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

[drivenfromdistraction]

Sounds sensible to me. 3 straightforward births here, I only saw midwives (though I was in an ordinary hospital ward). Doctor came by to stitch me up after the first one.

As long as the doctor-expertise is on call when it's required, I think a MLU has better expertise for straightforward births.

[MollyBdenum]

It seems pretty sensible to me, based on the evidence of safest outcomes for low risk pregnancies, although it can be pretty hard accessing a MLU in some areas. I had both my children at home and would do so again, but might have considered a MLU birth first time round if there had been one available.

[MollyBdenum]

I did have trouble getting a home birth, due to staff shortages. I was originally told that no midwife was available when I was in labour with DC1 but after some fantastic assertiveness from DP they managed to find someone willing to come in just before I started pushing.

After several friends who planned home births ended up having to go into hospital due to midwife shortages (or had unplanned unassisted births) I had DC2 under the care of independent midwives.

I believe that things have improved in the 4 years since DC2 was born but in my city the options are basically the CLU or a home birth if they can find a free midwife.

[LaVolcan]

About time too. But they need to make sure that there are enough community midwives.

[WhoDaresWins]

MLUs I can see are a great idea and I'd be behind that.

Home births, not so much. Personally, I wanted to be surrounded by as many medical staff and equipment as possible. I wanted all my bases covered and would not have been happy at home with one or two midwives and 20 min drive to the hospital.

I think women should be given all the options and left to choose. They shouldn't be 'encouraged' in any direction, it's a short step from encouragement to pressure.

[eurochick]

I think the new guidelines are great. Hospitals are for sick people. Most women have healthy pregnancies and would be fine in an MLU or at home.

[AMumInScotland]

I was signed up with an MLU, and saw the two local community midwives throughout my pregnancy. The continuity of care was brilliant.

In the end, DS's arrival got complicated, and I had to be signed over to the consultant unit when he was 'stuck' but that was just a 'paperwork' exercise and I wasn't even really aware of it at the time, since the MLU was physically just the same hospital.

So long as the option is there to get doctors involved quickly if needed, then I'd thoroughly recommend MLUs.

[ArtFine]

What would happen if you need an assisted birth at MLU? Or an epidural?

[ArtFine]

I think the MLU should be in the hospital, or just next to it, incase there are complications.

I know of a MLU that is 30 mins from the closest delivery unit. How is that even allowed or safe?

[FiveFingerDeathPunch]

what happens when it all goes wrong?
so there you are at home with your lovely inexperience MW and the normal/uncomplicated birth goes dreadfully wrong?
no doctors in the building.....and every minute means more brain damage??
will your child be able to sue the MW?
will the MW have insurance??

[Thurlow]

Women should be able to chose. Where I gave birth, there was no option to chose to give birth on a consultant led unit. This wasn't the world's biggest problem as the CLU and MLU were in the same building. But I think it really could be a problem for some women if they are being strongly pushed to go to an MLU that is separate from a hospital.

In my first birth, I would have coped much less well if I was somewhere where the doctors weren't available within minutes. I just would not have been happy. I wasn't looking forward to birth, I was quite pro pain-relief, I wanted to give birth where the option of an epidural was there.

Encouraging women to have a choice works both ways, and a woman should equally be allowed to choose a medicalised birth if that is what she wants.

[LaVolcan]

The big problem is that so few MLUs exist and they are usually the first to get closed down when there are cuts in funding because it's so easy just to herd more women into the CLU.

It would need a concerted change of attitude: from about 1960 onwards women were told that home birth wasn't safe without there being a scrap of evidence to back this up, so 50-60 years of conditioning isn't going to be changed overnight. By the same token it seemed to be assumed that small maternity hospitals were also not safe because they lacked the high tech equipment and doctors on call, again without the evidence to back this up. My local hospital closed down because most of the GPs in town refused to refer women to it for this sort of reason. It was subsequently found that the closure didn't save the health authority a penny but the choice was lost.

At the same time I don't think we would want to go back to the 1950s where women who needed a hospital birth couldn't get one easily.

