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
I had a great NHS experience with my first baby in 2011, needing an emergency c-section. With baby 2 in 2013, I was confident I would get the same care. Not so. I had a c-section. I developed an infection and quickly became unwell. Midwives told me I was a drama queen. I couldnt breastfeed because I was so unwell, so when I asked for formula two midwives refused. I continued trying to breastfeed, baby lost so much weight that we had to stay in hospital a few more days. My husband snuck in formula so I could get out asap. Baby put on weight, we went home. But I continued to be very unwell. I was having contractions despite having had the baby and was having hot and cold flushes. I lost complete control when it came to having a bowel movement. Health nurses sent me back to hospital. I was sent home. I went to my GP, who called the hospital and I was readmitted and stayed in with baby for two weeks. I was still ignored by the midwives, despite being in pain - waiting up to an hour and a half for pain relief and formula for the baby. I was taking up a bed. Because I was a second time mum, I was told I should have had breastfeeding under control when I asked for help. Following more tests they found membrane had been left in my womb, but couldnt create a connection between the c-section, the infection and loss of control re: bowel movements. . It was a struggle to convince them I was unwell. I have improved but still have a few niggly problems nearly one year on and am convinced it was the result of being roughly man handled during the c-section. The emergency c-section I had had in 2011 was gentler more controlled if you can believe it! I genuinely believe it is the lack of funding and pressure on midwives that make them lose their ability to care. We all become numbers and spaces in bed, rather than women with our own recovery process and needs.
It was really hard for me to share my story. But I felt I needed to after I wrote a factual, non emotional complaint to the Chief Exec of the hospital, and received a whitewash of a reply, where the midwives had simply lied. As well as the things I already mentioned, when my baby was first taken to intensive care the midwife wouldn't give me information, when eventually I apologised for repeatedly asking her how he was (!), she replied 'Don't worry, you've just given birth, you are clearly hormonal' She denies saying this, despite my husband being there and the letter states "We were very upset to hear that was your recollection of the communication'. I wrote 8 pages, of basically a diary of things that happened and were said to me. Despite my mother and / or my husband being present for most of it, they deny them all. The only thing they agree was 'not sensitive' was when they left an empty cot in my room, whilst my son was in intensive care…
Thank you to everyone for sharing your stories too XXX
i don't know how the hospital inspection process works but i'm thinking it should be an access all areas at any time random spot check process which initially would need to be very frequent and have everyone from hospital managers to hcps on their toes and feeling accountable.
incidentally in over four days on the post natal ward my sheets weren't changed once and i never saw the floors properly cleaned despite heavy footfall of visitors coming in and out.
No, of course communication is not the be all and end all when staff, ^qualified and experienced staff*, is lacking.
incidentally i do have a fully functional vagina now i would however never, never, never have a vaginal birth in a hospital again. i was sent to theatre for repair because the obstetrician had butchered me with horrible over attempting at ventouse delivering before moving onto forceps and they flagrantly lied on my son's scores - my mother was there and saw oxygen administered which was left off the notes.
if you didn't get a baby at the end of it that you were busy loving and trying to feed and cope and ra ra ra you'd never let them get away with such things.
pregnant women and the elderly seem to come off worst in the culture of negligence.
also wtaf is it with giving a woman in agony who has been labouring for hours and required surgery 2 paracetamol for pain relief???
i don't think it's a communication problem.
being abandoned on a labour ward after a repair done in theatre under a full spinal block with a catheta in place and zero way to feed your baby given said full spinal block for hours and hours is not a communcation problem. it's neglect and outright dangerous. saying really you need to be in HDU but there's no spaces so we'll just leave you here and ignore you for 6hrs plus is not an issue of resources really. yes it's resources that mean you can't go to HDU but human choice and lack of accountability and disciplinary action that allows you to simply be abandoned in that situation.
the registrar who performed my repair (i had to come back into hospital two weeks later for a secondary repair and was extremely lucky it took and i didn't require plastic surgery) actually said out loud that there was no stitching required on the exterior because there were no cuts or tears there and all stitches were internal. when i told my health visitor she said that's ridiculous how could you perform an episiotomy without a cut to the exterior? to her utter astonishment not only had the registrar said that to me she had actually written it down in my notes! when a couple of days later on the post natal ward i didn't think i felt 'right' down there they eventually puffed and panted and called for the house doctor who appeared never to have seen a woman's genitals before as he looked terrified and when i said surely you can see it's not symmetrical and there's a weird bulge he said, 'well was it symmetrical before?'.
