AIBU to think antenatal appts over the telephone are pretty much a waste of time and precious resources?

[RainMinusBow]

Just that really.

I'm 39, 33 weeks' pregnant with my third baby, and low risk on every factor.

My baby is moving well and following her usual pattern here. I am more than aware if this changes at all to call a midwife for advice ASAP.

So what actually is the point of a telephone appt? They can't test urine or BP, listen in to baby or measure fundal height.

At a time when the NHS are clearly so short of midwives (hence pulling home births etc), it doesn't seem to me like an effective use of their time.

I'm now under care of an Independent Midwife so will be cancelling my appt anyway to free up time for another lady. My IM will be doing required antenatal checks face-to-face.

I don’t think it’s a fair solution, women are still going to get missed by not having urine, bloods and other checks made at these appointments

Agreed. I would have died had I not had checks in person, I had pre eclampsia but had no idea. It's dangerous but I guess they've weighed up the risks and factored that in.

I don’t think it’s fair to prioritise covid patients solely over anyone else and I don’t just mean maternity, for instance those with cancers and long term conditions etc are not getting care they need.

I agree. I’m a high risk pregnancy and am so so worried. Pregnant women still have to give birth!!

I read that NHS Nightingale is practically empty, and yet people with other illnesses are having their care delayed indefinitely.

Not to mention the fact that IVF has now been suspended, meaning some people will miss out permanently on the chance to have a family. It’s horrendous.

this care was given to women less than 3 months ago and had been the standard ante-natal care and now they are just saying it’s not necessary! If it wasn’t really necessary why were they doing it in the first place

Exactly.

Basically the nhs is damned if they do and damned if they don’t!

If they continue to offer appointments to all that would usually get them their staff will be at risk, the travelling patients would be at risk, the bus drivers would be more at risk.
And so it goes on. (And yeah I know there aren’t that many pregnant people but if justify travel for one group then others will want their travel justified, and so it goes on).

So they stop this nhs service amongst others.

If they announce they are seriously concerned that many women and unborn babies will be at risk there will be widespread panic.

Nobody wants panic during a pandemic.
So we are placated to keep us calm by being told we didn’t really need the check ups anyway.

The truth is probably somewhere in the middle.

There will be some women at risk. How will they work out who - Telephone appointments with referrals.

It won’t help those with conditions that have no symptoms granted, but presumably that will have been statistically weighed against the risk, the way all nhs services and medicines are.

It’s a pandemic. We can’t expect things to be the same.

It’s fine if people have money for private healthcare. They can choose to weigh up the risk of travelling to appointments and the dangers of being seen by someone who may or may not be Typhoid Mary themselves.

Or perhaps an option would be to buy pee sticks and a bp monitor and do your own dip tests in conjunction with the phone appointment so you can tell them the results. Perhaps even a stethoscope to hear the baby’s heart if that may help also.

All we can do is our best to stay safe.

@Elieza I’m not suggesting they should only treat pregnant women! At the end of the day there are people still having to go to work everyday - my partner works for a big medical company (no they don’t supply anything critical to covid-19), my mum is still at work as is my dad, I’m lucky I can work from home - unfortunately the bus drivers are already at risk due to this, companies are picking and choosing what is ‘vital’ work and the government are not enforcing anything!

For some people they simply can not afford to buy a monitor and pee sticks! Also I have had my wrists slapped in the past for doing my own research/checks and reporting back to Drs so I’m not sure this is the answer to the problem.

I know there’s probably no easy solution to this but it is a worry that ultimately people are going to also suffer the consequences of this pandemic because not enough is being done to provide support - not just to pregnant women but to many other people who need regular medical appointments.

It won’t help those with conditions that have no symptoms granted, but presumably that will have been statistically weighed against the risk

Yup - because at the end of the day me and my baby are just another statistic. And not even an important statistic - those are the Covid 19 patients.

Part of the problem is that is is inconsistent care that women are getting. Decisions are being made on a trust by trust basis. I am seemingly "lucky" that my 25 week midwife appointment went ahead last week face to face. I rang the day before to check this as there seems to be so much differing information out there which is adding extra stress at a time when it is not needed. I was told that currently in my trust everything is going ahead as normal (other than midwife wearing PPE and not partners allowed at the appointments).

