To expect continuity and possibly quality of antenatal care in central London?

[merryberry]

This AIBU is a lot about letting of steam and organsing my thoughts, but if you can make it through this endless post, I would really appreciate your thoughts.

I am 27 weeks pg with dc2. Having just had a poor experience for the nth time at the hands of the NHS. What do you think I might expect/request for the rest of my pregnancy? I have a meeting on Friday with the relevant head of midwifery where I can discuss these concerns.

Problem: shared care between hospital and GP when the relevant professionals NEVER see each other. And where I am asked not to have bloods done at my local GP but go into hospital as the results will get lost otherwise. What's the point? Am I just a burden they are splitting the cost of, or is this supposed to help me someway?

Problem: seeing a midwife in the hospital where I'd like to give birth. I saw one when I was booked, who was working out her notice and didn't know who I would see next (not specifically who, actually which team of midwives). My next appointment with hospital midwives is actually the head of midwifery as she controls access to the midwife led birth centre I'd like to go to. I carefully booked the date months in advance for Thursday pm when I could get childcare, so I could concentrate on the meeting. It's recently been changed to Friday lunchtime when I can't get care, and I couldn't rebook to another date before Xmas. I'm going anyway with ds1 in tow and fingers crossed I can avoid crying in front of him. Am I just being airyfairy to attempt appointments that work around my life, or should I expect my life to work around the appointments?

Problem: seeing a midwife in the community. I can't. I live in the hospital's catchment area, but not the community midwives for the hospital. Anyone heard of this before? Can it be right?

Problem: seeing my GP for antenatal care. He's nice in that space-cadet overworked fashion medics often are, but every time I see him he asks me why I'm not seeing a midwife. (Answer, because you told me I can't). When I last tried to see him for my 22 week appt, I called 10 days in advance of week 22 but couldn't get an appointment for 5 weeks (ie 25 weeks PG). Wonderfully, he called back and said that it was up to me whether I bothered to see someone else at the surgery, he personally thinks that the 22 week check is mainly meaningless and I could save my effort for the 28 week check. So I didn't bother, especially given I'd just had in-patient care at 20 weeks and knew everything relevant was fine (bloods, BP, fetal heartbeat). Was that irresponsible? I was given the impression today by my endocrine consultant that that was a flaky choice/advice.

Problem: conveyor belt care that doesn't work, part 1. Today I had this endocrinolgy consult (every couple of months these happen). I attend a mixed antenatal clinic where there are 30-40 other women waiting for a variety of services. My notes got lost in the melee, after 1.5 hours I politely asked to reschedule as I had to leave, and was there any chance of just doing my bloods before I left? I was treated as if I was absconding from high security by the HCAs, whipped into see the consultant 10 minutes later and told I looked stressed by her! Cue tears and 'I don't trust the NHS, this is not your problem but I can't stand it anymore' breakdown from me. Did a bit of our consult (no blood test for thyroid function, no time). Couldn't stop leaky eye crying all the way home on the sodding bus. Anyway, is this par for the course, or is it worth a complaint/suggestion letter??

Problem: conveyor belt care that doesn't work, part 2. I was in the neighbouring hospital as emergency admission at 20 weeks when an ovarian cyst popped painfully. I was misdiagnosed with D&V despite lack of D or V, had to argue with 3 people for antibiotics (which worked) and was not given an ultrasound during a 60 hour admission (Sat-Mon). Neither were the two suspected ectopic pregnancies over the ward able to have ultrasounds during that time. I got a scan on the Wednesday from my main hospital: was actually my 20 week scan and the sonographer had a look for me and pointed out the remants of the popped cyst. The fact there was no ultrasound at the weekend for a major teaching hospital with a large maternity unit still leaves me blinking. Any thoughts about this?

Is this all fragmented shite that I should agitate about, on my behalf for now, and later on others behalfs? Or should I gird my loins, get over myself, wax my stiff upper lip etc? I think I am being reasonable when I judge it all - the sweet suffering overburdened individual staff members excluded - a steaming pile of shite.

