Dissapointing Consultant Appointment - advice please

[MissTwister]

Hello All

I am 22 weeks and was referred to a consultant for an unrelated health condition that actually has no effect on my pregnancy which the consultant today confirmed.

However, she then went on to focus on my blood pressure. Now this has always been on the high side of normal when in doctor’s surgeries but the Midwives said it was fine as long as I kept monitoring it at home and it’s currently lower than my booking in appointment. At home it is around 125/75 which is fine, today it was 132/80 which is still within normal, plus I have a nasty cold which will elevate it. The doctor (she wasn’t a consultant) then talked a lot about pre-eclampsia and the risks and how I need more consultant appointments and weekly monitoring from 28 weeks.

She then decided I would likely get gestational diabetes as I am little overweight and started talking about its effect on pre-eclampsia and booked me in for a growth scan

She was actually a very nice lady but was clearly fairly junior (she kept looking stuff up) and I am really concerned her over precaution on the blood pressure is sending me down a very medicalised route. There is a lovely birth centre at the hospital but the entrance is quite strict and she mentioned this might stop me going there . However, correct me if I am wrong, but my blood pressure is not actually high at the moment and is actually good for me - probably because I have obviously not been drinking and have been eating healthier. I also saw a doctor before I got pregnant who said there was no problem at all with my blood pressure.

I also spoke to her about my low lying placenta and she said whilst she is confident it will move out of the way and not be a problem and it’s unlikely I will bleed I should still probably not go on my holiday at 26 weeks which would see me around an hour from a hospital. Which means I will lose my money for this……. She then kept saying she highly doubted there would be problems but it was a risk I needed to decide whether to take and should try and find a nearer hospital (there isn’t one)! Not helpful

What are your thoughts?

[Teeste]

Blimey! My booking BMI was 40, so I'm consultant led. I've had the GTT - all clear. My BP was 120/80 yesterday, although it has been 135/85 ish at times. So no, your BP is fine and the pre-eclampsia spiel is a bit premature, I'd say. They do so like giving you the scary risk lectures, don't they?

To be fair, my consultant appointments aren't much different from my midwife appointments, except waiting times take for-fecking-ever. The extra growth scans are actually quite nice as I get to see my little lad more often and who doesn't like extra reassurance? They do the urine and BP tests, ask if I've any questions, then send me off home.

Re holiday - only you can make that decision, I think. It's all about what you would feel comfortable with.

Re birth centre - despite my high-riskiness, I was told the consultant may decide I can go midwife-led for the birth if I had a very uneventful pregnancy. So, presuming your BMI is much lower than mine, you may be able to make a very good case for going to the birth centre. Fx for you!

[ShootTheMoon]

I'm sorry you had a disappointing appt, but I would say that there are risks of gestational hypertension (starts after 20 weeks) and PE, and if your BP is consistently high (a one off reading isn't really relevant at this stage) then it is better to know that in advance and ensure that you are in the right place. Most likely it just means that you need more regular BP monitoring and urine dip checks for now.

FWIW, I had consistently high BP in my first pg, starting around the level of your reading by 8 weeks (though I don't have essential hypertension outside of pg). I never quite had a high enough reading (over 140/99 I think) to be admitted to hospital, but came close. Several times I'd have several high readings but one would be low enough and that's what my MW would write down. In labour my BP went to over 170/130, which brings risk of stroke and organ failure - I had to be rushed out of my nice MW led unit, treated, try not to push etc, and then ended up staying in for treatment and monitoring for 6 days. It wasn't fun. My BP is already high in this pg so I am now officially high risk for hypertension and PE, and having extra tests and monitoring. I have no risk factors, so it's a bit of a mystery.

In the nicest possible way, your doctor would have been negligent if she hadn't recorded your elevated BP, and if this is indeed the start of gestational hypertension, or even PE, then it needs to be tracked and monitored. I suspect she is taking extra care based on your existing risk factors, and agree that it's premature to assume anything based on one marginally increased reading. Hopefully all will be absolutely fine for you, but having experienced somewhat more relaxed care with my first pregnancy, I feel much more in control this time around, and I'm glad of the care being taken.

[catellington]

Funny I was just reading this thread and a letter arrived asking me to come to a consultants appointment which was scheduled for yesterday. I am 38+2 and have had absolutely no risk factors or problems, they sent me for a growth scan because of previous low birth weight (but healthy) baby which came back all fine. I can only assume they want me to be signed off by a consultant anyway. But why not say something first not just arrange an appointment..?

