what happens next if I opt out of consultant led care?

[Cuppachaplz]

Horrendous antenatal appointment today, which I left in tears (again).

Background is that I have 2 DCs with a large gap and multiple miscarriages in the middle that were very likely due to huge adhesions left by extensive sepsis following a car ruin with ds1. I had a dreadful pregnancy with ds2, was very ill and he was delivered early following this by ELCS as transverse and unable to turn (happy for me to vbac up yo this point)
Because of this I have been told that I have to have an ELCS this time, which I really don't want. Consultant today said that she don't see me again if I don't agree.
Just wondered if anyone knows what happens next?

I assume she meant she'd refer you to a different consultant - I guess you would get a second opinion?

I have no more appointments. The next one was cancelled.
They just said to go to the next midwife one 'if I want to'
Feeling a bit lost..,

They can't just leave you to get lost in the system! Can't you call up and ask for an appointment with a different consultant? How far along are you anyway?

27w.

I'm a bit worried that ill wind up having the same conversation with a different consultant. No one has discussed anything other than booking an ELCS with me so I've no idea what happens. Last time j was do I'll that there was no discussion at all.., and I can't remember back to the dark ages when ds1 was born

No advice I'm afraid but loads of love to you.

It sounds like you need another consultant to explain exactly why an ELCS is recommended and what happens if you decide not to go for that.

Could you ring up your midwife and explain what's happened? She might be able to help you with what to do next.

Why don't you want the ELCS?

AFter 2 prior CS you will have significant scar tissue and are much more likely to rupture something trying for VBAC.

Surely you do what's safest for baby and you?

Whilst I agree it is very important for a woman to have a say in delivery her baby, I also think we need to realise these things aren't recommended to give the Doctors something to do. It is recommended for your safety and the safety of your baby. The consultant obviously feels strongly about this and I think you need to respect the fact that they know what they are talking about generally.

Dear Cuppa,
I am sorry you have had such a difficult time. Firstly you have the absolute right to make the decision you want about how your care will be managed. If the consultant felt that they could not support any decision other than an elective CS then they had a responsibility to refer you on to another consultant. It seems to me that what you need is a consultant who will listen carefully to your concerns and work with you to ensure the safest possible delivery for you and your baby that is acceptable to you. That is more likely to happen if the consultant keeps open the lines of communication and respects what you have to say. I would suggest you contact your local supervisor of midwives at your local hospital (call and ask switchboard for their contact details) and explain the situation. Explain that you need someone to support you to locate a new consultant and to help you advocate for yourself. Good luck.

I think you need to ask to see another consultant - preferably one with better communications skills - but you also need to really think about why you're so adamant about a VBAC. I can understand a consultant, having looked at the risks in your individual case, not wanting to bear the responsibility for the possible outcome of going against her advice.

I'd be very way about it, having seen the impact of a uterine rupture to my best friend after a poorly-managed VBAC. Apart from the physical impact she wound up with PTSD. It was horrific for her.

Princess's post was much better than mine, on rereading mine sounded preachy. Sorry, last thing you need.

How likely is it that you will be able to deliver your baby vaginally? You are very likely to run into serious problems and need an emergency section if you try for a normal delivery. Why would you do that to yourself, instead of having a nice calm elective section?
Take a deep breath, book an appointment with your midwife, ask for a referral to a different consultant and start again. Go in with a list of questions and an open mind, and see what they say.

The first thing many friends and midwives said when they saw which consultant I was under was 'you will never get a vbac'. She is notoriously over cautious. Last time I had 3 other consultants say that they didn't see that the problem was (however a transverse lie meant that this wasn't an option at the time).
Clobbered , my nice calm elective sexton last time was far from it. I crashed under the spinal and had to be lightened up so much that it stopped working and they wanted to give me a GA. I refused as by now I was deeply concerned about my baby, having categorically stated to every member of theatre staff to pass him straight to me unless he required resuscitation (he didn't). They ignored this. I was stitched up fully conscious and aware, so had massive post op pain. Despite the anaesthetist writing me up for morphine, I was told by mw on the ward that I couldn't have it without first trying nurofen or voltarol (I am allergic to NSAIDs so can't take either). I was therefore given paracetamol only. I went home and my lovely GP gave me tramadol but I would still rather avoid a repeat experience.

As far as I can work out, the big risk got this pregnancy is that my last baby has T21 and I have declined an amnio for this one.

