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?

I had my second on the labour ward because of complications with my first. I’d talked through my birth plan with the midwife supervisor and it went into my notes etc. I have to say that my labour was awesome-absolutely amazing. If they are pushing you to the hospital and that’s the result then sit down with them to come up with a plan. My second birth was with just a midwive (no intervention) the only difference was that the walls were not purple and didn’t have pictures of the sea on the wall like the midwife lead unit.

An hours drive away with your second is too far, if you have to stay then it’s a 2 hour round trip for DP etc.

You have obviously had a really tough time previously from what you have said OP Maybe a trip to the ward at the main hospital and a chat with the more senior midwives about your concerns and wishes would be a good way to go?
Unfortunately 1/4 is a big risk and it's a shame that it's how it is for you but it's far more important for you both to be safe and near to the best care. That's the first and most important thing you can do for your baby as they enter the world. Not all hospitals are quick to drug you up and get the forceps out but all midwifes are different and can completely change an experience. I hope you find the way that works safely for you and your baby. Good luck

The hospital has higher than average rates of intervention but that might because they cover a fairly big area and have quite a few high risk ladies like yourself?

I honestly think your best bet would be to look at ways of managing to cope in the big hospital. There are things that might help you such as a debrief meeting about previous labour, a meeting with Head of midwifery to air concerns and get a plan together, having a doula with you who understands how much you want to avoid intervention, asking if partner allowed to stay overnight in private room with you etc etc. There are things you can do to make it less awful.

Also, don't 'threaten' to have a home birth to try and force them to allow something that isn't really safe. Yes, a MW led unit probably would be safer than a high risk home birth, but neither are as safe as being near the theatres if things go tits up.

I lost my first baby to a placental failure. It was bad as bad can be.

My surviving DS had no high risk indicators except for my history with my first baby. During labour things suddenly went tits up- about 30 seconds after the Midwife pressed the alarm there were at least 10 people in the room doing their thing. DS survived because I was two sets of double doors from the theatre. He would not have survived had I had to be driven to another hospital.

I’m watching this with interest. I’ve also been told I’ll be consultant led / need a hosp birth due to previous retained placenta and pre term birth/IUGR. But I would love to be in a MLU. Hope you have a positive experience with the MLU attached to a hospital (no option of that here)

They won't take you. It doesn't matter what you say or what statistics they offer - I work closely with these units and they have very very strict guidelines on who they'll accept, hence their low rates of difficulties.

It's your right to refuse to go to the hospital (in your position I wouldn't but it's your choice) but it doesn't necessarily have to be awful. My local big maternity unit now has an alongside department with lovely rooms, pools etc and their criteria are expanding all the time, this wasn't available to me a year ago but may be now (mind you I ended up with an emcs but there we are!). Have you double checked what's actually available?

The homebirths team I have contact with have to go to some high risk home births and the stress on those members of staff is beyond belief - I really feel for them. They have huge numbers of meetings and time spent on every high risk case, massive amounts of resources and it's still their neck on the line if something goes wrong.

Reading the points offered up by PP there's something else I want to add - I wanted to be in MLU when I had DD. unfortunately meconium changed me to delivery suite, run by doctors. My the only difference in my actual labour was that I had continual monitoring as DD'S heart rate kept dropping. I thought I wanted to be moving around etc but by that point I was completely happy to be on a bed. I had no medical intervention and only gas and air.

The high rate of intervention that you are worried about doesn’t mean that you will be given intervention though; no one is going to come in with forceps or a consent form for an emcs if you don’t actually need it. Unnecessary interventions don’t happen because a ward is busy/understaffed, everything needs crystal clear rationale, if labour is progressing normally the doctors will be quite happy to leave you to it!

Zeeboo as a mw I can assure you that perv retained placenta is very high risk, it’s not just this but then the alongside risks of this like other posters have explained, pph, retained tissue, sepsis etc etc.

This doesn’t mean you will be treated like a walking critical case if you deliver in a high risk unit; you can still have a birth plan, dark room lighting and all of those things that an mlu promotes, lots of units have wireless CTG’ s that you can labour in water safely with for example.

Don’t cheat yourself or your baby out of a safe place of care for delivery, a stressful transfer to a hospital 45 mins after delivery is not the best start to your little ones birthday if you can avoid it. You would surely have to transfer to this hospital you want to avoid anyway? If this is nearest?

*previous

@Believeitornot yes, I've delivered plenty of "normal" births and I work in a hospital which has an MLU and obstetrician led unit. My advice is coming from vast amounts of experience. My views are not skewed, but thank you for enquiring.

You said you were a paramedic - not a midwife - so that’s why I made that comment. Most midwives I ever spoke to were more balanced in their views than consultants because they saw more normal births.

But in this case, if I were the OP I’d at least not labour at home.

However I believe that every woman has the right to labour in dignified and comfortable surroundings.

@DryIce exactly what I thought. Can't believe you'd want to 'fight' anything that could potentially affect you delivering your baby safely.

