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consultant led care

(16 Posts)
steph2412 Wed 03-Oct-12 14:49:40

hi just looking for some advice really, i am on 3rd pregnancy and was told i would be under consultant led care at my booking app. Reasons for this is high bp in previous pg, 1st baby had to be born early. Also pph type 1 after 2nd baby and also treatment for abnormal cells to my cervix in march 2009. So all this makes me high risk. Just really wondering what happens with the consultant as my first app is next week and any questions i should be asking?Any help or advice really appreciated. Also both my previous babies were born by natural deliverynointervention.

Secondsop Wed 03-Oct-12 15:01:17

This is my 1st pregnancy and I'm on consultant-led care because of high BMI and high blood pressure. I obv don't have a comparator but i can tell you what it's meant for me, namely:

- monthly antenatal appointments with a doctor (not necessarily a consultant) instead of with midwives, although the midwives have still been the ones checking my blood pressure and urine.

- I will be giving birth in the hospital not in the midwife-led unit.

growyourown77 Wed 03-Oct-12 15:15:57

Hi ladies, I'm 10 weeks and have been told I'll be consultant lead after surgery for a rare ectopic last year that left a scar on my uterus.

second does that mean you'll be having time off work for dr and mw appointments?

Secondsop Wed 03-Oct-12 15:21:13

growyourown I have time off work for it, but it's not double the appointments - it's one trip to the antenatal clinic where first of all the midwives check blood pressure and urine and then I see a doctor afterwards.

RhubarbCrumbled Wed 03-Oct-12 15:34:25

I'm consultant led as I had an EMCS last time. In answer to your questions...

*my first (and only so far) appointment was a chat with the consultant about what I hoped for this birth and any fears I had from last time. He went through my previous notes (I had them with me) and put a lot of fears to rest. I came away an awful lot happier and we got an extra scan so it was lovely to see the baby too!

*I asked questions about the type of care I would have; at what point they would decide on a 2nd cs; induction; risks of VBAC; why should I have to have a VBAC and what the risks are. I can't remember any thing else...

*I don't have another consultant appointment until 36 weeks but I can have time off for both MW and consultant appointments as they're both related to care in pregnancy.

I found the consultant to be lovely and listened to what I had to say and made lots of notes of what we agreed for the birth. At 36 weeks he's going to help us draw up the birth plan so that we all know what's happening this time!

growyourown77 Wed 03-Oct-12 16:45:44

thanks second and rhubarb that's good to know. I'll ask mw when i see her next weds how it works in our area. our mw centre is community based, therefore i think it will be separate appointments, but it doesn't sound like too many.

rhubarb so you are not deciding on CS or not until 36 weeks?

mummy2benji Wed 03-Oct-12 19:43:48

I used to work in obstetrics (am now a GP) and consultant-led appointments are very similar to midwife-led ones - usually the same number of appointments, unless bp is high for eg and needs checking more often. You will have more opportunity to ask about the birth and I would ask them if the treatment you had to your cervix will affect that at all - likely not, but I don't know what you had done so I couldn't say. Also, if your high bp started early last time, I would ask if they'll be seeing you more often. And if you're at risk of a further pph - depends on the cause of it last time. In reality your care will be pretty much the same, only you'll be being seen in the doctor-led unit so if any issues were to arise you would be able to discuss treatment straight away. Hopefully everything will go smoothly for you but this will just give you extra peace of mind.

Doraemon Wed 03-Oct-12 20:25:07

I'm under the consultant (2 previous prem labours) and haven't seen community midwifery at all, even though I do nominally belong to a particular midwifery team who are community based - midwife at antenatal clinic in the hospital does all the usual checks before I see the doctor. I haven't actually seen the consultant yet, only a registrar or SHO (not sure which he was).
I don't have extra appointments other than one scheduled on the same day as my 20 week scan (had an anomaly on scan with DS2), and extra scans booked in for 28, 32 and 36 weeks if I get that far. If I get to around 35 weeks I'll be kicking up a fuss to make them let me have the baby at home or in the midwifery led unit providing I get to term, otherwise it'll be on the consultant-led delivery ward.
To be honest they're not really doing anything that couldn't be done by community midwifery as the only advice is to go straight in the minute I feel like I might be going into labour....

growyourown77 Fri 05-Oct-12 22:32:31

If anyone's around who has had their baby and was consultant lead...does this mean that you are on a drip automatically when you go in or only if you need it?

