Consultant-led pregnancy - midwife-led birth?

[Plateofcrumbs]

I know this is a question for my consultant really but hey you lot are here on a Friday evening and my consultant isn't.

I'm on a consultant-led path at the moment. There was some talk of transferring me back to midwife care but I'm now very firmly stuck on consultant-led through the rest of the pregnancy (for good reason, not complaining). It hadn't occurred to me until just now that this might scupper any hope I had of birthing in the MLU at the local hospital.

Does being consultant-led through pregnancy inevitably mean I won't be able to have a birth in the midwife led unit? Or will it depend on my circumstances (my understanding is my risks are largely with the progress of the pregnancy rather than risks associated with the birth).

Any info or experiences much appreciated!

[Weegiemum]

My pregnancy with dd2 was consultant led, but I was able to give birth with only midwives in attendance, didn't see a doctor all the way through (from induction at 36+6) until dd2's paediatric check after birth (as I was ill it was necessary for them to see her immediately and she was fine).

Midwife even stitched my 2nd degree tear. There was a medical student there to observe. I expect dd2's rather fast and dramatic entrance to the world (waters only went on last push, midwife cheerily told me dd2 would have "hit the wall" if she'd not been caught!) put her off working in obstetrics and having children of her own!

[EyelinerQueen]

I have no practical advice but just wanted to say you're not alone. I'm under consultants and hoping for a home birth!

Let's see how that one goes

[Bue]

It really depends on WHY you're consultant led. Can you give us a bit more info?

[curlyLJ]

I've been seeing a consultant too (due to advanced maternal age) and at my last appointment I spoke to him about my birth plans and got him to write into my notes that he was happy for me to give birth at the MLU assuming I go into spontaneous labour and am not induced.

He was happy to do this and the midwives are now happy because it will then be very clear when I turn up, that I am 'allowed' to be there even though it says high risk on my notes.

[Suzietwo]

In many cases Consultant led doesn't mean anything more than there is a consultant assigned to you who checks everything is in order and there's someone to refer problems to. I can't imagine why they'd refuse Mlu if it were appropriate.

At 32 weeks I am yet to meet the consultant 'leading' this pregnancy

[Plateofcrumbs]

Sounds daft but I don't particularly want to discuss why I'm under consultant care - just because last time it was discussed someone made a (probably ill-informed) comment that scared the hell out of me. It's slightly rare so most people won't know and it just risks giving me the fear - I'd rather have that chat with the consultant.

I just thought I might already be out of the running for the MLU simply by definition of being under a consultant. Reassuring to hear other people in a similar boat have had or have been promised midwife-led births. That's all I needed to know really.

[ToriaPumpkin]

I'm most of the way through my second consultant led pregnancy. In my last I only met my consultant once, gave birth with only midwives in attendance (despite it being an induction at 39 weeks) and all my aftercare (including stitches for a second degree tear etc) was done by midwives.

This time round I've seen the consultant a couple of times, but that's because the baby's been breech. As far as I know I'll have another midwife attended birth unless I end up having a section. I've nothing against my consultant, but it does get a bit frustrating having to have extra appointments to be told exactly what the midwife has already told me!

[happypotamus]

My last pregnancy (3yrs ago) was consultant-led due to a pre-existing medical condition. I wanted to use the MLU (which is in the same hospital just down the corridor from the consultant-led delivery suite), but did not meet the criteria because I have the pre-existing condition. However, the condition was very well controlled and being pregnant did not really impact on it at all, so I discussed my wishes with a consultant who arranged for me to meet the midwife in charge of the MLU. She agreed with me that I could use the MLU with a couple of conditions e.g no water birth and did a risk assessment. I am now pregnant again and expect to have the same discussion with a consultant again in a few months. I don't know if I will have to meet the midwife to discuss it again or if she will remember from last time and still be happy.
I recommend you speak to your consultant about what you want for the birth, as it may well be possible with some negotiation. Good luck!

[Littlefish]

I was under consultant led care for my pregnancy and gave birth at the big city hospital near us. However, I didn't see a doctor or consultant the entire time I was giving birth. I had wonderful, midwife only care with a water birth without any other interventions. The only time I saw a doctor was when they checked dd before we left hospital.

I suppose what I'm trying to say is that even if you are under a consultant, it doesn't necessarily mean that your birth experience will be medicalised.

[bec0901]

I was consultant led and managed to wangle a birth in the lovely MLU. My advice is ask early and ask often! The consultant was reluctant for me but I just harassed her each time she saw me until she relented and wrote the magic permission note in my book.

[Nyborg]

I'm at 37.5 weeks and this pregnancy was consultant-led from my booking in appt until 34 weeks, and I'm now back in the midwife-led stream and on track for birth in the MLU. That's despite being referred for a growth scan at 30 wks because of small measurements.

It helps that the issue that put us on the consultant-led track relates to the baby rather than me / the pregnancy / the probable labour, I'm sure. But definitely worth asking.

