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?

@StepAwayFromGoogle

Well said indeed.

Interesting that the OP has not come back as yet

"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."

It's hard to read tone from printed text, but I assume you don't think that reducing the number of dead babies by 60% is a bad thing?

Oh dear op. I live near the Hospital the subject of the Musketeer Midwives debacle where those involved lost their jobs or were struck off but only after tragedies had occurred.

This involved midwives forming a clique, deciding that a natural childbirth was to be pursued at all costs and attempted to exclude senior medical staff, doctors, consultants.

Even if you are unsure about the consultant here, and dramatic language is being used, I think that you need to balance the two conflicting views. You all want a successful outcome but the consultant seeks to minimise risk.

because of course medical professionals are only interested in reducing stats, or meeting targets...nothing to do with actually wanting what is best for their patients is it ???

I am another person who finds it really hard to understand why pregnant women want to follow their own agendas, and not take the advice which is based on evidence as to what is going to be safest for their unborn baby...but disclaimer..i am a doctor so probably going to be bias

Personally I would opt for a hospital birth at the very least. Safety for you and the baby has to be the main priority.

Do we all agree the NHS needs to save money?

No we don't. The UK spends less % GDP on health than just about any other European country with a state backed scheme. Add in the money wasted in endless and useless reorganisations, plus ancient technology and equally ancient business processes.

There are many places to improve the NHS. Attacking women is not one of them.

The OP says quite clearly that the midwife she saw once, who behaved unprofessionally has one opinion. The midwives involved in her ongoing care, who have more information have a different opinion.

There is a reason why we use the word "Opinion" - nobody has the monopoly on the correct answer, just the best guess. You have a right, in the NHS, to seek a second opinion precisely because opinions and experience varies.

God help us if we destroy the NHS to the extent it turns into the stalinist model you advocate. It would certainly be in violation of just about every code of medical ethics as it removes choice entirely.

If you fundamentally don't believe in state involvement in healthcare just say so. Cheeseparing it back to a US style situation is weasel way of bringing about the same result

cathf, nail on the head with your first post. There seems to be an extraordinary amount of hysteria around the fact that the midwife is simply pointing out the statistics, from shouts of 'bullying' to screams of 'complain, how dare she'.

Pengggwn, re your statement So women would be forced to accept recommended medical treatment or they would be left untreated and therefore seriously at risk? That doesn't happen with any other type of medical care, does it? - yes, it does - the NHS makes these sorts of hard choices all the time, every day. Off the top of my head:

1. liver transplants denied to active drinkers
2. home oxygen denied to active smokers with endstage COPD
3. IVF denied to obese women
4. bariatric surgery denied to the obese in a number of different regions
5. all kinds of lifesaving medical treatment not imposed on patients who refuse it and are capacitous to make the decision
6. there are dozens of similar examples - unfortunately the NHS is sinking under the cost of patients' non-compliance with evidence-based medical advice because we always have to pick up the pieces later.

OP, someone has very kindly posted the RCOG impact papers link upthread highlighting all the evidence around induction of labour in older mothers - read it.

I know facts are unfashionable in our modern fact-free world, and it's a lot more fun seeking approval for your emotional rather than rational response to the midwife's advice in a mumsnet echo chamber, but I suspect you wouldn't be too happy if that baby comes out stillborn. As the papers indicate:

1. your baby's risk of stillbirth as well as neonatal death after delivery in significantly higher due to your age - it's around a 1 in 500 risk

2. there is evidence for reducing the risk by offering induction pre 39-40 weeks - 55% of NHS obstetricians would be offering you this at your age

If you'd rather go with your doula and home midwife who are pushing in the opposite direction, that's your choice. So long as you recognise the risks involved. Posting a hysterical mumsnet thread isn't the way to make a critical life decision that you need to make rationally, after studying the facts.

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.

You can't really advocate stripping away the opportunity of any choice for pregnant women and then feign concern about their mental health...

Jean

None of the scenarios you list equate to "you must do what the first doctor you see advises or lose access to medical care" which is what cathf was advocating.

Get your advice, take it or lose medical care. That is unethical. The second opinion and opportunity to seek more expert views is a key part of medical care.

I agree with the consultant midwife. By all means ask for a 2nd opinion but her advice is safe.
I’m a medical professional and I’d not even entertain a home birth in any circumstances so my views are deffo biased.

We have some of the highest rates of still birth around and that hasn’t changed in decades. Having seen the devastation that brings I think hospitals are right to look at whatever brings this down and stops more families suffering

From the NHS Stillbirth is more common than many people think. There are more than 3,600 stillbirths every year in the UK, and one in every 200 births ends in a stillbirth. Eleven babies are stillborn every day in the UK, making it 15 times more common than cot death.
Stillbirth - NHS.UK

If you will follow sleep guidance to prevent cot death post birth why wouldn’t you follow guidance pre birth?

