Elizabeth Garrett Anderson - Opinions Please!

[Kiwifruit]

Hi
Just wondering if anyone has given/is giving birth at EGA in London, and what your experiences have been like? I'm booked in at St Marys Paddington, but having done the labour ward tour, have decided to check out my other options (am due at the end of September, so need to decide soon, I guess). St Marys wouldn't be the end of the world, but am interested to look at other options.
All information gratefully received!

[franch]

Kiwifruit you might find this thread useful

[Kiwifruit]

Thanks Franch - very helpful!

[HappyMumof2]

Message withdrawn

[Ellbell]

Hi. May not be very helpful, as not really childbirth related. But I do have a friend (much older) who has had quite a lot of gynae things done, including a hysterectomy, at the EGA and thinks it's a brilliant place. Good luck!

[Katts]

Hi,
I'm expecting to have my baby at EGA in September. So far I've been really pleased with the antenatal care there. Everyone has been really friendly and pleasant. And the facilities seem relatively clean (only have the Whittington to compare it to in that sense though) Also, I've only heard good things about EGA from other mums and midwives. Hope that helps!

[Kiwifruit]

Thanks for that Katts - I'm due in September too. Am going to have a look on Sunday and do the tour. Don't think I've seen you on our September ante natal thread - come and join us!

[hub2dee]

Hi Kiwifruit,

Just FYI: we toured the Bloomsbury Birthing Centre which is in the same corridor as the EGA. It is the active birth / natural / alternative side to the perhaps more traditional / medicalised EGA bit. A woman called Astrid Osbourne is the Senior Midwife there. She has started up several other Birth Centres. If it's your cup of tea, CAT me for her mobile.

DW in the end preferred the Royal Free because it's MUCH closer to our house and it's all sparkly new (plus we got stung for a £50 Congestion Charge by accident when parking at UCH ! duuuhhhhh).

The facilities at the Bloomsbury Birthing Centre aren't 5 star, but the care and professionalism of the staf, I suspect, is excellent. Of course, emergency / consultant intervention if needed is easy peesy as they are right next to the 'regular' ward.

If anyone wants a particularly woman-centred / midwife led / homely environment, I'd recommend you check it out.

[franch]

I am the voice of doom about the Royal Free but that's off-topic and I can't make it my life's mission to dissuade all pregnant women from stepping inside it, much as I might like to hub2dee, you can always CAT me if you do want to hear my thoughts.

Katts, I'm using UCH for my homebirth in Sept (if all goes to plan) - as Kiwifruit says, do come and talk to us on the due Sept thread !

[hub2dee]

franch, will CAT you and thanks for the offer. All good background hub-brain-info.

Can I just ask: (1) Was it post refurb - it's all new now - but I understand the staff shortages still inger... (2) Do you have any general advice about improving birth experiences at hospital or was this specifically a Royal-Free-I-really-can't-talk-about-it type event ?

PS - re your home birth - are the UCH midwives due to attend from Astrid's BBC or from the EGA ?

[PrettyCandles]

I had both of mine at UCH, and also can't recommend it highly enough. Admittedly I had one midwife who was utterly awful and inflexible, but apart from her they were all gentle and caring and supportive. The food postnatally is abysmal, but they will give you something to eat whatever time you come up from the labour ward - none of this nonsense about giving birth at 11pm and then having to survive on a cup of tea and a piece of toast until breakfast time.

I was intending to have a water birth in the BBC, but the pool was already in use and I think the BBC was full in any case, so they put me in the regular labour ward but treated me as if I was in the BBC - no intervention. I asked for a specific midwife to look after me and they followed that request too.

Word of warning though, I found the postnatal ward swelteringly hot and took an amentiy room as soon as one was available so that I could have the window open (in December! ). Definitely worth the cost.

[franch]

Hi hub, (1) Yes it was just last Jan (04) I'm afraid. (2) I can talk about it and do have thoughts about getting the most out of hosp birth but I'm afraid my view is that the Royal Free suffers from a severe morale problem which results in a generally negative ethos amongst the staff. There are some exceptional people there but they are swimming against the tide. Some alarmingly basic errors were made and (worse, IMO) we were bullied from start to finish in the labour ward, having started out in the lovely birth centre. I posted my birth story on the ukmidwifery support group a while back and can email you a copy of that if you like.

