Following on from your initial thoughts Laura, and Soo's comments, I would also say that we have evidence about women's experience of transfer from midwifery units. In the main, this shows that while women talk about being "disappointed" that they did not have the birth that they planned for, they value and reflect positively on their midwifery unit experience. While some women, as with women who plan birth in any setting, may experience 'trauma' as a consequence of their birth experience, there is less evidence from women's accounts of trauma caused by transfer itself. Often, where there is trauma this is a consequence of how the transfer is managed. Transfer, or the potential for transfer, should be considered part of planning birth in a midwifery unit, and indeed is part of the reason why we see good outcomes in planned midwifery unit births. With sensitive care it need not be traumatic.
All best
Rachel
Rachel Rowe BA(Hons), DPhil
University Research Lecturer
Senior Health Services Researcher & NIHR Post Doctoral Fellow
National Perinatal Epidemiology Unit
Nuffield Department of Population Health
University of Oxford
Old Road Campus
Oxford
OX3 7LF
Tel: 01865 289713
Fax: 01865 289701
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http://www.npeu.ox.ac.uk/
-----Original Message-----
From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of Soo Downe
Sent: 14 November 2018 09:39
To: [log in to unmask]
Subject: Re: Debates on the ‘uselessness’ and costs of having MLU and homebirth in ongoing Italian Congress
I would say:
1. all women in hospital have had to transfer from home to hospital, often in strong labour, but no-one seems to worry about this - if we wanted minimum transfers in labour, we would have 100% home birth, with women only being transferred when they really needed the hospital 2. there are units with much lower transfer rates, still with safe outcomes, so if we want to reduce transfers lets look at these units, and use their guidelines - lets not work on the basis of units where the guidelines are so restrictive, without any benefit to mothers and babies.
3. If there really is a need for 40% transfer (which is unlikely) this still means that 60% of women are able to have their baby as they want to in a BC. This is much higher than the % of healthy women who manage to have the kind of birth they originally wanted in hospital - so what is the problem? Indeed, if we want to maximise the chance for women to have physiological births, even with a 40% transfer rate, BCs beat hospitals every time
All the best
Soo
-----Original Message-----
From: A forum for discussion on midwifery and reproductive health research. <[log in to unmask]> On Behalf Of Laura Iannuzzi
Sent: 14 November 2018 09:07
To: [log in to unmask]
Subject: Debates on the ‘uselessness’ and costs of having MLU and homebirth in ongoing Italian Congress
Dear all
I am attending the pre congress courses of the BIRTH Congress in Venice and I ll be speaking this afternoon of our experience in the Margherita birth centre in The Italian context The doctor who was chairing the course this morning in his presentation posed the question of what is the benefit of having MLUs if women in large part need to be transferred (he mentioned the 40% transfer rate for nulliparous in the birthplace study) and access to obstetric led unit with consequent trauma for women and costs for the system and ‘risks’ related to emergency (homebirth was not even considered to be an option being ‘risky’ - and he used US based literature ) So he was posing question on the issue of transfers
I am trying to slightly change my presentation trying to address this question (that express a very common cultural standpoint in some context, that encourages midwife led care in labour ward but not midwife led care in midwife led units or home)
For sure in my mind are coming reflection such as ;
- yes it might be quite a challenge the theme of transfer for both women/ family and midwives
- what is provided is not only intrapartum care
- the more you protect physiology the less u need to transfer
- the theme of women’s choice
- the fact that transfers are mainly not due to emergency reason but more ‘tranquil’ situation such as slow progress of labour
- what about the costs of unnecessary interventions ? Are we sure that they are lower than the costs of transfers
- health is more than a intact Perineum and so on
But as even if thoughly posed this is an interesting are of debate, I d like to know if possibile from you what would you argue, what points would you make to answer ?
This could be of massive help
Thanks!
Laura
Laura Iannuzzi
PhD, MSc, PgCert, BMId, RM
Lead midwife physiological pregnancy path and Margherita birth centre Careggi university hospital Italy
Inviato da iPhone
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