Went into triage today because of reduced movement/mean midwife

[Fiona1987]

Hi,

I went into triage today because I felt there was a reduction in movement. At the moment I'm 24 weeks pregnant and I have an anterior placenta so my movements are hit and miss and don't happen all the time. I just felt something was off today.
The midwife found the heartbeat within seconds, but she was quite nasty to me. She said 24 weeks is way too early to come in for reduced movements and at this point reduced movements are none of their concern. The way she talked to me was quite snappy, uncaring and condescending.
What she said also goes directly the advice in my pregnancy booklet, where it says: "If you are 17-42 weeks pregnant and experience any of the symptoms below contact the hospital:.......- your baby isn't moving as much ( once you start feeling your baby move)."
Also, my community midwife said that I should never take an anterior placenta as an explanation of why there is a reduction in baby movement.

I feel quite silly now. Was the midwife right that I shouldn't have come in ? She did find the baby's heartbeat and it was fast, but she only listened to it briefly. I feel like she didn't do her job properly, but she made me feel like a hypochondriac. It was quite a terrible experience today and despite finding the baby's heartbeat, I felt worse after going to the hospital.

I'm nearly 22 weeks with an anterior placenta and not felt any movements at all yet.
I've been told off a couple of different medical professionals that most women will feel some movement by 24 weeks but it doesn't really hit an established pattern until 28 weeks. It's still very early.

Sorry you felt the midwife was mean with you, it's undoubtably a very stressful time for all nhs staff at the moment but no excuse to treat people badly.

Not every area if the NHS is under severe strain. Some are much quieter than usual. Sounds like the midwife was unprofessional and she should complain. Stress is no reason. To take it out on a patient who was genuinely concerned.

Hi OP, you did the right thing, I'm sorry you had such a bad experience and some pushy comments here too. Obviously it's not you it's her, whatever reason she had. I would try to put this behind at this point. Baby is doing well that's the most important, don't worry too much about her being snappy. Hope it's the last time you had such a bad experience.

I’m curious to know the source of the booklet you mention. The advice is usually to contact a midwife if you have felt no movement at all by 24 weeks.

My maternity notes [from the liverpool women's] state that:

"From 16-24 weeks you should feel the baby move more and more up until 32 weeks, then stay roughly the same until you give birth"

"You must NOT WAIT until the next day to seek advice if you are worried about your baby's movements. If you think they have slowed down or stopped, contact your midwife or maternity unit immediately. DO NOT put off calling. Do not worry about phoning."

"If you are less than 26 weeks pregnant you should contact your community midwife who will arrange to see you as soon as possible [...] If you are more than 26 weeks pregnant you should contact your maternity assessment unit who will arrange to see you as soon as possible."

That very clearly says that if you are worried for any reason, you should do exactly as OP did and call. There's nothing whatsoever in my notes to suggest that 24 weeks is too early, I would absolutely be going off the guidance in my notes rather than from the internet. I am 24 weeks and I feel regular, consistent movement in the morning, midday and evening - it would be very noticeable for me if something were to change so if I were in OPs situation I would call immediately based on this guidance - which she did, and was advised to come in only to then be scolded.

OP - I am sorry you experienced that. I am sure the midwife is under a lot of pressure right now, and I think it's fair to have empathy for that but also acknowledge that you were just following the guidance you'd been given, and as others have stated her attitude could have really severe negative consquences. I hope you don't let this put you off calling again if you're worried at all. I would try to dismiss her comments and continue to follow the guidance in the notes they have given you - realistically that is what you are expected to do.

That guidance is pretty consistent with OP’s experience, @thethirdbar - if women are usually seen in the community before 26 weeks then a hospital midwife probably wouldn’t expect to see a woman at 24 weeks’ gestation.

Sorry but at 24 weeks - the normal guidance is to contact community midwife if any concerns. Most antenatal assessment centres won’t see anyone before 24 weeks anyway. So it’s unusual that you were seen in hospital. I’d be very very surprised if that’s what your book actually says. Most guidelines say that the normal movement patterns are established after 28 weeks.

Also please don’t ‘officially complain or report’ her. Regardless of what you think you saw, most HCPs are very stressed right now and a complaint is totally OTT. I’m a doctor.

@EstebanTheMagnificent: I know you don't believe me, but in my NHS pregnancy booklet from the hospital, the blue booklet that you have to bring to every scan and to every midwife appointment, it says that if you start to notice decreased movement from 17-24 weeks ( once you notice baby's movements) you should contact the hospital. My community midwife said I should call triage in these instances. So it's wrong what you are saying. You shouldn't assume that every hospital handles these things the same way, hospitals have different procedures.

I’m surprised they told you to come in, I was told 28 weeks.

I made no such assumptions and certainly did not say that I don’t believe you, @Fiona1987. Kindly don’t put words in my mouth.

I’m fully aware that practice varies between trusts. My experience is similar to that described in the guidance quoted by @thethirdbar. As many other posters have observed, your hospital is unusual for suggesting that women should attend triage for reduced movements from 17 weeks. Perhaps the midwife that you saw was a locum from a different trust.

I’m sorry that you had a bad experience and I wish you well for the rest of your pregnancy.

OP.....I did post a message this morning to you (not sure why it's not showing), with a photo of an nhs leaflet I have in my green notes, provided as standard in my area, supporting exactly what you said. It mentions from 16 - 24 weeks you should start to feel movements, then goes on to say if movements have slowed down or stopped, contact your midwife or maternity unit immediately. Just remember, it's YOUR baby, and this is happening to YOU. Ignore everyone else who thinks they know better than you, they don't, they just have an opinion about something that will not directly effect them. You absolutely did the right thing and please don't let it put you off doing it again and again if the need arises. With regards to the rude midwife, please don't let her put you off going in future, but if it happens again I suggest reporting it there and then instead of reporting it days later. Hope you have a happy pregnancy, keep smiling 🙂

OP if you're worried about your baby's movements you have every right to seek help. The midwife shouldn't have done that. I'd report her to PALS and mention it Maternity Voices at your hospital.

@Longfox: Thank you

Sorry you’ve had a shitty experience, I have noticed that things seem to have changed since I had my first only 3 years ago, they are so much hotter on reduced movements this time round, even at earlier stages there is much more emphasis on getting checked out every time, no having a cold drink and lying on your side for ages. You called and they advised you come in so why wouldn’t you have? Don’t let it put you off, my local maternity department put a post on their FB about not being put off getting checked because of the CV situation and to always call if you are concerned.

Rcog guidelines say that an anterior placenta prior to 28 weeks gestation can cause you to be unaware of all movements. National guidelines also say after 28 weeks if women report reduced fetal movement they should be seen.

So technically she’s right. Though she should have been a lot nicer than she was. Not sure why the hospital’s written guidance on when you should contact someone contradicts the rcog guidelines. She only needs to listen to the hb briefly as she’s literally checking the baby is alive, there’s no way to interpret heart rate so early. Too early for a ctg.

www.rcog.org.uk/globalassets/documents/guidelines/gtg_57.pdf

It’s early and you have an anterior placenta. I had that for my middle pregnancy and it was much, much harder to feel the movements. That said they were always there, but I would say I didn’t have an established pattern until 30+ weeks. Don’t frighten yourself silly worrying that you should have a pattern from 17 weeks, unfortunately it is different when it’s blocking the baby from your tummy wall.

You know what upsets me off the most ?Because that midwife made you feel bad for coming in , if this happens again you might hesitate going back to the hospital . And next time it could be something serious.

Don’t worry , you did the right thing . It’s better to be safe than sorry no matter how silly you feel .