Can you please tell me the diff between consultant led and MW led care?

[gem1981]

Hello
I may have to have consultant led care due to retained placenta last time round (not 100% yet though) can anyone let me know the difference?

I had an epidual and forceps last time and was hoping to avoid an epi this time as I am convinced that it was that that led to the forceps. Does consultant care mean it will all be very medicalised if so i think i will be gutted.

thanks

Usually means you see a doc for some or all of your antenatal check ups
Usually means they won't label you low risk so MW led birthing centre type places are often out unless you argue

Consultant led does tend to be more medicalised. It doesn't mean that you have to follow that trend though. Could you talk to your midwife (or even hire a doula) to go through active labour tricks/good birthing positions that will work even if you need things like foetal monitoring?
PS good luck.

Consultant led means you will have an an obstetrician taking care of you. if your pregnancy is something out of the norm or higher risk for any reason then I presume they decide you need an obsterician to follow your pregnancy rather than a MW. Obetetrician's are qualified to do more than a MW is allowed. It could be seen by some people as being more medicalised (as if there is any medical intervention, it has to be done by an obtetrician and not a MW). But that said this is only if intervention is needed. you should look on it as being well supervised rather than thinking ans not necessarily assume (as a lot oif people do) that you will be forced into a very medicalised situation. It just means you are in good hands if needs be. It all depense on what the obsterician is like. have you met him/her? Will it be the same one at every appointment?

as a bit of a hijack -

If you did have to give birth in a consultant led unit could it still be MW-style unless complications arose?

Due to geography and my past history (had an em cs) I would most likely need to be in a consultant led unit.

whoops xposted I think my question is answered!

'If you did have to give birth in a consultant led unit could it still be MW-style unless complications arose?'

Yes. Where I gave birth to my first two, there was no other choice for birth except homebirth and a consultant led hospital.

But you only saw a consultant if you were high risk to begin with or the midwife spotted complications during the labour or delivery.

DD2 was delivered by a sr. midwife and her student with no interventions at all.

I had epidural and forceps with DD1, however, but I don't think the epi caused the forceps, as DD1 was OP and had her hand up by her head.

I had cons led care last time
Still only had MW care during labour although I was on the consultant led unit at the hosp instead of the home from home unit

ta The Blonde and expat.

My local hospital is moving the consultant led unit to another location 20 miles away down a country lane of an A road - I wouldn't like to chance a transfer in the middle of things should a complication arise.

Not that I am currently pegnant, of course

You need to explain to your obstetrician that you want your pregnancy & birth to be as natural as possible and without medical intervention. That said if you have been put under the care of an obsterician it is because there is a risk that some intervention may be needed and keep in mind that this is for your own good and for the good of your baby. Some women feel that some obstetrician's are pushy and medicalise things to make it easier for themselves and although this may be true for some it can also be a bit unfair for the most part. Remember an obsterician is a highly trained Doctor who deals with the complex issues of pregnancy and is with who the responsibilty lies when making important decisions. By the way, usually you would have an epi to facilitate the baby coming out or to facilitate forceps or ventouse but the epi wouldn't be a reason for having forceps. You could discuss all that with your obstetrician though.

I've had both and there was no difference between the prenatal care and birth. In the end it's what you want it to be.

Actually Mollyfloss, having an epidural does increase the chance of having an assisted delivery (ie forceps, ventouse)

gem1981 - you could ask why having had a retained placenta last time means that you need consultant led care this time. There is an increased risk of it happening again, but you could discuss with them if being on the consultant led unit is likely to make any practical difference to your care - for instance are they going to expect you to have a venflon inserted on admission or any other precautions? Is there an option of a midwife-led unit within the hospital so that you could transfer to the consultant led delivery suite if necessary?

I thought epi meant episitomy. That's what I was referring to anyway. But yes an epidural does increase the risk of having an assisted delivery.

Oops spelling it's 'episiotomy'

gem, I am under consultant care at the moment, basically it means that you are kept a closer eye on.
However you can still go for whatever kind of birth you want, how hard you have to fight depends on how supportive your cons is.
Daisy is right btw,as are you, your epi probably did have something to do with the forceps, the less intervention (including epi) the more likely you are to have a ntural birth.
Generally our bodies can do it without too much medicalisation as long as we give them the chance.
Good Luck.

Gem 1981: So now that I have reread your first comment properly, why were you pushed into having an epidural in the first place anyway?

hi

I wan't pushed into an epidural but I was given one as soon as I asked for it - they didn't ry to get me in a new position or anything - I think because it was first birth and I was naive and v. frightened the pain took over.

My 9lb 3oz baby was back to back and I wanted it for the pain relief.

I found that after the epidural once it came to pushing I didn't know what to do/when to push and I got very tired. Baby wasn't being pushed out so they tried ventouse then forceps - but at this point I was too tired to care I just wanted my baby.

