Why are so many women having bad birth experiences?
Satisfaction with maternity care is falling, according to a report by the Care Quality Commission, with 25 per cent of women feeling they had been 'abandoned' during labour - up from 22 per cent in 2010. The survey also saw reports of unclean hospitals and even cases of mothers feeling "bullied" into breastfeeding.
In this guest blog, an MNer who blogs at Mrs Tiggywinkles Diaries details her own frightening and traumatic experience – and considers why women don't always seem to be getting the care they need.
Read her post, and share your own experiences and thoughts about the survey on the thread below.
Mrs Tiggywinkle's Diary
Fri 20-Dec-13 15:00:01
This week saw the publication of a report from the Care Quality Commision (CQC) which documents the ‘truly shocking’ birth experiences of many women.
One in four women was left alone during their labour or birth at a point when they were anxious or worried, according to the survey of women's experiences of NHS maternity care in England. "Feedback in the comments shows at times a truly shocking picture of experiences that should be the most joyous time in a woman's life, not the most frightening."
In a grim coincidence, I received a letter last week from the Chief Executive of the hospital in which I recently gave birth, responding to a formal complaint I made about my own treatment in the maternity department there.
At eight months pregnant, I suddenly began to haemorrhage badly, and was ambulanced to hospital. Everything happened so quickly that there was no time for my husband or mother, or even a friend, to get there. I was alone, frightened for my life and that of my unborn child, and desperate for reassurance from the midwife - but she was "too busy" to help me understand what was going on, and cross because my admission had "interrupted her lunch".
Immediately after my son was born by emergency C-section, limp and struggling to breathe, he was rushed to intensive care. My husband had arrived just in time for the birth; afterwards, though, we were left alone.
‘My son's birth was traumatic - that's nobody's fault. But the way I was treated, at a moment when I was terribly afraid and desperate for reassurance, made things infinitely worse.’
Somewhere in this vast, vast hospital was my tiny, helpless son, who desperately needed his mother - just as desperately as I needed him. Every instinct was telling me to get to my baby, but when the midwife returned I was told that I couldn’t visit him, until my "legs are back working". They wouldn’t take me.
On the postnatal ward, the nightmare continued. I vomited repeatedly in reaction to an antibiotic I was given, causing enormous pain to my still-fresh abdominal wound, but was refused adequate pain relief. I couldn’t get off the bed because I was in so much pain, but was shouted at for not leaving hospital quickly enough. I was desperate to stay with my son, who was still too sick to leave intensive care, and had I been discharged I wouldn’t have been able to manage to get back to the hospital to feed him. I was told this "wasn’t their concern".
With the utmost reluctance, they allowed me to stay one more night - "but after this, no matter what pain you're in, you're leaving". The following morning, the midwife answered the phone in my earshot and pointedly said, "We don’t have any beds right now, because we have some really selfish people here who are refusing to leave".
According to the letter I received from their Chief Executive last week, the midwives "were very upset to hear that this is your recollection of the communication". The letter is littered with phrases such as "We are sorry for your interpretation of events". The chief exec "would like to take this opportunity to thank you for your comments" - but clearly plans to do jack shit about them.
My son’s birth was traumatic - that’s nobody’s fault. But the way I was treated, at a moment when I was terribly afraid and desperate for reassurance, made things infinitely worse; it turned a difficult start to his life into a horrific one. I’m angry that I went through that, and I’m angry that I’ve now been disbelieved. I remember every detail with absolute clarity - though I wish that wasn’t the case.
Why are so many women having such dreadful birth experiences? Four in 10 of the 23,000 women polled by the CQC were unhappy with the quality of care they received. While standards of care in other branches of medicine seem generally to be improving, maternity care appears to be going backwards: the number of women who report being left alone and worried has actually increased since the watchdog last investigated the issue in 2010. Women’s concerns about the treatment they receive during birth are routinely pushed to one side: one in five women felt their worries during labour and birth were not taken seriously.
Birth can and should be a joyous experience - but for too many women, it simply isn’t. Sorry to point out the bleeding obvious, but birth is a uniquely female experience: men can't do it. If they could, though, I suspect the quality of maternity care in this country would improve pretty damn quickly.
