Bad Antinatal Care?

[guyshahar]

Hi there

We are just over 5 months pregnant, but have seen the midwife only once, at 12 weeks. She took blood, and told us to go to the GP after 24 weeks. We will see the midwife again only at 28 weeks.

My wife is 37 and this is her first pregnancy. We have heard that other people of the same age in other parts of the country have had regular checks and tests (blood, urine, etc) and been referred to a consultant as a matter of course. But when we asked about whether it would be possible to see the midwife again before 28 weeks, we were told that there is nothing of any value that they could do before that time, and they would be very busy if all pregnant women wanted to see them so often. My wife is feeling uncared for by the medical profession.

Is this normal? Some friends recently suggested that we should try to change our care to a different hospital or area (we are currently using West Middlesex hospital), as they had very regular support.

But we do not know whether this would be a good move - and how would we be sure that things would be any better in another area?

Any advice would be greatly appreciated. Thanks.

I think she needs to have more confidence in her ability to carry and birth a child. We only need health professionals when things go wrong, and they only really go wrong in a way that anything can be done about in the later stages of pregnancy, which is when your MW will be around a lot more. Frequent early antenatal care is not necessary, IMO, as most problems can't have anything done about them.

Very normal to have few MW appointments early on. Have your friends got very recent experience of the different hospital?

With the consultant - in my city it was normal for everyone to have one consultant or registrar appointment after the 20 week scan, but unless there were any problems, no more doctors after that.

btw have never heard of people having regular blood checks as routine with a straightforward PG, I had booking bloods done, and then a set of bloods to check for anaemia etc at about 28 weeks. Urine and bp were checked regularly in 3rd trimester.

I spent part of my pg in Italy where pregnancy is much more "medicalised" bloods monthly etc.
However I was working in England in the June, July and August that my dd was born in the September,so had midwife appts there. As an "elderly prima gravida" at 37 I had appts every fortnight, and was, as the OP says, referred automatically to a consultant. (who did only see me once as I had a perfect pg tbh)

Has she had any scans and been offered screening tests?

I've had a booking appointment with the midwife (just filling in forms and blood/urine samples), a 12 week scan, then another appointment with the midwife at 16 weeks which was just taking more blood and urine - for screening tests for Down's and Spina bifida. I have a 20-week scan booked and an appointment with the consultant after that to discuss results so far. I'm 33 but no complications identified so far.

Whilst flamingo is right that there's not much that the health professionals can do in the early stages, it is reassuring to 'touch base' with them. Especially for first timers like your wife and I, as even if all is ok it's good to feel you're not 'on your own' (no disrespect to my darling husband who is very supportive!)

Hi. My 1st pregnancy, I saw mw every 4 weeks. My second pregnancy was completely different. I saw the mw I think 3 times throughout, same with GP. To be honest, I wasn't happy with the shared care between GP and MW as there was no consistancy, each GP appointment was with a different doctor, and my mw was crap.
First pregnancies regardless of age is a scary time and if your wife needs the reasurances of more regular care, there isn't anythig wrong with that. You can understand their point about not being able to see every pregnant woman every week, but it's also not your fault they're short staffed.
In your blue folder, on the front of thegreen section, there should be a sticker with phone numbers on it, call the ante-natal clinic and ask to speak to the supervisor and explain all your concerns. They should be able to at the least get you a mw that's a bit more understanding. I did it, made a huge complaint about my mw, and the team supervisor made sure I didn't see her again.
Good luck. x

It makes me a little grumpy to hear people say things like, "I think she needs to have more confidence in her ability to carry and birth a child."

I think you do need more care than this. A dating scan? I would also say that from about 16 weeks you should be seeing a midwife at least monthly for BP and urine checks. Preeclampsia is a very real concern. Being 37 I agree should mean you get more antenatal care. You should be offered an anomaly scan at 20 weeks to check baby and all his/her organs are working ok. Leaving it until 24 weeks is just not acceptable.

If you are of the belief that 'pregnancy is not an illness', at least respect the fact that for others it is nowhere near as simple as all that.

Appointments should be 12 wks (hosp, bloods), 15 wks (community MW or GP), 20 wks (hosp anomaly scan), 25wks (community), 28 wks (community), 31 wks (comm), 34 wks (commm), 36 wks (comm), 38 wks (comm), 40 wks (comm), 41 wks (comm) and these are the minimum appointments for a first time Mum - both mw and Mum-to-be can request more. The NICE guidelines for Ante-natal care are here. All the community appointments have included BP & urine checks. Bloods are at 12 and 28 weeks.
IME visibly carrying the NICE guidelines helps
I'm also 37, but not getting any extra appointments - 37 isn't classed as that old anymore

Isn't the point of the 16 week appointment to take bloods for downs/spina bifida?

Where a Nuchal scan is offered and bloods taken at 12 weeks then this is in fact not needed?

My experience - first baby currently 32 weeks and appointments have gone pretty much as Jetli has written.
In addition, from 16 weeks, baby's heartbeat is checked at every appointment (except last because I went to GP instead of mw and he couldn't be bothered).I have to admit that it takes me an inordinate amount of time to get to the appointments due to work location, then I get there and appointments are literally 5-10 mins max - take bp, check urine, palpate to find position, listen to hb, measure fundal height, ask if i'm ok and that's it, but the reassurance of hearing heartbeat and checking size is comforting esp as this is our first. After next appointment, I'm supposed to go every 2 weeks, I'm 36 and haven't had any additional app's due to age.
Think if you're worried about level of care, you should talk to the mw again and talk talk to place you're thinking of moving to as it may be the same there.
Best of luck!

