Declining Ob-led care

[Mslongears]

I'm 12w5d today, and yesterday I had an email to say I have an obstetric appointment for January. No reason was stated why, although my last baby was IUGR and induced (5.9lbs at 38 weeks) so I wasn't allowed to go past 38 weeks. My midwife said I wouldn't be allowed to be midwife-led at all this time, even if all is going well. She said they may even automatically want to induce early even if baby isn't IUGR. So what I'd like to know is, can I decline ob-led care if there is no reason for it? I'm planning on a "BBA" home birth, but I have a feeling they'll be onto me and try and induce me early to keep me on the system. Obviously if there is a genuine cause for concern, this will be different but I'm just thinking about my options in case everything is normal this time.

There is a genuine reason. Your last baby had IUGR and was small. If this one doesn't, then you'll be able to move from consultant led care (or at least I was able to) closer to the end once they know what's happening.

They are only considering this due to the additional risk to your baby; you can discuss what you’d like to happen but I’d be inclined to listen rather than dismiss their concerns. Many birth plans get changed due to risks and circumstances; you’ve got more of a heads up due to what happened last time.

I just feel they always push for induction, even if it's not medically necessary. And just because last baby was IUGR surely doesn't guarantee this one will be. Last time I ate 200 calories a day, ended up in hospital with covid twice which is said to cause low birth weight, and I was on medication which isn't safe to take during pregnancy. So several factors came into play, which doesn't apply this time around. I'm just worried I'm going to get bullied into another induction like so many other women do. I was told they only do it to get you off their books as soon as possible, since they're so short staffed, which of course could be a load of rubbish but you never know 😕 I just want to give birth the way I want for once, in the position I want and not strapped flat on my back which is proven to increase complications. I feel robbed of being able to enjoy my pregnancy because of how much this is worrying me

Why did you only eat 200 calories a day and take medicines which can cause harm during pregnancy? Could this be why they want you to be consultant led?

Because I was very sick and it was all I could handle throughout my whole pregnancy. This time my sickness wore off completely by 10 weeks and I'm eating like a horse - maybe even a little too much! The medication was a SNRI. Because I didn't find out about the pregnancy until 19 weeks, they weaned me off it as soon as possible which took a couple of months since it was such a high dose. They told me there is a correlation between the SNRI and low birth weight, so with that combined with the sickness and covid it didn't really surprise me that he came out so tiny

Plan on a home birth by all means, but please don’t ‘plan’ for a BBA / free birth. I had a BBA with my second and it took a long time to get over - genuinely frightening.

I didn't think 5.9 pounds at 38 weeks would be considered IUGR? My baby was only 6.0 pounds at 41 weeks and was not considered IUGR.

I've spent the last 3 years wondering this myself. On a group I'm in I've never seen a single case of a baby with IUGR born larger than 5lbs. So it does seem odd how they treated baby as failure to thrive, saying he'd never make it past 38 weeks because he was so small and likely wouldn't cope with contractions. I previously thought he was 6.0lbs until I had a look at his notes for the first time the other day. But I'm almost certain the obgyn said 6.0lbs after he was born, so I'll never know. I do wonder if it's because his growth slowed down. They probably told me at the time, but my mind was likely all over the place so I didn't take any of it in

I elected to remain in midwifery care after being offered ob-led care for my 3rd. It's a long story why I offered ob-led care but there weren't strong reasons for it and I had huge stress with my 2nd after the ob-led additional monitoring led to several false alarms, extreme stress and unnecessary antenatal steroids.

They were fine with my decision and let me have the useful ob appointments while I remained primarily in midwifery care. I found it useful when my ob pressured me into booking in for induction for at 40+4 in case baby was late - I felt able to ask my midwife to reschedule for 41+2 which I was much happier with.

The problem is I have absolutely no trust in the medical system. I'd quite happily birth alone, I trust my body to know what to do, especially as I've done it several times before. Nothing worse than being screamed at constantly by an obgyn telling you to do things your body isn't ready for. I got very "told off" last time for doing what felt right, and standing up for myself, even during transition I had a clear mind and shouted at them to back off and let me do what I need to

Ok, sorry to be that person but I had a look. It sounds as if you've only had one straightforward pregnancy/birth so far, along with one sad late miscarriage and your baby with IUGR. I can see why they'd want you to be consultant led - a week ago you were dating their was a 70% chance of similar issues with this baby.

