Pregnancy booking appointment

[chattycaterpillar]

I have my pregnancy booking appointment next week and I'm very worried about the following:

A) I am overweight, ( BMI approx. 29/30). I understand they take your height/ weight at booking and am worried they will judge me, assume I will feed the child rubbish, make me go to dietician.
B) Last year I took a low dose antidepressant, ( 10 mg fluoxetine), for the first time in my life, ( very stressful situation that has now resolved). I stopped taking the fluoxetine, (with GP approval), when I found out I was pregnant due to potential risks. I also accessed NHS counselling via IAPT last year, ( that finished several months ago). Do I have to disclose this , as I feel it' my private business ? I don't want a well meaning referral to a mental health midwife/ social services on the grounds that would stress me out more.

Please be honest about your medical history. I’m on anti depressants and seeing a therapist. The midwife noted the Citalopram on my notes but there are no concerns raised and I think she seemed reassured that I was open about it and have treatment in place. My trust has a flowchart of escalation/referrals and you need to have a very serious mental illness to be flagged to social services, and even then it’s only to make sure support is available.

I had a raised BMI at my booking appointment and a history of anxiety for which I took sertraline a couple of years ago but did not have time off work. BMI meant I was put on strong folic acid for the next few weeks but no judgement whatsoever. Also had a glucose tolerance test further down the line but again no judgement though the test itself was horrid. Other than that have not had any further conversations about it. The anxiety was completely ignored they’ve not mentioned it once and I am 40+1.

Oh I’m also allergic to penicillin and due to have a c section very soon (baby is breech) I told them about this as they do give antibiotics as standard during a c section but they were already aware of my allergy. I would certainly mention it just for your own peace of mind though. Good luck and congratulations!

You will be asked questions about your health history. Certain conditions such as kidney problems and recurrent uti's can be significant in pregnancy. They will ask if you have any problems with your thyroid. At our trust we ask whether you would be happy to have blood transfusions if necessary. We check for family history of genetic conditions and high bp or diabetes. The booking appt is a fact finding session and you need to be honest so the midwife can make any necessary referrals and can support you appropriately through your pregnancy. Don't be worrying. It's not a judgmental thing. We need to know these things so we can look after you properly

Midwife here: yes, we can review your GP records so can see everything anyway. We ask about mental health because we want to make sure we look after you as best as we can. Please disclose the previous mild depression, I can assure you it will not result in a social services referral or anything of the sort. Feels like every other person has depression and anxiety! Likewise with the BMI. 29/30 feels really average now and I wouldn't bat an eyelid. Definitely wouldn't judge and expect you to feed your baby rubbish. Our job is to look after you and your baby so please be honest with your midwife and trust us to be there for you. Personally I know I'd find it more concerning if I saw mental health on someone's records but they told me they had no history whatsoever. Congratulations btw

Congratulations on your pregnancy OP! Please try to relax - the booking appt isn't a test for you to pass or fail but a way for your midwife to get to know you so as to best support you through your pregnancy. It's quite straightforward and definitely isn't designed to catch you out. Please be honest, you'll feel better for it.

@littlemissalwaystired

Midwife here: yes, we can review your GP records so can see everything anyway. We ask about mental health because we want to make sure we look after you as best as we can. Please disclose the previous mild depression, I can assure you it will not result in a social services referral or anything of the sort. Feels like every other person has depression and anxiety! Likewise with the BMI. 29/30 feels really average now and I wouldn't bat an eyelid. Definitely wouldn't judge and expect you to feed your baby rubbish. Our job is to look after you and your baby so please be honest with your midwife and trust us to be there for you. Personally I know I'd find it more concerning if I saw mental health on someone's records but they told me they had no history whatsoever. Congratulations btw

Just to check, do you review GP records as standard before you speak to a patient ?

So they would know about the assault, ( I had to explain about the assault to my GP, as obviously had to explain why I was requesting antidepressants for the first time in my life). I do think it's a bit bad they can view your GP records without asking tbh.

