To find midwife appointments a bit useless, and wish I could just switch them to online?

[OneCheeryPinkCat]

I think I just need a little rant. Other than the booking appointment (bloods taken), midwife appointments feel a little useless to me and I just really wish I could at least move them online, which my trust doesn't offer.

I can do my own urine dip test and take a blood pressure reading without wasting 90 minutes of my day (and more frequent readings = more likely to spot issues). I'm perfectly capable to read the guidance and research on things like vitamin K; travelling around the city "for a chat" about these things with someone who attended a lecture on this once, years ago, and now 90% of the time just regurgitates what is written on the NHS website really isn't of much help to me. Supplements always seem to be handed out too late, if needed, too.

Oh, and of course I can only get an appointment on Wednesday. No other day, even if I change midwife - I could travel 60 minutes one-way for an equally inconvenient Thursday appointment. But no availability on my weekday off. I like work, I don't actually want to take time off, and it is the kind of job where I just end up making up time later that day. I live in a big city, this isn't a dreamy rural town with just one midwife, there should be more than one day with availability.

Ended up scheduling vaccines at my GP, as otherwise I'd have even more inconveniently scheduled appointments. Obviously, in-person should be offered for people who want it but why on earth do some trusts insist on in-person only?! I seriously considered cancelling my 16 week appointment but went, because it was a massive gate-keeping exercise (i.e. I needed an update on my test results and consultant appointments....which could, and should have been, posted or emailed). Absolutely nothing happened that could not have been done online, it was a complete waste of my time.

This!

It’s not just about you OP, it’s checking your baby’s health too. Two of my friends had emergencies with their babies resulting in very early delivery that were picked up by a midwife.

If you value your personal convenience over the wellbeing of your baby, parenthood is going to be a bit of a shock.

(although having had 2 easy pregnancies I do agree they feel a bit pointless - but as others have said, they’re pointless until suddenly they’re not. It’s not a risk I was willing to take personally!)

Is this your first child?

I mean it’s important because even though you know how to dip urine and take blood pressure not every woman wants to/is able to correctly which puts unborn babies at risk because of the tons of conditions these 2 things can pick up. People who are not medically trained should not be doing potentially life saving medical tests/checks at home. Are they a tad inconvenient? Yes, but they are necessary…

Everyone I know who had serious issues had them picked up at midwife appointments. And that often involves looking at you, checking you physically and asking other deeper questions.

To be fair, auscultation at appointments doesnt tell us anything at all about the wellbeing of the baby. We would need to monitor to you for 20 to 30 mins on a CTG to have any idea of that. It isn't necessary to do it, but it is nice and creates a rapport between midwife, mum, wider family and baby.

Abdominal palpation - yes it is good to know baby is head down, but the measurements we do are not very accurate. Most other things about the baby's position are unhelpful to know before labour as it can easily change.

The only things with real clinical values worth checking is urine and blood pressure every visit. Not everyone does the blood pressure correctly alone nor do they read the urine test correctly so that's why self reporting isnt a first line approach but it is part of some people's care. You're also meant to be building a trusting bond with a midwife at these so you'll feel more comfortable disclosing any issues. But that's not how it works any more.

Earlier on maybe. But after a certain point when they can listen to heart beat etc less so.

Even more important for face to face appts than, unless you can record foetal position and measurement of baby, and listen to the heart beat yourself of course.

Edited to say as well that is good to build a rapport with your midwife, rather than meeting her for the first time later on. I used to love leaving work to go to them, have a little chat about any concerns, and what to expect.

I suppose you could sign a waiver explaining that you take complete responsibility for anything that goes wrong, any condition diagnosed too late or not at all. If you were prepared to do that, fair enough.
Even that doesn't always work though.
I have experienced one person start legal action against the hospital, in spite of no fewer than 4 senior doctors telling her the consequences of refusing treatment, documenting every conversation and having witnesses sign the records.

I refused to deal with midwives after being present at a birth where midwives were present. Thankfully there was a private obstetrician on call.

I had a friend whose healthy baby died after midwives delayed calling a doctor. She almost died herself.

When I was pregnant I chose to go through a private obstetrician. You can choose your appointment days/times and when there was an issue with my labs she just phoned me at work. The obstetrician measured my stomach to make sure I was putting on enough weight at each appointment, managed my diabetes and performed ultrasound scans in her office.

I had a male midwife present at my c-section. He stayed up next to my head the entire time snd didn’t talk to me. The only thing he did was take a photo.

I don’t understand why you are complaining about something that you aren’t paying for privately. Of course you’re not going to receive the best care when you go through the NHS. Of course you need to take time off work to attend to appointments. Also, midwives check your blood pressure to see if you are developing pre-eclampsia - which isn’t something that patients can be trusted to do themselves.

Also, I’m in Australia. I wasn’t educated about vitamin K. It’s just dealt with by the paediatrician after I gave birth. It was something I didn’t even need to think about.

Interesting - I'm considered a high risk pregnancy and my Obstetrics appointments have been phone calls !
i actually think that's a compleat waste of time. What can they possibly tell on a phone call?!! Give me a physical appointment any day. Your entitled to paid time off anyway.

Just some reminders from the NICE guidelines so we remain factual:

1.2.30
Offer symphysis fundal height measurement at each antenatal appointment after 24+0 weeks (but no more frequently than every 2 weeks) for women with a singleton pregnancy unless the woman is having regular growth scans. Plot the measurement onto a growth chart in line with the NHS saving babies' lives care bundle version 2.

