Unhappy with standard of care

[Spod]

Hi - I'm new to mumsnet but have been reading through the site. I'm booked in for an elective CSection on 17th Oct (39wks), first baby. Pregnancy has been normal so far but I have had several spinal operations over the past few years which is why I'm opting for csection. I'm 29 wks and feeling totally NOT reassured. I have shared care btw GP and midwife for standard antenatals - plus have been to see consultant ob/gyn, who it seems every mum-to-be gets to see at least once during their pregnancy. I have expressed my desire for a csection since day one and also my concerns about whether or not I can have a spinal block (i have bone grafts and metal plates and screws in the base of my spine)which is what I would prefer to a general. Considering the extent of my pre-existing spinal injuries I was expecting to be treated as an 'unusual' case and that perhaps someone somewhere would seek to discuss my birth/csection with me! At the consultants appointment I wasnt even invited to sit down and the whole app lasted 2 mins! I have no information about what happens at an elective csection, what I need to consider/questions to ask, what preferences I can express in terms of general/spinal, types of stitches etc, effects on breastfeeding how long I'll be in, whether or not they can avoid cutting through stomach muscles (important for spinal injury patients) . Also (sorry this is getting long) I have a connective tissue disorder (which has meant i heal poorly) and in previous surgeries I have needed more blood transfusion than the surgeons expected - this is worrying me - who should i tell? On top of this (!) the consultant I have met (for 2 mins!) is only a locum so may not even be the one doing the c section! I am feeling very uneasy about having my section at this particular hospital.....and it only scored a 0* in recent league tables! Can I switch hospitals? how? How do I get my concerns listened to? Who needs to know what? I have Bupa and may be covered for csection....but where do I go? Are private hospitals good at this sort of thing.... at least I would have a decent appointment time to discuss my concerns? I'm really worried that the first opportunity i will get to discuss my concerns will be the day of the csection!!! Any advice on any of the above would really help to reassure me.

Spod,
Any news yet? I've really felt for you as you seem to have been let down by the medical profession. Let us know how you are.

I met with the anaesthetist last week - spoke about my options for the c-section. He actually read my maternity notes and looked at my spinal xrays! and spent around an hour with me! he was very nice and whilst made no promises, said he would look into my connective tissue disorder thingy and check things out and do his best to see if i can have a spinal rather than general. He can't guarentee that it'll be him there on the day though. He also said that there is no permenant ob/gyn consultant at the hosptial either!!! the (useless) guy I saw is a locum..... so not happy about not knowing/meeting the person doing the section given the not so straightforward nature of the csection.... so I'm not really feeling that much more confident in my local maternity services. I have an antenatal appointment with my GP on monday (after literally demanding that the receptionist over-ride their stupid 'cant book appointments except for on the day' system) and so will discuss these concerns again with her. Am tempted to be 'accidently' in another district between 38-40 weeks and encourage labour to start!!!! joke! Has anyone on here actually changed their hospital? how do i do it, can i do it?
CheekyGirl = would appreciate any reccommendations you can offer about consultants - i still have 9 weeks left to sort alternative arrnagements - why do you say its probably too late for me? is there a time restriction?

Spod, changing hospital is def an option. One friend of mine planning a home birth changed at 38 weeks because she was getting too much pressure for a c-section (she had a suspected placenta praevia). In the end she had a c-section but felt it had been her choice, not something she'd been shoved into a corner about. She said the attitude of the obs at the two hospitals was poles apart.

Another friend has just changed at 6mo because she felt she wasn't getting enough support for her vbac. Very happy now to be working with a supportive team.

Spod - it must be a very small maternity unit if there is no permanent consultant. We have 9 consultants so it is easy to change to a different one. If that is the case I think you should be getting referred to the tertiary centre. You hospital must have a referral pathway to a more specialised unit which would seem a more sensible place for you to deliver IMO. Your GP should be able to give you that information and it should not be a problem to get referred there.

i think the maternity unit is fairly small in terms of staff...they are expanding i think - which is why its impossible to find the maternity ward! but the main problem is i gather the hospital is not an attractive employment option...under-resourced for the population, expensive area to live etc. I have no idea how to find out about tertiary centres or referral on to a specialised centre... I shall ask my GP. Can I be refused a request to go to another hospital?

No. Stand your ground. I had a complicated pregnancy in that I had severe placenta praevia and would not have wanted to have my cs anywhere but a proper hospital with permanent fulltime consultants, good emergency care and a special care baby unit. As it happened, everything was absolutely fine with me and my ds but I would not have felt at all confident in your situation.

