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?

That’s the thing with autonomy. We are at liberty to make our own decisions, even when they are completely unwise.

Both I and a dd had one difficult birth - neither was foreseen. I was 31, she was 38. We were both so glad and grateful that help was so readily and quickly available in hospital, and that both resulted in healthy babies.

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

I'm amazed not one of them has suggested IOL at term

OP if you have made your mind up, have the backing of your midwife and obstetrician, then why has this one off meeting "put so much stress" on both you and the father?

Re her being a bully: if as you said she repeatedly told you that your baby will be stillborn or you will have a pph then I would be inclined to report her for incorrectly disseminating medical information. If (as is more likely) she told you of the increased risks due to maternal age then I would take it on board.

Being ten minutes away from hospital is great if you start haemorrhaging or otherwise having complications that threaten your life. They'd almost certainly be able to get you there quickly enough to save your life.

However, when things go wrong the baby can be starved of oxygen and die or be severely brain damaged in a matter of seconds, not minutes. That's the real risk. Ten minutes also won't be ten minutes by the time they've got you both there (by ambulance? Car - with the baby stuck in the birth canal?) and assessed. In hospital a crash team would be with you within seconds and that could make all the difference for your baby. Why risk it?

If the OP does go against advice and has a home birth, what would happen if something went wrong?
Would the home birth be at her own risk, it would she be able to sue?
Genuine question.

She could sue the independent midwife but there was a problem with them being able to get indemnity cover. Can you guess why?

Also, you're a professional in mental health, not obstetrics. Would you take a midwife's opinion on a psychiatric patient over that of a senior mental health practitioner?

In the end of course it's your choice to make, but qualified people pointing out the risks isn't bullying.

Might add that my dd still sometimes still trembles to think about what might have happened if she'd been any distance from the obstetric unit, instead of having it just downstairs from the midwife unit, where she'd blithely assumed that since she was fit and healthy, her first labour would go smoothly.

If the OP does go against advice and has a home birth, what would happen if something went wrong?

Which advice? The midwife who wants to induce at 38 weeks based on statistics (which is not statistically supported in any reports I've seen - 40 weeks may be but not necessarily) or the other experienced midwife who has direct knowledge of the patient over a period of time?

Why is one automatically The Expert and the other not?

pengggwn

You weren't arguing the NHS make a patient accept treatment - no-one is. You were arguing that the NHS can't and shouldn't dictate subsequent rules of engagement based on the patient's decision. I was pointing out we do it with all sorts of other patients but never with pregnant women, who form a special group on account of a) pregnancy not being a pathological condition b) there being two lives involved.

It will nevertheless have similar implications in terms of outcomes and cost in this case. As I pointed out above, the numbers indicate a worse outcome for her and baby if she has a home birth. Now if she accepts an induction the evidence indicates there is a) a reduced risk of stillbirth and neonatal mortality b) a reduced risk of pre-eclampsia. If on the other hand she goes with a home birth instead she and her maternity/paediatric units are subject to a) increased risk of c section with all the associated complications and cost b) an increased risk of neonatal ICU admission with all the associated complications and cost.

Nevertheless the NHS will never dictate subsequent rules of engagement to her despite those morbidity/mortality/cost implications in the way we do with all sorts of other patients multiple times every day, because as a pregnant woman she is a special case.

Pregnant women aren't a special case. Baby/fetus has no rights until it's born.

OP..i am not being goady, i genuinely am curious evenif i probably disgree with your decision, but why are you set on a home birth ? what is it about a home birth that in your opinion would outweigh the potential risks to your unborn child ?

I am a medic so am naturally inclined to see medicalised birth as safer and preferable, but also accept that it is your decision, based on your consideration of all the facts and evidence. I am intrigued as to why or what it is about the riskier option that makes it worth it ?

It's a shame there isn't a MLU attached to the hospital as that would probably be a good option and compromise.

But to be honest, in your position id go for a hospital birth, possibly refuse induction before 40w if you've read up on it but I think induction and place of birth are different issues.

You might feel less comfortable in hospital but your baby won't care where he/she is born so I would put their safety first.

