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Consultant led care

(31 Posts)
allisgood1 Sat 11-Jan-14 18:21:12

What does this actually mean? I know you are mainly seen by mw but does a consultant deliver you?

I really want to go consultant led on the NHS with dc3 (all being well), but not sure if I will be allowed?

Briefly, I went private for DC1 and 2. I was mw led with DC1 but that ended in a failed venutouse delivery and forceps (with a half working epidural). DC2 was forceps. Both DC had a few issues at birth (1st was blue, 2nd was grunting to the point all the mw's were concerned and we had a few extra days in hospital before they let us go home). Both very traumatic births.

I am not interested in "mw led" care which includes no intervention. I want an epidural. I have had 2 big baby's and I need one (regardless of what other women say about bigger baby's being easier--not in my case).

What do you think my chances are of getting consultant led care on the NHS?

bluehearted Sat 11-Jan-14 18:27:35

I think if you've had difficult labours in the past that will help your case. For me, my son was delivered by forceps and it was a very difficult and traumatic birth. I am currently pregnant and when discussing this with my midwife at my booking appointment she recommended I have consultant led care (which I had first time due to my bmi) because of the difficult labour with DS.
Talk to your midwife and explain your reasoning and I am sure it won't be a problem.
Hope this made sense and is helpful in some way!

allisgood1 Sat 11-Jan-14 18:33:09

Thanks Blue smile I will ask them when I see them she says thinking she must book the GP appointment to get referred to mw

jaykay987 Sat 11-Jan-14 18:34:42

I could be wrong - but on the nhs, mw led doesn't mean no intervention. If you pick to give birth on a labour ward - as opposed to a mw led birthing unit - then you will have access to all options. Doctors areas end on labour wards with midwives, and won't only deal with the "consultant led" patients.

Consultant led care primarily covers the pregnancy period, and they've a bigger say in your birthing plan.

Unfortunately I have the other problem. I'm am under consultant care due to a high bmi. But I'd give anything to be allowed to give birth in mw led unit. All I want is a water birth! grin

Definitely ask for what you want at your booking in, but I am not certain you need consultant led care. You just want more control over your birthing plan which you can definitely push for.

lilyaldrin Sat 11-Jan-14 18:38:13

Midwife led or consultant led won't effect your access to pain relief. CL will mean you give birth in the hospital rather than have access to a birth centre or homebirth though.

Even if you are midwife led, a doctor will still deliver your baby if necessary.

You'll only be under a consultant if you need to be - if for some reason you are high risk during pregnancy.

bluehearted Sat 11-Jan-14 18:43:57

Jaykay, on the consultant led ward I was on with my DS there was a birthing pool, so perhaps there is one on your consultant led ward? Definitely worth checking out, I'm hoping to try for a water birth this time round of I'm allowed (bad spd).

OP, If you have midwife led care and decide during labour you want an epidural, you can, you just get moved to the consultant led care ward.


bakingtins Sat 11-Jan-14 18:45:02

I'm under "consultant care" as I'm considered high risk due to previous PPH and medication I was on in early pregnancy. So far I've seen consultant once, MW for booking and 16 week appts and will be MW for all normal appointments. Consultant has made some recommendations about what should happen at delivery and said I must go to delivery suite rather than MW led unit where I had my previous 2 children. She also booked additional scans. For the birth I expect to be cared for by MWs and the junior medical staff and will only actually see the consultant in the event of something going badly wrong.
If you want a consultant to be there for your delivery I would think the only way to achieve that is to be somehow spectacularly high risk or to go private.

lilyaldrin Sat 11-Jan-14 18:45:59

You shouldn't have to move ward to have an epidural, at least not where I am. There isn't a midwife ward and a consultant ward - just one delivery suite staffed by midwives with consultants available if necessary.

Mabelandrose Sat 11-Jan-14 18:46:07

You can choose to be consultant led. You will still be delivered by a midwife though unless there are any problems. You can't request the consultant to do the hands on delivery bit unless you pay privately.

AnotherStitchInTime Sat 11-Jan-14 18:46:07

I think what you want is to have the baby on delivery suite where there will be midwives, anaesthetists, registrars and consultants available. You cannot have an epidural on the MLU.

A consultant wouldn't necessarily deliver you unless complications arose, I had a registrar for my second c section after a failed ventouse in theatre.

Consultant led care may mean you never actually meet your consultant, often their registrars run their clinic and feedback to them. I saw a consultant once in the ante-natal clinic when under consultant led care with dd2 and only 4 times with dc3 despite being very high risk and an inpatient for most of my late pregnancy.

Gowaygoway Sat 11-Jan-14 18:51:00

I had consultant led care in 3 pregnancies as I was high risk for several reasons. Saw my consultant and a midwife at all appointments. Had 2 sections-one performed by my consultant and the other was an emergency so had the reg on duty for that one. I think consultant led refers to your ante natal care rather than the delivery itself.

AuntieStella Sat 11-Jan-14 18:54:09

Consultant-led care in pg is unrelated to who leads your care for delivery.

But if you keep stating a preference for an epidural, and you book for a hospital delivery, then it should all come together on the day.

allisgood1 Sat 11-Jan-14 18:54:35

The reason I would also want to be consultant led is previous mc's and big babies (I have had to have growth scans in the past and DD2 was induced 16 days early due to her size).

Wibblytummy Sat 11-Jan-14 19:00:55

If your previous babies were large (I think it's 4.5kg/10lbs round here) then you'll be consultant led anyway as they want to monitor growth etc and put plans in place. My 1st was 10lb4 and so I was automatically consultant led second time round.

