treedelivery--- or any other midwives around?

[thisisyesterday]

sorry, didn't want to hijack the placenta accreta thread, but had a question i was wondering about.

i am on baby number 3. straightforward pg's and births with first 2.
no sign of any probs thus far with this pg (am 17 weeks)

is there any reason why I need to see my midwife more than a couiple of times before birth???
it isn't that I am anti antenatal care or anything, just that it's such a faff getting to appts, and all I did in any of the others was say "yes, i;m fine" check bp and uring sample.

are there any real risks of me not having mroe appts??

bump

i just went to my Gp instead for most of my care. only went to hospital for 13 week booking visit

i think you do need to go in case you develop soemthing like GD or your blood pressure gets high

i found going to teh hospital a real pain. its about 1 hours drive, no parking nearby and you always had to wait about 2 hours. with one or two other children. no seats. nothing for them to do . no fun.

tiy i did not go to the midwife more than a couple of times wtih last pg - no need

i should have gone for some bloods at aroud 20 week iirc so that might be one to remember - but otherwise fine

i felt quite happy and healthy and was not worried as had scans ...

you will have your scann at 22 weeks i presume?

midwife is at our local surgery, but she is only there one day a week, when ds1 isn't at nursery, which means I Have to take in a 4yr old and a 1 yr old each time. it's just a bit of a nightmare that's all! lol

yeah got 22 week scan booked already.
i don't think i am going to have the second lot of bloods though.

There are very minimal visits for 2+ pregnancies. They are done by your midwife at the local surgery.

28 weeks - to check for raised BP, size of baby, etc To take bloods for repeat iron stores and general blood group (to check for antibodies).

34 weeks - Again to check for signs of pre-eclampsia, gestation diabetes, urine infections (all of which could be present but you would not be aware of them). Also, we will check on growth of baby.

36 weeks - To ensure that baby is head down and not breech, again we will check size, BP and urine.

38 weeks - BP is quite important at this stage - again if there is any problems with blood supply to baby (would be unknown by you) growth would be affected.

41 - Discuss options re -induction of labour if not delivered within a week. Also Stretch and sweep offered.

It's completely up to you if you want to have bloods repeated. It's just a routine iron level as you can become anaemic during pregnancy due to haemodilution. If you are anaemic it can put you at increased risk of bleeding heavily following delivery and also leave you pretty knackered!!! bAlso - can cause palpitation etc. Easily sorted out with iron tablets. It will also check for your platelet count (involved with clotting of blood - vital to stop you bleeding following delivery) and white cell count (to check that there isn't any infections that can be treated with antibiotics.

Also - there are loads of other conditions that we look out for during the antenatal period - often mums can feel well but there is concerns that are picked up at the antenatal check - ie. fetal growth retardations, reduced fluid around baby, cholestasis etc. - all of which potentially could result in fetal demise.

Honestly - the checks are there for a reason - midwives haven't got enough time as it is to do checks if they were unecessary.

x

Gosh - I'm sorry if I sounded a bit 'matrony' in the post above!!!! Also - sorry for the spelling mistakes!

Hello,

I am a hospital midwife and i would totally agree with reesie. yOU WILL ONLY have minimal appointments anyway.

Although things were fine with you other pregnancies and i am sure they will be fine anyway, you never know and things like raised blood pressure may not give you symptoms.

You cant always tell the position of the baby yourself and you wouldnt want to present in labour with an undiagnosed breech or transverse lie.

Having said this, due to the clientele at the trust I work I see a lot of women who have had lttle or no antenatal care or booking extremely late into their pregnacies and they are fine! I would not recommend this though!!

Anyway, I think its lovely to go to antenatal appts as it helps the pregnancy pass quickly, its great to hear the baby and be reassured and its free in this country so take it up!!

carmen - i totally agree with you re having the checks. but i have to disagree with your statement that it helps make the pg go more quickly! Op has two small children so i dont think she is sitting around with her feet up! I find the whole " hey its fun and its free and you have nothing better to do " attitude a bit patronising.

My hospital ante natal visits involved nearly two hours of travelling alone with with a bf baby/child, trying to find expensive parking in the city centre and then keeping a crawling (then walking) toddler amused & quiet in a waiting area for two hours or more. often there was not even a seat. I also had to get Dh to take time off work to collect older child from nursery or school, as you coudl not rely on being away from a 10.30 appointment by 12.30

This is not fun, truly its not. And with respect i think that you as a MW need to recognise what its like for women.Maybe you could think about making your service a little more user friendly if you thought of it from the clients perspective.

If well motivated informed patienst like teh Op are thinking of missing checks because its such a hassle, no wonder many others simply miss them

Why don't you ring your midwife and see if she can do your checks on a home visit? You won't be the only munm who otherwise has to take the whole tribe along to ante-natal. If she has the time I'm sure she'd rather see you in a more relaxed setting - and get to suss out where you live so she's ready for the post-natal visits.

Have you asked if you can have home visits? I now have all my appointments at home, because of SPD, 2 flights of stairs at the drs surgery, and a 2 year old to juggle. My midwife suggested it. It's so much nicer - surely it can't hurt to request it?

You could request home visits - a letter to the community midwifery manager should sort it out nicely!!!