Good luck with whatever you decide hope all goes well

Pengggwn and *C8H10N4O2

So the alcoholic isn't being autonomous when he places his need for alcohol higher than his need for a liver transplant? The smoker with COPD likewise isn't being autonomous when saying his need to carry on smoking overrides his need for home oxygen? The obese infertile woman isn't being autonomous when she decides not to lose sufficient weight to make herself eligible for IVF?

All of these are outcome based medical decisions on the patient's/recipient's part. The only thing that matters is whether your medical outcome is better or worse as a result of the choice you make. In this respect it's no different from the drinker or the smoker. The evidence indicates worse outcomes if she fails to have an induction, in the same way as the alcoholic will have a worse outcome if he de facto refuses a liver transplant by not stopping drinking.

The only difference here is that there are two lives involved so it's far more controversial for guideline-writers to place conditions on treatment, which is why they rarely do when it comes to pregnant women.

Not rtft .

Do you actually want to home birth or would you prefer MLU? Often they offer MLU if you are determined to home birth.

Is this midwife consultant the supervisor of midwives? If not speak to her.

I'm 35 weeks and midwifery led, no real problems apart from HG and now large for dates (big baby). I will be following whatever advice I'm given, which so far is really only that if I go overdue it might be inadvisable to watch and wait rather than have an induction when offered as baby will be even bigger, with the possible associated problems... Fair enough really!

I'd really prefer not to have an induction because of the increased need for further interventions that results (and more pain!). But I have been to the funeral of a newborn and I NEVER want to go to another, and definitely not that of my own child.

Whilst pregnancy is one big game of risk and statistics, and the vast majority of the time, as with op, statistically things will still go in her favour, I just can't see that it is worth the risk not to take the evidence based advice and act on it.

I don't think she was bullying you or unprofessional. So I don't know what you can really complain about other than the evidence based medical research they have presented you with doesn't match your idea of an ideal birth plan.

If you insist you want a home birth then accept the risks are yours. I won't give you my opinion.

I've just read through all of the responses.
Firstly, as a professional working in mental health, I am fully aware of autonomy and statistics.
I gave birth to dd 4 years ago aged 41, 3 days overdue in same birth centre I've been refused. Guidelines have changed.
I would never put my baby at risk, and have read papers and stats on women my age having babies. The midwife consultant is the first throughout my care to enforce such opinions.
I've had scans throughout the pregnancy, and baby and placenta are growing well.

My personal midwife who I've seen throughout my pregnancy, suggested I have a home birth.
I have not taken the decision lightly, and researched extensively all the risk factors.
If during labour complications arise, I will transfer straight to hospital, which is a 10 min drive away.
I am grateful to all those who have posted and contributed. Yes, the MC is doing her job, but, women are entitled to their autonomy and to make informed decisions about their bodies.
In my case, yes, I am well aware I'm 45. In different circumstances, I would have loved to conceive a few years earlier. But, I haven't, and I feel childbirth is a very personal decision, not to be taken lightly, but, with choice, options, and facts and statistics should be on a case by case basis.
I am not going against medical advice. I've seen obstetricians and they are happy with my progress as far.

OP, you say that you won't put your baby at risk, but are considering going against the advice of a highly experienced consultant midwife (I'm assuming a Supervisor of Midwives?).

As for a Doula, I don't even know where to start on that one - they will support you in whatever you want, you are paying them & they often have no recognised qualifications. So yes, they will tell you what you want to hear.

It seems a case of not liking what you are hearing from the Consultant Midwife: "shoot the messenger".

The midwife suggested a home birth? Really?

There are no Supervisor's of Midwives anymore. They were scrapped last year (Morecombe Bay was used as part of the rationale). Women's (and midwives) voices are becoming much harder to hear in the NHS at the moment. It is only going to get worse.

I've seen obstetricians and they are happy with my progress as far.

Have they explicitly said that you're low risk and so suitable for a home birth or a birth centre? Because that's not the same thing.

I can never understand why pregnant women seem to think they know better than the expert who is treating them
Putting a hand on your stomach is a bit intimate, but not worthy of the hysteria on here, and telling you what you don't want to hear does not mean she is bullying you, fgs.
We all have a duty to cost the NHS as little as possible, but for some reason, pregnant women seem to be immune from this and can make all sorts of costly demands which are often pandered to.
In my world, there would be no choices - you would get what the experts recommend or pay to go private.
The fact the NHS is free at point of use means we don't put a value on its worth.

I agree cath. All these anecdotes of "I ignored the consultant and was fine" are so smug and really annoying. What if things had gone the other way, would people have been so please with their decision to ignore all medical advice?

what Lisasimpson said...

progress so far and a currently healthy placenta does not trump the evidence.

I often wonder in these cases what an unborn child would say , if they had developed intellect enough to have an opinion...

OP - you are right it is your decision to make in the end, the MC did not 'enforce' her opinion on you, she stated it firmly, and it is not an opinion it is evidence based facts. If she could enforce treatment on you , you would be having your baby in hospital ..wouldn't you !

Again i remain baffled why anyone would put themselves at the risk of a stillbirth when it is not necessary.