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.

I am a midwife on a very busy consultant led labour ward.

The majority of my colleagues and I will always endeavor to provide you with the birth you want but ultimately we have to inform you of all risks etc to yourself and the baby. Thus enabling you to make an informed choice. We will not strap you to the bed with ctg belts!

I know of no midwife that will put on a ctg advise epidural etc without good reason and everyone I know practises within guidelines with up to date evidence based research. To not do this is a breach of our professional responsibilty to you and your baby.

Fwiw medicalising birth is a lot more work for us so it wouldn't be done lightly. We would much prefer you to have a normal delivery with entonox

OTT that is out of order and unless you have had access to the OPs/James' medical notes, not a statement you are qualified to make.

Every patient should have the right to make an INFORMED CHOICE about their care. Every patient has the RIGHT to decline any procedure or treatment and the need for these should be explained properly. The OP's hospital has neglected to do this.

OP i can sympathise, it seems most of the time it is far more about covering their own backs than caring about the individuals involved, in fact i had a junior pretty much admit that to me. in my experience the supervisor of midwives can be brilliant help.

geek of the week that's brilliant but so far from the case in some hospitals, during my last labour i was bullied into getting onto a bed during a well managed controlled labour as 'we have to attach you to the monitor now you're in labour' had been in labour for hours but had been left to get on with it, baby was descending quite calmly till they got me on my back at which point she shot out (2/3 contractions)leaving me with a big tear which took around 8 months to finally stop hurting, im convinced if i had been allowed (and i hate that phrase) to labour as i needed to she would have come out slower and probably not done half as much damage, we will never know but i know the difference getting onto that bed made to my labour.

for those who think i should have been grateful for being there/treated like that i had been admitted (planned home birth) for monitoring contrary to all standard advice purely because i have had pre eclampsia in previous pregnancy's, i was not ill, and had been told in anyone else they would have been happy but because i had 1+ protein it was better i was checked out, of course once i got there i was told i had to stay to be on the safe side, was given a sweep and then kept up till 1am by the most patronising woman(midwife) i have ever met, come the morning i was told i was healthy and could be discharged unfortunately i was in labour and an hour from my home, so healthy and cleared for a home birth i was treated like a pre eclampsia case just because i happened to be in the clu when i went into labour!

OTT, this is what it comes down to, people who think that we should all either put our lives on hold until we are thin as if it's the be all and end all, or put up with (and be grateful for) unpleasant and/or potentially unnecessary treatment during labour as if it's all we deserve for being fat and daring to still have a life.

You said that we should be grateful for Consultant Led Care because it's there to save you and your baby WHEN things go horribly wrong (and Midwife Led Care isn't?) That kind of assumption is exactly what I'm talking about - assuming things are going to go wrong, despite all evidence to the contrary from antenatal tests, growth scans etc.

Terrible things can happen to slim women in labour too with no warning, yet they aren't routinely told they can't go in a pool, can't have an active birth, and should prepare for a section (like I was last time. I went on to have an 11 hour labour, drug free, he was out in about three pushes)

I'm only saying that care outcomes should be based on hard evidence on the woman in particular. This is very schmaltzy but I agree with the basic sentiment. I am not a number.

If I get to talk to someone who actually knows what they're talking about, have an informed discussion and be listened to then I'll happily accept any intervention that is evidence based and reasonable.

But I am sick of being patronised and brushed off. I'm fat, not stupid and I have given birth twice before so I know what under ideal circumstances I can do. It is not pleasant to be made to feel that you can't give birth naturally because the people you are speaking to repeatedly, have a wholly medicalised view of birth. I don't want a home birth but just feel like saying I do because they might listen to that.

Do try to get through to your supervisor of midwives, molly. Mine literally sorted everything out and even gave me a hug as she left!

i shouldn't post her again, because i can not see past what i see as ungratfullness.
women all over the world would chop an arm of to recieve NHS care during pregnancy and childbirth, and all i see is someone complaining about the service provided because she is a risk, which is proven from previous pregnancies, being obese whilst pregnant and having pre eclampsia is dangerous, they are doing this for you & your baby's safety.
If you don't like it have a HB and take the risk yourself. - remember you don't have to have your baby at hospital, but don't moan about people trying to help you.

Molly - does your hospital have the initials RBH and is in one of the home counties? Your descriptions sounds familiar to me.

Iagree OTT.
It's just a completely puerile strop.Get a grip-you aren't the only woman in the world to ever have had a baby.

And as for your assertion that you are 'not massive' at size 20-22.

Words fail me.

Ott - you are very aptly named!

Look - the op appreciates, as do we all, the wonderful provision the NHS can make, but that doesn't mean we have to accept qithout question every option offered to us.

A cascade of interventions arising from one assumption 'this woman is too big to deliver naturally' is by no means unknown. The op is entirely right to be concerned about that and you are entirely wrong to insist that she must simply be grateful and put up with anything she is compelled to undergo.

'and you are entirely wrong'

Who are you?
King Herod?

yup

And now for my post promised from last night.

Op - I am the same size as you and dd3 was delivered in 2007 when I was 30. Dd1 was 8 8 (15 days late), dd2 was 8 13 (7 days late) and dd3 was 7 15 (8 days late). All three were vaginal deliveries.

