Q. I had a c section 12 yrs ago, as i was taken in on my due date for a large baby, i`m 5ft, they tried to induce me over 3 days and nothing happened so they decided i needed to have a c section. I then went on to have a very successful and enjoyable vbac in nov 2007. Im pregnant again and i want to be able to use a local MLU, is it my right to be able to choose mlu or will i be forced to use the consultant led team? many thanks

A. I'm really pleased that you were able to achieve a vaginal birth after your earlier caesarean section (VBAC). Experiences such as this often give women renewed confidence in their body's ability to labour normally and give birth, so I can understand your wish to use your local midwifery led unit (MLU) in your current pregnancy. However, while you have every right to choose the location for your baby's birth, you also need to ensure that you have received sufficient and reliable information to enable you to make an informed decision.

MLUs tend to set criteria for women who wish to use their facilities for labour care and childbirth. These criteria are not set to discriminate against individual women, but instead, are designed to ensure that women receive appropriate care from the appropriate health professional, so that neither the woman nor her midwife are left vulnerable should there be a change in circumstances, or a deviation from ‘normal' labour and birth progress. Midwives are regarded as experts in normal pregnancy and birth and their education and practice enables them to be the lead professional where there are no medical, pregnancy-related, or social problems/concerns. However, where any complications have been identified, midwives are required by their legislation to make a referral to a medical practitioner (obstetrician) for their expert advice and, where appropriate, input to care.

Because you have had a previous caesarean section, your midwife and doctor may well advise you to give birth in the hospital consultant led unit; this is because there is always the concern that the edges of the scar from your previous caesarean could start to separate during labour. Each pregnancy can weaken the caesarean scar and the first indication that there could be a problem is often an abnormal change in the pattern of your baby's heartbeat. This is why you are likely to have had continuous electronic monitoring of your baby's heartbeat in your last labour. This allows the midwife and doctor to see how your baby is coping with your labour contractions. Should any concerns be identified, you then have much quicker access to the necessary facilities and expertise that are always on hand within a consultant led unit. However, I'm also very aware that you have previously achieved a successful vaginal birth, so providing this baby is around the same birth weight, there should be no reason why you cannot deliver vaginally again. I am not sure whether the MLU you wish to use is alongside the consultant unit, or is in a different location. If it is adjacent to the hospital labour ward, it may be possible for you to labour in the MLU, while recognising that should any problems arise, you can be transferred without delay to the consultant unit. If the MLU is not close to the Consultant unit, there may be concern about the potential delay associated with transfer into the consultant unit from the MLU. In addition, you do need to think about how this might affect you in labour, should this situation arise. However, talking through these issues with your midwife and doctor should help you all decide on what is the best action to take for all concerned. Maternity services will always be respectful and supportive of women's informed choices; however, where there are concerns for the health and safety of a mother and/or her baby, they have a duty to ensure that women are fully informed of these, as well as any potential risks associated with them. I would therefore urge you to speak with your midwife and obstetrician who will help you develop a plan of care for your labour and birth, which meets your wishes whilst also safeguarding you and your baby's health and well-being.

Best regards

Vicky