Which boxes do you need to tick to get consultant lead preg care in the UK?

[twogirls1more]

Hi!
I'm nearly 40wks preg with my 4th at 39yrs old and feel v forgotten about bu my MW and "the system!" It's all changed so much it would seem (AGAIN), since I had DD3 19mths ago and everyone I seem to be talking to now has had consultant lead care for some reason or another during their pregnancy, been offered a sweep around their due date etc etc..
I don't feel that necessarily I've needed a close watch this time but this baby does appear to be big, I've had unexplained bleeding on and off throughout and now getting serious pains laying on my side, making sleeping v difficult. (amongst many other latent labour "signs"/niggles!) Position I'm in at the mo is I've not had MW appt since 37wks, I'm 40wks in 2 days and can't get MW appt for nxt wk as she's full. Have left a couple of msgs for her that haven't been returned so feel as though if I didn't keep trying I'd just get left! (I also have a few questions/concerns I wanted to discuss with her!)
Before I call triage at the hospital, (don't really feel I've got much choice,) could anyone fill me in on the "rules" for "special case pregnancy" and when you get either consultant lead care, or at least more frequent MW appts and/or interest in this country!! I've heard frm a few that you get a more appropriate level of attention if it's your 1st pregnancy, have any concerns in obstetric history or are over 40? Is this right? Want to get facts straight before I have a moan!! Thanks all! :)

I doubt there is one set of rules (absolutely everything varies by regional PCT and individual hospital/consultant).

It's been a while since I had my babies, but there were no special protocols based on maternal age or whether first pregnancy. It was solely by medical need: mainly previous gynae history, issues which showed up in scans, or any potentially concerning symptoms which emerged.

You say you've had unexplained bleeding throughout. Is this why you think you should have been seen at a hospital? (NB: consultant led care doesn't mean you see the consultant, it might be one of the junior doctors in the firm - you also might need to go to hospital based midwives, not your local team).

If you are concerned today about anything, then yes go and be reviewed.

If this is at the hospital, it might be worth getting the details of the local rep on the Maternity Services Liaison Committee - often a good place for finding out how things ought to be working locally.

You are receiving shockingly poor treatment. I would be tempted to bypass the mw completely and go to the consultant directly. Can't get you an appointment at 40+ weeks? Bonkers. :(

I agree, take yourself to the midwives at the hospital. I didn't realise I could until I rang to change an appointment date. There is a number for the hospital midwives in my pack and they can be contacted at anytime. Worth a try to see if you have something similar? You need a 40 week appointment whether your midwife is too busy or not! Hth and that you get seen.

I think you need decent MW care not a consultant. To not be able to get a 40.week appointment is shocking. As others have said there will be ANC at the hospital.

Around here it's normal not to have a 40wk appointment. They don't want to see you until you're over due and need a sweep.

I agree that you should phone the mw's at the hospital. Effectively the number you'd ring if you were in labour should be fine. Sounds like you need reassurance more than anything else (also prg with dc4 but I'm 41), experience doesn't take that need away ime!

I wouldn't worry about consultant now, I've been under consultant care with dc3 and this one and I'd never actually met the man himself until very recently. It's always been one of his junior doctors and then they scurry away to get everything checked. Last one couldn't find the heartbeat... good job mw was there too!

Thanx for your advice girls! I quite agree with you all and yes brettgirl2, have never really felt the need for consultant care this time and know I'm not considered "high risk" but do think I should be getting better MW care and not totally forgotten! I will call the MW's at hosp but don't think it should need to come to that as would expect more frm my community MW! Will let you know what they say. At the very least I would expect my concerns to be answered over the phone and a promise of either a call frm a MW, (any MW!) to book me in to be seen sometime nxt wk, OR for them to invite me in to hosp today to be checked etc..

Sorry, think with my title for this thread I've been a bit misleading... didn't mean it to sound as though I feel I should be under consultant throughout, just wanted to know about protocol etc.. as had heard that if you're over 40 u get better/more regular care and checks, (some had indicated that you're also offered induction a wk before due date?!..not sure if this right?) I'm 40 in 10mths and if the above is the case then I can't quite believe the extreme difference in level of care frm one year to the next?!
19mths ago when I had DD3 I had checks every wk for at least the last mth and personally think these are important. (If only to listen in to baby, check blood pressure, urine etc.. and give you the opportunity to address any concerns or get any questions you have answered.) To go from 37wks to full term being ignored, only to be told that MW can't fit you in and then to have calls left unreturned is appalling and quite bizarre to say the least I feel!

I've been offered an induction on my due date, but only because I have spd and have been on crutches since about 22ish wks. I'm 34wks now and signed off work. I've declined as my due date is 22 Dec and I really don't fancy an unnecessary induction. Holding out for my home birth as long as everything else is ok.

I have an appointment at 36 weeks, so will be interesting to see what's next!

I do think you should have had better mw care however.......What happens if you have any problems/concerns? I can phone our mw's and someone will see me if necessary.

twogirls The being over 40 thing does not mean extra care, at least not here in Southampton.

I was under consultant-led care in my first trimester because this is my 10th pregnancy and only the third to make it past 12w and only the second to do so with fatal deformities. So I was under both recurrent miscarriage and also fetal medicine until they knew this pregnancy was def okay after 12 weeks. This meant a since appt with one recurrent m/c consultant about 8 weeks in and another with a fetal medicine senior house officer at 14w.

Before and since then I've had the normal, midwifery care even 'though I turned 40 during the pregnancy and will be 40.5yo at delivery plus I'm aiming for a vbac in a month's time.

Should have added, I have a whole pile of numbers I can ring at any time for the hospital based midwives, physio, day gynae etc if I have any concerns at all. To a certain extent the midwives around here expect you to be able to self-refer when you need to.