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?

Pengggwn

You said: 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?

No-one is forcing an induction on her. They'd be perfectly happy for her to refuse. They can't subsequently withhold a c section which she's more likely to need in the way they could withhold a liver transplant for the drinker. Or home oxygen for the smoker. Or IVF for the obese woman.

Is that clear enough?

Very odd to put her hands on your stomach, and very inappropria

The point is the midwife didn't put her hands on the OP stomach, she took the OP hands and placed it on her own stomach. That is just weird behaviour from an HCP.

Its also inappropriate to tell her that dire consequences will happen - it should be a discussion of the statistical risks rated against the individual patient.

If hers was the only opinion I'd had I'd be seeking a second simply because it was so unprofessional. As it is the OP already has another experienced opinion.

I agree its a pity there is no middle path being offered between a heavily interventionist birth and home, for a healthy pregancy in a healthy woman

With my horror show first birth, one of the reasons I initially went for a home birth was that we live 5 mins from the hospital, vs the MLU that was 20 mins away. But in my circumstances I don't think 5 mins would have been enough to either of us (obviously it would have been more to get an ambulance to me, me out the door, to the hospital, through all the corridors and lifts). They were consenting me verbally to general anaesthetic and surgery as they ran the bed along the corridor into the theatre.

But look, if you've got the stats, if you know you've a 1 in 500 chance if stillbirth and you want to go ahead, that is entirely your choice. They are pretty good odds! If you've considered an accurate risk, if you have been able to tell yourself that if the worst happened you'd still think it was a fair risk for you and your family to take, I really think that's all you can do, it's your choice. (I'm not being sarcastic, but given you've already got kids I really would consider life insurance if you haven't already got any).

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

Its two medical opinions - the OP has a regular experienced midwife who disagrees with the hospital midwife. The fact that a doula is part of the OP's midwife team is neither here nor there.

"I think the pp was suggesting that, if any treatment is refused because you (as an untrained patient with google at your fingertips) don’t want it, then you should have to go private. That seems reasonable."

What if you refuse a certain treatment because you think it might put yourself or baby in danger?

When my MIL had her breast removed, the consultant put it upon himself to build up her breast with some injected material while she was under the anaesthetic, without having got her permission: the material later leaked and she became very ill. Being MIL, she decided not to make a fuss, but what if he had asked her beforehand and she had said "no, I don't want that"- 0are people really saying she should not have had her cancer treated on the NHS?

Consultants are medically trained, but they are also human: they miss symptoms, they make mistakes, they have their own pet ideas. I have been in the unenviable situation of being informed afterwards that my child is likely to suffer permanent damage because we trusted a consultant and did something we had concerns about at the time.

I've also twice had an NHS dentist (presumably also trained) try to inject the wrong half of my mouth. Should I not have said anything because taxpayers' money?

I am not saying that the OP is right in this specific case, maybe she isn't. But as a general principle, being unable to question a doctor for fear of losing one's NHS status seems a very dangerous route to go down.

Sorry 5 minutes wouldn't have been enough to save either of us

In terms of going past your due date when older & the risks of increased risks of stillbirth....yes the risks are small (but statistically significant) but the stakes are SO high.

Daily foetal monitoring/Doppler will only provide a snap shot at that moment in time. It could change hours later, without warning.

Having actual data might help you view this decision coldly.

Yes I agree but also an independent opinion who can discuss that data in the context of the individual patient, rather than try to scare and coerce into a path of action.

Statistics are always at population level. They mean nothing in individual terms beyond being the best start point for the individual discussion.

Also "cheapest, safest, most efficient" is not the same for every labour or every woman. There is some evidence that some women get so stressed in a hospital environment that this increases the risk of birth complications. Also, induction itself is associated with a higher risk of damage and/or caesarean intervention. Which of course must be weighed against the risk of the baby coming to during a late labour.

@C8H10N4O2 a doula is not medical though are they... don't get me wrong I'm pro Doulas I've used one myself but the view of some I met was rather extreme and they certainly weren't in any way medically qualified, many were trying to get into midwife courses as mature students but did not have the right qualifications. The lady I used was very balanced but I met a fair few before her who were quite militant in their views and pushing their own agenda. Equally there are medical
Professionals pushing the NHS agenda which may not suit the individual but you have to be aware of conflicting views in order to reach your own conclusion.

Having held my full-term stillborn granddaughter last month (sudden placental abruption two days after a perfect scan) I cannot understand how anyone can knowingly and willingly put their baby at increased risk.

My mother also gave birth to my stillborn sister and my stillborn brother so I do feel strongly about it I suppose, but I think that it's completely selfish and sef-centred.

What type of regular monitoring are you having OP?

It’s not quite that straightforward is it &Jean* since induction carries its own risks. It’s not really a black and white decision in terms of risk or cost.

It’s the enormity of the consequences that would sway most people into one direction rather than another.

