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...

I understand it's more a case of getting your consultant/the midwives on side so that they agree to letting you use the BC in the first place. The one thing I know they (at Wythenshawe) are not happy about is people seeing the BC as a stepping stone for the first part of labour and then transferring to the delivery ward later on when they want an epidural, for example. They only want people to use the BC who are, for want of a better expression, fully committed to the way the BC operates and happy to birth within the limitations of what the BC offers i.e. limited pain relief options.

I know that's not what you're suggesting and I think it would probably help to show that you are aware of risks and your decision making process is reasonable and measured but I would try and ensure that you aren't making it sound like you want to start off in the BC and then just transfer later on for no good reason. Surely everyone would agree to transfer if there was good reason for it?

I intend to go in showing that I have done my research, know the risks and why they would prefer me not to use the BC but explain why my preference/decision would still be to use the BC and then throw a strop and threaten a home birth if they still refuse

I have found, that they're more likely to give you what you want if you make it clear that you won't budge (obviously, in your mind, you will budge if absolutely necessary, but they don't need to know that - which means that whatever your mind has decided is the maximum compromise, you will be more likely to get)
It goes like this:
(using myself again as example)
I don't want to be induced, baby will come out when it wants to
"but your baby will diiiiiiiie if you're not induced now!!!"
"i'm not being induced"
"but your baby will die!"
"i'm not being induced - NICe guidelines say 14 days before I need to worry about intervention"
"well, okay, don't be induced, but come in for monitoring"
"that's fine, i will do that"
"when's the latest date you're willing to think about induction?"
"i will go to 14 over and then I will see what I think"
"we will let you do that"
"i will let you do VE with mind of sweep if I go over"

meant that I didn't need to be induced, and sweep said that I was 3 cm, anyway, so DD was born at 40+16 (would have been +15 but she went till midnight , which apparently makes me very naughty, but I can't help that!)

it also helps if you have a twat of a consultant coming in to tell you over and over again that your baby will diiiiiiiieeeee! (i'm not exaggerating - I had to tell her off. )

you tend to get better treatment after that - because they get embarrassed that they've overreacted...

I had a retained placenta, PPH and transfusion with my first. I had my second at home despite almost everyone and their dog trying to talk me out of it. (Birth centre not an option, we don't have one).

After my first birth I (eventually, about 18m later) wrote to the hospital to ask just what had happened. In reply I got a letter from my consultant which very usefully pretty much confirmed what I'd thought, that the PPH was down to all the intervention and assisted delivery (ventouse) and not anything to do with me. She said I was at no increased risk of it happening again unless the birth followed the same pattern.

I hadn't requested the information to push for a homebirth in the future (I just wanted some answers and didn't get pregnant for a further year anyway) but it was very handy ammunition when I had meetings with the (different) consultant during pregnancy no 2. I also had a very supportive and pragmatic midwife, and a friend who was a student midwife at the time (and subsequently delivered my son ). It was stressful though, and you say you don't want to be difficult - and ime it was the most demanding I've ever been, insisting on my rights when they were quite clearly used to women doing as they were told.

Hope it works out for you!

and exactly what Soozle said.

(it's amazing what they'll agree to when you prove that you've done your research, or say that you can't possibly budge)

that's good news, badpoet
:)

Soozle, your comment made me smile because I did in fact have DC2 on the hall carpet with the ambulance on it's way! This was despite my labour with DC1 being pretty long and drawn out, ending in an assisted delivery. So tbh you could be planning/worrying for nothing! Given your history I would recommend that you read up on what to do at an unassisted birth though just in case (DH wishes he had done so in advance!).

Anyway, just wanted to say to the OP that I had a retained placenta and manual removal in theatre with DC1 but was positively encouraged to use the birthing centre for DC2 and in fact the midwives were even encouraging me to consider a homebirth. I wasn't keen on hb but wish I had gone for that option given what happened! Anyway, when I expressed my concerns about another retained placenta they said not to worry, I'd just be transferred in. As it happened, the placenta came out without any intervention at all.

Fab advice everyone, thanks.

Nickel I think you are right- I should start off being v firm and non-negotiable ie I want/intend to use birth centre.

And soozle, yes, you are right, I must make it clear that I want, and am committed, to staying the birth centre with no intervention/epidural if at all possible. I absolutely don't want to transfer to delivery suite unless necessary.

And I am def going to contact the hospital where I had first baby, to try to get similar info on why the retained placenta/PPH may have happened. If they will confirm that it was likely to have been caused by intervention and no inherent risk factors in me, then that totally strengthens my case (in fact it makes even more important that I go to birth centre!).

