Does it make a difference if you see a registrar as oppose to a consultant?

[CrazyChristmasLady]

I was referred due to the birth I had last time and I saw the registrar. I remember this happened last time too and I never actually saw the consultant.

I have an appointment in January to discuss and finalise my birth plan and I have many questions and different scenarios that I want to go over.

Is seeing the registrar just as good as seeing the consultant and do they have the same level of authority? I thought they were more consultants in training so I find it strange that I have been left in their hands rather than ever actually getting to speak to a consultant.

The registrar is the consultant in training.

Depending on how much training they have had they might be very close to being a consultant, or a few years away from it.

It is the consultant who carries the responsibility for thier patients care, so the registrar may want to run things by them, especially if the questions that you have arent issues that the registrar is familiar with.

Ok, I don't know how much she will run by the consultant as the first time I saw her it was to discuss M.E. and giving birth and she immediately said having M.E. would make no difference to pregnancy or birth. She didn't explain how she knew this or ask anyone for advice. She said the same thing this time (I saw the same woman again, so last time would have been 3 years ago) even though that wasn't what I was there for but I did wonder how she could be so sure of her information as nobody actually knows much about M.E. and pregnancy and birth. My concern was having the stregnth and energy to push last time, but she did give me good advice on that, I'm just keen to avoid the same sort of birth due to the results of last time.

In my birth plan I put that I would only consent to a c-section after talking to a consultant (ie the most senior person and the one whose responsibility it is if it all goes wrong).

This was 3 years ago and this eventuality never actualised but recently when I was discussing it with my Mum (who used to be a G-grade/senior midwife) she said that if it all goes pear-shape you are better off with the registrar. I was quite shocked by this. He reasoning was that they are the ones who do most of the sections so are more skilled than the rusty consultants.

So, to answer your question, seeing the registrar is probably fine. However, depending on the issue I'd still want to see the consultant too.

Really? Thats surprising, I assumed it would actually be the consultants who did the surgery.

My issue is, I have a choice whether or not I want a c section this time as I had a forceps birth with 3rd degree tear with DS. I was stitched in theatre and had to see the colorectal surgeon later on.

The surgery went well and I have been told that I healed really well too. As a result they are letting me have the choice as to what birth I want (I don't actually want a c section but want to give birth naturally). If I hadn't healed so well, they would recommend a c section.

I want to know that in the event of me needing forceps again, I would rather have an emergency c section than go through another forceps birth.

The registrar also said that if I choose a natural birth they will automatically do an episiotomy to try and prevent tearing, even though she then told me that there is no evidence that this actually helps at all.

I discussed that with my MW and she agreed that there is no need to auntomatically do an episiotomy and I have read on the net about it. There is simply no evidence that it prevents tearing at all, so I'm not completely sure of the registrars advice on that one.

I have had 2 CS, one done by reg, one done by the cons, and IMO the reg did a better job.

It is up to you to decide if you are going to consent to an episiotomy or not - they cant do one 'automatically' regardless of your wishes.

When you are in labour the reg isnt likely to be there in any event - even if they are on call they are unlikely to become involved if things are progressing well.

You seem a bit worried about the knowledge base/experience of a registrat: I think you may not realise how long most registrars will have been working in their chosen specialty. Most are in their 30s, so have been doctors for a long time (10 yrs plus). The registrar grade comes after passing all your specialise membership postgraduate exams, so they will be bang up to date with the theory and doing the bulk of the ward/theatre work (the consultant often spends a fair bit of time away from the ward, they have teaching responsibilites, may be involved in research etc). The consultant does have ultimate responsibility for each patient however.

I worked in obs and gynae for a year as part of my GP training and I would agree with the midwife who said the registrar is often the one to see in preference to the consultant: they are doing the job day in day out so tend to be on top of their game.

Sorry for the multiple typos. Must learn to press preview.

I had 2 CS's, both done brilliantly by a registrar.

However when talking through options re birth and what the hospital would agree to I said i would ONLY speak to my consultant (he had been heavily involved with my first pg, but not the actual CS). they did agree to this, but i did have to stage a sit in put my foot down

Ps they would probably recommend the epis as you tore so badly last time, they will want to avoid you tearing "naturally" along the previous tear line - the tissue will be weakest here - and therefore risking damage to your anal sphincter again. So whereas usually its better to tear, in your case it may not be.

(I apologise unreservedly for mentioning your anal sphincter when I have only just met you )

My own view, when I had concerns about my birth plan, was that I needed to talk them over with my consultant and not with "a member of her team". It was better that I saw her because she spoke to me like I was a grown up (gave me a sensible risk assessment instead of trying to scare me) and did not just spout hospital policy, as the juniors did. Also, when I was in labour and the registrars proposed a course of action which was really not a good idea I was able to tell them the consultant had agreed it wasn't a good idea - and she had recorded that in my notes. Even though the team on that night were not in my consultant's team, they respected and abided by what she and I had agreed.

If you want to see your consultant, next time you have a clinic appointment tell the receptionists you want to see the consultant and not any other doctor. You may have to wait a while, but you'll be seen eventually.

I'm consultant led and all the registrars I've seen are quite junior so far and at the start of their rotations. The last one I saw was beyond useless in a consultative capacity - didn't even open my notes, asked me about my scans rather than looking at my records, and when I pointed out I was having twins, it was like pressing Play on a tape, and our came all his twin-related-facts, starting with how much higher risk I was for x, y and z. I let him bang on for a bit and said "with respect, I'm 28 weeks pregnant, it's a bit late for all this now, don't you think?"
He grunted and shuffled a bit so I helped him out by asking about the blood tests I was due to have. He said I wasn't due any, and at that point I gave up and went to see the phlebotimist to ask what to do next. I knew I needed my diabetes test doing, a FBC for anaemia and my platelets monitoring cos I'm on clexane. But divvy reg wouldn't have known this as he never opened my file. The phlebotimist laughed and said "you saw that big lad, didn't you? He's new." she sorted it all out somehow and since then I've asked to see the consultant, not some daft lad!