Problematic pegnancy, cervix incompetence and NHS rules - seeking advice

[Mummy801]

Hello all, I apologise in advance for a long post and maybe silly questions but I’ve been in the uk only a year and currently I’m 8wks pregnant with my second child. - the 1st was born in Russia. So things are very new to me here. I had a troubled 1st pregnancy right from the start but in Russia they fight for you tooth and nail trying to save every pregnancy so I was prescribed utrogestan (progesterone) straight away and had my entire pregnancy supported and checked due to cervical incompetence. I also had a pessary from 7th month otherwise I wouldn’t have carried my baby until 40 wks. After seeing my gp here, I realised that 1) early stage pregnancies aren’t really supported, my doctor literally advised to me “to wait and see the nature taking its course”, 2) one needs to go through devastating experiences of late stage losing - not just once, as I gather - to be eligible for utrogestan prescription.. So they’re telling me I’m not eligible..
So my questions are:

1. anything I can do to get utrogestan here? I can get it from Russia but I’m only flying in 2-3 months.. I’d need it earlier than that as it takes time to accumulate in the body..
2. with cervical incompetence it is crucial to look regularly after cervix length and dilation - I had those scans monthly in Russia, what’s normal here anybody knows? Same question about progesterone blood tests - I had them done monthly so that we would increase the dose of my pills in case it wouldn’t be enough.. can I ask for progesterone blood tests here and how often?
3. if my requests are beyond standard here, who is the best person I talk to to try and explain my situ? My midwife? I’m not seeing her until I’m 16 weeks which is unheard of in Moscow... my gp? She only gave me a wry smile saying I was over medicated in Russia.. but I have my overmedication 4,5 years old running merrily around me, so who cares?! Or do I need to get through to a consulting midwife? And how? For I know, much easier said than done.. Thanks for your help everyone xx

Personally, I'd suggest that if you prefer the medical system in Russia, then have your baby in Russia.
Or you could try going private and see if you can get the medication you think you need if you pay for it yourself.

Well, tywysogesgymraeg thanks for the helpful advice but that is not what I asked is that? Cheers

As Pp said private or back to Russia.

Perhaps get your medical records here and translated and speak to your GP with them in hand.

It's hard to tell someone how to get their hands on prescription only meds.

NHS care can be a bit 'one size fits all', and you are correct that some quite inexpensive meds are not prescribed until several pregnancy losses have been suffered. I think your best bet is to see an obstetrician privately, though this can be very expensive.

Have you looked at www.nice.org.uk ? This will give you an indication of the U.K. guidance that the NHS works towards when considering intervention or medication for your condition. If the prescription is outside of the guidelines then as pp said you may have to go privately or elsewhere for treatment. Good luck - I can understand why you're concerned about this.

How much did you pay in Russia for your medical care? Did you know their healthcare system is actually ranked very low... it's outdated and loads of people have no access to medical care at all...

In case you didn't notice, here it's free for everyone.

If you don't like it, pay to go private or go back to Russia.

Why should taxpayers pay for your crazy perception that something as natural as pregnancy needs to be overly medicated from the get-go?

And btw, if you do have an actual diagnosis of cervical incompetence, then this will be treated by the NHS.

First midwife appointment is at around 8 weeks, not 16. And if there are issues with your pregnancy, you get a lot of monitoring. (Eg. I was given a scan at 6 weeks.)

Some hospitals will measure cervical length, but yes, you do have to experience a loss to know it’s an issue. Otherwise I would go private.

Did you have short cervical length in your previous pregnancy?

Dear OP, I'm sorry for the anxiety you're going through and I'm absolutely shocked at the lack of compassion in some of these responses.

I had my early pregnancy supported by progesterone (after IVF and a rocky fertility history) and I'm convinced that is at least partly why my daughter is here.

NHS care for pregnant women is (at least in my experience) a complete disgrace. Nobody cares, pregnant women are treated as an inconvenience, you have almost no access to obstetricians because everything is relentlessly midwife lead and you have to fight hard and advocate for yourself to even get a barely adequate standard of care.

