Appalling antenatal care citing covid

[DueOct21]

I'm 20 weeks pregnant and due in October. My last birth 2 years ago was both physically and mentally traumatic, long story short I almost died.

Aside the psychological trauma I sustained permanent birth injuries and for those reasons have opted for an elective cesarian this time.

My request was approved, I assume, as after expressing my wishes to my midwife a month or so later I received a hospital appointment to be seen by anaesthetic antenatal, 4 weeks before my due date.

My midwife also assured me she has referred me to be seen by a consultant to go over everything and discuss my last birth / this impending one and I would receive an appointment within a few weeks. Months later and I've heard nothing.

Ditto my request for a debrief to discuss my last birth. I was assured I could have one and they'd be in touch well before now. I haven't heard a peep.

This afternoon I received a letter from the hospital informing me that my appointment with anaesthetic antenatal, mere weeks before i'm due, has been cancelled and changed for a fucking telephone appointment, because 'covid'

On top of all of that I'm also aware that anti E antibodies were detected in my bloods which puts baby at increased risk of HDN. No plans have been made to monitor the levels or have regular blood tests. I only found this out after a visit to the early pregnancy assessment unit at 10 weeks due to bleeding.

The only reason I was able to continue with this pregnancy was because I was reassured I would be well looked after throughout and have consultant lead care. I'm half way through now and feel totally abandoned.

AIBU to think this isn't acceptable, or am I being neurotic?

YANBU to expect good antenatal care. Whether it matter that your anaesthetic appointment is done over the phone I dont know, do they generally examine you at that appointment? If appropriate, phone consultations can be a lot easier than spending hours travelling to and sitting in a hospital corridor.

Regarding the debrief, that you should be offered. Raise it again and if no joy, raise it with PALS.

@BarbarianMum

YANBU to expect good antenatal care. Whether it matter that your anaesthetic appointment is done over the phone I dont know, do they generally examine you at that appointment? If appropriate, phone consultations can be a lot easier than spending hours travelling to and sitting in a hospital corridor.

Regarding the debrief, that you should be offered. Raise it again and if no joy, raise it with PALS.

I appreciate what you're saying, but it does matter to me.

After what happened last time, the thought of turning up for a serious operation without going over it in person in advance is terrifying.

I was assured I would be well prepared and well cared for and don't feel like that at all.

Then talk to them OP. At this point (low no.s of hospitalised COVID patients) "because COVID " shouldn't be a hard and fast rule. But, presuming you are unvaccinated, they are going to be nervous about bringing you into a medical environment unnecessarily as your pregnancy progresses. So you need to make it clear that, in your case, it is necessary.

There are lots of reasons why you would have an appointment with an anaesthetist - in many trusts you would need to see/ have video or telephone appointment with a Consultant to discuss your birth plan for a section . I would check this with your midwife / hospital .

@BarbarianMum

Then talk to them OP. At this point (low no.s of hospitalised COVID patients) "because COVID " shouldn't be a hard and fast rule. But, presuming you are unvaccinated, they are going to be nervous about bringing you into a medical environment unnecessarily as your pregnancy progresses. So you need to make it clear that, in your case, it is necessary.

Thank you, I'm going to call them in a minute and see whether I get anywhere.

I wanted to see what the consensus was before making a nuisance of myself, it's hard to be objective when it's such a worrying time for me.

Contact your PALS service at the hospital and complain. In terms of the anaesthetic appointment, I had one with my previous pregnancy and it was soooooo pointless that they made me go to the hospital for that. It was just a chat through how it all works. I understand you might feel differently but they may just be changing appointments over to phone appointments where appropriate because it just makes sense sometimes. If you want an in person appointment I'd mention it to PALS but honestly for that specific type of appointment I'd much rather have had a phone call!

Go ahead abd have the have anaesthesia appt by phone, I guarantee they'll ask you all the same questions before they put the needle in, just in case anything has changed.

Good luck!

Could I have misinterpreted the purpose of the aesthetic appointment?

I've had two natural deliveries and didn't require such an appointment during either pregnancy. I assumed that due to me requesting a section this time, the aesthetic appointment was an important part of preparing me for that?

No joy on the telephone I'll have to try again Monday.

@DueOct21

I'm 20 weeks pregnant and due in October. My last birth 2 years ago was both physically and mentally traumatic, long story short I almost died.