So I should just say, " as you will have seen on my GP records, I was assaulted in Jan 2021 by someone I did not know, and went on to request antidepressant medication from my GP a few weeks later. My GP also advised me to self-refer to counselling via IAPT, which I did and completed and was discharged in summer 2021. I found out I was pregnant in Jan 2022, ( first cycle of trying), and after speaking to my GP , agreed the best thing to do was stop taking the fluoxetine as I felt I had been stable for many months and the counselling had helped. I stopped taking the fluoxetine approx. five weeks ago and feel fine. " And i think, ( having spoken to my friend), that if said calmly wouldn't raise alarm bells.
Also, just to clarify, this wasn't a sexual assault, but very , very violent mugging, ( threatened with a knife), from a stranger.

My friend, ( midwife, but different NHS trust), says they will have seen a lot more complex cases and I'm worried about nothing.

No we don't routinely check your GP records before seeing you so they probably won't know about your assault.

In terms of questions asked, it's generally lots of questions about your medical history and any family history of note. The appointments usually 1hr 15 mins so it's hard to summarise.

We ask about mental health. Most people say they have past history of anxiety/depression. It really is so common and a complete non issue.

We ask about social history, get all of your details and next of kins details.

We let you know about all of the appointments you'll have during pregnancy and cover a few health promotion topics.

We take a sample of your urine, and take some blood, this will all be explained. We take your height, weight, blood pressure and a CO reading.

We explain screening for your baby and ask if you want it or not.

It's not a grilling, it's just information gathering, making necessary referrals and having a chat. It's a chance for you to ask any questions. If you're feeling anxious you really should mention it. It doesn't make you look bad, it just means they can offer support. Pregnancy changes everything so it's important to keep an eye on it.

If they needed your GP records for a specific reason they could check but it's not routinely done.

It depends if the midwife is completing your booking at your GP practice or if it's the antenatal clinic at the hospital.

If it's the GP practice your GP record is the system she's using so it's quite normal to skin it before seeing you but we don't always have time.

If it's at the main antenatal clinic at the hospital they don't just have access to it and are likely using a different hospital system.

I had my booking app two days ago and my BMI was 30. Midwife was fine with it and said I'm still low risk. I will just have to have an extra glucose test later in the pregnancy. Dont worry OP

It must vary on trusts then because yes, where I am we routinely check GP records prior to a booking appointment.

It's a rule where I am that we have to check, and then document that we've checked.

@littlemissalwaystired what type of thing do you check the GP record for ? I'm quite shocked that they're allowed to check without consent tbh.

I mean their could be all sorts of confidential information, previous terminations, STI treatment, treatment for herpes, BV, that isn't relevant to the current pregnancy but is still something the women may want privacy for and not want to share. It seems very intrusive.

Approx. five years ago I tested positive for, ( and was given antibiotics for), Chlamydia by my GP. I hadn't thought they would go that far back, but will they know that as well if they have a look through ?

I mean I have a friend who was referred for psychosexual counselling via her GP, ( orgasm problems). I think she'd be very hurt and embarrassed to know that her midwife would have access to that info.

Also, genuine question, do you tell the patient at the beginning of the appointment you have "checked," their GP record ?

Or do you test them and ask about mental health, STI's etc and see whether they are honest ?

What do you say if someone says they had no mental health concerns but the GP record marks antidepressant prescriptions ?

How many years back do you check ?

When I had mine, I had a high bmi (probably around 30 but can't remember snd had electric notes which have now disappeared). They just monitored me a little bit closer, spoke about risks of gestational diabetes. As it happened, I had HG and lost over a stone in my first trimester.
I was on 150mg of sertraline and 20mg mitrazipine for depression at time of booking. I was offered additional support via counselling which I declined as felt it was not needed (I'd been under MH services from the age of 11 and then intermittently from age 20-22 (now)). They advised that I can seek advice and support at any time but it was not a cause for concern. I am very aware of my triggers and when to seek help. I also have PTSD and have self harmed/tried to take my own life in my younger years, this was briefly discussed but not to the extent that I was worried anything negative would be said/happen.

