Pregnant with twins - falling between the gaps

[KatEddy]

I'm 31 weeks pregnant with twins and keep feeling that I'm falling between the gaps in the NHS. Really sorry if this ends up being one big moan, I'm particularly emotional about it today (probably hormones!).

Today I've managed to find my last blood test online (from 3 weeks ago) which shows I have anaemia and vitamin b12 deficiency and no one has contacted me about it. I have messaged my midwife to talk through the results (who I haven't seen since 16 week appointment) and no reply yet.

When I first found out I was having twins, the system wasn't updated so I wasn't referred to a consultant until 18 weeks.

My last "consultant" appointment (3 weeks ago) was terrible, the doctor was so vague when I was asking questions about risk of c sections "it's a major surgery" was the only reply. She shrugged at me for other questions about premature labour "birth is unpredictable". I've just found out that actually I only spoke to a consultant once and I've seen doctor registrars (trainees) since and due to see them for the final two appointments.

I'm just suddenly feeling really anxious, worried and unsupported.

I'm not seeing my midwife until 34 weeks and she has already said that twins is out of her remit so can't go into birth stuff etc.

It feels like I was given the expectation of getting great additional care being high risk with twins but it feels like the opposite.... I've only met my midwife once, I have never seen the same doctor/consultant twice (and they have given me different information) and no one has even mentioned a birth plan or anything!!

I'm based in Reading and going to RBH and I guess I'm looking for any advice from women who have gone through the same, words of support or reassurance...?

Xxxxx

It is probably no help but I was the same when I had my twins 27 years ago and I really feel for you.

All I can say is keep asking questions, do as much homework you can and don't expect to be supported, but make the most of it if you are!

Hopefully someone with more up to date advice will be along. x

Firstly, just to reassure you, I had awful care when pregnant with dd. However, when I went to hospital in labour the midwives and doctor on the labour ward were absolutely amazing. I had to have an emergency c-section and I felt so looked after. I was really upset and the midwife who came into the theatre with me was stoking my head the whole time. It was such a little thing but it made the operation really calm.

With regards to the care you are receiving, I would actually make a formal complaint. I’m not sure of the process but I believe you can go to PALS.

From my experience, just be way more sassy and demanding. This is your personal journey and whatever you need make sure you push for it. I found that my requests were not uncommon, and so if I didn't get anywhere, I'd be a pain in the arse until I got somewhere. X

That sounds like BULLSHIT! You are entitled to support, you pay your taxes for this! Be vocal, be annoying, you won't get answers if you are placid! This is awful but this is the way it works. If you aren't happy or need to know more, ready your nerves to be a nag

Sorry you've had a rough time but Registrars are not trainee doctors! They have been qualified for many years and are senior doctors in their own rights

Another one expecting twins here and I’ve had similar. I had an appointment today which was like an episode of Fawlty Towers, complete with me sliding halfway across the room on a bed with the brakes off. I’ve had to act as go -between between MWs and consultants repeatedly, and tbh consultant appointments so far seem really perfunctory. They kept asking me for things like thyroid results/cervical length results (fucked if I know), but then happily talk over me after asking me a question I do know the answer to.

I’m not sure it’s a twins thing. I’ve had similar just in my GP office over the past year.

Registrars are more than qualified to see routine patients (a normal, uncomplicated twin birth is 'routine' from a hospital-led care point of view). They have been qualified as doctors for years and have several years' experience of working in obstetric care. They're just not qualified to lead the care as 'experts' (the consultants' role) yet. They will see patients in clinic and will carry out most caesarian sections too.
So please don't worry about this.

Ooft that sounds rubbish. I had DCDA twins. Do you know what type you’re having? Identical twins are classed as full term at 36 weeks, non-identical they’ll let you go to 38 weeks.
Really don’t understand how a midwife can say that twins are out her remit though?? That seems to be bonkers!
Keep badgering them. have you looked up the twins trust website? Really useful stuff on there. Good luck!

Just to partially reassure you I was considered high risk and wasn't told I was anemic until I was 33 weeks pregnant.

Luckily for me I knew what to do as I've had anemia before and still had in date supplements left over from last time.

If you can get a print out or even full screen shot of your blood test results make an appointment with your GP asap as you need to get your levels up before you give birth. (So that will be Monday.)

Tell your GP that you have iron deficiency anemia and a very low B12 level. Ask the GP for a prescription for iron supplements and vitamin B12 supplements, and if they don't have access to the results say you will send them or drop a copy off at the surgery.

This is because as you are pregnant you get your prescriptions free and midwives don't prescribe anyway.

Im sorry OP, for no one to follow up on your blood results is extremely poor care. Have you been symptomatic of the anaemia?

And just to echo others have already said, registers are very senior doctors, just below consultant level and extremely well qualified! I'm a nurse and would normally go straight to the reg if I had a very sick patient.

I had twins 8 years ago and my antenatal care was excellent. I only saw my midwife once (at booking in at 6 weeks) then not again until 32 weeks. I saw the same consultant each time and that was every 4 weeks until 32 weeks then every 2 weeks. I asked to see the same one, continuous care was important imo. However, 2 female registrars delivered my twins and they were amazing! The birth was a wonderful experience and I couldn't have asked for better care.
No one discussed a birth plan with me and I was only given my c section date at 32 weeks. It was only then a c section was decided on due to position of the babies.
I would be more vocal with what you want.

Hi,

Another twin mum here, I had my twins last summer.

