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.

Mm, I was banned from the birth centres and MLUs in my city because I had a previous caesarean.

For me, being at home and having an active birth was far safer (even with the tiny additional risk of rupture) compared with the risks of going into hospital with CFM, high caesarean rates, unfamiliar environment, stress etc.

It's very easy for women to be labelled high risk for a million and one reasons. It's so important to not just settle for this label but to figure out what risks there are which are specific to you and whether they are significant enough to change your birth plans to suit.

Hi Mollybob

I think in your position I would try to get an appointment with the consultant themselves, rather than their juniors ( who are not in a position to deviate from protocols). The idea would be to find out precisely why they think YOU personally are "high risk".

Your community midwife can help you to arrange this. Or you can just ring the hospital. I would also speak to your midwife and find out if a different consultant/team is likely to be more sympathetic. You can also try to talk to the Head of Midwifery. Sometimes it is about finding the right people to talk to.

I think I would also write a birth plan in advance of those meetings and take it with me to be discussed. And I would think about hiring a doula, too.

Giving birth on the consultant led unit does NOT have to = CFM, epidural etc, although some of the staff there might be of that mindset. If you have a birth plan signed off by someone senior it will help.

BTW I am technically ridiculously high risk (having had shock horror 2 previous C sections, oh and I'm OLD) but am going to the MLU and use the pool if it is not already occupied.

Good luck

Call the MW team and ask about the facilities

I had DC2 on a CLU and it made no difference - still just G&A no interventions
Okay the room wasn't all homely and there wasn't a sofa bed for DH but otherwise it was fine

I would request a consultation with the consultant and push for birth on the MWLU, if I were you, mollybob. Given your history, he might be willing to refer you there. Is there any indication that the baby is big, because if scans/exams say the baby isn't big, that is another piece of evidence to weight things in favour of you giving birth on the MWLU - and were your other two dc large?

You could also discuss with the consultant the fact that you would be willing to transfer to the CLU if that proved necessary in labour, but would like a trial on the MWLU - in other words say the right things that will reassure the consultant and get you onto the MWLU, even if once there, you'd hang onto the doorframes or padlock yourself to the radiator in order to stay there.

DS 8lbs 9 DD 8 lbs 5 and according to growth scans this one is spot on (50th centile) on every scan to date

I would be happy to move upstairs in labour actually - but would like to start on MWLU or if CLU has pool etc then I'll go straight to CLU and use their facilities - the decor doesn't bother me

Some great advice here - thanks so much

Hi. Understand your concerns and am totally on your side wanting midwife led care (....hated all consultants and doctors I saw on my 3 births, my midwives were fab)......but remember statistics don't tell the whole picture.

I did some research when deciding where to give birth and was comparing two hospitals. One hospitals intervention was so much higher but after more digging that was partly explained by the fact the higher risk patients went there in the first place.

Don't get me wrong. Am on your side! Just wanted to put your mind at rest that if you end up in C led section, there may be options.

Hope it all goes well!

Good luck.

hi

I have been under consultant led care for all four pregnancies and I really dont think it has made all THAT much difference. I still saw the normal midwife for all the routine appointents and just saw the consultant on top of that once a month. All of the deliveries have just been me, husband and midwife although for the second when I was quite unwell I found out that the doctor had been sitting outside the room on a chair in the corridor in case he needed to rush in! I have been able to move around as I like, use the bath in labour, and have just had straightforward deliveries with gas and air. I dont think that you are being unreasonable to be a little sad that you cant use the midwife centre BUT you can still have a nice relaxed birth in the consultant ward it doesnt mean you will end up tied to the bed on drips etc or c section.
The consultants I have seen all four times have actually been very pro natural birth and have gone out of their way to avoid c section etc.

That's a shame about the swine flu thing. I thought that was out of fashion now!