it was farcical. when i finally got discharged the midwife checked my wounds and also said it was fine, just a bit swollen. fortunately i went with what i knew and went to my gp who took one look and was horrified and straight on the phone to the hospital and the top gynae consultant booking me in to see him. he couldn't believe what he was looking at and didn't even make excuses - admitted he could not understand what had been done, apologised that he would have to remove the stitches there and then as they were doing more harm than good and it would be impossible for me to heal the way it had been done and booked me in for a secondary repair warning me that it was highly unlikely to work, that it was amazing i didn't have an infection (warm baths with salt and lavender oil twice a day) already etc.
i DID NOT have the energy to start legal action and i wonder if anything whatsoever happened. the midwifes on the ward, the registrar who did the surgery, the house doctor who came to the ward and the midwife who visited me at home afterwards were all incapable of seeing that it was an utterly bodged job that would have led to infection, no healing and the eventual need for plastic surgery yet presumably they're all still working.
even to my non expert by a long way mind it was clear to me that you cannot do an episiotomy without cutting from the exterior and if you ended up with no stitching to be done on the exterior you've done something wrong. it's farcical really.
sorry epic post and i said earlier i wouldn't bore with the details
No, I agree, I don't think that there is a 'One size fits all' solution.
Home births are not necessarily the answer- I had a fantastic hospital birth with DD1, despite ending up in the normal birthing room when I'd planned to use the MWLU.
It was my home birth that was bloody awful. There were no complications whatsoever and had I been left alone to give birth instead of being prodded, poked, tested and fisted every 5 seconds then it would have been fine. But I was made to feel like a slab of meat. I have so many regrets about my choices that day, I have to keep reminding myself that it was not my fault.
You are right, MWs are restricted by so many guidelines and rules that they cannot treat the mother as a human being.
Up to 30-40 years ago, home births were quite standard where I am. They are now a vanishing minority.
I went from thinking "anybody who considers a HB is insane" (a sentiment I now regret) to wishing I'd had one. Even though I am perfectly happy with all my deliveries.
The vast majority do not need an obstetrician, they need an experienced person with them, traditionally a midwife, a confident, knowledgable MW who is not hobbled by policies and guidelines and petrified that if something does go wrong she'll be hung out to dry. MW and nurses enjoy rather poor professional support by their own bodies.
Independent MWs have almost ceased to exist because they cannot affort the insurance they need. I think that is a loss.
I was under the impression that it was the disenfranchisement of midwives and the increased medicalisation of childbirth that has led to more <ahem> patchy provision of good maternity care.
"NHS = a bit crap" is a really sad sentiment to read.
Much as all our individual experiences are important, as far as policy decisions go the bigger picture needs to be looked at.
IMO the single most important aspect of good care is good communication*: expecting/labouring women *must feel listened too and need to understand what HCP are telling them and why.
I delivered in an old, crumbling mat hospital x3 (it has closed in the meantime) and had DS4 in a shiny new hospital.
I had a highly medicalised induction with epidural and synto at T+15.
I had an emCS at 31 weeks for placenta praevia after being in hospital for 5 weeks and being transferred to 3 different hospital in the middle of night for threatened delivery because of big bleeds as 'my' hospital did not have an available intensive care cot.
I had VBAC x2.
I have had contact with the Recurring Miscarriage Team, a consultant who is a Professor in Fetal Medicine who did all my CVS/Amnio and many, many midwives. I felt really well looked after and the fact that the paint was peeling from the walls did not change that.
I don't know whether I have just been extremely lucky or whether it helped that I always felt that I knew what was going on and what was going to happen?
Back in the past, however, obstetricians were almost all male, hence the paternalistic approach and treatment of women as if they were too silly to decide on their own care. Now many obstetricians are female (about 50-50 in my admittedly subjective experience) and the culture of care has changed.
In my, again subjective, experience the obstetricians I encountered were much more respectful towards me than the midwives, who had a very dismissive patronizing attitude.
I don't think that there would be enough obstetricians to take responsibility for all births - it just wouldn't work. In the heyday of doctor led care there was even less personalisation and I think there was a patriarchal culture within maternity wards. I really don't think at a return to that type of care would be acceptable to the majority of pregnant women.
In the far off past, though, Avery, mw were charge. Iirc men didn't get involved in delivering babies at all really before 1660.