I'm glad its not just me who thinks this situation is ridiculous!! I have been on the phone to AIMS (assocation for the improvement of matenity services) and they said it stinks too. Worryingly though, they said all i can really do is stomp my feet - by writing to the hospital cheif exec stating my medical problems and my worries about not having a named consult and aneasthetist on the day, explain same to GP....if not happy with response (i can just imagine how long it takes to get a response)then I should ask GP to transfer me to another hospital - which they apparently dont like to do cos it involves money going over to another authority.....surprise. Apparently part of the problem here is that all pregnant women see the consultant whether they are low or high risk and i seem to be being shunte d along in the 'normal but wants to have a section for some reason' category. So women who dont need 'extra' care get their time wasted by having to go to additional antenatals and women who do need extra care dont get enough time or a nameed consultant to address their additional needs! Is it all about control? When I asked the lady at AIMS what i should do if I get nowhere...she said that i dont have much choice but to have baby there and that I should ask for guarentees that no mistakes will be made as a result of their care or the surgery!! I am still not happy!!!! don't we have any rights to demand the care we need!! am getting so fed up with this! i dont need the stress and just feel constantly worried about doing battle with a bunch of people I have lost all confidence in.

Hang on, when I thought about changing my mind (quite early on) I just contacted the other hospital direct and that all seemed v straightforward. Why not just ring another hospital yourself? I'm sure it doesn't have to be this complicated. Mears?

oh right.... but.. I have under 9 weeks to go...and we dont have another hospital in the health authority area... it would mean going into Northamptonshire health Authority - which is actually my home postcode area... GP surgery is Milton Keynes Authority however...? I guess I could just phone up Northampton hospital and ask them anyway....

Is there a website where I can look up a directory of staff at maternity units - so that I can find an obst. consult. who deals specifically with 'complications'?

Use the google search engine and put in something like Northampton Hospital maternity consultants and see what comes up. You can then type the names of the consultants into google and check them out that way. Give the hospital a ring, you've got nothing to lose by it.

Spud, Try looking here

I don't understand why this is so complicated for you. If I was unhappy with my care here, I would ask my GP tp refer me to Glasgow. It is my choice. Cost does not come into it. Certainly my postnatal care would be undertaken by my local hospital because I could not expect the midwives to travel down here. Have a look at that site and see if there is anything there to help you. You must have a consultant's name that you are booked under. Even if he is a locum it will be for a length of time. Is there no other consultant there at all? I cannot understand why an appointment cannot be made for you to see him, tell him your concerns and if necessary be transferred. The alternate route is the GP referral. Good luck.

Soory, I meant Spod. Too busy checking the link to notice the spelling.

I have looked at your area Spod and there must be more than one consultant atat Milton Keynes because the delivery rate is over 3000 births. We have 3500 births at our unit and 9 consultants. The site I've put the link in for is really useful with contact numbers etc. Hope you manage to speak to someone with some sense.

Spod, I am appalled at the lack of care and attention you have been given. You seem to have been left to a "lets hope for the best" type of care. You must have a plan which is highlighted in your notes so that everyone knows exactly what is going to happen whether you require delivery electively or in an emergency. I would suggest that you book at a unit that has a dedicated obstetric anaethetist. It is not too late to do this. Your problem is such that your plan for delivery requires detailed inout from your spinal consultant, obstetrician and anaesthetist. It may not be impossible to aim for a vaginal delivery; this can be done in a varietyof positions which would lessen the pressure on your lower back - obviously then aplan for second stage(actual delivery) would be required. If your spinal consultant and/or yourself believe section is the way togo then discussion of the type of anaesthetic must be made. Spinal anaesthetic may well be possible at a higher level however your surgery may mean that the spread of anaesthesia would be incomplete and unpredictable and not satisfactory.Again your spinal consultant can advise. Ifit is decided that GA would be better then this should be highlighted in your notes so that there is no p around in the unlikely event of an emergency. It is also important that somebody takes on board your concerns re your connective tissue disorder. |Dependingon iits exact nature it may or may not be relevant but it should definitely b e discussed. You have every right to expect a reasonable level of care and I would absolutely demand that you are referred to properly staffed unit by your GP. In fact don't leave his surgery until he has made the phone call and got you an appointment. I wish you all the very best and good luck.