Consultant led care, what does it actually mean?

[PasstheBucket89]

Im consultant led for raised BMI, although ill be honest as much as she seems nice im a bit confused as to what they actually do in addition to the midwives or do i just have a bit of a pants one, do i discuss birth plan etc? i had to wait 20+ extra minutes, all she did was read back to me my green notes, didn't ask me any questions, i have HG i haven't been offered any anti sickness medication and dismissive when i brought it up , and then just asked if i had any questions , what should i be asking her? what should she be asking me??.

It depends why you've been referred to the consultant in the first place but, in your case, it's probably more a case of keeping an eye on you through pregnancy more than anything else.

High BMI can be linked to several issues further down the line which might necessitate giving birth at a delivery suite instead of a birthing centre, having an ELCS, extra growth scans, medical intervention etc which would be arranged/discussed via the obstetrician rather than the midwife.

Your first appointment sounds normal. Mine was just going through my booking notes with a registrar discussing why I had been referred and giving me an indication of future appointments (all of which were third trimester for me but will vary on a case by case basis).

Anti sickness meds would be through your GP.

I’m consultant led for high BMI also. I had my first appointment with him on Tuesday when I was 28+5. I think it’s more if there are any complications they can pick them up with extra scans etc. Everything has been fine through my pregnancy so far but I will see him again at 32 and 36 weeks.

Baby could be Breech, could be on the smaller or larger size due to BMI, a csection may be needed for other reasons etc so they just keep an extra eye on you.

You will get scanned more and get to see your wee baby more often than you normally would so just look at the positives :)

There isn’t much extra for them to do in the earlier stages. There are additional risks associated with high BMI which need monitoring but not really anything specific to be done at this stage. Depending on your BMI, you may be invited to see an anaesthetist also to discuss options for analgesia and anaesthetic during delivery.

I was consultant led for raised BMI in my first pregnancy and only spoke to the consultant once. They booked extra scans and that was it.

Consultant led in this pregnancy (previous DVT) and Ive had a phone appointment at 9 weeks with another at 16. He spoke about certain precautions I need to take, whether I had thought about VBAC vs ELCS, and extra monitoring they would give to me and baby throughout. The consultant was thorough enough that I would say the last “consultant led” pregnancy was just a box ticking exercise compared to this one 😂

I'm consultant led for mental health reasons. I had my first appointment in the first trimester where we went through my green notes and discussed that it was safe for me to continue my medication and what extra support might need including if I wanted a referral to the perinatal mh team (my on the ball gp had already sent the referral). I had a phone appointment at 24ish weeks where they assessed how my mental health was in pregnancy and decided that as the perinatal team was involved they would let them handle it so I haven't had to see them again.

In the early days I see consultant led as a safety catch for most people there isn't much they can do but it means if you do need anything later on you are already in their radar.

For your sickness it might be better to see if you can get your gp to prescribe you something. I was having bad acid reflux at the time of the second appointment and the doctor did recommend a prescription but it was my gp that actually prescribed it. The registrar wrote to my gp and then my gp sent the script to the local pharmacy for collection. I can see how some clinics wouldn't want to play the middle man.

Thanks i feel a bit better now, probably right its better to chase the GP, i sort of felt like it was unnecessary middle man.

I'm 18 weeks and I haven't even seen mine yet...! Assuming that means they can't be THAT worried!

I was consultant led because it was a twin pregnancy. I had scans every 3 weeks from 20 weeks on, and he saw me after to discuss the results.

I hardly saw my midwife.

I was just on the cusp of high BMI so they let me choose between
Midwife or consultant led. I went consultant led, only ever saw one in labour and not before. Worst decision I ever made. Everything took 8 hours to get an answer because consultants were always otherwise engaged

I was consultant led due to recurrent miscarriages (DC1 pregnancy) and then for the same reason plus having had a prem baby and pre eclampsia (DC2 pregnancy). DC1 they just signed off on extra scans really and I had an appointment post birth to discuss what had happened to make DC1 prem and small. They were really on the ball for DC2 and really let me lead with what was required (scans, monitoring, clexane injections) and they signed off on a 37 week induction (not required, DC2 came on his own the day before!).

In my area we have two maternity centres that are midwife led and one hospital that is consultant led. If you are consultant led you can only go to the one hospital to give birth.

It means jack shit for me!

I’m consultant led as I’ve had two previous sections and am having another (and I’m fat and old).

I’ve seen a jr doctor three times and it’s just been a waste of time. Wait for an hour, go into an office. They just look at me and say “all okay?” And I say yes. They say nothing. I say nothing. They hand me back my notes and I leave.

Pointless exercise.

Yeah @Billyjoearmstrong im wondering if it will be similar for me. I don't think there are any birthing centres near me, just general hospital.

I was consultant led because I only have 1 functioning kidney.

It just meant that some of my appointments were at the hospital instead of with the MW.

I was allowed to be transferred to MW care at the end with DC1 because I wanted a home birth but with 2 was a csec and 3 was an emcsec so it became irrelevant.

It mostly means an extra pair of eyes on your notes which can never be a bad thing

@Billyjoearmstrong a 'pointless exercise' until there is actually an issue?

Personally, I welcome the extra appointments or scans as it's an extra pair of eyes checking on me and the baby - is that a bad thing? especially this last few months when so many appts have ended up cancelled or changed to telephone only .
I find the consultant appts (whether with junior consultant/registrar whoever) different to the midwife appt. If you don't really need the extra level of care and have a straightforward pregnancy, great, but if you did develop problems later on, you'd appreciate already being on their radar.

[quote sel2223]@Billyjoearmstrong a 'pointless exercise' until there is actually an issue?

Personally, I welcome the extra appointments or scans as it's an extra pair of eyes checking on me and the baby - is that a bad thing? especially this last few months when so many appts have ended up cancelled or changed to telephone only .
I find the consultant appts (whether with junior consultant/registrar whoever) different to the midwife appt. If you don't really need the extra level of care and have a straightforward pregnancy, great, but if you did develop problems later on, you'd appreciate already being on their radar.[/quote]
Oh I agree. Which is why I go to them and just moan about them on Mumsnet It’s different for me as I’ve already had two sections. I guess I would find them more beneficial if it was my first as them I’d have questions.

If there was a problem then yes, I’m sure I’d be in good hands.

My midwife appointments before hand are just a case of handing over a urine sample, taking blood pressure and then leaving too. But of course I still go.

I’m having extra scans for growth but that’s under the Fetal medicine team so handled elsewhere.