I don't think it is the fault of individual mw - mine were amazing. IMHO it is due to the following:
Erosion of culture of care in our hospitals
Too much medicalisation of labour meaning labours are rushed - cascade of intervention
Poor resources meaning mw over stretched
And yy to previous posters saying that women are treated like children in the current system! There is so much of this attitude that we don't know our own minds or are exaggerating pain to get special treatment. So infuriating...
It's something to do with how MWs have taken over the maternity care system in the UK if you ask me. Many MWs seem unable to cope with their jobs or seem untrained in managing stressful situations and complex schedules.
The MWs I dealt with in Scotland's NHS varied from OK to downright unprofessional. The obstetricians I encountered, however, were very professional and efficient, cool as cucumbers as well when my labour got into difficulties.
The worst part of my birth experience was the bitchy midwife who dismissed my pain and made snide remarks to me while I was in agony. The best part was the obstetrician who calmed my fears, discussed my concerns, and safely delivered my son. She was fantastic - oh and so was the anesthetist who administered my epidural!
Maybe the only way to improve things is to get the obstetricians back in charge, like how it used to be? Or else change midwife training so they are better at handling patient needs and managing resources?
I had two births at the same hospital, and if I hadnt experienced both, I would have been doubtful that the other existed, one absolutely perfect and one with a bad midwife. I wonder if those who do have the good births are doubtful as to how bad the bad ones are? I have only recently given details of my first (the bad one) birth to my health trust, and only because they asked as they are investigating a lot of complaints. DS1 is 3.
Yy to the low dependancy postnatal! Worst thing in my case being that, I couldnt get officially discharged when i wanted to go, which surely makes more work for everyone!
Both of my were ok but had a couple if terrible things. One by the actual Consultant! This was at one if the top London hospitals!!
The funding fir the NHs is so lacking. I can't see that this will ever change. No matter how much people complain or petition.
Long story sorry guys but thought I would share my experiences x
I also had a bad experience first time round with my son I was induced because he wasn't moving I was left in room myself with only my dh and sister to which I told my sister I needed to push do she shouted down the corridor we need the midwife at this point she came running and said what's your problem my sister said she needs to push to which the midwife replied you have been in labour 3 and a half hours there is no way my sister then says look I've had 3 kids I know check her now this was at 21:00 I gave birth at 21:01 they treated me like a wee girl because i was only 20 but my baby was planned and I'm much older for my age anyway she then said I needed stitches but she gave me a local anaesthetic she said if it runs out tell me so I did n she went stop complaint you've just gave birth this can't be sore to which point another midwife walked in and gave me gas and air n said ok hen I said i am now n she said to the other midwife I will deal with you later then she couldn't get me to stop bleeding heavily took 6 hours then I was put on a ward the next day I wasn't feeling right but thought well I've just giving birth I stood up to go to the toilet to see blood running down the ward my dh hit nurse button the natron came and said have you changed your pad I said look it's running down the ward she checked me and I got a crash call putout12 doctors appeared in less than 30 seconds I got 12 jags the ward was emptied as it was visiting times the midwife then said get that baby out if here to my dh the baby was screaming which was breaking my heart I couldn't get to him bug "that baby" there is ways of saying things then I was took to recover where I had 10 small clots and 2 massive clots pulled out of me and was not allowed to see my son or hubby for 2 hours I then needed a blood transfusion so they would not allow my visitors in who had traveled quiet a distance to see us not even my mum and dad!! Once I was took for my blood transfusion my hubby had to go talk to visitors to explain the position and my son started to cry to which the midwife said "did you not bother feeding that baby before you came down" to which I said he had been fed but I have been waiting 2 and a half hours for her to give me my transfusion n she started complaint to midwifed then the one from the start if the birth that gave me pain relief for stitches walked passed as took her outside I heard her shouting at her and she quickly changed her attitude but turns out the midwife that delivered my baby did not give me the correct dosage if injection you get as u give birth and also not at the right time do my womb had collapsed and it was all her fault so was glad to get that over with and out of there although I did go back there to have my daughter 23 months later and was a totally different experience had one to one midwife who stayed the full time apart from breaks which the student midwife that was there the full time took over much more relaxed and I get a triple dosage of the stuff you get as you give birth and I got home the same day so any complain about hers and the care was so much better but no wonder it took me 2 years before I had another lol bug nhs is a disgrace x
I had a slightly different experience of the maternity unit of my local hospital (Leeds General Infirmary), because I was in for a managed medical termination at 16 weeks (due to abnormalities). They have a separate suite behind the main mat unit for bereavement cases, but MW are the same team.
