16 week appointment as a group session!? Cost-cutting in the NHS

[Londonmamabychance]

Went to my 16-week appointment yesterday at University College London Hospital. This is my second pregnancy, and with the first (the care was also at UCLH) the 16 week appointment was a one-to-one with a midwife. Now it was a group session with 8 women in it. Each of us got our blood pressure measured behind a little makeshift screen, and before coming into the room was instructed to do a urine sample which was then tested behind the screen as well.

Afterwards the midwife sat down with all of us and told a lot of general information about the appointments we would be having, different options for birth and pain relief and a bit of advice on diet. And then asked any questions. Not surprisingly, none had any.

She also mentioned that they had decided to turn the appointment into a group session as "it was a waste of time for the pregnant women to have to come into the hospital just to have blood pressure measured and urine tested". However, she did not say how it was less of a waste of time to have to do this in a group, and afterwards sit through 15 minutes of general information, which I think all second time mums would already be aware of, and for first time mums, starting to talk about pain relief and birth options may even be a bit too early. The diet advice was random and scattergun, e.g. she mentioned not to eat runny egg yolk and raw fish, but did not mention unpasteurised cheese, never mind alcohol.

My main criticism of this practice is, however, not that it may be "a waste of time". I think few pregnant women find their midwife appointments a waste of time, given that most are quite anxious and love a bit of reassurance. There may be a few very confident mammas to be, who find the schedule of appointments a bit much, but I think they're far and few between, and making it into a group session did not this cut down the number of appointments anyway. The main problem as I see it is that most women do not feel comfortable talking about private issues in front of complete strangers. I and another woman hung back when the others left, to ask some private questions one on one, but it was not encouraged and the midwife, although not being unfriendly, did not at all seem to encourage it and kept us standing by the door while talking to us so we were made to feel as if she was in a hurry to get us out.

It's a blatant cost cutting exercise, and it makes me so angry that it is concealed with this nonsense of it being for our sake in order to "save us time". I am worried that it will reduce the quality of care, as many women may not feel encouraged to ask private questions or voice concerns, and the midwife does not ask each woman individually how she is doing.

It is the same with all the focus on women being "most comfortable in their home" while having the first contractions, you're positively kicked out of hospital if you come in too early. I'm sure many women may feel more comfortable at home, but you can't just make a blanket statement that all do. I, for one, did not, as I was very anxious in my first pregnancy and felt much safer being in hospital. When they insisted on kicking me back home when I first came in I said I wanted to stay, much to their annoyance, and I'm glad I did, because 4 hours after I was fully dilated and ready to give birth - and the hospital is 30-40 minutes away by car. And as everyone who've given birth knows, sitting in a taxi with contractions really isn't the "most comfortable place".

I am curious if other pregnant women have also had group sessions at their hospitals or local midwives/GP's, and if other second time pregnancies have noticed any worsening of the service and care they received compared to first time around, that is, if they're in the same birth centre/hospital?

I'm pretty sure they don't at St Thomas's, they didn't when I had my daughter there four years ago and I haven't heard any of my friends talking about a scan at 32 weeks recently.

thanks, SleepyMe, were you happy with St Thomas otherwise?

looks like a scene from "Call the Midwife".

I was very happy with St Thomas's I couldn't fault any of the care I received.
It's a shame I'm to far away otherwise I would of referred myself again.

I found the schedule of appointments too much and a waste of time especially as I work full time. A 10
Minute appointment often takes half a day because the time is mid-morning and you then have to travel to work after.

However, surely having a group appointment means it takes longer and doesn't save the women any time whatsoever?

Thanks, Sleepy! If UCH continues to disappoint (fingers crossed it gets better) may go there instead! am sot of equal distance from both.

Marmelade, exactly, group appointments doesn't safe the omen time, just saves the hospital time and money.

London, Lj8893 and Hopelessly, thank you for the advice and suggestions! I'll try to calm down about it and take it as it comes, but will also look up some lactation consultants to call on if I struggle. Thank you!