BoffinMum, quote: "...I think a size 20-22 is a bit porky but not really in the big zone..."
What on Earth would you consider 'big'?
Where does 'plus size' start? Thought 14 is definitely a 'plus size', never mind 20....

Size 14 isn't a plus size, its a healthy size. For me, size 16/18 is when you start to think big/look big .. But sorry, size 20/22 is vastly overweight in my thinking. Weight aside, surely the most important thing is whats right for the baby.

As someone who is size 22, this is definitely in the FAT zone. It's not good to be preggers at this weight, as I can testify, and I am now trying to shift this weight to get to a healthy (not necessarily slim) level, and fitter for the kids.

People who are size 14 should be within the healthy BMI range.

I'd recommend writing a birth plan, and giving it to the midwife who takes your details when you arrive in labour.

It can be your written record of the sort of birth you would like, so the midwife will have the chance to see you want a low-intervention birth, regardless of what has been put in your notes.

Start off by saying that your prefered option is to give birth on the MLU, and that is that is not an option you still intend to have as little intervention as possible. That you want to remain mobile and active throughout the birth and that you do not expect to be permanently monitored or be restricted to the bed unless there are overwhelming medical needs.

Put whatever you want. And then show it to everyone you come into contact with as you get close to the birth. Share it with you birthing partner, the consultant, the junor doctors, the midwives.

Once it's written down it is much harder for HCPs to ignore.

I was a 20-22 when I had each of the three dses, and had no problems whatsoever - bp never high, blood sugar normal, no problems in labour or delivery (apart from long labours) and three healthy babies, weighing in at between 7lb and 7lb4.5oz.

Oh, and I had ds2 and ds3 at home, and no-one made any objections to the homebirths on the grounds of my size - even the consultant who was very anti-home-birth didn't use that particular bit of ammo.

I know I'm a heifer but at present a pregnant but healthy one. I would be a whole lot happier with your type of consultant led care fernie3 - I have to see a doctor every time because that's what the protocol says but never an actual consultant. I booked a hospital midwife appointment once and she refused to see me and was very unpleasant - this was at 16 weeks. I have met the community midwife twice but I was told by hospital that was unnecessary duplication of appointments and made to feel awful for wasting resources, Last time the junior doctor had no clue how to use the scanner and came out with a due date in August...

Good god mollybob, you are slim and sylph-like compared to me when I gave birth. And my weight caused me no problems during labour either time. First birth, I did have some issues but they were unrelated to weight and the second time round my bum barely touched the bed of the CLU as the baby arrived so fast.

And FWIW plus size catalogues start at 16/18 so that's my definition - definitely not 14. I last had a perfect BMI years ago and was a 14/16 then. Have put on about 1 stone in pregnancy to date and plan on losing weight with breast feeding afterwards as I did with DD.

Erm, this isn't style and beauty. The point is whether size 20-22 is likely to cause any medical complications NOT to judge how 'fat' the op is.... or how dare she consider getting pregnant when not the perfect bmi. (And size 14 is perfectly normal).

It would seem that if her bp and sugar are ok, then the risks are very small. I know home birth midwives who would happily take on someone of this size. Hopefully the op will be able to get the info she needs now about her own personal risk.

It seems to me that your hospital has neglected to grasp that there is even a concept of woman-centred care.

I'm appalled that they feel that they can make you feel bad for wishing to see a community midwife.

Please do pursue seeing the consultant, or ask to be transferred to another team's care. They are not listening to you. I think it is definitely worth threatening them with a home birth plan just to get them to start taking some notice.

if you would to like to stay in the MWLU to begin with but can't - and i can understand why they don't put you up there sorry -
then could you not stay at home until you really couldn't stand it??
surely you would feel better there and labour more effectively, meaning you probably won't be pressured into any interventions not really needed?

i think you need to swallow your pride, you and baby are at a higher risk, that won't change if they put you on a different ward?

i am all for every woman having her ideal birth, but really this is for your safety.
I f i were you, i would stay at home for as long as possible, then go in to deliver as close to the last stage as possible.