You don't need to worry, just be open and honest, they are there to help

OP all the conditions you’re listing are relevant for a future pregnancies.

You’ve been told midwives don’t routinely check past records. They are medical professionals the exact same as your GP and practice nurse. Why do you think they ought to see a partial or sanitised picture of their patient?

Your reaction here is really become quite extreme for someone who thinks they’re so fine.

It is important to be honest with your midwife about your physical and mental health history so they can make sure you get the correct care during your pregnancy. Things like herpes can impact delivery the baby as they are born. Divide is one of the biggest killers of pregnant and post partum women so having back ground information about mental health means they can quickly get help if it is needed.
Midwives see so many women from all sorts of back grounds and circumstances they are not going to judge your issues past or present. If anything hiding things from them is more worrying behaviour

So in short the three things worrying me , a) high BMI, ( approx. 29/30), b) recent, ( but not current), antidepressant use and referral for counselling following mugging and c) Chlamydia diagnosis and treatment 5 years ago are likely to have been seen by them on quite a regular basis ?

My friend thinks I'm just finding things to worry about now lol. Hopefully i'll get someone nice who understands these things happen and won't be too shocked.

@umberellaonesie

It is important to be honest with your midwife about your physical and mental health history so they can make sure you get the correct care during your pregnancy. Things like herpes can impact delivery the baby as they are born. Divide is one of the biggest killers of pregnant and post partum women so having back ground information about mental health means they can quickly get help if it is needed. Midwives see so many women from all sorts of back grounds and circumstances they are not going to judge your issues past or present. If anything hiding things from them is more worrying behaviour

Just to add, I've never had Herpes, ( although was diagnosed with chlamydia five years ago), but it was an example of something someone might want to keep quiet.

@chattycaterpillar

So in short the three things worrying me , a) high BMI, ( approx. 29/30), b) recent, ( but not current), antidepressant use and referral for counselling following mugging and c) Chlamydia diagnosis and treatment 5 years ago are likely to have been seen by them on quite a regular basis ?

My friend thinks I'm just finding things to worry about now lol. Hopefully i'll get someone nice who understands these things happen and won't be too shocked.

I'm sorry if I've added to your anxiety, that wasn't my intention at all. Yes I'm honest with people that information is shared between GPs and midwives, and no don't trawl through everything. Ours is broken down into sections and there's one for any past obstetric history, mental health, any referrals made to hospitals etc. I only check relevant things such as previous pregnancies, fertility treatments and mental health etc. It also flags up people with a history of smoking. I can assure you I wouldn't be interested in the slightest in trawling through every record ever made in your life, for irrelevant things like a historical chlamydia diagnosis. In the nicest possible way, other people's records are in no way interesting enough that you'd even want to bother!

But of course you’ll get someone “nice” who won’t be shocked. The things you’re listing are not remotely shocking. They are extremely common problems.

I really wouldn't worry about your BMI. Mine is over 40 and all that happened was I was put under consultant care (just meant a couple of extra appointments and additional growth scans) and a glucose test for diabetes. They didn't mention my diet, just gave me a few leaflets! I doubt anything would happen with your weight anyway, I'd imagine it's BMI over 35 maybe when they class as high risk?

Op, as several people have said here, and your midwife friend has told you, your BMI and antidepressant use won’t have anyone batting an eyelid. At most you’ll probably be asked if you’d like a referral to the pre natal mental health team at the trust, and depending on the rules at your trust you might need a glucose test later on in pregnancy, especially if you have any other risk factors (family history of diabetes for example).

Midwives are health professionals who have the best interests of you and your baby at heart. No one is going to be judging you for being a little bit overweight and having seen a counsellor! Or for having had a STI in the past. You do sound very anxious about this, so maybe you should mention it to the midwife in the booking in appointment? They are there to help you, not judge.