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Childbirth

Share experiences and get support around labour, birth and recovery.

How do I talk to my consultant?

8 replies

heartmoonshadow · 04/04/2012 14:57

Really asking for advice from anyone who has anything to do with consultants in general as although I know that they are only people their status is a bit daunting for me.

The story is that I have moderate Pregnancy induced hypertension / queried pre-eclampsia as protein in urine going from trace to ++ at different opportunities with some anomalies in two out of 4 blood tests. Anyway I was in hospital last week for a couple of days and I am now 35+6 today.

I managed to persuade them to let me out as I have a 2 year old to look after. I have to have a community midwife visit daily to take bp and check urine which is fine but I have a consultant appointment next Wednesday at 36+6 at this time I want to broach the subject of when not if I will be induced. I have looked at the NICE guidelines who say if I was severe that they would induce me at 37 weeks if not that it should be decided between the doctor and the pregnant woman. Which I take to mean the doctor as they often take over.

I really don't want to go past 37 weeks as last pregnancy I had the same problems and when I gave birth at 37+0 dead on my placenta was so degraded it looked like someone had raked it over with a fork.

I guess I need some advice on how to get my own way and not to give in to the wait and see philosophy which just causes me stress and worry. Also it would help me to know what date I was to be induced so I could organise childcare.

Sorry for essay any help appreciated thanks

OP posts:
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oikopolis · 04/04/2012 20:28

i suggest bullet points. write everything down and organize your concerns logically. be factual, use short sentences that are easy to skim-read.

then give your list/s of concerns to the consultant to read, and talk him/her through it.

try not to get emotional or show that you're anxious (i know it's difficult!). just be firm and factual and serious about what you want. say "i need to be induced at 37 weeks. i have xyz problems, last time xyz happened and i will not take unnecessary risks."

i.e. don't be wishy-washy about what you want, be direct, firm and clear, but be polite and let him/her also explain the concerns they might have.

good luck, i hope everything goes well x

cravingcake · 04/04/2012 20:46

As oikopolis says bullet point your concerns/worries/issues as this will make it clear and show that you have thought about it. Be clear about what you want, a small show of emotion is not a bad thing - they need to know how much this means to you.

Also, can you take your DH with you to the appointment? He might be able to speak up if you feel emotional/tearful or like things are not going well. He could help state what it was like during your last pregnancy and birth. If not then your mum or a good girlfriend for moral support.

Cant say I've had to do this but I've always found having a loved one with you at difficult appointments helps you feel stronger in your mind (even if all they do is litterally hold your hand).

Good luck.

HybridTheory · 04/04/2012 22:26

If you reall dont think you can manage to voice your concerns write it all down clearly and hand it to the medical staff (explaining why) to give to the consultant to read prior to you seeing him/her. Or get someone you trust to speak on your behalf.

heartmoonshadow · 05/04/2012 08:31

Thanks for your replies I have been really worried that I was being a wuss and that my concerns weren't valid it is nice to see constructive advice.

OP posts:
catsareevil · 05/04/2012 08:34

You could also ask your midwife to help advocate for you, if you will find it difficult to say what you want.

awingandaprayer · 07/04/2012 09:57

Hi heartmoonshadow,

I'm a consultant and we are not all scary people! Grin. Seriously though I do understand where you are coming from, some of my colleagues are not known for their people skills and despite my background I still dislike seeing doctors when im the patient. I feel fobbed off sometimes too and don't always get the answers I need particularly if I have forgotten to mention my job I only hope my own patients don't feel like that though none of us do as good a job as we'd like all the time.

It annoys me that this is sometimes necessary as if you aren't able to talk to them that's a failure on their part not you being a wuss, but here are my tips for getting a proper discussion and your views taken seriously:

Speak to your midwife first about your concerns about what happened last time, what you want to happen now and also what the consultant is like. In particular explain that you are worried about the consultant just taking over and not having the opportunity to express your opinion and what you want. Hopefully you'll get some reassurance if you've got someone with reasonable people skills!

Ask her about which studies/ guidelines are relevant. It's good you've looked at NICE - if you look at the full guideline and the references then the details of many relevant papers will be there. Take some of these with you with the NICE guidelines on the top of the pile which you will hold prominently in the consultation! You sound like you have clear informed views already but it will help to make the point that you are someone who has read up on the issues and may need a different level of discussion than someone who hasn't.

Also write a list of questions/issues/concerns and let the consultant know you have done this as near to the start as you can so they can take this into account and you don't run out of time to ask them.

If you are not happy with an answer then ask questions like: why? What is the evidence for that? What are the alternatives? What are the risks? For each answer he/she gives, pursue it with further questions in this vein until you feel youve been given sufficient explanation.

A tricky problem that is good to keep in mind is this. He/she is human and therefore has human concerns like keeping the clinic running on time, not making a fool out of yourself in front of a patient and doing a good job. The best and worst consultants feel this but the worst are often unaware of these internal motivations and unfortunately just get defensive and consultoid if faced with a patient with a lot of printed out notes. You can counter this from the start by addressing their human concerns by saying something like 'I realise you have a very busy clinic so can I mention I've got a list of questions I'd like to discuss at some point today?'. Smile and be friendly to put them at their ease too. I know it sounds odd as you're the patient, you're the one who should be getting the reassurance and professional treatment and of course it is really up to them to ensure the consultation goes well for you. But believe me it is intimidating being faced with what could be an unsmiling, potentially angry patient with a massive list of well informed questions. For this reason I'd probably avoid starting off by saying 'I need to be induced at 37 weeks' and try something like 'After what happened in my last pregnancy i really feel I need/I really want'. The problem with the first approach is that at that point the doctor may not know much of your story and not know if this is entirely reasonable or a very bad idea. If faced with 'I'm having an induction' they then instinctively worry they might have a difficult job in front of them to persuade you out of something that - for all they know at this stage in the consultation - might be really unwise. Some will give up on the idea they can make this consultation go well before its started and try to take over which is not what you want.

However, being direct and clear about views is important. Taking someone with you and briefing them beforehand is helpful and definitely explain what happened to you last time and how that affects you emotionally as well. Showing emotion is fine too though ideally stop short of lying on the floor screaming :)

If all of this does not work, then there are a number of options open to you. Speak to your midwife again and say you weren't happy. See if you can get another appointment. You have the right to request a second opinion and if the advocacy service is any good then they can be useful.

heartmoonshadow · 08/04/2012 11:37

Thank you so much wingandaprayer #i must admit I hadn't really considered how the consultant feels and that it is a two way street - talk about blinkers! I will look at lots of studies and prepare myself with printouts.

HMS

OP posts:
awingandaprayer · 08/04/2012 12:15

Yes, but I hope I was making it clear that you are the patient with real worries and concerns and it is your consultants job to make you feel at ease so you can address those to your satisfaction - not the other way around. These are just tips I use myself when a patient to aid the process! However, if it doesn't go according to plan and you feel unhappy with the outcome then that's the fault of the consultant so get a second opinion and if possible see if you can get your midwife to recommend who would be best.

Good luck, hope all goes well.

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