What does consultant-led means?

[Cassie2015]

For ladies who are consultant-led, what does this mean. Who do you see and how often during your pregnancy?

Consultant led care is usually given if you are over 40 or there are concerns with you and/or baby's well being or I think also if a multiple pregnancy.

I had consultant led care because I was over 40. I was referred after my booking in appt with midwife at 12 weeks. I then had monthly appts with consultant and monthly scans and only saw the midwife again twice. I think you probably only see the midwife a few times anyway so with consultant led care you have additional appts (with consultant). I loved having consultant led care and felt really well looked after.

I should've sad consultant appts were at the hospital.

I'm consultant lad in this pregnancy due to previous CS.

All it meant for me is that I saw a registrar at my 12 week scan to discuss my birth plan and at 34 weeks to confirm it.
I assume it also ruled me out of a home birth and using the midwife led unit

I've had consultant led care since 20 weeks with this pregnancy as baby has a brain abnormality. At my local hospital it's been appointments every 4 weeks with the consultant, (although he's hardly at clinic so have seen duty registrars twice instead of him) They also have a regular midwife who works his clinic with him so, luckily, have had a consistent person in her.

I haven't had extra scans locally as I was simultaneously referred to another hospital for diagnostic testing and the consultant there, who I saw around 4 times, did that part.

I've been told birth plan/labour can all be normal, although consultant will only let me go so many days over if baby's late. I've had a fairly good experience despite the circumstances.

Sorry - the rest of my care was with a midwife at the doctors, same as first pregnancy, so different from Inshocks experience. I guess it depends why you're consultant led & what NHS Trust you're with.

Hi everyone,

Thank you so much for your replies! I am 7+2 and really baffled as to who is going to look after me.

My first baby was born with a severe heart defect. Diagnosed at 20 weeks. During the whole pregnancy I had shared care with my community midwife and my GP. On top of that, I had monthly scans to check baby's heart at the hospital with the cardiac consultant after the 20 week one. I should also mention that baby was born with emergency c section (and there will only be 16 months difference between his birth and this new baby's).

This time, I want to avoid midwives from the community. I went to see my GP and asked for a hospital referral which he did but I don't know whether I am supposed to call anyone or what for booking appointment. He referred me for the regular 12 week scan but also referred me to the obstetrician department of the hospital. I tried to call the department but no one is picking up the phone...

I know that I will get 2 heart scans with a cardiac consultant to check the heart is (hopefully) ok and I guess more if there is an issue again.

I am just very confused in terms of regular routine check ups... I d love for it to meant that the obstetric department from the hospital will do them and so I don't have to see the community midwives again who I found really useless first time around.

I saw the community midwives for all the routine checks, and additional ones with the registrar attached to the consultant clinics.

I was consultant led throughout my last pregnancy, as I'd had recurrent miscarriages and then went on to develop preeclampsia. It meant that in addition to the standard MW appointments (of which there really aren't very many), I was also seeing a consultant - at least as frequently as I was seeing the MW and at the very beginning and end, more frequently than I saw the MW.

It also meant that I had DD on the labour ward rather than having the lower risk opportunities open to me, but despite being there and being high risk I still delivered with the MWs rather than a consultant or dr in the room - although one did pop in and out to keep an eye on how things were going.

Unfortunately I don't think you're going to be able to avoid the community midwives altogether. As far as I can tell you have a couple of options really; speak to the supervisor of MWs about your experiences last time and see if they can help, transfer to a different hospital/team, if it's feasible for you, or go private.

I hope everything goes ok for you.

I was consultant led as I was a late booker and no one was 100% on my due date so I got monthly, dropping to 2 weekly scans to monitor babies growth. Whenever I saw the consultant they were always slightly confused as to why I was there though. I still saw community midwife to normal appointments, flu/whooping cough jab etc

For me it's normal appointments with community midwives but extra appointments at the hospital with a consultant. So far I've seen the dr after the 12 week and 20 week scan and am booked in for more scans and appointments at 28, 32 and 36 weeks. I think consultant led normally means extra appointments instead of replacing community midwife ones, but of course different areas and/or conditions might have different procedures.

Ah that's what I was worried about :( I complained to the supervisor of midwives last time and emailed all my questions. She just said I should have said earlier and did not answer any of the questions I had put in the email so no clue whether my care was right or not... Frankly she made me feel so tiny..! So worried of going back.

