Midwife led vs Consultant led

[MillyStar]

sounds like a silly question but what are the actual differences?

Not sure whats happening with me yet I have to see a consultant next week to get a decision

It depends on your risk factor. Most low risk women have midwife led care and delivery all the way through as long as they don't develop any complications.
Consultants deal with complications of pregnancy. If you are higher risk you might have shared care, with some consultant appointments and some midwife appointments, but would probably not be a candidate for a delivery in a midwife led centre. Some people have medical conditions that mean that all of their care and their delivery is managed by a consultant.
It really just depends on your medical status.

I've been consultant led this time after having a EMCS with DS. I'm also over 35 which places me at higher risk though not sure if this alone would have made a difference.

The only difference has been is that I saw doctors (not the consultant but part of his team) for two of my routine apts. They did exactly the same as the MW's. I assume I couldn't give birth at the MW centre either, though I'm going for ELCS this time anyway so it's irrelavant for me.

It will all depend on your med history. The most important difference if this is your first time will probably how much is may restrict your delivery options ie labour ward v birthing centre, no home birth etc.

I have gallstones and i'm due to have my gallbladder removed next year.

I've not had any problems yet as i've been very careful with food being pregnant and my midwife thought i'd be ok midwife led but she rang a consultant to check and they want to see me next week, i'm only 11.5 weeks by the way (i think, got scan on Fri yaaaay)

It's a shame they cant do a C Section and whip my baby and gallbladder out at the same time lol

The differnce can be very little to completely different depending on your medical conditions.

I started as technically consultant-led because of my history of recurrent miscarriage but I was discharged by the consultant at around 14 weeks after one appt with her junior doctor. The rest of my ante-natal care has been completely midwife-led despite having had a semi-elective c-section with my son (basically labour had stalled massively, no change for 12 hours, and everything was stable so we had a few hours in which to have the c-section rather than a emergency c-section when they heve to get the baby out there and then) and being 40.

However because I am going to try for a vbac, I have been risked out of the midwife-led birthing centres and will have to have my baby on the consultant-led labour ward. If things are going well, all my care in labour will be from midwives, but there will be doctors (and operating theatres) on hand if anything does not go as standard.

Basically midwives are the experts in normal, low-risk pregnancies and birth and consultants (and their junior doctors) are experts in non-standard, high-risk pregnancies and emergency situation births.

Where I live I'm going midwife lead and that's at a birth centre compared to consultant which is at a very busy maternity unit that does thousands of births a year. The birthing centre just over 300 births a year. I've gone with midwife lead cos I can cos I'm low risk but also you get 1:1 care. I don't like the fact that I'd be left for at the otherplace. Also at the birth centre u go home after 4-6 hrs and I really didn't want to stop in hospital. The only down side is with midwife lead there are no epidurals and if there are complications or emcs you get transfered to the maternity unit which is a 15-20 min ambulance transfer

Can I hijack slightly and ask when people actually see consultants? I'm supposed to be consultant-led, not because of my high BMI or possible GD, but because of previous PND. However, I'm now 27 weeks and haven't seen a mw since 16 weeks never mind a consultant. Do you usually see them later on?

I think it depends. I saw mine at 6 weeks to get my drugs and then again at 12 weeks to review the care plan after the booking scan and explain to me what would happen later on. I won't see the consultant (or their junior, as is generally the case) until 28 weeks now and will just see midwife in the meantime.
In the case of PND, I guess you would expect to see them later on as it doesn't affect early pregnancy although perhaps you would be more prone to antenatal depression.
Some people see their consultants loads, other people only see them once. I think it is on a case by case basis.

Oh my god i NEED an epidural lol

So can you have an epidural and hospital birth even if you are midwife led rather than at a unit?

Ha! I NEED an epidural too so had to rule out birthing units and centres! Also had to rule out water birth :(

As long as you are in a hospital you can have an epidural, midwife led or not :)

Thank god, it's my first time and i'm clueless got a lot of research to do!!

