What is reasonable to expect of my obstetrician?

[Volley2014]

I've gone private due to living abroad mostly. In London, Lindo Wing. Well known obstetrician.

I am 28 weeks and i'm feeling a bit unwell with sickness, dizziness and very LOW blood pressure (93/50.) Also I am losing weight and haven't been doing anything differently. In fact I've been eating more but only gained 5kg. My bump doesn't look big, in fact it looks barely there some days.

If I am paying him, should I expect to be able to call him up and get seen the same day? Or at least get some advice over the phone?

On NHS I would expect to be able to speak to a midwife same day if I was really worried so yes! When I've seen consultants privately (not obstetrician) they usually return calls promptly or their nurse does, not sure about same day appointment.

As puppy said - you would expect so. On the NHS so even more so when your paying mega bucks

Hope you feel better soon

I'm St Mary's consultant led on the NHS and would expect to speak to someone same day for this. You should have a 24 hr phone number for the midwives on the front of your notes even if private - remember if it's an emergency you can still call the NHS ward!

There are various things which might cause this - of course it may simply be you carry 'small' (I put on only a little weight but it was just me- but my BP etc' is fine) but sometimes people get thyroid issues or anemia - simple to treat and diagnosed by a blood test.
In terms of blood pressure, how do you know? Home BPT is quite unreliable - again I would contact St Marys.

Yes, you should be able to phone him. And I expect he would want to see you more often to keep a close eye on you. That's what my private gyn would have done. HTH.

Squizita should I be phoning the midwives at St Mary's before calling him? I do have that 24 hour number.

allisgood1 He is not in contact with me much. The last time I saw him was at 26 weeks and that was just a "how are you feeling" chat. And at the time everything was fine.

Volley do you think you might be anaemic? Have you had an appointment or 28 week blood tests? I'm 28 + 5, had blood tests a week ago and my ferritin count is v low, I pretty much have no iron reserves. I've been feeling absolutely wiped out, and a bit dizzy/faint - apparently it's not unsual for iron deficinency to really kick in about now. Definitely call & asked to be tested - I'm on 105mg iron supplements and making a conscious effort to eat more meat and I'm feeling better already.

P.S. I'm not in the UK but my LMC is an obstetrician and I call/email whenever something occurs to me. I figure I may as well get my money's worth!

I have my obstetrician's mobile number and have been instructed to call him with any concerns day or night, so yes.
Have you had difficulty getting through or something?

I had a private obstetrician, although not in the UK.

During office hours I could call her at her office and expect a call back within an hour or so if she was too busy to speak straight away. If a problem was deemed urgent then she would ask you to go to delivery suite at the hospital to be assessed by the mws, who would then act accordingly, either getting her to come to see you or calling her to let her know all was ok.

Out of hours I could call delivery suite and the mws would decide if you needed to be seen straight away and they could call the ob out if needed.

But even if you're not paying you should be able to access advice 24/7.

Regardless of who you should call, you really sound like you need to call someone. If you make the call and it's not quite the right person then they will just direct you to whomever is the best person for you to speak to.
Don't let your concerns about protocol get in the way of getting the assistance and care you need.

Ring the MWs

I had full consultant care on NHS, and the MWs are the ones who track down the consultant for you, work out when you can be fitted in, see you beforehand (and fit in tests/scans is needed) so that when you see the consultant, all the info on which they could possibly base their judgement on what happens next is already in their hands.

Though of course, the MWs/scanners will all have told you what's going on before you get anywhere near the consultant, so they can easily seem a bit irrelevant if it's something and nothing.

Hope you're OK OP.

Yes I would ring the mw helpline. They are the 24 hr 1st line of care for everyone. They'll put you through to a Dr if required.

Volley, I would contact his secretary and tell her how you are feeling. She will call him and he will likely call you and want to see you. When I was private the hospital wouldn't have helped me as I was a "private patient to dr x". Anytime something went astray (and this happened a few times) I either called him or his secretary and they called the hospital then arranged to meet me (for example in triage). That's what you should be expecting from him. How often are you seeing him? I was every 4 weeks until 32 weeks i believe then every 2 then every week.

Allis even if you are private, the hospital should treat you (if you have an nhs number) in cases of emergency or concern, via maternity triage or A&E. Your national insurance entitlement doesnt vanish. Otherwise private patients would be unable to travel away from their hospital and likewise consultants would never be able to have a day off (bearing in mind they have several patients) or take NHS patients just in case a private patient was taken ill - dropping things 24-7 simply isn't viable. My consultant couldn't exactly call me and say "sorry a private patient needs to see me now and no one else will treat her, so I'm not seeing you today" - it simply wouldn't be allowed.
Volley has the 24 hr midwife service on her notes, therefore they clearly permit her to use it.

I don't think this is an emergency really is it? Things like this should be discussed with your midwife.

My consultant gave me a full and v detailed list of when to contact him immediately, when to wait until the morning (and had his mobile for this) but otherwise I would just call his PA/appointments team and schedule a check up. Private or not I wouldn't expect to be seen same day for this as he has the rest of his practice/presumably urgent NHS work as well. Something like bleeding, high fever, lack of movement I would. Either way you need to let him know. Outside of regular appointments they don't generally ring you up and ask how you're feeling no matter how good an OB they are.

Squiz, in an emergency yes, they can't deny you. But they would immediately be paging your dr or expecting you to have already called. But this isn't an emergency. If volley is private then she isn't known to the mw team and they would likely tell her to call her consultant. At least that was the case when I went private. It's a whole different kettle of fish.

If it's an emergency and your consultant is in his NHS clinic (or away) he will have set up a colleague to see you in his place. Three times my consultant met me at the hospital for various reasons that would be deemed "emergency" at the time.

I had a private OB (not in the UK). In a situation such as yours, I'd call his rooms during hours and they'd squeeze me in to see him (unless I called him at 5pm where they'd fit me in first thing in the morning). Or, I could speak to a midwife in delivery. Either way I'd get to see someone fairly quickly.

That's the point/advantage of private care.

I'm having a LIndo consultant for the third time. Not clear why you haven't called his office already. I would be astonished if, having left a message in office hours, he didn't ring you back or see you. Just ring and don't be daft!

Sorry you are not feeling well. IME the symptoms you describe are fairly common in third tri - low bp is a fairly typical pregnancy related thing and weight gain/bump size very individual too. However you are feeling unwell and worried so my advice is - eat a nutritious protein/fat and veg meal, drink plenty of water/clear fluid to raise blood volume and call your obs office first thing to make an appointment to see him asap.

Hope you feel better soon.

Stone IME when you're a private patient you don't have midwife.