Shared midwife/GP care - any alternative

[Sal321]

I'm 27 weeks pregnant and under shared care. I am being seen by a team of community midwives attached to a different hospital to the one I am expecting to have DC at and they don't seem to know much about the hospital I am going to. Seeing them seems to alternate with my GP. I don't really like seeing a different midwife each time and not knowing who it is I am going to see until I get there. Last time I was seen by a student (with supervision) but not asked if this was ok. They don't get my blood test results, answer my questions with "we don't really discuss that at this stage" and have dismissed some of my concerns without even writing them down. I am sure they are perfectly pleasant and competant though, I just don't seem to get on well with this system. The midwives so far seem to do just what the GP does (fetal heart rate, BP and measure my bump). I am due to go to NCT classes soon so that should help me with a birth plan. As this is my first time round am I missing the point of the midwives? Do they do something mystical later on that I would be missing if I asked just to see my GP? I would rather just see my GP and get continuity of care. Is this possible? Sorry for lots of questions in one!

NCT classes seem like a very good idea in your position. Your midwives sound crap.

For both my pregnancies luckily I've been at a doctors where they have one midwife seeing everyone.

As to what they do - mine does the blood tests, fetal heart rate, measures the bump, answers any queries I have, checks my BP and my general health. Provides information/leaflets. Not giving you the blood test results is crap. As is not answering your queries. Mine also answers any queries about stuff in the hospital.

As I also have mental health problems she checks that I am being regularly seen by the doctor and reports back if she has any worries about me, checks on my general state and checks that I am 'in the system' as it were and that things are being done by the psychiatric teams (she gets a copy of any reports that they do). I am under GP care for the mental health stuff but the midwife acts as a back up to check it is all being done. Also acts as emergency contact if I have any problems.

As to what you can do I don't know. If you book an appointment with the GP rather than the midwife surely they would have to see you and you could do it that way round.

I think it's normal for them to just share the workload with the GP. Not good them not getting you your test results though!

I wasn't impressed with the midwife at my booking-in appointment - I didn't get any questions answered, she said the answers would be the info she gave me and then I went home to find the info pack contained a list of questions to ask! Luckily I'll now be seeing a different midwife at the childrens centre near us, and I've already spoken to her on the phone and she seems more with it, lol.

It's annoying when your nearest or preferred hospital is actually out of your PCT area, so the midwives and GPs are connected to a different hospital. I had that option here and the midwives don't seem to know much about the out of area hospital at all! But then, they'd never work there, so not too surprising I suppose. Have you seen if the hospital has a website with info? I found that answered more questions than the midwife could!

I don't think GPs will usually take up all the workload from shared care. One option would be to get a private midwife, but that's pretty expensive and if you are having a hospital birth, then they may only be able to be your birth partner at that hospital, not your main midwife.

The NHS midwives don't seem to spend much time on birth plans (a friend said you get a LOT more support with a private MW), but there's a lot you can research yourself if you like to be prepared (like me!). Dr Miriam Stoppard's book has some excellent advice and the NCT are fab. Maybe see if the NCT have a Working Bumps or Bumps & Babes group near you so you can start going along now, rather than having to wait for your class - the group leaders are great for asking questions and meeting other local mums-to-be who already have kids or have investigated local services saves a lot of time and effort.

I'm on consultant care but I suppose that's not really an option unless you want one? I'm high risk so I have to have one but originally was shared with a MW I didn't get on with.

I had that alternating midwife and GP care when I used to live in Croydon. I was more worried that the GP didn't really know much about antenatal and if I asked him anything he'd tell me to ask the mw next time. mw appts were brief. I think they do it because the community mw can't cope with all the appts and are overstretched, but that's just IMHO.

this is very common, at this stage they just wan to check general health. nearer the time you will see hospital midwife and then the NCT classes will help too. Its the way it is I'm afraid and the birth plan often gets shot to shit anyway!

Thanks for all your responses. There is no indication that I will be seen by a hospital midwife, but perhaps that is something that they will spring on me later. I had a doctors appointment today and discussed this with her. She said she would happily see me instead of some of the MW appointments, but then didn't actually do everything the MW do, so I think I will give the MW another go. I also asked my GP about my blood test results from 12 weeks and she said that she didn't seem to have all of them either!

Porcamiseria - I get your point about birth plans completely - I think part of my general plan might be to not get too attached to any plan at all.

Who has taken your booking bloods? Who are you seeing at 28 weeks?

My booking bloods were taken at the 12 week scan at the hospital I am signed up with - that's why they seem to have got partly lost. I'm seeing the doctor at 28 weeks, then it's the MW at 32.

If they were lost can you ask for them to be done again? They do the tests for a reason - seems stupid that they can't give the results and noone seems bothered by this.

I'm having more done next week - not sure if they are for the same things, the MW was quite vague about what they were for. That said, I don't know which ones were lost before, the doctor seemed to have results for rubella immunity and STDs (I think there were 3 listed). Not sure where the thyroid function one my dermatologist requested went, but hopefully the dermatologist got the result. The more I type, the less convinced I am about this.

It all seems very shambolic with no one taking overall control to sort things out. Surely there should be one person in overall charge to make sure things are happening.

TBH I would consider complaining after you've had the baby. This idea of shared care could probably work if organised properly but no one seems to have bothered doing that here.

What is happening is that your regular midwife will not have access to your blood results. When this sort of thing (getting community care in one PCT, giving birth in another) it is the hospital that took the blood's responsibility to feed the results back to you and/or your GP. Your midwife won't be physically able to get hold of those results in any way. So you need to contact the hospital and get results that way. Does your hospital have some sort of day or maternity assessment unit? if so, ring them. If you aren't sure, just ring labour ward and they will tell you who to contact. If you are 28 weeks next week then some more bloods will be taken then and sent off to your delivery hospital, again you may need to chase them. You need to know your blood group and iron level (and TFT results) from your first lot of bloods - if you are rh neg then you will need some anti D next week (at most Trusts - some have a slightly different policy) so I suggest you find that out now in case you need to try and organise it.

With regards to appointments, no, midwives don't do magical things! wee, blood pressure, measure bump, listen to baby, check position of baby (later on). Answer questions. I understand you may feel fobbed off but some topics - like for instance, pain relief in labour - are just massive and all your questions will be answered by your antenatal classes. Then, late in pregnancy when you have done your classes, you go through your birth plan with your midwife. The fiftene minute slots we get for appointments just aren't long enough to cover massive topics when we know they will be done in classes.

I'll ring the hospital on Tuesday and see if I can get my blood results out of them - I would really like the thyroid function one as it seems a little scary if there is a problem. One of the things I was fobbed off on was when the NHS antenatal classes are and I asked this at 25 weeks! I suppose I need to take more control of the whole process as I have been a bit to accepting when told that I would be rung if there was a problem.

Do it now Sal, it is a 7 day service, Saturday is same as any other day! And then you have time to organise stuff for your appointment for next week.

Done! I phoned the hospital and a very pleasant lady has arranged for my blood test results to be waiting for me to collect when I am in next week (she didn't want to give them to me over the phone which seems reasonable). Hopefully they will be fine. Thanks HTK for getting me to do this, I feel much happier now!