To say this pissed me off about my booking appointment ?

[chattycaterpillar]

I had a pregnancy booking appointment recently, and was talking to a friend about this yesterday, and she agreed this equally pissed her off about her's too, ( she had hers 12 months ago in the same NHS trust).

The actual medical questions were almost skimmed over, ( I wasn't asked if I had any medication allergies, even though I have a serious allergy to doxycycline). But the amount of nosy, social questions asked to "judge," your suitability to parent was ridiculous.

Examples on the proforma list included:

• How long have you been with your partner ? ( Yes, it is a long-term relationship so wasn't an issue for me, but my friend's child was conceived after a short fling and she didn't want to be answering exactly how long it was).

• What is your highest level qualification/ are you educated to degree level ? ( I'm educated to degree level, but interested in the medical relevance of this. Imagine getting asked that at any other medical appointment ...)

• Are you employed ? Is it full time work, what do you do for work ? What does your partner do for work ? ( Why on earth is it medically relevant what my partner does as his job ? )

• Does your partner have any other children ? ( No, but again, not medically relevant...)

• Do you own or rent your property ? ( Why, do you want to take a look at my mortgage deeds....)

Seemed to be a lot more interested in asking a list of nosy, intrusive questions than either a) a serious physical health condition I have that could impact the birth, or b) my medication allergies.

I'm just trying to work out in what other medical scenario this would be appropriate...

@Kennykenkencat

FourLittleStars Being functionally illiterate doesn’t mean you don’t want to know how to do things.

Not everything is written down to wade through if you struggle with literacy

YouTube etc can be referred to if you don’t know stuff or just want to see what alternative ways there are of doing anything.

I failed Functional English but can still read and write and have a wide knowledge of a variety of random stuff. I know I struggle with a lot of written instructions sometimes so when I get to a bit where I just don’t get then YouTube/Pinterest etc does help
Ds has struggled and failed to get an. English qualification and only has one GCSE
In the past year he has gained an almost encyclopaedic knowledge of camper van prices and how to renovate the interior
Learned Spanish for 14 hours per day for 6 weeks
Learned about Bitcoin and stock trading and had now decided to try forex and currency trading which he is finding complicated.
Learned how to build a computer and done a stint as a manager of a large carpark

Just because you struggle academically and have a learning difficulty doesn’t mean that you don’t have a thirst for knowledge.

Not wanting to learn new things isn’t the preserve of those who are functionally illiterate. I have come across many many highly educated people who have not a clue about anything outside their own lives.

Of course it doesn't. But I'm talking about my DHs family. Who are all low level education, with absolutely no thirst for knowledge or desire to learn anything past what they need.

Same for the area I grew up in. Multi generational poverty and deprivation. School was an authority figure to be tolerated until you could leave, social services were evil and to be feared, don't engage with anything beyond the bare minimum so you don't get reported.

Struggling with how schools teach and expect you to learn and perform is no indicator of intelligence. But if you've grown up with no support in learning or education at home, then it's harder. I had an ex who went to sixth form and his dad would actively put him down "you think you're so fucking clever, college boy, don't think I'm paying your bus fare" because he was so insecure about his own level of education, he was frightened that his son would think he was better than him if he educated himself.

@Elisheva

It isn’t that the mother is just thick or preferred to go out and party rather than study to gain a degree I don’t think that anybody is saying it is? The OP wanted to know why the midwife asked about her level of education, and I am explaining that there is a correlation between maternal education and different outcomes for the child. Educational outcomes may not be as relevant for a midwife, but likelihood of a low birthweight, good maternal diet, and things like use of alcohol/smoking are. It’s just an indicator of things that the midwife might need to be aware of.

Then ask about smoking, alcohol, diet because having a degree doesn’t automatically mean women know about folic acid, drinking and smoking during pregnancy. It isn’t automatically the ones that aren’t degree educated who are the walking red flag. I know someone who both her and her Dh by these questions would have looked perfectly good parents. Both degree educated, their own home, good careers. An informal conversation would have shown the cracks with a multitude of red flags sticking through. These are the people being missed.

It's very disheartening to think that so many of my patients might believe I am asking them these kind of questions just because I'm nosy.

If you want to know why I am asking a particular question, just ask me and I'll explain. Because there will be a reason.

Where would that have put me then? Dropped out of uni after a term, did a secretarial course then spent a year in Europe. By 20 I had a job in the City, by 26 I was selling Eurobonds, and earning large sums of money. Burnt out at 34 but hardly one of life's failures. My professional qualifications came later when my DC started school and I started carving my 2nd career.