With dd3 I requested midwife led care because I saw no need for consultant input if all proceeded within norms. I was sent an appointment to see the consultant however which I kept. He wanted to see me to arrange for a foetal cardiac scan as dd2 has a CHD but he also mentioned booking me for a GTT which I declined. We had a chat about this and dh and I asked him to show us the evidence that testing all women with higher BMIs in pregnancy as a matter of course, without any other indication at all, improves outcomes for mum and baby. He couldn't because there isn't any. Testing symptomatic women is of use - but I wasn't at any time symptomatic. He then looked at the birth weights of the first two and said dc3 would be at least 9lb and they needed the GTT so they would be 'ready for' any problems in labour such as shoulder dystocia. But I said - SD can't be predicted can it? Er no was the answer (and in any case all units and all midwifes drill for SD because it can happen to anyone. It's not like the GTT has a preventative effect or that otherwise they wold be taken especially unawares ) Any way he accepted we wouldn't be having the test and handed me back to midwife care. I had a text book pregnancy (again) and delivered my smallest baby with an episiotomy (as with all my other births) but no other intervention.

Plus size women aren't trying to harm their babies nor are we too proud to listen. Like all mothers to be however we reserve the right to weigh up all our options and make choices.

Op you've had some good advice on here (amongst the casual insults) and I agree the key is to talk to the midwives involved.

The system is stupid.

You are having extra scans and blood sugar checks while my concerns about gestational diabetes are being ignored and my baby remains unchecked even though I have had one macrosomic baby.

OTT - you are ott

OP is not 'massive'. I am! Have had 3 deliveries at size 24-26. First one was OP, ventouse assisted. Others were SVD, one induced at 37 weeks will gel for unrelated medical complications (the only other person the doc had ever seen with my condition was a 17 year old size 8 - he didn't think I could have it as I was too big !!)

There is more risk in pregnancy from being overweight, but, apart from large babies, not in delivery as far as I know. My babies were all big (9lb12, 9lb3, 7lb13 at 3 weeks early) but then my tiny teeny mother had a 10lb6 baby - runs in the family.

I know I am fat - well, years of depression and some other medical problems do that to you. I hate people suggesting it is a moral failing.

You could "bargain" - say, right I am having a home waterbirth then. They will start flapping. Pretend to think about it all and start negotiating - you'll drop the HB if allowed in the MLU etc. All you probably need to do is ensure you see a consultant who will probably sign you off for MLU anyway - just insist next time you go in. Also speak to Supervisor of Midwives. I know it seems like a massive annoying faff but just ring them up tomorrow and speak to the supervisor on duty.

OTT and moondog's posts are foul and ill informed.

The op does not have pre-eclampsia and obesity isn't necessarily highly dangerous.

Here's a relevant study - Scroll down to 'complications of delivery.

From my reading, if she does not have bp or gd, the risks aren't really significant. Obesity dos not affect duration of labour. A C-Section is more likely because of pregnancy complications (which you don't have) and possibly failure to progress, which is less likely as you have had a previous uncomplicated delivery.

Actually, she may be very wise opting for a home birth as that would reduce her chance of a C Section which does carry more significant risks for larger women.

OP, I am totally with you. Different circumstances (I am pregnant with twins rather than a big size) but all I get told is that I won't have the same choices to have a natural birth this time (ds was a homebirth). I recognise there are risks for baby 2, which is why I want a hospital birth, but a hospital twin birth seems to come with a cascade of intervention as routine. There must be a middle ground between homebirth and compulsary epidural and continuous monitoring.

Being ready to react if there are signs of baby/mother being in distress is good, and something I would be grateful for OTT. But creating a cascade of intervention which can lead to negative outcomes itself "just in case" is not, IMO. I'm with you OP, YANBU.

Well - I think I'd rather be friends with the OP and Carmen and weegiemum than with moondog and OTT - not that they'd want to be friends with an obese lazy greedy depressive like me.

It's worth repeating that not even my very anti-home-birth consultant told me that my weight would make a home birth more dangerous - and I'm sure he would have, if he'd got evidence.

SDTG - don't let that get to you ok?

Ok, Northernlurker - thankyou.

I agree with screaming eagle, noone is forcing you have a medicalised birth. They cant force you to have an epidural. You can have (we hope!) a natural birth, use gas and air etc up there.

The NHS are dammed if they do, dammed if they dont. Clearly (maybe unfairly in your eyes) you are in a category they see as risky. They have to do what they have to do. Many people fall into said category, they are not being "sizeist".

Rather than getting het up and stressed, maybe try to relax, go with the flow and have your natural birth one floor up? You only have 4 weeks to go so AVOID STRESS

and that includes posting on AIBU as you are bound toget some upsetting feedback, not nice for a heavily pregnant lady!

I think though, Screaming, that The OP's hospital has done nothing to reassure her that she can have a reasonably active, low intervention birth. I know that it IS possible on CLU, but they have repeatedly failed to explore or discuss with her how she would like to approach the birth, nor why, in her particular case, she is considered "high risk".