Deciding whether to go consultant-led - what questions should I ask?

[Mcakes]

I am 44 and 19 weeks pregnant with 1st baby. No complications so far and am pretty fit and healthy so my age is the only 'high risk' factor. Midwife has said she is happy for me to have a home birth if I want but I have been offered the opportunity to go consultant led if I choose.

I am undecided at the moment. The local MLU is not an option for me apparently and, whilst it would be great to have the chance to have a homebirth, I am more concerned with the outcome of a healthy baby (and pain relief if I want it!) so am leaning towards the hospital option. We live about 30 mins from the nearest maternity hospital so that is a significant factor too.

The midwife said that the consultant is likely to want me to go for early-ish induction due to age so sounds like it could all be quite medicalised if I go the consultant/hospital route.

This is all completely new to me and I am not sure what questions to ask to help me make the decision.

I have my first appointment with the consultant on Monday and would appreciate any advice on questions to ask her, or places I can research this stuff online (e.g. pros and cons of induction etc.)

[EastDulwichWife]

I was just about to post a very similar question! I'm 16 weeks with my first and 30yo, also low risk like you. I'm really keen to have a home birth if everything stays low risk, and I'm only an 8 minute drive from the hospital.

I was reading a very informative link (post below) from the NHS website this morning which suggests the risks are marginally higher for first time births planned at home. There's a far higher rate of C-Section amongst women who have a hospital birth vs those who have home births or give birth in midwife led units. Pain relief is a huge factor - my midwife says she'll provide gas and air but little else.

Downside of hospital births is that it's common to see contractions slow down when you get into a hospital setting (unless you're a Dr / Nurse and very comfortable in that setting).

Did you have your 16w apt with the community midwife? How did it go?

www.nhs.uk/news/pregnancy-and-child/births-at-home-or-in-hospital-risks-explained/

[mindutopia]

I would think about how you picture your birth and what you want in terms of care? Like where do you see yourself?

There's no reason to think of yourself as needing a higher level of care just because you're older. But when you picture how you want things to go and where you will be the most relaxed, what is that like? It might help as well to go take a tour of the hospital (and the MLU as well, even though you said you felt that wasn't right) and even talk to people who have had home births and then see what feels right. I think trust your gut and be where you will be the most relaxed. Realistically, yes, if you opt for the hospital and consultant-led, you will be more likely to have a medicalised birth and more intervention. Does the idea of that make you feel more comfortable or does it stress you out? That might give you your answer.

I'm younger than you (37) and on my 2nd. But I had my first at home and planning a home birth with this one as well. For me, I just couldn't picture myself giving birth in a hospital (we don't have a freestanding MLU here, though you can have midwife led care in the hospital). It seemed scary and stressful and painful. It just didn't appeal to me. I could really only imagine a birth that was at home. I was healthy, had an easy pregnancy, etc. so there was no reason for me not to be where I felt most relaxed. I did take a tour of the hospital and it was fine and good to see it (in case I did need to go in), but it definitely solidified for me that it wasn't the place for me. You'll probably get a similar sense of what's right for you if you go have a look and talk to people about their experiences.

That said, no matter where you birth, you still get to choose what you want. If you don't want to be induced, but do what to be in hospital, just tell the consultant that. They don't get to choose your care. You get to choose as much there as you would anywhere and you can decline and induction and go for a natural birth. There's no reason you couldn't have a lovely natural labour in hospital, with the added reassurance of intervention being available if you did need it. You just tell them that's what you're doing. It does inevitably make it less easy as it can be harder to feel like you can decline once you're in that situation, but there's no reason you can't if that's what you want. You may just need to be quite persistent.

[Mcakes]

Thanks for the replies - both really useful!
I have been told I can't use the MLU because I am classed as higher risk (that's the policy in this area apparently. Midwife thinks it's ridiculous).
I'll have a good read of that NHS link and also ponder what you have said Mind. A tour of the hospital is a great idea.

[gryffen]

Hi ladies

I was consultant led with my first in 2014 and loved it, fair enough, as you know you dont get a bath or to walk about a lot but it was relaxed and the same midwife stayed with me throughout the night and the consultant was hysterical (and that was without the diamorphine lol)

We actually dont get a choice, if our midwife says consultant then thats what it is, they will take your wishes in but they do stress a risk for a reason - thats fair.

I do advise a visit to hospital but consultant led areas are normally not open for visits to prevent risk of infection etc - normally they will have a video tour on DVD - again, i'm in scotland so it could be different elsewhere.

have a great weekend!