What Is The Difference Between A Consultant Led Unit And Midwife Led Birth(CLU/MLU/Homebirth)

A guest blog post  by Kath Harbisher

My perspective goes like this.

A consultant led unit (CLU) is the place for high tech, high intervention, medic-led obstetric care. They are in place for women with obstetric complications that are high risk and this care saves lives. We’re grateful to have them.

But, what research and the Birth Place study, in particular, shows, is that low risk women on a CLU end up with a lot of unnecessary interventions. Interventions affect birth outcomes.

Some women prefer to give birth on a CLU and our society has certainly bought into the myth that all women need medical help when giving birth. If a woman feels psychologically safer birthing on a CLU then I respect that, and believe she should have that option because psychological well-being is as important as physical well-being.

Midwife led units (MLUs) and home births are not high tech, so the overall level of intervention is much lower and those interventions are low tech. The point is to facilitate normal physiological birth with skilled midwives.

In the UK we have seen a rising trend of Post Natal Depression (PND) and birth related post traumatic stress disorder (PTSD) that correlates with the rising trend in intervention and caesarean birth. It’s extremely complex and this is just one facet of that complexity, but one has to consider whether women are suffering psychological damage when births are happening in high tech environments.

One of the reasons linked to this seems to be that in high tech environments, particularly when the NHS is driven by litigation and defensive practice, how women are treated seems to deteriorate and the focus in only on keeping mother and child alive and undamaged physically with no thought to the impact on the dyad (mother and baby as a unit).

In fact, most maternity care related complaints are about or will include issues of poor communication, being treated unkindly, without compassion, without explanation, being treated disrespectfully and having legal rights ignored.

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Then comes scaremongering and coercion followed by assault. While a focus on keeping mother and child alive is absolutely necessary for the true emergency, many women on CLUs these days are not in dire emergency; they’re there just in case an emergency might happen. Yet they may be subject to many unnecessary interventions, and for some, all the poor treatment things I’ve mentioned. This kind of treatment is far less likely to happen on an MLU or at a homebirth. I think, in part, because there is far less pressure on staff to be seen to be doing something or to ‘fix’ birth even when it doesn’t need fixing.

Sam’s story Jan 2021- Sam is a member of our Home Birth Support Group UK and her story is such a powerful one.

Well I didn’t get my HBAC but I did manage a VBAC, much to my own surprise as well as literally every single HCP I encountered in the later stages of my pregnancy.

My daughter Birdie was measuring 9lb 5oz at my 38 week scan, which in hindsight I probably should have declined, as it caused me a lot of grief and mental energy in advocating for my choices over the remaining weeks of my pregnancy.

She was predicted to be over 10lb at birth.

I wanted the most time and the best chance of achieving a VBAC, and by the time my trust suspended planned home births I had run out of puff and decided to labour on the delivery suite. The last few weeks of my pregnancy were extremely hard emotionally, but perhaps that’s a story for another time.

When she made her arrival it turns out she was 7lb 11oz… I call that a pretty material difference! I suppose the moral of the story is to take growth scans with a pinch of salt.

Thankfully I had the support of this fabulous, life changing group and the confidence to stand my ground when faced with opposition. As a previous poster mentioned, if you can donate to the running of the group, please do.

I can’t believe I actually grew a baby and pushed her out! 

There’s nothing quite like getting a letter from your consultant in the post, listing all the reasons why you shouldn’t try for a homebirth or even a VBAC, three days after you’ve actually had one!.

The whole atmosphere of an MLU and home birth is invariably far more relaxed and accommodating.

Vaginal birth after a caesarean (VBAC) has a scar rupture risk of 0.2% which actually makes it low risk. This risk is comparable to other obstetric risks which do not exclude women from MLUs and home births. But women planning a VBAC in the UK are, generally, routinely excluded from MLUs and advised against home birth, where they feel they will get a more positive birth experience, and from the option of low intervention physiological birth which is better for mother and child where possible.

Women seeking to birth on an MLU or at home are looking for skilled help in a calm and relaxed environment which also facilitates physiological birth. It’s because that’s recognised that we have MLUs at all

So, wanting to be on an MLU or to birth at home, is all about the benefits of physiological birth and protecting oneself from psychological damage which is very reasonable.

For vaginal birth after caesarean, this can be explored in more detail in this articles

Uterine Rupture By Intended Mode Of Delivery In The UK.

Samantha Says 

The Royal Berkshire Hospital now has midwife led care as the standard path way for women who want a vaginal birth after a previous caesarean. Although I am not a fan of routine sweeps and vaginal examinations – I think this is a massive step forward for VBAC. The Royal Berkshire Policy can be read HERE. This link also contains all the latest policy and research.

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