No one has said to me I was being referred to a consultant and I may have the baby any day, I am totally confused and rather irritated to be honest. I feel that the whole process is just a struggle and they want to find a reason to stop me having a home birth or be in the midwife led unit.

[RugBugs]

I had a similar experience during my 2nd pg after having PE in my 1st, consultant said need extra monitoring, don't advise a hb etc. thankfully my blood pressure stayed stable and I was discharged back to midwife care.
I had a lovely home birth with DD2 in the end even if it wasn't 'approved' until 5 days before!

[catellington]

Rug that's reassuring but why do they leave it so late!! Are they trying to make women more stressed!!

[RugBugs]

I know! I was really stressing! Home births are usually booked at 36 weeks here but there was a change in clinic boundaries and then staff issues and the added complication of the Drs opinion.
Luckily I had a very pragmatic midwife at booking in this time and she didn't refer me to the hypertension clinic even though she should have based on history.

[MissTwister]

thanks for the responses, they're appreciated.

ShootTheMoon My issue is I wasn't referred for blood pressure I was referred for something else which is now not relevant anymore. The MW have always thought my BP is fine but the doctor today suddenly focused on it. And surely if my normal pre-pregnancy blood pressure is c. 135/85 (which is classified as normal) and now it reads at 125/75 (even better) with a one-off of 132/80 today (which is also normal!) then this is all normal for me. I don't know why this necessitates consultant led monitoring from now on. If I hadn't had the unrelated pregnancy condition I would never even have seen her!

[ShootTheMoon]

twister, sorry, I might have sounded a bit narky in my email. Bad day.

Good medical care is holistic rather than specific, so because of your other risk factors, the appearance of a higher BP reading might be enough to trigger concern about new issues. I do agree with you that your reading wasn't especially concerning in of itself, but I expect that if it returns to your regular pregnancy level then you won't be seen by consultants over much.You'll probably see the MW more often than usual with the occasional consultant appt.

So it's not the BP per se that is initiating consultant care, but the BMI, the pre-existing condition - is it your first baby or first with a new partner - both are also risk factors? (I know it is deemed not relevant but as part of a package it could be), and now the elevated BP, as a whole give them enough concern to bring in a consultant. Usually you need more than one minor risk factor I think.

FWIW in pregnancy, a BP of over 140/90 usually needs extra monitoring, but over 140/99 usually means being admitted for monitoring. You're not massively far off the lower one and hypertension is a largely silent disease so there's no way to tell without being checked. The readings that were recorded for me were below 149/99 though they were often the lowest of 5-10 readings which were taken in my appointments. Because they were under the threshold, I was able to use a MW led unit. But I had to be transferred at 10cm, which I wouldn't wish on anyone!

In any case, good, luck, it was probably just a one off reading because of the annoyingness of waiting on consultant appointments, so you may find it all goes away if your other readings drop. Also, you can decline to take the advice, but it depends if the MW centre would take you against consultant advice.

[MissTwister]

Thanks for the response. It is my first child but I don''t really have any other risk factors. My BMI is under the level that initiates consultant care so it's not that. And the thing I was referred for really isn't relevant - the consultant said so!

I actually monitor my BP at home as I know I get 'white coat' syndrome and its been really good lately. I showed her my readings and she agreed they were good. I think she was just quite junior and over zealous - hopefully I will see someone else next time and things will carry on as previous as I have had no other problems

[Slongette]

With my first DC I was referred to the consultant as I have a high bmi and slightly raised BP because I'm fat..... Saw the actual consultant who was great and referred me back to the MWs - easy.

I'm 27 wks with DC2 and again have been referred to the consultant. Thiisbtime have seen 2 baby Drs who gave been over the top - in fact the last guy I saw nearly got a punch in the faced for being particularly goady.... I do t mind the being overweight lectures but I'm not going to take it from someone who is just as bloody fat!

Oh and he kept asking me questions that, if he'd read my bloody notes he'd have known the bloody answer to!

As I was leaving I overheard the receptionist say to another pg lady that she can ask to specifically see the actual consultant at her next appt - that's what I'm hoping to do when I go back.. Maybe you can do the same and hopefully get referred back to the MW's?

[applecore0317]

I was referred to he consultant for something completely different and am under consultant led care now for the remainder of my pregnancy for a completely different thing that they picked up on in that initial appointment just from talking to me.

