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Different birth settings explained

What is an Obstetric (Consultant Led) Unit?


Obstetric units (OUs) are a new name for ‘labour wards’. Obstetric units are based in hospitals that provide 24 hour services including medical, obstetric, neonatal and anaesthetic care. Although care is provided by a team of people, obstetricians (doctors who specialise in birth) lead care if you are at high risk of complications during labour and birth.


Midwives also provide care to all women in an obstetric unit, and lead your care if you have a
straightforward pregnancy and birth.


Expectant mothers are advised to give birth in a labour ward if;


‐ They go into labour before 37 weeks
‐ Need a caesarean or an epidural
‐ Have had medical or obstetric complications during their current or previous pregnancies


What is a Midwife Led Unit (MLU)?


In recent years, many hospitals have opened midwifery units, or changed parts of obstetric units into
a midwifery unit (MLU).

MLUs are for healthy women at low risk of complications, and specialise in providing care which
helps women to have a normal birth (birth without medical interventions).

All forms of pain relief are available, with the exception of an epidural. If you are healthy and your pregnancy is straightforward, the evidence says you should give birth at home or in a birth centre.


There are two main kinds of midwifery unit Alongside midwifery units (AMUs) and Freestanding
midwifery units (MLUs)


What is a freestanding / standalone MLU?


Freestanding MLUs are birth centres on a separate site from the nearest main hospital.
A freestanding unit means that there is no Obstetric or Neonatal presence at the unit (medical
consultants or facilities to manage sick babies).


Midwives take responsibility for your care during labour, and support you to have a normal birth.
If you or your baby need specialist medical care or you decide to have an epidural or drugs for pain
relief, you will need to be transferred to an obstetric unit, which may be several miles away.
Transfer is normally by car or ambulance.


What is an alongside MLU?


An alongside MLU is based within hospitals but operate as a separate and distinct facility to the
consultant led unit.


Midwives take responsibility for your care during labour, and support you to have a normal birth.
If you or your baby need specialist medical care or you decide to have an epidural for pain relief, you
will need to be transferred to an obstetric unit on the same site. Transfer will normally be by bed or
wheelchair.


This allows women to benefit from a midwife led birth, whilst offering swift access to medical staff
(obstetricians, anaesthetists and neonatal) should these be required.

What sort of reasons would a woman be transferred to from an MLU to an obstetric unit?

A woman may be transferred from a MLU to an obstetric unit for;


‐ Delay in first or second stage labour
‐ Abnormal foetal heart rate
‐ Request for regional anaesthesia (epidural)
‐ Retained placenta
‐ Repair of perineal trauma
‐ Neonatal concerns (postpartum)


Who can birth in a Midwife Led Unit? What is a low risk birth?


Women who are classified as ‘low risk’ can choose to deliver their babies at a MLU. Low risk patients
are generally;


‐ fit and well before becoming pregnant and have no underlying health problems
‐ have had a previous uncomplicated pregnancy and delivery
‐ haven’t experienced any complications during pregnancy
‐ go into labour naturally between 37 and 42 weeks of pregnancy with the baby in the normal
position
‐ don’t want to have an epidural


Women access a MLU through their community midwife team and, subject to satisfying the clinical
criteria, will continue to receive care through their midwife team until they visit the MLU for the first
time at around 36 weeks for an assessment and to familiarise themselves with the surroundings.
They will attend the unit for delivery and, in normal circumstances, postnatal care will revert to their
original community midwifery team.


When birth in an obstetric unit is recommended


In some circumstances women are advised to give birth in an obstetric unit (labour ward), where you
have access to care by specialist midwives, doctors and the wider team. Also, more intensive
monitoring facilities are available, if you or your baby require these.


Current pregnancy
Twin or triplet pregnancy, pregnancy or ‘gestational’ diabetes, placenta is too low‐lying, breech
pregnancy, high blood pressure, high BMI (35 kg/m2 or more), pregnancy lasts less than 37 weeks or
more than 42 weeks (including induction of labour), baby is too small, anaemia (low iron levels), too
much or too little water (amniotic fluid) around the baby, active infections including group B
streptococcus, where antibiotics in labour are recommended.


Previous pregnancies and births
Previous caesarean, post‐partum haemorrhage (bleeding) which required additional treatment or a
blood transfusion, pre‐eclampsia requiring pre‐term birth, eclampsia, retained placenta, previous
shoulder dystocia (when it is difficult to deliver baby’s shoulders), previous stillbirth.


Long term medical conditions
Diabetes, heart disease, kidney disease, history of high blood pressure or stroke, asthma, cystic
fibrosis, sickle cell disease, clotting or bleeding disorders, hyperthyroid, current infections (for
example HIV, hepatitis B or C, toxoplasmosis), liver disease, epilepsy, mental health conditions
requiring inpatient care.

When individual assessment of place of birth is recommended
Some circumstances mean that place of birth should be considered on an individual basis. These
include if you have a medical condition which is stable, previous severe tears during birth (third or
fourth degree tears), being aged over 35 at booking, having a higher BMI (30–35 kg/m2 ), expecting
a fifth or subsequent baby.