Aside the psychological trauma I sustained permanent birth injuries and for those reasons have opted for an elective cesarian this time.

My request was approved, I assume, as after expressing my wishes to my midwife a month or so later I received a hospital appointment to be seen by anaesthetic antenatal, 4 weeks before my due date.

My midwife also assured me she has referred me to be seen by a consultant to go over everything and discuss my last birth / this impending one and I would receive an appointment within a few weeks. Months later and I've heard nothing.

Ditto my request for a debrief to discuss my last birth. I was assured I could have one and they'd be in touch well before now. I haven't heard a peep.

This afternoon I received a letter from the hospital informing me that my appointment with anaesthetic antenatal, mere weeks before i'm due, has been cancelled and changed for a fucking telephone appointment, because 'covid'

On top of all of that I'm also aware that anti E antibodies were detected in my bloods which puts baby at increased risk of HDN. No plans have been made to monitor the levels or have regular blood tests. I only found this out after a visit to the early pregnancy assessment unit at 10 weeks due to bleeding.

The only reason I was able to continue with this pregnancy was because I was reassured I would be well looked after throughout and have consultant lead care. I'm half way through now and feel totally abandoned.

AIBU to think this isn't acceptable, or am I being neurotic?

The anaesthetic antenatal is just so they can meet you and discuss your history and make sure they have any clotting disorders / preclampsia / obesity recorded so they can refer you on if required. If you’re having an elective c-section I assume you’re healthy and so that’s why they are giving you a telephone appointment.

If you have E antibodies then there is no treatment that can be offered to you. All they will do is offer you more frequent scans from 28-30 weeks to keep an eye on things; but that’s so they can (usually) offer you a c-section at 36-40 weeks any way. If you already have one planned in that time frame then I’m not sure there’s much more they could do for you. This is why it’s important for women to know their rhesus status before they start ttc, so they can get injections as soon as there’s a confirmed pregnancy. But too many GPs don’t even offer blood typing it’s so frustrating.

Thank you Ozanj that's very helpful.

I've spoken to a couple of ladies who also had anti E and was told by one that routine blood tests to monitor the titre(?) levels was standard, so the absence of such a plan worried me a bit.

I'm otherwise healthy but do have a history of quite severe hemmorages, both post partum and post operative after unrelated surgery in the past.

I understand that you are worried.

But I don’t see any difference between the anaesthesia appointment over the phone and in person. They wouldn’t physically examine you. It’s simply a case of explaining what will happen, ask about allergies and if you have had a bad reaction to anaesthesia in the past. In fact not having to travel to hospital and being able to talk without a mask on should make the conversation much better all round.

I'm blood type O+ and the anti E is suspected to have come from a blood transfusion that I had after the birth of my youngest child.

@Dishwashersaurous

I understand that you are worried.

But I don’t see any difference between the anaesthesia appointment over the phone and in person. They wouldn’t physically examine you. It’s simply a case of explaining what will happen, ask about allergies and if you have had a bad reaction to anaesthesia in the past. In fact not having to travel to hospital and being able to talk without a mask on should make the conversation much better all round.

Thank you, I feel a little less OTT than I did after posting. I'm just that anxious for everything to go smoothly this time. I know there can be no guarantees but I felt that having good comms and contact with the people handling my care would alleviate some of those worries.

To be honest I'm a bit sick of telephone appointments after having no end of them over the past year

The anesthetist will also go through things like allergies, spinal surgery or issues which could affect an epidural, medical issues, problems getting cannulas in, previous reactions to anesthetics, any issues opening your mouth fully, any dental issues like crowns etc. Other than possibly getting you to open your mouth to see how wide you can open it, it doesn't involve a physical examination.

I know that telephone appointments seem more impersonal but they are not.

Plus you don’t have to sit in a waiting room or pay a fortune for parking

@Elouera

The anesthetist will also go through things like allergies, spinal surgery or issues which could affect an epidural, medical issues, problems getting cannulas in, previous reactions to anesthetics, any issues opening your mouth fully, any dental issues like crowns etc. Other than possibly getting you to open your mouth to see how wide you can open it, it doesn't involve a physical examination.

Ah.. now that could be an issue as I do have a condition that does restrict jaw movement. TMD.

