Am I crazy to be considering declining further consultant care?

[Cuppachaplz]

I am currently nearly31 weeks pregnant with DS2.
DS1 born 11 y ago by EMCS after 70h of labour, having been fully dilated for several hours. Section was because waters had been broken for 30h and they we're worried about infection / run out of things to do next.
There was no urgency, no foetal or maternal distress, and I had had no pain relief beyond gas and air in the ambulance.
He was supposed to be a home birth, and I remained at home for mist of my labour, where I was active and comfortable, but transferee after fully dilated 6h and waters gone 24h.
In hospital I felt as though I lost control, no one would listen or explain things yo me, and I became very uncomfortable, especially when I was not allowed to stand up or move around.
After my Caesarian, I developed an infection progressing yo an abscess (which fully ruptured the wound) and the septicaemia. I required repeated surgeries, and had several mcs after, possibly due to the mess my insides were left in.
This pregnancy has been difficult, with early SCH, high risk of downs (amino declined) and a cranial cyst (now almost gone) detected at anomaly scan. There are n sift markers if downs seen to dates which makes mire sinister concurrent conditions unlikely if baby is downs (I don't care either way) and neurologist is not concerned about the cyst. I take clexane, but am due to stop in a month.
I do not want anoth Caesarian.
I accept have if I have the baby early, I will need to be in hospital. I accept that there is an increased risk of uterine rupture, and all the potential sequellae in my case. In short, I accept the consultant's concern and the reasons behind her advice.
However, I really don't want to be constantly monitored, to feel inhibited, or to lose control. I am very nervous even on tours of the CLU, and the consultant MW is concerned that this will lead to another section. I am prepared to accept MLU (it is in the same building) as a compromise, but would rather be at home as late as possible. I live less than a mile from the hospital. Every time I see my consultant she brings up the birth plan, saying, 'so we are agreed, you will come to CLU as early as possible'
No, I have never agreed that. Every time I see her I leave in tears. She keeps talking about telemetry units, but can't get her head around the idea that I don't want to be there at all. She has written on my notes that she would like to refer me for psych eval (MW was furious). I understand that she is the consultant, however she is not listening, which was exactly what I hated about CLU last time.
Both DH and MW are concerned that if she persists I will say yes, the stay at home and have unplanned HB with no monitoring...
AIBU to be considering to be considering just saying no to any more consultant appointments / care?

No, you wouldn't be crazy at all - you're aware of the risks, well-informed, have the support of your midwife...you could ask to change Consultant if you feel you need Consultant led care but lotherwise just decline further appointments. I declined Consultant led care in my 2nd, 3rd and 4th pregnancies purely because it was a waste of time the first time round.

You could also think about making a complaint via PALS - it is not acceptable for your wishes and concerns to be dismissed and overidden by the Consultant.

It is quite normal to suggest a psych evaluation with a history like yours. Mental health is health: NOT an insult "you're crazy if you don't agree". As someone who had support during pregnancy and immefiately after because of previous losses and health issues, i am concerned that your mw was angry: clearly she thinks the psych support which is often lacking (with tragic results from pnd to ptsd) is some kind of insult.
It could well work in your favour: my psych support made it very clear indeed that my anxiety was triggered by any intervention which could suggest danger and thus I was to get my first choice of birth location (MLU).

The fact they think you might go off grid and free birth means your levels of anxiety are high enough to warrant health care.
Getting that element sorted out may well help you get the home birth you want.

This is a very tricky question to answer and I am so sorry to hear about your traumatic experience. I would agree with above about mental health support - you have been through a trauma and it is utterly understandable that you are in fear of a similar result.

However, there is also the issue of the well being of your dc - which I don't doubt is your 1st priority. With the markers you indicate and the concern over the uterus due to the infection last time - I have to say that I think a more managed delivery is worth considering. You certainly don't want to end up in an emergency situation again, I imagine that would trigger some difficult feelings, so it may be worth thinking about ways that you can best remain in charge of the situation from the outset - and despite appearances -that may well end up being an elective c sec. Unfortunately birth is an unpredictable beast and if you are opting for a vbac and the birth does not progress well, it strikes me that the situation you would encounter at that point would be more likely to result in a similar style of emergency delivery to your first birth. Of course everything might go brilliantly, but I think you would need to make your peace with the possibility of another emergency cs in order to go into vbac feeling in control.

