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!

Depends on the hospital size too. Our local hospital has 24/7 consultant cover but it a huge teaching referral hospital for whole region who they airlift to in emergency, it’s who senior registrars and paramedics in the region call for out of hours for guidance if they don’t have a consultant on site at the time/at an emergency. Consultants on call are expected to be able to get to the unit within a certain timeframe, and crucially give advice by phone to senior registrars who are highly skilled drs. Whilst it’s right to investigate all aspects of treatments/procedures that do not go to plan, the lack of a consultant is unlikely to be the reason for the situation, registrars will be handling more births than consultants.

My DB is a consultant anaesthetist and does on call from home, he’ll often be in the hospital too so he knows what’s going on, and is always on the phone when needed, and they tend to have to live or be available with a certain timeframe (I’ve worked in clinical setting myself for many years and habe worked with consultants who live a long way away but will be in a hotel or similar when on call at home)

I had an emc on a Sunday, no idea if a consultant was around. I had a second emc (failed vbac) on a Saturday. It was a crash section and it was rushed into theatre in 2-3 minutes. A consultant turned up in this time to perform the surgery. So there was a consultant around at the weekend, I dont know if this was just lucky chance or normal at my local London hospital

Thats the same in every specialty in every ward at evenings and weekends. The drs that covet are adequately trained, consultants have to be within 30min away to attend if requested. I've finishes training last week 16.5 years after medical school, the press likes to suggest we are toddlers but most of us are v senior. Csections are classified according to urgency of delivery, if you delayed for a consultant to attend would result in v bad outcomes for babies.

Sorry this has happened to you although there's no guarantee wouldn't have happened with a consultant.

If you want consultant lead care 247 you need private

No consultant job plan finishes at 4 they were probably in a meeting or something. Anaesthetic cons job plans finish at 6 or 8

I agree with you OP. Whilst it may be considered normal not to have anyone, it is what we should aspire to.
Consultants do a lot of private work. Where I am sure they are available if needed.

Would having a consultant there have meant a different outcome for you?

That's a very unfair gross generalisation and simplification. Many consultants do no private practice, myself included. Of those who do, for the majority it's a day or two of clinic/operating on top of their NHS job. They will be nominally responsible for any of their private patients who are inpatients, but their actual physical presence out of hours will be the same or even less than in the NHS. Remember that most private practice is elective work, not emergency, which will get sent to the NHS.

Private obstetrics is pretty rare outside London and a couple of other big centres.

This. And when something goes wrong with a patient in the private sector where are they sent? Straight back to the NHS - which incidentally is using private healthcare facilities to reduce waiting lists.

This is actually wholly incorrect.
Private work maybe done during the day or evening/weekends and the job plan is integrated with the NHS job plan so there is oversight of where the consultant should be practicing, whether it is on-site nhs, off-site nhs or in private practice.
It is possible and reasonable to work full time in the nhs and do private practice but the sessions and on-calls should not overlap or clash. Same also if part-time practice.

Same with every speciality in every hospital, even private ones.

I work in a large DGH. As far as I am aware there are no resident consultants in any specialty overnight. ED have a consultant in until midnight, most other specialties have one on site until 8/9pm then on call from home. Registrars run the hospital out of hours and call the boss in as needed. Most emergencies can wait 30 minutes but some obstetric ones can’t, similar to airway issues or massive bleeding, but the registrars have a lot of experience and will manage these until help arrives.

I am currently in a private hospital doing an elective theatre list. I will leave when I’m done (as will the anaesthetist) and there is a junior doctor here overnight in case of issues. I’m on call from home for these patients but you certainly don’t get 24/7 Consultant led care! If I were sick or injured, I would feel far more comfortable being in my nhs hospital than in the private one.

If you listen to some of the posters on this site, they seem to believe that non medical “associates” should in any case be able to cover wards more than adequately 😳🙄

Bonkers.

Coming back to this having read the replies. The registrar doing the section was calling for the consultant but presumably they didn’t come as no one else arrived. The problems started during the surgery so I guess they couldn’t leave me open on the table waiting for help to arrive.

How awful for you op. Suggest checking your various insurances as I had inadvertently ticked legal on my house insurance which covered medical, and whilst the NHS suspended a registrar to investigate the chaos and endless fuck ups during my emcs, I also had a lawyer to represent my baby and me and access therefore to reports.

I was amazed to learn it was very common for the NHS to be taken to task over poor care for birth. Not bashing btw- some of the staff were amazing. Some advised I get legal help. This was a very long time ago.

Wishing you well.

Where consultants are off site they have to be within 30mins of the hospital - this has been the case since forever ago. Over the weekend they will often be on for 72hours and it's unreasonable to be resident that whole time but there is an expectation that they'll be onsite for ward rounds and depending on activity stay onsite if there's something that particularly needs them. Labour wards will be staffed by experienced resident doctors/SAS doctors 24/7 and the consultants are often onsite for a lot longer than you think and always contactable by phone. SAS doctors often have as much/more years experience than consultants. Complications during a delivery are not always preventable and do still happen when consultants are present too. For the anaesthetics side every consultant covering on call will have done obs training, but not every one will have a specialty interest in obs and so while they'll be able to do a safe anaesthetic in an emergency they may not always be so up to speed as the SAS/reg's with current practice. Bottom line is though that there aren't enough consultants for 24/7 cover and more often than not the work doesn't really need that so you'd be paying for an awful lot of consultant hours, and it would have knock on effects for elective operating/gynae lists/clinics during the week so you'd all be waiting longer for those appointments too.

I don’t know if this will make you feel any better, but I had an ELCS after going overdue for DC2 (would otherwise have tried for a VBAC) at a big London hospital at 10am in the morning. All went tits up, massive hemorrhage, couldn’t stop the bleeding, and despite repeatedly paging the consultant she didn’t answer or show up. Eventually she did, they managed to stabilise the bleeding, and she left as they started sewing me up. Then something else went wrong and she was inaccessible/unreachable for a second time. Husband was losing it, baby was being ignored/ looked after by the midwife, and I was passing in and out of consciousness by the time she arrived again. What surprised me wasn’t so much her unavailability (I assumed she was dealing with another patient) as everyone else’s inability to manage the situation or make any decisions until she returned. Having said all of this, I can’t imagine what would have happened if she hadn’t eventually returned because there seemed to be no plan at all.

Very sorry to hear about what happens to you, and hope you are able to enjoy your new baby soon.

We'd have to employ a lot more consultants to have 24/7 consultant presence. Which would cost money. I'm a paediatric consultant. I've made it from at home asleep in bed to obstetric theatres in 6 minutes. But we work the whole day, and then are oncall the night, and then work the next day. So we can't just hang around the hospital in case we're needed (unless we know something is kicking off, like say a looming preterm delivery).