For me its worked out, because I am risk of pre term and wouldn't have known that otherwise and have been on medication to try and prevent it.

consultants can sign you back to the midwife later on if they are satisfied all is ok. At least with being monitored regularly, if there is any change it will be picked up quickly

[Skiptonlass]

Shoot the moon is spot on - one factor alone won't always trigger a move to consultant care but the whole picture might. I review patient records for clinical trial admission and it's the combination, the whole picture, that counts. For example, if a blood glucose is in range but high AND the patient has high HbA1c AND they are overweight we will likely need much more information. If we just have one out of range value then we can ask for a retest and generally we allow the patient in.

I suspect you're in this situation - your medical history plus some borderline results are driving this, and don't forget the consultant would be negligent if she didn't act. :)

Talk to her, let her know you'd like, if possible, to be back on midwife led care, but I think she probably made the right call (it is frustrating for you!)

[ShootTheMoon]

You put it so much more clearly than I did skiptonlass, thanks

[tobysmum77]

Consultant led care is a completely separate issue to hb. What still happen op is that they will see you again and then may make a very late appointment. I ended up consultant led with dd2 and had a hb. The mw who booked my hb just asked me if I had discussed it with the consultant and that was it.

[MissTwister]

Thanks all. I have no medical history risks, my BMI is within the limit and my BP is within normal range so fingers crossed!

[Skiptonlass]

Hopefully you'll get the birth you want ! I live in Scandinavia (sweden) having moved here from the UK. Having seen how relaxed and midwife led things here are, I understand your frustration .

[WindYourBobbinUp]

Regarding the holiday, do check with your insurer that you are covered, as most only cover a complication free pregnancy and take your notes with you.
It's up to you what you do and if it's somewhere with good medical care you should be ok. I had low lying placenta and gave birth preterm, if you bleed heavily you might need to deliver - I was about to drive to Scotland from the south - that would've been a stressful trip if I'd gone!
It is rare though, I understand I was quite unlucky

[Mrscog]

If it's just the BP then you can always carry on as you are and not go to your consultant appointments. They're not compulsory - just phone and keep rearranging.

I'm not advocating this, as I don't know your full picture, but you could see how your BP pans out over the next few weeks, and buy some urine dipsticks for at home to check sugars, and if you're happy, and you go to your MW appointments and she's happy you could just do an extra consultant appointment at some point, and see what they say with a clearer picture.

[yummymango]

Try to be pleased they are keeping an eye on you. I didn't have high blood pressure at all but later in my first pregnancy it suddenly became high in the third trimester and I had to be put on medication to lower it, plus numerous overnight stays and weekly checks. It wasn't particularly pleasant but it can be so dangerous in pregnancy, and of course can be a sign of preeclampsia - which you wouldn't want to go unnoticed. I am hoping I don't get it this time but am also having extra scans and consultant appointments. I will do what I need to do keep me and my baby safe.

[MissTwister]

Wind your bobbin up - I am going in UK so should be fine. I have actually switched to somewhere 25 mins from a hospital which is a pretty normal time I guess. I will only be 26 weeks so fingers crossed I don't have to deliver!!

Yummymango - I too will do whatever is needed to keep me and my baby safe so am not sure what the point of that statement/ implication was. I was merely enquiring from others more experienced than me whether they though the doctor was bring OTT at this point.

[tobysmum77]

I think though that talking about pe is a bit premature. It is more likely that the op was slightly stressed by having to go to the hospital and her bp was just slightly higher than usual.

[Bue]

It sounds like she was indeed very junior. I have experienced this with a trainee GP before when being prescribed the pill - my BP was 130 something / 80 something (normal for me) so she made me come in for more frequent BP monitoring. When I came in and saw a more experienced GP, she immediately put a stop to that! When I had a consultant appt recently my BP was around 135/85 - higher than my readings at the midwife (I was stressed!) No one said a word about it. Many people don't seem to realise that 120/80 is optimal BP - 130/85 is normal.

[MissTwister]

Exactly Bue - and I know my readings are normal for me too. Its not like they've gone up. She was talking about monitoring me weekly in case of PE!

I will try and speak to my MW as otherwise I am going to be listed as high risk and won't be able to use the birth centre which is upsetting

[MissTwister]

Also my BP was 118/69 at home this morning which is amazing for me!