By Mrs Tiggywinkle
The quality of maternity care in this country would improve quite dramatically if MWs were fit for purpose.
I had my DCs in the 1980s. Only one acquaintance had a good birth, everyone I knew was quite shocked or disappointed including me.
We don't live in tribes where you see childbirth on a regular basis. It is a painful and scary experience, we are used to our health issues being fixed by the doctor, but this doesn't happen in childbirth, unless you have an epidural, but those weren't available much then.
Giving birth is not fun. Hence new mothers complain.
I think part of the problem is that the NHS has no idea of the problem IYKWIM. You're so bloody relieved that a) it's all over and b) the baby's alive and well (hopefully) that you just want to get the hell out of there.
When I was in Marketing we had a rule of thumb that only 5% of people with a bad experience actually complained; I bet with maternity care it's significantly lower than that. So hospital managers will be breezing along thinking they have satisfaction ratings in the high nineties.
I wrote this post about my own experience having twins in a well known London hospital, which is supposed to TEACH maternity care. It was utterly abysmal. Both the care during labour and then afterwards in recovery. At the end I've set out recommendations for the NHS and for parents to be.
What's really sad is the amount of comments I got with scarily similar stories...PLEASE spend money on improving maternity care, rather than bribing people to BF with Matalan vouchers. If that scheme were rolled out across the UK the equivalent cost would provide the 5000 midwives the Royal College says we're short, and would help go some way towards making bad experiences the exception rather than the apparent rule.
We used the birth afterthoughts service and got similar "sorry that you perceived your care in that way" comments. The care I received was chaotic and I was lucky to avoid more serious complications. I obtained my notes, but the records were scant and there was a sense of "it wasn't recorded, so it didn't happen". Surely high quality care would not leave room for these "misinterpretations". And it is frankly insulting it refuse to believe two adults (mother and father) in this way.
There are units where birth experiences are generally excellent. I gave birth in one but it has been threatened with closure
I think the culture of truly caring has been eroded in many units. When I called a London teaching hospital at night during my last pregnancy having fallen right down the stairs the mw I spoke to was rude and callous. I made my mind up there and then not to give birth there.
Oh and I should have said the the unit where I had my amazing birth aims for constant one to one care in labour and as a result has a very low epidural rate even though there is 24hr epidural availability, as they are simply not requested. Their emcs and instrumental delivery rates are also low.
This is exactly why I went private for my antenatal care and to give birth. I realise I am very lucky and that option simply isn't available to most women but I still find it galling that I had to spend £11K to be assured of decent midwifery care (aside from the private hospital niceties) that should be available free.
I have no confidence in NHS midwifery, I'm sure there are many great nhs midwives, but I haven't met any.
We need more midwives, trained to show compassion and who put their own agendas aside when caring for patients.
If we have any more, I will be going private too. Though I found the MW good, they were over stretched and never seemed to know my history. Continuity of care was pretty much absent. The junior doctors were abysmal and I'd prefer to see a consultant with adequate time available. I found postnatal care particularly poor. I think that is because the risks to you and your baby diminish significantly post birt, so it is a low priority.
I gave birth to my first baby in hospital 10yrs ago. I remember being left alone on a maternity ward for a long time, with some paracetamol and occasional checks. No one was with me, so didn't realise my labour was actually progressing very quickly. When I was eventually taken to the labour suite I was ready to push within 10 minutes of arriving there. It was all a bit of a shock, but I felt that the birth had been good as it was quick, relatively easy and I had a healthy baby - it is only afterwards that I realised I didn't receive much care during my labour at all.
My next two births were at home and completely different experiences. The midwives were wonderful - they were with me the whole time, checking me regularly, talking to us and massaging my back . I felt very well looked after and I look back on these births very positively.
I had a good hospital birth and opted to have my second at home. The MWs were dreadful. Amongst other things, I was given a sweep without my permission- only I wasn't, because it wasn't on the notes and therefore didn't happen
I wonder whether part of the issue could be the midwives do not always fully realise how afraid women can be during labour. Even when things are going well from the midwife's perspective, and so she thinks she can leave the woman alone, actually the woman may be afraid because she is going through a new and frightening experience.
