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?

In my last pregnancy I did see my named consultant at every visit and on the ward post birth.

But with the pregnancy before that it was a few registrars who popped back and forth to the consultants office with questions or who phoned him when I was admitted into the pre natal ward.

It's not so much seeing the same dr face to face, it's the reassurance that one person is consistently coordinating care. So that you dont have many people saying different things.

For example in my past two births I didnt have anyone refuse me a epidural when I had given birth with no pain relief before. Epidurals lower your blood pressure and it was important to me as my BP was very unstable in labour.

Probably for you it's more reassurance that your choices are validated and recorded so you dont have it poo poo'ed at the last minute.

That really takes very little time or resource compared to, in my case, being in hospital for 14 days pre birth, five professionals being called into the room during pushing, a week plus stay after giving birth only to be readmitted for a further week.

If you can avoid all that and the stress why not? Consultant lead is mostly about one person deciding on a plan with you that others then follow.

There is no harm in chasing up or querying why it's not be done yet. In my case it would have been pointless seeing the consultant by say 30 weeks as when I did have pre eclampsia my placenta had already started to die off by then. It had 50% failed by 35 weeks.

Can you afford a private consultant? I had my baby 4 weeks ago privately because I was appalled at the lack of care / continuity provided by the NHS with DC1 and had an appointment every month until 35 weeks and then weekly appointments thereafter. Scan at every appointment, consultant available to text between appointments. I felt well cared for and supported to have a textbook VBAC. Just a thought?

We are doing a lot of anaesthetic assessments remotely now, for lots of patients it helps as means they don’t have an additional trip into hospital. You will be seen on the day of your section in person by the anaesthetist doing it who might not be who you see/talk to in an earlier appointment anyway. If there are any major issues flagged that will mean more is done if that reassures you at all.

I am consultant led this pregnancy and have had 3 consultant appointments between 20 and 33 weeks (no.more planned after that). All by phone, none with the actual consultant, just junior staff, all of whom gave quite different advice. Not that helpful really. I was originally told I would have more regular midwife checks towards the end but they have not materialised. I think that you can't expect too much on the NHS. Certainly hardly anyone gets a single named consultant. And consultant led still means midwives do nearly all of your actual care, following their protocols, and consultant gets asked if any issues arise. But they should provide an opportunity to discuss birth plan well before 36 weeks, whether with consultant or senior midwife. I would try and chase that up.

I think @Dishwashersaurous nailed it, there's a difference between expectations and the reality of the care you are getting.

In my local trust you wouldn't get an anaesthetist appointment just for having an ELCS, only if you have anything which would make a spinal/epidural/intubation difficult. They are doing most of these appointments over the phone as pp have said.

With respect to the antibodies- you should generally be offered repeat grouping at 28 weeks anyway. In my Trust we would take 2 samples so if one needed to be sent to a different lab for titration then it doesn't mean another blood test. Before your section you usually have pre-op bloods- including a grouping- and MRSA swabs done. This is so they can cross match for the CS.

Also usual not to get an ELCS signed off and booked til 36 weeks here so to have one booked by 20 weeks is reassuring!

Also remember that in second pregnancies the NICE schedule for midwife appointments is a lot less frequent- 16 weeks and then 28 weeks. This is irrespective of Covid. However there is always somewhere to get advice if needed.

I would contact your midwife to ask about the debrief appointment, sooner rather than later would always be better!

I hope this pregnancy and birth goes much smoother this time

You're 20 weeks.

Totally normal for the rest of your appointments to be this far on. Your routine mw appointments should be as per nice guidance, pg 7 if you have green national notes.

Thank you all for replying and the helpful info.

The main gripe I have, and why I seem to be expecting more than I'm due, is purely because I've been told I'll get these appointments through "within a few weeks" of midwife sending off the referrals.

I promise I'm not entitled by nature, I was genuinely lead to believe that by this point I will have had a face to face appointment with a consultant and separate debrief to go over my previous birth.

IR

Second or subsequent baby, you'll probably have seven appointments. There will be the booking appointment, then you'll have checks at around 16, 28, 34, 36, 38 and 41 weeks.

I'd actually forgotten that you get less for subsequent babies.

Its worth checking again about the debrief as at some trusts they won't do them when younare actually pregnant,

Thanks Dish

I'll leave a message with my midwife about the debrief as it's her who made the referral for me.

also, generally the consultant appointment would be to decide if you were suitable for a c section. It seems that the consultant has agreed to that without needing to see you which is fantastic, but you should have been told that the appointment was no longer required.

Do you have an email address for the midwife, might be worth writing down specific questions for her

I'm guessing that from the hospital, midwife point of view everything is in hand and as it should be.

But from your perspective it all seems really unsure and unclear and scary. All of which you wanted to avoid .

I'm sorry for what happened to you. My local hospital failed it's recent CQC inspection that was brought forward due to internal whistleblowing and loads of money is going into increasing staffing and putting perspex screens to allow partners in. It was all blamed on the pandemic but I know that care was shocking in the two years before Covid too. I hope things improve. Make formal complaints if you're not happy. It's the only thing that leads to change.

I think you're spot on, Dish.

All is in order as far as they're concerned but I'm feeling uninformed and in the dark.

It does sound reassuring that they've seemingly approved the section with no fuss, I was told that should be the case given the complications with the last birth. Touch wood.

I'm going to check my notes now and see if there's an email address for the midwife.

Good luck. I know how scary it all is, and that it feels like you are just a small thing in the massive machine.

But , in this case it does actually sound like your midwife is doing good

@Flittingaboutagain

I'm sorry for what happened to you. My local hospital failed it's recent CQC inspection that was brought forward due to internal whistleblowing and loads of money is going into increasing staffing and putting perspex screens to allow partners in. It was all blamed on the pandemic but I know that care was shocking in the two years before Covid too. I hope things improve. Make formal complaints if you're not happy. It's the only thing that leads to change.

Thank you flitting.

I hope things improve with your local hospital, shoddy care citing pandemic isn't good enough.

It's strange because I can see a hospital based psychologist face to face for page management therapy for my chronic condition (different hospital) but can't have an aesthetic antenatal appointment in person.

Very bizarre.

YANBU, telephone appointments are rubbish compared to the real thing. I had a few very brief conversations with I’m not sure who exactly, I’m not sure they had even read my notes all they asked was do I wang to be booked in for a csection or not. I would have liked to discuss my individual risk. As it was I went into labour beforehand and it was terrifying as I wasn’t sure how risky it was.

I went into hospital to meet with the anaesthetist ahead of my elective section. After waiting 6 hours in a side room to be seen we gave up (this was pre covid!).

Presumably he was busy operating so it seems unlikely any of these appointments run to time as they can't schedule around emergencies so it may be that the phone appointment will save you a lot of waiting.

Hi OP,
I’m consultant led this time due to issues with previous birth, I had a telephone anaesthetic appointment and I think this is the way a lot of clinics like this are going to go to be honest as it felt incredibly helpful efficient and was exactly at the time I’d been told to expect the call. I also didn’t start to see my consultant until after my 28wk scan. Ultimately until you’re past 20 wks it’s still early stages. I am having an elective c next week and i feel really confident that it’s going to be a lot better than last time - my best advice is check your green notes to see exactly what’s been written and when you should have appointments, then call the maternity department and tell them you should have an appointment and get them to book it for you. I did this with a few of mine and preempted them so I felt like I was more in control of the process.