Is it possible to give birth in mlu after emc

[LadyPug]

I’m planning a VBAC for dc2 and have been told by consultant can’t have baby in the birth unit (even though it’s in the hospital close to labour ward). Does anyone know why this is? Can I contest it?

It will be because VBAC has a 1 in 100 risk of uterine rupture, thereby risking losing your baby and/or your uterus.

It may also be related to the reason for your first section.

Midwife led care is supposed to be exclusively for women with zero risk factors. All pregnancy and birth is inherently dangerous but certain pregnancies present no evidence of risks - these are the only ones that should be eligible for midwife care. As a VBAC, you are far from low risk.

Why are you so opposed to receiving the level of care you need?

I was told this too when I was pregnant because my iron levels were a certain percentage below the 'allowed percentage for the birth centre' percentage thing because of risk factors. (Even though the birth centre was like 1 min away from the hospital building )
They also told me I needed a certain injection to make the placenta deliver quicker afterwards, due to the low iron percentage.

I booked myself another blood test and it turns out my iron went up above the certain allowed percentage that changed me from being 'high risk' to 'low risk'
And then I had a home birth. (That ended up with complications for reasons entirely unrelated to anything previously considered anyway)

It's all about specific statistics that determine 'high risk' and 'low risk' though at the end of the day it diusnt really. Make much specific difference usually.

I would probably try to oppose them if I really wanted to birth in the birth centre instead of the hospital. Bit if they say you are not allowed and for decent medical reasons, the hospital usually isn't massively different to the birth centre anyway. You can still claim your space and make it your own to the extents you can.
You could van have a home birth if you wanted, if you informed yourself on all the medical info and decided that it was right for you with the medical info in consideration. Not saying you should i yourself ur circumstances, just that you could. ( I probably wouldn't after c section) you have the right to feel abaolutly comfortable and in control, where ever you are birthing.

Thank you lily

Goodness sycamore I am not against receiving the level of care I need. I had a very bad first experience in the delivery ward with a bad staff member and I was not informed of some of the things I should have been.

Obviously my baby’s needs come first but since the mlu is one corridor from the delivery suite I don’t understand why I can’t labour there.

My first emc was because dd got stuck (turned her head and lifted her chin) and consultant said it’s unlikely to happen again.

There is a very big difference between our new mlu ward and dated old ward (where I was greeted with a room the size of a cupboard, machines everywhere, strip lighting and cigarette smoke coming through the window)

I think if you aren’t allowed to birth somewhere they should be clear about why. And if the reason is uterine rupture which my consultant told me has only witnessed twice in his 30 year career, I think being one corridor away (and being monitored correctly) should be fine

Hi

I know someone with 3 c-sections who had mlu birth as she wanted home birth and mlu was the compromise.

Also rupture risk is 1 in 1000 not 100 (this is what my consultant wrote in my vbac notes and also what I founs through LOADS of research).

A lot of places don't offer mlu vbac but it certainly is possible and worth further discussion if it ia what you really want.

Thank you anxious that’s good to know. I’m happy to be monitored etc. All I really want is dim lighting, preferably some sort of water eg birth pool/bath and to be active (not on my back the whole time like last time)

You should be able to hVe dim lighting etc on delivery suite. The issue will be the midwives on mlu will only offer certain monitoring and it sounds like you need more than that

Tell them you’re having a homebirth. They will offer you the birth centre.

Plenty of MLU’s happy to have women having VBACs.

Ask for a referral to a consultant midwife or birth choices clinic.

If you are happy to be continuously monitored, your hospital may have a telemetry CTG that you can use, be this on birthing unit or delivery suite if they have a room with a pool. If you are keen to have intermittent auscultation (use of a sonic aid or pinnard every 15 minutes) then this would be considered ‘more risky’ although the evidence does suggest that CTG monitoring does little, if anything, to improve outcomes for babies. Set up a meeting with a midwifery matron (they will have a named midwife in charge of birth choices or a midwifery unit lead midwife) who can discuss the options with you. Usually, if you have a rational and sensible discussion ahead of time, your wishes can be accommodated if you are willing to sign a waiver which aknowledges that this is not the standard package of care. They obviously have to make you aware of the potential/perceived risks in order for you to make an informed choice, but will usually be happy to support you.

