Midwife Consultant bully!

[libertysilk]

Expecting my third child, and, as I'm 45, am monitored quite a lot. I have 3 weeks to go. I've had a complication free pregnancy. Scans and tests all normal and within expected parameters.
Due to my age, I've been refused the option of giving birth in my local birth centre as its not attached to a maternity ward. I challenged this, and was booked an appointment with a midwife consultant.
She wants me to be induced at 38 weeks, due to statistics of women my age having problems. She keeps saying I'll haemorrhage or have a still born. In a meeting on Wednesday she took my hand in hers, and placed it on her stomach. Said she wants the best for me and wished me well.
My midwife has ok'd me for a home birth, and disagrees with the consultant.
I feel I'm being scare mongered, and bullied.
I'm part of a group run by a midwife and doula with 38 years experience between them. They support me along with my midwife, and say I am healthy and fit and perfectly able to have baby at home. They've said the midwife consultant is behaving professionally and is bullying me, and I should report her.
I'm in two minds.
I'm not naive, and will not put my baby at risk, but, this is putting huge stress on my pregnancy, including confusing and upsetting the father too.
AIBU to be upset?

Given you have your own midwives, who know you, know your history etc. I would take their opinion over an NHS consultant midwife at any point personally.

Yes, obviously there are risks, but in my experience, the NHS played the stats, rather than actually look at my history (both my labours went exactly the same way - it's clear that there's something up with me, and I won't be able to give birth vaginally, but that was dismissed by the VBAC midwife as 'oh, it's because you were induced' - having spent all of 2 minutes reading my (copious - from another country) notes.

I had an NHS consultant wanting to prescribe me aspirin, because I was obese, but when I read the research, given other issues, it wasn't appropriate at all, and she was scandalized that I wouldn't take it (and yet wouldn't talk to me about it, just wanted me to accept her orders) - ditto when I refused induction, and later epidural (decided to hold off for a spinal just before EMCS).

Consistent care from a single midwife (or practice) who knows you is infinitely better, more personalized, and in my opinion safer than the production-line NHS birth.

I believe there’s one large teaching hospital in the UK which now offers everyone the choice of induction at 40 weeks regardless of age, other risk factors, etc. Obviously some high risk women may be offered induction before 40 weeks.

This is due to the research about increased risk of stillbirth at term.

I can see more and more hospitals adopting this policy. I suppose it’s a reflection of the risk averse/litigation averse nature of obstetric units. With the evidence been there I suppose hospitals are starting to worry that they will one day be faced with a case where s woman has a SB st 40+3 and then sues the hospital because she wasn’t informed of the increased risk.

Such a policy may well lower the SB rate but it will increase the intervention rate, section rate, instrumental delivery rate, pph rate, epidural rate, etc. It will also be expensive for the nhs.

The NHS should be using the cheapest and most efficient was to deliver the baby safety for both mother and child.
Mother's wishes, sensibilities and demands should come a lot lower down on the list.

No. The mental health of the mother is also incredibly important, as is her right to bodily autonomy.

As medical professionals we have no right to force ANY type of birth on any mother.

But does the NHS needs to save money Pingu?
Too much choice leads to extra stress, angst and decisions mum is not qualified to make, which I don't imagine is great for mental health either.

If she was telling you what you wanted the hand on the stomach wouldn't bother you! Induction doesn't have to be problematic and can be just as 'natural' as a spontaneous labour

Have you been refused the option of the birth centre just because of your age, or because they want you to have an induction which can't be done at the birth centre? If because of your age, what is the reasoning behind that?

Ask to see the stats, they are not biased by a professional perspective. I am aware that it is common for placentas of older mothers to degrade earlier, which is very risky for the baby. I think personally I would agree to an induction for that reason (and I'd do anything to avoid an induction usually). It doesn't matter if you are fit and healthy, age is an independent risk factor for this.

