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.
I think a lot of it's because women feel they have no ownership of the experience and in the current system, how can they? I paid for private ante-natal checkups (not because I didn't trust the NHS ones but because the time off work required would otherwise have been unmanageable -- the NHS makes no concession to the fact that many women don't work near their home postcodes). I paid for a private scan because the NHS could not offer me one until 18 weeks, again two hours' drive from my work. There's an NHS hospital a few miles from my work but I wasn't allowed to go there! I paid for a home birth with an independent midwife because every single week there are stories of local women giving birth in the carpark or by the side of the road because they've not been 'allowed' to come in till it's really late. I ended up going in as an emergency admission and staff and care were good, but I had my independent MW there fighting my corner and reassuring DH (also at least I would have had an experienced person with me in the carpark scenario -- my nightmare was being left alone or spending ages at home in pain worrying about traffic to the hospital).
Yes I was lucky to be able to throw money at the problem (we are not rich btw and far less so now thanks to paying for all this plus IVF twice).
I would prefer to be able to trust the health service but I used to work for them and I don't (nor would I trust any other large bureaucracy to treat individuals in a caring and organised way).
Posted too soon -if hospital care was up to standard I wouldn't need a doula!
I recently had DC2 by ELCS (DC1 was EMCS). I would love to have tried for VBAC but I had absolutely no confidence that I would get the 1-1 care I wanted to be comfortable with this choice because of poor staffing levels and lack of space in my hospital (we are in London). In the end I felt the safest option was to have a planned c section... Isn't it a sad day when I felt I had to undergo major abdominal surgery because that way I was guaranteed staff to care for me throughout my delivery. And yes I'm aware of the resources this may have taken from real emergencies but in the end all I cared about was the safe delivery of my baby. And like a PP there is no way we will have a DC3 unless we have a large lottery win and can pay for private care. The post natal care was diabolical, as in the staff were great but clearly overworked and simply not enough of them to provide adequate care! We waited 9 hours to be discharged as that's how long it took the midwife to get the paperwork done - NOT her fault at all, she was looking after loads of other women and just didn't have time!!
Shortage of staff. I am a regular nurse but have several labour ward midwife friends in busy London teaching hospitals. They are delivering twice as many babies per annun than the units were designed for and often caring for more than one woman in labour at a time. Very often they work 13 plus hours in a shift and may, if they are really lucky get a 15 minute break during which they gobble a sandwich go to the loo and get back to work.
Me and DH are currently saving to pay for next birth to be done privately. I nearly died giving birth to ds. They thought he was breach but had no portable scanner to confirm. I was then left to give birth vaginally to a breach baby on my own apart from dh, midwife came in to cut cord, tell me I didn't need stitches and pointed me to a shower I could walk to down the corridor. I have since had surgery privately for the massive prolapse I suffered due to lack of stitches.
I also received the 'sorry you remember your experience this way' bullshit.
I always got the impression that women in labour are treated quite patronisingly. You're often made to feel like you're making a big fuss about nothing or being a bit of a wuss. The single biggest issue I believe is the staffing, and the fact that the one-to-one care recommended just does not seem to happen because of a shortage of midwives. I was lucky and had midwife and a 3rd year midwifery student. The student did not leave my side at any point and could not have been better. Compare that to my SIL who like me gave birth at "Queens College" and still gets tearful when she talks about my DN's birth, largely because she was left alone, in pain and scared for large chunks of her labour - as in the OP's blog, this was mainly on the ante-natal ward after being induced.
The main problem I had was trying to communicate the special instructions from my consultant written in my notes to the midwives on the labour ward when trying to persuade them to let me come in. The staff on the ward had no access to my notes to see my medical history and didn't even ask how long/far apart my contractions were, when all I knew was that my consultant wanted me to be regularly monitored but the
random woman at the end of the phone wouldn't let me come in.
Post-natal wards are a whole separate issue, I have met no-one who had a positive experience there.
