Am I "consultant led"? And what does it mean?

[MuddyWellyNelly]

Currently 13+4 with first pregnancy. Long time trying to conceive, eventually did so with donor egg IVF, from a 28 year old (I'm 40). I was on numerous medications from my treatment abroad, so when I got my BFP I went to see the GP to see if he'd prescribe them. Primarily this was to cut costs given how much we'd already spent, but also I wasn't sure I should be taking steroids and heparin without being under doctor supervision. The GP referred me to a consultant obstetrician at the hospital, and I got the medication. I thought that'd be it, but he asked me to come back (which happened this week), and now he's said he will see me again at 23 weeks, 28 and 32, and is arranging extra scans.

So far baby is fine, 12 week scan the midwife marked as high risk, but explained she was only doing so as it was such a precious pregnancy. Scan therefore was very thorough and sonographer said absolutely nothing worried her at this stage. NT screen has come back extremely low risk, I'm very low BMI, low blood pressure, very healthy in all ways. However the consultant told me my age made me higher risk for pre-eclampsia, GD etc. I think this is why he's seeing me again, and I'm happy to have the extra scans, but don't know what the other implications are. Does consultant-led differ in some way? Would I know if I was officially high risk? Is it likely to preclude a home birth? I'm not set on one, but want to keep my options open. Or are they just being especially thorough because I've had such a slog to get to this stage!

Clearly all a bit new to this! I'm not especially stressed about it, more curious; but it's a bit of a minefield to the uninitiated...

I guess you'll be having an appointment with the community midwife in a few weeks; she will be able to clarify what, if any, your actual risk factors are. I think that the high risk status is ongoing as you progress to help you get to term, but if you get to 37 weeks and there are no risk factors other than your age, you can choose a home birth.

Congratulations and good luck.

Have you read your hand-held notes? Any specific risk factors should be noted in there.

Thanks Guyropes - my notes are pretty empty at the moment. I will have a look and see, but nothing has been called out so far. Yes I see MW again in 3 weeks or so. Apparently I'm only the second Donor Egg pregnancy she has ever dealt with, so perhaps there just isn't a standard protocol in these cases. I know some areas treat all IVF pregnancies as high risk anyway, but not sure about my area.

Good to know a home birth could still be on the cards, all being well.

The empty notes are a good sign welly! Long may they stay that way. I was hoping for a home delivery, but less set on it since the consultant wrote a list of risk factors last week! With dc2 it looked like high risk and hospital delivery until 37 weeks when I was given all clear and had lovely home delivery.

I accept that I'm not in control of this process. That was much harder for me the first time around.

I'm sure your midwife is excited to be looking after you, it's really Livy that she said it was such a precious pregnancy. Enjoy it!

Lovely, not livy!

Sounds like a thorough and helpful consultant!
I have sadly a hig risk pregnancy, with issues noted for concern at 12 and 20 week scans and it is almost impossible it seems to get extra scans or appointments with known risks and medical issues where I am ( have 28 week scan), so was told to go to the FMC in London, grrr!!!

Silver.. That's crap! I'm so sorry to hear you can't get the appointments you need. Have you been to PALS?

Have you been given a set of hand held notes?? I don't know if theses are the same everywhere but here there's a page for management plan(it's on page 15 here) where I've been put as low risk and referred to the MLU- it might be there.
Here being "consultant led" as opposed to "mw led" means that you would give birth in a delivery room rather than the mw led unit and I think home births would be heavily discouraged. But, my friend went through the majority of her pregnancy as C.led as her scans showed that her baby was very small, baby had a growth spurt so she switched to mw led, then had to be induced so switched back to C.led. I was mw led until my labour had to be augmented then I had to be C.led (on the synto drip) and moved from the MLU to the delivery room.
So I think that being mw led or C.led isn't set in stone and doesn't at this stage rule anything out. It's hard to advise as everywhere seems to do things differently!!

Ok I found something. I'm on the red pathway. This is Maternity Care team. Green is midwife led. So I guess that means I am consultant led. The reason given is "IVF - donor egg". Hopefully if no actual risks are identified I can still get full choice. It's great that they are being so cautious of course, but I'm not wild about a hospital birth, so don't want it to be an inevitable consequence of them just being extra careful up to that point. Still a long way to go to worry about that though.

Silver, blimey that's awful. Hope you get seen soon. Best wishes.

From my experience - if you are over40 and have assisted reproduction then they will try to reduce all possible risks to ensure that you have a health pregnancy and also end up with a live healthy baby at the end. If this doesn't work out, then chances of you falling preg again are rather slim (as it was very bluntly pointed out to me!) and therefore they are safeguarding you and your baby as best they can.

