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.

Fab post porcamiseria

I do have to wonder, given that the CLU is only one floor from the MWLU, why the OP can't start her labour there, and transfer to the CLU if neccessary. That is bound to happen there when women with no indications of any potential problems suddenly develop a problem in labour.

The OP would be monitored on the MWLU, and could transfer if neccessary - and if she's somewhere where she's happier she will be more relaxed which should make things go better, whilst being on the CLU might make her less relaxed and more stressed, and cause the problems they are so anxious (rightly) to avoid.

she shoukld ask, but if they say " you have a BMI of XXX, this puts you in XXXX category" then wont she get even more upset?

There are things worth fighting for . Op needs to think if she really wants to have a fight when (a) she is 36 weeks PG and (b) the NHS have (and I know some dont like it) valid reasons that put her in a risk category

Thanks for your concern but I've not been in the least upset by anything said about me here in AIBU - I'm not a long term MNetter but I've been here long enough to know what AIBU is like. I was a bit perturbed at people who say size 14 is plus size - not for me (I may never see 14 again) but for our young girls who hear that sort of message and end up with a really screwed up body image.

I know I'm fat - jeez I'm not stupid. I have not said on here that I'm not massive - I just made a few excuses about being fat due to comfort eating but being (when not heavily pg) pretty active. I actually have a mahoosive arse and treetrunk legs.

I lost a fair bit of weight after DD was born but then my life hit the toilet and I ate my way through 2 bloody awful years - we still have a home and my DH is still alive so my figure suffering was a small price to pay. Yes, I should have lost weight before getting pg but I didn't. I was eating healthily when DC3 was conceived and had lost about half a stone that month - I just didn't expect to get pg so quickly (2nd month of trying - I know how lucky that makes me) especially since I'm an old hag of 37.

I did say that I have no complications in this or other pregnancies - my BP has never been raised, I did not have pre-eclampsia although obesity is a risk factor for this. I do not and have never had gestational diabetes - I have put on very little weight this pregnancy. I have been eating healthily and avoiding junk food and sweet stuff. Baby's growth is absolutely spot on.

I am mostly peed off that I have been told all about what I can't expect in labour, not what I can expect. That being consultant led for antenatal care in this hospital means being positively excluded from midwife input and midwives are the experts in normal birth, not doctors. That because I'm high risk but not really high risk that I haven't actually seen a consultant ever. And I don't need to be told I'm high risk but I want to be told what at this stage I'm at risk of - particularly as I had a MLU delivery for my daughter and the only difference is hospital policy.

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

Words actually fail me that you could type something so offensive. Women who are 'plus size' (I am a size 18 after having DD, was previously a size 10-12) are all too aware of their size. The reality is that we 'massive' women can lose weight - Sadly you cannot change your tactless and thoughtless attitude.

OP, please be reassured that just because you may give birth on a CLU, it does not mean you will have a more medicalised birth. I was a CLU mummy as, despite being normal weight, I actually suffered PE during pregnancy and was heavily monitored throughout. In my experience, the midwives and doctors on CLU will strive to give you the best experience possible. Good luck x

I really can't understand why they won't let you see a midwife - it makes no sense at all. Of course the doctors aren't the best people to advise you about what happens in the CLU when women have a straightforward delivery without intervention as this is not a situation that they get involved in.

I'm having a high risk pregnancy and am under my hospital's special unit for women needing more than straightforward consultant care. I still get to see the midwife at every appointment, then I usually see 2 different consultants. I know my community midwife would be happy to see me as well if I had other concerns I wished to discuss with her (I haven't bothered with that this pregnancy, but did in my first pregnancy and she was great at setting my mind at rest and helping me make the most of having to have my baby in the hospital CLU rather than my local MLU as i had orginally planned.)

Have you managed to speak to the supervisor of midwives yet OP?

When is your next antenatal app? Could you ring up, ask who you'll be seeing (if it keeps changing every time) and let them know some of your concerns / things you'd like to discuss and can they ask whoever and be able to answer your questions?

I'd agree to taking a birth plan along and seeing their reaction - maybe offer to send in advance or leave them a copy if that would help.

Then have anything particular you're keen on right at the top - I'd like to be in the MLU please; active natural birth; intervention & monitoring only if necessary; I'd rather not lie on my back, it hurt last time (which is going on my plan for 3 weeks time); etc.

Thanks for the support and advice here - I have managed to speak to a community midwife and she was very supportive and has arranged for me to definitely see a consultant at my next appointment and she suggested as many have here that I bring along my birth plan and discuss what is and isn't possible in terms of MLU, CLU, active birth, water etc and the consultant she has arranged for me to see is apparently good at explaining things. If what she says makes sense then I will accept it and stop stressing and alter my birth plan accordingly.

Great news, hope it all goes well for you

Honestly, try not to worry. We can and do facilitate normal labours and delivery on clu!

I would definately advise doing a birth plan but do be flexible and prepared to deviate from it if neccessary. I say this to all ladies, not just 'high risk'.

Oh good. Hopefully should answer enough of your questions, and hope it goes well on the day too.

Interestingly I have just seen a research job going at Kings College London looking at improving pg outcomes for obese women. The emphasis seems to be on reducing insulin resistance via healthy eating, which as they admit in the research outline, might well be all it takes. There's more detailed information about the study here. Probably worth quoting to any consultants who get stroppy.

Download the Word document

Consultant was fab - she described me as low risk because of how well I've been this pregnancy and my 2 previous deliveries. If totally up to her she would be fine with MLU or home birth and assuming babe stays head down and I go into labour spontaneously, she expects all to go well. She wouldn't even have a problem with me attempting a vaginal breech delivery. But the lead midwife on MLU is very strict about BMI and although a stone of weight loss before getting pregnant would have been enough to allow me through the doors, rules apparently are rules unless I really want a fight.

We have discussed a compromise which is that when I go to hospital I will be assessed on the ward and as I don't want drugs I can stay there until I'm over 8cm - they have baths, birth balls, gas and air etc on the ward which is all I really need - have looked into a water birth and tbh don't think it's for me anyway. Spent about 2 hrs in bath when DD was born and although it helped the contractions it was no better than the TENS and it was boring. Wandering around was better for me.

She then did a scan and DC3 is growing and developing perfectly

I'm v interested in what you said BoffinMum about diet as I have been following a low GI diet strictly to prevent weight gain and reduce risk of gestational diabetes as seemed a sensible plan in view of my size - interesting that it's being studied - it just made sense as an idea for me (DH has diabetes so easy enough for me to fit in with it!)

Thanks for all the support - think I was being AIBU for being peed off with consultant led care - I just needed to see the bloody consultant once though.

fantastic, so glad you managed to speak to the right person and all is looking good for the birth you want

good luck - looking forward to hearing your birth announcement

Great news! Good luck for the birth.