Advice-let down by midwifery services

[RSHW]

I am 35 weeks pregnant with my first and in a bit of a state. Hoping you can share some advice. It's long and I am really sorry in advance!!

My pregnancy has not been straightforward. I have had close monitoring by a telehealth system in respect of blood pressure (where I have to test my urine and BP at home x4 per week-although no issues have developed with it at all and I am stable which they did not expect). The emphqsis on my blood pressure and pre-eclampsia (which I am fortunate to not have developed) has led to me developing terrible anxiety. I have tested positive for GBS. I have been under a consultant but have not seen them consistently, instead seeing a variety of different junior doctors. I also have SPD and am under a physio. I had a previous MC which has not helped the anxiety either and even now at 35 weeks I am constantly worried about Fetal movement and I struggle to really believe it's going to happen, which I know makes me sound a fool.

I am onto my 4th midwife. The first left for a new job, the second disappeared, the 3rd was 'cover' and now I am being monitored at a 'drop in' at 36 weeks onwards. I have no birth plan, no one has discussed it with me at all.

Problem is I am now 35 weeks and have no idea what to expect about labour. I saw the consultant's junior doctor on Friday who said that provided everything stays the same I will be 'allowed' to go into birth 'naturally' and then monitored. I am petrified of being continually monitored as my physio said they will try and keep me flat on my back which is not the best for SPD. The doctors have said I have white coat syndrome anyway in respect of the hospital/blood pressure and I am terrified of decisions being made about the labour based on false readings etc. No midwife has discussed anything with me. I don't even know where to go or the number to ring when I go into labour or when to go and have the antibiotics because of the GBS or basically anything!

The biggest problem is the lack of consistent person to ask questions of and getting told different things. Because of this, every appointment has been going over my history and making them understand e.g. Yes my BP is high now but at home it was low so please don't send me to hospital as I am already being monitored!

The whole experience has been fraught and awful and I am dreading labour as it feels totally out of my control. The anxiety is through the roof. I am a professional and feel ashamed of the state I am in.

Please, please can anyone suggest something to help me get some clarity? I have no midwife now, the consultants does not want to see me until 38 weeks and I could have given birth by then. Is it normal for there to be no discussion of birth plans until later on? The girls on my antenatal course all sounded as if they had very positive relationships with their midwives so I guess maybe I have just been unlucky. I don't want to complain as I don't feel it will be helpful to do that but I am stuck.

Sorry for the long post again :(

[WhoTheFuckIsSimon]

Birth plan is normally discussed at the 36 week appt. are you seeing a midwife next week?

If you have blood pressure issues then they will want to monitor you continuously in labour but that does not mean being flat on a bed at all. Most hospitals have wireless telemetry machines so you can mobilese and not be tied to a machine by a length of wire. Even if they don't have telemetry the wire is quite long and you can stand by the machine or sit in a birthing ball. Most labour beds do funny things like can be converted into chair type positions.

Your physio is wrong about the midwives keeping you flat on your back, it's no good for the baby for you to be flat down in labour.

Talk to your midwife when you're in labour and tell her what positions you'd like to be in, tell her if you want to try and get off the bed, etc.

[milkjetmum]

Unfortunately I think it is the norm to see a range of midwifes, I didn't see the same one twice with either of my dds antenatally and the midwifes at the birth were new to me both times.

But...that is ok. You can think through your options now, write out a bullet points style plan to give when you go in and make sure your birthing partner is familiar with your wishes.

It's such am unknown what will happen in a birth and unfortunately not within your.consious control, but what you can do is think through the possibilities eg what is your 'ideal' birth, and what route will you go down if that's not possible.

[creamoftomato]

What a nightmare. I really feel for you. I also have white coat hypertension and spent a lot of time with midwives explaining myself and requesting repeat and manual BP readings to be taken.

I am not sure if it's possible where you are but in my second pregnancy I was referred to a Consultant Midwife (possibly this was the same person as might be called Supervisor of Midwives?) to discuss my first birth and sign off on a birth plan for number 2. I am wondering if you might be able to see an equivalent person. They had a lot more time to discuss my whole history and preferences and seemed much more able to take into account complexity (rather than just the sort of straightforward problem -- standard solution thing that can seem to happen sometimes). I saw them twice in my second pregnancy and both times spoke for over an hour and had a good detailed idea of what my options were and what might happen. Appreciate I might have been very fortunate but this might be worth a try?