You've also got a partner who your struggle to get hold of to the extent you're thinking of paying someone to look after the kids when you labour in case he doesn't answer his phone. And no other family to look after the kids in labour.

To top that off, clearly your struggle (or at least did) with your mental health given it took a couple of months to wean you off your medication for it because you were on such a high dose.

Someone might be consultant led because of a history of MH difficulties
Someone might be consultant led because of a previous late miscarriage
Someone might be consultant led because your last baby had IUGR.

Any one of those could have left to it, with all 3, I think it's very sensible indeed.

Ps: I'm confused at your were eating 200 calories a day, because your were so sick, and yet no one suspected pregnancy/you didn't take a test until 19 weeks. How could that have been missed if you had such severe symptoms?

You can decline any medical recommendation for any reason. It's your body and your choice. You don't need anybody's permission to go past 38 weeks or any other number. You don't need anybody's permission to decline consultant led care, even if they have a reason for it, even if they have lots of reasons for it.
If you feel you are being coerced you can go to Birthrights to get information about your human rights during pregnancy and birth.
Do you want advice about what you can do or about what you should do?

So I do have a history of MH, but nothing that would deem me as high risk. I went to the doctor to say I was feeling low and they stuck me on antidepressants. No diagnosis for anything, I don't think depression is even on my medical record. I obviously didn't get any symptoms at all until later on. Took a test, and it was positive, sickness started a few weeks after but it was more aversions than actual sickness. Had my scan and I was 19 weeks gone already. I was on the pill which stops my periods anyway, so it wasn't exactly obvious.

I know what the majority would do, yes. I'm just thinking ahead that IF there is no concern with the pregnancy then I feel I should be allowed to go midwife-led. To be told I NEED to be induced again so early on just seems very unnecessary at this point. I want to be given the chance to see if anything is wrong before being told what will happen

If you accept ob led care it doesn't mean you will definitely have to go with induction. I would go with the pathway and have the additional monitoring in pregnancy and growth scans as having a previous baby with IUGR is a risk factor for having another. If nearer the end of pregnancy all is looking ok then you could make a decision about home birth.

The thing is that smaller babies or babies where there is concern for placental function can find labour more difficult and can become distressed more easily. I'm not a midwife but work in obstetric theatres- you need to talk all about your personal risks with your midwife and consultant.

@Mslongears the important thing is, it is your choice. End of.

There is no "allowed to go". The consultants don't "allow" you, you allow them. It's up to you.

You are an adult, you are a human being, it is your right to decide what is done to your body. No one can compel you to go to the hospital. No one can put needles in your arm or fingers in your vagina without your permission. Assuming of course you haven't been declared incompetent by a court, but that is very rare.

You can absolutely decline and have an intentional alone free birth but it’s your baby’s health at the end of the day, if you can live with the potential negative consequences go with it

At the moment you just have an appointment with a consultant, right?

I was referred for an appointment due to my low pre-pregnancy weight. I had one appointment and they booked in a couple of extra scans later on to check DD’s growth. The consultant cleared me for a home birth as long as the scans were fine, and I was under the home birth team the whole way through the pregnancy. So having a consultant appointment doesn’t mean it becomes an all or nothing thing.

Don’t plan a BBA birth. That’s nuts. I lnow someone who had a home birth against medical advice and it went horribly wrong. And tht was with midwives attending.

You can decline any health care worker involvement or intervention you wish, for whatever reason. You are absolutely free to choose.

I think you would be not just foolish but downright negligent to choose a ‘free birth’, but the freedom to choose includes the freedom to make whatever stupid dangerous choices you like with your own and your unborn child’s life. Once the baby is born you no longer get the same freedom with regard to choices that affect the baby, of course, but until then your freedom is absolute.

You could also accept the appointment, accept extra scans/testing/consultant led care, be recommended against a home birth, and then decide with all the information to have a home birth with midwives, whether or not it's recommended. If you wind up declining recommendations, ask for a personalised care plan.
They do have a responsibility to support the choice to give birth at home, even if they don't advise it. The choice is not just between hospital and free-birth.
Of course it's always possible services could be interrupted for whatever reason, if they don't have enough notice they might not have midwives available, etc.