You could go to your GP again and try to explain that you've had a previous high risk pregnancy and you're not leaving without an urgent referral to a specialist. Even if you don't need the medication in this instance, that decision should surely logically come from a specialist after a thorough review of your situation, not being dismissed by a GP in five minutes.

Alternatively, there's private care, but I don't know what your financial situation is like.

I wish you a healthy and easy pregnancy and all the best of luck advocating for yourself.

I think you need to speak to your midwives regarding referral to a consultant Asap. I am unsure why you have to wait until 16 weeks have you already had your 12 week scan? I would phone them today.
I experienced 2 late losses unrelated to cervix issues but had no issues getting an appointment with a consultant after my first loss.
Good luck and sorry you have had some unhelpful comments on here.

Hi Op,
You are well within your rights to worry about things not being the same here when you had problems in your last pregnancy. Have you seen a midwife yet? Worth getting an appointment with a midwife and asking them for a consultant referral, I think if you went through your history with a midwife they would listen and refer you.

I had cervical issues in pregnancy, I was given progesterone pessaries from 24 weeks as my cervix was shortening, these allowed me to carry my daughter to full term and I was able to avoid having a cervical stitch. I had regular appointments with the consultant from 21 weeks to keep an eye on things. So they do look after you for things like this, but you need to be referred to a consultant so that they can go through your history properly. Hope you get things sorted :)

You should have a booking-in appointment before 16 weeks.

This is the NICE guidance for the schedule of antenatal appointments for straightforward pregnancies.

I would have thought that a history of an incompetent cervix would merit a referral to a consultant, but the care is still pretty light-touch compared to the Russian system that you describe.

I can't believe some of the responses you have had here!

If you had issues in your previous pregnancy, these should be taken in to consideration. Was there evidence in your last pregnancy that you needed progesterone or that you had cervical incompetence? It's rarely diagnosed here prior to a loss, unless there have been significant cervical issues prior to pregnancy. A cervical length scan isn't a standard scan on the NHS, though you can have one privately.

Have yo got your booking in appointment and 12 week scan date yet?

The NHS is great, but maternity care in the UK is not great, and for our level of health care have a surprisingly high level of pregnancy loss and still births.

Have you had your booking in app yet? This would be your opportunity to discuss your previous pregnancy and create a plan based on that. You don't then see another midwife till 16 weeks if your situation is standard but will have other appointments if they're deemed necessary. Once the booking in is done it may be time to consider private if they don't agree that you need additional scans / medication.

Also: sadly, this is the case:

The NHS is great, but maternity care in the UK is not great, and for our level of health care have a surprisingly high level of pregnancy loss and still births

Dear ladies, thanks for your responses it made my situ much more clear. Yes, I can try to break this wall with a bulldozer or I might as well save my nervous cells and go see my doctors in Russia once I can. She is also an IVF specialist, that’s why she is so thorough about cervix issues - to avoid any miscarriage risk.
I got ahold of utrogestan last night through Russian community in England, so I’m good. Your responses were very helpful, though.
I’d like to emphasise - I do think nhs is very good, but just not in the obstetrics/matennity care etc. Not yet, for I believe things will change for the better.

I’ll take some effort to respond to @artemis2 - you wouldn’t think I’d try to compare apples to pears, i.e. private medical care in Russia to NHS here? Well, I didn’t pay a penny (or rather a ruble) for what I got, however I give you some right in what you say about Russian medical system. Depending on where you live, you’re either bad like in the middle of nowhere, or very good, like in Moscow where there is plenty of great doctors, lab services etc. Free or very affordable private (on average 5 times cheaper than here)
And in case YOU didn’t notice, lots of people here mentioned the same thing as me - cervical incompetence is not tested and check-ups are not made until something bad happens. There is even a petition online, I’ll copy it here just for you. I don’t think it appeared without a reason.
www.change.org/p/nhs-england-cervical-incompetence-nhs-to-make-cervical-checks-mandatory-from-16-25-weeks-save-babies-lives

And since writing this post, I was connected through my friend with her relative, a doctor in Austria to seek some advice, we spoke and she said that British healthcare is seen in Austria as scarce and insufficient. Booo. Well, for maternnity even devilish Russia is obviously way ahead.