That said, it was no different to the midwife led care, in fact it was less personal as I never saw the same 'consultant' twice and they never seemed to read each other's notes anyway.

I think as others have said what you seem to want is more about your place of birth. Drs won't really get involved unless there's complications though from my experience. Also I was on Midwifery unit when first labour started to get tricky and they knew I needed assistance so moved me to the labour ward where I had the epidural, prepped for c-sec and forceps delivery. Even then I only saw the dr in the last 2 hours of a 28hr labour.

lilyaldrin Sat 11-Jan-14 19:02:20

What is it that you want out of consultant led care allisgood? To see a consultant while pregnant, or to have one present at the birth, something else?

BelleateSebastian Sat 11-Jan-14 19:15:13

I don't think consultant led care will make any difference to your birth experience, I had consultant led care with mine as I had a neurological condition all this meant was that I saw a doctor -never the actual consultant - a few times during my pregnancy and he advised what I needed in my birth plan and wrote it up (ie I was only allowed to push for a max of 30mins) I didn't have any more 'doctorly' (consultant or otherwise) intervention during the births than anyone else.

I think if you are desperate for a consultant to deliver you you may have to go private - but specify it this time... good luck smile

kitkat1967 Sat 11-Jan-14 19:25:54

I had mw led care in first pregnancy but due to pre-eclampsia saw consultant on day of delivery (he came in on a Saturday for me) and delivery was by 2 drs. In second pg was then under consultant but he was not required for the delivery.
My point is that you get the care during delivery that is required irrespective of what ante-natal care you have.

TeacupDrama Sat 11-Jan-14 19:27:35

some MW led units do not have access to epidurals in fact in local unit if you needed EMCS you would have to travel by ambulance 20 -30 minutes away provided bridge not shut due to high winds( then 45+ minutes) to be fair they will not let you use this unit unless low risk alos will send you by ambulance to the other hospital much earlier if there is just a whiff of things not quite going to plan

consultant led care tends to mean that you may need extra care. pain control intervention or monitoring, it does not mean that the delivery will not be midwives but that the docotrs are closer to hand and there is a plan in advance as to when and if intevention is needed, in my case it was known DD was small had stopped growing therefore a long labour would be risky for her so if it did not progress ( which it didn't) intervention would be necessary ended up with emcs but DD was fine which is what really matters

lilyaldrin Sat 11-Jan-14 19:33:04

Midwife led birthing units are not the same as being "under midwife led care" though. Most woman who are under midwife-led care still give birth in a hospital delivery suite.

Pinkbell123 Sat 11-Jan-14 20:27:10

I've been under consultant care and have seen the consultant team (usually a reg) for half of my appointments, the rest have been with my midwife. I've also had additional haematology appointments on top.

But I don't think this makes any difference to giving birth, I think il just go to the delivery suite with everyone else (phew). I'm 35 weeks now and have my 36 week app with the consultant to discuss the birth.

I think you can be clear from the outset that you want an epidural, or whatever type of birth you want. Good luck

Writerwannabe83 Sat 11-Jan-14 20:42:47

I'm under Consultant led care. I first met my Consultant when I was 16 weeks pregnant and see her every 4 weeks at the hospital. I'm also scanned at each appointment and have a general check-up with the hospital midwives too. I also see my Community Midwife at my GP surgery as per standard protocol appointments. My Consultant is really, really lovely, I feel so lucky to have her overseeing my care smile

YoungWoman94 Sat 11-Jan-14 21:18:57

I wernt consultant every 2 weeks... sometimes weekly due to a previous late loss. I've only seen my midwife twice (22+3weeks). I'm assuming I will be given birth with Midwives around, but beforehand it will be all consultant care (removing cervical stitch). I was really hoping for a waterbirth but I dont think ill be allowed one.

My consultant is pretty good, I get scanned the day before I see him to check baby and my cervix.. I also have a swab to check for infection (all due to my first pregnancy loss) and when i see him he explains all the results to me and lets me know what's going to take place before I see him again. He also listens into babies heartbeat everytime I see him to put me at ease smile

As for my midwife.. she isnt the best. Fails to reply to me if i contact her with a problem and I'm currently waiting to hear from her about my 24 week appointment (contacted her a week ago about a date!)

Consultant care is worth it, I think I would of gone crazt without my consultant and I would of lost my baby too.

PenguinsDontEatKale Sat 11-Jan-14 21:40:14

I'm not quite clear what you are after?

If you are talking about the birth, on the NHS if you give birth in a CLU (which you can simply choose to do), there will be a registrar/consultant available. So they would deal with any issues with delivery. They will perform any assisted delivery, deal with any complications, give their views on treatment if anything crops up. You can also have an epidural without a consultant being present (though obviously an anaesthetist does the procedure!).

Consultant led care during pregnancy doesn't automatically result in anything different to that at delivery.

allisgood1 Sat 11-Jan-14 22:49:41

Thanks ladies.

What I don't want is "oh you don't really want an epidural", or "you're not in enough pain yet" like you see on OBEM. Those midwives sitting chatting drinking cups of tea while those women are in really bad pain and begging for an epidural. On top of that, I've needed forceps twice, odds are not in my favour that this birth will be any different. I'm worried and really scared of getting a mw on the day who refuses to listen. I know the same could go for a consultant but since they aren't as fussed as mw's when it comes to interventions, they may take my side and push for me to have one. Or I'm getting a big loan and going private again...

lilyaldrin Sat 11-Jan-14 23:00:23

Even if you are consultant led during pregnancy, you will still be on a midwife-staffed delivery suite and it will be midwives that will deal with pain relief.

You would only see the doctor if there was an issue, like needing forceps.

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