Some important context:

I enjoyed my last labour despite the fact it was poorly managed by A.N.Other central London hospital - I'm not going back there. They dehydrated me, screwed up a simple induction and discharged DS with severe jaundice. He was readmitted to my current choice of hospital 12 hours later into NICU for 8 days. Guess what I'm saying is - 'aw, but you have a healthy baby' is not a cop out for poor care. I didn't have a healthy baby last time round.

I've only recently stopped working clinically, scientifically and managerially for the NHS after 20 years, and again probably know way too much about how it (doesn't) work.

Thank you for reading all this. War and Peace it ain't.

excellent link

I could write a thousand words on the bad care I feel I suffered whilst pregnant and after giving birth- I'm in London too. It was so upsetting the lack of continuity and lack of info that I did get all tearful at one midwife appt. and was told i should consider counselling!!! She then tried to give me details of counsellors- I wasn't depressed I was totally upset at the lack of care i was receiving! I thought that was so obnoxious. I too saw a different midwife each appt, plus a midwife I had never met was there for the birth. Lots of other stuff I could go on about, but it's so miserable i don't even want to think about it. It was 2 years ago but I wish i had been outside of London. Anyone got recommendations for where we should all move to next time we're up the duff?! I want to get out of London for lots of reasons anyway.

Jetson sad reading your experience,really should have been happy time for all of us. like you i did not see the same mw twice, so constantly felt had to explain self to each unfamiliar disinterested MW.

where is better? - genuinely i dont know maybe some one will elaborate for us

The ante-natal care at the Royal London (where I am being seen)is a complete shambles. The disorganisation and time wasting is incredible. I am not going to get into a full on whinge, and the catalogue of incompetence I have experienced so far as I could be here all night! But just to give a taster, my last appointment was to see a doctor. 4 hours after my appointment time, I was told that all the doctors had gone.......I have to admit I did get a little bit weepy at this stage. Anyway I now have the clinic manager/ head of midwifery 's mobile phone number. Next time I go in I will be calling her to meet up and go through my LIST of issues!

upsidedowncake thanks for the info I will definitely have a good read of it!

had mine at RF - shambolic antenatal care. Do complain - i did, face to face and written complaint too. hope your pg proceeds well

merryberry, how funny - I left at just about bang on 9.40, so we were probably ships that passed in the ante-natal clinic ... the catchment area thing is infuriating, isn't it? Seems completely nonsensical. I have the telephone number of the community midwife, though, so am planning to call her directly - can email it to you if that would be useful? I find that as I have no idea what to expect I'm substantially less shocked by the general crapness than my mother, who is tracking progress from about 200 miles away - we have sunday night phonecalls which generally involve her saying "it's been HOW long since your last appointment? what do you mean no one's weighed you? WHY don't you know whether you need to see your GP or not? In my day ... "

ps - the only good thing about my visit this morning was hearing an advert on that pregnancy tv thing they have on in the background for "Talking Tummies, the new pregnancy podcast ... " Couldn't decide whether to cry with laughter or just cry ... My tummy also juggles and does tricks, as it happens. We are planning to run away together and join the circus.

merryberry! so sorry you are having shit time, hope these posts are helping. i am having similar themes (destablized by shared care, feel like no one is in charge, no community midwives in my catchment area, lost blood results - hospital fault btw - etc) but bc pg is running quite smoothly, no actual crisis/confrontations. i agree with others that your mounting occurences of NHS incompetence are cause for complaint. they are much beyond my just generally loose care. in the same catchment area.

here's my saving grace - my gp is actually quite good. i saw the midwife at you know where at 7 weeks and she was a complete drip. i go back this week at 28 weeks but of course i will see someone different, which sad to say i am not particularly upset about. in between the two i've had 3 gp visits (16, 20 and 24). he's very unconnected to what's happening over at the hospital but he appears to care and recognize me when i walk in which gives me a small sense of continuity and the two complicated questions i had, he was very professional and prompt about calling the relevant specialists, getting the answer and channeling it back to me.

because i know where you live :.) (for others who think i am weird stalker, i have met mb face to face!), you are in my catchement area and maybe you could switch for final weeks? also think you need a doula (as do I, must get on this!!!) as you are likely going to be wanting an advocate given your experience to date.

