Maternity
Complex Pregnancies
Complex Pregnancies
You may have a complicated pregnancy due to a pre-existing medical condition which will require extra monitoring by the obstetricians during pregnancy, such as Type 1 diabetes or epilepsy.
Why your pathway may change to 'complicated'
There are a few different reasons why your pregnancy pathway may change from uncomplicated to complicated. For example, if you are pregnant with twins or triplets, or if you develop a condition in pregnancy, such as gestational diabetes or pre-eclampsia, your pathway will be changed and you will be referred to an obstetrician by your midwife, though you'll still see your midwife as well.
We have developed planned pathways for common conditions such as a raised Body Mass Index (BMI), age of the pregnant woman or person, those who are at risk of having a small baby. Ask your midwife which pathway you are following. Your midwife can discuss and explain your care pathway with you.
We will reassess the situation at each appointment to ensure you continue on the correct pathway.
How it works
If you are placed on the complicated pathway it does not mean that your pregnancy and birth will be entirely medicalised. We aim to ensure that visits to the hospital are kept to a minimum.
You may need to see an obstetrician once, to plan your care, and then continue your antenatal care with your midwife. You may be required to have regular obstetric appointments and scans to monitor your baby's growth.
Your midwife and obstetrician share the aim of keeping you and your baby safe throughout the antenatal period, during labour and birth. They will listen to your birth preferences and involve you in any decision making. They will offer you advice, based on NICE Guidelines, about the safest place to plan your birth.
Obstetric antenatal clinics
Each specialist clinic is run by a multidisciplinary team who has specialist expertise in your condition which means that you and your baby are placed at the centre of care.
Over 40% of all pregnancies may be complex due to a variety of reasons. The term 'complex' may seem frightening - but you do not need to feel anxious as it only indicates that your pregnancy needs additional input from specialists who are experienced in such conditions.
We aim to provide you the best possible care delivered by an expert team of both doctors and midwives to ensure the best outcomes for both you and your baby.
Day Assessment Unit (DAU)
You might be referred to the Day Assessment Unit (DAU) by your GP or Community Midwife or indeed the specialist at the hospital condition-based clinic. The DAU will monitor you and your baby or offer further investigations if necessary. This helps avoid admission to hospital and avoids anxiety and inconvenience to you. You will be cared for by our expert team of midwives who will refer to a doctor if a further opinion is required.
Referrals to other specialties
If you have a complex pregnancy that requires input from other specialties, for example if you have epilepsy, diabetes, heart or kidney disease, you will be referred through the relevant clinic to specialists looking after these conditions. There are specialist joint clinics with obstetricians, specialist doctors and specialist midwives and nurses.
You may also be referred to the Anaesthetic Assessment Clinic (held in DAU) if any factors in your condition, your previous history or your present pregnancy indicate this.
We have a perinatal mental health specialist midwife and a bereavement specialist midwife who you can have access to if you have mental health issues or have had a previous pregnancy loss.
For pregnant women and people who are on the Complicated pathway birth is most likely be recommended and planned for Bath Birth Centre (BBC). All midwives support normal birth, even when you have additional health problems. They will work with you to achieve your birth preferences, such as waterbirth, optimal cord clamping and skin to skin at birth. The midwives are trained to assist the obstetricians during ventouse, forceps and caesarean births.