Can you get taken off 'consultant-led' once on it??

[MrsSenior]

I have been put under 'consultant-led' care due to BMI (35). Have yet to have first appt with consultant (at 21 weeks). Presuming there are no other complicting factors and it is just my weight then is it possible to get transferred back to 'midwife-led'?

The reason I ask is because we have an amazing midwife-led birthing facility near my home that I wouldnt be able to use if I was under the consultant.

I totally understand the reason for referral (increased risks of probs if high BMI etc) but I am only just over the cut off for this referral and although of course I want everything to be as safe as poss for my baby I dont necessarily think that means having them in a hospital with more chance of intervention etc (and the local hospital is not renowned for being great maternity-wise).

I just wondered if any other ladies have had any experience of this, obviously I will ask when I see the consultant anyway, it's just nice to have a bit of info from MN as a backup!
Thanks xx

Forgot to say, I am curently 18+4

Yes! I did ten days ago. High BMI, mildly deformed spine and History of Depression. Now 38+2 :-D

my reasons for being consultant led were all medical and to do with the baby / previous miscarriages and uterine complications, and my experience was that this was a massively reassuring experience. I honestly don't know whether the care decision is one which they can alter, or whether they just want to guarantee that you and your baby are in the best place if there are additional risks. It would do no harm in airing your wishes for the birth to be in the midwife-led unit, as long as you understand that the answer could go either way.

I am/was consultant led after problems in last pg, but as time has gone along and things seem ok (not right but not as bad as last time) I'm becoming more mw-led.

There is even talk that I might be able to birth in the nice mw-led centre rather than on the regular labour ward - an idea that they laughed at when I first suggested it months ago!

You can get taken off Consultant led, if the consultant agrees. I was under a consultant both times until about 34 weeks and then discharged into the care of a midwife.

Think you will have a struggle getting them to agree with midwife led care though if the reason you are under a consultant is your BMI as, as I understand it, it can cause problems during the birth.

shipsladyg was that a decision you or your consultant made? Was it just decided you weren't that high a risk anymore?

fuddled I do understand that I may need to stay under consultant and will of course do that if that is the best thing for baby... I jsut wondered if there was the posibility of coming off this if everything is going well and healthily.

good luck, the mw unit does sound nice

Ineedsomesleep I hope not, after all if I weighed literally 2 pounds less or was 1 inch taller at my booking in appt I wouldn't have been under the consultant in the first place.

I realise they need a cut off at some point, but do the risks seriously go up massively jsut due to 1 inch or a couple of pounds?

Thanks for posting everyone, as usual MN is a wealth of information!

I had consultant led pg with both of my babies; first one because of my weight and second becuase I had an emergency section with the first (and a huge baby!)

With both I had to see the consultant at each scan - 12 weeks, 20 weeks and growth scans towards the end but the rest of my care was wholly midwife led.

Can't do any harm to ask can it - I think as long as you're not showing any of the classic signs of weight-related issues like rising blood pressure etc they may be OK.

Good luck!

I have been taken off consultant led care and put on to midwife led care. I can't however have my baby in a midwife led unit due to complications in my previous labour. But I don't have to go to see the consulatant every 2-4 weeks like I did in the last pregnancy which is lovely.

There is a fab midwife unit here and I would love to go there .

Hope it works out for you.

MrsSenior Consultant made it. I didn't expect it at all, although as I'd been fine for so long, I was thinking that the extra appointments were a bit of a waste of time.

As the consultant said, it's all a question of risk assessment.

I was put under consultant led care with dd3 for two reasons. 1 was my BMI. The other was dd2's heart defect. The latter was dealt with by a cardiac scan which showed that dd3 was fine and healthy. The former was dealt with in a discussion dh and I had with the consultant. I declined to have a glucose tolerance test and therefore there wasn't a lot of point in him seeing me again. I had a straightforward birth producing dd3 weighing 7lbs 15ounces - the smallest of my three! I think the thing to do is get them to talk to you about the risks for you not for all women with your BMI. Have you any other risk factors, what about the baby's size - can they assess that later in pregnancy etc?

