Anyone managed to get a midwife unit led high risk birth?

[Toadsrevisited]

I had a blissful midwife unit birth a few years ago- gas, water birth etc- and then sadly had a really stuck placenta so had epidural and surgery. Now pregnant with number 2, and have been refused to register to have birth at MLU. Am threatening home birth but consultant said although it's my responsibility to right, it's risky and I would be better in a big obstetric unit hospital. Anyone managed to negotiate an MLU birth when high risk?

[Bobbiepin]

@apples is conpletely right. One hospitals have higher rates of interventions, inductions and CS because that is where high risk patients go. MLUs have less rates of these because if patients need intervention they are transferred because the midwives are not qualified to deal with it which dramatically increases the risk. I can't understand your reluctance to be cared for by the most qualified people. Stop dreaming of a perfect birth, no one can guarantee it regardless of your history.

[NanooCov]

I was moderately high risk with my first due to high BMI and history of epilepsy. I had my son in the MLU but he was very poorly when delivered and went straight to SCBU. Thankfully the MLU is attached to the main hospital so there was no delay in him receiving treatment.
I was high risk with my second - same reasons plus I had gestational diabetes in second pregnancy. I was not allowed to birth on MLU as by the time I delivered I was on insulin and induction was recommended a week before due date. The birth was amazing, I felt supported and had skin to skin and delayed cord clamping after, etc. Instead of a baby in SCBU for a fortnight, we were home within 24 hours.

In hindsight, the most important thing was being clear as to how I wanted to labour, not where it happened.

Is there any chance you can visit the labour ward? Bear in mind that you only tend to hear the bad experiences and not the good ones.

[TheVanguardSix]

I don't understand people like you.

Just get your baby out into the world safely. You're being offered the best support available and all you can do is get all 'fuck you, I'm leaving' about it?

Slow clap for fighting for you beliefs and wishes. Enjoy your home birth/spa day.

[VivaLeBeaver]

A retained placenta increases your risk of a pph by 3.5. That’s from a base of approx 7%-12% depending on study.

The only way of dealing with a pph caused by retained placenta is by removing it. Something neither midwives or paramedics are trained to do. And something which if done without adequate analgesia apparantly could cause significant issues/clinical shock. You can lose blood at a rate of 700mls per minute at this rate.

So you have a 25% chance of having around a 35% chance of a significant pph. Someone better at stats than me would probably be able to tell you the actual risk. But for me having seen some terrible pphs involving retained placenta I would not take the risk at all. A MLU won’t have blood products, it won’t have drugs to help with a pph.

[StylishMummy]

I'm sorry OP but you're being incredibly selfish, the health and safety of you and your child absolutely trumps your need for an idealistic birth. The MLU will not accept you and a home birth would be dangerous and selfish in the extreme

[PeasAndHarmony]

Am really very surprised you have a1/4 risk but want to risk a MLU delivery?

I was high risk with DC2 and although I wanted to use the MLU I was happy to take the consultants advice as she was the medical expert not me.

Bloody good job I listened to her, DC2 struggled to breathe on delivery and ended up being rushed to NICU (just 1 floor up) with a collapsed lung.

[YouCantArgueWithStupid]

I totally understand where you're coming from OP. I'm high risk for the exact same reasons and currently 31 weeks with No2.

I have spoken at length with the consultant and consultant midwife and I have been told it's a big fat no for MLU due to retained placenta.

And the MLU and DS are in the same building. Just a door separating them.

I think you need to come to terms with the idea that you won't be on the MLU.

[Isittimeforbed]

If you're comparing statistics then look at intervention and caesarean section rates for people at the main hospital who have previously had normal deliveries. That should be much, much lower. Taking a doula is another good option.

[zeeboo]

Retained placenta doesn't make you high risk. Mine followed my home birth and if I had another ( which I'm not!) it would also be at home.
I thought you were going to say your baby got stuck, shoulder dystocia etc or pre eclampsia.
I agree that an MLU should be fine for you as you'd be in the hospital should that happen again.

[Canyousewcushions]

I get where you're coming from- i had a retained placenta and a big PPH in an MLU with my first and the ensuing hospital stay was the most hellish night of my life and the worst start to parenthood imaginable. I'm never going back to that place again.

Luckily midwife and consultant were both happy for me the have a homebirth for the second as the risks were deemed so low despite my history. It was fantastic, and complication free. However now in a different health board for the third and getting mixed messages - consultant is reluctant but community midwife still sees it as a very low risk and is happy for me to choose where i have the baby.

Given that it sounds like home is closer to the hospital than the MLU if you did a transfer then could this be a better option?

Fundamentally if anyone qualified had expressed that the risk was high I'd have reconsidered. But medical professionals have been fine about risk levels, MLU is also an option for me (although it is on the same site as the hellish maternity ward i landed up in, so transfer is quick!) and home is also not remote from hosptial access so low risk again even if i did need a transfer.