However at 27w, all risks appear very low and genetic testing for us was normal (I allowed all of this try to reduce my risk to get her to back off, and it made no difference despite what she said before).
Also thus pregnancy being unplanned seems to increase risk (why????) and coil still in situ.

"I'm a bit worried that ill wind up having the same conversation with a different consultant."

You'll only find this out by having that conversation, and establishing whether the advice is the same or not.

The way I read your earlier posts is that the consultant does not assess that you require consultant-led ante-natal care and so has transferred you to MW-led. You still have weeks to decide what type of delivery be safest for your baby and best for you.

It might help you make those decisions if you ask for an appointment for a birth debrief (or another one, if you've had one before) to come to terms as far as ever will be possible with your earlier experiences.

Stella - I read it that the Op wants to try for a VBAC and the consultant feels this is too risky and is not willing to try , she is insisting on a ELCS. So the consultant is no longer willing to treat her .

I think she needs to see her GP ASAP and ask to be referred to another consultant . I'm surprised that her GP referred her to this particular consultant in the first place, given that she seems to have a reputation for being very conservative .

I assume the OP is still seeing her midwife for check ups

If you are not happy with your care under one consultant, then you need to request to be seen by another - either through your midwife or PALS. Do consider though what you will do if the next consultant says the same thing. Every effort should be made to enable women to have the birth they want, but doctors have to balance that against the possible risks to mum and baby. Looking back at your past experience, I'm not surprised that you aren't keen on another ELCS, but in the nicest possible way, is the trauma blinding you a little to the risks involved in a VBAC?

You need a good two-way discussion with a new consultant about the pros and cons of each.

Auntiestella she didn't discharge me to mw care, just says if I didn't agree that she couldn't see me. End of discussion. My next appointment was cancelled, and that was where it was left.

As I said, she was the same last time, and yet no other consultant could see the problem.

GP doesn't refer here, you are allocated a consultant randomly. However, I saw her as referred back to foetal medicine due to DS2. I had all the extra testing they insisted on (except an amnio) in order to make myself lower risk, but it made no difference. That's why I'm upset, I jumped through her hoops despite making if obvious that I didn't want further testing, in order to hopefully be allowed more choice in my birth. Despite what she had said previously, she moved the goal posts and wouldn't even discuss it.
I have however now been discharged from foetal medicine and can see someone else.

I gave today rung up and asked for an appointment, but the way I feel right now, I just want to stay away. I can't stop crying. All I can think is that I've been bullied into tests that I didn't want for nothing. I've lost all trust in the hospital, and just want this all to stop.

Oh you poor thing. Firstly, I'm really sorry you've experienced care which has been insensitive to your emotional needs, which are very understandable given your history.

The thing is, much as you would like to be low-risk, and to have a VBAC, there are statistical risks in your profile. These aren't going away, and doctors have to base their advice to you and the care pathway they advocate on the present risk factors, otherwise they could get into very sticky ground.

I think in answer to your question, even if you left consultant-led care, those red flags would still be attached to your presentation, and one risk could be that you go into birth and are transferred back to consultant-led care there because the midwives decide your history requires monitoring etc. Then you'd be having to make decisions on the fly and without having had the opportunity to talk things through calmly with your consultant first.

While I completely believe in the importance of a woman making decisions over her own care, it sounds like you'd do well to find another consultant who you feel listens to you and who you can trust, and with whom you can plan your care. No one can know in advance the definite outcome of any treatment plan, natural birth or Caesarian. You make the choices by weighing up the risks and the advantages of one course of action over another. You need a doctor who can take you through that process rather than forcing their decision on you.

Quod, when I said 'reducing the risks', I actually meant for the baby, as I fully understand that nothing can be done to change my history. Consultant had initially made a fuss about my declining testing, despite there being no indication of any potential problems this time.

I agree totally. I need to be able to discuss a plan. This is why I'm upset, because she simply won't discuss anything. If I felt that there was no need for discussion, I would simply not turn up.

This is the problem with the model of maternity care in the UK. First your consultant has terrible bedside manner. They work with pregnant women day in day out and should be able to communicate with empathy.

If you are close to another hospital I would consider going there. If not I would look at who else is an obn consultant and ask around locally so you have an idea of what to expect.

I would report the obn to the hospital because it's a problem when a doctor can't communicate.