Would I get consultant led care?

[Emerald89]

I’m 4+4/40 with my first baby. I have narcolepsy and had to stop all my medication on getting pregnant as my meds are associated with heart defects. Stopped them at 11-12 DPO.

I really want to try for a vaginal delivery but I have some worries about it - my narcolepsy is worst when I’m emotional and sleep deprived!! At worst I can lose all muscle control and go limp for a minute, and I’m worried this could happen in second stage of labour or pushing etc. That said, there’s a chance it might not if I can stay calm a have good pain relief.

I’m not dissing midwives at all - this is my first baby so no prior experience. But I’ve found in my life that most people have little to zero knowledge or understanding of narcolepsy and I need to know that someone involved in my care gets it and that there will be some continuity in this regard.

Would this be something that would get consultant led care? Has anyone had anything at all similar??

I should add that my concern about the muscle control thing is that if it happens and I’m upset it can become a chain happening again and again and I’m worried that might lead to people panicking and having instrumental delivery or CS. I’ll do whatever is safest to get the baby out but would like the continuity of care and oversight to plan for my narcolepsy causing issues and try to avoid them.

Sounds like you would get consultant led care. You can discuss with your midwife at your booking appointment and she will arrange an appointment with the consultant.

Just to reassure you, if you are consultant led. I wasn't in my first pregnancy and I am in this (10lb 5 baby last time and I'll be 42 at birth). I've had one meeting with a consultant at around 20 weeks. The conversation went like this:

"Would you like a c section?" (Had elective c section last time.

"Yes please."

"Ok then, take care now, bye bye then."

It doesn't have to be a big deal. If I wanted to try for a vbac, he was fine with that too. Otherwise, I'm booked in for 3 extra growth scans and all the usual midwife appointments. Please don't worry about it - for me, it's been no big deal at all.

I would say very very high chances are that you will be seeing consultant and may be that the birthing options may be a bit limited (a friend with a very different condition, but in similar boat was very strongly recommended c-section), but you will discuss that with your midwife at your first appointment.

yes I would expect you would be. It may be that they support an induced vaginal birth with an early epidural if that is something you're comfortable with and that would be medically appropriate. This was how they managed my friend who has epilepsy with fits triggered by pain.

I think consultant led care is likely and that's a good thing to discuss your options :)

I would also recommend an induced birth with early pain relief in the form of an epidural. I had this in my last pregnancy - not due to any health conditions but due to baby having an unstable lie which meant they were worried even in labour he could turn into an awkward position and be in trouble. It was a great birth, I was sat watching the Office on my phone for most of it!

The only thing about that I would see a problem with that being is getting the epidural as you have to be able to keep very still, however you would need that with a C section too so it should be fine.

The hospital where I want to give birth does remifentanil PCAs so I’m interested in finding out more about that as an alternative to epidural.