I have had 3 children and generally found the staff on the delivery ward were much more supportive than the staff on the postnatal ward. However, when I became really ill after one of my births, the staff were absolutely fantastic - but I was very ill by that point.
The midwifery care at an individual staff member at our local hospital was high, they cared deeply individually. At a group or higher level it was ropey at best. At times it's been proved fucking dangerous up to and including life threatening and conclusive.
There seems no money. There's a reliance on agency staff. There's a belief that every birth is the same. There's a palpable sense of disbelief surprise and shock when it's proved that births are very individual.
It's trite, but if men gave birth there really wouldn't be this situation. There's a complacency about maternity care that makes my blood run cold.
Queens Essex. Google it. It made on various occasions National news. The worst bit ? The bit that makes me puke? This mat service IS run by a woman. And it's still shit.
Minnie, I think men's health issues are often unfunded/underfunded too - DH has had prostrate problems and wasn't well treated.
The birth rate is rising - I believe it's higher now than it's been since the late 60s. At that time, far more births were at home, and when GPs were skilled and experienced in obstetric care. (I must say that my mother has terrible stories about midwives from the 60s too). Births are dropping in the North, but rising in the South, especially London, but where can the midwives afford to live? When staff are being asked to do impossible things, they behave in impossible ways.
I think also that passive-aggressiveness (as in the phone call you describe, talking about you as selfish in front of you) has become a national trait. People are not taught to put others first. That is what religion is for - by getting rid of the dogmas, we've also got rid of the social education in reflecting on your own behaviour (confession, prayer) and trying always to put others first. It is very hard, though, to work out how to put others first when you are looking after too many of the others.
It's shit in this bit of Canada where I live. This city has no midwives. It's population is 130k and rising. There are 3 obgyn's. If you have an uncomplicated pregnancy you will not even meet them until 36 weeks and it's not unusual to be waiting five hours to do so.
If you go into labour before 36 weeks you are automatically flown to the next big city. Your DP/DH then has a five hour drive to meet you.
The CS rate is 1 in 13. If you have an uncomplicated delivery you can be out in 4-6 hours. It's a 2 or 3 night stay for a CS.
I can't complain about my birth experience but sadly I think the reason for this is I opted for a home birth. The midwives cared, and stayed with me and only me through the whole labour. I was even lucky that my community mw is the one who was on call that night, and she did our postnatal care as well. What's sad is that if I had had more complications in pregnancy or childbirth, I would have needed more reassurance and attention, and probably would have received less.
I was the birth partner for my cousin for the delivery of both of her daughters, both were dreadful experiences from a neglect and sheer callous treatment perspective. her second daughter was in distress with monitors going off, a ventouse didn't get her out so an episiotomy and forceps were used. she was blue, not breathing and limp but nothing was said to my completely hysterical cousin. she was told to shut up when she began to scream thinking her daughter was dead....
when it was my turn I had a home birth with a private midwife and bypassed the NHS system, though the antenatal classes and the tour of the maternity unit reinforced my decision.
dd was huge (10lbs) though and it was very hard work getting her out (!)and I retained the placenta and started to haemmorage. I needed to be transferred to hospital but my local unit was full, I had to wait for an hour for an ambulance to take me to the next nearest unit.. I then waited a further hour once there and was unconscious and so lacking in blood they couldn't find a vein for the iv. the registrar made me, my dh and mw feel that I was a major inconvenience, that any trouble I was in was entirely my fault. I was treated brutally, frankly, and sustained a tear from the extraction.
once on the ward, with a spinal block I was left with my dd feeding, which was good as we had been apart for several hours, but I was still affected by a spinal block so couldn't get out of bed (with an iv, a catheter I guess it wasn't really possible anyway) my glasses had been broken so I couldn't see the buzzer and the line in my hand meant that I couldn't reach for water not that I could see it. nobody came to check on me for 6 hours. I got loudly told off for risking my daughter by not putting her in the cot at the bottom of the bed...
when the paedriatrician came to give her the check over she was left naked and crying in the cot at the end of the bed and I was told off for that too.. I still had a catheter and an iv.....
it was a beautiful experience giving birth at home, genuinely lovely and relaxed and needed no pain relief bar a tens machine at the start and a birthing pool. as soon as I got into the public health system it was horrible.
my notes are almost non existent so I was unable to raise a case about my care.
