NICE draft guidelines on giving birth - home birth or midwife led unit?

[KatieMumsnet]

Hi All

NICE (the National Institute of Health and Care Excellence) are in the news today with draft guidelines recommending that midwives advise mothers-to-be to opt for a midwifery-led unit (MLU) or a home birth when deciding where to give birth.

What do you think? Would these recommendations work for you? Would you still stick to a traditional hospital ward? Have you had a home birth and loved it? Or did you opt for a home birth or midwife led unit only to find out the resources weren't there?

Would be great to hear your views.

Thanks

MNHQ

viva two of my three labours had very long latent stages. With the first I had an epidural, with the second (which invoked me getting stuck at 8cm for over 10 hours, I didn't. What I had instead was the support of a midwife friend and colleague who I had a long relationship of trust with.

I really, really believe in case loading and in the power of intimate and familiar midwife support. For me it was as powerful as an epidural in helping me cope. I wish more women had this. I think it would really change birth for the better for many people.

I don't think internet extremists are imaginary - I just give them no attention at all in the same way I give no brain space to people who say the moon is flat. Everyone who's got two brain cells to rub together knows that birth is very, very variable and that sometimes things get beyond any sort of control at all

:) Absolutely.
But what about someone with PND or laid up with a C section scar that won't heal who is wondering 'what if...?' after another sleepless night?
Or someone who wanted a MLU pool and they've just told her she's got PE, straight off to hospital, and she's terrified.

Of course there are people out there who say how things 'should' be done. So what? I still don't think they deserve chastising about their morals or values.

Sorry, poor phrasing.

I mean people who should have been columnists for the daily mail in the way they tell people (or scare them) about everything.

If someone is so raw that they will read personal criticism into a chuck away comment giving advice about coping strategies for labour from a brand new mum, reading it in such a way as to unbalance them, then they honestly they probably shouldn't go on Internet forums.

If someone is so raw that they will read personal criticism into a chuck away comment giving advice about coping strategies for labour from a brand new mum, reading it in such a way as to unbalance them, then they honestly they probably shouldn't go on Internet forums.

Absolutely. But just thinking of the young people I work with, it's probably the raw, panicking ones who run straight off to Dr/Prof/Psych Google and get themselves in sixes and sevens.

But the worst thing for me, as I mentioned before, is that when you get blase "black and white" opinion makers, they do tend to suggest an unevolving 'way things are' (usually good for them, not for those they disagree with) rather than identifying issues and looking for something to be done. It happens in every area of life.

Or someone who wanted a MLU pool and they've just told her she's got PE, straight off to hospital, and she's terrified.

That's me!

I'm sorry but some people have no idea about the psychological effect that feeling you have failed at labour and breast feeding can have! I'm not some insecure vulnerable young girl I'm married nearly thirty and completely confident and yet my first birth experience has left me frankly scarred. The midwife I had was the worst person I have ever met who told me after 20 hours induced labour, back to back, with a failed epidural that I was to blame for the dip in my DD heart rate. If only I could have controlled myself and not had an epidural then I would have given birth with no problems she actually said this to me as I was wheeled into theatre. Actually I could never have given birth naturally my pelvis did not nor will it ever expand during labour like it is supposed too. Does this make me abnormal? Now I'm pregnant again should try to do it "normally" or should I have not got pregnant as I cost the tax payer to much for my ELCS? Unless you have failed like I have you cant tell me how other peoples comments make me feel. There is an underlining current within society and the NHS that if you just try hard, stop being so selfish, you can give birth "normally". Unfortunately the language people use does matter to those of us who are made to feel like this.

Due to the trauma my body sustained I got no milk not one drop and same thing again if you try harder at it, you just don't want your boobs to sag (someone said this to me in RL!) your not giving your DD the best start. I'm sorry breast feeding and natural birth nazi's exist wether you see them or not!

Sorry for the rant but in the same way I would never say another mothers feelings on her birth experience weren't valid neither are mine.

