Referred to mental health midwives without being asked

[ChikiTIKI]

Just wondering what others would do in this situation.

With DD1 the birth was traumatic and I ended up with severe ptsd. The trauma came from two main things: medical staff doing an instrumental delivery against my wishes and without my consent. And large blood loss with no communication from staff, I thought while it was all going on that I might die.

That was over 2 years ago and I had emdr therapy which finished well over a year ago and I don't struggle with ptsd any more. The treatment was really successful.

Feeling alright this pregnancy. Pretty good actually. Not struggling with anxiety or ptsd at all. Bit anxious about the birth but not too bad. Having a planned c section this time.

I got a letter today saying my midwife has referred me to the mental health midwives... Because I have symptoms of depression or anxiety.

I was never asked if I wanted this and I do not have symptoms of depression or anxiety.

What would you do in this situation? I feel a bit annoyed to be honest. I wouldn't have minded if they had suggested it to me and asked first, I would have said no thanks, I don't feel I need it. But I feel like the trust is broken now as I really don't appreciate having decisions made about my care without my consent.

I actually have a midwife appointment tomorrow. Am 36 weeks now and don't want to miss the appointment. I have seen this midwife the last 2 times so I think it was probably her that made the referral, unless it's taken a long time to come through. She asked how I was feeling last time and I said good, my husband was there too. She wrote in my notes about how everything was going well and that my husband was supportive etc.

Would you bring up the referral in the appointment or just leave it?

I think I would ask her about it.

I believe that you should have been asked for your consent for the referral, and be within your rights to decline assessment by the MH team.

You could take it two ways: either sometime is genuinely concerned (perhaps having read about your last birth but without knowing about your successful EMDR therapy. They might be wanting to make sure you don't slip through the net as being sometime who might need more support. You could go along with MH assessment, tell them you are feeling ok thankyou very much and you'll get in touch if you need them. It's a waste of resources on their side, but if you decline, they may be concerned you are trying to cover up/avoid services that you could need.

The other option I'd consider is to ask to contact the supervisor of midwives/patient experience midwife/head of midwifery. If people are being referred without awareness or consent, that isn't on. If you don't feel listened to or in charge of your care, if trust in the service is breaking down, the service needs to know. They should be empowering you, and delivering the service you need. Presuming you are in the UK there should be a clear mechanism to do this.

Personally I couldn't let it lie, but there are different approaches you could take.

I wasn't asked consent for my diabetes test - I was seen as high risk and told they were referring me for one. I guess I could have refused to turn up, but the point is that their job is to assess this stuff.

With your history, I would absolutely expect the midwives to feel that some additional mental health support is reasonable. In my case, due to various things my midwife told me that she was going to recommend I get extra help including a mental health assessment. Again, I had the right to say no I guess.

I think it is a bit silly that this wasn't mentioned to you in person before they sent off the referral. But otherwise I don't see the problem here. And I also don't understand why you wouldn't just go along to the assessment. If they told you they were worried about something else and asked you to have a blood test or an additional scan you'd do it?

I think it’s not respectful of them to refer you without your consent. It’s quite ironic in a way, you got severe PTSD also because during your last delivery procedures were done without your consent and now they have decided that you should see a mental health midwife but they haven’t asked for your consent for this. I also wonder if this isn’t an illegal violation of your privacy.

I would personally follow @tatyr ‘s advice and contact the head of midwifery about this.

I would ask her tomorrow why you were referred; it seems odd to have done it without informing you or asking you what you thought. I also think it’s important to ask because your experience last time was that you weren’t part of the decision making so it’s even more important this time that decisions are made together

A referral for a medical assessment is an illegal violation of privacy?? Now I've heard it all. I find it interesting that people are so sensitive over mental health stuff. As a pp says, would you feel the same way about a blood sugar test? They are just being cautious given your previous experience. They should have spoken to you about it yes, but they'd be remiss for neglecting it.

I don't understand why they didn't discuss the referral with you but otherwise I agree with Bling that they are following a recognised procedure based on your case history.

I can't see any harm in discussing it with the midwife, asking why you weren't asked about the referral. Going straight to the head of midwifery sounds like a complete overreaction.

I think usually they should tell you they are making the referral. But am I right in thinking that your previous birth was only two years ago? That’s a very short timescale to have such a traumatic event happen to you, undergo therapy and completely recover, they may understandably feel you could use some support down the line. I know you say you feel ok now but be prepared for this pregnancy to throw something up, having a baby is a vulnerable time for anyone, let alone somebody who has been through a trauma like you have.

It’s not a bad thing to take support if it’s offered but I can entirely understand you wanting to feel informed and in control every step of the way this time around after what has happened. Look after yourself op.

I think they should have discussed it with you and would enquire why this wasn’t the case but at the same time I also think that the referral itself given the history is probably well worthwhile so that your under the care of those who can help prevent or reduce the risk of problems developing

I think it sounds fairly standard. Someone is recognising a previous issue and making steps to ensure it doesn't happen again. Whether it's automatically generated or by your midwife.
The referral probably did take months. It may even be an admin issue that a letter didn't go out.
Seems responsible to me. Maybe they could have communicated better but they have a duty of care to you and your baby, and if your issues arose during birth the last time, it is safer to ensure you have access to these services if the need arises, as well as providing an advocate for you to express your wishes and concerns for this birth.
All the best with your birth. I really do think this was all done for your benefit and is probably an autmatic referral if you've accessed mental health services.