So sorry you're having a rough time. Have you joined the Twins Trust? They have advice on their website as to the medical care you should be receiving and are also really helpful if you email them.

Are you taking iron supplements? Spatone and a pregnancy multi vitamin with iron might help with your iron and B12 levels if you aren't already taking them.

Have you been having regular growth scans? These should be every 4 weeks. Do you know if you're having DCDA twins?

I'll echo a previous poster, once you're in hospital you will be very well taken care of. C section success rates are very high, if you feel comfortable going for a vaginal delivery then you will be encouraged to have an epidural in case the delivery of twin 2 needs to be sped up. Twins are more likely to arrive early so if you feel any changes in movement or feel contractions might be starting call up the hospital and ask to be seen by maternity assessment.

You will be ok but be assertive and try to get reassurance if you need to. Do you have a scan booked for 32 weeks?

Cracking post @SnowAndIcicles

Twin mum here too. Mine turn 10 soon. I researched and decided a planned CS was best for me. Had to fight, write letters, fight again when I went into Labour spontaneously. I'm afraid you need to be assertive to get the attention, treatment or care that you need.

Best of luck. Loved my CS. DTs in NiCU for 10 days. It's starts hard but gets heaps easier.

My experience is that they watch your levels drop to rock bottom before taking action. I needed an infusion 2 weeks before birth. I'd start up on iron tablets now and if that doesn't bring your levels up push for an infusion.
I don't understand how your midwife can't advice you on birth. Surely she's felt whether they're head down leading to a conversation about natural birth or c section.
I'm assuming you're seeing a consultant next week? (I was scanned every 4 weeks then every 2 weeks for 36 and 38 weeks). I'd discuss iron levels and birth choices with them, if you're not satisfied go to PALS. If you do want a c section different hospitals seem to book at different times, mine only booked it the week before but I have friends who had their date from 20 weeks.

I would call up your ante natal department and ask to speak to a consultant.
I never saw my MW after 16weeks as she said that my consultant was more qualified with my care. I never actually met my designated consultant and spoke to registrars or a different consultant. Most didn't really answer my questions about birth and kept saying it was too early to discuss and they said we could talk about it at my final appointment which I would have been 36+1 and would have meant I only got a few days notice. I did my own research to make my choice of section.
In the end at 32 weeks I pushed and said I wanted to discuss with someone as it was making me anxious and they finally gave me a c section date.

The registrars would just check the report from my scan and check my BP, urine etc.

I did however have low Iron and they gave me tablets but I ended up with two transfusions as they wanted my levels to be a certain amount before my section.

If you don't get the answers you want I would speak to PALS.

Registrars have been in post for many many years and have tons of experience they are not trainee doctors.

About 16 years ago they changed how they named doctors at different levels which is why people are confused. (My friends who are hospital doctors got caught up in it and weren't impressed as they knew it would confuse people.)

Most hospital doctors who basically aren't a consultant are regarded as junior doctors and this includes registrars. You need to have a minimum of 8 years of experience before you apply to be a consultant but most registrars have more.

@20viona

Registrars have been in post for many many years and have tons of experience they are not trainee doctors.

Came to say this too. You've had poor care and deserve better, but registrars are fully qualified and will often have been so for many years.

I’m really shocked at the terrible antenatal care you’ve received! When I had my DTs I saw a consultant every 4 weeks after my scan, and the mw every 4 weeks so I never went longer than 2 weeks without seeing someone. Admittedly this was 3 years ago, but given twins are normally higher risk I’m really surprised.

I’d ring your gp on Monday to get an apt to discuss the blood results. Today, I’d nip to the pharmacy and get some spatone to get some iron in you until you get to speak to someone. I wasn’t prescribed iron, just got told to buy spatone with mine.

I didn’t see the same consultant all the way through although I did have a named one. Quite glad about that really as he was very anti elcs and made me justify why I wanted one and told me “I’m only considering it because you’re having twins”. The next (female) consultant I saw got the diary busted out and me booked in

If all else fails I’d ring triage and ask them for help.

OP if you are anemic you need more iron than what spatone gives you to get your levels up.

On every thread where a poster says they have anemia someone posts this when actually the poster should see a doctor asap.

This is why I said just go to your GP with your blood test results and ask for the supplements.

Anemia is common in pregnant women which is why they test for it.

Any doctor can prescribe them for you if they have the blood test results and they know your medical history. Your GP has more of your medical history then the hospital. If the GP is decent and has any concerns will contact a specialist to check before prescribing.

I should add I just got a letter in the post telling me I was anaemic. I was annoyed as unlike you I was seeing a health professional every two weeks from 26 weeks for my pregnancy.

I spoke to a hospital doctor friend about it who has worked in different trusts and she pointed out that they only get a few hours to deal with their admin for all patients, and for some things it's just quicker for the patient to sort out themselves.

Just wanted to say thank you to all of you guys who replied. I had some excellent advice and it really helped. I have been more assertive with my subsequent consultant and midwife appointments. Luckily I have a different obstetrician now, who actually answers my questions and has given me a lot of information and I feel so much more supported. It has made such a big difference to my state of mind!!

OP I’m so sorry this is your experience as I know it’s nerve wracking being pregnant with twins. I had twins 4 years ago in Aberdeen and my care was excellent. Like others have said maybe it’s time to speak up and tell someone you aren’t happy. I know it’s difficult for some to do this if it’s not in your personality but it looks like you’ve been given no option. I saw a twin midwife at the hospital from 20 weeks and then a consultant every 2 weeks from 30 weeks. Xx