@Dishwashersaurous

I know that telephone appointments seem more impersonal but they are not.

Plus you don’t have to sit in a waiting room or pay a fortune for parking

Good point

I had an Elective back in January.
I didn't have any face to face appointments with anyone except my midwife due to Covid.
If they really need to see you... they will.
I hadn't met any of the section team until I turned up on the day. Its REALLY routine. They do loads and loads of them. Also, being elective can be a lot more controlled.
Good luck!

I had preeclampsia and have been consultant lead in my last two pregnancies.

If I remember correctly I started seeing the consultant in the last 26 weeks but it ramped it considerably in the last ten weeks. In my last pregnancy he made all the desisions and even stopped my discharge two days after giving birth. Not everyones cup of tea but I did feel safer letting him make most of the desisions. I had been readmitted after going home multiple times before.

Your not making a fuss here. Your potentially saving your and baby's life. Its important that you have a consultant eyeball your case notes and heath. I kind of remember that might have started st 16 weeks but it went quite until later on.

I think you should expect to be seeing a consultant by now even if they just park you afterwards for a later date after taking your history.

@Wantabub

I had an Elective back in January. I didn't have any face to face appointments with anyone except my midwife due to Covid. If they really need to see you... they will. I hadn't met any of the section team until I turned up on the day. Its REALLY routine. They do loads and loads of them. Also, being elective can be a lot more controlled. Good luck!

Thank you, I'm glad yours went well.

I was clearly naive in thinking I'd be seen and closely monitored more than I have been. If I'd have known this was the reality I would have been reluctant to continue the pregnancy.

@Legoandloldolls

I had preeclampsia and have been consultant lead in my last two pregnancies.

If I remember correctly I started seeing the consultant in the last 26 weeks but it ramped it considerably in the last ten weeks. In my last pregnancy he made all the desisions and even stopped my discharge two days after giving birth. Not everyones cup of tea but I did feel safer letting him make most of the desisions. I had been readmitted after going home multiple times before.

Your not making a fuss here. Your potentially saving your and baby's life. Its important that you have a consultant eyeball your case notes and heath. I kind of remember that might have started st 16 weeks but it went quite until later on.

I think you should expect to be seeing a consultant by now even if they just park you afterwards for a later date after taking your history.

Thank you for this.

I don't always trust my own judgement when it comes to this pregnancy. I just know that what I was promised and what I've had so far are two very different things.

I don't even have an appointed consultant that I'm aware of so don't have anybody to chase up other than my midwife who assures me she's made all the nessecary referrals and asked that I be seen.

I think that the main issue is your expectation of what 'you will be looked after and paid close attention ' meant, and what the reality is going to be.

In your head you expected fa e to face regular appointment from early on.

But the reality is that, almost irrespective of other factors, almost everyone is not really engaged with until much later in pregnancy. You are only 20 weeks.

You have a midwife. You have an agreed c section, and you have an anaesthetic appointment. The reality is that you are highly unlikely to ever meet the team doing the c section until the actual day.

Ante natal care at the moment is dreadful. I had dc3 in June, and have a history of complications and a condition that needed close monitoring. My first baby was stillborn because of this (then unknown) condition. Dd1 was born prematurely, again because of this condition.

During covid most of my appointments were cancelled, nothing was monitored and I was treated appalingly. When ds1 was born, all previous history and notes were ignored, my condition escalated and the previous complication occurred again, and its solely by the grace of God that me and ds survived. Its sheer luck that there hasn't been more tragedies.

I also would like to add that I do not blame the doctors and nurse and other health care staff- these failings are due to bad organising, shortages, funding cuts and bad management during covid that left the delivery unit at my local hospital dangerously understaffed on the night my ds was born.

Pre-covid I had an ELCS - I was told I'd have the anesthetic team due to a previous adverse reaction and ended up speaking to them the morning of my op! I saw the consultant at 36 w and didn't get my c section date until 7 days before it happened (it happened at 39+3). I'm always amazed at how little antenatal and postnatal care there is and I totally appreciate it's even worse now due to the pandemic (I'm pregnant again now!). Keep pushing, keep asking questions and keep chasing stuff up - hopefully it all comes right in the end. Wishing you a healthy pregnancy and delivery

Re your anti bodies I would check their plan in case you need blood transfusion as they will need to ensure cross matched blood is available .