Please don't feel ashamed, you've been passed from pillar to post and it hardly inspires confidence. I want to add something here about how in all likelihood in a couple of years time you'll be reading posts like this on mumsnet and thinking about how distant this time all seems - but I don't want to minimise, just reassure you that you'll be able to get this sorted. It probably unfortunately will take a bit of insisting. Hopefully more knowledgeable people are also posting useful advice right now.

[creamoftomato]

Oh and yes I agree as above its normal to see lots of different midwives and doctors (alas). Also like me you may well have to reiterate preferences and plans when you are in labour and in hospital so bullet points and a well briefed birth partner are useful. I do think though with three things going on (GBS, BP and SPD) youd benefit from some kind of overarching chat.

[Andbabymakesthree]

Ring the supervisor of midwives number which should be on front of your records and talk this through.

[Pixie2015]

Hi the anxiety sounds normal after miscarriage and complications (BP) - group B strep is so common but sounds scary the midwives in hospital will be on it as soon as you go in and the will reassure you - they won't make you lie flat at all only time you might be restricted to bed is after epidural and your symphysis pain will be numb by then.

Write a list of questions for your midwife when you next see them use information on here and from your hospital. Think what you would like in birth plan - mine will be blank and to deal with issues as the occur with early epidural if in excess pain (also going to ban husbands iPhone as sick of seeing it!).

Enjoy your last few weeks - mind website also has info on prenatal and postnatal anxiety x

[seven201]

I was consultant lead and never saw the same doctor twice (I think I went in about 10 times) and it was always a junior doctor until my 36 week appt where I saw a quite old man (I'm not ageist it's kind of relevant) who told me that because my bp had gone up it would definitely turn into awful pre-eclampsia so I would 100% be having a c-section at 38-39 weeks. He was so obsessed with this that he ignored the results of the scan hat showed my baby to have a large abdomen which should always mean a gestational diabetes referral. I went away and told everyone I was having a casaerean. The next week I lucked out and saw the lead consultant who told me the previous doctor had an outdated approach and that I could birth naturally. She queried why I hadn't had a gestational diabetes test so I had one a week later and it came back positive. As it turned out I did have a c-section as my baby was breech and I did get pre-eclampsia but only mildly so wouldn't have affected my birth choices. I wrote my own birth plan, not that I needed it in the end. I thought that is something you just do yourself, not with the midwife.

I can understand you're anxious but it is normal to see different staff and for them to be junior (they're sometimes better than the older more experienced ones though!). You just need to get used to summarising your situation. I learned to go in with of my conditions (otherwise I always forgot one!), a list of all the medicines I was on (types and quantities kept changing) and a list of questions. I think the asking for an appointment with the supervisor of midwives is a great idea. Nowadays I think we are expected to be proactive about the care we get and do research ourselves into how to manage conditions etc.

[PerspicaciaTick]

Definitely get in touch with the Supervisor of Midwives, they support best practice and will be able to answer your practical questions and help you formulate a plan.

[KayTee87]

I'm sorry you're so anxious

I've seen about 6 different midwives throughout my pregnancy (39+3) so I think it's normal to see a number of different people. No one has discussed a birth plan with me at my midwife appointments. Pain relief and positions etc were discussed at the 3 antenatal classes I attended and I found these useful and have written a plan based on this and my own research from the Internet.

Why don't you call and make an appointment to discuss all of this, take in a list of questions you want to ask if it helps.

Were you not given any information on when to go to the hospital at your antenatal classes? We were all told to go in when we were having 3 contractions in 10 minutes, we really couldn't cope with the pain anymore or the contractions were so strong we couldn't speak through them.

I'm a bit anxious as my baby's head still hasn't engaged, my next appointment isn't until I'm 40+5 when the mw said she will look at booking me for induction so I then started panicking about c-section if baby isn't in my pelvis yet. I've realised though that we don't really have any control over any of this and being stressed out will make things less likely to happen naturally. I've been distracting myself with films and nice food and trying to forget what date it is

[Quodlibet]

You poor thing. In my experience a range of carers is v common too.

I had GBS and was told to go in when contractions were 3 in 10, or, importantly, when there is any sign of your waters having broken, even if no contractions.

I didn't discuss my birth plan til 38 week appointment. Making the birth plan was something we did at home on our own having done our own reading and research - not really in discussion with midwives. There's lots of choices you can be in control of, and it's worth thinking through different scenarios to see how you'd feel.

One bit of advice I've heard to SPD mums is to get physio to measure the distance your knees can part comfortably when on your back, and to write this very large in your notes, as if you do have an epidural you don't really want your legs pulled wider than this as it can exacerbate SPD even if you can't feel it at the time. Maybe your physio can advise on this?