Well said @peng. I wanted to respond to that “pregnant women get special treatment” line, but you’ve beaten me to it and have been more articulate than I probably would have been.

So the alcoholic isn't being autonomous when he places his need for alcohol higher than his need for a liver transplant?

Actually if the patient is genuinely alcoholic then no, they don't exercise a free choice - that is the nature of addiction, especially with alcohol. However the overriding point there is that the surgery is unlikely to help them unless they can give up alcohol. So major surgery with life risking complications and unlikely to realise a benefit.

The OP isn't an alcoholic who needs to change her behaviour. Its disingenuous to bracket her with those examples.

The OP has two medical opinions from experienced professionals:

• one who has seen her once and is pushing a solution from population statistics (aside from the unprofessional behaviour - I've never had an HCP take my hand and put it on their body!)

• one who has seen her regularly through pregnancy and has individual knowledge of the patient to apply to general population evidence

Why the former is automatically 'the expert' and that latter advice invalid.

Very odd to put her hands on your stomach, and very inappropriate. Mabey she is concerned about your baby, and that she wants you to have a good delivery with a healthy and alive baby at the end of it.

Can you get an opionion of someone more professional? Also, can you find out the actual NUMBERS, ie how much more risky is it to carry to term vs to have an induction? My understanding is that, while the numbers do grow with age, they are still tiny. Having actual data might help you view this decision coldly.

At the end of the day it's your right to deliver when and how you want. However, I don't understand why you would want to incase you and your babies risk of something going wrong when you are being given the opportunity to avoid that? Seems bizarre to me. I ended up having to have an emergency section & they literally had minutes to get baby out due to her heart rate dropping, for that I am so thankful I had an amazing midwife, registrar, consultant and operating theatre on hand. Think of your baby rather than your own wants for your birth. They rarely stick to the plan anyway!

If I was in your shoes I would not be having a home birth. I had a fairly easy first birth, second birth I attempted at home and ended up transferring myself in via ambuluance as the midwives at home were letting me push for hours and hours even though baby was clearly stuck. It ended up ok, I had vontouse but came out without a tear and was home 2 hours later. It just shows home birth can go wrong and I was 31.

I desperately wanted a natural birth both times but had to have an emergency c section with my first and an unwanted planned c section with my second. I was desperate for a VBAC but was advised against it by my consultant who was worried about me going to 43 weeks and needing a section anyway, and the increased risk of still birth. I was bitterly disappointed but went with his advice. I'm a doctor myself and knew him and trusted him. Thank goodness I did because, when she was delivered, my youngest had a 'true knot' in her umbilical cord. The consultant gasped when she saw it. If I'd had her naturally then the cord would have tightened and she probably would have died.

Go with your instincts but also speak to a consultant obstetrician. They just want to prevent you from the emotional pain of not having your beautiful live baby.

Well, that's the thing with informed choices and risks - it can be fucking scary.

While I, like many here, think that the hand on stomach thing was maybe overstep the intimacy mark, the information you have been giving is factually correct and do not amount to 'bullying' or 'scare mongering'.

I gave birth at 44 and I have had many similar chats like yours. DS4 was 10 days overdue and I had to stand my ground quite firmly (I did deliver in hospital though, that was always the plan).

If you are happy and confident with your plans for your delivery, you understand the risks and what can go wrong, then you have every right to go ahead. Just don't shoot the messenger of unwelcome information.

V best of luck on the day

What @HeteronormativeHaybales said...

You are caught between the medical
Opinion and the opinion of some well meaning but sometimes biased doula types.

Ask for a second MEDICAL opinion from an obstetrician, look on your hospital website see if there is a slightly younger and possibly more enlightened one who may give an alternative.

However I do agree that the midwife has your best interests at heart and in my group there has been several unfortunate incidents amongst the older mum's so I am inclined to agree with her sorry. Equally I know we do tend to over medicalise birth in this country but personally at 45 I'd be wanting all the medical attention I could. If you are in the midlands at all ask about Serenity which is a birthing unit but attached to a hospital rather than stand alone. Good luck!