Of my anti natal class ladies we are a 50/50 split on good/poor experiences, we all feel that our problems are because of the perception that birth can be time tabled and all should follow a similar pattern, deviating from this causes trouble and there just aren't enough staff to deal with the numbers of mothers birthing. there is no time for proper care, there is a culture of writing a 'safe' report and an expectation that we can all be up and running within 4 hours and heading home.
my independent mw left the nhs because she was not allowed to give the level of care that she once had done, that there wasn't enough time to devote to patients to make sure that they were secure and relaxed.
sorry, that was very long!
#1 was born in London (St Thomas') to AMAZING midwives. It was a 42hr labour with every intervention known to man (other than a c-section) and they were brilliant.
However - I had never met them before and they knew nothing about me and my personal preferences. Although they did take the time to read my birth plan, they were still basically strangers. In fact, even during my antenatal care, I never saw the same midwife twice.
The postnatal midwives were ok.
#2 was born in America where I was cared for by a fantastic OB practice. I knew the doctor who delivered my baby (a very straightforward natural birth), and she knew my wishes / worries / concerns.
From a medical perspective there was no difference between the care I received. But, given the choice, I'd choose the USA due to the continuity of care, and I think this is what is missing from the UK: with this, medical problems could be better dealt with and women would feel a lot more confident approaching birth.
Could not agree more with radiator. I think if the midwife women saw throughout their antenatal care was the same as the one who delivered their baby they would feel much more confident & less scared. If this wasn't possible (1 midwife can't be everywhere at once!) at least having the same person throughout the birth. I also think mws need serious training in people skills to go with the medical expertise that most undoubtedly have - ways to deal with scared women and things it simply isn't appropriate to say. At the end of the day yes we are lucky to have the nhs but it is still a service we are paying for through our taxes so the customer is always right attitude should still prevail.
Myself, I've had mixed experiences. First birth involved an unsupervised junior doctor doing my stitches without the slightest amount of local anaesthetic whilst DS left on my chest as I screamed. Second birth was at home & all fine but the mw did repeatedly grumble that I was making her miss her tv show. None of my notes were filled out properly & we literally had to fight the birth centre the next week to be given the Vit k injection he wasn't given at birth. On the flipside. The paramedics who attended until mw arrived were absolutely amazing.
I had a very simple labour with my second (recently),and the midwife in delivery suite helped make it what I wanted it to be. We we're. Ever left alone.
My ante and postnatal care, including a week's stay in hospital we're less than ideal.
The details aren't relevant, but I think midwives forget that you're going through a special (and scary and painful) experience. This is your only current pregnancy. You've given none months of your life to grow a baby, and are willing to go through unknown pain to get it out.
Delivering and discharging babies is their day job. I think the blasé approach to what could be the best experience of a woman's life, and should at least be one she feels involved it, is the key issue.
It's a cliche, but I'm not sure many women receive much actual care.
Aside from under-funding etc., I wonder if, in part, it's because of the word "care". I'm imagining to a medical professional that means them doing/administering something. Many women don't need anything tangible (so easily measured), they need support. Support can be in ways that look to the bystander that the person is just chatting, giving "massage" (and who has time for massage these days, it's a luxury, the NHS isn't a spa... Not what I believe, but I can imagine a hospital manager looking for "efficiencies" thinking about that), etc. running a bath, just being there.
I also think that care for men's prostate problems should not be compared to birth. To cervical cancer, perhaps yes, but not birth: it is unique.
Perhaps nothing will really change until the NHS deals with it as something entirely unique and one where, with proper "support", fewer women would need "care".
And this is why I absolutely refused to give birth in hospital - But I was lucky - I was low risk. What about the mothers who have to be in hospital? And what about the mother's who feel that they want the reassurance of hospital? The stories I hear are utterly disgusting. But how can people who have received bad service fight back when notes are often sketchy at best and downright lies at worst?
Happy, I would love a homebirth next time, but I am going to be high risk as I had a pph last time. I'm going it have a doula who is an ex independent mw but no longer practising midwifery.
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