Afterwards the cord snapped and this is why they had to manually remove placenta but I did not have to go to surgery as I had already had an epidural.

I then lost some blood and they offered a transfusion but my iron levels rose overnight so it wasn't needed.

I wasn't told a about placenta until 6 week check!! so don't really know why it happened. Can the cord snap if they are being rough?

MW has refered me to consultant to look into it further and he will make decision as to whether i need to have MW led care or cons. care.

I just hoped that this time i could avoid that epidural and have an unassisted vaginal delivery if poss. i think I have a preconception that a consultant may be a bit pushy and impose a more medicalised route.

sorry about the loooooong post

I've heard of cords snapping if the midwife uses too much traction, especially if the mother is having a physiological 3rd stage (can take longer for the placenta to detatch). I doubt this is the only cause, though. I'm not sure I understand why the cord snapping would necessitate manual removal of the placenta, though.

You need to talk to them and see what you think. Have a list of questions (incl. about the birth) and see what answers you get. You might also want to make an appointment to go through the notes from your last labour with a senior midwife to try and get a handle on why the cord snapped. Once you understand what happened, why it happened and whether it's likely to happen again you'll have a more rounded understanding of the situation and can put what the consultant tells you into more of a context. If they do recommend you stay under consultants care for this pg you'll be able to make an informed decision over whether you want to accept that care or not. It's your body, your baby, your birth and your decision - not theirs.

I'd share your concern about consultants tending to medicalise birth. DD was breech and I felt the options were a vaginal breech birth at home or a CS - the registrar I saw was very unsupportive of vaginal breech birth and made me feel I didn't want the battle to be "allowed" a vaginal birth in the hospital (in the end I stayed home with IMs). That said I have heard of some consultants that do see childbirth as a normal process and are supportive of active birth, vaginal breech birth, VBAC, etc, so try and keep an open mind. Innocent until proven guilty and all that

With consultant care you will probably only see the consultant three times. Frankly I find it a complete PITA and waste of my time. Consultants never find nothing wrong with you - even when there is no big problem.

BTW I'm apparently high risk (bollocks) having had a cs plus PE in previous pregnancy but I'm still having a homebirth and midwifery care - you can refuse to see the consultant and you can give birth at home - but the mw unit can refuse to take you - some have a policy that they won't accept alleged high risk women yet you can birth at home

The best way to get accepted for MW led units is to get the consultant to write on the front of your notes that you are okay to deliver there

Hiya Im under consultant (obstretician) care cause of high blood pressure. I am monitores more often and dont see midwife except for ante natal classes.
I will be considered high risk when i go into labour and will be monitored more closely. Also have been told to expect maybe needing epidural if blood pressure rises as this will bring it down , less pain = less BP but i am going to go with flow and see what happens. However i do think i will leave it in their hands to deide anything re my labour cause after all they are the professionals and im not

gem - the cord can break / seperate from the placenta for many reasons, often due to a heavy handed doctor being a bit quick to try to pull it out, but it can happen if the cord is thin or friable (tears easily) or it is attached to membrane. There are lots of reasons and it almost certainly wont be documented in the notes. It will just say 'cord snapped'

If they did a ventouse and then changed to forceps, it was because baby would not come out with the ventouse, possibly because of lots of caput,(the swelling on babys head which doesnt let the ventouse cup attach well) or because they needed to use more traction, or force.

If they were thinking of transfusing you, your haemoglobin must have dropped quite a bit, (it normally is lower just after delivery due to haemodilution as they will have poured fluids into you, when the fluids have been absorbed the hb is higher - thats why its not accurate until at least 6 hours after birth.) so you have lost enough blood for them to classify you as a PPH.

So, the consultant will say 'difficult delivery, manual removal and PPH' and will probably suggest consultant care. You can see the interventions and complications snowballing!

However, with a second baby you will most likely have a much quicker birth, are really unlikely to need an instrumental delivery, which will reduce your chances of a retained placenta and therefore you are less likely to bleed and have a PPH.

Even less likely if you avoid an epidural and stay mobile.

I think you may have to fight to stay low risk (at least in the hospitals view) however you can also see that you will probably have a much better experience next time round, even with cons care.

Good luck and sorry for the long post and technical stuff

thanks everyone for all your wise words and help.

I have my first appt with the consultant soon so I hope to get it all sorted then (I will go with a list of questions!!)

I don't mind what care i receive as long as it is appropriate for my situation. If you see what I mean.

x

i had consultant care with my last pregnancy due to surgery during the pregnancy but they let me start my labour in the midwife-led part of the unit before being transfered to the consultants ward (difficult time with delivery as DSs heartrate kept dropping). this time the consultant has seen me and is happy to try again with the labour and hopefully the birth within the midwife-led unit but the consultants ward will be made aware when i go in.

hope they answer all your questions and imo as long as you and baby are healthy after the birth, it doesnt matter where you deliver.