I'm in Scotland and I am almost 20 weeks pregnant now.

I got a 12 week scan at 14.5 weeks but saw no midwife then though they did take urine sample and weigh me.

I have only seen my midwife once at 17.5 weeks for a booking appointment and blood test. No real info given either, was very rushed.

I get my 20 week scan next at 21.5 weeks, (they only just started giving 20 weeks scans here in Feb this year), then I see my doctor the end of May and don't see my midwife again until the end of July!

we get only 2 anti natal classes, where my midwife says that is where you discuss your birthing plan - in front of 20 other people I presume.

I don't want my pregnancy to be medicalised but I do wish for a little more support as this is my first baby. That's how I ended up on mumsnet.

I told my doctor I was pregnant at around 3 weeks so I was booked in very early for appointments too. I have asked about it but they just keep telling everyone here that they are busy but that is not very reasureing! There is a baby boom going on I am told!

With my first baby I had booking in at 14 weeks and my BP was already 170/90 and I had gestational diabetes already. I dread to think how my blood sugar was in the early weeks or my blood pressure. I then was seen monthly for the diabetes. I had swelling and high BP even though I was taking it easy. At 22 weeks I developed full-blown preeclampsia and HELLP syndrome (which was diagnosed by an out-of hours as acid reflux). Being a first-time mum I had no clue what it was. At 24 weeks, very ill, I went to my appointment and was admitted and my little one's heart stopped beating later that day.

It turns out that I have a tendency to do this in pregnancy. However, in my second pregnancy I was very closely monitored and managed to get to 29 weeks, then managed PET until 31 weeks when ds was born by emergency C-Section.

This is why I think you can't be flippant and all "pregnancy is not an illness" (etc)

I am under Queen Charlotte's and have had booking in with bloods at 10 weeks, 12 week nuchal scan with bloods. 20 week anomaly scan - no bloods. Now have 24, 28, 32, 38, 40 no bloods. 30 and 36 with bloods but only I think because I am Rh-. I was surprised there wasn't more but I am not concerned as pregnancy progressing well (touch wood) and have always been made to feel that if I needed anything I could ring.

Just to let you know that West Mid was my second choice (on distance only) and lots of my friends have had fantastic care there.

I sympathise - it's really frustrating when you're pregnant that the midwives/health people don't ever want to see you!
You just have to console yourself that it means you're a low risk pregnancy.

Once you feel the baby moving you feel more reassured yourself that everything's going okay (they say you can feel it at 18 weeks, but despite this being my second baby I didn't feel it till I was 20 weeks, and only then because I was sitting still for hours on a long-haul flight).

In Bristol you get
a booking visit (10weeks ish, blood tests),
a dating scan (12 weeks - this is new, with my first baby I didn't get this),
then 15 weeks (blood tests for down syndrome etc.),
20 week scan.
Apparently first timers get a 25 week midwife apptmt (chance to get your MAT B1), but otherwise they don't want to see you till 28 weeks (which is really AGES!).
After that appointments are more frequent (31 weeks (for first timers only), 34, 36, 38, 40 although they will make them more frequently if they detect anything they're concerned about e.g. high blood pressure, sugar in urine, etc.)

I've never saw a GP or consultant in my first pregnancy or in this one, (midwives are specialists in this area so in my opinion probably know more than a GP; consultant only useful if there's something potentially wrong). Also only went to hospital for scans (again, never saw a doctor or consultant) and delivery.

They do say that if you're worried about anything (baby not moving, bleeding, fainting, swelling etc. )to go and see them, but the chances of getting an appointment without having to go three rounds with the receptionist are so slim that I'd have to be really worried to do that.
You do have the excuse of being first time parents though, so if you are worried about anything don't hesitate to get an extra appointment in.

I think this is probably "normal" for the NHS. There will be scans, but you don't usually see your MW at those times.

As has been said, you can console yourselves that it is regarded as a low risk pregnancy, therefore no need for more contact in the early stages, but I realise that with a first baby you might feel a bit isolated and ignored.

I never saw a doctor at any stage at all (I am 36), and didn't feel the need to. The average MW has delivered hundreds more normal babies, than the average doctor. I know who I trust most

FWIW, apart from workload issues, I believe that many MWs think that extra, more frequent tests (that aren't warranted due to known high risk or actual symptoms having appeared), simply create more stress for the parents.

As the pregnancy progresses your wife will see more and more of the MWs and near her date she will see them once every week I expect. Have you got good books to read to tell you what is or isn't "normal"? "What to expect when you are pregnant" is a good one.

If you are feeling very anxious, you could always intruct the services an independent MW. You can also buy off the shelf devices to listen to the baby's heart beat for about 20 quid (boots or argos), although be warned, they arent always that easy to use and, again, this could cause more stress (sometimes its very hard to find it, depending on how baby is lying) and convinced yourselves that something was wrong, when in fact its just fairly cheap and cheerful equipment that doesn't work that brilliantly. HTH

Has she been given a scan date?

For a normal low risk pg she should still have a couple of extra appointments before the 28 week one I would think