Do I have the RIGHT to insist on a midwife led centre?

[TheEvilDead2]

I have been told due to my BMI that I probably can't go to a midwife led centre.

I want to have a natural birth and to be honest have had a very traumatic experience at our local hospital. Discussing going to give birth sent me in to a screaming, crying panic attack (and scared the shit out of DH) the other day. I really feel like going would ruin the whole experience for me and lead to PND (have suffered from severe depression/ suicidal thoughts in the past)

The midwife centre is next to the hospital, so why can't I go? hardly a bloody commute if somethign goes wrong.

Can I just turn up on the day?

No, unfortunately you can't. They don't have to let you in. Your best bet would be to ask to see a supervisor of midwives and see if you can get them to agree to it, or get your consultant to agree to it.

The thing they're probably worried about is the fact that you're at a slightly higher risk of a houlder dystocia, if you have this there is no time for a commute and being in a unit with no Drs may not be very good.

However if you've had a normal birth before with no shoulder dystocia then this is all in your favour. But you do need to try and get them to agree to it before.

Thank you Viva :(

This is my first one, so nothing to go on.
The traumatic experience wasn't birth related although also had a few horrible unrelated experiences during the TTC game.

Disappointed, but DH who adamantly against a home birth started promising me one when I lost it over the idea of a hospital birth. He said even if they don't let me in the midwife centre they can't force me to leave home. Wonder if I can use that as a bargaining tool? If you don't let me in I'm going to go home and squat over a bath tub with DH.

I always find it odd that you can be 'risked out' of a birth centre but still go on to have a home birth if you want to

I think telling them you want a home birth but are worried and feel that the best way to reduce your risk would be the compromise of a MLU might help, possibly?

Thank you for the advice Loopymumsy I genuinely feel I would lose the plot if brought in to hospital and worry about how that would affect the labour process and bonding with the baby after. If I didn't feel that way totally I'd follow midwife/doctors advice.

BTW (knock on virtual wood) have had a totally normal pregnancy so far..

Possibly Bertie, I will try and guilt them in to letting me have it my way. I suppose they are afraid of something going wrong and it being classed as a NHS fuck up. As opposed to someone engaging in the "risky" business of homebirthing.

They don't have to let you in, but if you can come up with a good case as to why their reasoning does not apply to you and meet with the supervisor of midwives, they may well let you anyway.

I know several people who were told they were not allowed to use the MLU, who then went away, did research as to what the increased potential risks were and what would mitigate them, had a meeting with the head midwife and were given permission to use the MLU. Worth a try?

IIRC the main increased risks with a high BMI are shoulder dystocia (because large women tend to have large babies who then get stuck), pre-eclempsia and heavy bleeding after the birth. So if you had a normal weight baby last time and no bp/bleeding problems with your first, and you show you have no issues with bp throughout this pregnancy and have a growth scan to check this baby isn't too big the supervisor may well agree as the risk would be lower than if it were your first.

You could also point out that being relaxed and mobile in a MLU would be more likely to allow your labour to progress and be low risk rather than being distressed and immobile in a CLU etc.

Good luck, and congratulations on your pregnancy!

You could try the threatening to have a homebirth argument but it may well not work. If something goes wrong at home then it is your choice/risk, however if something goes wrong in an MLU and they haven't followed NICE/RCOG guidelines about whether you were suitable for the unit or not then they have "allowed" you in. They would be worried that you would turn round and sue. Unfortunately Obstetrics is very much a blame culture these days and staff work in an environment of covering their own backs. Thats why I spend more time doing paperwork that actually supporting a woman when I look after her in labour.

EvilDead - the midwives at your hospital could be very different to the nurses/wards that you've come across already. How about asking to make an appt to have a look round the labour ward, get a feel for the place and the staff. It may be a lot better than you think.

Maybe that is an idea viva, but i'm actually in tears just thinking about it :(

GetTheHalloweenPartyStarted I will try those idea thank you, this is my first baby though. So we'll see if they give in.

Loopymumsy I would love a homebirth but DH doesn't really want one, it scares him. Also I am worried about living in a village and giving birth during the winter incase I do have to be sent to hospital in an emergency. (roads were a nightmare last winter...)

Talk to your MW. And I would book a hospital tour asap.

I was hating the idea of a hospital birth, having had lots of bad hospital experiences in the past and had decided on a home birth, but now have OC so don't have the option (wouldn't want to risk it now anyway).

But after 2 trips to the day assessment unit and a night in the higher-risk ward, I'm now weirdly a lot happier about the hospital and giving birth there. All the staff there have been brilliant, the ward was really friendly and the Delivery rooms look great, especially the birth pool room (which I'm still hoping to be able to use as it's on the Delivery Suite not the MLU). I've been really well looked after at the hospital maternity wing, in contrast to A&E experiences there.

I saw photos of a stand-alone MLU locally and it looked horrible TBH. Would prefer to be in hospital than there by a long way.

I'm now doing hypnotherapy (Natal Hypnotherapy) to help with my stress and to make me feel mroe able to stay calm despite circumstances (travelling to hospital, etc) and feel its really helping.

Although this is your choice, the healthcare professionals do not have to support your decision if they think it poses risks to you and your baby. If they won't book you into the MLU, you can't just decide to go there anyway. And even if you stay home, they can send an ambulance instead of a MW team with homebirth kit.

I would have a serious discussion with your MW about the risks. Some areas have different policies on BMI-related stuff so if you are borderline (e.g. pregnancy BMI of 31 when your area have a cutoff of 30 rather than 35 like many areas) then you may be able to get the MW and doctors to agree that the risks aren't high.