Should I put something in writing to take to consultant do you think- or is that a bit heavy-handed?!

nothing's heavy-handed!
there's a reason there are blanks in your ante-natal booklet thing, you know. :)

(i also found it meant that I didn't have to pluck up the courage to say what I wanted - it was already written down, so I just had to explain what I meant)

Shushbaby, quick update for you....

Had my appointment with a consultant this morning, which was very positive and she signed me off for the MLU at Wythenshawe. The supervisor of midwives who is the MLU manager however flat out refused, full stop, no discussion, it will not happen and was pretty obnoxious about it all.

I am so angry, disappointed, pissed off etc etc. She made it very clear it would not happen no matter what, leaving the only option as homebirth or consultant led unit.

I have no idea whether there are any other midwife led units at any other nearby hospitals but I will be exploring whether they also apply such a ridgid policy.

Obviously the emotional wellbeing of the mothers is completely irrelevant.

:( Soozle.

you could always put your request in writing and ask to discuss it again.

oh, and write a complaint in your book about how she treated you.
that always gets results

nickelbabe she made it very clear indeed that it was her decision, there would be no movement on it, I could complain to whoever I liked and offered to get me the hospital management but that that was the way it was, end of story.

I really don't ever want to step foot in that shithole ever again.

ow!

I shall offer to beat her up for you ,

Complain anyway. Even if you don't go back there. Regardless of the decision, her attitude and the fact that policy is overriding wellbeing needs flagging up. All she's doing is trying to push a "problem" elsewhere.

All complaints have to be recorded and registered. If people don't complain, then policy will always override wellbeing. You never know, you might change policy for other women if not yourself.

I personally think that when someone says that they will get hospital management she's using a bullying tactic and she playing a game in the hope that you'll back down just by using the threat.

If you end up having a homebirth, in part because you've been told you are unsuitable for a MLU, thats just nuts. Its your choice, your risks ultimately.

Apparently it's not my risk she's worried about. She's worried about and has to protect her midwives (and presumably her MLU statistics). Her not letting me into the MLU is because, if anything goes wrong, her midwives do not have a consultant to hand to deal with the situation and so she has to protect them by not letting anyone not classed as low risk in (even though the consultants are just down the corridor). This is pretty much exactly what she said to me.

I can have a home birth if that is my decision. The fact that I consider myself being pushed into a homebirth when I believe being in the MLU to be safer is irrelevant as far as she is concerned because the option is there for me to use the consultant led unit - so if anything goes wrong at a homebirth it's my fault for not choosing consultant led.

That was my understanding of how it would be when I posted about this earlier

Even if you were to turn up on their doorstep in labour and you're anything other than low-risk, chances are they'll send you straight to the CLU.

so basically, she's denying you access because she's worried her stats will look bad.

i think you have a reason to complain to the management.
that's not a valid reason.

I suspect, though, that management will consider it to be a very valid reason and back her up. She'll argue it that she doesn't want to put her midwives in a position where they may have to deal with an emergency, notwithstanding that the chances of scar rupture are small and there are plenty of emergency situations arising in first time low risk mothers that they do let into the MLU.

To be fair to her, as a high-risk case and fervent no or low intervention/home-birth fan myself, I see her point about protecting her staff, and think the policy is fair.

Thats precisely what I thought it was about Soozle. And why I hold to the fact that people NEED to complain in circumstances like this.

I am firmly of the belief that its not a lack of money thats damaging the NHS most but an inflexible approach to targets and the need to rate everything within the system at the expense of treating patients with humanity.

I think it actually is much more apparent in maternity care more than anything else as there are "choices" to be made. The irony being that time and time again you'll see the most bullshit reasons to justify a decision which is about protecting the hospital or policy or figures and in no way shape or form about the patient. Which are all designed precisely to limit choice. You just have to read threads on here on a daily basis (like the woman being told not to have a homebirth because the baby is back to back for example).

The thing is she has no idea who is high risk in a lot of cases - its an educated guess for many - certainly for first time mothers. (I think the impossibility to say who is low risk with certain was a finding in the place of birth study, but someone please correct me if I'm wrong on that). So what does she do in those cases to "protect her midwives?" Its bullshit.

Her duty is to advise you of risks, and look at your individual case properly and have it documented that she has made it clear and to try and persuade you to change your mind but ultimately it should be your decision. The system should be a lot more flexible and approachable.

Its not even a cost effective way of going about things. CLU are the most expensive births. Even with transfers MLU come out more favourable.

but that's just it - if the MLU was in a different building, I could understand it, but it's just down the corridor!

Well yes nickelbabe. Quite.