Panzee Fri 05-Oct-12 22:42:11

I've been told that as long as baby is happy and labour is progressing well I can labour just like the low risk mothers. Only difference is they want me in straight away instead of staying at home.

LittleBearPad Fri 05-Oct-12 22:47:56

Hi, I had consultant led care due to a high bmi. It meant I saw him at 16 weeks and 34 weeks and he arranged for an extra scan at 34 weeks to check the size of my DD, who was growing exactly as she should. I also had to give birth on the labour ward not the midwife led unit. Other than that there were no differences.

Moominsarescary Fri 05-Oct-12 23:12:30

I've been consultant led with ds2,3,4 and this time. With 2 and 3 I didn't have any extra appointments until problems started occurring, so I guess it's different for each individual. It did mean that when I had problems I had already met the consultant and we had talked about what would happen.

My pg history is is a bit hmm though

Ds2 I had heavy bleeds from 14-23 weeks and they couldn't find the cause, he was born at 35 weeks due to premature rupture of membranes.

Ds3 I was consultant led due to ds2 being prem. He arrived at 32 weeks again due to prom I had an emcs. I'd seen the consultant twice by that point. I also had my post natal with him to talk over the birth.

Ds4 I saw the consultant at 12 weeks,we discussed csections as i wasnt a csndidate for vbac. Ds4 was born at 20 weeks due to incompetant cervix We have no idea why my cervix is now a problem

With ds5 I've seen him 4 times so far, I'm 21+3. I've had a stitch placed because of the cervical problems and we've spoken about the birth. It's a little bit play by ear this time, I can have a vbac as long as the baby comes before 35-36 weeks. After that I will need a csection. My next appointment is at 37 weeks.

I've been lucky enough to have the same consultant the last 4 times. The last 3 pg have been very close togeather. Ds3 is 19 months old so the consultant has seen quite alot of me over the last 2.5 years!

LonelyCloud Fri 05-Oct-12 23:31:13

I guess a lot of what happens with the consultant depends on why you're consultant led.

I was consultant led because hormone levels and placental blood flow problems put DS at higher risk of growing too slowly and premature birth. I had to see the consultant every 3 weeks for growth scans.

The questions I asked the consultant were along the lines of how my problems might affect the baby, what risks were associated with them, what would happen if my pregnancy problems started to worsen and so on.

growyourown77 - I didn't get put on a drip when in labour with DS. Labour progressed more or less normally, so there wasn't any need for one.

growyourown77 Tue 09-Oct-12 09:53:54

Thanks for the further info ladies. I'd imagine i'd see them at the 21 weeks that MW mentioned for a discussion then maybe once more for a decision nearer the time. Mine is more of a fixed issue, so I don't think there's anything they can monitor. I will ask if there's a point at which they can see the scar on an US (or not).

Good luck with all your pregnancies.

RhubarbCrumbled Tue 09-Oct-12 11:36:08

Hello, sorry I haven't replied before now. I don't have to decide what I want to happen until the very last minute, but we have agreed that if I get to 2 weeks overdue then I'll be booked in for a CS. It's taken 2 years but I've finally realised that I actually went to natural labour last time and got to pushing but DS got stuck with his head in a funny position, everybody panicked and I ended up in theatre. I was convinced that I'd gone in to be induced and then it all went wrong - completely forgot the 3 days of contractions! This time hopefully it'll all go far more smoothly.But I have said I don't want to get to the panicking point next time!

Hope the consultant appointment went well and you're happier about it all now.

3rdtimelucky73 Tue 09-Oct-12 19:22:43

Hello, I've found out today (booking appointment) that I will be under CLC due to previous IUD.

My MW told me to think of it as being kept a special eye on - it will mean a couple of extra appointments, one extra scan and I will won't be able to use the local MW led birthing centre, but will be in a doctor led unit in the county hospital which is a shame....

I'm only 8/9 weeks so have a long while to learn the rest......

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