Why would the GP have referred me to an obstetrician then? What is their role? He is not the cardiac consultant that will do the extra checks on baby so if he is not replacing community midwife what will he do?

Consultant care can mean very different things to different people as you can see from the responses here.
I am consultant led because I have RA and am on long term steroids. I saw my community MW for booking in appointment and have had a few appointments In-between my hospital appointments but it's more of a hi, is everything ok appointment.
I started off with monthly consultant appointments and scans but as I've developed GD from the steroids I now have fortnightly consultant appointments and scans and weekly physio, it's getting hard to fit the MW appointments in.
My MW only really wants to keep seeing me because I have shared care across two trusts so she's based where I live but the hospital is in another trust.

I have no idea, sorry. It might be that for cases like yours it is purely dr based. Must be very frustrating for you not knowing.

Sorry to hear about your first-born. Hope they are doing okay. As others have said, it really differs as to why you are consultant-led as to how often you see them/what they do.

I'm consultant-led because I have a slight bicornuate uterus (meaning there is more chance of baby being born prematurely or being breech). However, I have to say that this has made very very little difference to the care I have received. I'm 30 weeks and have had all the usual midwife appointments. The only consultant appointment I have had so far was at 24 weeks and I found it extremely uninformative.. She barely knew why I was there (not helped by the fact that my booking in notes had been lost and weren't on the system) and gave me no more info than what I knew already (from my own research!). I have another appointment and growth scan at 34 weeks.

As a matter of routine they do the usual blood pressure/urine test/bump measurement/heartbeat so there is some overlap with midwife appointments. A friend who started under midwife care and has moved to consultant-led care and who has been having monthly scans as a result has been informed that she doesn't have to attend some of her upcoming midwife appointments as the same things are obviously being checked by the consultant within a short space of time so you might be able to get out of some of them but I'm sure they will still want to see you.

I was consultant led both times due to a previous medical condition. They saw me every 4 weeks in my first pregnancy but only 3 times in the second. I had some extra scans and was seen slightly less by the midwives as they basically did the same basic checks at the consultant appointments (BP, urine, measurements). It did mean I had no option for home birth or birth centre, and they were only prepared to let me go to 41 weeks before induction.

This is all so confusing. I guess I'll wait a little to see if I hear from the obstetrician department from the hospital (I kept trying to call today but they don't pick up and it goes to voicemail so left a message explaining I needed to know where to have my booking appointment and if I needed to call and book anything myself). If I don't hear anything, I guess I'll have to plucker up the courage to go back to the midwifery led unit and have a midwife there whilst I wait for baby's heart to be big enough to be check by hospital consultant.
I'm stressing over this. My first experience with these midwives was not great and I hated having to explain over and over that my little one may not make it and how surgeries would be needing only at a few days old. Things got worse as my little boy did not make it and hubby and I had to turn off support when he was about to turn 6 months old. I feel I have the right to be a bit picky but you have no clue as to what the options are or how the system works (and it seems ever so different for everyone), it actually really limits your choices...!
I suppose the most important thing for me will be the scan anyway. Checking the heart beat meant nothing for me. It was perfect when listening but his heart had severe malformation so the only people I kept wanting to see was the fetal cardiologist who would have a good look at the heart every month to check development progress.
Thank you so much everyone for taking the time to write your experience xxxxxxx

I have a child with a heart defect and referred to obstrictics so they could refer me to the hospital which I attended my son antenatally and for surgery etc. Also my son technically small for gestation age at birth so referred for that as well although discharged after a quick scan. Although when they did a growth scan this baby is looking quite large so got referred back . If your bmi is 30+ at booking this will make you an automatic referral.

Just wanted to add I've only seen the community midwives once during this pregnancy, before baby's brain abnormality was picked up. I'm now 35 weeks and it's only just dawned on me perhaps I should have been seeing them as well! Although, I do remember a phone conversation with a screening midwife saying it's more for continuity of care after birth (which is odd as with my first pregnancy the midwife I saw throughout wasn't the same one afterwards).

In your case, it seems to be that you are referred because you asked the dr.

I was originally referred to a consultant because of age and a previous silent labour. I saw the registrar a grand total of one time, at either 12 or 20 weeks (can't remember). She discharged me back to the community midwives. But I got a note on my records with my labour history and telling the MLU to admit me to the unit and perform internal inspection to check labour progress whenever I request. That came in useful during labour so it wasn't a waste of time for the one appointment.

