Unhappy with NHS pregnancy care...traumatic read for some

[WatchingWithDisinterest]

Spoke to a consultant for the first time today in this new pregnancy.

She's said I can't have a cervical stitch by cesarean section, but they 'may consider it if this pregnancy doesn't work out either'!

She said they'd happily consider a normal cervical stitch though and a consultantion appointment to say yes or no to one has been arranged for next week so they can put plans in place

It feels like my baby's life is just a gamble to them, and they're happy to risk 'this one' but will act more strongly 'next time'.

I'm so very sad by this. I lost my baby girl in October at 17.5 weeks. Countless miscarriages beforehand, all reaching at least 9 weeks with a confirmed heartbeat a week before, so each time I've seen a fetus. It's beyond exhausting and traumatic. A cervical stitch only offered after the 18 week loss.

I have a son and his pregnancy was normal.

I'll just add too that I'm the biggest advocate for pregnancy choices and fully support abortion at the limit for social reasons. But I also believe the language and approache you use must be different for each pregnancy and woman as circumstances surrounding the issue are different and language needs to be appropriate and considerate

Sorry op I don't understand about the different stitches, but didn't wanna read and run. Could you speak to PALS if you feel you're not getting the right choices for you and your baby?

Thanks Sleeping. Basically the better one out of the two is more secure and has to be removed by c section

The other one is just a small stitch on the outside of the cervix and is removed around 37 weeks. Not as effective

Have you seen this support group. They can provide you with a list of obstetricians who carry out this procedure. (I think you may need to be referred to someone who specialises in this procedure) www.facebook.com/groups/UKTACsupport

Could you ask to see a different consultant?

Ask for a second opinion. Shout loudly about it (not literally) but don't take no for an answer. Really insist.
Keep bothering them about it. Research the different options as much as possible, including their outcomes so you're armed with facts.

I’m really sorry about your baby girl, miscarriages and what you have been through.

I agree about contacting PALS. Otherwise is changing hospitals or a different consultant possible? Where are you based? Can Tommy’s help as they have some antenatal care available and you can email them.

I had lots of concerns in one of my pregnancies which were dismissed. Then my daughter died neonatally and the change in care for my next pregnancy was massive, but it shouldn’t be given because an earlier baby has died. It’s not fair.

I think the criteria for a TAC is different to a normal stitch.

If it gives you hope OP, I lost my firstborn at 20 weeks. Then went on to have two healthy full term babies, both with cervical stitch.

I'm not a doctor, but my understanding was that the abdominal stitch was only done if a previous cervical stitch hadn't worked, i.e. that's not the NHS or your particular consultant being difficult, it's NICE guidelines. I think it's because the abdominal stitch is a much more invasive procedure and higher risk. It's also recommended that it's put in before you get pregnant, or really early in the pregnancy. You may already be too far along for it to be feasible.

I do feel for you, and maybe they're not expressing themselves too well if it comes across as though each pregnancy is just a risk worth taking to them. But abdominal stitches are really really rare and if you haven't had the cervical stitch (and progesterone treatment and high level monitoring) before then they would be the normal treatment.

I feel very sorry for you going through this, but I don't think the consultant appears to be doing anything out of line, it sounds like they're following best practice. By all means seek extra reassurance from a second opinion if it would help though.

What was the reason given why you lost your daughter at 17 weeks? If it wasn't for cervical issues then I can see why they wouldn't contemplate offering even a normal cervical stitch.

What @fink says!

If it wasn't for cervical issues then I can see why they wouldn't contemplate offering even a normal cervical stitch

Quick look online suggests it's offered even if they have no idea why you had a late miscarriage or very prem birth. But anyway it was announced to me when it was confirmed my waters had gone that a stitch would help need time

Hi OP, firstly, that's so tough and I'm really sorry to hear about your losses. I had to change hospitals due to issues with care at the first hospital. It was for a different reason, but you are perfectly within reason to phone other maternity units in the area and explain the situation, then book in with them if they are willing to do the stitch. I think it's a good idea, as hospitals and different doctors are likely to have different views on whether they would or wouldn't. It also might give you some peace of mind if you're feeling listened to and cared for by the staff you're working with.

but you are perfectly within reason to phone other maternity units in the area and explain the situation, then book in with them if they are willing to do the stitch.

I'm sorry, but this is just nonsense. A transabdominal stitch is a very specialised procedure. Only a handful of doctors are trained in it, so it doesn't matter what maternity unit you call, if you were referred for the abdominal stitch it would most likely be with the one and only specialist in the area who could perform it. They're not hanging around in every hospital and maternity unit.

And, I repeat, it would be very very very unusual to offer the abdominal stitch unless the cervical stitch had already been tried. The only case I know of when it might be done is if there were very extensive damage to the cervix.

I'm sorry, OP, but people giving you false hope that an abdominal stitch might be possible if you just ask around enough is not going to help. The advice you have received from your consultant, although possibly poorly expressed, is in line with best practice, and particularly in not subjecting you to major surgery without exhausting other options first. You are unlikely to get a different answer from any other doctor.

FWIW, OP, I know of someone who had two full-term pregnancies with cervical stitches after two approx 20-week losses.

It sounds as if the consultant may have expressed herself less than ideally, but I think PPs are right.

I am sorry for your losses.

I have had a previous pre term labour at 23 weeks. My research (and what I got from the hospital) suggested that the best approach for this pregnacy (woth a MMC in between) was monitoring cervical length every 2 weeks, with fetal fibronectin as soon as available and the a stitch only if required. From my review, the abdominal stitch is generally a worse option that the normal one. I am now 30 weeks and didn't end up needing a stitch.

Obviously not judging your own circumstances and needs, and the doctors comments were unacceptable, but just wanted to highlight that there may be different positive options.

Second what @fink says. Just to add, you could ask about progesterone also if you have cervical incompetency (horrible phrase I know) or other cervical issues. I was offered the cervical cerclage and/ or progesterone and got to 34 weeks on progesterone. As far as I know the cervical version has good success rates, so I wouldn't discount it. There are some threads on here (the short cervix club being one) which might offer some more experiences of those who have had a stitch put in or similar issues to you. Sorry for your loss

I am also on progesterone to 34 weeks.

@Fink, apologies, I wasn’t aware of how few there were specifically. I transferred for different reasons, but did transfer due to disagreement in care down to procedure/policy being different in different places. The two hospitals were very different in policy, but it took me a long time to find one who would give the care needed. I wasn’t aware it was possible to transfer care at all at the time, which was why I mentioned it here as it would have saved us a lot of problems if we’d known this was possible sooner. I wasn’t trying to mislead the OP at all or give false hope.

@MagpieSong no need to apologise to me, but thank you. The false hope bit wasn't specifically aimed at you, there were a few previous posts along the same lines, and I just feel that, although they are very well meaning, they don't seem to understand the issues surrounding this specific procedure.

Sorry to hear that OP Can you not pay privately to have the stitch? Terrible that they are happy to risk this pregnancy!

Op I’m really sorry to hear you have suffered so many sad losses of your babies. I have also experienced pregnancy loss and can understand exactly what you mean about language and approach.

Sadly medical staff are not given enough training on what to say to women experiencing pregnancy loss or with a history of it. I had a serious complaint upheld around inappropriate language so I totally sympathise.

I think you need to ask for a second opinion. See a consultant and get a clearer explanation of the options.

I will be thinking of you and hoping that if the normal stitch is what is deemed clinically appropriate that your baby will be born healthy at term

Would you consider the cervical stitch if applicable?

I’m sorry for all your losses.