My care at UCH has, so far, been in a different league from the Free, right from day 1. They are worlds apart IMO. And anecdotally, I've heard almost 100% praise for UCH and about the same amount of horror stories about the Free - including from my own GP! Just wish someone had told me all this earlier.

Homebirths are done by UCH's community midwives, who also run the Birth Centre. I've been in close contact with Astrid and also with the consultant midwife Alison McCrae, who's been round to my house to talk through my first birth and to make plans for this time round, taking into account all the disasters of last time. But as Alison said, physically it was a very straightforward birth that was made traumatic by the actions and (above all) attitude of the staff. Everyone at UCH has been very shocked at my experience and I'm as confident as I can be that the same wouldn't have happened to me there.

More by email - do CAT me - I have no wish to hijack

[hub2dee]

Have CATed. Mieow.

Some of them already think I'm a Dr. as I kicked up a fuss when booking appointment wasn't set up / dw refused early scan on bleeding etc. and I called through to Director of Midwives Office etc...

Were you implying your GP had a bad birth experience there, or one of their other patients ?

[franch]

Haven't got your email yet but will reply when I do. The GP just had a generally low opinion of the Free and strongly agreed with my decision to go for UCH this time. I wasn't the first of his patients to bring him a horror story from there.

DH is a doctor and although he doesn't make a big thing of that and is very respectful of other medics, our general attitude of asking questions and having an opinion about our care went down like a lead balloon - NOT, I must stress, in the Birth Centre where the midwives discussed everything with us in great detail - but on the labour ward where, as I said before, I felt utterly bullied and intimidated from start to finish. Also - although at the time I had nothing to compare the antenatal care with, I now know from my experience at UCH that it was way below standard and that I should've expected better.

[goldenoldie]

Glad to hear someone had a better experience than me there:

• it was dirty - cockroach in bathroom,
  
• never saw the same midwife twice in the whole anti-natal experience,
  
• inconsistent advice/opinions from midwives about what my options were
  
• was refused a particular test - incorrectly - they later admitted liability!
  
• entered me for a clinical trail - without my consent!
  
• had a slip of a girl-midwife, maybe she was a trainee(?) but could not have been more than 21 - max, tell me to shave myself before going down to theatre - at 37 weeks I could not even see my knees, let alone my front-bottom bits!
  
• generally ignored except when they wanted to do something - put in/take out drip/bloods/catheter and so on
  Had a rotten time and discharged myself early, and will not be going back.
  If you want to chance it - good luck, you might need it.................

[goldenoldie]

Yes, I am talking about UCH/EGA

[hub2dee]

It appears that there's a statistical ratio of good to bad birth experiences - at every place.

One woman could have great service / sound attitude / alert midwives another - through no fault, and at the same place - gets lumbered with poor attitudes / less-than-helpful midwives etc. etc.

I wonder if there are key behaviours (in the client) / conditions which could be correlated with better birth outcomes:

Presence of partner ?
Day labour or night admitance ?
weekday or weekend ?
Forthright / serious / inflexible initial attitude vs.
Flexible / easy-going...
cm. dilitation on entry ?

etc. etc. etc.

Any comments (supportive or dismissive) welcome.

PS - franch: Think the CAT sitters are asleep... doubtless you'll get my message on Monday.

[goldenoldie]

Hub2Dee - you are right - different people will have different experiences, and you might be right about some of the key factors in having a good experience, but I feel that things like cleanliness, continunity of care, and consistency of advice given, should happen regardless of the time of admittance, how dilated you are, how stressed/laid-back you are, or if you have a partner with you.

Interested in your thoughts?

[hub2dee]

goldenoldie: in complete agreement with you.

I think most people would share an image in our minds eye, however, about how things should be handled, what condition wards should be in, how staff might behave... regardless of personal decisions (please induce / let me wait it out / elective cs please / epi preferred / water if poss etc. etc. etc.)

I am not suggesting it is any parents' fault that a bad experience arose !

What is intriguing however, is noting factors which correlate with these experiences as they may warrant further investigation...