Oh and sorry if I'm imbalanced I shall try to keep my uncontrollable feelings to myself and off Internet forums as once again that's not normal

How horrible Missteacake - but you didn't fail. You could say you were failed by the people attending you. I know that they are under pressure but it's inexcusable to talk to people like that.

I didn't think it was BF which made your boobs sag - I just thought it was Old Father Time.

After nearly five years I understand now I didn't fail but for a long time I thought I had. In fact it took me three years to even consider TTC and another six months wondering if I was doing the right thing. I just wanted to explain to some on this thread who dismiss peoples feelings regarding a feeling of failure. Some of that feeling is internal however is it a natural feeling from a biological point of view or does society and the language that people use influence how we feel? I'm sure most people don't even realise what they are implying when they talk about "normal" experiences.

Oh and I have no idea about saggy boobs and breast feeding it was just something someone said to me. Maybe those who hold the moral breast feeding high ground can enlighten me.

Yaaaay!!!! I waited for the results of Birthplace in 2011 and am delighted to see the wheels slowly movingso that women can be offered genuine choice of midwife led care in an mlu. In about 10-20 years it might eventually exist. Obstetric led units have been shown to be less safe than MLUs and it will take at least a generation for public attitudes to change/widely accept this. I had to choose homebirth because an mlu was not a viable choice where i lived and i had to pay an im to do it. Both births were great at home and i wouldn't have it any other way but i regret having so little real choice. Others without savings have even less. These NICE guidelines should improve maternity care for all. Eventually.....

Some people say that this is just a cost cutting measure, but throwing money at a problem doesn't always improve things, so cost cutting of itself is not necessarily bad.

What they now need to do, IMO, is to look to those areas which have successfully implemented these ideas e.g. caseloading midwifery, decent home birth services, properly run MLUs, and ask how they did it.

I think squizita is spot on. The mere fact that you can never mention women getting decent pain relief without some doom-monger going on about "the cascade of intervention" and it not being a "normal birth" speaks volumes.

I would also agree with the ManWithNoName's post about risk.

Finally, I can understand being passionate about women being fully informed, given options, maternity care being well -staffed and resourced. All these things are wonderful and should be happening.

But the drum banging for a "certain method" of birth and claiming that it is
what women should have above all other methods, frankly it gives me the creeps, particularly the thought that if should have any sway over my life, my body, or my choices.

LaVolcan - since when have they "thrown money" at maternity care? It has always been underfunded and understaffed. That underfunding extends to NICU's too. Adults and paediatric ICU patients get 1 to 1 care, babies on NICU, even those needing the most intensive care certainly don't.

Goshann, the day you can find me a mum who actually would prefer a forceps delivery or emergency caesarean in preference to a straightforward birth is the day I'll start to reconsider whether doctors should recommend low tech settings for women.

Maybe 'thrown money' is the wrong expression. They certainly haven't bothered to 'throw money' at staffing.

There was a big push on, back in the late sixties/early seventies to get everyone away from home or small cottage hospital type of maternity hospitals.This is when they started to build big CLUs. I think to some extent that could be said to have been throwing money around. (A time when the birth rate was dropping and the economy was doing well.)

IMO a wrong turn was taken at that point and that any organisation is only as good as its staff and if you haven't got enough staff it doesn't matter how good your equipment is.

The point I wanted to make was that it doesn't necessarily cost money but sometimes it's a change of attitude which is required.

So I didn't see the NICE recommendations as 'banging a drum' for a certain method: I saw them as taking a rigorous piece of research and saying that a substantial number of women should be given more options which may also offer a better outcome healthwise.

I agree that the danger will be if a certain 'option' became compulsory.

Would also add, that I had health problems during my pregnancy and was recommended to give birth in a CLU with CEFM, advice I chose to reject in favour of having a homebirth. Was my doctor wrong to recommend this just because it wasn't my preference?

Doctors are HEALTH professionals and their job is to make evidence based recommendations which they believe optimise the chance of a woman emerging from birth in good health and with a well baby. The woman is within her rights to reject this advice, as I did.

