To be totally peed off with "consultant led care"

[mollybob]

I'm nearly 36 weeks pregnant with DC3 - tough pregnancy with hyperemesis and still needing medication now to stop the vomiting. But otherwise all going really well - baby growing and developing perfectly, my blood pressure and blood sugar and everything absolutely perfect (have only been checking sugar because DH is diabetic and got a bit paranoid a few weeks ago) 2 healthy kids, normal deliveries, no complications antenatal or postnatal in either pregnancy. But I'm under consultant led care because I'm fat. OK, I should have lost weight before getting pregnant but I'm not massive - when not pregnant I'm size 20-22 and I'm pretty active - we walk and cycle a lot as a family - basically DH is a great cook and I eat too much and tend to comfort eat when stressed and have had a stressful few years. I know - excuses, excuses.

Every time I go to the hospital it's to see a doctor. I have to go there (too) regularly for scans but as I'm not as in need for medical input as other people with real complications I always see the most junior doctors. I am not allowed to deliver on the midwife led ward - one floor below the consultant one (even though I delivered dc2 on a midwife led unit - things have changed since then). I have been on the consultant led ward once because of a false alarm and I took the opportunity to ask for information about the care in labour (as can't have a tour as they don't do these) and all they talked about was drugs and epidurals. I delivered dc2 with gas and air after a stint in water and can't see why that's not apparently an option. Last doctor asked me about delivery and despite saying any drugs would be a last resort he wrote down a completely different message.

I want an active, low intervention birth and feel let down that the bl88dy doctors don't seem to think that's possible. Maybe it's too late to have a home birth but am very tempted to go down that route rather than put up with this nonsense.

I have read a fair bit of the evidence about obesity and pregnancy/labour etc, am a HCP myself and feel I should be allowed the same autonomy and choice as any other non fat pregnant woman.

It's your body, and if you want a natural no-fuss delivery, then theres nothing they can do about it, they have no right to force you into anything you dont want to do. They need your consent before they can stick epidurals in e.t.c.
One of my friends had a carry on when she was having dc3, cause she was breech, they tried to force her into having a c-section, even though she had 2 easy (and quick!) labours before. She put her foot down and said she was not having a c-section just because of breech (her older bro was a breech, and her mother gave birth naturaly, and there both still here!) And in the end, they said ok, and everything went fine, slightly longer labour but no complications.
So just be firm with them, cause they have to let you labour how you want, they cant legally force you into anything you dont want to do.

molly - i need to go to bed but will be back tomorrow and give you chapetr and verse on this! I also have three dcs, am same size as you and had similar conversations.

Sorry dear, it is better for your unborn child to be under the care of consultant because your weight could cause complications.
Simples.

They're very possibly concerned about BP issues...

no joke in my mind.

If you are regarded as high risk then a home birth would be daft. With analgesia they can only give you what you agree to. Who is coming in with you? Make sure they know your wishes.
If your first 2 labours were OK then this one will probably be brief and straight forward and you just refuse the opiates etc. There will still be a midwife with you even if at consultant unit. hand her your birth plan.
If things go pear shaped it's good to know help is near by though and the decision of who is regarded as having a high risk pregnancy is usually evidence based.

I agree with what 2rebecca has just said, about consultant unit and help near by.
However, even though it's a 'high risk' unit, they should still respect your wishes, because even though you MAY have complications, it doesnt mean you WILL, like in the case of my friend with the breech baby, everything went fine, left hospital the next morning. If she had went along with the consultants, she would have had section, been in hospital for days, and would have been unable to look after her 3 young dc's until scar healed (her 'dp' left her when pg). However, she understood there was a higher risk, and everything was set up near enough to intervene, should the help be needed.

My BP is perfect - lower than average actually. The biggest issues are a higher risk of post partum haemorrhage and bigger risks to me if I need a section - PPH and section are more common in patients on consultant led units and patients who have more interventions in labour. One nearby consultation led unit has the highest rate of CS in Europe. Clearly a low intervention labour is best all round for me and baby, assuming all remains normal.

The midwife led unit I want to use is one floor below the consultant led unit so even if things go pear shaped help is hardly far away.

Is there a pool in your CLU? Sometimes there are but they are not well publicised...
You could still get a low-fuss birth on a CLU. You've already had vaginal births so arre probably not all that likely to end up with cs.

The unit has adopted new guidelines in the past 2 years - I am no different now than when dd was born - just a bit older.

One reason I'm so peed off is that no one has explained anything to me - I just see the junior doctors in clinic who have no idea about birth beyond drugs, drugs and more drugs because I'm not high enough risk to actually see the consultant but too high risk to see a midwife. Am not planning to be totally unraesonable, just want to speak to someone who actually knows something and who will listen.

I think, personally, that it's all about covering themselves legally rather than what is best for me and baby.

