UK labour wards don't have 24 hour consultant cover?

[Mama12341]

I've read this on the 'campaign for safer birth' website that UK labour wards often don't have 24 hour consultant care. Does anyone know what this means? It sounds like there would not necessarily be an obstetrician on site if u went into labour at certain times of the day/week? If that's true I'm truly shocked. Emergencies can happen any time any day. What would happen if a woman needed an emcs and there was no obstetrician? Can anyone explain this to me as my local hospital is one of those that doesn't have 24 hour cover which sounds a bit scary!

Here's the link: www.campaignforsaferbirths.co.uk/page4.html

A registrar would do a section in the abscence of a consultant. Regs do the bulk of ELCS in my area with a consultant on call or available on site.

Surely a registrar could deal with most things?
I had placenta praevia and went down for an EMCS bleeding and a registrar started off, the consultant joined her later.

Oh thanks! This is really helping me understand! Reading that webpage scared me a bit. What's the difference between a registrar and a
Consultant then? Is a registrar fully qualified and trained? And a consultant is like their manager? Someone more experienced who can step in for a very complicated situation?

A registrar is the grade below a consultant but they probably see more emergencies as they are the ones there OOH. There will always be a consultant on call who can get to the hospital quickly if needed.

It's the consultant you sue when it goes wrong!

They are ultimately responsible for your care, regardless of who performs what.

Registrars do c sections more frequently though so your not getting a second rate service by having one done by them rather than a consultant.

I'm sure there is some research though that shows that it is more dangerous to give birth 'out of hours'. Which is one of the reasons women/doctors prefer to plan elcs during office hours if a labour is likely to be one that'll end up in an out of hours emcs.

The thing I find worst about this is not so much that so many hospitals don't meet the target, its which hospitals don't meet the target. The largest hospitals which are more likely to be consultant led and more used to dealing with more complex and difficult births are the ones MOST likely not to have consultant cover, whilst the smaller ones which you would presume would have more issues over funding enough consultant level staff are the ones that are able to meet the target.

Which begs two questions: are bigger hospitals being more poorly managed or are bigger hospitals who have patients with more complex needs being funded at the small level as the smaller hospitals which is an appropriate level for the extra demands they have. I think perhaps its a combination of both.

I don't think its as straightforward as being up in arms about there being a lack of consultants because as previous posters have said there are registrars. However I do think that women expect that if they go to a bigger hospital there will be more senior staff available more often and this is just not the case. Many women go to large CLUs precisely because they perceive them to be safer. I think that belief is often misguided and not really reflected in this data and other data (such as the place of birth study) and may make woman reconsider options if they were aware of it.

In my personal opinion, I think if you have a special need for a large CLU then they are worth their weight in gold, however I do think that specialised services that they provide all too often are coming at a cost elsewhere due to them having to spread their resources more widely and more thinly.

My cat 3 emcs done in office hours was done by my baby's consultant and her registrar. My middle of the night crash section was done by 2 registrars. All 3 registrars were perfectly capable and did a great job. The registrar who delivered DS5 came to see him afterwards in nicu, explained to me why a C-section in a hurry had been necessary (at the time there wasn't time for explanations or consent forms) and gave me a hug. He was lovely and if I ever had another baby I'd be asking for him to be my obstetrician. I much preferred him to most of the consultants I saw.

With my emcs which was on the weekend, they called the consultant as it was complex placenta praevia. She got there very quickly as it was all done within an hour, so I guess she lived locally
I'm confused by the hospitals on the lists that have 0 consultant hours though?

Are they hospitals with a stand alone midwife led unit? Those wouldn't have obstetric cover...

Ellie

If you had a c section done without your consent that doctor should be struck off!

There are exceptions. Unconscious/semi-conscious due to blood loss from a placental abruption being one that leaps to mind...

I one of my emcs done without consent forms. It was a cat 1 and they tend to very hurriedly ask consent if they can and then fill stuff in retrospectively. All of my birth notes are written in retrospect (quite clearly stated on there). No consent forms is very different to no consent. My consultant came into recovery with me and arranged to see me again the next day for a debrief once we were less traumatised. He too gave me a hug and explained everything. He had a cuddle with the baby too and told me about his own tiny baby who was also born by a cat 1 emcs.

Yes, with the consent it's the best consent they can get, if that makes sense. So if you're unconscious it's your birth partner that gives it (side issue but this is why 'it doesn't matter if your birth partner is drunk, just get a taxi' responses on drunk DP/DH threads annoy me, they can be very important) or if you're alone they take the decision.
I was signing stuff on the trolley, no time to read it although they explained quickly what the forms were

A consultant will always be "on call", even if they are not present. When my DD1 was in a very awkward presentation on a Sunday evening, there was no consultant on site. The registrar was unsure whether to try to turn her head with a ventouse or do an EMCS. He had to phone the on-call consultant, who made the decision.

Mine was similar to Saul. Some of my notes are retrospective as well. I definitely didn't give any kind of consent. I was in shock, had a temp of 39C and was huffing away on the gas and air. There wasn't time for them to explain to me enough so that I could understand. DH didn't sign anything either although he may have given consent verbally. I was still in my nightie, which felt really weird, like going to a wedding wearing jeans.