All these stories make me so sad. I am a midwife, I work in a relatively small hospital which has "performed" excellent in recent reports. (Not sure how we we do next time though)! I have been a midwife for 11 years and even in this time I have seen the standards drop. From our point of view (which is no excuse) is the services are ridiculously over stretched. For example,, we work in a intergrated system so I could work all day in the community then as I would be on call have to work all night at a home birth or called into the unit as they are under staffed, then we are still expected to try and work a part of the shift the next day. The knock-on effect is awful as the next day we would be short again.
I have always given this job my everything but it seems to never be enough. Doing these kind of hours with the pressure of the job has broken a lot of midwives. We have a huge percent of sickness due to "burn out" or job inflicted mental health problems. Which in turn effects the rest of us as short staffed again! These things do effect the Effectiveness of care given and until the big wigs and government understand this unfortunately I don't see it changing. So sad as the people I work with are fantastic - just they can't be fantastic with no sleep for two days or minimal food. Sounds really dramatic but it is, the services are literally at breaking point because of the cycle that it is stuck in. I want to stay to see it change...to get back what I originally set out to do but with another 30 years ahead of me it is no wonder people leave.
Bigbuts ..yes, can see that it must be very hard to work under such conditions. Are the people who man reception / the phone lines also in such shortage as I agree with other posters that often its not even the mws that are the issue but the person who 'allows' you to come in or not on the phone. My 2nd birth ended up a bba purely because it started progressing really fast, I had some bleeding (but not haemorrhaging!) & started feeling the urge to push. I was down for mw led care and had a v trouble free pg. woman on the phone at our local MLU (5 mins away) refused to let us come in as they were too busy to check my bleeding. DH explained I was literally ready to push. They still wouldn't let me come. The nearest consultant led unit is nearly an hour away - I knew if I got in a car baby would be born en route. So as a result he was born in our living room with DH & the lovely paramedics only. I still think its ridiculous the MLU would rather risk a mother & baby's health like that rather than letting them come in. & at every check up since I've been chided for being 'reckless' enough to have an unassisted home birth. Erm - whose fault was that?
I had two births with fantastic staff. One with terrible, unprofessional, frankly horrible
bitches. Poor staff is down to a lot of it.
Boymeetsworld... That is so awful! We have a reception but they put woman through to a midwife to speak to. There are bigger units near to us who have closed as no staff to look after woman so they have to go to the next unit. The government have trained loads of midwives but then won't let the hospitals employ them as have restricted the budgets so much. The whole thing is ridiculous, and has awful consequences
And my daughter in law has one of the laziest, most patronising, community midwives. I'm shocked she's still in a job. If you're in Dewsbury you'll know who I mean.
I am sorry for everybody who had a bad birth experience because of the care they received.
I think maternity care needs more trained staff, more autonomy for experienced midwives to be less hobbled by guidelines/policies - policies are not worth the paper they a written on if they are not followed up with training/resources/staff/time.
There needs to be more time for good communication - this is always the first thing that goes when staff are overstretched and are expected to be doing 25 things at the same time, 24 of which are bits of compulsory paperwork .
FWIW, I had 4 v different birth experiences in 2 hospitals in the UK in the last 10 years and realise increasinly how lucky I was to remember them all fondly. I did have NO expectations about how things were going to go, but did always feel listened to and had things explained to me.
Onesleep, complain (or get your DiL to complain) about this MW. She'll never change unless issues like this are flagged up. Also your DiL can ask to see another MW if she wishes.
She's complained, shes not the type to take that. She's also asked then told her to speak to her and deal with her properly. I don't think she's the first, either, but a lot of the attitude is quite subtle, some people will just take it, and the complaints probably don't get the way she actually is across.
That's horrible, Onesleep. Address concerns to Supervisor of Midwifery?
I had a similar experience to you Mrs Tiggywinkle - hemorrage and baby very, very poorly after birth (unfortunately with long term consequences too ).
What I found most distressing was not the medical care for both my baby and I which I feel saved both our lives, but the horrible lack of empathy from the doctors whilst she was in intensive care. As parents, we were treated like an inconvenience and we were either told nothing about her condition or too much medical jargon that we couldn't understand.
We were too stressed afterwards to make a complaint but I will never have another baby and talking about birth with others is a no go for me. I feel really sad that for many people, they do not have a good birth experience.