I really hope you get the support you need, very best of luck.

squiz I think MW was angry as she had written it on my notes and made the referral without discussing it with me, ie without my consent, exactly what I was upset about the first time.
Was happy to seek counselling following many losses etc, just object to be overridden by an overbearing harpie who thinks I have no right yo an opinion.
MW happy for me to be in MLU ( and will arrange HB if it's what I want ) , and is concerned that the anxiety I experience with consultant is detrimental.
I am happy to go MLU rather than HB, but would appreciate consultant backing off rather than haranguing me at every visit. If this is the only reason that I need to see her, and it upsets me every time, maybe I am better off asking to just see MW for the next 2 m...
devon had already made up mind not to have consultant led birth, was wondering about sacking off consultant appointments unless any more concerns flagged! given how much they upset me.
Thanks everyone for advice and opinions :)

Whilst your anxieties are important I think you need to ask a few more questions about what could go wrong.

It most births the answers are very little. But in you're case you could well be giving birth to a child with special needs and if there is intervention that needs to be done asap after birth you will be in the wrong place. To me what you are saying sounds like putting your own concerns from the past above your child's welfare. And I feel very bad saying that.

Both my dc were born comparatively easily. But with ds there was a moment of panic when transfer looked imminent due to placenta problems. Thankfully they resolved that moment i really wanted the consultant onsite. 20 minutes up the road was just too far.

I think having some counselling is actually a superb idea and a really good birthing partner. In your case I would absolutely look into whether you can get an independent midwife or doula who is there through the birth for you.

I would be asking for a new consultant as you need one who can work with you with absolute transparency

A consultant led unit doesn't necessarily mean lots of intervention, it's just there if you need it. Dd was born on a CLU. She was born with gas and air, tens, a birthing stool and a heart beat monitor that moved around as I moved. really I couldn't have asked for a more perfect place to give birth.

As a previous poster has said, I am sure that the wellbeing and safe delivery of your baby is your priority but I think you are making assumptions about how your care will be. Have you considered having a discussion with a supervisor of midwives? (Assuming you are in the UK) They can be very helpful in formulating a birth plan taking your preferences into account and are accessible via every hospital.

Would you really consider a free birth?

The MLU here is next to CLU; you just turn left instead on right on entering maternity, therefore transfer of baby or I, would take seconds. They are not expecting me to have a baby with special needs requiring anything immediate. Pretty much everyone aside from the consultant (including other docs I have seen) is happy for me to have MLU delivery, and most agree that it would be beneficial to both the baby and me.
I have had counselling and dealt with many of these things, and one upshot of this was identifying my need to avoid monitoring and intervention. What upset me was the consultant entering this on my notes without discussing it with me, and given that I was not planning on clu delivery and all specialist are now not concerned about baby, I was considering declining further consultant appointments.
mrspatrick could you explain in what way a supervisor midwife us better than the consultant MWs And the birth choices MWs who I have seen, and what benefit I might expect. I'm not being difficult, just trying to void unnecessary visits to the hospital if possible.

Sorry mespatrick but what do you mean by a free birth?

If anything went wrong who would take responsibility?

You might be in the wrong place. What would you see happening if you did need a c section?

I support what you say fully. Before I say the next bit!
Ok, baby is looking good but cyst and other markers MAY indicate issues. This is enough to give consultants heart failure, in terms of the wishes you have outlined for your birthing choices. They are the
I don't agree with them but can appreciate their concerns, whilst realising they are overthinking.
Re the MH referral, this could work in your favour, as outlined above, as in you could outline your fears re birth (justified) and then the MH team would work with birth team to put plan in place to make sure the specifics are dealt with, e.g. monitoring, etc.
I am sorry you are going through this, and wish you the best for your birth and after.

I gave birth in a similar MLU to what you describe. Minimal intervention but moments from the labour ward if needed.

The supervisor of midwives has a management role in preventing dissatisfaction and problems with maternal care. Her say so holds a lot of sway so she can pron ably persuade them to have you in the MLU.

Thanks everyone,
feel I have slightly mis-represented myself in the OP.
MW and everyone bar one consultant had already for me to agree to give birth in MLU, for similar reasons to you squiz. Also, and question of baby needing special care answered (so far as they can tell). The MLU is next door to maternity, and equally close to SCBU should this be required.
The question was more, having had the above written in my notes for some time, having been through numerous, discussions, counselling, meetings with birch choices consultants etc, and having had concerned about the baby allayed, was I crazy for not wanting to go to any more consultant appointments prior to the birth, since the only purpose of these now seems to be for her to have another go at me about my birth choices?
I don't see the point in changing consultants at this stage, explaining my whole (long) history again, and potentially requiring more appointments in a clinic which I now found profoundly upsetting. Given that I have had shared care up to now, have jumped through all of the required hoops, and had my request for MLU VBAC approved (actively encouraged by most, given my anxiety) so hopefully, would not be requiring CLU anyway?

Well that's very different kettle of fish if it's all on site.

I would still be attending the consultants appointments

Could you see your consultant and ask "what is the point of me attending any more appointments with you, since the only purpose of these now seems to be for you to have another go at me about my birth choices?"

That might clarify whether there is any other purpose of the appointments.