[Christelle2207]

I was consultant-led, discharged to mw-led but ended up in consultant-led unit due to bleeding in labour. Anyway I was adamant I wanted to go to the mw-led unit so that I could use the pool, I really pushed (no pun!) and they eventually got a consultant to examine me then let me go. Depends on the reason you are consultant-led I guess but if it's safe and you are insistent enough I'm sure they'll listen. Of course after labouring in the pool I ended up back in the consultant-led unit anyway

[NationMcKinley]

I had consultant (foetal medicine) led care for my third baby as I had a "pathologically low" PAPP-A so I needed scanning every 4 weeks as there's a risk of inter uterine growth retardation and problems with the placenta. Happily, everything was absolutely fine and my brilliant consultant gave me the go-ahead for a home birth (I'd had very easy births with the other 2 and had already had a home birth). I would suggest that you discuss things with your consultant and see what they recommend. Best of luck!

[januaryJump]

Echoing the above. In pg I see 2 consultants - one for a medical condition that can affect pg/development, the other for family medical history that could impact me in pg and postpartum. However in 1st pg I gave birth in an MLU and had MW care postpartum, just had to have a follow up with the latter consultant at 6wks pp. I had extra appointments in order to see consultants, extra meds and blood tests, and pp injections, but everything was still largely MW-led and I had a great birth experience, also had 2nd degree tear stitched by MW in delivery suite, had option of pool etc.

In first tri now with my 2nd and looks set to be much the same

[squizita]

Plate I asked my consultant this very thing yesterday!

She said she couldn't tell me 100% until nearer the time (as with any woman), but provided I progressed well whilst they would recommend against home birth it was 'very likely' I could have a birthpool/midwife centre birth. The centre is attached to the main hospital. The home birth thing is merely for monitoring in my case, and because they will have to do pathology on the placenta afterwards to inform treatment in future.

My health issue is medication for APS (sticky blood) so the 'mechanical bits' (muscles, uterus, cervix etc') are normal in my case which probably has a bearing!

[HolidayArmadillo]

It depends really. For instance if you're consultant led because you delivered at 24 weeks in your first pregnancy but you've got to 39 weeks with this one then there is no reason to be excluded from the MLU.

[SimLondon]

I think it depends on what it is as well, my consultant wanted me to go for consultant led due to scar tissue on my cervix being un-predictable during labour, she felt that if it was going to cause a problem then it would be picked up more quickly on the consultant led ward.

[ChicaMomma]

You'll probably only see the consultant either if there are problems during labour, or at the very end. It's hard to say.

If youre as high risk as you seem to allude to i'd imagine the consultant will be present on a regular basis throughout- but it's very hard to say.
I'm consultant lead and she told me that unless there are difficulties i will only see her at the very end for the delivery- or one of her colleagues- that they tend to stay away and let the midwives do their thing for the rest of the time.

[Plateofcrumbs]

Thanks for all the thoughts. I don't think I really want to fight for MLU if the consultant thinks it is risky, but equally I didn't want to just end up on the main unit by default. At least now I know it's something that is worth discussing.

To be honest I don't think I am particularly high risk for labour itself, it's more a probably a case of a small chance they will find problems with baby when it is born - which is of course something that can happen to anyone and I don't really know how much more likely it is for me than anyone else.

The MLU is right next door to the main unit and SCBU so presumably if something was wrong the help is right there - I guess it's a case of whether you need a consultant reviewing the situation to spot the problems in the first place.

[ChicaMomma]

OK, well then i'd imagine the consultant will be present once the 'pushing' stage starts, as it were. My friend had this exact situation and from what i recall the MWs were told to page (or is it paige??!!) the cons once that final stage of labour approached. They had some minor worries about the heart chambers of the baby which turned out to be unfounded, so fingers crossed whatever their worry for your baby is also unfounded. It's great they are being vigilant in any case. The last thing you'd want is for some emergency to be sprung on you post delivery without the right people in attendance!

V best of luck

[Plateofcrumbs]

Thanks Chicamomma - was your friend in an MLU?

I think chances are everything will be fine and they are just vigilant - everything looks good so far, just keeping fingers crossed it stays that way!

[OhTheDrama]

I am wondering this too. I went to my GP today to get referred to hospital and he told me my pregnancy will be consultant led under a fetal medicine specialist, I won't see my GP or practice midwife at all, all appointments at hospital. My last birth was a home birth so I'm worried that this one will be highly managed and monitored which is my idea of hell.

[HolidayArmadillo]

Why ohthedrama? Seems like a huge change? Did something happen last time?

[DinoSnores]

My last pregnancy (as with this one) was looked after by fetal medicine (previous baby DC2 with congenital abnormalities and was stillborn). My consultant, until things started getting complicated at the end, was fine with me having a home birth as I'd had one with DC1. Once there were concerns for this baby, he recommended induction on the delivery unit, which I completely agreed with.

This time, I'm again under fetal medicine and am provisionally planning a home birth but we'll see what happens.

[OhTheDrama]

HolidayArmadillo I had a PPH of 2.5litres last time, also when she was 9 months old we were all (myself and both DD's) diagnosed with a genetic condition.