AIBU to be shocked consultants are not always on site in maternity care?

[Fivegates]

AIBU to find it shocking that labour wards and postnatal wards can be run at weekends and evenings with no consultants on site?

I fairly recently had DC2 and sustained a significant birth injury that has been categorised as a level 4 safety incident, meaning severe and prolonged changes to my life, which has triggered an NHS investigation. I was shocked to hear that there were no consultants on site during the birth and as I had a csection they were not able to come to the delivery in time. Also that the anaesthetist was also not a consultant.

I had naively presumed that as babies are born at all hours of the day that the labour and postnatal wards would be one place where a consultant is always present, but apparently this isn’t the case. AIBU to be really surprised and concerned by this and feel that it may have contributed to what has happened to me? I know that maternity services are bad in this country but even when things were going wrong I had always thought a consultant was there!

I assume there are doctors present who are competent enough to handle most things and a consultant is on call for emergencies.
There would have to be a lot more consultants for one to be present at all times.

Well this was an emergency and one wasn’t on call, in any practical sense, anyway.

Consultants are normally on call at night and the weekend. Senior & junior drs run departments. There aren’t enough consultants in the county to be on shift 24hours a day.

I dont know how it would be possible for it happen

There will be An on-call registrar permanently on site.

Consultant’s rarely work out of hours on site. Once they’re at the top of the game they just do their clinical hours and leave at 4pm. I know from first hand experience because it was a nightmare to try and catch one to speak to them regarding the care for my ill parent. Registrars on the other hand are always on call and physically present out of hours. They’re one step down from consultants but at that point very knowledgeable and experienced in their domain.

Was the same in the 80s and 90s when I had my babies 🤷🏻‍♀️

There will always be a Consultant on call but not necessarily physically present in the hospital 24/7.

The Specialist Registrar will have many years of training since medical school under their belt and can manage most occurrences out of hours without contacting the Consultant. However the Consultant is on the end of a phone or within a short drive to the hospital if needed.

In the last 30+ years, at least, there have never been consultants permanently on site, 24/7. There will always be someone on call, who can be consulted and who can, occasionally, come in (but this isn't always needed).
An experienced Registrar will do just as good a job during the actual birth.

I'm sorry you had such a bad experience, OP. I can understand why that would make you question the care that you received.

However, I don't see how it would be practical to have consultants on site at all times - we would need so many more of them, and the cost would be astronomical. I'm also less than convinced that it would make that much difference to the care that people receive - an experienced registrar with access to an on-call consultant if required should be able to handle the vast majority of situations effectively.

There is normally a junior and senior registrar covering obstetrics plus gynae who are typically excellent. plus doctors earlier in their training. I was always more worried about the number as we couldn’t really run a gynae emergency theatre plus an emergency csection but I guess this hardly happens and you have a little warning to get on call consultant came in. I am very sorry this happened though

Back in 2003 I was rushed into hospital hemorrhaging after giving birth. The consultant was called in on a Sunday - that was when I knew I was really not doing well…

He went through my options with me and oversaw my care, but my surgery was done by a registrar who did a perfectly good job, and the anesthetist was wonderful.

I hope you’re doing ok OP. It is scary when things go wrong giving birth.

My local (home counties) hospital has Consultants on site 24 hrs a day except for 8hrs a week.

When I had my second in 2021 there was a consultant on site at night as I he kept coming in to see what was going on after he did his rounds at 8pm. I now feel very grateful as he made the decision that I needed an emcs

In every specialty? I highly doubt that. Even just obstetrics would be extremely unusual - I am a consultant in an obstetrics-adjacent specialty, in the home counties.

In most acute specialties, in all but the very biggest and busiest hospitals, consultants are not resident on site 24/7. A previous poster's suggestion that all the consultants go home by 4 is also not true - my standard day finishes at 6! And when I'm on call I'm expected to be on site till 10pm; in jobs like emergency medicine they may be rota'd to midnight, but very few hospitals/specialties have consultants routinely on site 24 hours. A lot of the out of hours work is done by resident doctors, many of whom are very experienced - by my final year of training I had been a doctor for 13 years and was able to run an emergency theatre list or oversee an intensive care unit independently except for the most complex cases, where I'd call the consultant.

I was on call last night, in fact. Got home just after midnight. And if any more cases had come in needing my help before 8am today, or if my resident had any questions, they'd have called me. I get paid the same for my on call hours whether I'm in my bed from 10pm or in theatre all night - usually it's somewhere in between!

In order to have 24/7 consultant presence in acute specialties like obstetrics, we would need at least 3 times the numbers of consultants we currently have to cover the hours without sacrificing elective work. I'm not sure where either the money or the people for that would come from.

In obstetrics. I also participate in the rota.

Interesting! But still pretty unusual, wouldn't you say? We are a long way off that in my place.

Ours too. Neonatal and ED, yes, but not obstetrics.

DD had an elective Caesarean, because they assured her, she’d get a consultant obstetrician and senior anaesthetist (can’t remember if he was a consultant too) doing it; whereas if it were an emergency, it would be a registrar. I have heard of cases of babies dying at our local district hospital, because junior doctors didn’t make the decision to send the mother in labour, to another hospital nearby, with an neonatal intensive care unit.

There are doctors below consultant level with considerably more experience than those above. There wasn’t a doctor on site at all when I had my first in the 70s, my GP was called out to stitch me.

You’ve had a horrible experience @Fivegates but I don’t think you can blame it on a consultant not being present.

This is the case for most departments not just obstetrics.

a and e often doesn’t have 24 hour consultant cover.

there are not enough consultants to do this.

if you read any of the books about medicine published recently (eg this is going to hurt) the issue of when to call the consultant (who is on call at home) is a call registrars have to make frequently

My mum-in-law is a retired GP and she always said I shouldn't give birth at a weekend for this reason!!

@Fivegates I am sorry what happened happened to you. I would urge you to ensure the complaints process is exhausted but to focus on recovery and ensuring every scrap of care moving forward is optimal and consultant led. Hopefully at a different hospital.

I hope you have real life support and are receiving good quality therapy, funded by the NHS and high standards of clinical support to maximise your physical health moving forwards.

If you haven't already, do get your MP on side.

There is always a specialist OBs/Gynae doctor on site who will have many years experience and the on call consultant in most areas lived within a 30 minute drive ideally. I agree it would be great to have a consultant on call on site 24/7 but that's underfunding for you.

I wouldn't have expected your a anaesthetist to be a consultant unless you had a complex medical with additional cardiac or respiratory needs history, in which case you would have probably had a scheduled procedure during the day.

Same for the consultant obstetrician. Was it a senior reg who did the c section.
What they should be looking at is whether had a consultant been on site instead of the reg, would the decisions made and likely outcome have been different. And whether there was overall enough experienced staff on site to enable you to have been seen as soon ad necessary

I hope you are getting the support you need to make a good recovery, and get the answers you need x