When do you get consultant-led not midwife-care?

[strangerjo]

I've had a few issues during this pregnancy which have contributed to off-the-charts depression and anxiety. Some of my issues have been missed or ignored by midwives so I've ended up going privately for advice and scans. Due to an admin error I actually have two midwives (hospital one and community one) although they don't know this. Unfortunately what one misses the other picks up so I have been reluctant to give up one!
My issues so far have been: -anxiety/depression (under perinatal mental health but have only had two appointments since August)

• pgp/spd due to ehlers danlos syndrome (under physio but have only had one appointment since August due to booking errors at their end)

-cervical stitch placement since 20 wks (I was discharged from pre-term clinic after that) followed by bleeding and infection

• osteopenia in spine and hips
• hepatitis b carrier so my baby will need to be hep b protected
• private scan before Christmas showed the baby was small (7th centile) although one last week suggested it has grown since.
• potential problem with recent blood test for which my gp has referred me to haematology (high white blood cells)
• potential problem with thyroid and blood pressure (last bp was 119/67 which was significant increase on all other readings to date).

I'm 31 wks, and at uclh. Ideally I'd like to see a good obstetrician from now on and not midwives. Is this possible with my medical history?

You absolutely should be under consultant care. Can you go to your GP to be referred if your midwives are no good?

To be honest, with all of that I'm surprised you're not consultant led care although that can mean different things. Some people under CLC only see doctors twice and get all the rest of their care by the community midwife, and others for example with twins hardly ever see their community midwife.

Did you have a consultant opinion at the beginning? Because I would have referred for the osteopenia and the potential cervical stitch placement.

Just to add, from what you've said I can't see that your BP is a problem at the moment. One reading that's still within normal range and a bit higher than normal isn't enough to refer to a doctor. Am not sure about the blood test, could just mean you had an infection at the time. Why was your GP taking your blood?

That all said, you CAN ask to be consultant led care if you want to be. You don't have to have a reason. If you're worried about the baby's growth then I think you're well within your rights to ask to see one and be placed under CLC. You're unlikely to just see doctors and no midwives though.

You should totally be under consultant care, but to be frank it made little difference in my case as the consultant was useless and didn't have a clue.

I'm partially consultant-led (due to being 40 and this being my first child) and I have two midwives, one community midwife and one hospital midwife. So it's possible it's not an admin error and your hospital one is part of the consultant side.

Which midwife gave you your notes? With me, even though I saw the community midwife first, she couldn't give me my notes as, as I'm partially consultant-led, the consultant midwife had to give them to me.

You should be under consultant lead just for the EDS, I'd have thought. Mine hadn't been diagnosed when I was pregnant with DD but I was consultant led because of other genetic disorders in the family and a scar across my tummy from previous surgery (even with ehlers danlos skin, it didn't take kindly to stretching!!).

I think you definitely have a good reason to request to see a consultant.

I would have thought you would have been consultant led from the start. However that may not mean you would see the consultant that much, it would depend on what they decide you need. I would have a word with your MW & your GP.
I'm consultant led as I have RA and due to meds am being scanned and seeing consultant regularly. I was referred to consultant at booking in appointment and saw them after my 12wk scan. My consultant is fab.

Jorahmormont - that's interesting to know. Did you have any pregnancy or labour complications due to EDS? Neither of my midwives commented on it until I was about 18wks when one phoned me because it had occurred to them that it might be a risk factor for a short cervix (which I was diagnosed with two weeks later). I've asked about potential complications with labour and hip/back joints but they've shrugged it off.

Thank you all for your answers! I will speak to my gp this week.

It made my joints very loose but apart from that my symptoms improved during pregnancy. I did get pre eclampsia but that's probably luck of the draw as opposed to anything caused by EDS :) labour was very very easy but I tore and stitching afterwards was horrible as obviously the local anaesthetic didn't work! I was being stitched for two hours and had to have gas and air for it all.

*However once the gas and air was working I barely felt it, so don't worry too much.

Thank you. I hadn't thought about local anaesthetic and stitches but I will bear that in mind (when I had my cervical stitch placed, the spinal anaesthetic didn't work properly and it was terrible).

EDS can lead to premature rupture of your membranes - this can happen at any time. There is information about this on the hypermobility website and I presume the EDS website too. Make sure it's on your baby's notes too that you have it so they can look out for it.

I've been signed up for consultant-led care just because of a history of anxiety and depression - nothing else.