what to expect in consultant-led care?

[ai38]

This is my first pregnancy and in the booking appointment the midwife told me that my care will be consultant-led (I guess) because of a previous fibroid surgery and history of blood transfusion.

I am currently 14 weeks and tomorrow I am going to see the consultant for first-time. Does anyone know what will happen in this appointment? At the time of my fibroid operation, they told me I would need a c-section if I ever become pregnant. So I know this is something that I need to discuss with the consultant. But what else will happen at this appointment?

And more importantly, will I always see the same consultant in the coming months? and is this the same person who will perform my planned c-section? If not, when will I meet my surgeon?

In my experience, I don’t think I ever actually saw the consultant. I was consultant led with my second due to previous pre-term delivery. It meant that in addition to the usual midwife appointments, I also had monthly appointments at the hospital antenatal clinic but I think it was always a registrar that I saw there and certainly not the same one. It usually involved a long wait followed by a short consultation where they did all the usual checks. They also discussed any increased risks due to my history. I was referred for a cervical scan to check for any early dilation when I went for my 20 week scan.

Once I neared full term, I asked to be discharged back to midwife care as the risk of another premmie had clearly passed. They were happy to do this.

I can’t advise on the c-section, sorry. I had a natural delivery. I would say write down a list of any questions you have and take it with you as I would always forget what I wanted to ask when I got in there.

Congrats on your pregnancy and I hope all goes well tomorrow. X

I was consultant led as I was IVF plus previous surgeries. I was told by consultants following my surgeries that I would likely need a c-section but when I raised this with the OB consultant they were happy for me to have a VB. The appointments for me were just like the midwife appointments tbh, bit perfunctory, just making sure someone higher up the medical chain saw sight of me regularly.
I ended up requesting a planned section as due to my previous surgeries it was also noted how much scar tissue I had so I didn't want to risk going to emcs and wanted everything nice and calm when baby arrived.

I had consultant-led care for both my pregnancies, but for different reasons. The term is a bit misleading - most of my care was still via my midwife, it was literally 2 to 3 appointments with the consultant throughout each pregnancy. Same consultant for each appointment (and the same one for both pregnancies, as it happens). In terms of what to expect tomorrow - probably just some routine checks of things like blood pressure and a chat about your medical history and the implications of it.

It most likely won't be the person who does your c-section, and you most likely won't meet that person until the day of the surgery - there's too much unpredictability around it (your c-section may be scheduled, but many others the team will be dealing with won't be - you'll get whoever's available). On that note, be prepared that even when you've got your c-section date, it could still be moved if there's a lot of emergencies that day - somebody in my NCT group waited around all day for her planned c-section only to be sent home and told to return the next day!

My second was consultant led, first was a 'big' baby. He was 8lb 10, induced at 40 weeks due to his 'large' size. I also had a underactive thyroid diagnosed after the birth of the first. At the first appointment I said I wanted a home birth, consultant basically went ok you have big babies, off you go. Never saw one again. I thought it was all a bit bizarre as the midwife had said I might have to have a c section booked.
Baby two was born at home, all 9lb 8 of him.

I saw the same consultant across my 2nd pregnancy (due to a fully dilated emcs following failed forceps and postpartum psychosis with dc1) and she intended on doing my surgery herself but dc2 decided to come early.

I was consultant led due to being born with a heart condition (although it was repaired when I was young). I saw consultant at my 12 week scan, he asked a few questions, referred me to another hospital for baby to have a heart scan at 22 weeks and then I saw him again at 38 weeks. Depending on why consultant led I assume it would be different the amount of times you see them but I only saw him that twice and it was the same person both times x

I’m consultant led due to BMI, the person I saw was very straight to the point, telling me that I’m more at risk of PPH, they’ll struggle to get IV access which will delay emergency treatment. I wouldn’t mind but I’m not even THAT fat🤣🤣

I’ve got a midwife and consultant appointment next week so I’m assuming I’ll be seeing them throughout

@FirstMondayInMay I was consultant led in my pregnancy due to BMI and didn't see a consultant the whole way through! I even had a midwife led birth as by the time they assessed me I was 10cm and pushing so they didn't have time to take me to the obstetrics ward 😂

@honeybeeeee i’m praying that happens to me because the thought of an epidural or c section absolutely terrifies me😂

My experience of consultant led care was one appointment with a registrar who recommended additional scans at 30 and 36 weeks. At the 30 week appointment the doctor got everything totally wrong and thought I was about 14 weeks. They missed pre-eclampsia and even though the community midwife spotted it they did nothing with the urine and blood sample results. At the 36 week scan which they forgot they'd asked for they predicted DD would be 6.5-7lbs. She was 5lbs and teeny tiny and both of us had to remain in for several days after, her for tinyness and me for pre-eclampsia.

I won't bother talking about the birth itself. So in short, I would recommend not expecting a better level of care and attention and continue to ensure you really advocate for yourself. I imagine however they come into their own for very complex labours.

@FirstMondayInMay oh it was wonderful. I'd been told I'd have a midwife in the room the whole time, constant monitoring etc and I had absolutely none of that 😂 pretty much left to my own devices until the end and thankfully she just popped out without any issues! Wishing you luck 🍀

Thank you everyone for your replies. I had my appointment today. I think it was with a registrar. Surprisingly, they booked me for C-section from this early on and gave me a date for when I am 39 week. The appointment was very brief and we mainly discussed some basic questions about the c-section.