The Royal College of Obstetrics and Gynaecology want to know what you lot think about...

Yes, it was published and is probably on their website. I'll check it out and send you the link.

Thanks Rowan. It would be fantastic if we could get some action on postnatal care. I wrote a report on this for the RCM over a decade ago and so far as I can see it has got worse rather than better.

Thanks for letting us know Rowan

Any feedback on how it went Rowan? I hope you survived .

I've read that the majority of Obs go for Elective sections. Can you tell me if they are predominantly NHS or privately funded and whether or not the mothers are made to go through counselling.

I am also interested in why private consultants agree to electives for no medical reason. Surely if vaginal births are in the best interest of the patient as the NICe guidelines state, there is something unethical about c/section for choice by payment?

Just to say I had a male Obs consultant and he was fab. As an 'old' first time mum he called me in at 20 weeks for appt. which was his standard practice. (I know cos the midwife thought it was odd so rang to find out why!) A wise move as it turned out and he then put me on fortnightly scans. He never spoke down to me and I felt reassured and able to ask questions throughout. Ended with ELCS but I was happy that was right decision.

Oh yes and please could someone invent a better way of doing a smear test than the present method. Thanks. (not sure if that's in their remit but you can but ask).

I think it's all been said already but I would agree that obstetricians should be required to attend a number of "normal" births, at home or at a birth unit, to observe how birth should be, ie with no complications. I think too many always just see the worst side of birth and this can skew their decision making on things like when to do a c/s. The could do worse than read a bit of Ina May Gaskin while they are at it!

There is nowhere near enough understanding of womens health needs, I have been trying for months to get a referral to a gynae and I have ended up having to go private for a referral and treatment even though I can not work because of my health problems. To often GP's are too willing to fob people off, self referral or drop in care would make a huge difference

I would like to have been listened to and treated like I had an idea of what was happening with my body.

Tempted to start this off by saying that 'I'm an educated woman etc, etc' but that would be insulting to anyone who feels they're not able to make an educated choice about their health care. EVERY woman should be treated with respect and dignity with healthcare choices explained at every step, in detail if needed.

With DC2, at term+3 with SPD (so severe that I needed a brace and crutches) I requested a 'sweep' at the obs&gynae wing of my local hospital to 'start me off'. They declined with no valid reason given other than it was a Friday.

Next time it's a home birth unless nature dictates otherwise.

I was consultant led for ds. wouldve been nice to actually meet her, not a series of underlings who scuttled to and fro so she wouldn't have to deign to see me.

when I had hyperemesis with ds @ 9/10 weeks I had to refer myself directly to hospital after GP told me ''everyone gets sick'' I rang the ward after testing my own ketones and they told me to come straight in - onto a drip for 4 days.

Not that inpressed by doctors TBH

I think obstetricians should be encouraged to respect women's birthing bodies and not just view them as malfunctioning machines like some do. I agree with others that they should be required to observe home births and see what low risk birth entails and what is possible when a woman is not stressed by her environment. I think there are very serious issues around informed consent for obstetric procedures. The option to refuse should be respected and scare tactics and rhetoric about risking the baby should not be used. They should be upfront when a suggested course of action is because of hospital policy rather than clinical evidence (eg induction, AROM etc) and keep themselves up to date on latest research. just because they have always done things a particular way eg. valsalva pushing in 2nd stage doesn't make it right.

I have been referred and found no problem with that, though I was then rereferred for the birth which I didn't want as there was no evidence of problems and then I was given lots of undue pressure about being over dates.

I think all drs at consultant level are expected to keep abreast of current practice. There needs to be good provision for part time women to make it to consultant level to ensure there are women in the specialty. They could interest themselves more in the pyschological and spiritual side of birth and how their interventions, even when necessary, can leave women traumatised despite the 'healthy baby'.

Pain relief (lack of it) is the Elephant in the room !

oops

I think an experience similar to this would contribute to the career of a gynaecologist and an obstetrician.

My 6 week check involved an internal (could have opted our) checking that my stitches were healed, my uterus was normal sized, my cervix closed. Also advice on breast care and contraception, a postnatal smear and reminder to book another (must do that), checking my emotional state and any plans for future pregnancies (and reassurance that there was no reason not to IYSWIM unlike a CS), an offer of a birth debrief and gentle nagging about pelvic floor physio.

