Does it make a difference seeing the registrar as oppose to the consultant?

[CrazyChristmasLady]

I was referred due to the birth I had last time and I saw the registrar. I remember this happened last time too and I never actually saw the consultant.

I have an appointment in January to discuss and finalise my birth plan and I have many questions and different scenarios that I want to go over.

Is seeing the registrar just as good as seeing the consultant and do they have the same level of authority? I thought they were more consultants in training so I find it strange that I have been left in their hands rather than ever actually getting to speak to a consultant

A registrar is more junior than a consultant. One rank below.

Hopefully someone will be able to advise as to whether that matters in your situation! It may be that you wouldn't actually get any better quality care / advice from a registrar.

I'm consultant led and although I saw her in July my last two appointment have been with 2 different registrars. Although they seemed quite competent in terms of dealing with me medically at my last appointment I wanted a decision on wether I would be able to attempt birth in the midwife led birthing unit rather than the delivery ward- he wouldn't make the decision, ran around trying to find my consultant who was in theatre so ended up talking to another consultant who decided no. My consultant had seemed quite optimistic about me being in the birthing centre providing no problems arose in pregnancy, which they haven't, and I feel like had I seen her rather than the registrar the outcome would be different.

So just my experience but I'd say it's not the same, registrars may be good doctors but don't seem to have the authority to make the bigger decisions.

I'd agree with izpie. IME, registrars don't have the experience or necessary clout to make the big decisions and can be a bit dithery.

I'm not sure how to guarantee/maximise chances that you see the consultant though.

That is what I thought really.

I want to know if it comes to me needing forceps again, whether I can say I want a c section instead.

I want to avoid a c section (I have a choice as to whether I want an elective or natural birth because of 3rd degree tear last time) but I don't want to go through an assisted delivery again but there isn't anything to say I will need one which is why I want to opt to try naturally.

I had consultant led care in my previous pregnancy due to complications and always saw the consultant or senior registrar. I did once see a 'normal' registrar, but she passed my case onto the senior as she felt she couldn't deal with it herself. I found the senior reg. actually a bit better than the consultant, but all decisions were untilmately down to the consultant.

If you insist, you should be able to get an appointment with the consultant.

CCL, how worrying for you.

Maybe I'm wrong, but wouldn't it be too late for a c section once decisions about forceps/ventouse are being made in terms of the baby being descended in the birth canal?

But, yes, definitely, you need a consultant to explain your options to you and ensure that they're noted on your birth plan.

As a doctor myself - yes registrars are more junior than consultants but the variation is huge. A first year registrar won't be making as many decisions as a senior registrar who the next month may be starting their consultant job. Don't worry - it's probably a good sign you're seeing the registrar. The more junior the doc the more 'straightforward' the case in general.
That said - if you're concerned your consultant may have given different advice about a birthing centre then you could always contact the consultants secretary if you haven't got another appointment lined up.

My experience with the registrar was fantastic. I'd been given the impression by my consultant that a c-section would be the better option, and we didn't really discuss a VBAC. The registrar talked me through various options, discussed my concerns and fears and took the time to listen without being dismissive. Whether it was because she was new, and not yet jaded, or just her personality, I don't know. But, I ended up with a VBAC and a much better birth experience second time around.

I think you can get good and bad Registrars in much the same way as you can get good and bad Consultants. I was under a Consultant for DD and saw a mix of him and his Registrars during my pregancy. Level of care was the same no matter who I saw during the pregnancy, no complaints whatsoever.

However, DD ended up being delivered by a completely different Consultant (serves me right for giving birth on a Sunday ), who was clearly nowhere near the hospital when I started having problems with my second stage and spent several hours advising the Registrars over the phone. I suspect these conversations went along the lines of "keep telling her to push, I'm at the 17th hole" and when he finally pitched up, he used both ventouse and forceps, resulting in a 3rd degree tear on top of my episiotomy and he managed to make a complete balls up of my stiches, resulting in a haematoma and massive infection.

I've since been told by several GPs and midwives that DD was the last child that the Consultant ever delivered, and that he probably hadn't delivered many more in the previous 5 years. Give me a Registrar who is more hands on any day!

I was told you can ask to see the actual consultant rather than underling...so was booked in with her and still saw Registrar. I thought would see her as have high bmi and high bp and way they talk was a big deal but no lol. Never seen the consultant yet!! not in any previous 5 pregnancies lol.

I think that if you are looking for advice/guidance a registrar could be just as good as a consultant, but if you are looking for someone to sign off on something (like agreeing only a consultant will do. I made a complaint during my ante-natl care and thereafter only saw the consultant. I think if you request you can see the consultant although you might have to wait longer.

Re a EMCS FWIW I was told that if it gets to the point where forceps are in the picture it is too late for a cs.

HTH and you get the birth you want.

I'm under consultant care but have not seen one at all during this pregnancy. I also had the question about being able to use the birthing unit (I've had thyroid cancer) and asked my midwife. She rang the unit directly who reviewed my case and rang me on my mobile to say they would be happy to have me
:-)

I have always been told that you can request specifically to see a consultant but the reality is that the registrars are often much more hands on at that stage in their career and so you're more likely to avoid the horrific scenario described above.

Thanks fro your replies.

Probably fine for me to see the registrar then as it is the same one I saw with DS which was 3 years ago so she must be pretty far in her training now.

WRT not being able to have a c section once decision for forceps is made, not sure how that works as last time they said to me if DS didn't come out within 3 pushes I would be having an EMCS so it must be possible. Obviously I don't want either situation so I guess I'll just wait until my appointment and discuss it with the registrar then.

Another concern I have is the registrar said if I do opt for a natural birth, they will automatically do an episiotomy and she has noted this in my maternity notes. She also told me in the same sentence that there is no evidence to say that having an episiotomy prevents tearing as I had one last time and still tore, so I am going to push for not having one unless it becomes really necessary. My MW agreed with me on this.