Tips for dealing with dismissive consultant?

[April2013]

Has anyone had to push their consultant to get what you want out of them? I've got an appointment coming up where she may admit me from now until birth or may not, may book me in for c section, may not. I want both (transverse and small baby) but worrying I will have a battle on my hands and not feeling massively confident about it.

I wouldn't necessarily assume that your consultant should agree to whatever you want from her - it might be that there are good reasons for her offering an alternative treatment and I tend to think it's always worth listening to the doctor's reasons for offering you a particular course of action even if ultimately you disagree with them.

However, in general these are things that might help when dealing with healthcare professionals who you feel are dismissing your concerns:

1. Do your research before your appointment. For example, it's often worth looking at the NICE guidelines for how your particular issue should be dealt with. If necessary you can then ask the consultant why they're not offering whatever treatment the NICE guidelines recommend.

1. Try to have someone attend the appointment with you who is well-informed about your wishes. Sometimes it's easier for someone else to be assertive on your behalf.

1. If you disagree with what's being suggested then try to explain exactly why you're not happy and what you'd like to happen as an alternative. The more specific you can be about what you want to happen the clearer the discussion you can have about why that is or isn't appropriate for you.

1. If you really feel you're not getting anywhere with the consultant you're seeing then you could consider asking for a referral to a different consultant. Although in your circumstances it sounds like that might be difficult if your situation is quite urgent.

Good luck, I hope the appointment goes better than you expect and your consultant is willing to listen to your concerns.

just in terms of the ELCS request, per NICE guidelines, a consultant cannot outright deny this. NICE guidelines outline a process for managing expectant mothers who want a CS for no clinical reason and essentially if you follow the process and at the end of it you still want a ELCS then you should be able to have one. You will of course need to hear about the risks, etc first and any reasons why the consultant thinks that ELCS isn't suitable option. You can read more about this here: www.nice.org.uk/guidance/cg132/chapter/Key-priorities-for-implementation

We spent pregnancy and after telling consultants what we wanted from them. My advice is stick to a line eg "I think it would be safest for me to be admitted and to have a caeserean section" and then listen and don't get diverted.

So repeat your main point "I understand that you think it is possible for me to have a vaginal birth but I would feel safest to have a caeserean section" or
"I am delighted that another woman in this situation had an easy birth with no problems but I would prefer a caeserean section"

Either they will agree (and prepare to feel judged, unreasonable and want to capitulate) or you will actually get to stalemate, it is clear that they will not agree under any circumstances, then you can say "I don't think we agree on what is best. If you feel I should not be admitted and have a c-section, could you refer me to another consultant who might be more willing to consider this"

Polite and persistent usually gets you there. I think the main thing is don't get diverted, often you end up in some other conversation, you leave feeling like you got nowhere but the doctor is under the impression that you are happy with the outcome. Just make it clear what you want and unless what they say genuinely does change your mind (in which case its probably best to stick to your guns, go away and think about it and then change your mind) do not be diverted.

Do you want the C section because your baby is transverse? They will offer you an ECV. You do not need to consent to this and you should probably bone up on the risks of an ECV to demonstrate you are making an informed decision. If your baby is still transverse at birth then I think they will have to give you a c section unless things have changed.

The difficulty is if you want a c section through choice and the baby turns head down in the interim.

All good advice.

Write down what you want to say beforehand. Don't waffle - try to be clear about what you want and why. Be clear that you have concerns and if you're unhappy with their response, emphasise that you still feel concerned. If you think you won't get further, ask for another opinion - don't get stressed trying to battle with someone who you think won't change their mind. Good luck. X

Thank you so much!

Brilliant advice.

Honestly, this has made a world of difference.

Wish me luck!

I'm totally up for taking her advice on most things apart from when to admit me as she seems more accepting of risk than me - was v dismissive about strep b when I told her I had done that test privately. Seems hospitals vary in admitting with transverse between 36 and 38 weeks, NICE guidelines say 37, I'm a fair way from hospital and so want to try for 36 weeks. I just don't want a cord prolapse at home with a small and more likely to be vulnerable baby, though the risk is significant it is still fairly low but the severity is pretty bad. I have had 2 fairly rare things happen to me on the reproduction front so can no longer be confident that these things probably won't happen and am happy to do whatever I can to mitigate the risk.

Oh if only it was easier!

But i am ready to be a total pain, feel like a time \resource\money waster etc, got to give it a go.

Thanks!