But yes YABU to resent consultant care, you should be bloody greatful for it.

If I were you I would ring the CLU and try to find out what facilities they have - ours has a pool etc and you might find the CLU pool is much more likely to be available than the MLU one!

Ah op, I could have started this thread (and pretty much have in the past!) Very annoying to have MLU/home birth/water birth options ripped away because of bloody box tickers, I know exactly what you mean.

Last time despite having a bmi of 53 I had a perfectly healthy pregnancy, everything was fine, labour was normal and reasonably quick (I didn't enjoy it much but it was fine!) and had a normal weight baby. However despite all test results coming out clear, and the labour progressing in a textbook manner I still gave birth flat on the bed on the CLU surrounded by quite a few staff, with an IV in and attached to a scalp monitor.

That is what pisses me off about the whole consultant led stuff - I can absolutely see the need for all the tests, but it's shit that the results appear to make no difference to how you're eventually treated - like a bomb that's about to go off in their faces!

Anyway I'm 37 weeks pg with dc2, and again I'm under consultant led care, but this time round I contacted my supervisor of mw's who came out to the house and had a good long chat with me about my birth options. She's been an absolute star, reassuring me and supporting me - she said there's no reason I should have to give birth on my back, and although she made me aware of the reasons for monitoring/IV's etc she did say it's all my decision and they can only recommend things, not force them on me.

She's coming along to my consultant's appointment next week as he's a bit of a high handed tosser and she knows I'm anxious. She even said to ask if she's around when I go into labour as she'll come to support me if she possibly can.

I'd really recommend calling you hospitals switchboard and asking for your supervisor of mw's number, even at this late stage. She may be able to answer many of your questions and let you know your real options.

I was told for example, that even though I probably wouldn't have access to a birth pool in the CLU, unless there was a problem at the time I would be able to labour in the bath for a while which are "nice and roomy". I asked what would happen if I inadvertently got in too late and had the baby in the water, she said "well, nothing really, they'd probably try and encourage you to get out but if it's too late it's too late, not the end of the world. They can't drag you out or anything, that'd be assault!"

I'd say she's about your size by the way. She's great.

And all the people who say we should be grateful for having NO CHOICE in how we are cared for are obviously not listening when we say we are healthy, all test results clear, expecting normal sized babies which are head down, that we have had previous normal pregnancies and labours, and that we are accepting of all the tests and checks they want to perform.

It's when all those test results come back clear throughout yet are ignored and birth choices STILL utterly restricted that people become ungrateful, as then it seems more about the HCP ticking boxes and covering their own asses than it is about actual care of the patient.

Yes. Well said, James!

but you are a time bomb waiting to go off ffs!
just because you have a text book pregnancy whilst being obese doesn't mean the delivery is going to be textbook does it?

i don't see how you don't have a choice, certain options may be not given to you, but you do have a choice, you may not like it, but thats the crap reality of life and childbirth!

YOU SHOULD BE GRATEFUL FOR IT, BECAUSE ITS THERE TO SAVE YOU AND YOUR BABY WHEN THINGS GO HORRIBLY WRONG.

no one has a bmi over 40 and is healthy, thats a load of bull.

yes they cover there arses, because guess what if every health professional gave in to every paitents whim and request we would be knee deep in malpractice and neglegence cases.

MVs are not specialy trained for complicated births, thats why there is a different level of care for woman, if you don't like that then you should of lost the weight ( if that was the only issue ) before getting pregnant.

tbh its your own fault your in this situation really, so stop complaining and choose the lesser of 2 evils or get some private health care and pay out of your own pocket for exactly what you want.

OTT, you are OTT
She has had teo straightforward deliveries before - nothing has changed other than the hospital's policies. Surely we should be striving for care based on individual circumstances with guidelines to form a starting point, or best practice in most cases.