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?

Do you mean the Trust where you work?

We absolutely have them in Obs where I work.

@BPquestion there is actually. You have to have a life or health sciences degree.

My current birth plan is that I don’t have one. In other words, I entirely agree with you.

I am thinking of submitting a birth plan that is one sentence long, as per my OP. Otherwise, I won’t have one!

No - ‘ideally’ it will be - but it’s not (yet) mandatory that it is.

I think birth plans are worth doing 🤷‍♀️

Given that you literally have to give your permission and consent for any decision and procedure made, it’s a really good idea to actually be informed so you know what you are happy to consent to, and what pathway you’d want to take should certain situations arise (especially since labour and birth can be quite unpredictable!)

My friend is a PA. She has a nursing degree, about 12 years experience then did the two year course. She's currently studying for a Masters.

She's bloody awesome and I would choose her over a junior doctor any day.

Not all PAs are the same.

I know it’s quite off topic but I did a birth plan purely to educate myself on the possibilities and potential choices that comes with childbirth and I’m so glad that I did. I wasn’t in the position to take on any information during labour so decisions came from what I already understood. It didn’t actually get looked at by the midwives that I know of.

I had my blood taken by a PA in gynae assessment when I had a miscarriage. She had apparently done the extra training for more difficult veins. When I had my baby 18 months later I never saw any PAs in maternity throughout pregnancy, none around when I had my planned c section (everyone introduces themselves in theatre), and none on the post natal ward.

If you're having a planned c section the Consultant comes to see you beforehand and so does the anaesthetist. You can ask them any questions, so that would probably be a good time to ask if a PA will be assisting and confirm you wouldn't give consent.

@s4usagefingers Same here. I think there’s a huge misconception about birth plans, that it’s all about ‘whale music’ and unrealistic expectations. Although I suspect that myth will always be peddled as some people undoubtedly don’t like women having control and autonomy over their bodies.

I believed the whole ‘birth plans go out the window!’ with my first labour and ended up with a negative experience and some injuries/side effects. When I looked back at my labour and birth I realised decisions had been made on my behalf that I wouldn’t have made myself if I’d known the risks and benefits. But I was young and amazingly wasn’t even particularly aware of the fact you have to consent and you don’t have to ‘be allowed’ to do things by the doctors! Once I was a bit older and educated it seemed mad to me to go into a situation not knowing about the options and the risks… you would want to in any other medicinal situation or procedure wouldn’t you? So why not birth.

Second pregnancy, was a lot more educated and had a birth plan. Way better experience and felt so much more in control.

Thst was definitely not a thing at my 2 sections.

A PA did our 6 week postnatal check and she was excellent.

Depends on what and how you write it.

You can have consent based printed birth plan signed by you and whitnes and no hospital will skip reading it.

During childbirth woman is in situation where she can have limited ability to speak or advocate for herself. Birthplan is document written to show your wishes where your thinking was not "obstructed by pain and emotions". If you are in situation to have PALS or court involved, a fact that you had birthplan in place can be great help as no one can claim they "did not hear her" or that you said something else.

Midwife will go through it and if anything is possibly problematic flag it up. I know as I refused consent for specific thing and was informed that in case I become unconscious they would not be able to proceed with that even if it is to save my life. Same way you can opt out from transfusion.

So yeah, birth plan is not "just a paper".

So what?

Unlike nursing and medicine (doctor) the requirements for PA's are such that someone can become qualified with very little training and experience. Your friend being overqualified doesn't change the fact that many others are the opposite.

Patients aren't going to be interrogating the staff on their qualifications during labour so how are they supposed to know who's who?

No one is going to look at your birth plan. There's highly unlikely to be a choice of staff anyway. Just be glad if they actually do your c section on the day it's planned for and don't send you home again because they are too busy.
The aftercare is similarly shockingly and dangerously lacking. I would just be grateful to have someone providing some care. It's not like you can turn the person away and get someone else of your choice. A more likely scenario is no one turns up at all other than a healthcare assistant taking your obs, despite said obs declining.

Birth plans are good for you educating yourself about pain relief options, vitamin k, skin to skin etc. You get to choose who cuts the cord maybe. But once it all starts happening it's largely either protocol driven or down to pot luck.

Not true. It may have been in the past but there has been an explosion of courses and people accepted with all kinds of degree. Even science might be zoology or nutrition. The course is two years and the exams are multiple choice with a 100% pass rate. That says it all.

@BPquestion I too follow Med Twitter and it's quite worrying that some of those dimwitted insta PAs might be let loose on patients. Anasthestic Associates seem to be the most risky. The training to be an anaesthetist takes at least 15 years, they are the ones keeping you alive in surgery.
I would note the consent form as you suggest.

It can be from nursing too. Nurses were the first to go into PA courses.

Why would it be unreasonable for someone with 2 years training, no medical qualification, to be involved in surgical and anaesthetic procedures?

Are you really asking that?!

… and… they’re not even regulated!

Thanks all, I have my answer! 😊

Isn't that the same for junior doctors though?

I've been through the system twice in the last couple of years and had two quite extraordinary experiences with junior doctors who clearly didn't have a clue what they were doing.

I'm clinical NHS so have a vague idea myself how it all works.

The face of healthcare is changing and there are surgical first assistants that are not doctors. Anaesthetic assistants are relatively new but will probably be coming. They are still overseen By consultant. In most other healthcare systems these roles all exist. Med Twitter is foul just now and highly unprofessional. There is one junior doctor who is particularly stirring up bile and fury and is not entirely accurate in her rhetoric. There does need to be registration of all HCP’s and how that is enforced needs to be clear. That should have been in place before they came to post. That was a mistake. ANP’s are a good model and have been in place in all critical cares adult/paeds/neonates for a large no. Of years now and it’s a care model that has spread through all acute and primary care well. Would I refuse a PA, no. Probably not. If they are the person on shift to provide the care I need then I am not going to refuse that care. If I asked for someone else I don’t know what that would look like. They are not going to bring a consultant in from home for a non clinical reason of my preference. And another provider is not going to offer care for someone not in their service. Any surgery would still be overseen and led by consultant.

YABU. If you don’t want NHS treatment then pay privately. We don’t get to pick and choose.

PA role has existed for more than ten years. Leeds uni started the post grad.
agree though that that’s plenty of time to get a regulatory body.

Junior docs start on less money and worse terms. Not surprised there’s tension.

Don't be ridiculous. The patient has a right to choose where they receive treatment and to request a change in the person treating them if they are not happy with the treatment they are receiving. It is literally a protected patient right in the NHS guidelines. Also NHS treatment is not free, we pay for it with our taxes and deserve to be treated with dignity, respect and receive safe care provided by competent people. You can't just got around saying "stop moaning it's free" to everyone who has received sub par and dangerous care.

How do you know she was?

She may have been polite and appeared thorough with the exam but you don’t actually know in reality that she was capable of performing what is actually a very important screening exam for abnormalities.

ANPs are entirely different to PAs in training, experience and critically in their assessment of their own competence and regulations to practice.

Pay privately then. If you go NHS, you get NHS.