My first baby, I was going to have a homebirth (water birth, hypnobirthing etc). It was all planned. The stats for a first time home birth are actually not great for a women in my demographic (older, white, well-educated). The rate of serious negative outcome is significantly higher than than hospital births (outcomes are better for home births than hospital for subsequent births, after a successful straightforward first birth). Anyway, a week beforehand there were signs of concern - rising blood pressure, some protein in urine. Switched to a hospital birth. If I hadn't been in a hospital most likely we'd both have died (placental abruption, crash general anaesthetic c section, 4 transfusions, undiagnosed IUGR, a week in NICU, weighed less than 3lbs at 39 weeks, and the rest). So, a little horror story for you there. But the stats bore out in my case. I'd err on the side of caution (obviously biased by my experience), based on research, not professionals with an agenda.

I can't see how highly medicalised births will save the NHS money.

CathF: of course the NHS needs to save money, but highly medicalised births are not the way. They are more expensive, and anything that denies women bodily autonomy is frankly wrong.

Being able to make your own decisions about how you want to give birth does not lead to angst. Treating women like silly little girls who don't know what's best for them is utterly ridiculous. We present information to the women - pros and cons - it is then up to the woman as to what she chooses to do with that information. Women are adults, capable of making thier own decisions.

You seem to have very little faith in the ability of a woman to make the decision that is best for her own body and her own baby.

You need to read the research yourself OP, and ask for the stats for your hospital (rather than national ones) and then weigh it up.

If you feel you are being misadvised or coerced you can contact your local Maternity Voices Forum (the hospital will have details) and give them feedback which will then be used to help improve the service.

Risks do increase past 40 but you also need to look at by how much, and consider your own medical and birth history.

Ultimately it is your decision and you need to be happy with it. But the key thing is to make a properly informed choice.

IVF, liver ops for drunks, A&E accepting and treating the drunk every weekend, those who choose to participate in extreme sports, clinically obese people who refuse to change diet/living styles to get fitter etc - should they all be part of the same system?

Yes, absolutely. Unequivocally.

The NHS should be using the cheapest and most efficient was to deliver the baby safety for both mother and child.
Mother's wishes, sensibilities and demands should come a lot lower down on the list.
Do we all agree the NHS needs to save money?

The NHS should use the most supportive and effective treatment at whatever cost.
The lack of regard for mothers wishes and sensibilities causes great harm and trauma and indicates a level of disregard for bodily autonomy that is horrific at best.
Actually, no, I don't think the NHS needs to save money. I think it needs to be properly funded.

Sorry to hijack OP. Get another opinion if you need. Write a comprehensive birth plan. Your body your choice. That is the principle here. Stay safe and good luck with your birth.

If she was telling you what you wanted the hand on the stomach wouldn't bother you!

^Agreed

I would have your baby at hospital

Years ago heaving my third, previous 2 sections, I said I want ed to try for a vac. The consultant told me I was selfish and irresponsible. I was in pieces , however, my doula and the senior midwife told me that because consultants are only ever involved with problematic pregnancies and births they have a skewed opinion.
I did give birth in hospital and naturally, I went on to have 3 further natural births, the last 2 of which were at home. I also went three weeks over with three of them and couldn't be induced because of the sections.
I was 39 when i had my last one.

In fairness to her- you forced a meeting with her- was not considered eligible for the service she provides due to your age initially, but you got what you felt was best- and an appt with her. She feels that an induction is safer. You want a home birth with a doula. Since it seems you already have a doula and a midwife supporting you home birthing- why did you force a meeting at a birthing centre, knowing that they didn’t initially think you were suitable, and probably wouldn’t change their mind, just because you challenged their guidelines? She is giving you best practise, and researched guidelines and stats on the risk of being a ‘geriatric’ mother and carying to term (I was a geriatric mother too- the phrase still tickles me) slightly condescending, yes- but I’ve been touched in plenty more Soward places than my abdomen by a midwife. I think because you’re sensitive about this, and professionals not supporting your view of how the birth should go, you’ve taken this more personally than it needed to be. Just don’t go back.

But it's not as simple as that, in fact, the current situation is the direct opposite of that. And if you want to strip away medical autonomy for pregnant women, it stands to reason you would want to remove it for the whole population. Either way, it is a ridiculous notion and one that wouldn't get through the democratic process.