another random suggestion. tonight i attended a workshop given by janet balaskas (birth guru in north london). was very good class (gave reassurance for some reason even though i'll never see her again - just someone who cared was novel concept and very affirming) but anyways, she gave the class the name of a private dr who will do second opinions on whatever crap the nhs is selling you. dr. gibb on harley st, can't remember his first name, maybe donald. she said his consult fee is 120 plus any tests so for a few hundred quid maybe you could see him, get some reassurance and get any pressing bloodwork, etc done. jb said he is usually used by nhs women to get a second opinion when they want to resist induction (which our beloved hospital also does) but worth a call to see if he would see you at this earlier stage.

keep us updated!!

cheers mm, and all pthers. am up at daft hour as cough is back. COUGH COUGH COUGH.

marchmum: i cannot believe you live outside the catchment area for the comunity midwives! where the hell is there area? I mean you could aprobably spit from your house and hit the hospital...

pardon typo, coughing att 0430, yknow

Had same problem...london and abysmal care. For my first pregnancy I never saw the same midwife twice through either my pregnancy or my 40 hour labor followed by emergency cs (the necessity for which i blame squarely on nhs and poor care). 2nd time around I sort of got the hang of how to deal with them. I was dumped by my gp at 6 months pregnant and because of gp shortage in my area got awful idiot gp. I was in wrong postcode for midwife led hospital care. But i told midwife that I refused to go to gp as she was useless and that I woudl just do the half of the appointments at th hospital....amazing how quickly they foudn space for me in the midwife program. Then at 20 weeks had awful visit with consultant at hospital who told me i was stupid and made me cry. I marched out of there, went to natural birth floor and insisted on seeing head midwife who was wonderful and she took over my care and i had a successful vbac and never saw consultant or muliple midwives again. I would highly recommend going to Queen charlottes and asking to speak to Debbi gould (if she's still there) and asking her to deliver you. I was 39 when I gave birth to my second and was really pleased with her care. I ended up having post partum haemmorage, so was really glad to be in hospital as i had to be rushed up to theatre (only 1 floor away from natural birth floor). But at least was able to give birth on mats on floor in down dog position. And had my dd put straight on my breast afterwards (i was so blissful, i didn't even realize i was bleeding to death at the time).

sofiames: i think i will probably need to do some voting with my feet in future as well. good on you for doing it. will be thinking of you when i ineveitably copy some aspect of this.

gp - who is good to me but out of it when it comes to the whole system - said something bc i am so close to multiple nhs services and it's an urban area, that there are no community midwives for this area. think they are assigned to the more residential areas to the north. but then you said they were'nt up where you are either? they're phantom, clearly.

will ask on friday for us. sounds like they cover somers town, stop at camden sainsbury's and thumb their noses over at primrose hill...

I am so sorry that you've all had such crappy experiences. I just wanted to add that it can be done differently.

The central London borough in which I live has fostered a considerable number of group midwifery practices, who cover both hospital and home births. As such, you don't have to commit to hospital/HB until a later stage in your pregnancy. I was seen by a team of 5 midwives, all of who made sure they got acquainted with me well before my due date. This groups covered 3 GP practices, running clinics at each of the surgeries, and other GP practices locally had the same access to other group practices.

My borough is as deprived and financially strapped as any other, so if one can manage to provide continuity of care, why can't the others?

merryberry, happy to tell you where and how much the private care cost, plus my consultants details. Can you cat me if you are interested? Or let me have your email...

...and south of the park. That sounds like the area that my gp explained to me. Fyi, am going for my 28 week at the MW tomorrow, v.interested to see what happens if anything useful. Will report back when I see you tomorrow night.

When I did checking in at private costs it of course varied as to procedure - terribly hard to budget for even if you have some wiggle room. The highest I heard was £15000 at the portland, that was a caesearan and 6 day stay over. lowest, £4000 at lindo, was for a ventouse and 2 night stay over. we came to the conclusion that we needed a minimum of £5K (most places ask for a £4K deposit), had to reserve at least £8K and be prepared to make up to £15K available. As you know, we opted back out to the nhs, harder for me to justify given routine pg and annoying but still meeting minimum standards care :.) I still worry some days that we made the wrong decision.

