Natural birth units 'putting mothers at risk'
HUNDREDS of pregnant women are exposed to avoidable risk each year by having their babies in midwife-only "natural" birth units, a new report has revealed.
Up to a third of expectant mothers are rushed at the last minute to doctor-led labour suites because midwife-run wards cannot deal with medical complications or provide sufficient pain relief.
The problems are most likely to affect first-time mothers, and some women suffered "unacceptable" delays of up to 13 hours transferring between units because of hold-ups with organising ambulances, according to the research.
Interest in "natural" childbirth has increased in recent years and many maternity hospitals now offer the choice of a unit run by midwives, free of doctors, and offering minimal pain relief. The trend has been driven by concern over increasing rates for caesareans and other medical interventions.
But research by the Scottish Programme for Clinical Effectiveness in Reproductive Health suggests women are not receiving sufficient advice about the rigours and risks of childbirth.
Dr Gillian Penney, director of the programme and one of Scotland's leading maternity experts, has examined outcomes at all 22 midwife-led units in nine health board areas across Scotland. The research was conducted in 2005 and has taken two years to analyse.
Penney's audit shows that 31% of 627 first-time mothers who were admitted to midwife-units were transferred during labour, or shortly after giving birth, with rates as high as 65% in one hospital, the Vale of Leven District General Hospital in Argyll and Clyde. This compared with a 9% transfer rate among women who had already had children.
The researchers also found "unacceptable" delays for many women who were moved between midwife-led and traditional units, an average of two-and-a-half hours. One woman had to wait more than 13 hours.
Penney's report is backed by figures released by health boards to Scotland on Sunday under Freedom of Information legislation.
They show that over the past three years, between 13% and 40% of women have been transferred from midwife-led units to doctor-led units.
Penney said that midwife-led units make a valuable contribution to maternity services but that pregnant women needed to be told of the risks.
She said: "Nearly one-third of first-time mothers had a really traumatic experience of being transported in labour. If I thought I had a one-in-three chance of being transferred in labour by ambulance I would not want to expose myself to that risk. But there are women who are willing to do that. If they make that choice, understanding these figures, they are free to do so.
"But they should be given the full information to inform their choice. It is more psychologically traumatic rather than dangerous, so it's about making that choice to expose herself to an experience that may be at best unpleasant and psychologically damaging to her."
One mother, who asked not to be named, told of her experience in the midwife-led unit of a major hospital when she gave birth to her first child. When her labour failed to progress she was sent to the consultant-led ward, a move that she says left her bitterly disappointed.
"I was in intermittent labour and I had been awake for a long time so the staff decided I had to be moved because I was not going to have a normal delivery. I found it quite distressing and felt very disappointed and unsure. I ended up having to have my waters broken for me and needed a forceps delivery."
Doctors and midwives are deeply divided on the issue.
Carrie Longton, co-founder of the parenting website Mumsnet, said that the reality for many women was that they actually have very little choice when it comes to childbirth.
She said: "At the moment the choice is between a homely place with more risk of running into trouble or an over-medicalised experience in a hospital. If women have to go into a consultant-led hospital it could be made a more pleasant experience."
Gillian Smith, the Royal College of Midwives' National Officer for Scotland, said: "It is important to remember that this was a snapshot taken in 2005 and the recommendations in the report have been met or are being dealt with."
A Scottish Executive spokeswoman said: "The recommendations and the findings of the report need to be looked at in more detail and will be discussed by the Ministerial Action Group on Maternity Services."
Controversy pits midwives against doctors
Sarah Montagu, the Association of Radical Midwives
"Only 14% of first-time mothers go through a 'normal' birth - without any intervention at all - and obviously that figure could be a lot higher.
"Midwife units tend to reduce the number of complications and interventions, and as long as there are robust guidelines on who should give birth there, they are a very good choice. If one in three first-time mothers are being transferred then that means two-thirds are not being subjected to the higher intervention rates of consultant-led units.
"Midwives are more likely to have the skills to help women to give birth normally and use birthing pools, birthing balls and slings to support them in an upright position so that you are more likely to give birth naturally. In a consultant-led unit you are more likely to be continuously monitored and offered an epidural which can slow labour down and increase the chance of a forceps delivery."
Professor James Drife, Royal College of Obstetricians and Gynaecologists
"In the past, midwife-led units were closed down because women were finding themselves having to be transferred in labour with unacceptable risks. I have been in obstetrics for 30 years and the wheel has turned full circle. In the 1980s the home-from-home midwife unit was introduced into hospital premises, which meant patients were only down the corridor if they needed to be transferred, which has always seemed to me the ideal way to go.
"The government has not been honest about the risks that women face in stand-alone midwife-led units because the whole thing has become very political. However, they are more risky and there is a higher mortality rate.
"There has been an anti-obstetric atmosphere about the politics of maternity care for the last 20 years. We do not need to be particularly loved but we do need to be sure that women are told the facts."
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