To put that I don’t want to be treated by PAs in my ELCS birth plan?

[BPquestion]

I have recently been following the news, and ‘med Twitter’ about the growing problem of physicians’ associates. It seems there’s an issue with many of them performing outside of their limits of capability, expertise and knowledge. I also understand that they are not currently regulated by a professional body.

I recently read of a PA taking on an anaesthetic role, and another taking on a surgery role.

I am having an ELCS soon. Would I BU to put in the birth plan that I don’t want any PA to be involved in any part of the surgery itself?

Totally agree.
PAs have TWO years training...
Doctors (even before they specialise) have SEVEN... 5 in med school and then two foundations years. My DD1 is a doctor and they are genuinely scared of what is happening. Some PAs are a useful addition... as a less qualified add on to help with some of the easier stuff and paperwork but there have been quite a few cases of PAs going way above their skills level and with bad results.

I work in maternity. We have no PAs there never had never will.
It will be an obstetrician performing your CS a fully trained medical doctor training to become a consultant. Your anaesthetist will also be a fully trained medical doctor who is specialising in anaesthetics.

Thanks both. It seems that they do work in surgery in some hospitals, but good to hear that they don’t in yours @Thedogscollar!

Just bumping to see if there are any other thoughts.

I feel a bit sorry for PAs as individuals - it isn't their fault the government / NHS managers have made such a hash of their profession. I believe they are competent to do a lot of tasks, but problem is they are being used to plug gaps in doctor rotas, and therefore being asked to do a lot more than they have been trained to do. Also, not their fault that proper regulation hasn't been introduced.

I'm not sure if you get many PAs in specialist areas such as obstetrics? I think it would be a bit unreasonable to not let them do anything in your care (e.g. theoretically, they could just be asked to take your blood or something simple). I'm heavily pregnant and wouldn't mind a PA doing a simple task like that. However, you obviously wouldn't want someone doing a complex task if you weren't confident in their training.

You could ask your midwife, it might be that there are no PAs in your maternity hospital anyway.

I work in a surgical speciality (nurse) I have never come across a PA.

Not unreasonable at all. Every single one of us needs to refuse to be treated by them.

The ones in theatre are anaesthetic associates rather than PAs

they aren’t that prevalent in obstetrics at the moment - you’ll be more likely to meet them in neonates / paediatrics if baby needs it after being born. Quite common relatively in paeds.

Not all of them - some PAs have reported doing c-sections ‘with the consultant by your shoulder,’ others report assisting in c-sections and others have delivered the placenta. No, thank you!

Why do you think it might be unreasonable?

YANBU OP that sounds terrifying. But do you even know if your maternity unit uses PAs? Are all those stories you mentioned from your local hospital specifically?
Even my GP surgery for example doesn't have any. They only have paramedic prescribers.

Having known(and dated) several doctors they spend a lot of time dealing with paperwork, filling in forms etc so I imagined PA's were to do all that. Not to replace an actual doctor.

PAs are, well, physicians’ associates. Not surgeons’ associates. Surely?

I had a PA involved in my pregnancy (not the CS, thankfully) and it was an awful experience. I will never be treated by one again.

I'm sure you already know that your birthday plan is not worth the paper it's written on? It's just a ruse to make you think you have an element of control.

You might as well write that you want your baby to be delivered by a unicorn while you listen to an angel playing the harp.

The best you can hope for is that you are given some form of pain relief and end up with a healthy child

BIRTH PLAN not a birthday plan, stupid autocorrect. Why can't I edit my post on my phone?

Really? I work in this field and haven't come across any?

Don't blame you. Think the whole concept of these roles is deeply troubling.

I have worked in maternity a long time and have never seen a PA. You’re reading made up stories designed to stir up anger.

Not true.

I don't know, they do need to have a 3 year science degree and then do the msc to get the pa degree. Whilst this is 2 years on paper, it is 3 years in reality as it is an intensive full time course with no summer break. So they spend at least 5 years at uni training.

PAs tend to specialise in one area and remain in that area so they do become an expert in one small part. Whereas junior doctors are constantly rotating so they may not have as much experience in that particular area.
But what I would say is that all health care professionals can and do make mistakes, no matter how senior they are.
I am speaking as someone who had a bodged c section performed by a junior doctor.

I don't think you're wrong in your concerns, but can it work on a practical level?

If the particular "thing" you need has a PA scheduled to do that task on that day, would there be a doctor available to do it?

I'm not sure birth plans are ever really adhered to? Mine never made it out of the bag.

they do need to have a 3 year science degree and then do the msc to get the pa degree

There is no requirement that their undergraduate has to be a science degree.

I’m not, sadly. I’m reading accounts from doctors, nurses and consultants about what is actually happening in hospitals.

You can consent or not to certain things in your birth plan but it does depend on what constitutes your birth plan 1) yes to vitamin K etc and no physician associates or 2) fairy lights, nice music and a water birth. They take notice of number 1 not number 2.
I had an early unplanned vbac and the student midwife was having to try and go through the birth plan for the important bits in between my contractions!

I don’t know why the government are pushing PAs when nurses, paramedics, physiotherapists and pharmacists who have all done more than two years initial training, then practiced for a number of years and reached a certain level can do a masters and yet more training to do Junior doctor type role. It is only certain health trusts that offer these roles but they are very experienced and don’t do surgery.