Further I suspect I have mild ADHD and dd was diagnosed aged 17 with ADD variant (never picked up because she was always high performing) after a hellish 18 months of depression, anxiety and self harm for which there was no support whatsoever on the NHS. She got a diagnosis and got well again because we could afford to pay privately via a combination of BUPA and our funds for the bit BUPA didn't cover (more than £500 on therapy and anything linked to neuro diversity). DD graduated from Cambridge this summer with a very high 2:1 presently working as a TA in a school for autistic and ADHD young people, considering whether to do a masters in speech therapy first or a PGCE or vice versa. 30 years ago she would have been under no pressure whatsoever to go to university or get high grades and wouldn't have felt a failure for never feeling she had reached her potential.

In a world where HE is contracting and apprenticeship routes growing there's a great deal of catch up required. 28 years ago when my first was born University for my generation (the boomers - a group much abused on MNet because they had all the "wins") was not the norm. There still is a vast gap between well educated and well qualified and sadly many well qualified people today are not at all well educated.

A generation before us, MIL went to teacher training college, mother to the Royal Ballet School. Neither degree educated. Was that a big red flag - because neither had a degree? Of course not. Both however were in stable employment and had husband's who were too. A far better signifier and whilst I accept their are outliers who abuse from professional/wealthy families if one looked at the proportion of women affected by domestic abuse and compared it to the proportion affected in demographically lower social groups I am sure there is evidence to say it is vanishingly insignificant.

I do recall a professional family with several disabled twins whose mother killed them. The pressures were such that she had become mentally unwell. In Wandsworth she got enough NHS and social care to cope; when the family moved to Kingston the support vanished because there were lower provisions. That family were known to the NHS and other agencies for legitimate reasons - the state knew the support needed and didn't provide it. It couldn't have been more obvious.

If the state fails people in those circumstances (as in a far more miniscule way it failed my dd) then I have less than zero time for intrusive and too often exceptionally rude comme to, combined with subordination the mother who is a key and equal stakeholder. A little common sense and sensitivity wouldn't go amiss.

Apologies for typos, typing quickly on phone - how I would love MN to introduce an edit button).

@flipflopjump

It's very disheartening to think that so many of my patients might believe I am asking them these kind of questions just because I'm nosy.

If you want to know why I am asking a particular question, just ask me and I'll explain. Because there will be a reason.

@flipflopjump, but couldn't you pre-empt this by explaining why you were asking potentially intrusive questions r.e. previous pregnancy loss, degree status, parent's employment status, housing status, length of parental relationship etc ?

I think it is the lack of transparency that is getting people's back's up.

Someone may, for example, have dropped out of uni and it be a very sensitive subject to them.

And again, surely just ask what is relevant ? " do you have dyslexia or reading difficulties that mean you would like extra help reading through pregnancy information, would highlight for example, someone who got a degree in a practical subject, ( e.g. music), but still had dyslexia and found reading difficult; without making the majority of people without a degree, ( who have perfectly fine literacy skills), feel inadequate as it is obvious what the "preferred answer" to the question is.

@hugr

Haven't read the full thread but have seen a few people speculate why the degree question is there. It's because lower educational level is a risk factor for poor pregnancy and birth outcomes.

I suppose you believe that higher educational levels = no risk factors

It certainly pissed off more than one midwife/hv who made snarky micro-aggressive comments because we lived in a large and lovely house in an expensive area. In my experience they will snark whatever one's circumstances because ultimately there are a high proportion of women in these occupations who are hard, bitter or thoroughly unpleasant. The HV of a friend of mine walked into her house and disdainful said "don't think your baby's any better than anyone else's just because you have all this". The funny thing is that family gratefully received 2nd hand our cot, high chair, and pram. I rang social services to see if I could donate and was snottily told their families were only provided with new things - 2nd hand more than good enough for investment bankers though. The system beggars belief.

@RosesAndHellebores you are the one who sounds very bitter

@chattycaterpillar that's just silly. DD got grade 8 voice with distinction pre degree and her boyfriend did an organ scholarship in one of the world's music capitals post degree although now taking Prof quals.

A music degree is not a practical degree it is a highly academic one and often links with mathematics and linguistics. Reading music and professional musicianship rarely go hand in hand with dyslexia, etc., sometimes high functioning autism.

You may be mixing it up with something like musical theatre.

"You see whilst I personally would not be in a relationship with somebody who had children they chose not to see, I think it's completely unprofessional for a HCP to be quizzing an expectant mother about why her partner doesn't see his other kids. If he is a shit dad, he should be the one getting stick, not her."