I think the midwife consultant has delivered her message in a clumsy way but the evidence supports her decision. Of course you may well sail through a Home birth but you are more likely to have complications needing intervention. Is there another consultant you can speak to for a second opinion who can have a discussion of the facts in a less emotive way. I know it’s disappointing when you don’t get the birth you want (I planned for birth centre and ended up with a EMCS under GA) but the safety of you and your baby has to be the only consideration.

I would disregard the community midwifes opinion more than the consultant midwife. Yes she may know the OP but there's no way of telling who may or may not have a stillbirth in such circumstances. She does not have a crystal ball. The consultant midwife is talking from a position of evidence.

By all means a community midwife can act as an advocate for a woman and still support them when they choose to go against advice. But they should never be reassuring them that it will be ok as they have no way of knowing it will be.

So women would be forced to accept recommended medical treatment or they would be left untreated and therefore seriously at risk?

No woman is forced to accept anything. It's a discussion of, "Here is the evidence, here are the risks"

If a woman says, no thanks, that's fine.

But the responsibility is theirs, should there be an adverse outcome and it's investigated, there would be a trail that the risks were discussed and documented.

In the Montgomery ruling, the mother hadn't been warned of the risks of her diabetes and shoulder dystocia with her small frame. Her baby was starved of oxygen for 12 minutes and she was well within her rights to bring a case against the Trust.

Hi OP I am 43 and have just had my second child, u had my first at 41.

I the last two years the medical guidance around older mother's has shifted to be mostly about prevention of still birth, and the most effective way to prevent still birth is to induce at 37/38 weeks.

My baby on some measures was viewed to be small and I was advised to be induced at 37 weeks.

I looked at the primary evidence behind the guidelines and then made a decision based on the guidance, but balanced with what I viewed to be my personal risk. I was also offered and accepted increased monitoring for the last three weeks and opted to be induced at 40 weeks if I had not gone into labour before that. So, I understand that standard medical advice is not always right for the individual. However, I do think you might be under estimating the risks.

At 45, you are amongst the oldest women to give birth. You will have substantially higher risk of still birth and significant post partum haemorrhage.

Beyond 40 weeks the placenta in all women begins to struggle, and unless you are being very closely monitored, there is no way you will be able to tell if your placenta is failing.

Does your plan change if you go beyond term? If you went 2 weeks overdue, what then? At what point does the desire to have the baby out over ride the desire to have a home birth?

Also, you need to remember that whilst you are entitled to assess and accept the risk of having a home birth, medics are equally entitled to assess the risk and deny attendance bat a birth they deem to be too risky.

My personal view is that you are either willing to accept a much higher risk of still birth than I would be, or you under estimating the risk. One piece of evidence that really swayed me was the observation that in a substantial portion of still births there were no signs or signals and prior to birth. Placenta failure can be silent.

Sorry, I missed the context of the quote

Haven't read the whole thread so apologies if this has already been raised and dealt with but why on earth do people think the OP needs to speak to a Dr? What will that achieve? We know what they'll say already. She's spoken to a Consultant midwife who has read the same research as any of the Obstetricians in that NHS Trust and any of those Drs/Obs will only give the same advice the Cons midwife gave. The advice is correct based on the evidence. Whether the OP decides to take it or not is entirely her choice and if she decides that another course of action suits her and her family better the NHS should be able to support her in that choice. That's what informed choice is - having the information and making the choices that suit you and your personal circumstances/ethos best. Those people saying 'speak to a Dr' are missing the point and not understanding the NHS hierarchies of knowledge at all.

.@Jassmells a doula is not medical though are they.

No they are not. I wasn't comparing the hospital midwife with the doula. The comparison was between the advice of the hospital wife with the odd behaviour and the other experienced midwife who has intimate knowledge of the OP and her pregnancy. The OP's midwife group includes doulas but she was taking her midwife's advice.

I haemorrhaged and then had a retained placenta after my 3rd child was born, the birth took an hour, the previous two each took nearly 24. I would have died if I was not at hospital,and I was a lot younger than you are. That midwife consultant will have seen still born babies and mothers dying in childbirth, 45 is old to have a baby and the risks are higher. Go to hospital, it is just not worth the risk.

What ever your thoughts about this woman, please remember, babies die, more often than we would like to know. That should be the basis of your thinking, nothing else. Even a less than perfect experience and a live baby is better than losing your child

I cannot understand how anyone can knowingly and willingly put their baby at increased risk.

This assumes the risk is all in one direction. Unnecessary intervention can increase risks to both the mother and the child.

If the hospital midwife had said "at your age we consider induction and would have concerns about going over 40 weeks so we should discuss that" or "at your age we recommend tighter monitoring once you get to 38 weeks" that would be the basis for a discussion.

Telling the OP she must be induced at 38 weeks because populations statistics bear it out, without considering the individual patient is bad medicine. Its not even evidence based as far as I can see - stats point more to close monitoring to consider for induction fom 39 weeks. (policy in my area is to monitor closely from 38/39 weeks and discuss induction at 40 weeks)

So different experts have different views - that is as good a reason as any not to deny treatment to a woman who isn't happy with the first opinion she is given (as advocated by some PP)