I've had an awful hospital birth and a good hospital birth, a good homebirth and a very awful homebirth. It all came down to the people and how their views affected how they treated me and the situations as they came up.
One of the biggest reliefs of deciding we're done with having more kids physically is that I'll never have to deal with our local antenatal care or postnatal care again. I think that says a lot about major problems in the systems. It often felt like I was no longer an individual with concerns/feelings worth considering.
In my last pregnancy, the antenatal midwife, who knew I'd been abused in a medical setting and found hospital very stressful and had previously supported me, decided to try convince me about a hospital birth because 'how nice the new environments are, you should see how lovely they are in the hospital video'. My previously valid concerns turned into 'they knew best/any other medical professional would do that' and went on about the new paint job - seriously. She eventually started talking about all the dangers my kids 'would be more aware of if something happened' - right in front of said children (my oldest spent the last month of my last pregnancy afraid I was going to bleed to death at any moment because I wasn't in hospital at that moment because of that midwife) in a manner that felt like she wanted my son, who was 7, to convince me when all I'd asked for was more information and some time to decide. Neither the hospital videos or the pamphlets she gave answered any of my questions and midwife was no help at all - no stats or options, just scare stories and talking about how lovely the new redecoration made the hospital feel. I still get angry at how stressful she made the end of my pregnancy, even though the hospital staff treated me mostly well (though the hugging me while trying to get me to change my mind in front of a dozen students felt quite insincere).
agree with whoever said they have no ideal of the scale of the problems due to so few of us having the energy or will or time to complain.
i was too busy trying to undo the damage that had been done to breastfeeding by their incompetence and attending appointments to establish that yes i did need a secondary repair due to incompetence and coping with the further disruptions that caused to breastfeeding and the whole new levels of pain to deal with that complaining was just not even on the table even for a usually assertive and articulate person like me who isn't intimidated by authority figures.
i won't bore everyone but the incompetence i encountered and that was actually totally evidenced because they were so incompetent they even recorded the stupidity without realising it was unbelievable. yet funnily enough i was too busy to sue.
i am assured that if i had sued i would have been compensated and heads would have rolled. too late for that now though - my son is 6 and healthy despite their best efforts.
It saddens me that there are so many midwives out there who are amazing, and then there are those who let the women down, the whole profession down and thus tar the whole lot with their bad practice.
I have a lot of midwife friends, they've had to train for a long time and gone through life changing processes to get to where they are and they don't take that for granted. Midwives are now trained to care holistically, you can actively see the difference from a midwife who embraces this holistic care and one who just thinks of it as 'baby out, mother done, go home'.
I hear stories almost everyday from fellow nurses and midwives who want to leave the profession because they are unable to do their jobs properly, and feel they are letting their clients/patients down. Whether this be staffing issues, reams of paperwork to be filled in, lack of support from management, and being overworked and burning out.
We need to get back to the very basics, which of course is to provide care.
We need more staff, more support, and we need to be able to identify those who shouldn't be in the profession and make them answer for their mistakes, that have led or facilitated to someones bad experience.
I did try to talk about the birth with a community MW that visited when DD2 was a couple of days old. I was told "you've got a healthy baby, what have you got to complain about?" and regarding my birth plan: "you women, always setting yourselves up for disappointment".
So glad DH has been for the snip and I never have to go through all that again.
I have had two hospital births with postnatal hospital stays. Both times, the individual midwives were brilliant, reassuring, competent professional etc. But I think the systems in place don't work all that well. The midwives are run off their feet and protocols and procedures aren't transparent so you have no idea why something is happening unless you can ask the right questions.
The worst bit was the postnatal stay as a low-risk patient. You're basically ignored because the staff are too busy dealing with high risk patients (absolutely not blaming the staff here - of course if staffing levels are low they should focus on those who need it most).
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.
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.
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.
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...
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!!
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.
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
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.
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!
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?
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...
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
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.
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 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?
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.
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.
No, I agree, I don't think that there is a 'One size fits all' solution.
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
also wtaf is it with giving a woman in agony who has been labouring for hours and required surgery 2 paracetamol for pain relief???
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.
No, of course communication is not the be all and end all when staff, ^qualified and experienced staff*, is lacking.
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.
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 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.
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