For example, I think weekend births had been correlated with higher incidences of problems in one study (don't have it to hand, so forgive me if I've got the wrong end of the stick, or am summarising incorrectly).... (even if such a correlation occured, this would not demonstrate cause and effect of course).

What I suppose is interesting to discuss is what steps parents-to-be can take to attempt to secure the best birth outcomes all things being equal...

Being well-informed through antenatal classes / books, for example, is one 'tool' which I presume helps...

[hub2dee]

Of course, it would also be valid to consider things from the midwives / consultants' (and other hospital staff) perspectives too...

Perhaps such obvious factors as wards being unusally busy, round of paycuts / layoffs just been announced, changes in shift patterns / new management / extra bureaucracy etc. could be correlated with individual's experience ?

It would be interesting to hear from any midwives on MN, as well as all the mums, for example, if they feel there are any consistent factors which correlate well with successful birth outcomes:

• Clarity of birth plan ?
  
• Personal optimism ?
  
• Flexibility in approaches to treatment ?
  
• Belief in God ? (!)
  
• Degree of medical knowledge ?
  
• Friendliness / respect for staff attending to you ?
  
• Ability to trust your 'gut instinct' / 'sixth sense' ?
  
• Having birth partner as advocate when you might not be able to express your preferences....
  
• resistance to acceleration / inducement to avoid cascade of intervention
  
  The list is potentially endless...
  
  Hope it's clear I'm interested in open discussion of ideas / opinions... I have no particular vested interest in this area except attempting to help dw achieve healthy / happy birth when our time is due (looking like early August BTW).
  
  Esp. as it won't be me actually 'doing it' IYSWIM (I'm the hubby)...
  
  I guess I'm asking - 'what's the best thing I can do to help dw' (except perhaps doing overtime on wrist / finger excercises in the weeks ahead preparing my muscles for hours of endless massage... 'no problem darling, my hands aren't at all tired'
  
  All the home-birthers too would have strong opinions on all this no doubt...
  
  Perhaps rather than hijack this thread about UCH I should start a new one, could potentially be very useful...

[goldenoldie]

Hub2Dee - sorry to be a cynic - I think the overwhelming factor in having a good experience is having a quick, safe and uncomplicated birth.

From what I know, have heard, read about and seen, if labour starts to take too long to progress, and/or interventions start, and/or things that were not 'planned' for start to happen and it all gets complex, the chances of coming out of any hospital feeling you were cared for correctly, professionally, with sensitivity, in a timely fashion, by the right number of staff, of the right calibre - go down exponentially.

To be honest - I think most women, and their partners, often put up with treatment and behaviour they would not stand for in any other domain - as long as they go home with a healthy baby. I know I have................

[hub2dee]

golden: I don't think you're being a cynic - just a realist, and I'm not in disagreement with you, but part of your argument is slightly circular:

You say the main factor in having a good experience is "having a quick, safe and uncomplicated birth."... surely that's the definition of a good experience ?

We're in 100% agreement about desiring a quick, safe, uncomlicated birth though.

But the question is what best practice - on behalf of the mother-to-be, her partner, any birthing coaches, the staff who will care for her etc. GETS US TO THAT PLACE ?

(stuff that's within out control... there will be individual differences in physiological size / strength / stamina / previous history etc.)

I agree and understand your comments regarding cascades of intervention, but the question remains, what, if anything can individuals / staff do to prevent that (except when it is medically indicated - ie. not just when it's convenient to process a mother through particularly swiftly)...

Your last comment is perhaps most interesting, where you state "most women, and their partners, often put up with treatment and behaviour they would not stand for in any other domain" - so perhaps one key is being particularly verbal / stubborn / opinionated / paranoid about the level of care or expertise you are exposed to...

Hmmm...