32 week scans aren't standard are they? I only had scans in late pregnancy due to GD

I had both my babies at Northwick Park which doesn't have a great reputation but I was very happy with my antenatal care. I've never had an antenatal midwife appointment at home and I wouldn't expect that to be honest. It doesn't sound cost effective at all. I had appointments at the children's centre or GP surgery until the GD diagnosis and then appointments with the specialist diabetes midwives at the hospital. Waiting times were usually long but the care was good.

Must have been five and a half years ago I was offered a group booking in appointment. I refused. There was no way I was walking into a room of people who I might have known before we're told our parents. It was my second baby, so I refused, and said I would popin and collect the paperwork they 'needed' to hand out at the meeting another time.
I don't know if that practice is still ongoing.

Expats

Lj883 with respect, if you've gone into midwifery wanting to spend time with women I'm sorry to say you may become disillusioned very quickly. Have you read the recent RCM caring for you report?

london group antenatal sessions I believe will increasingly become the norm here in the UK. They've been doing this on the continent for a while for all AN sessions excluding the booking but with 1-2-1 time available at the end of sessions. It does reduce costs but the associated impact of peer support and making connections with others can be an advantage especially with the demise of funded AN education.

In terms of geographic differences each CCG will be allocated a pot to spend on maternity care so it'll hugely differ dependent on local demands.

Thanks, MidMay, I think you're right that the chance to meet other can also be a good thing! I just think that the negative side of women not feeling that they want to ask questions in public is too big a negative compared to this small positive. I think group appointments would be fine if they openly said that there was an option to have 1-1 questions at the end, but this was not the case here, and only I and another woman asked questions, tellingly we were both second times pregnancies so may have felt more confident to demand a bit of 1-1 time, it seemed by the way that some of the others were hanging around after the session that they may also have wanted to ask questions but didn't feel encouraged to ask for it, and I can understand that, as the midwife was literally standing by the door looking impatient.

This is making me very much appreciate the Scottish system! I have an NHS Scotland set of maternity notes that set out the appointments I should expect, all at the moment 1:1. My last appointment was just over half an hour and I didn't feel at all hassled. I'd have hated a group appointment at 16 weeks, who wants to ask about thrush remedies in front of a group?!

Hopper 32 week scans are not standard in pregnancy but when I was choosing my hospital, UCH made a big thing of advertising how they were one of the few centres in the country that do offer them as a standard and explaining why they are so good. Its left me extremely disappointed to see them 'advertising' that when they knew full well that they would no longer exist by the time we got to that stage
(They were promoting them on their website when I chose them in early March but they stopped them for all ladies who were

I'm a student mw too. Group appointments are being considered in my area to cover the antenatal education aspects of appointments, because they are forever adding more and more things that we have to discuss with women and it can't be done in a 15 min appointment along with all the other things that need to be done.

At 16 weeks some midwives do and some don't listen to the fetal heart. It's a difficult one because if you can't find it, you won't be able to book a scan for the woman anyway so you are a bit stuck.

Despite all the paperwork and the conveyer belt system, I see midwives going above and beyond for women every day, providing good care in spite of the limitations. It keeps me going

There's so much variation county to county. I wasn't weighed, I never had a fetal heart rate checked for, I had no dietary advice, a scan at 12 and 20 weeks only and I had each appointment with a different midwife.

You can't tell looking at my kids though.... so I'd try not to stress about it.

For those worried about bf-ing support I'd recommend La leche www.laleche.org.uk

you're right, Celtic, I saw that first with my first pregnancy, lots of midwives giving extremely good care and being so lovely, despite being under various restrictions. I'd say the vast majority were lovely.

Riddles, I'm considering getting a private scan at 32 weeks to assure myself, they're around £100 from the fetal medicine centre (or any other) in Harley Street. Had an scan there at 18 weeks last time because I was such a nervous wreck, pricey, but totally worth it for the peace of mind it gave me.