But no one is giving her stick, they're asking a question. The dad could not see his children for any reasons ie it could be court mandated due to risk, so they need to know to safeguard the baby.

@flipflopjump

It's very disheartening to think that so many of my patients might believe I am asking them these kind of questions just because I'm nosy.

If you want to know why I am asking a particular question, just ask me and I'll explain. Because there will be a reason.

Great!

Could you explain why these questions are there and what you are doing with it as a MW?

Could you also explain why the questions are just asked with the expectation women should just answer and there is no need to explain why to start with?
As a HCP I never ask questions that could seem unrelated to their issue Wo asking why I’m asking those questions.

For all those posters thinking this is intrusive, you do realise when your DC is at school there will be things written about them on the school safeguarding database, some of which may seem trivial but could add up to a bigger picture of concern. This information can then follow them to their next educational establishment

Sorry but you’re definitely over reacting and I’m currently pregnant with my 3rd so have had these questions 3 times.
I have absolutely no problem with them, they’re to keep babies safe. Why on earth would the midwife ask them just to be nosy???

Reading music and professional musicianship rarely go hand in hand with dyslexia, etc., sometimes high functioning autism

In my experience it definitely goes with dyslexia.
I have known a lot of professional musicians over the years who struggled with reading and writing words and who either were diagnosed with dyslexia or probably had dyslexia but when it came to notes on a page they could read them as easily as others can read a newspaper

The starting point is that you are at the appointment because you want appropriate care. I am asking questions to be able to personalise the care I offer to your circumstances. That is it.

I'm not judging you
I'm not being nosy

@Kennykenkencat - thank you, not something I was aware of.

@flipflopjump to be honest, whenever I saw a midwife I wanted appropriate clinical care tailored to my clinical history, not social care of any sort. It was very disappointing that so often the former wasn't forthcoming.

Examples: pg with ds1 after two late miscarriages in my mid thirties both noted in the referral letter "is it a planned pregnancy?".

Total lack of attention regarding thyroid disease and failure to ensure TSH was monitored- not once but three times.

In early labour with DS failure to diagnose a posterior baby.

Later in labour administered pethidine without my consent.

Even later when I had an epidural said she was going for a sandwich and told my husband to do the same. The heartbeat disappeared and I couldn't reach the alarm button because I had an epidural and shouldn't have been left alone.

She hoisted the belt up and said "oh no worries the belt slipped must be a bit faulty. The third time that happened dh opened the door and yelled "I want a Dr in her right now.

Senior midwife appeared took one look and hit the red button. The room filled - the baby had the cord tightly wrapped around his neck. He was too far out for a section and they cut the cord whilst he was still in the vaginal canal - I was given one more push to get the baby out whilst the registrar got a forceps delivery ready.

I managed to push hard enough for the baby to be born - he was bright blue and took minutes to resuscitate and spent the first night in special care. I had a prolapsed bladder as a result. Fortunately baby was fine.

Post Natally was visited by six midwives. I have noted above how the first was more interested in my sex life than me or the baby and did something very vulgar. At day 9 I expressed concern about feeding and engorgement and was told no problem.

The next morning I had flu symptoms and rang the hospital concerned I could give the baby flu. I was told oh don't worry as you are feeding he'll have antibodies. By almost 6 I was very unwell and phoned my Dr's surgery and was told the Dr's had been non since morning and certainly would not speak to me and to call the emergency Dr. He arrived at about 8.45pm. In those days there was one pharmacy about 5 Miles away in Earl's Court and my DH made a dash for it in a cab.

Would you like to comment again on appropriate tailored care because it wasn't available in 1994 at a major London teaching hospital and that was before midwives were as stretched as nowadays.

Would you also perhaps like to explain why anyone would reasonably have expected me to trust a midwife's judgement ever again?

@flipflopjump

The starting point is that you are at the appointment because you want appropriate care. I am asking questions to be able to personalise the care I offer to your circumstances. That is it.

I'm not judging you
I'm not being nosy

Is there a difference in care if the mum doesn't work, Dh doesn’t work and neither has a degree

To someone who is degree qualified and both parents have good well paying careers

Who would need the help?

As it happened It was the latter couple i could tell had problems but it was first couple who got red flagged The fact that the husband was between jobs and the wife was going to be a SAHM didn’t seem to matter

@flipflopjump

It's very disheartening to think that so many of my patients might believe I am asking them these kind of questions just because I'm nosy.

If you want to know why I am asking a particular question, just ask me and I'll explain. Because there will be a reason.

Then @flipflopjump, can I ask why it is relevant to ask if I have a degree ?

