Consultant-led care but without the consultant

[ginandtonicformeplease]

Due to a neurological condition I have my midwife said I need consultant-led care. I'm now 27 weeks and I haven't yet seen a consultant. At my 12 week scan I saw a junior doctor, who put me down for GAP scans from 28 weeks on, with a consultant appointment afterwards. I was supposed to have a consultant appointment after my 20 week scan, but that didn't happen (I was apparently supposed to know that I needed to call every day until one was booked).

In the interim I had an appointment with my neurologist, who has said that he highly recommends I have a caesarean.

I managed to get appointments booked with the obstetrician after all my GAP scans: I asked about whether I need to send in the letter from my neurologist but was told not to, just to take it to the appointment (they're different trusts so no communication obviously).

Today I received a letter cancelling all my appointments except for the last one - now I have no clue how I'm supposed to tell the obstetrician that a different doctor has recommended a caesarean. The letter just said she'd reviewed my notes and I don't need to see her - I don't know what has changed since 12 weeks!

Just to make it more complicated, my midwife is from a third trust, and yet again the two trusts seem incapable of communicating - all she can do is make referrals and I have to wait for the letters.

I have absolutely no idea what to do. Has anyone else had consultant-led care without actually seeing a consultant?

It does seem strange to me!

I’m supposed to be under consultant led care and kind of the same as you, I was treated for something by a consultant in a different trust so no one seems to really take any notice of the advice my previous consultant has given me.

Although I have just received a letter about an appointment with a consultant (not for the issue I was expecting!) and it looks as though my 12 week scan triggered that appointment as I just happened to mention my condition the Sonographer and she made a note of it.

I would suggest contacting your midwife and ask her to do some chasing up for you - if you’ve been told you should see a consultant there’s clearly a need for you to see one. Definitely be firm with them and say you feel you need to see one.

I have to keep chasing my midwife and it turned out that they thought I was moving to a different trust and so did not book me an appointment with the consultant at my current trust - maybe it’s a clerical error? So worth checking.

Hi OP, I had a bleed on the brain last year and my neurologist has recommended a section too due to the risk of seizures in labour.

Fortunately I fell pregnant just before Covid so had an appointment with the consultant around 15 weeks where I was able to discuss this with them.

I just had that one appointment then they booked me for a follow up at 28 weeks (I'm now 25 weeks so unsure if that's going ahead or not) but said the section wouldn't need to be booked in until I'm 35 weeks or so.

It's not ideal that you haven't seen a consultant yet but please try not to worry. If it's just the labour affected and not the actual pregnancy like me, then it won't be arranged till much later in pregnancy anyway.

Thanks both. I'm just worried that I won't actually get to see a consultant at all - I was supposed to see her at 12 weeks (pre-covid) but I ended up with a junior doctor instead who was worse than useless.

If the trusts communicated with each other I'd be more relaxed about it, but if my midwife wants to book me in for anything she has to ring the same general line that I do as she's a different trust!

@ginandtonicformeplease my community midwife is in a different trust to the consultant/hospital where I will give birth too.

It's very frustrating. Mine don't even use the same pregnancy record so I've got 2 running at the same time and that was before the added complication of Covid.

What gestation will you be at the last appointment?

I think you just need to send an email to either the antenatal team if you can find that (is there anything on the letter you’ve been sent) or if you can’t raise anyone on email, send one to PALS saying you cannot get in touch with anyone to discuss your care and need someone to contact you. Sounds like you may just need one appt to book the c section, and that can probably be done on the telephone. Alternatively when you have your next scan ask to speak to the maternal medicine midwife or antenatal team leader.

It’s normal not to see the consultant themselves but you would usually see another doctor on their team (usually a registrar, so still technically a ‘junior doctor’ but with a specialism in OB-GYN).

If you have the name of your consultant I would try to get hold of her secretary for clarification.

It’s a bit of a joke where I am.

I’ve only seen a jr doctor twice - once at 14 weeks when I booked in and once at 20 weeks after the scan. Both appointments were less than useless. Every question was met with “I don’t know about that”.

Luckily this is my third pregnancy and unluckily, I’ve been treated the same shoddy way in the previous two so I’m well used to it.

Just to be clear - in the NHS a ‘junior doctor’ is any doctor who hasn’t yet become a consultant. The term implies a 25-year-old who is fresh out of university. I had a whole consultant-led pregnancy where I did not see the consultant once. All of my appointments were with members of her team. My caesarean was performed by a highly-skilled surgeon who is not yet a consultant and is therefore still a junior doctor.

That being said these are extraordinary times and what OP describes doesn’t sound right.

I was referring to 'junior doctor' as in fresh out of university, when they rotate for six months in different specialties - he had absolutely no clue about why I'd be referred to the consultant and only found I'd need the GAP scans when the midwife present told him to check with the consultant after he incorrectly told me I should be midwife-led.

I know these are unusual times, but the rubbish treatment started before the pandemic and I really don't want to be having life-threatening seizures during labour because I haven't managed to actually see a consultant to ask for a caesarean.

That’s why I said it didn’t sound right, OP. I’m sorry you’re dealing with this additional worry. I highly recommend contacting your consultant’s secretary directly.

Thanks Buxbaum but I don't actually know who my consultant is, the letters name several different people and the only email addresses I've been able to find online are from their private work.

I did consider whether seeing an obstetrician privately might help, but then I imagine I'd have the same problem of no communication between them and the trust.

My maternity unit tend to be very helpful with stuff like this. There's a number for antenatal appointments, I'd try that first of all, and even just ask who your consultant is and how to contact them.

I think you probably got an F1 or F2 in that appointment who was clearly in over their head. If you ring the antenatal unit and ask for the name of the consultant you are registered under (you will have been assigned one) and get their secretary's details. That should hopefully sort something out. I've been consultant led but the consultant herself has written on my notes that I am only to see her so I don't get a reg. She is very diligent though, I don't think they are all like her unfortunately!