[BetterWithCheese]

I started off in a MLU with my first and ended up with a 20 minute blue light transfer to hospital when things failed to progress. My DS was fine throughout though, his heartrate never dipped and no signs of distress so it didn't feel scary but it would have been terrifying if it had been more urgent. I had a retained placenta and PPH with my second but was in CLU so was in theatre quite quickly. The MLU was a lovely environment though, I think having co-located with CLUs is the best model.

[Pinkje]

No thanks, I'm so glad of the availability of the paediatrician at each of my three deliveries.

[KleineDracheKokosnuss]

I think the MLU should be in the hospital, or just next to it, incase there are complications.

^^ This

I went to an MLU next to a hospital and it was fantastic. I would have been immediately transferred from the MLU to the hospital (a whole 20 metres or so) if something had gone wrong. Home birth sounds lovely in theory, but I would have been about 45 minutes blue light away from the hospital if something had gone wrong, and that's just too far and too long for a baby.

So, in all, I think making good quality MLU's available to all would be best, but only if they are near to the people who can, if necessary, carry out the emergency C-Section.

[TeWiSavesTheDay]

I think it's sensible too.

Maybe with the caveat that 1st timers should be made aware of MLUs close to CLUs for ease of transfer if necessary.

That was reassuring for me when I had my first at a MLU. Next two were born at home.

[LaVolcan]

I thought that the Place of Birth study found that free standing MLUs were safer than ones attached to the CLU?

[MollyBdenum]

Whodares. I absolutely agree that if a woman wants to birth in hospital she should be able to do so. But at the moment it is not made clear to women with low risk pregnancies who have already given birth at least once that statistics show the safest place of birth in those circumstances to be at home.

[Viviennemary]

I think people should have the right to choose. I would have hated a home birth.

[Dwerf]

My maternity unit had a home-from-home room at the time of my 3rd birth, and I was desperate to use it. Except when my waters broke, there was merconium, so that went out of the window. I was going to ask again with my 4th, but she arrived so quickly that I was just transferred from ward to available room and I could have been anywhere at that point, quite frankly.

When my daughter had her two, both were inductions, she wasn't offered the home from home for her first, and by the second, our maternity unit then boasted a birthing unit and she was told not to even look at it (jokingly by the midwives) as she was too high risk.

I do love the idea of them though.

[gurningpug]

What vivienne said. I also think MLUs should be close to CLUs in case of problems, or in case the woman changes her mind during labour.

[BomChickaMeowMeow]

My response to hearing the report on the radio was "What MLU?"

I considered home birth both times but concluded I would prefer to be in hospital. I had two six hour labours and straightforward pregnancies so would be a candidate, but with DD1 I was very grateful for an epidural. The second I managed with gas and air but DD2 was born dry and we had to stay in 24 hours in case of infection, so we would have ended up in hospital after anyway.

[merrymouse]

Are there lots of midwives kicking their heals in midwife led units because there isn't enough demand? I thought it was a bit the other way round?

I think I gave birth in a MLU, but couldn't tell the difference because it was in the hospital and the birth was very straightforward.

[Shouldbemumof2]

I wanted a home birth but was convinced to go to the MLU after taking a tour. I was told that They would transfer me at the first sign of trouble. They didn't, they waited far too long and my daughter died.

[Treats]

I can't help feeling a bit cynical about this. I hate being told that there is one 'best' way to give birth, or - worse - hearing that what 'women want' is to give birth at home. We all have different needs.

Birth is completely unpredictable - even a low risk pregnancy can result in complications during labour* - and it's impossible to say what kind of provision is going to be best for the mother and baby until - almost - the very last moment.

Funding and planning has to recognise this reality. There needs to be a range of options available for women and no pressure to decide until they're ready. If they're lucky enough not to have the decision taken out of their hands by circumstances.

There isn't an easy or cheap way to provide those things. I agree that an MLU located on the same site as a CLU would be ideal.

As an aside, I would take some of the stats about MLUs/home births with a bit of a pinch of salt. Mothers giving birth in these situations are a pre-selected group of low risk births. You wouldn't see the same safety record if they were accepting all births, regardless of risk.

*Sad personal experience.