Discuss the topic of babies' movements with the woman after 24+0 weeks, and:

ask if she has any concerns about her baby's movements at each antenatal contact after 24+0 weeks

advise her to contact maternity services at any time of day or night if she has any concerns about her baby's movements or she notices reduced fetal movements after 24+0 weeks

assess the woman and baby if there are any concerns about the baby's movements.

Offer abdominal palpation at all appointments after 36+0 weeks to identify possible breech presentation for women with a singleton pregnancy.

https://www.nice.org.uk/guidance/ng201/chapter/recommendations

There is nothing about listening to the baby's heartbeat because it is of no clinical value.

On what planet would you not want to hear your baby's heartbeat? All of the checks the better is what I say..

100%.

I would rather go to a midwife appointment every week during my pregnancy than another woman being abused not have the space to speak to a clinician alone, put a sticker on her form so the midwife gets her alone and can offer the appropriate support. OP is on one.

Glad I'm not your midwife.....or child for that matter. If you think that's all that's happening at an appointment then you're mistaken, even if you're unaware of it. Perhaps you're not as smart as you think you are.

This is so painfully accurate down to the phonics (which was 2.20 last Tuesday 😅). Midwife appointments are the least inconvenient parenting appointments!

What you've said about not caring about safeguarding made me feel sick tbh. Anyone could find themselves in an abusive, dangerous situation. You'll think nothing of me as I work in elderly care and safeguarding is one of the most important things we do.

What are you expecting from this thread? For midwives to flood it apologising for doing their very important jobs which includes saving expectant mothers and babies lives?

Some women would give anything to have access to regular pre and post natal care.

I haven't any problem with NHS birth care. Have you or is it just hearsay that it is crap?

Everything is fine until it isn't. Midwives are expertly trained to pick up on problems. You dont have their expertise. I'm sadly a bereaved mother of twins but thanks to the midwife who spotted the problem, we got a few days with our second twin when he was born.

I'd never miss an appointment unless I had to.

My 18 week appointment did feel a bit like it could have been a phone call except for BP and the urine test.

The later appointments increased in usefulness.

You do have to remember that it’s not all about you but about the population. They pick up enough issues at these appointments to make seeing everyone worthwhile.

The do drop the frequency in second pregnancies.

If my midwife hadn't listened to my baby's heartbeat at my 28 week appointment she wouldn't have detected an issue. She sent me to triage who blue lighted me to a fetal cardiology unit. I had no idea anything was wrong and had a scan 10 days previous where there was no issue.

Because it doesnt tell you anything of clinical significance when we listen in that way for a random minute outside of labour. Even in labour, you are comparing each time you listen in to look for abnormalities rather than seeing each figure individually. You plot it kn a chart.

The best indication of fetal wellbeing in pregnancy is maternal observation outside of scans. The tests you do like blood pressure check the maternal wellbeing, and that in turn can affect the baby.

Imagine that you didnt ask the mum about movements and listened in and got a fetal heart of 120bpm over 60seconds. That's perfectly normal and I could just write that off as "baby fine". That baby really might not be fine.

This is why those home dopplers are discouraged. People would feel something is off and then use that to establish a "normal heartbeat" and find one. That would falsely reassure them that all was fine. The reality is that it isnt rocket science to find the baby's heartbeat and count it for a minute and see if it is normal. Its the first thing you learn to do as a student. But it is of no significance alone.

The analogy of just checking an unconscious person has a pulse and then walking away is often used. You need to find out why they are behaving that way, not just if they are alive at that very moment.

That's why id tell everyone here that if you feel something is off, your community midwife should refer you in to your emergency assessment unit because there is nothing we can do to establish all is well in your local clinic. But you need more tests with machines that arent available in the clinic.

It's not just simplistic things like this though - in later pregnancy there's random pregnancy specific illnesses...for example sudden itching can indicate a rare condition (I think meaning your liver isn't functioning properly) that can be very serious.

There are all sorts of strange, "normal" symptoms like itching that you would dismiss/could be missed without these appointments.

The midwives are trained specifically in pregnancy conditions/complications, so they know all the warning signs for these very specific diseases and often save babies lives.

@LoftyRobin

"The best indication of fetal wellbeing in pregnancy is maternal observation outside of scans. "

This is hugely untrue. If I had have listened to that and not gone, my baby and I would have died. It was picked up in a routine midwife appt, not during a scan.
Edited to say, with my other baby my placenta was at the front blocking most, baby was pretty none active as well (and is one laid back kid as well). Thank goodness for the midwife appointments to reassure me.

Jesus this thread is crazy, no words!

Well research has proven otherwise. Of course there will always be outliers but the NICE guidance states it for a reason. I cant speak of your individual case but what I will say is that is many cases where things go very wrong, there were clinical indications or a lack of risk assessment that clinicians missed earlier. Things like missing that the person should have never been on a totally low risk pathway and therefore without the big gap in scans which is appropriate for low risk individuals, we may well have seen something sooner.

OP it is clear you have become a doctor via Google, and therefore think you know everything. In the kindest possible way, you don't.

Your arrogance in refusing care could lead to endangering your pregnancy: just look at maternal and fetal mortality in developing countries, where women don't have access to healthcare. Pregnancy is unpredictable, and at times, dangerous.

I am also very sad to hear how you demand midwives, who are valued healthcare professionals.

Regardless of your mode of delivery, antenatal care is important (and birth plans aren't just for vaginal deliveries either).