't handle the idea of having to get to the hospital while in labour.

(and i had a few complications - DD was a bit stuck and refused to come out - turns out she had her hand tied against her head!, and very nearly had to be transferred, but was sorted with an episiotomy - I also had a PPH and had to go in an ambulance (not blue-light) after the birth and placenta.
I am pretty damn sure that if i'd been in hospital, I would have ended up like you, with massive interference)

Well, I have my first appointment with a consultant (also can't remember name but she's fairly new apparently) next Friday so we shall see what happens. I'll let you know. I'm prepared to put up a fight though.

I did have a rant about discuss all this with my midwife this morning. She did joke that, given that I went from no contractions and waters breaking to fully dilated within two and a half hours last time, I could be having number two on the hall carpet with the ambulance on its way!

also - if they say they haven't got room in the BC, then agree to go to the labour ward, and keep asking every half hour or so if there are any rooms in the birth centre now.

(things happen very quickly, and it's likely that one will become free, but if you don't keep asking, they will leave you where you are)

I wonder if I say that I would like to use the BC, but am absolutely willing to transfer to delivery suite should medical need arise, that might help?

Flisspaps "FWIW I planned a homebirth for DS, and ended up transferring after 17 hours of contractions and no sign of DS after 2 hours of pushing, with eventual forceps birth and 1500ml PPH (no transfusion, sent home with 2 boxes of iron tablets!)"

I had very very similar - except I was forced to try different positions (and ended up in my least preferred- on my back, because DD wouldn't move in any other position!) and the cut, followed by a push on a half-arsed contraction meant that she came out before being transferred (the ambulance crew were in the doorway of the bedroom when I pushed her out!)
PPH of "750ml" (my friend reckons it was actually more than a litre, but the MW put 750ml down on the form), and two days in hospital, when they refused to give me any food with iron in it , and refused to give me my iron tablets until I left , which meant I had to force them to discharge me (while I was actually in no fit state to be discharged) because it was the only way to get them to give me the sodding iron!!

Shush - i probably wouldn't even do that.

Tell them, in no uncertain terms, that you want to use the BC when the rooms are available and that you will transfer only if complications arise that mean you need extra care. (which is exactly what you've just said, but more "i know my rights!" )

and while you're at it, make a detailed birth plan outlining what steps you will accept if things happen:

eg:
you want to be mobile/use pool etc etc
if the baby is stuck : episiotomy, no forceps
if episiotomy doesn't work, then forceps
(if it gets to that stage and the baby is out, they won't be able to EMCS anyway, it'll be out the vagina or nothing!)