Not "allowed" to use MLU. Can I insist? What are my rights?

[Rolf]

I'm 34 weeks pregnant with my 4th child. After initially considering a homebirth, I'm now planning on having the baby at my local hospital. It's women's hospital with a Midwife Led Unit and a Main Delivery Suite - which are in the same building.

My consultant is generally supportive of my desire to use the MLU and the birthing pool, but with certain provisos. She is going to speak to people at the MLU and is prepared to write to them if there are "issues" which would put them off, but which she is happy can be dealt with safely in the MLU.

I'm seeing the consultant again at 37 weeks and I need to prepare myself for a confrontation if I'm told that I won't be "allowed" to use the MLU.

To my mind, the reasons they are likely to give aren't good reasons and I think that the baby and I will be as safe in the MLU as we would be in the Main Delivery Suite. Can I insist on using the MLU? If I turn up at the door to the MLU in labour, will they send me away to use the Main Delivery Suite instead?

thanks

Why should they refuse to let you use the MLU?

I was refused a MLU until I insisted on a homebirth and suddenly amazingly it was available to me.

But yes they can refuse to treat you, but by the same token you can refuse to go in and they may well prefer to have you in the MLU than at home if that is the choice presented to them.

Legally, I don't know if the MLU could refuse to let you in. And I wouldn't want to be arguing at the door with anyone at that stage of pregnancy.

Why would the MLU turn you down? Is it connected to why you are no longer planning a homebirth? As far as I know the criteria for either of these places of birth is very similar.

Our local MLU has very strict criteria - many women who are having consultant led care are excluded.

However - if as whomovedmychocolate says, high risk mums who start to make noises about having a homebirth are often offered it as an alternative....

If you have any problems just contact the supervisor of midwives directly. And if your consultant is ok about you using the MLU that will probably stand you in good stead.

If the consultant is ok about it, then I reckon she'll get it sorted out for me. It's if she isn't ok about it that I have a problem.

Funnily enough, when I was talking about a homebirth the consultant was very positive about me using the MLU. It was when I agreed to deliver in hospital that she became a bit more shaky . It was really stupid of me to give up that bargaining tool.

The possible reasons are threefold:

1. I get anaemic in late pregnancy. My Hb was 10.2 at 28 weeks, which I hoped would be enough to get them off my back about it, but my consultant wants to re-test at 36 weeks. I've been taking spatone throughout the pregnancy. I'm now taking fluradix as it's helping with the breathlessness I have had recently. I'm being careful with my diet as well. My consultant has said that so long as my Hb remains above 9.5 she'd be happy for me to use the MLU. There's a chance that it will fall below 9.5 - what danger (if any) would a MLU/water delivery pose to me or the baby in that case?

1. I have had GBS in the past and at my hospital the policy is to consider you GBS positive in subsequent pregnancies and recommend prophylactic antibiotics. I'm going to take the ECM test privately and if it's negative will decline antibiotics. I had antibiotics last time and although I found them unpleasant I'm willing to have them again if the result is positive.

1. I had a PPH last time. It was 12 hours after delivery (long after I'd left the delivery room) and caused by uterine atony. I'm convinced it happened because of the relatively long walk between the post-natal ward and SCBU, where my DD was. It was treated with an oxytocin drip and in any event the blood loss wasn't particularly great or dramatic. I would rather not have the injection at delivery but as a compromise would be willing to have it once the cord has finished pulsating.

I don't think any of these things will make me less safe in the MLU than I would be in the main delivery suite. I would even consider arguing that the baby and I would be safe delivering at home. But certainly I think the MLU is fine.

Remember too with GBS that it comes and goes on the test, so if it's positive maybe go back again in a week?

Is there any other reasons you're seeing a consultant? It's just that you're don't seem particularly high risk from what you've said, and if the consultant seems to have changed her mind, then maybe don't go and see her! Or say you've changed yours and want a homebirth instead. Other than the GBS there's nothing so far that you've said that suggests you shouldn't have a homebirth anyway, and even the GBS is a controversial topic anyway

Good luck, and be tough about what you want, don't get pushed around

1. The only problem with a low Hb is the symptoms you've already described such as breathlessness. Also, if you had a PPH again, because your Hb is already low, you could deteriorate quite quickly. However, docs/midwives cannot prevent you delivering wherever the hell you like!

1. What a ridiculous policy!!! GBS is a transient infection, it comes and goes. Most women who test positive early in pregnancy will most likely be negative approx 5wks later.

1. Research shows that if you've had a previous PPH you are at an increased risk of PPH with any subsequent pregnancies. In view of your history I think its reasonable to wait for the cord to stop pulsating before it is clamped and then, only then, if there is any sign of excessive bleeding consent to syntometrine.