Fundamentally it's your body and your choice in terms of home vs hospital, and worth arguing for the MLU but it may be harder to win that one!

[welshweasel]

Zeeboo, you’re wrong. It does make you higher risk. I assume you trained at a good medical school did you? Hmm, thought not.

[Toadsrevisited]

Thank you for considered and helpful responses from many points of view. An no thank you at all for condescension or rudeness to one or two people. I have, as have said, a very personal and real reason not to want to go to any obstetric unit, which I will not go into here, but know that some MLUs will accept people with my history, so I am looking for ways to convince my local MLU to take me. This seems to me to be a very sensible compromise.

[Toadsrevisited]

youcant Just got off phone with alongside MLU at a further away hospital with obs unit next door who are now considering me pending a booking in appointment. Fingers crossed.

[NerrSnerr]

What if you develop preeclampsia, go into labour at 30 weeks or something? Are you still going to refuse the hospital? There must be a point where the health of you and your baby comes before the reason you don’t want to go there?

[Blastandtroph]

It may be worth a chat with the Trust's PMA (professional midwifery advocate). These were previously known as Supervisors of Midwives. They can review with you your previous birth and the reasons that led to the retained placenta and develop a plan/risk assessment for this birth which aims to takes account of your wishes, the evidence and protects the midwives who will be caring for you.

However, it is unlikely that an MLU will be able to 'accept' your care due to clinical risk drivers.

[Goldiehawnoverboard]

Not negotiate, no. Why would they agree to this when it’s clearly high risk?

I was considered high risk for different reasons (over 40, previous prem baby and this baby was off the growth charts huge) was under the consultant throughout my pregnancy and resigned to delivery in the safest place for us both which was the nearest main hospital.

What actually happened was it was snowing, middle of the night and labour started suddenly but intensely, drove to local MLBU 10 minutes away (where I’d had all of my antenatal checks) to be assessed, fully expecting to be either sent home or sent on to main city hospital. But I was already 7 cms dilated and baby arrived less than 2hrs later..

Some terrifying moments when baby’s head was stuck and midwives were very concerned and lots of talk of ambulance to city hospital, but it was a 30 minute drive plus around 20 for them to get out to us.

Yes baby safely delivered (albeit with a mighty cone head) but we were very lucky and felt very vulnerable and stressed throughout. Midwives too I think.

Incredibly thankful not to have had a poorly baby or emergency situation and we all realised it might not have been the case.

[RavingRoo]

You really don’t want midwife led for a high risk birth. Trust me. You really don’t. I have a friend whose son was born with cystic fibrosis because midwives didn’t escalate her to a doctor in time.

[RavingRoo]

Cerebal palsy not CF

[Toadsrevisited]

And Vanguard I'm not being offered 'the best' available: I'm being asked to choose between:
a one in three chance of csection/forceps etc even for low risk first time births drug happy hospital with terrible reputation that turfs you out 4hrs after delivery as massively understaffed and overstretched,

a risky home birth;

an hour or more driving to a MLU with hospital delivery suite alongside, for which I will have to fight tooth and nail.

It's not a great choice is it? And I'm not being some sanctimonious hippy, I'd like a normal birth without an episiotomy, forceps damage etc.

[CotswoldStrife]

As apples said, MLU only take low risk so of course a hospital is going to have a higher ratio of assisted births! I would be very surprised if a MLU would take you and wonder what you've said to the other one.

I also had a retained placenta - only one child but no way would I be anywhere else than a hospital for birth if I did it again. I needed a transfusion days later before we could go home - I lost a lot of blood!

[Toadsrevisited]

I've said the whole thing to the second hospital with the MLU (hospital M for ease of ref) and they are happy that delivery suite and theatres are on site. But it's an hour away. Too long to drive in labour?


To clarify, Hospital N (MLU only) doesn't have those facilities on site hence refusing me.

Hospital H, middling size obs unit with shit reputation, will take me but I don't want to go there.

[Toadsrevisited]

Hospital H has higher than average rates of intervention even for low risk first births, that's my point. It's not just that the profile of patients in the settings is different causing different intervention rates.

[StylishMummy]

@Toadsrevisited the only stats you should give a shit about is the statistics of successful births after said interventions. Your birth experience should pale into comparison to your babies safety!

[DryIce]

I'd like a normal birth without an episiotomy, forceps damage etc

I would have preferred that myself.

Of course, having those interventions meant my son didn't die.

[wrongway]

OP they are not going to intervene with forceps / epidural etc without your consent. And only if absolutely necessary. I had both mine in consultant led unit and it was no different than if I'd had them in MLU. Natural births etc. Oh except the lovely reassurance of knowing my babies would be saved if things went wrong. You can still walk around, labour standing up , no drugs etc. You're not shackled and force fed drugs! Quite the opposite actually, the doctors only cone in if the midwives request them too and you're unlikely to see a doctor at all if all goes well.