I would take the appointment and speak to them bring up the referral was a suprise to you . Anything could be a trigger to you the hellish time you had has been flagged up and they want to look after you. Nobody has invaded your privacy and once you speak to midwives you don't have to see them again if you don't want.

Is the planned C section relating to your difficulties first time around or for another medical reason?

I would definitely ask at your next appointment why the service is continuing to go ahead with recommendations without your consent.

The not mentioning to you must have been annoying as it was out of the blue but I don't think it is meant to catch you out or anything.

Yeah it's the not asking for first that bothers me. And that they are writing in my notes that I am doing fine but then making a referral which according to the letter suggests otherwise.

If it had been a letter about a diabetes test, I would have been confused since it says in my notes from all my appointments that I did not have traces of sugar in my urine. So the letter I have received confuses me in the same way.

Its not an appointment letter its a letter asking me to call up and make an appointment, so one has not been scheduled yet.

I am going to assume for now that the letter was sent in error, and like I said I would be doing the same if it was a letter about diabetes. Will see how I feel on Monday, I may ask the midwife about it, may wait first to see if she brings it up.

Maximum 3 weeks left of this pregnancy so I am slightly surprised if this is a standard procedure to wait until the end of the pregnancy to see if you need more support during the pregnancy. I am also at work for at least one more week and won't be taking time out for an appointment I don't need.

I won't contact the head of midwifery. I dealt with them a fair bit when I complained about the first birth and they treated me awfully in the complaints procedure.

The birth this time will be at a different hospital but I am still using the community midwives of the previous one due to where I live. When the consultant scheduled my c section they asked if I was OK with this and offered for me to have my appointments at the hospital but I said I was fine using the community midwives. If this next appointment goes badly I will just have my final appointment at the hospital.

I am having the c section due to how it went last time. Nobody had ever questioned it or tried to persuade me otherwise thankfully. I have recovered from the ptsd. If I took a ptsd questionnaire the score would be very low, too low to suggest I might have ptsd. Same with questionnaire for anxiety or depression. Obviously the experience affected me and I will never forget it. I won't try for a vaginal birth again but that's OK, we all have limits and for good reason. I won't risk the exact same situation happening to me again, but that certainly doesn't mean I am therefore currently suffering with ptsd.

You sound really sensible about it talk to your regular midwife maybe it is an automatic referral or your answers to the questionaire flagged somethin g up but keeping communication open goes both ways they should have warned you it might come in the post.

I don't think it's necessary a bad thing, but I can see why you feel a bit weirded out by it, especially given the issues of consent around your previous birth.

In my experience a couple of times midwives/consultants have (seemingly randomly) read through my notes, sometimes going back further than anyone seems to have looked before (e.g. previous pregnancy) and then raised new issues (they noticed that I'd had a LETZ procedure and later noticed that I had tested positive for strep in previous pregnancy). It was good that they did notice these things but left me feeling that it was all a bit random and could easily have been missed. I wonder if this is a similar issue?

I would raise it what the midwife appointment and mention (politely) that you would have preferred to be consulted before a referral was made and see what she says..

Ask her if she referred, and point out you don't need it and she can cancel

Could it be that she has done it to ensure that you get your c section? As a way of 'proving' that you must have a c section and cannot get fobbed off at the hospital and 'encouraged' to have a vaginal delivery?

OP good luck with your planned section and new arrival.

To use your analogy of a diabetes test, most often you are referred, not because you have sugar in your urine but because other factors indicate you are at higher risk such as bmi, ethnicity or a close relation with diagnosed diabetes.

Likewise, the referral could have been made, not because you are demonstrating symptoms now but that it has been recognised that your mental health has been affected before and you are therefore at increased risk of requiring support with this pregnancy.

I would hope that the referral has only been made with your best interests at heart however completely understand that this should have been discussed with you and you should have been given the option to decline.

The best thing would be to ask, either call up the number on the letter and ask what the details of the referral are or speak to the community midwife and ask them. You could always also speak to the community team leader and raise your discomfort at being referred without your knowledge.

@whatisheupto my c section has been booked in since I was 20 weeks, so over 16 weeks now. I don't think it's likely to be cancelled. I signed the consent forms at 20 weeks too.

I see what you're saying @monr0e but the letter said that I have been referred because I am showing symptoms of anxiety or depression, which I am not.

I suppose the only way to find out why they did it is to ask on Monday.

Then definitely speak to them as you are doing. I hope you get to the bottom of it and can put it to rest so you can enjoy your last fes weeks of pregnancy.

I would complain to be honest. A failure to communicate is what caused your MH problems in the first place. What a shitty thing to do.

Although just to add its probably a standard worded letter. My name is written on it in pen. I realise postnatal anxiety, depression, psychosis are the "main" recognised mental health problems. There are tick boxes for those on the green notes but not for postnatal ptsd.

Thanks @Monr0e 🙂

I saw a mental health midwife for my second, she was wonderful and I had all my appointments at home with extra time with her. I would have had extra support from her after the birth too but unfortunately DS was premature and it went a bit differently although I was seen by another mh midwife in the team while I was at hospital.
However, I was aware I was being referred and for what reason (extreme anxiety about things going wrong) and it happened in my booking in appointment so I was supported through the pregnancy. I would have been very confused to receive the referral at 36 weeks (not least because my DS was 5 weeks old by then ) without being told. Definitely discuss with your midwife