You could book at a different hospital or find one with an MLU right next to labour ward, though I still doubt they'd accept you. With your history, there is more GH chance that your baby will die or be brain damaged on an MLU. I'm not saying it will happen but that's the stats. Do you really want it on your conscience if you have a bad outcome?

What upsets me the most about this post is the fact you are so focused on yourself and having this ideal birth that YOU want, that you are not thinking of anyone else. From the biggest being your unborn baby to your family who will have to deal with it if it goes wrong to the professionals you put under pressure to care for someone they don’t feel competent enough to do so.

@Steeley13

Well said

What upsets me the most about this post is the fact you are so focused on yourself and having this ideal birth that YOU want, that you are not thinking of anyone else

That’s not how I read it.

This is someone who wants to have the best labour possible with minimal interventions. Interventions aren’t always good for the baby - things like epidurals do impact on a baby but I bet plenty of women ignore that because they want the pain relief.

Having a bad labour experience can make it incredibly difficult to mother a newborn. So why wouldn’t you want to go somewhere that means you have the best chance of having the best labour possible?

Wanting a good labour and wanting the best for your child are not mutually exclusive.

I feel sorry for the OP. She has every right to question whether she can birth in a MLU and some MLUs would accept her.

There’s no reason that obstetric led units have to be so harsh and clinical - they are because it better suits the medical profession with no thought to the woman going through it. Childbirth is not a disease.

I feel sorry for the OP. She has every right to question whether she can birth in a MLU and some MLUs would accept her.

Believeitornot I actually feel sorry for OP too now, though I'm worried that she's trying to work against those providing care, rather than with them. A friend of mine had a very similar attitude to OP - was high risk plus refused induction AND demanded a home birth. She ended up having a CS as it wasn't physically possible for her to birth the baby. This wasn't picked up because she was at home, so it happened after 40+ hours of labour due to her refusing to go to hospital. If she'd gone in earlier she'd have avoided a string of surgeries since the birth to repair the damage done to her body.

Can I just point out that a previous retained placenta increases the risk of a second retained placenta and therefore increases the risk of bleeding after delivery. By this point the baby has been born, what is with all this people saying about risk to the baby? There isn't any additional risk to the baby the increased risk is to the OP.

My placenta first time was manually pulled...was v close to going to theatre after having a tranquil Labour in a MLU.
Second time it popped out no problem!

what is with all this people saying about risk to the baby?

it's quite significant to the baby if they are left without a mother within an hour or so of life which is perfectly possible if you have a significant PPH in a MLU.

also she said "stuck" - not sure of the exact medical terminology but if there is more risk of placenta accreta then I think that increases risk of abruption

I totally understand how the OP feels. They take you on a tour of this lovely new midwife centre with private ensuite rooms and tell you how natural is best and birth has become over-medicalised and interventions are bad, and the latest research indicates that you need this sort of quiet, secure environment with dim lighting, and how it will stimulate your natural hormones and you'll have a much better birth experience. And then they tell you that you're high risk so you have to give birth on a non-private ward in the sort of brightly-lit old-fashioned medicalised environment they've spent the last several months dissing! Of course women are going to say they don't want that!

I felt the same as OP - after I saw the private ensuite rooms in the brand new midwife centre and heard the spiel about natural birth I point blank refused to go on the tatty old high risk ward with nothing but a curtain for privacy, even if I needed to. I was adamant I was going in the midwife centre and if they wouldn't let me I was having a home birth. If they don't want women to react like this then perhaps the high-risk wards need to be updated to a similar standard as the midwife centres?

Go private if the NHS can't support what you want
FWIW I wouldn't risk it, retrained placenta will happen I suspect good birth bad birth or indifferent ... you don't want to be more than a couple of minutes from a qualified consultant doctor to save your life if necessary

Bellamurte- I agree there has to be some balance the labour wards don’t have to be soo clinical

I understand that the loss of the mother obviously affects the baby but previous posters have said she risks her baby being brain damaged or dead, that's not true and is an awful thing to say. The risk of bleeding is to the mother herself and it's up to her as to wether she takes that risk or not, it dosnt affect the baby's chance of survival at all.

Thanks again for such varied views. Fwiw I I don't feel I am risking the baby, and I am trying hard to balance the needs and wants of my existing DC, my DH, unborn baby, me and my mental and physical health. It's difficult. And not made easier by so many of the professionals involved having such different views:
Community midwife thinks home birth is feasible and not unduly worrying for me,

independent midwife whom I booked for several hours of debrief and planning also very happy to do home birth but sadly I can't afford her,

Consultant thinks home birth is risky but not impossible,

One MLU (M) have said probably yes they'll accept me as delivery suite next door but it's an hours drive

Closer MLU (N) point blank said no.

Not helped by Hospital H refusing tours or debriefs of any kind. Told me to look at pictures on website!

I had PND last time and am keen to avoid interventions for me, and for baby as I'd like to maximise chances of breastfeeding etc : as a thoughtful poster said, a good birth is not selfish, it could be best for everyone!