However, please remember the strain on the service - I agree antenatal checks at the hospital can be a complete nightmare - they take forever. It's only because some women have poor outcomes and problems so we cannot predict how much time we need to spend with them.

However, if OP is well - she will only have one more appointment at the hospital for her anomaly scan and then the other 4 (or 5 if you go overdue) will be done at her local GP surgery. Women in my surgery are usually seen promptly!!!!! It's only a quick 15 mins of a check up.

Being a pregnant midwife - I wouldn't miss any of my appointments as I know that they really all there for a reason. Lots of complications can be sorted out (ECV for breech for instance, or referral to growth scans for IUGR etc).

Also - I don't want to scare you but you really do increase your risk of maternal and fetal mortality and morbidity by not accessing maternity care. Even though you have had previous normal pregnancies and deliveries - complications can arise. Women and their babies in remote areas ie Africa still do die because of lack of antenatal care.

I'm a firm believer in maintaining normality and that pregnancy is a healthy condition. BUT, it's imperitive that any complications (which day to day - I see frequently) are picked up early and therefore treated effectively

my checks with GP were fab. 10 min drive, easy parking, was seen almost straight away so no hanging about with other kids. lovely female Gp who had two small kids herself and knew our family situation. Also she was prepared to listen, so when i insisted baby was breech even though she didnt agree she sent me to hospital for a scan. So i was in time to have baby turned by ECV

thisisyesterday - please try to get your appointments soemwhere more suitabel so you and your baby dont miss out on care

thank you for the info everyone! it does help in making an informed decision. am due to see my midwife on the 8th anyway, so will discuss with her then. my thoughts atm are that instead of 4/5 following my scan which is booked for 23rd Jan putting me at roughtly 20 weeks, I could have maybe 2 or 3 instead.

so, perhaps it'd work if they could do 30, 35 and 39 or something?
the problem with blood tests is that we have to go to the local hospital where it's basically a ticket system and you have to sit and wait your turn. Last time I was doing a GTT and it ended up pointless because I waited for over 2 hours to be seen!
I am willing to have a test for iron levels as I am vegetarian and do tend to be anaemic anyway, but will only have it if they can offer it at the surgery instead of having to go to hospital.

again, I will be doing plenty of OFP and if baby ends up breech I would be looking at a vaginal breech birth- position wise this is soemthing MW could check at 35 or even 39 weeks right?

I actually have a friend who is a nurse and can check my blood pressure for me lol

I think that if you were going for the VD of a breech baby you woudl want to talk to them about it beforehand, so they can make sure that you get experinced staff. maybe even talk to the consultant. My understanding is that not many staff have skills in delivering breech babies and that one of the problems can be that they are too hand on when they need to be more hands off

I'm sure if you turn up in labour with a breech baby they will pressurise you to have a section. Esp if its at night with junior staff on. so you def need to sort it out in advance

BTW i havent done this i just researched it a bit as i had 2 breech babies. one turned himself at 39ish weeks and one was turned by ECV. i think it depends on the type of breech as well?????

Blimey katie that was a bit OTT towards me!What did i say? Wasnt being patronising at all and i am not the person that organises the service so i am not sure how i am able to make it a bit more user friendly??I work in a hospital i am not a community midwife

Also i actually did find that antenatal appts made my pregnanciesy go really faster. Was just saying what i think personally

pregnancies go really fast

if i knew baby was breech i would still have my homebirth. but my savings would be taken up on hiring an IM!!!! lol

i've only been to the gp twice and am 35 weeks.

had a few hospital appointments too, about 3 not counting booking in and i was raging after the last as after driving an hour to get there, having to get the kids to my parents to be minded (dd was off playschool with a bug so shouldn't have been out of the house full stop) and waiting and hour to be seen the mw spent less than 2 mins with me and didn't even check lo's position or anything... all she did was bp and urine and doppler... fgs, i could have gone to the gp surgery and gotton a more thourough check. the next appontment is on the 13th and it'll cost a fortune in petrol etc and mean getting my mother to babysit again so am seriously considering not going tbh.

at this stage i've done it often enough to know myself if anything is wrong and the gp and nurse are there any day i need them if i'm concerned. baby is already head down and engaged so not as if i have to get position checked or anything

Only just seen this - sorry!!!!

Will have a read but sounds like a few mw have alrerady said what I would have done from the skim I had through....

Nice have the final agreement of routine care of pregnant women and that is where most trusts start to plan your care. It's online and makes really interesting reading.

I can't see why, for routine bloods, your midwife can't do them in the surgery in the appointment time or at home. All midwives can take blood - though obviously the GTT is different.

The BP checks are timed to coincide with hot spots for the onset of pregnancy induced hypertension. Think of the bad old days when checks were fortnightly till 34 weeks or so then weekly!! Urgh!

The bump measuring business is also considered the most sensitive way of picking up small for dates, interuterine growth retardation, decreased fluid etc etc.

I agree that the visits do spint he pregnancy out for me - sort of milestones. However I can completely see that they are a major bind for others. Negotiate and liase with the com mw, maybe if her caseload isn't massive she can coem see you at home 50/50 or something?

All the same advice as above!! Sorry didn't see thread sooner.

spin the
come seen you

Tut!!