Northernlurker that's great, really helpful, thanks. I was wondering about the GTT too - can I ask why you chose not to have it (I have chosen not to have the quad test for Down's etc - so am all for informed choice based on what you'd do if it was positive etc) just wondered what the harm in having it was - unlike the blood/nuchal test where there would be decisions to make. I hope you understnad that I am just asking from an interested pov, not in any way questioning your choice. Also want to be prepared for anything the consiltant might ask/discuss/suggesst etc.

I just didn't think it was a necessary or helpful test for me and contrary to what is often suggested - it can lead on to choices and decisions.
I wasn't convinced of the evidence base for testing all women with a higher BMI but no other risk factors. I asked my consultant if he could show me the evidence that testing women based on BMI alone improved outcomes - and he couldn't. However A lady told me on another thread just a few days ago that the current thinking is that actually GTT should be done for all pregant women as risk based alone isn't revealing all the cases. I suppose you can say that's an arguement for everyone having it - or you can say that's also an arguement for people such as myself not being singled out for it at present. Clearly what are now considered to be risk factors aren't that exhaustive.
I do feel that there is a cause and effect problem too - do mothers with impaired glucose tolerance have babies with problems because of that issue - or because of the stress and intervention the medical profession imposes in an attempt to mediate said effects? I don't think there is a clear view on what the pregnant body should be doing with glucose anyway (though the medical profession would disagree ) and I certainly didn't think the format of the GTT was best designed to show what my body was actually doing day in day out. In ordinary circumstances I don't know any pregnant woman who fasts then has a massive sugar boost. It seemed to me that the conditions of the test actually put the body under a lot of stress and I wouldn't have accepted an induction at 40 weeks or continual fetal monitoring in labour or an epidural or a c-section on the basis of a 'positive' GTT - so there seemed no point putting myself through it. Obviously had there been any indications of actual problems I would have revised that view. I also suffered severely from sickness throughout pregnancy and I'm quite sure that I would have thrown the blessed sugar stuff up as soon as it hit my tummy.
What really concerned me though was what our midwife said after we'd refused it. Her feeling was that it was over-used in women such as myself and that it was being used in that hospital to place women on a certain pathway and restrict certain choices if you didn't question this and assert your wishes. That was interesting because it was what I had thought but I thought that was a bit paranoid of me. It's not that your consultant doesn't intend well towards you and your baby - but they are operating on the basis of if they have a 100 of you they know what will happen to 10 or 30 of you - they don't know what will happen to YOU in this pregnancy and I think it's healthy to question that. My consultant said dd3 would be 'at least' 9lbs - she wasn't even 8! The evidence base would certainly suggest she would be heavier than her sisters but she wasn't!

Thanks for taking the time to post that NL, I do appreciate it. I equally wouldnt want excessive interventions/monitoring/induction purely based on a result without considering the specific indictions for myself and my baby. So maybe I shouldn't have it. I don't want to be set on a certain pathway just becasue of protocol or averages. Although equally I don't want people to think I don't want to do the best thing for my baby and presumably these protocols have been written in for a reason. I will see if I can get some more pros/cons and see what the consultant says when I see him.

Thanks again for sharing your thoughts

hey mrsS hope your days going well!! just because your under consultant lead care, doesnt mean you cant get the consultant agree to have the birth you want, you can be monitored in the pregnancy to keep the consultant happy, make sure both of you are ok, but theres nothing to stop you having the mw lead birth that you want.

talk to the consultant about it, with any luck they will be understanding about things and help you get the care you need, and the birth you want, or some combination of the two

OP, I got taken off condultant-led care by simply refusing to be referred to one. I am not saying that is an appropriate decision for anyone else, it is just what I decided to do.