I agree with you that women's bodily autonomy should always be placed first, at all costs. I can't imagine why someone would be so blasé about such serious risks - and I'm very jealous of the charmed life that would lead someone to imagine that they could never be on the bad side of the stats just because they're 'healthy' - but I think it's their choice to make.

However, if we're honest with ourselves, if you asked the general public 'should women be allowed to choose home birth when there is an increased chance of the baby dying as a result?' there's no chance that the popular vote would be for yes. My vote is that you'd actually find it very, very easy to get through a democratic process if you wanted to - which is why we don't tend to put individual rights issues to a vote.

Sorry OP but the midwife consultant spoke the truth to you for your best interest. Fine you don’t like her way of doing it and yes perhaps a bit odd. But the facts are correct.
You and your baby are at greater risk.
Taking the advice of a dula over a consultant midwife is madnes.
Go talk to the consultant obstetrician if you want a second option and I suggest you take the advice given.
To be blunt as one of the people who has the unfortunate job of trying to save babies when a birth goes wrong you never ever take the risk! Births do go wrong older mothers are a much higher risk and going over due massively increases the risk. Shocking but true you can have 2 perfect home births then number 3 can go wrong seen it happen.
Just go for safety and have a hospital birth as when the call for help we are there in seconds.
Good luck OP but don’t be so arrogant you risk your child’s safety.

Ooh and to the op who said a dead baby saves money. The inquest costs money plus the more likely outcome of a damaged child will cost the nhs millions over its lifetime.

*my guess

The hand on her stomach is weird, but did she actually keep telling you that you will have a stillborn or that you have an increased risk of baby being stillborn? The first is an outright incorrect statement but the second is factually true.

The thought of being pregnant at 45 would terrify me and I would be going along with their guidelines for peace of mind , but you do have the option of doing your own thing. I wouldn't be giving much weight to the doula though, they are there for you as an advocate, not to offer medical advice.

I'm at the 46 year old twin IVF pregnancy wanting to leave the babies 'until they are good and ready'.

In women who want to go against what's advised, I always tell them I'm an information giver, not a decision maker; however, there seems to be an expectation that I'll tell them what they want to hear and I tell them that's not my job.

I once had a patient threatening to make a complaint about me because I suggested cannabis wasn't going to help her growth restricted baby. Or the heroin user who told my colleague to get fucked because she wanted to leave labour ward at 7cm to get a hit.

Bottom line is, we tell people the risks, hand the responsibility back to them but they don't seem to want to accept the responsibility.

Well of course the nhs would say they’re not trying to save money by having more medicalised births, they’re trying to improve outcomes and make things safer.

There’s a massive drive at the minute as we’ve been told nationally we’ve got to reduce the still birth rate by something like 60% by 2020. So units are getting their stats scrutinised and audited. Money isn’t the issue. It’s about reaching targets.

I think you are BU.

I had DC3 at 42. Totally straightforward delivery but honey, we're old! 45 is OLD even if it's the new normal to be delivering babies at our age. You can't predict whether or not a delivery at any age will be complicated.

A midwife consultant is a highly trained professional. She has rigid guidelines to follow, especially in cases like ours- old parents. You are at greater risk of shit going down at our age. Biology doesn't lie. The likelihood of something bad happening mid-delivery is probably slim. But I think you're being arrogant and totally unappreciative of your healthcare advisors. Sometimes safety trumps your birth plan. You're not 30 OP. Get real. Go private if you want to go all doula-la-la.

OP, I'm 41 and pregnant with my second. I'm going to be induced at 40 weeks in hospital due to my age and on the advice of a consultant. I'm assuming the medical staff have recommended that because it's safest for me and my baby, not just because they are being bloody minded. I never understand why people think they know better than than professionals who have been looking after mothers and babies for decades. I'd never forgive myself if I doggedly pursued my own path and my child was stillborn.

Whilst your own consultant sounds really strange (what is that hand on stomach thing?!) they are trying to do the best for you and your baby. And it's not bullying either.