Hence the additional close monitoring to check all is well. If you get to 36w ok i'd recommend having a sit down with consultant and lead midwife at birthing/delivery unit and discussing options within your birthing plan. (Natural v induced v assisted v CS)

We've done that and we've got a plan that if baby arrives pre39w then we're ok for birthing suite, water birth and intermittent monitoring. However if no signs by late 39w then we progress to starting induction etc with aim that baby is here during w40 and no later!!

With "older" mums they have concerns over the state of our placenta etc and hence once you get to 40w they want to have baby out as its "unknown" territory.

I know it's not a great prospect, but they are trying to have our best interests at heart. It's taken me since my booking in appt to get my head around this & we're now on "final approach" and hoping this baby arrives on her own in next 10days.

Continue to look after yourself and talk to your midwife / consultant about your concerns.

Good luck!

Thanks Pinky that's really helpful context. At this stage I'm pretty sure I'd flat out refuse an early induction if no other issues have appeared. I just hate being told what to do! I'm so bloody stubborn. But yet I know in my heart that all that matters is safe delivery. I probably just need time to process these things.

Best of luck for you, for a slightly early sneeze birth .

Muddy. You are me and I claim my £5 :)

I can't answer your questions, but congratulations!!!! You deserve it. Im on consultant led care and feel very happy with the service, you'll get loads of baby scans and feel more connected. Xxxxxx

I think the midwife is offensive of course your pregnancy is precious op. But so is anyone's.

Could it be a very low bmi? I know someone being underweight could require consultant care.

I have to agree with soontobesix.

Thanks scenic.

My BMI is normal, just over 19. So not too low, I don't think it's that.

I think "precious" meant "last chance saloon". Which after 4 years, 4 IVFs, our life savings, and donor eggs, it is. Everyone has a very precious pregnancy, yes. Not everyone had such a hard time getting there. I think the MW was acknowledging that.

Muddy - just as an aside, and don't answer if you don't want to, but why were you on heparin and are you still on it? And if so, has anyone suggested that you see the consultant haematologist as well, or is that considered unnecessary as you're already under the consultant obstetrician?

Thumbwitch - the Heparin/Clexane and Steroids is part of the "Bondi Protocol" which is used within IVF - usually just prescribed for first trimester (apols if teaching you to "suck eggs" on this!)

The management of this prescription is something that should be discussed in co-ordination with the IVF consultant. In my case, it was advised to take up to the 14w point, and then to tailor off the Steroids (you can't just stop taking them). It's to do with Natural Killer Cells attacking the embryo as a "foreign thing", and to ensure good blood flow in the establishment of the placenta etc. I was moved onto "low dose aspirin" for the remainder of the pregnancy.

I also was slightly narked when MW said "precious pregnancy" - but I think that's also slightly kinder than "last chance saloon", although that does give you the wake up call of "I will do whatever I can to safeguard the arrival of this baby!".

Hmm perhaps I have a different Perspective on the 'precious pregnancy' comment. My pregnancy was unplanned, and whilst I expect to receive the care I need to have a healthy baby, I am glad for op that her midwife acknowledges that her circumstances are different from mine.

No, not teaching me to suck eggs, I wasn't aware of its use in that scenario; I had clexane throughout both pgs because I have a clotting disorder, so was interested as to the reason here.

Pinky I'm glad you answered as it was more thorough than mine would have been. I was a bit "head in the sand" by that point. Yes I have stopped the Clexane now (at 14 weeks) and it was just to aid the pregnancy, not because of an underlying disorder.

Sorry if my comments offended anyone. Guy ropes, thank you for your comment, it does feel very fragile and I appreciate that the NHS are pandering to my terror.

i think for the "older mum" they have concerns about the vascular system generally and that's also a factor - they said to me it's akin to the fact that 40yr old men are increasingly likely to have heart attacks and hence 40yr old women are likely to have issues with building/maintaining a healthy placenta and so the Clexane thins the blood so it can get around so much better. At least that's how it was explained to me.

IVF and older maternal age have now been shown to carry slightly higher risks, such as stillbirth (although still a very small risk!), which is why you are consultant-led. I would think that they will definitely try to push for induction at term, etc. I think it's important to remember that you have final say in everything. Of course they will have your best interests at heart, but don't think you must be be pushed into anything you don't want OP.

Muddy you don't need to apologise you didn't offended me yourself you were just quoting. You put it much better yourself with " last chance saloon" I wish you well with the rest of your pregnancy