About £6k at John's & Lizzie's but they get booked up early so probably not an option. I don't give a damn that i'll be paying off private care until dc is 35 (well, I do...but) it was a fabulous experience.

Having said that, I had crap ante-natal care with dc3 and fast NHS birth. Chances are it'll be ok and, once it's over, you'll forget about all the irritations and be £6k up.

If you can find an independent midwife (circa £2-3k) you'd probably be very happy and reasssured.

ah will be interesting to hear what the 28 week appt is like, marchmum. i heard a report at my last antenatal class that the birth centre accept independent midwives. of course, like the doulas, they are usually well booked in advance, but that is sdomething i'm asking about on friday.

yes, those are the prices i know of too (thanks for the offer orangina, but we won't do private inpatient as we can only cover low end of the range).

anyway, mostly have my fingers in my ears about it all today as i can't worry about it. am just continuing to try and arrange cover so i can go alone.

merryberry, even if the hospital/midwife led centre you go to doesn't accept IM's they can be very reassuring to have when you are in labour.

they may not be able to deliver you, but they will fight your corner and cut through any bureaucratic or medical bullshit that you may face.

they'll recognise when something is being done because of shift or bureaucratic reasons rather your/your babies health.

you may have more luck finding someone late in your pregnancy. After moving area and finding it impossible to get ante-natal appts, I booked with an IM at about 30 weeks. She was terrific. I had long, leisurely and frequent consultations over coffee on my sofa (no lugging 2 small kids to GP's surgery), unlimited phone and text support, and the full attention of an extremely experienced m/w.

Definitely worth looking into it, if for only one reason: it takes all the stress out of the situation...and you sound very stressed. heck, you may even decide on a home birth, ha, ha!

mb, if you are absolutely stuck on cover, i could go with you and wait in waiting room with vincent...don't know if you/he comfortable with that but thought i'd offer!

oh wow that is lovely of you! at present i have two mates offering services if they get out of court (no she's not a crim) etc.

anyway see you tomorrow and think it trhough more (as long as chest doesn't get worse i'm coming along). good luck with appt. xx

I had the exact same experience with my pg last year (was high risk as it was my fourth pg and first live birth...) but I never saw a consultant and usually didn't even see a midwife, just HCAs.

Had the same endocrinology issue as you exactly.

Also came into contact with chickenpox during pg and got tested to see if I had been exposed. Called the hospital about 30 times for the results - never heard anything. Eventually gave up. Daughter is now 13mo.

Shared care was chaotic. My GP's doppler was broken for the entire duration of my pregnancy so the five or so visits that I made to the GP were all completely pointless. He had no idea that I had been diagnosed as hypothyroid, borderline GD and high risk pg.

I was at UCH. Not read the thread in detail enough to work out where you are, sorry. But I desperately wanted someone to take charge of my pg and my care so I shipped out and went private - the Landsdell at St Thomas's. The best 10k I ever spent (had a cs so longish stay). I should not have to type those words but I so recognise where you are right now. It was at about this point that I thought "You know what, I don't trust these muppets with my life and my baby's life - I'm getting out".

If this is not an option for you, the letter route is the way to go.

Just read again and I think you are also at EGA? So sad that things are just the same and it wasn't just a one-off.

I hear about people talking to "their midwife" and making a note to "ask her about X next time I see her" and it sounds like a dream world. I literally never saw the same person twice. And that's all it would have taken to make me feel ok actually. Just one person to have an idea who I was and what my history was.

for you.

yes margo, EGA. I really agree, all it takes is a feeling that someone is taking a bit of care, and it's the one thing that it seems just can't be provided

I am so glad you got great care at tommy's, and have your daughter after so many struggles. Thank you for telling me about your experience.

My meeting is tomorrow. I have a rnage of things to talk about, but now fixed plan still. That is probably because I've had to deal with this chest infection in the meantime - one thing at a time!