We had 3 different MW & a student MW over the 24hr period that we were in, and they were absolutely marvellous: sympathetic; cheerful; attentive; caring; tactful. Everything me & DH needed at a really difficult time. I was pretty terrified about the whole thing, but it went more smoothly and was much less distressing than it could have been because the care was very good.
I have to say, I was surprised, as I'd just assumed NHS = a bit crap, but not the case for us, although obviously it was not a standard birth experience. Every one of the MW said they hoped to see me back again in better circumstances, and I feel confident that when I'm there for the real deal the care will be good.
I had a great experience with no1 ironically perhaps because he was a planned c section due to placenta praevia. At 30 weeks I had contractions on a Sunday, was fortunate to be told to go to the hospital and was actually met by the head of OB/gyn (on duty on a Sunday?) - the mw I rang at my local mlu actually rang through to them to tell them we were coming.
I had DS at 39 weeks v healthy, no complications other than the usual c section recovery etcetc. Transfered to the above mentioned mlu 3 days later and stayed another 2 days to help establish bf.
Dc2 - had a vbac. But not without everything being tried on me. Mw weren't interested, only the last one who managed to get baby out was the one who also understood I had a previous c section which was planned therefore I had no idea what labour is having never experienced it but now with a scar I can't labour for too long.
I had to have a blood transfusion, made to feel guilty about it as they are really too busy to get it ordered for me (they said that I should really have a transfusion in the day time but they started me 2 nights later at 11pm because someone didn't order the blood in time because they were too busy (er yes so you really should tend to me so that I can be discharged earlier!!).
Other post natal issues like not getting my DD's hearing check done (the usual check) and not being able to check the records (which were on the shelf behind her desk)... Dd ended up getting her hearing check after we were discharged from hospital because we met the head of audiology who happened to be a mum who we knew thru nursery!!! She rang me at home having bumped into dh at nursery who told her the story!!
When our postnatal group were at the pub (so DC around a year old) we all got talking about our birth experiences and realised 3 or 4 of us had horrendous memories of the same MW. She was unkind, unpleasant, bullying, physically far more forceful then necessary with newborns and women who had just given birth, and none of us had complained at the time as we were all too shell-shocked from birth and suddenly having a baby for the first time.
I wish I had complained but, a year after the event, it already felt too late. Maybe this MW just had a bad couple of months, but if 3/4 out of 8 of us were that effected by her, assuming a shift pattern which meant she was actually at the hospital less than 50% of the time, she must have traumatised hundreds (thousands?) of women in her career. Amazing how one person in the wrong job can make such a difference to so many...
oh and being high dependency but having no spaces for high dependencies therefore getting dumped on a normal ward and ignored doesn't help.
i can't imagine another situation where a HD patient would just be dumped elsewhere without extra obs etc being put in place. it is hard not to think that it is because it's a 'woman's issue' and therefore not taken seriously when you just cannot imagine it in another context.
in some ways more care was actually given post natally before due to babies being off in the nursery and mothers getting to rest.
i'm glad i had my baby with me the whole time (i was forced to stay in for over four days and it was hell) but it obviously is more strain on women than when babies were whisked off and women got to rest and women with bad wounds via tears or repairs or through CS weren't abandoned to cope with the pain and mobility issues as well as trying to care for a new born baby.
if i ever had another birth i would desperately hope to be able to have a homebirth, if forced not to i would discharge myself and go home immediately even if i had to fight them for it.
I had good care for my first birth, despite rarely seeing the same MW. Long hard labour, over 50 staff involved, all fine. Appalling postnatal care. I complained eventually, got fobbed off.
When pregnant again ended up with PTSD and physical symptoms and needing a lot of care from GPs, MW, psych team, specialists... all of which would have been less likely to be needed if postnatal care had been adequate the first time.
One MW apologised profusely, acknowledged that should not have happened to me and explained what the hospital and new management had done to improve matters, mainly moving from night staff being 90% agency temps to 90% rota staff. That being believed helped a lot - where else is it acceptable to call a client a liar when they talk about their experiences - and thankfully the second time both birth and postnatal care were faultless. And that care probably saves the NHS money downstream but hey, that's a different budget.
Labouring women are a more complex population than 30 years ago - older, less fit, more likely to have survived with disabilities etc - and it needs to be recognised that care is needed possibly more than previously.
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