LaVolcan exactly. Rather than herding everyone to one 'approved' way (which as you mention seems to happen every few decades based on crude interpretations, zeitgeist, politics etc'), let's have the resources and trained staff to allow women to decide/access what is best for them and their child. Let's have people properly trained in this advice so lower risk women aren't barred from HB on a box-tick, nor are more complex women (particularly those with mental health reasons for preferring being near a CLU e.g. previous loss) given well-meaning pressure to 'try' something which upsets them.
More women would end up getting access to MLU or home birth because there are enough and they are well staffed enough.
For women/babies with health conditions (including mental health e.g. anxiety), CLUs where they're not rushed off their feet and can focus on their patients better.

I also wonder if there's space for some kind of "IAG" (independent advice and guidance) for women? Just because if your MW happens to work in a certain way usually, they're only human, that will be their default when advising.

In youth services, there has been a big turn around recently with what is called "IAG" (independent advice and guidance) - where qualified people give young people advice on employment, education etc'.
One of the ideas behind it was to stop (for example) young middle-class students from certain schools being herded into university when it really wasn't for them, and likewise young students from less well off background being pushed towards vocational/apprenticeships inappropriately. This was happening via very, very well meaning teachers and counselors because of their experience and expectations - essentially 'what they were used to seeing/saying'.
Prior to this, it was counteracted by volunteers. But they weren't qualified and might give really poor advice!
So now, the advisors are qualified and work within youth services and education but a slightly separate from provision making them more impartial.

Would something like this work in maternity? E.g. a MW, Nurse or Dr who doesn't work (and therefore lean towards) their local community team/MLU/CLU who could advise women who feel confused?

I am sure IAG could be a good idea squizita.

Where I live the type of care you are offered depends entirely on which GP surgery you register with: from one which used to throw people off its list if they even asked about a home birth, and never ever referred to the MLU, one happy to state what the local options were: CLU/MLU/home, and another surgery which took the CLU as the default but was happy to consider alternatives if the woman knew to ask.

Lemiserable you seem to be overlooking the fact that plenty of women do opt for elective csections, to them that is a "straightforward birth".

Again you seem to be waving the banner that unless women opt for low tech maternity areas (HB or MLU) with little to no pain relief, they won't have the nice "straightforward" birth that good, stoic women supposedly have.

I find such an attitude to be victim blaming at best and extremely sinister at worst.

LaVolcan my GP surgery almost 'keeps out of it' - they pass you straight to midwives either in the community or a certain hospital, in the first trimester and then backs off bar a 24 week check up.
Which has an impact on advice because of course (and to some extent you'd hope this, as you want birth attendants who have faith in their place) they'll slightly 'sell' their place. For example I am with a large teaching hospital with an onsite MLU - they have a sister (maternity) hospital slightly near my house also with a MLU. I know I need to be on the site of a hospital (for treatment/placenta tests immediately post-birth due to past molar and losses) but may well get to use an onsite MLU (as am in good health). It's just been kind of assumed I'll want theirs, not the (similar) unit nearer me. Purely because that's where they work and they see women like me every day so why wouldn't I?
Well for me it's as simple as "the other one's slightly closer" not trauma or a difference in recommended route... but it's not impartial advice nonetheless.

...likewise the community midwives, if you opt for them straight after BFP, give leaflets about homebirth and local hospitals and MLU. Being London, there are other MLUs close by with more pools etc' that take women from my borough - but the local MW are obviously proud of 'their' patch.

Squizita From the website of the surgery I quoted (who used to throw people off their lists if they asked about home birth), from their information about ante-natal care: ......you need to be seen by the Nurse first followed by the doctor ....

Very much a medical model of care being 'offered' although whether the word 'need' counts as an offer, I am not convinced.

To be fair they then do mention that the midwives also offer (no word need there!) appointments, but this is listed afterwards, and is relatively new information; it wasn't there on their old website, but that's just had a revamp.

So I think your idea of an Independent Advice Group could be a good idea.