(I'm out most of the day, so will reply to anything much later)

[CarolinaMoon]

hub2dee, if i can butt in with my experience (at the homerton last year) - dp and i had been to NCT classes, read various books inc sheila kitzinger, janet balaskas (Active Birth) etc, brought our birth ball with us... and i still ended up having an emergency c-section for failure to progress/arrest of descent (after 17 hrs active labour). there's no way you can predict what will happen.

i agree completely with goldenoldie - if you have complications and still feel you've had a good experience, then you are v lucky indeed and can count yourself as having had excellent care (not that the two are mutually exclusive).

having said that, although we had v indifferent care from the MWs - largely because they were insanely busy and we were put in a room off the postnatal ward because the labour ward was overflowing - the actual c-section was made much easier by the lovely theatre staff.

you will definitely get better treatment if the labour ward isn't too busy - but of course, that's not within your control either.

i think all a birth partner can do is offer emotional support, understand if she wants to be alone (i felt v guilty for hiding in the en-suite for hours while poor dp was out in the delivery room wondering what was going on, but i just needed to be by myself, can't really explain why...), keep track of what's happening and ask lots of Qs, because being in labour is a bit like being really pissed - i couldn't follow half the stuff that was going on around me.

[goldenoldie]

Hub2dee - sorry did not explain myself properly, you might think I am a cynic now........... what I was trying to say is that 98% of having a good experience is outside of the control of the mother and/or birthing partner.

Agree with you CarolinaMoon, being on a quiet, rather than busy ward helps - but, as you say, this is outside of our control.

At the end of the day it really is all down to whether you have a good/caring/experienced team of midwives/doctors - again, outside of our control.

What tends to happen is that you get a mix - some really great members of staff who do everything they can to make the experience as good/safe/memorable/happy as they can. Some people are lucky - and all the staff that care for them are like this. But you also get those midwives/doctors who are simply rude/overbearing/unpleasant/uninterested/incompetent - bullies in uniforms, and so on. Some people are unlucky, and many or most of the staff they encounter are like this.

Almost impossible to be vocal about poor treatment when you are in labour due to tiredness/drugs/focus on getting the baby out and so on. Almost impossible for the partner to be vocal about this too - unless they are very experienced - a doula or midwife or doctor themselves, they don't know what to expect anyhow, and staff tend to ignore them anyway, or try and blind them with science/jargon/technology.

So I suppose I'm saying that I feel it is really down to luck, or the woman or her partner being a midwife/doctor/doula.

Agree with Carolinamoon, unless partner is a midwife/doctor/doula - all they can really do is offer to hold hands, rub backs, and be undertanding..............

If maternity wards were run on the basis of satisfaction ratings more than half would be closed overnight!

[franch]

goldenoldie I strongly agree with what you say about the influence of the attitude of staff on a good birth. And I also feel strongly that some hospitals have an overall ethos/philosophy (often due to a strong character at the top who has 'radical', i.e. woman-centred, beliefs - or not), which leads to the bulk of the staff leaning one way or another. There are good and bad stories about all hospitals but my own unscientific/anecdotal 'findings' are that the ratio of good to bad stories is a good bit worse at the Royal Free than elsewhere.

Under my own circumstances, being well-informed and assertive AND having a doctor as a birth partner AND a straightforward, healthy pregnancy (and a labour which could and should have been the same), were not enough to prevent the 'bullies in uniforms' from ruining the birth experience and early days of motherhood.

I discussed this at some length with one of the wonderful birth centre midwives at the Royal Free (I repeat, my criticism is only about the medical/labour ward side), and she said a lot about her feelings that the 'tradition' of bullying women in labour has gone hand-in-hand with the medicalisation of labour for decades now, and that it only persists because the patients in question are, by definition, all female - and, of course, in the most vulnerable state of their lives. She's one of the many people trying to reverse this situation by a return to woman-centred, midwife-led care - but as I said before, she's swimming against the tide, especially in a hospital like that. A huge no. of midwives simply quit (hence the current shortage) or go independent because of the opposition they face.

However! This is a thread asking for opinions about the EGA. Hub2dee, I've got your email and will reply asap. Maybe we should start a separate thread if we want to take this much further.

[hub2dee]

Back briefly from day out... the sun !!!! Oh, twas loverly.

Anyway, thank you all for the feedback. Some very interesting comments / observations. I will start a new thread tonight (am out again now) and link to it in a later post...

The comment that 98% of the birth experience is out of your hands is at once reassuring and at the same time v. worrying, IYSWIM...

Hmmm... will write later and thanks for the posts on this.

(If someone else wants to start the thread, please put a link here. Thanks)...