I have no idea if there's a pool, tens, birth balls, mats or anything on CLU as nobody will talk to me about anything other than drugs.

I don't really want a home birth tbh but I feel that unless I say I do nobody is going to take the blind bit of notice of me.

From homebirth.org.uk: - "Large women are more likely to suffer from diabetes and blood pressure problems in pregnancy, which might affect your decision regarding home birth. There is also an increased risk of shoulder dystocia, but it is not clear whether this persists independently if you do not have gestational diabetes. Apart from these issues, though, weight alone should not be the deciding factor. Whatever your weight, you can still make an informed decision to plan a homebirth, as did Rachel, Helen, Genevieve and Carolyn. A wonderful site packed with information on pregnancy for large women is Plus-Size Pregnancy, by KMom. See also this discussion from the US Midwife Archives - 'Is Weight a Contraindication for Home Birth?'."

I was a size 22 (easily) when I attempted a home birth with dd1. My weight was never mentioned. This may be a hospital policy rather than an evidence based decision. Because a consultant says you fall in a 'high risk' group doesn't necessarily mean that you as an individual has any significantly elevated risk. If your bp and sugar levels remain ok, I would be asking what exact risks they are concerned about.

But I can´t see where you´re not getting a choice.
You´re under consultant care-but he´ll only "interfere" if necessary?
Isn´t it just a precaution?

Could you request an appointment with a consultant to find out the actual set up in the ward? Or a midwife might give you a tour.

MintHumbug - ok that is the case to some extent but if you're surrounded by staff who only see birth as high risk then they will be less able to manage lower risk and less experienced in managing low intervention labour. It's the whole cascade of intervention thing. I'm happy for whatever interventions are necessary but do not like the protocol, box ticking approach I'm seeing here. I just want someone knowledgable to talk to me and explain why interventions are needed when rather than being told "this is how we do things."

Would it help to rty and speak directly to the person in charge of the MLU?

If you could convince them that you were sufficiently low risk then it would make things much easier. At the very least they would be more able to explain why they 'didn't want you there'.

I have experience of 'getting on the wrong stream' IYKWIM. I was allocated for consultant care due to health issues that had no implications for pregnancy (because computer said no). Did get sorted in the end and I was ok for the MLU.

I wanted to use the MWLU when i had my ds, but because i was overdue, i had to be induced, so i had to go on the CLU, and i was dreading it. I hate needles, and i thought i would have to have drips and all sorts, be strapped to the bed with legs up in stirrups!!! LOL, i worked myself up into a right state! On the day however, i went in and said "your not sticking needles in me, im not having this, im not having that" They simply put the gel stuff in, and left me to it! I was allowed to go for a wander around the grounds and everything! When the contractions really started to kick in, they even let me use the pool! However i was monitored slightly more than i would have been for a 'totally' natural birth, but other than that, everything was how i wanted! Well, apart from the fact the room i gave birth in just had a standered plastic cot, rather than the lovely swinging cribs that the MWLU had!

I'm not getting a choice to access facilities to enable an active birth or a choice to even find out what facilities are available. They don't do tours and the junior docs in clinic have no idea unfortunately.

Yes, muddleduck that is a good idea - I did ask to speak to a midwife at last hospital appointment and got told I couldn't. Have to try again.

That's really reassuring IveStillGotIt - I tried to find out what they have on the CLU and all I got was leaflets about drugs but they may well have facilities like yours did which would be great.

I think a size 20-22 is a bit porky but not really in the big zone, IYSWIM. I was probably that size after a very awful and sedentary pg and I had a perfectly simple HB (I also had SPD and was stoned up to the eyeballs on codine FWIW). If you want a HB, and you've given birth easily before, then I would just start making arrangements for one. I should probably also mention I was under the consultant at the time for the SPD and she was very supportive as she thought HB was a sensible option, so this is probably just your hospital's policy.

mollybob can you call the supervisor of midwives on the ward and speak to her? SHe may be able to swing it for you.

I agree that the junior doctors/registrars are hopeless in most cases and you are much better off with an experienced midwife OR the consultant!

I would definitely try to speak to your local MW team... they might be able to advise you further on facilities available in the hospital and also support you in your care. Surely for baby no.3 then they should be a bit more supportive in your wishes!

I am a bit concerned though as I have just been referred to consultant led care when I reach 28 weeks due to my BMI being 35. My MW thinks these weight guidelines especially as this is my 3rd too is completely unnecessary and feels I would be better under her care!

Please call the consultant secretary (or supervisor of midwives as susie100 said) and request an appointment. Even a HCA could do a quick tour of the ward with you surely?

thanks shaz10 - they stopped doing tours because of swine flu and still refuse them - blanket ban

there is a nice DVD about the MWLU though

there is an active birth class but no one booked for CLU is allowed to go to that either