I can understand them doing the booking appointment over the phone aside from the blood tests, not sure how they’re working around that one. Can’t understand why they’d bother with telephone calls later down the line.

@Elieza Use of a doppler or stethoscope by a non-professional is not recommended as in fact it can give false reassurance. The mother could, for example, pick up own hb assuming it was baby.
Also, I think midwives don't just listen to speed of hb but other things too.

There are a lot of things that Mums to be might not think are anything to worry about that a midwife could pick up during a conversation.

Totally agree with this- particularly the post natal checks. FTM, 1 week old, discharged on day 2, and had one post natal visit since then (on day 5 for heel prick test), should of had one day 3, and day 7, and not sure what’s happening for day 10. They are at the end of the phone but it’s not the same. I was high risk consultant led all the way through and literally went from 2x hospital appointments a week from 12 weeks-32 weeks to NOTHING after my 35 week scan which was very unnerving at the time.

I get they want to protect their staff and protect new mums/babies but the processes they have in place don’t feel to be doing that- they have admitted they are seeing many more readmissions from babies not feeding etc which to me says the new system doesn’t work.

We bought scales when this kicked off so we could give ourselves some reassurance but appreciate not everyone can do that!

I am seeing so many posts of people who are unhappy about the lack of appointments.

Surely if the majority are unhappy with this and make this known something can be done to improve the situation for everyone.

If we just keep quiet and let it happen then they will just assume we are ok with this.

I can’t get my head around why covid-19 is being prioritised against anything else, is this the same in other countries I wonder?

I agree with so much that's been said here. Like @luckyme30 says, if there wasn't evidence to show that the tests and appointments are worthwhile, they would never have bothered. Some poor ladies and their babies will inevitably fall through the cracks!

Like others have said, phone calls just aren't the same as face to face conversations and concerns and worries will be missed.

Like @rainminusbow said, HCPs regularly discourage us from doing our own investigations (e.g. checking baby's heartbeat) because we're not professionals in interpreting results.

And like @MrsHa said, it's different everywhere so there's no standard of care right now. I went for a gestational diabetes test the other day and it was so busy (obvs all there for the same test), no hand sanitiser on offer and no 2 metre distancing between patients at all. Same cushion used for everyone's blood test (which goes under the elbow- you know, the part we're all told to cough and sneeze into). It was just carrying on pretty much as normal except nurses wore masks and a few chairs were removed. My friend, on the other hand, had her test cancelled, presumably to avoid the unsafe scene I was involved in.

@SerBrienneOfHouseTarth Agree with you, but the issue I have is that some problems can only be picked up face to face. At my last appointment (which I saw the midwife) my baby's heartbeat was a bit high, so we waited to see if I need to go to hospital or was free to go home (the appointments are not in hospital but a GP practises/children centres). This would nto have been picked up over the phone sadly. So while it is better to have a phone appointment over nothing at all if you want to discuss birth plans or mental health, but lots of things are very hard to look at via phone...

@Elieza The much wider issue is that some trusts still offer face to face care, and some do phone, and some ahrdyl anything. My hospital advised us to attend all appointments- scant, tests, midwife appointments. They clearly think that benefits outwieght risks.Some trusts think this is not the case. There is no unoform approach, and it's worrying and concerning that the approach is so different depending where you are and that some people are getting guidance and support and other places.

Also like some people say, measuring your own baby's heart beat has been massively disapproved by everyone in health care as not safe and should not be practised, so again maybe not the best option.

I would suggest people buy a basic bp monitor (£16 on Amazon) and check your own BP before telephone appt and tell your midwife what it is. Could also get urine dipsticks (not difficult to interpret)

I know that there is guidance on the RCOG website which states which appointments should absolutely go ahead but as I found out with my trust they are not even adhering to that - my particular situation was that my trust website stated that at the dating scan they MAY not be able to do the nuchal measurements and bloods for the screening for downs, Pataus and Edwards.