I'm with St Thomas and have found it wonderful so far. I'm only 19+5 but have been up at the hospital quite a bit wary on due to lots of bleeding and spotting, and 3 times since 12 weeks (on top of my 16 week check) for cramps and every time have been given excellent care. We're moving overseas in a few weeks and I'm actually quite sad I won't be giving birth there. I'm slightly shocked at the group 16 week check, but it sounds like what happened at yours was the same as happened in my 1-1 16 week check. BP, urine check and a quick chat. No HB check and I didn't push it, but I might have had I not had such wonderful support with the EPU at that time.

The only thing I have to compare it to is the Queen Elizabeth in Woolwich where I was for my MMC in Jan, and I was up there a lot for bleeding too. That was a horrid place, hence why we self-referred up to St Thoms. Do slightly wish we'd gone to Kings, but if I have any future children in London I think we'd go there.

I agree with that Celtic All staff I have encountered at UCH have been absolutely lovely and I don't doubt for a second they are doing the best they can with current staffing levels. I guess I would be more happy with something as simple as giving the additional information in the maternity notes book St Thomas provide - there is a lot lot more information in it than what I have been given.

On the flip side, the staff are a million times nicer than any of the hospitals closer to me and the doctors doing the ultrasounds are simply fantastic - the detail they go into is the same as a private centre.

London I am planning to do the same and have a private 32 week scan - I know they are expensive but if it reduces anxiety and keeps me positive, it is totally worth it. I will probably use FMC as I used them for an early scan this pregnancy and they are fantastic - can't find a single fault with them!

Dreadful.
The one on one component is vital for asking questions of a personal nature and for identifying vulnerable women.
My mw supported me through hideous hyperemesis- her support was invaluable. She also probed discreetly at various sessions to see if there were any mh/drug/alcohol/FB issues ( none at all but glad she asked.)
Putting women through on a conveyor is going to miss critical markets of dv etc. It's often that few minutes where they ask 'anything else you want to ask' that can reveal significant health or social issues.

As pp said it is Nice guidelines not to listen in to fh at any routine appt.

Some midwives may do this as they feel women like hearing it (which is true). But there's actually an argument that it may be doing some women a disservice. There is evidence that women in later stages of pregnancy are less likely to seek help for reduced fetal movements if they heard the fetal heartbeat at a routine appt recently. They think "oh I heard the hb yesterday and baby was fine". Midwives should be educating women to concentrate on fetal movements which is a much better indicator of fetal well being.

And I completely disagree with production line midwifery/group appts. Not good.

I'm currently under UCH for DC2.

You had an option to do a group or private 16 week appointment. And it is the only appointment that is done in a group. God forbid the NHS should look for ways to make the services they are providing to an ever expanding population more efficient and more cost effective.

As for the 32 week scan, this was run as a trial at several London hospitals to see if it had an impact on successful birth outcomes. This is now done at 36 weeks, it hasn't been dispensed with altogether.

I had Dc1 at UCH 3 years ago and had an amazingly positive experience, despite having a big baby who was back to back and needing to stay in for 3 days after. I wouldn't hesitate in recommending it.

I'm suffering with PGP and had a group physiotherapy appointment for that and didn't really find it useful at all. Two of the other women had young children with them, which was really distracting. It felt like we were just being told lots and lots of information, without being listened to and no chance to ask questions or get advice. I would really not have been happy to have a midwife appointment like this.

I've had the same midwife for two pregnancies and she is excellent. At my 16 week appointment I talked to her about birth choices after a consultant told me I couldn't go to the midwife led unit, and she advised me and set me up to see the supervisor of midwives. Would I have had this chance in a group setting?

Twirlyhoss, I'm confused, I was not given an option to chose between group or private appointment? They just told me there would be a 'group component' to the appointment when they booked me in for it, and gave me no other option. Glad to hear you wouldn't hesitate to recommend UCH, I had my DD there in autumn 2014, and were very happy, that's why I decided to go back, just now got a bit surprised by the changes and slightly worried that the entire service may have got worse due to maybe more pressure on the service...can imagine, as it's a v central hospital and so popular, that they're under quite a lot of pressure.