I agree with everything you've said, you def know your stuff. If you have any problems speak to your supervisor of midwives. However, if your consultant is on side then I really don't think you'll have any problems!

Good luck!

Jaynz - I've been with the same consultant for the past 4 years, since I had a late m/c at 19 weeks. I first met her at the post-mortem consultation. She looked after me in my subsequent pregnancy with DD, which was pretty much normal except for concerns about foetal abnormality, and I was induced at 38 weeks becuase of that. This pregnancy has been fine though, and my first 2 pregnancies (before the late m/c) were fine too. I think that's what's so annoying about it - I'm a healthy old bird and don't like feeling as though I'm a "special case" . I've had enough of being a special case in a maternity hospital.

A negative ECM swab for GBS is considered reliable for 5 weeks - so as long as I deliver within 5 weeks of a negative swab it's safe to assume I'm still free of GBS.

Does anyone know what happens if I am advised to use the main delivery suite and I chose to ignore that advice and use the MLU? Can the MLU turn me away? Is there a way of avoiding having that argument when I turn up at the hospital in labour?

I have booked a doula so she can help on the day but obviously I would much rather have it sorted out in advance.

bump

Thanks for the replies. There is no reason to think I will need any special equipment (eg forceps) as an emergency. Oxytocin will be available along the corridor if my 3rd stage goes wonky, but again there's no reason to think that will be needed during delivery.

Fair point - but in my past 2 labours I've been fine with G&A and had a normal, managed 3rd stage. my labours are really easy.. It's post natal for me and potentially neo natally for the baby that we need a bit more care.

Sorry I can't help, Rolf, but let me know what happens. I have a consultant appointment at 34 weeks because of my BP and past induction. Frankly I would have thought that if you turn up anywhere there's room in an advanced stage of labour, they are going to admit you before they read your notes - and once you're admitted, you should be OK. (but i maybe wrong)

As a midwife who works in a birth centre (a co located one) I would not turn anyone away. If it was high risk I would advise them to deliver in the cons unit and if they refused contact a supervisor of midwives for advice and support, but I would continue to give care to the woman and offer her my support. If I were you when you are in labour phone them and don't let on that there are any worries, they can find that out when you are there and as a pp suggested they could then discuss it with you. Less likely to try and move you in strong labour. Make sure that you write a birth plan that says that you don't want to be transferred unless there are specific concerns on the day. If you are able to speak to a supervisor of midwives or a consultant midwife in the meantime that would be useful.

Maxbear - that's really helpful, thank you .

I'm keen to get the point across to them that if there is a genuine reason, for my safety or the baby's, to deliver in the main delivery suite, then of course I will do so. But that I don't want to simply because I don't tick the appropriate boxes on a protocol. The delivery suite holds such bad memories for me that I would very much like to avoid it if at all possible.

It might be interesting for you to know that I had an hb of 10.2 at 34 weeks in my second pregnancy and did not take iron . I had had a gbs swab with my first pregnancy. I decided to have a homebirth and a physiological third stage. All went well, lost quite a bit of blood, (at least 500ml) but am a healthy 30something year old woman and although felt extremely tired for two weeks did not do me any harm. Would have gone to hospital if any concerns re infection or anything else significant but was really pleased to avoid it. If I have another one will have another homebirth as long as baby does not seem too much bigger than my last one (I think that is why I bled quite a bit) My poor midwife, looking after a collegue must be quite stressful, (she has done it twice and knows I want another one!)

Maxbear - how reassuring. Your "alerts" are almost exactly the same as mine AND you're a midwife! I am so tempted to have a homebirth but every time I see my consultant or midwife I chicken out as neither of them are keen. There's an Ind. Midwife who I would love to use and who is really positive about me having a homebirth, but it's so ££.

Rolf - have you talked to the IM? Some can be remarkably flexible with payment plans or payment in kind (I know ours was looking for a decorator). The worst they can do is say no, afterall!

Fingers crossed you have a better birth experience this time round

Yes, I was a bit surprised to lose that much blood as I lost next to nothing first time round. Starlight, quite a few women can lose 500ml and feel totally normal afterwards, it is only classed as a pph if the woman is symptomatic, which of course most women are after a 750ml + pph. My friend loopymumsy lost quite a bit second time around can't remember how much exactly and she felt normal afterwards, I think her midwife (me!) felt a little worse for wear worry is one thing, but at 4am, something else!

Gosh, Starlight, those symptoms sound horrible. I'm sure I'd have been ok if I'd stayed in bed but because I kept getting up to go and see/feed DD everything went a bit pear-shaped. Fainting on the desk at SCBU with big sploshes of blood in my path wasn't really a good idea