Draft: Birthplace Decisions, Information for pregnant women and partners on planning where to give birth

Appendix 1

Examples where birth in an obstetric unit is usually recommended alongside discussion about your individual circumstances with your obstetrician and midwife

Pre-existing medical considerations

Women who have pre-existing medical conditions, will be advised to birth in an obstetric unit.

These complications include (not exhaustive):

• Cardiac disease with intrapartum complications
• Hypertensive disorders on medication
• Hyperthyroid with detectable TRAB
• Myasthenia gravis
• ITP
• Pre-existing type 1 or 2 diabetes
• Non-specific connective tissue disorders and systemic lupus erythematosus, scleroderma
• Sickle cell disease
• Past malignancy
• Von Wilibrands Disorder
• Cystic fibrosis
• Organ transplant
• Rhesus isoimmunisation
• Hep B/C or liver disease with abnormal liver function
• History of thrombolic disorders
• Asthma with an increase in treatment or hospital admission in current pregnancy
• Epilepsy
• Atypical antibodies putting the baby at significant chance of haemolytic disease
• HIV without effective antiretroviral treatment
• Inflammatory Bowel Disease
• Current active Varicella Zoster, rubella, herpes
• Abnormal renal function or renal disease requiring supervision
• BMI >40
• Significant substance or alcohol misuse

Current pregnancy

• Obstetric conditions arising in this pregnancy or during birth
• These complications include (not exhaustive):
• Less than 37 or > more than 42 weeks, gestation
• Pre-eclampsia or pregnancy- induced hypertension
• Current malignancy
• Haemoglobin less than 85g/dl
• Multiple pregnancy
• Fetal size less than 10th centile
• Fibroids >5cm
• Malpresentation – breech or transverse lie
• Maternal age >45
• Spontaneous rupture of membranes and not in spontaneous labour >24 hours
• BMI 35-40 with complications, BMI >40
• Recurrent unexplained antepartum haemorrhage
• Significant meconium present (defined as dark green or black amniotic fluidthat is thick or tenacious, or any meconium stained amniotic fluid containing lumps of meconium)
• Polyhydramnios
• Oligohydramnios in the absence of ruptured membranes
• Gestational diabetes
• Obstetric cholestasis
• Significant fetal abnormality/ anomaly
• Tocophobia (excessive fear of childbirth)
• Certain fetal infections

The above lists provide examples, but are not exhaustive.

Any other conditions of concern should be a discussion with your maternity team.

Previous pregnancies and births

For some women, complications in their previous labour and birth will mean that they may be advised to labour and birth in an obstetric unit.

These complications include (not exhaustive):

• Previous shoulder dystocia
• Eclampsia
• Placental abruption
• Uterine rupture, previous uterine surgery
• Post partum haemorrhage (requiring significant additional treatment or blood transfusion)
• Previous Caesarean section
• Previous preterm birth
• Fetal death related to intrapartum difficulty

What to do if you have been advised to give birth in an Obstetric Unit

In this situation, it is really important that you are given information so that you know why birth in an obstetric unit has been recommended. If you have been advised to give birth in an obstetric unit, but would like to consider birth in a midwifery unit or at home, do discuss this with your consultant obstetrician, and your primary midwife as early as possible.

Page 19 includes some additional resources and contacts for you.