I'm posting this to try and help, and not to be a cow: please don't take offence! If it is unfair, then ignore it and bear in mind I've not met you in real life etc.
But it sounds to me like you're fear /loathing of hospitals is very extreme and a bit irrational. Obviously nobody LIKES hospitals, and most people have an amount of dread of them. However to be so hysterically scared /unhappy about the idea of hospital birth (espescialy whithout having seen the hospital in question) does sound a bit of an extreme reaction.
Could you talk over your feelings with a midwife? Maybe call to make an appointment, alongside booking a hospital tour and MLU tour as well? Take your DH with you for support. It may make you decide you definitely don't want to be in hospital, of course: it's just fact-finding and not decision making so there's no need to stress about going.
Whatever you decide, IMO it is important to be able to step back and logically weigh up the hard facts of the risks of both the MLU (due to BMI) and the hospital birth (due to your stress levels).

Without wanting to sound like a big meaney straight after bumperella (who I don't know - we're not ganging up on you, promise!), I agree with everything she says with one additional point. If you have serious issues with the hospital I think you need to try to overcome these. Even if you do manage to go into a MLU, what if there are complications and they move you next door to the hospital? Then you've got the stress of a complicated labour AND a hospital phobia to deal with at the same time. For the sake of your own sanity, you need to be in a good mental place where you can trust the hospital staff, and place the care of yourself and your baby into their hands if necessary.

FYI, I also wanted a MLU birth last time, but had to go into hospital to be induced. This time round I'm still hoping for a complication-free birth in the MLU, but know that, if I end up in the hospital again, they're still a pretty amazing bunch of people!

so sorry to hear you are so upset about what should be a positive part of being a mum. How long have you got to go? I ask because I do think you need to consider the possibility that you might NEED to be in hospital for some reason such as a breech birth that has nothing to do with your BMI but presents risks that require a consultant led birth. If this happens you need to be able to deal with it at the time so if you can address your fears now and find some way of managing them it could help. Its not something that would work for me but have you considered looking into hypnobirthing - a friend of mine had it and thought it was amazing. I don;t know if it would help with your specific issue of hospitals in general but maybe worth looking into.

Best of luck, however it goes, the birth is only a tiny part of what is to come so try not to let it take over all of this lovely period of anticipation.

Sorry I have only just seen that there were additional responses to this.

Basically I know my reaction to the hospital isn't normal. But I did have a really traumatic experience which I'd rather not go in to. Just to explain though, it was the worst day of my life and thinking about that day makes me cry. I was treated horribly. And the idea of going back for something so important scares me to death. :(

I can't see why my BMI is so important when I have had a healthy pregnancy.

trixie123 Thank you for your post, I am 30 weeks pregnant private scan this week shows that the baby is already in position (hopefully it will stay that way!)

And actually I am doing a hypnobirthing class, I thought like you did it might help me calm down for the labour.

Unfortunately in the book it shows many examples of hospitals through time not listening to women and how much pain has been created through the over medicalization of child birth (basically what I expected!).

So while I am feeling confident that I can give birth and do so in a calm way and a have a good birth I am not calm about being in the hospital which I believe (maybe not rationally) will give me the exact opposite of what I want for my child's birth,

I am mostly annoyed because apparently the midwife led unit is actually in the hospital but on the floor beneath the normal delivery suite. WHIch I didn't realise so effectivly I will still be in the hospital but won't have all the scary contraptions etc around me. But could me moved upstairs in no time.

Clearly they must feel they are going to have to not allow me a natural birth.

Stop panicking. I was considered high risk for my DD2 but ended up attempting a waterbirth in a MLU with the blessing of my consultant.

You need to:

• read up on the risks of your BMI being higher.

• contact the consultant midwife at your hospital and (if different) the midwife who heads up the MLU. Midwives are experts in normal birth and they may be quite inclined to support your request.

• even if the consensus is that you should be on the labour ward, as my consultant said to me, they can do a lot to make it pleasant. My friend, on the same unit, had dimmed lights, her own ball and yoga mat, moved around freely. She was on a monitor some of the time but when she wanted to move the midwives assisted her and adjusted the wires. If unwanted intervention is suggested you need to practice saying "no thank you" in a calm and zen fashion!

• There are not generally "contraptions" on display in a labour ward room. They bring these out towards the end so you are not labouring next to a tray of forceps, for example. This is really no different to an MLU.

Since you are so frightened I strongly recommend getting an experienced doula or an independent midwifw (who is willing to act as doula in the hospital). I was fairly afraid of birth having had a difficult time with DD1 but I talked through my fears for months and was actively looking forward to it by the time DD2 was born.

HTH, good luck.

Thank you for the info on mlu and hospital rooms haliborange, as for a doula, that would be nice but out of our reach financialy.

the 300 pounds for hypnobirthing was a huge stretch but I felt it was worth it to keep me sane (although seem to be losing the plot anyway... )

Doula UK offers some financial help for families who can't afford a doula. Might be worth a call?

oh wow thanks for that, i will look in to it. I had looked in to it before but ruled it out cause o fmoney.

Being on a CLU does not mean they'll be forcing "contraceptions" on you. But what it does mean is that if you need a CTG, or a doctor, they are right there. I've got to give birth on the CLU because of OC (previously had a HWB booked) and my MW has said they will do their best to give me as natural a labour as possible, while keeping me and my baby safe.

On a MLU, they're not set-up for anything risky, so they have their rules about low-risk only. Doesn't actually mean that if you can't go on the MLU you can't have a natural birth, just that they are concerned you are at higher risk of needing equipment & staff they don't have available.

High BMI (and I assume yours was over 35?) does mean you are at higher risk of issues like dystocia.

Have you actually discussed this with your MW or the hospital? Or done a hospital tour?