[Solved] Midwives on Call

Welcome to the site ladies.

Dads feel free to ask anything of our new experts on the site. Widmife, Special Delivery and pinkmadwife are here to offer advice and guidance about anything pre birth and birth related.

Gooner

Hi All,
Do you feel you were well supported in labour? What do you think the midwifery profession could do to enhance your experience? We would like to hear your views!

Hi there

We had a male midwife for the birth of our eldest and I was very concerned - but like many he was superb, reassuring us both and keeping me fully informed.

They all do an amazing job and I would like to thank each and every one of you

Hey, we would like to hear from dads who have attended Antnatal Classes. What were they like, did you feel welcome, involved, what improvements could have been made, did they prpare you for labour and early parenthood??? Also do you think there is a need for a Dad's only class?

Hi

Just wonder if one of you midwives can give me some advice/help with something pls?

My wife is expecting her 3rd baby in November and was 22 weeks gone last Tuesday. She went through a very hard divorce about 3.5 years ago, at the same time as being pregnant with her second child by her ex-husband. Unsurprisingly this was quite difficult on her and coupled with the baby's semi major health problems she suffered from depression. It took us the first year of our marriage before she finally got help from her doctor and now she takes 20mg of fluoxetine everyday. This works wonders for her and although she is resigned to the fact that she may have to take a tablet every day for the rest of her life, she understands how much better she feels when she does take them and how normal life can be.

Yesterday my wife was having one of her not so good days, a combination of a lack of sleep, possible anaemia and plain old pregnancy hormones. She went to see the midwife about changing iron tablets, or doing something else to give her a bit more energy. Now our midwife, who has been the same midwife in both my wife's previous pregnancies, going back 8 years, and who knows the family situation etc decides this would be the best time to tell her that before our baby is born, she needs to be referred to a more senior midwife so that a "care plan" can be put in place for her and that our baby will need to stay in hospital for 24 hrs to be monitored for "withdrawal"!! Now immediately this caused alarm bells to ring like Notradame in my wife's head and for me, when I heard about it, it sounded like we were a risk to our own child. At this point I called the midwife, who told me it was standard procedure to generate a care plan, they are very generic and that it's nothing to worry about. I also asked about the monitoring and she told me that it's just to make sure there are no side effects from the tablets. When I asked why we hadnt been told this earlier, she said it's because she feels my wife would benefit from being on them more than any risks to the baby. Now while I agree with her my wife needs to be on them, no-one has taken the time to explain what the risks may be! Up until now they've also advocated a home birth, or at the very least, using a midwife led birthing centre and my wife is keen to try the latter of these 2 options as she really doesnt want to be in the hospital to give birth. I then made the comment that if they want to monitor the baby for 24 hrs, surely these are no longer an option. The midwife then said that depends on if she comes off the tablets towards the end of the pregnancy. So now I'm confused!??!? 😕

I'm sorry if i've waffled a lot, I guess my questions are:

a) what is involved in this "care plan" and how much say can we have over it?
b) what are the side effects of the fluoxetine on the baby, if any?
c) what is involved in the monitoring and can I refuse this?
d) what happens, if anything, if I dont allow my baby to be monitored?
e) at what point would my wife need to come off the tablets in order for the baby not to be monitored and for there to be no need for a care plan?

I'm not saying I would or wouldnt take a certain course of action at this point, I just want to know the facts to be able to make an informed decision. Hopefully one of you will be able to help.

Thanks for taking the time to read this.

Dear Basdad,
Firstly, many congratulations on your news!
I have encountered many women and infants who have been in a simular situation to your wife's in being treated with fluoxetine and other medications for depression. Each hospital will have a protocol in place to whether your wife will be able to access a home delivery, midwifery led birthing unit, or delivery suite. I would suggest it would be worth discussing using the midwifery led birthing unit with a consultant at your hospital, in view to having the birth you and your wife are planning for.
The care plan that you are discussing, is simply a document to ensure all health care teams (midwives, paediatricians and obstetric doctors, GP) are aware of the fact your wife has been taking fluoxetine and that subsequent monitoring of baby would be strongly advised, although the risks to infants are very low. Think of it more as a plan for all departments to follow guidelines and communicate effectively. I would suggest that if you would like to see such a care plan, your midwife should be able to show you one. It may also be possible to discuss this with the paediatric team in your hospital, so again ask your midwife if it is possible to arrange an appointment to speak to them if you feel you would like to.
When we talk about 'monitoring' baby, what this means is that your baby's physiological observations would be observed. This would be heart rate, respiratory / breathing rate and temperature, movements, sleeping patterns and so on. These observations will not cause baby any distress, however they will give the medical team information that your baby is in 'tip top' health.
During pregnancy, hormone releases can make emotions difficult to deal with, therefore, I can see why your midwife may recommend that your wife continue to take her fluoxetine.
It is a case of weighing up the 'risks' and ensuring your wife is able to function well throughout her pregnancy, with as little effect to her as possible (tiredness, emotions). If she feels she can do this without the medication, then it may be possible for her to be weaned off this medication, however, this should ALWAYS be fully discussed and planned with your GP, it is not safe to simply stop taking this medication.

In 'monitoring' baby, we would also be looking out for any signs that baby is jittery, especially sleepy and so on, as signs of withdrawl. Fluoxetine has a long half life, therefore there is a very minimal risk that baby will show signs of withdrawl from this medication.

I would strongly recommend that you allow baby to be monitored after delivery. Some hospital's policy is to monitor baby for a lot longer (3 to 4 days), therefore 24 hours is a relative short time for 'peace of mind' that baby is fit and healthy.

Within the healthcare services, there are care plans for nearly everything (when we use a urinary catheter, when we assess someone for risk of falls etc...) so try not to get too worried about a plan being in place, it just means the relevant services are all communicating well.

I hope this is of some help to you, please write back for any further advice / anythin you want to discuss or chat about.

Special Delivery.

Hi Special Delivery,

Thanks for the advice, it doesnt sound quite as bad as maybe we were first led to believe.

Our midwife is coming by this weekend, so might have some more questions then if thats ok.

thanks again

Hi Basdad,
Hope it all went well with your midwife, please let us know!
Special Delivery.

We went to the midwife yesterday, everything is fine medically, mum & baby are doing fine at the moment

As for the issue of monitoring etc, it was kind of glossed over. We filled out a referral form together which is passed to a specialist midwife who will contact us shortly. However, because of this, our own midwife cant tell us much. She thinks it might be 12 or 24 hours montioring, she's not sure. She didnt mention the coming off the tablets but my wife and I have decided it's best for all concerned for her to stay on them.

We also asked about the midwife led centre, she's given us details to arrange a time we can go and have a look around but again, when asked if this would still be possible combined with the monitoring, we were told "i suppose so" but that the specialised midwife would again, advise us on this.

I feel she could have looked into the issues a lot more and been ready with the answers to potential questions but she wasnt. She doesnt seem to like me very much, I'm the one asking the questions and trying to get the answers, trying to be proactive, but she's used to dealing with my wife only, who can be very submissive and mild and just nods her head so as to try not to cause any problems.

Anyway, she's 24 weeks now, so only 16 left and we wont have to deal with the midwife. Now just got to wait and see what this specialist midwife says.

Thanks for asking though