As a 29 year old woman, will I be put on a different care pathway if I say I left school at 16 to do an apprenticeship in hairdressing, than if I had a master's degree in engineering ?

[quote RosesAndHellebores]@Kennykenkencat - thank you, not something I was aware of.

@flipflopjump to be honest, whenever I saw a midwife I wanted appropriate clinical care tailored to my clinical history, not social care of any sort. It was very disappointing that so often the former wasn't forthcoming.

Examples: pg with ds1 after two late miscarriages in my mid thirties both noted in the referral letter "is it a planned pregnancy?".

Total lack of attention regarding thyroid disease and failure to ensure TSH was monitored- not once but three times.

In early labour with DS failure to diagnose a posterior baby.

Later in labour administered pethidine without my consent.

Even later when I had an epidural said she was going for a sandwich and told my husband to do the same. The heartbeat disappeared and I couldn't reach the alarm button because I had an epidural and shouldn't have been left alone.

She hoisted the belt up and said "oh no worries the belt slipped must be a bit faulty. The third time that happened dh opened the door and yelled "I want a Dr in her right now.

Senior midwife appeared took one look and hit the red button. The room filled - the baby had the cord tightly wrapped around his neck. He was too far out for a section and they cut the cord whilst he was still in the vaginal canal - I was given one more push to get the baby out whilst the registrar got a forceps delivery ready.

I managed to push hard enough for the baby to be born - he was bright blue and took minutes to resuscitate and spent the first night in special care. I had a prolapsed bladder as a result. Fortunately baby was fine.

Post Natally was visited by six midwives. I have noted above how the first was more interested in my sex life than me or the baby and did something very vulgar. At day 9 I expressed concern about feeding and engorgement and was told no problem.

The next morning I had flu symptoms and rang the hospital concerned I could give the baby flu. I was told oh don't worry as you are feeding he'll have antibodies. By almost 6 I was very unwell and phoned my Dr's surgery and was told the Dr's had been non since morning and certainly would not speak to me and to call the emergency Dr. He arrived at about 8.45pm. In those days there was one pharmacy about 5 Miles away in Earl's Court and my DH made a dash for it in a cab.

Would you like to comment again on appropriate tailored care because it wasn't available in 1994 at a major London teaching hospital and that was before midwives were as stretched as nowadays.

Would you also perhaps like to explain why anyone would reasonably have expected me to trust a midwife's judgement ever again?[/quote]
I mean whats that got to do with midwives asking questions at a booking in appointment that do help some women?

Because if they can't competently perform the clinical aspects of their job, they are hardly likely to be able to form social judgements in relation to red flags and shoukd not be trusted to do so.

As most women have shared care with GPs presumably that's where an holistic relationship is likely to be formed in relation to social support. Not with a midwife a woman may see sporadically over 6 or 7 months.

I know in our trust the education question is asked ‘at what age did you finish full time education’ it plays a part in picking up those people who are unable to read, and therefore we would provide information in a different way/format. I do remember your post worrying about telling the midwife about your previous use of antidepressants and having to be measured and weighed. Everyone tried to reassure you that neither of these things would be raised as an issue. I think you can probably rest easy that the midwife isn’t out to get you, rather they want to support you through this journey to motherhood!

I have a job to do. Sometimes this means asking questions a patient will be offended by. As a professional I don't get to skip questions because I assume they are unnecessary for that patient or because I won't like the answer or think they might annoy the patient. I am not there to judge, I am there to provide appropriate care and I need information to do so.

At a National level education levels are known to be correlated with outcomes. We wouldn't know this, or be able to take steps to improve standards, if we didn't collect this data. At an individual level it's a really helpful shortcut to know what level to start pitching information at. I'll then adapt my approach as I go along to suit that patient.

As others have said, a question that may feel irrelevant or intrusive to some, may improve care for others or even save their life.

At the end of day if you are unhappy about what you are being asked tell the person doing the asking or speak to their superior.

Well then @flipflopjump if you have to ask questions you know may offend, that is precisely why I introduce myself to HCPs as Mrs Hellebores. Two reasons, firstly it means at the very least you may address me with a modicum of respect whilst asking questions you know may cause offence and keep the relationship professional and boundaried, secondly as all the midwives I met referred to the Consultant as Mr Bloggs, Miss Jones, etc, you may address me as though I am equal to every other stakeholder in my care. I was left with that stance after ds1's birth and the appalling care, both clinical and social that I received from midwives.

FWIW whenever I ask a nurse further questions they usually say "I don't know, you'd have to ask my supervisor, the senior sister or a Dr." It's far better use of my time to go straight to the organ grinder.