Ah, and regarding taxpayers - you don’t need to worry. Before coming here I paid an extensive amount of money for health surcharge ahead - google immigration services health surcharge if you’re interested. I appreciate what you write is a lack of knowledge and understanding but please not another word about you, taxpayers, paying for smth for me.

I think that if you don't trust medical experts in any country you happen to be in, your options are to either
*pay/pay more
*go somewhere where you do trust the experts.

But don't buck the system by getting non prescribed drugs and/or advice from people who haven't examined you and then expect the NHS to pick up the tab when things go wrong.

While the NHS is free at the point of use, I find it dreadfully inadequate in some respects, but you're told to suck it up and be grateful because it's FREEEEEEEEE. But I usually daren't mention that here, or you get flamed! People seem to take it as a personal blooming insult. I think British people like to think they have one of the best medical systems in the world, and when inadequacies are highlighted particularly compared to another country (could be anywhere), people act like you've actually told them their baby is ugly or something equally insulting.
Meh!
Glad you got your meds sorted.

Op, I'm sorry you've had some frankly awful and thoughtless responses. This isn't a reflection on you or where you're from, it's how Mumsnet sometimes, on all sorts of topics. Of course the answer isn't for you to go back, and you are rightly seeking to understand the new system.

As others have said, you should have had your frist midwife appointment around 8-9 weeks. This is really important and please chase this up with your GP or self-refer to a local hospital if that's an option. They can categorise you as low or high risk during this appointment and you will then receive appropriate care (consultant-led if needed). Whether 'appropriate' is equivalent to elsewhere (Austria, Russia, Germany etc) is another question, but it's what the NHS deems suitable enough for the money it has to spend. If you don't feel it's good enough, you can definitely use private care, but it costs a lot. Be aware that many of the private consultants (if not most) are NHS trained and also practice there concurrently. So you'd need to shop around for the type of approach you want.

I watched in horror as the predictable taxpayer money point got rolled out. It shouldn't be. The surcharge you paid is what the state deems appropriate. Before anyone says that the surcharge is far lower than the average cost to the NHS of even a low pregnancy and birth, they should remember it's what the state has modelled as adequate.

In case helpful, do be aware that:

• GPs are rarely expert in pregnancy matters and the the first port of call for your type of query should be a midwife;

• you can choose any hospital to have your midwife care and birth, even if you don't live locally; I'd recommend a teaching hospital if you are in London;

• you can always see a private doctor as a top up/extra scan/second opinion, even if you don't have all your care with them;

• you need to keep, as you are doing, taking responsibility for your overall situation as sometimes things can be less efficient - the key is understanding how the NHS works.

Honestly the NHS has been pretty good in my experience.

Good luck!

If you are in London then King’s College Hospital are one of the few who measure cervical length as standard during scans.

My experience of NHS maternity care with a pre existing condition for two pregnancies has been exceptional, honestly could not have hoped for more. The problem here seems to be more that they either don’t know, or don’t believe, your pre existing condition. (Although of course NHS guidelines in terms of treatment may be different to what you’ve experienced previously). Agree with what a few other poster have said, you really need to discuss it with a midwife at your booking in appointment, which should usually be 3/4 weeks before your 12 week scan. The midwife would usually go through your history, categorise your risk level and refer to appropriate additional care. Good luck and hope all goes well for you.

Hi op, I also can't believe how rude some of the posts are!

I'm currently 12+6 and didn't the midwife didn't see me until I was 10weeks. I have a cervical history after having two LLETZ procedures. I have been referred and got a letter from the consultant but my appointment isn't until I'm 17weeks! I had most of my cervix removed so I don't understand why they would wait so long to see me :(. If I were you I would go to Russia, and I say this in a nice way, not in a rude go back way. I don't have any other choice but the NHS and if I did I would take it. I'm so worried that the baby won't make it until I see the consultant. This is my first pregnancy and I guess u til I've lost a few they won't take me seriously from what I've read. And that also they won't do anything until 13weeks. Maybe wait until then and then demand your GP referres you :)

I've just found that babybound / ultrasound direct (smart thing) do cervical length checks. I think it's £89 maybe there is one close to you. They do an internal ultrasound but they only do it from 16 weeks, so annoying!