I had my booking in and all normal checkups with the community midwives.

Well, update. I finally managed to get hold of the obstetric department at the hospital and the lady did not understand what I did not understand. Anyway, turns out I don't think I'll see an obstetrician, I think this department is where the consultants are and where I was before with my first when they found out about his heart. So, I'll have my 12 week scan and a letter after. She did not let me finish to explain so kept saying they don't see women after 20 weeks. Well, I beg to differ because all women who I know and lost a baby due to heart condition have scan at 16 weeks as they can start looking at the heart. One of the women I know is even based at the same hospital so I know that's how they do things. Anyway they clearly don't do the booking appointments so I just called the community midwives and will soon get a call back with a date for my first appointment. She asks if it was my first and I had to fight back tears so this won't be easy so I really hope they are good and don't behave like it's a factory again and care to read my notes and spend a bit of time listening to my worries.

Cassie2015 I'm sorry you had a difficult phone call. Given what you've been through previously it's not surprising it was tough I've found contacting the screening midwives at my local hospital directly the most helpful, can you find out who they are?

When you speak to midwives (community or screening) double check the information you were given. I'm pretty sure this pregnancy will be treated differently due to the circumstances of your last, therefore 'normal' timescales for scans etc might not apply.

The consultant I've been seeing told me that if I have a further pregnancy I'd automatically get referred to him for scans/MRI due to baby's brain abnormality this time round. There's not necessarily an increased risk but they'd rather offer it as a precautionary measure.

I know I'll have a couple of scans just for baby's heart at 16 and 21 weeks done by the cardiologist who diagnosed my first son. I trust her and she was so lovely to me and my husband. She is one of 2 antenatal fetal cardiologist so she does this day in day out but still stayed after her clinic to answer the billion questions we had. So, I'm glad she will be checking this baby's heart too. I just find it a bit annoying sometimes that they don't let you finish explaining and just seem to hurry you up. Just like you must know, it has been an extremely complicated road for us so when I want to ask a random question to a professional, they do need the full background to answer and the lady at the hospital almost sounded annoyed. She asked You did not have any previous complications did you? And I say My first baby was diagnosed with HLHS and passed away in December and she just carried on We don't see women before 20 weeks. Yes you do, it's just you are not listening to my circumstances! You will see me at 16 weeks you idiot.. And I really hope I get a good community midwife. I know they are not the main person for us and the consultants and scan people are the most important but the midwife is supposed to be the primary person here to listen to concerns and I really felt they did not care the first time around because we were too complicated for them and they were quite happy to not be fully in charge of us.

The paediatric cardiologist recommended a 20 week and 32 week scan for me, this is because you can see much more at 20 weeks and things are less likely to be missed. The 32 week is because some issues don't show until later in the pregnancy. It does sound like your midwives etc don't have too much of an idea of what to do in your circumstances.

In my trust any complications with your previous pregnancy and/or baby then you get referred to obstrictics. They then refer onto who or where ever is a specialist. They follow set procedures for and have a different one for each complication. Have you rang the hospital and asked to speak to the midwife who deals with the ultrasound dept. Can't remember the exact title for them sorry. Sorry that you've had such a tough time and I hope you sort this asap

I'm sure they will take into account your first birth. Don't worry about it until you have your book in appointment. In mine for DD2, the midwife went through my previous labour and birth, and also my miscarriages. That's when I was given the consultant appointment. I was also referred for a after birth session with a midwife in the hospital to go through the labour note too.

All the best.

I have no idea who else to call.

I only know I ll be seen by fetal cardiologist at 16 and 21 weeks on top of regular scans because that's what happened to another mum who lost a baby due to a heart condition and who is under the same hospital as me.

I went to see my GP and he referred me for the 12 week scan and to obstetrics but obstetrics say they don't see women so early in the pregnancy (which I now get, I was hoping I could also have all my regular routine check ups by hospital midwives but I guess not). She said the community midwife will refer me even though I had started the conversation by My GP referred me. She just did not listen and could not wait to get me off the phone. Maybe I should phone back explain everything and asks what will happen for sure but I guess a receptionist might not know to be fair. I ll have to explain it all to the community midwife as apparently they have all the power, never mind that my GP did refer me.

What is a screening midwife, never heard of that..?