Ah right, your op was referring to giving birth in a midwife led birthing centre? I thought it was about ante natal care. Sorry!

Yes, if you are low risk you can opt for the midwife led centre if you would prefer that to the hospital environment. More home-like apparently, less medicalised. However, no epidural, just gas and air. good for waterbirths perhaps? Transfer to big hospital if it is necessary or you want more pain relief.

But even if you are in the proper hospital (we dont have a midwife led centre anywhere near here) it will still be a midwife delivering the baby unless they need the consultant. In the hospital you can have whatever drugs are on the menu!

I have consultant lead care due to problems with number 1 - guess they are just cautious. Basically means no to home birth or a mid wife lead centre. Baby number 1 did get a consultant in the room, but only right at the end of my labour (most of my labour was managed by a midwife) with extra checks post delivery. Baby number 2 didn't see a glimpse of a consultant (apart from the occasional checks after each scan, which tbo are pretty much the same as a midwife does).

I think IssyStark summarised it well - consultants are called in if the pregnancy/birth is not considered low risk as it would be the Dr who gets involved with the more 'interesting' intervention if requried. If it helps, our first was induced early and considered high risk - however he had an APGAR of 9 at birth and came home 12 hours later. High risk doesn't necessarily mean there will be problems.

Sorry i've not got a bloody clue what i'm talking about yet i really need to get learning, i do mean just generally midwife or contultant led, i just jumped to conclusions and thought you couldn't have an epidural if you're midwife led lol think i'll go for a hospital even if i am low risk then, give me all the drugs lol

A lot of areas don't have these fancy midwife led birthing centres anyway and hospital or home is your only choice.

have a look at the pregnancy section on the NHS website if you are feeling confused. It explains about your antenatal care and your options for the birth.

Hi, I was and am again under consultant led care. Basically I had my antenatal appointments with midwife and extra appointments with consultant. I also had to go on the consultant wing of the hospital rather than midwife led side when I gave birth. The doctor visited me just as I was induced (due to pre-eclampsia) but then I was looked after by a midwife for my birth. I think unless there is a problem the doctors leave it pretty much up to the midwives and note down you are there and that they may be required. I would say don't panic after all having loads of people keeping an eye on you is not so bad really.

I was under consultant care with (high risk of pre-eclampsia) and they were happy for me to plan a home birth right until 10 days before my due date when my blood results started to go very funny. So depending on the reason why you're under consultant care, it doesn't necessarily mean you can't give birth in a midwife led unit.

There's a difference between midwife-led units (tend to have birthing pools and beanbags, more space and ensuite loos, but pain relief limited to g+a and pethidine), and midwife-led care (you may still get the choice of a MLU or the delivery suite where epidurals are available).

I've managed to stay with MW care after a couple phone calls and the MWs confirming I'm ok to stay with them (and opt for the MLU if I like) as long as XYZ doesn't happen. In labour I went to the MLU but after some hours transferred to the delivery suite for an epidural. And ended up seeing lots of consultants!

With either consultant-led or MW-led you may also end up with 'shared care' where you see your GP or a MW at their practice instead of a hospital MW sometimes...

My notes had a page near the start saying who I was supposed to make appts with and when... and lots of scribble over it! Can you ask what ones you're supposed to arrange?

And you can be considered 'high risk' and be a candidate for consultant led care, but you are within your rights to refuse to see a consultant and only have midwife-led care.

In this case the Supervisor of Midwives would probably like to meet with you to discuss an action plan for your pregnancy/labour though.

I was midwife led with dd1 and being consultant led this time. There really hasn't been much difference apart from the fact that the consultant would have a better knowledge of my medication I am on this time (in my case blood thinners) and have gone through what I should do in labour. I know they want to keep an eye on me in labour so I am supposed to go in as soon as it starts whereas last time was told to stay at home as long as possible.
Other than that nothing really. I have seen a different consultant every time I have been to the hospital so they seem to go through the same questions every time. (mind you same with the midwive this time too. Different one every time)
...and of course I will have to labour on the consultant led ward.