Can I decline to be consultant led?

[Katiekins86]

I'm 22 weeks pregnant, I have a 13month old and the appointment waiting times are ridiculous, so ridiculous that I've been waiting 3h ours and had to leave to get lo home for some food.

I am only consultant led because I have abnormal Pap-a which can mean I am at increased risk of a smaller baby or pre-eclampsia. I'm not worried I had the same marker and was consultant led with my first and there was no problem I was signed off to be midwife led again at 36weeks.

I just don't see the benefits of being consultant led, surely I can be measured by my midwife and blood pressure and samples taken would indicate if there was a problem. But what would they do anyway?

Am I able to refuse to be consultant led and ask to be midwife led?

Thanks

The fact that you mentioned the waiting time makes me think that is probably more to do with that then any real understanding of the risks. If you're not sure what they would do/why you should be consultant lead then you should ask as right now it seems like you don't know enough to make an informed decision anyway. I know you ask that at the end but it really sounds like it's the waiting time. Which is annoying but it must be important.

Obviously I'm sure you know this but just because you didn't have a problem last time doesn't mean you won't need extra monitoring this time. If the midwife spotted a problem shed have to contact the consultant and then you'd have to go and see them anyway. Being consultant lead might mean only one appointment rather than midwife then wait for consultant.

No, it's not true, I know quite a bit about Pap-a it's also a relatively new thing that they monitor it with growth scans.

I'm against 4 weekly scans anyway there's not any evidence to support their safety. I want to know if I am able to insist on being midwife led. I am attending an appointment tomorrow and have some questions to ask but if the answers are as I think I hope to referred back to the midwife.

In your shoes, I would rather be consultant led and have the extra scans, it's not worth the risk imo.

That means that there also isn't any evidence to say that they are not safe? No one has demonstrated that ultrasound scans cause harm.

I'm not sure there is any downside that you've explained other than you have had to wait a while to be seen.

Believe me the NHS would love to save money by having as many people under midwife care as they can (safety permitting). If they say you should be consultant lead, and you decide against it because nothing bad happened last time, you have to wait a while and... You're not sure ultrasound scans are safe?

Sounds like you've made your mind up anyway. But I don't know what it is about pregnancy and childbirth that makes people feel that they should go against medical advice.

I don't think your being fair. You're assuming I don't know what I'm doing and I'm uninformed. Which is not the case. I'm interested in getting all my ducks in a row before I see the consultant of course. I don't want to be consultant led that is true but if I believed it was in my best interests I wouldn't be going down this path.

For example Hampshire operate a different policy on pap-a results. You have an additional growth scan at 34 weeks and in the interim you are measured as normal by the midwife if there is any cause for concern you would be referred.

I see no benefit in having the added stresses of getting to and from an appointment with a 13month old just to plot growth on a chart and tick a box for the particular region I live in.

As I say I'm not concerned I had the same with my first and my particular reading is slightly low but it's not alarmingly so.

Of course you can refuse. However, your midwife may want you to go to an appointment in order to have a conversation with the consultant team about why you are refusing (and to document that you understand the risks of declining).
Multiple studies have shown that ultrasound is safe. Serial targeted growth scanning reduces stillbirth rates but increases intervention risk.

Nobody can make you do anything or go anywhere you don't want to (providing you have capacity).

(Am an obstetric consultant so the above is fact).

Thank you Nan0Second that's all I wanted to know.

Yes you can refuse any medical treatment or appointment. That doesn't mean you are right too and if there's risks involved it will need documenting that you are refusing too.

Doesn't mean you are wrong to refuse either especially if different trusts do things differently. You may even be ok to compromise and go with less appointments and be seen at key important dates. Speak to your consultant and midwife.

To be fair, consultant won't actually do anything re papp-a. You will see you midwife regularly for BP monitoring and pregnancy assessment. If you have concerns re fetal movement you will call in, and the Scans you have been offered.

Your care would technically still be consultant led you just a wouldn't be seeing them... Which is very common. Most CLC gets signed off to MLc very quickly

That's what I'm hoping for Mummy me 😊 I had appointments for scans every 4 weeks plus other appointments which seemed very excessive. I had the same with my first (it's just down to district) but because I was having to see the consultant each time to write up straightforward notes it was very time consuming and needless. It was just scan or doppler.. how are you feeling.. blood pressure.. urine sample.. okay sit back down and wait for the consultant who reviews the results writes in green notes and dismisses me. Just totally needless.

I spoke to consultant yesterday and she agreed with my point of view but said she still wanted me to have the growth scans every 4 weeks but is happy for a midwife to write up notes and alert if any problem.

Hallelujah