Consultants only in during the day?

[Maybemaybenot76]

I’ve just found out that at my trust, obstetric consultants are only in during the day and are then on call during the night.

Im sure this can’t be totally right. Is an entire maternity/labour ward really run by registrars? What happens in the event of a severe emergency? Is this the same at your trust?

That’s completely normal. If there’s a clinical need overnight then the consultant comes in. Same in every specialty.

This sounds about right. Consultants come in overnight if called at a lot of Trusts. At my Trust they have to be 30 mins or less away

Yes, they called a consultant In from home for me with dc3 due to complications.

I think that’s normal in all branches of medicine isn’t it?

So what happens if something happens that is beyond the scope of a registrar? For example, an amniotic fluid embolism or another rare complication where things need to be actioned correctly within minutes to save a life?

I’m completely shocked that they wouldn’t have at least 1 highly experienced doctor there at all times?

I think everyone forgets how very senior and experienced a medic can be without being a consultant.

A Registrar saved mine and my child’s life you can’t just rely on a Consultants’ expertise in an emergency you have to have faith in the medical team. Consultants can be ill too and as we know there is not enough of them anyway. What if there were two simultaneous emergencies at the same time and only one Consultant?

Senior regs are a thing. And they are often incredibly on the ball and sometimes more so than the consultants.

Registrars and SAS grades are well trained, experienced doctors! The consultants wouldn’t be leaving the ward if they didn’t think they could deal with any problem that can arise long enough for them to get back in. You’d perhaps even be better off having a senior reg with an obstetric interest on the ward than the consultant with a predominantly gynae interest!

The people on shift will be highly qualified and able to deal with things.

@Eatbetterthisweek Well, this happened with my first, except there was only one doctor!

The midwife came in to assess my “pushing” to see who was most likely to need the doctors help.

That’s healthcare for you. Nothing is ever perfect. Hopefully you and baby were fine? Unfortunately, we can only strive to make healthcare 100% safe but it’s not achievable as nothing is 100% safe all the time.

Completely normal in the vast majority of specialties in the vast majority of hospitals and always has been. Doctors who are towards the end of their training schemes or non Consultant career grade doctors are capable of dealing with the vast majority of emergency situations, at least initially and Consultants are generally required to live near enough to the hospital to be able to respond to out of hours emergencies in an appropriate time.
I used to sleep in the hospital when I was on call if there was a particularly unstable patient under my care or if the weather was really bad but usually I was happy to go home safe in the knowledge that the resident staff would be in touch very quickly if I was needed eithet for advice or to come in.
Remember that in all likelihood the on call Consultant will have done a full day's work already and will probably be doing their normal work the next day too. Providing 24 hour resident Consultant cover everywhere would be massively expensive (on call is very cheap compared to having staff working night shifts) and have a huge knock on effect on provision of non emergency care, even if there were enough suitably trained people to do it, which there currently aren't.
Lots of other services work the same way, depending on the usual workload. For example, whilst you might have a night shift in the labs or a resident CT radiographer in big hospitals where the out of hours workload is predictably high enough to justify it, in lots of smaller hospitals if you needed a CT scan in the night or someone to process say a lumbar puncture sample then someone on call would come to do it - it's not just Consultants who are on call from home.

I presume they don't just drag random people off the street and just say 'you do it' they are actually qualified for the job

do you genuinely not understand that?

Yes very normal in all medical specialties including obs.

In case of an AFE a crash bleep would go out. Registrars are capable doctors, they call the consultant if and when needed.

“I’m completely shocked that they wouldn’t have at least 1 highly experienced doctor there at all times?“

Senior registrars ARE highly experienced.

It’s because consultants aren’t the be it and end all of medical knowledge. Also just being a consultant alone doesn’t mean they will be the best person if a specific emergency was to happen. Albeit many of the consultants I have worked with are amazing, everyone has there strengths.

Very common- most hospitals, never mind obstetrics are run by Registrars overnight- most A&E's, ICU's etc won't have a consultant on site.

I have just finished my training and about to start as an anaesthetic consultant. Only a couple of weeks ago I was the anaesthetic registrar on Labour ward overnight with many many years of experience already, managing emergencies and calling my consultant whenever I needed them.

Senior Registrars are highly experienced. They will have passed their exams, which means they will have acquired a breadth of up to date knowledge very recently.

Also, urgent does not mean complex.

This was my experience, and unfortunately for me it meant a botched induction where though I was contracting every 2 mins they were reluctant to move me aveoss to labour ward at night and opted to wait the 24 hrs the pessary usually takes to work, then by the time that came round at 11am and though I was dilated enough to have waters broken, there was then no beds on labour ward... for two more days. I was induced as overdue and had suspected preeclampsia as blood pressure went up, so was on antenatal for three nights woken every every 4 hrs for obs and woken up by every other ladies obs, horrendous experience ending in botched epidural during agonising 8 hr back to back labour and an eventual emergency section at 3am.

All because they don't like transferring at night bevause there are no consultants, the midwife said it herself when I asked the first night what happens now as I was contracting enough to be checked then. This was in a highly rated London NHS hospital. I understand it's normal for consultants to be on call but the problem is this is bleeding into the care given ie midwives reluctant to transfer in my case.

You're right to be shocked and lack of consultants on the shop floor is consistently highlighted in serious case reviews. In my local Trust there is a culture of anxiety around waking the consultant on call overnight and a pressure felt by the registrars to handle it all. It's been slammed by CQC and rightly so.

Yes that's normal. My elective c-section was done at a civilised hour by the consultant who I'd seen a lot from when I was referred to her at 20 weeks pregnant.

My emergency one was done in the middle of the night by the registrar who had been looking after me for the last 4 hours. He was very good and got ds out very quickly, even though he did rip my womb in the process by accident. He was very kind to me and he came to see me and ds twice on the ward afterwards to check we were ok.

Same as my local hospital. I think it's wrong because the midwifery team are so under staffed at my hospital. The amount of emergencies that have happened on wards are insane

The answer to the problem there though is to have a properly funded midwifery service not more consultants on the floor. They do very different jobs.