Baby was dealt with by paediatrician.

If my heavy periods, intermittent spotting, easily irritated scar tissue, painful intercourse are bothering me then it's serious to me and it should be investigated. They may seem like a worried well to the GP and in the grand scheme of things those problems probably aren't life threatening but by gum are they depressing enough, even without having to battle the GP to take you seriously, and very worrying.

I thoroughly agree that if self-referral the way it's set up is a disaster then gynaes should be having drop in clinics so it won't be.

Perhaps self-referral would be a disaster the way the NHS is set up, but it shouldn't be

Having lived in the US and France, where women can self-refer to gynae and thus bypass GPs, I feel very strongly that all women should have this right. I don't think the 'worried well' argument holds as much water here, it's not like my vagina can catch a cold or sprain its finger. Can we really not trust women to know when their symptoms are serious? Considering that the UK does not perform as well as other countries in terms of ovarian and breast cancer screening and survival rates, I think improved access to gynae services is really important.

What is a post-natal check meant to involve? I took my baby along to our 6 week check and he was given a thorough examination. I, on the other hand, was treated to a conversation, where the GP asked me how I was feeling and had I thought about contraception.

I think nobody should be able to qualify as an obstetrician unless they have attended half a dozen home births, as due to the escalation in infections in hospital, in 15-20 years this may have to be a standard model for normal birth. Plus I think it would give a better view of normal birth anyway, rather than the institutionalised model that is more often the case. The last thing I would say is that vaginal repairs need to be given a higher priority. Half of Britain seems to be staggering around with avoidable damage and this comes down to a lack of surgical training in many hospitals, meaning an appalling standard of postnatal repair on wards and afterwards. There are many parts Kegels will never reach.

I would like to see gynae's being more involved in the induction process - gaining fully informed consent (not just mentioning risks to the baby) and discussing options with the mother, much like the consultations surrounding ELCS. It is hard to "demand" to see a doctor when people bang on about natural processes and then put you on a conveyor belt of care. I would like doctors to be more visible on antenatal and postnatal wards.

I don't think that doctors careers are necessarily the same throughout their careers. The core work is the same (just like most jobs, such as teachers who will teach the same subject through the course of their career). The challenges and variation come from taking on teaching roles, being members of committees, taking on management responsibility, doing research etc. These opportunities exist or can be generated by career minded individuals, so it is down to them to plan careers accordingly. Alternatively they may decided to focus their spare time on building a lucrative private practice (less so in obs).

There is a risk that obstetrics becomes a bit of a Cinderella specialism due to the demands for 24 hour cover and the lack of private opportunities due to the cost of insurance. Consequently it may not attract women with the un-family-friendly hours and it seems that British trained doctors are not choosing to go into it as much as foreign trained ones.

I can only answer re (1), and I don't know if this is entirely relevant - but here goes. I was classified as a 'high risk' pregnancy, and therefore automatically transferred to consultant-led, rather than midwife-led, care. But I only saw the consultant twice - and both times the response was brief, careless and insensitive - I felt rushed through the appointment, unable to ask questions and consultant was generally lacking in empathy. I had to be induced at term, and as soon as the consultant had booked me in, I never saw her again, and didn't see a doctor at all until, after four days of unsuccessful induction, one came in to decide on a c-sec.
Sorry the explanation is rather long, but my point is: if you're going to have consultant-led care, that is what it should mean - that you see the consultant, including (especially) once checked in to hospital. And if you can't physically see the same person, some impression that they actually talk to each other about your case (or read the notes first!), so you're not repeating the same thing over and over and over... I might be the tenth woman you've seen that day, but it's the first time I've ever been pregnant, and the term 'high risk' means something to me, even if it doesn't mean much to you... rant over!
Agree with the other posts about hand-held notes, and about the 6-week check. and with inhibernation - took ages to get the appointment through, then they ummed and arred about treatment, and ended up telling me (a few hours after an uneventful appointment) on the phone that I was to have daily injections.

Self referral (as suggested by a few mners) would be a disaster

Consultants would be inundated with the 'worried well' and have no time for the uneducated/ socially deprived and socially excluded women who really need them.

All the stats show that these are the women who are at risk, yet no one (apart from some midwife teams) seem to have schemes or stategies designed to improve their access to specialist care.