I contacted them as was unhappy that they were not following guidance and they called me back to say it was purely down to the staffing levels on the day, if they could do the testing of course they would but if they had staff off sick they just wouldn’t have enough time to do it.

Of course it’s not the hospital staffs fault but on the RCOG guidance they state that this testing should still be taking place - no one seems to be enforcing it and I feel like I’m not even getting basic care let alone any consultant led care or mental health support - my midwife promised me I would get extra support - not her fault personally but I honestly feel forgotten about - I’m only 11 weeks pregnant :(

@Luckyme30 that's terrible. Even saying that they might not do the tests will cause a lot of worry and anxiety for many pregnant ladies.

I think mental health will be the biggest casualty. At my first midwife appointment in December, they asked me lots of questions to make sure I was okay and made clear there was support available. Now there seems to be very little just as women are feeling most isolated and anxious. It doesn't affect me personally but I feel bad for those it does. I think it's probably bottom of the list of priorities when people aren't even getting the tests they normally would.

I know and when the lady from ultrasound called me back (after my email to PALS explaining I wasn’t happy) I just felt like a bit of a burden on them and the way she explained it was just basically ‘that’s the way it is sorry!’

It’s such a scary time and the worst thing is that I don’t think it’s going to improve for a good few months, even with lock down lifted I can see it still having an effect on maternity services for the rest of this year... maybe I’m being too doom and gloom but I do really worry for those of us who are currently pregnant.

Just wanted to clarify I am in complete agreement that face to face maternity care is needed and even prior to CV NHS maternity care needed a kick up the arse! Doing phone appointments only will lead to things being missed, no doubt about it. There's data from previous pandemics to show this happened in other countries.

I'm a high risk pregnancy after a premature birth and 3 losses so I am worried about my care (and was prior to CV too). I do appreciate though that the NHS is between a rock and a hard place and have to weigh up the potential risk of exposing Mums, babies and staff to CV versus the risk of not picking up something at a general checkup so for me, the phone appointments feel like a fair solution. In no way do I think it's the best care I could be getting but neither do I feel the phone appointments are a waste of time. I'm trying to make the best of it by making notes and questions for the MW/Consultant for the calls.

I might order the pee sticks too - does anyone have any recommendations?

Completely agree!! Wish I could get an IM, where did you find her? Xx

Totally agree even if they reduced the apps slightly but still did the measurements and blood test and urine test, honestly I think its inexcusable. I've seen different people at my scan so nobody knows me personally. Who knows whether I'd be at risk of pre eclampsia or gestational diabetes? The bottom line is phone apps just dont do enough to assist. Im assuming that the measurement checks arent as important until later on...

I am probably an outlier here because I am medical. I think the greatest risk here is to mental health. For the vast majority of people, the risk of face to face appointments will be greater than the risk of not having them, particularly earlier in pregnancy. You will still get the vital elements of care and this will vary person to person.

In all honesty, nothing happened at my 16 week appt which couldn’t have happened over the phone. Whilst it was lovely to meet my midwife (as booking appt was with a different one), it didn’t change my care. You do not get Pre eclampsia at 16 weeks - blowing into a Carbon monoxide monitor as a non-smoker was pointless, my BP predictably low and urine dipstick normal.

I am a high risk pregnancy - old, IVF and underlying autoimmune disease. I was meant to have growth scans from 28 weeks but depending on the situation in 2 months time, the earlier ones may not happen - and that’s fine - because I’m safest at home and at 28 weeks, the chances of any intervention is so miniscule for an asymptomatic person.

For those saying that investing in a BP monitor and urine dipsticks is too expensive - it will be less than £20..... which if you are shielding, will be less than the cost of transport to and parking at a number of face to face appointments.

Your midwifery and obstetric teams are available and will see you if needed. The vast majority of times, seeing you is actually for your reassurance only. It is this change which makes it difficult to feel happy and comfortable.

Re which urine strips - to be honest, any. Probably worth doing (for your reassurance) once a week from 25 weeks so you don’t need that many. Just make sure they have glucose, protein and nitrites. They are the 3 things being looked at. There are some packs of 15 for £3.something on amazon which will do the job.

Thanks @Anaesthetist83 will have a look on Amazon for the strips!