Thanks mini said we would do Home birth and although they don’t agree with it they won’t allow MLU. We also have no consultant midwife where I live. Thank you though, I know these things work elsewhere

Thanks didntcomehere no wireless monitoring available apparently, only cefm which I think I will be refusing as read so much on it and think intermittent is fine and has a better chance of VBAC. Have offered to sign a waiver and told no, mlu is totally out of bounds for all vbacs

I managed to get my hospital to agree to this. I had to agree to be monitored with a handheld monitor (I was going in the pool), to time limits on each phase of labour, the jab to speed up delivery of the placenta, and that I’d be moved to the Labour Ward at the first hint of trouble.
I got my consultant to agree to consider it, and the consultant midwife was on side too. We did have some fairly frank conversations before I got sign off, and it wasn’t totally agreed until I reached quite late on in my pregnancy without any issues. I’d had a terrible time with my first (no “care” to speak of; stuck on a monitor and a mw who came in and told me off for not progressing enough once an hour).
In the event my second baby got stuck in the same position as my first and I had a crash CS, but it was a far more pleasant experience than my first labour.

Wow polly that’s amazing to hear. I will keep pushing but not holding out lots of hope!

Are you in the UK? Could you try contacting AIMS?

Sorry you are in this position Pug and that you had a horrible experience last time. I just wanted to correct the stats on uterine rupture as both 1/100 and 1/1000 are way off. The stats your consultant is likely to use will be 1/200 (that is from the RCOG guidelines). It does seem silly that there can’t be a compromise, hopefully with time labour wards will become more like the MLU and feel less old fashioned etc.

I hope you have a successful VBAC.

Hi didntcomehere yes in cornwall so we are very far behind. Didn’t realise AIMS would be able to do anything? Thank you Goulash

Pug I was in a similar position to you. I was told that I wasn’t ‘allowed’ to use the MLU (the use of the term ‘allowed’ made me as I felt it was my body and my baby and therefore my decision). I had a very bad meeting with a doctor who said some really horrible things to me (I’d have a dead baby if I didn’t go on the Labour Ward being one of them). However, I had done a lot of reading of the most recent research and guidelines, and I realised she was quoting me old, out of date stats. The whole thing was extremely upsetting. I had a meeting with the supervisor of midwives and we sat and discussed it at length. She informed me that the reason they didn’t have vbacs on the MLU was because that was just what they did there. She said that there was not really any other reason, as the same as you, the MLU was right underneath the Labour Ward and offered wireless monitoring etc. The level of care leading up to any (very minimal risk of) a rupture would be the same whichever ward I was on and response would have been immediate. She gave me special permission to use the MLU. As it happened, my second birth was so quick that I barely made it to the hospital, let alone the MLU!. However, ultimately it is their hospital and therefore their rules, however much we may dislike it. This is why a lot of women opt for home vbacs, to try to regain an element of control around their birth choices, as they get fed up of being told what they are ‘allowed’ to do.

I have two recommendations for you. There is a fantastic vbac (UK) support group on Facebook that has a lot of very knowledgable ladies on it. I found it to be more helpful than Mumsnet. The other thing I recommend is a book by Katharine Graves called Hypnobirthing which has a chapter in it about birth choices, rights of the mother and how to remain assertive and in control during conversations around your birth.

Good luck!

I managed to get my hospital to agree to this as the MLU was directly nextdoor to the delivery suit. It wasn't common practice then and I had to fight for it. However I was unfortunately in that 0.5% who rupture... It happend when I was still being assessed so had yet to make my way over to the MLU. Since this happened I know the hospital has not allowed VBACs on MLU at all, even those who have successfully had a VBAC previously (so a midwife friend tells me).

Knowing what I do now about how badly things can go, I'd still have tried for the MLU based on its proximity to the consultant-led ward (a set of double doors separating them) as it is pretty unlikely to go so horrifically and quickly wrong, but if it was any greater distance there is no way I'd risk it.

Thanks teacoffee that’s v helpful!

Anxious that must have been incredibly scary

Anxious I’m so sorry to hear that you went through that but pleased that you fought for the birth choices you wanted. I hope everything was ok with you and baby

Don’t forget you can spend a huge part of early labour at home. How far is the hospital? Can you stay at home until he last minute?

Ladypug unfortunately what you're likely to find is that because of your previous lscs you don't fit the criteria to labour and birth in the mlu.

While this seems hugely unfair, one of the reasons for this are that there is an increased possibility (I hate the term 'risk') of uterine rupture. Because of this potential, it would be recommended that obstetricians be involved in your care and that continuous monitoring of fetal heart be recommended - one of the key indicators of rupture is a change in fetal heart rate pattern which won't be picked up with a normal Doppler.

Another reason is insurance. The criteria is set by bodies outside of the trust and maternity dept. The NHSLA who insures the nhs against litigation set strict criteria for all aspects of medical and obstetric care and trusts have to adhere to this criteria.

Another issue is that midwife led care (which you'd get on mlu) is not suitable for all - those with complications should have input from appropriately trained medical staff and a midwife led unit is not the place for that kind of care.

All MLUs have criteria for their women and they have to do this due to capacity issues as well as insurance. They just can't let everyone into an MLU because it then would not be a midwife led unit.
If your local nhs trust cares for 5,000 labouring women and all went to MLU it'd be constantly closed as there really would be no capacity for anyone, let alone those who are deemed to have no predisposing risk factors who are appropriate for care there.

Midwives are experts in normal labour and birth. They are not to lead care for those who have predisposing risk factors or complications arising during labour and delivery suite/labour ward is where appropriate medical care is situated.

I totally get why it seems unfair and I do understand that MLUs appear to provide a nicer birthing environment but for many women, this environment isn't appropriate for their births.

In demanding care on MLU you could well be delaying care that you or your baby may need in an emergency, putting those midwives who aren't equipped with the equipment needed to care for you under immense pressure and risk of registration loss and legal proceedings and removing a labour room from a woman who does meet criteria to birth there. Same could be said for home birth - extra staff on call, very limited equipment, extra delays in care if you did need help.

That said, many nhs trusts are now investing in making their labour ward/delivery suites nicer environments because they realise that women don't want to feel that they're having a lesser birthing experience and you can make the room that you're in more comfortable with simple things like insisting on low lighting, taking pillows from home etc.

Well gunty where do I begin? My consultant actually told me that whilst I’m high risk on paper I’m not in reality because my only risk is that I’m a previous c section and this was caused by baby in a bad position which he says is extremely unlikely to happen again. Yes uterine rupture can occur but I believe there is often a confusion between true uterine rupture and scar dehiscence. The actual true rate of rupture ranges from 0.09 to 0.8%. The consultant has also recommended induction to me knowing that it increases chance of scar rupture but believing my occasion was a one off and therefore I do not understand why I can’t be in the MLU. Scar rupture also happens to first time mother’s (not just VBACS) and also hysterectomy due to c section was ten times greater than that of having a VBAC that had scar rupture which is already much less likely. In fact, no study in VBAC literature has recorded a maternal death attributable to VBAC. CEFM has been proven to have a 60% false positive chance of recording incorrectly and ending in emc and actually has no proven effect of working better than intermittent monitoring every 15 minutes (this is widely reported upon so please feel free to share your evidence to the contrary) I also feel that reliance on a machine and leaving a woman alone to labour on it (as I have experienced) is no substitute for effective maternity care. My labour is a normal labour. If you write off every c section as “not normal” then quite soon nobody will be allowed access to the MLU because of the increasing rate of c section (a by product of machines that tell you things are wrong when they aren’t, induction, cannulas, tubes, bright lights, bad care and women being kept on backs on the bed). Don’t get me wrong, I believe in high risk but I am not high risk. I am a woman who had a c section and a bad reaction to a harsh drug used because my baby was considered “abnormally big” (turned out it was a scan gone wrong and she was actually just 7lbs) it’s not about lighting, it’s about comfort, safety and trust. Something all mothers should be entitled to, not just first time mothers. I was treated particularly badly as a first time mother and I won’t be accepting that treatment again.

Thanks whatisthewhat that is the back up plan. It’s 25 mins away so more than I’m comfortable with but if not allowed in MLU then I will do that (and that is understood by doctors who would prefer that to MLU which is on site) then will transfer in last minute I expect

LadyPug that was me too. My only high risk factor was the previous CS and in my first pregnancy the only complication was DD1's position (breech), which was picked up early so I was booked an ELCS rather than it being an emergency. I was the perfect VBAC candidate.
In terms of monitoring etc the plan had been to use wireless monitoring (telemetry?) in the MLU so I could use the pool which was my main reason for wanting the MLU. My understanding is they were going to/have now installed pools in the consultant-led ward to get around this issue.

Yes the baby and I are fine. She is 21mo now. My situation was a bit of a fuck-up all round as I experienced the sudden and ongoing pain across my scar 3hrs before the baby's readings dropped but the team around me were very reluctant to believe what I told them was happening as 'computer said no'. They were convinced I just wasn't coping with the contraction pain. They waited for DD2's readings to drop, at which point they had 7 mins to get her out. It needn't have been quite the crisis it was. Her head had already pushed out into my abdomen by the time they got to her.