Worth complaining that they didn't try to stop prem birth?

[Myablack]

I posted earlier as I had my baby at 33 weeks, thankfully everything's okay and he is doing very well, neonatal team have been amazing as was the midwife who delivered my baby, I do however (especially considering I pay extra for private healthcare) that I feel a not let down.

I went in with broken waters 07:30 on Friday. I was brought to antenatal ward and slept had no pains at all just the broken waters. Was then told by a doctor that they were going to let me go tomororw afternoon and organise regular scans and antenatal appointments until they could induce me at 36 weeks (I had no medical consultation when he told me this, he was basing it on having no pain and just broken waters) he also told me any contractions would tried to be stopped with an injection.

Ok so that night was fine and was ready to be sent home the following day. The following morning they tried to send me home but due to pain I refused to go. They kept me in giving me codeine. At 6:30 I called various midwifes in explaining how bad my pain was they put me on a machine and said that my contractions were not showing as high enough (were going up to max 40) she told me to have a bath which i did. When I got a contraction the only thing that helped was to push but the only thing coming out was fluid.

I begged for more pain relief and was giving an injection of pain relief in my bum but was not offered this contraction stopper.

They tried to check my cervix but could not see it and wouldn't do an internal. It was only till I called a midwife in crying that they did an internal and then I heard "I feel the babies hair she needs to go to delivery" I was then transferred to delivery and had the baby 20 minutes later on gas and air.

I just feel as though they didn't take me seriously enough and the contraction preventative could have stopped this whole nciu stay.

Would you complain?

[Katz]

not sure on the stopping labour but when my waters went without any contractions i was told to not bath as this is an infection risk

[Myablack]

I thought that too but she said sometimes it helped ease off the pain then directed me too the bath

[thomasstockmann]

I'm sorry about what's happened to you and your baby boy. I'm happy he's doing well now.

I don't have experience of prem birth but I did complain about some of the postnatal care (or lack of) I had. First, you probably have quite a bit of time to raise a complaint (12 months in my hospital) and therefore a bit of time to think about what is best for you.

Then I'd say it depends on what you expect from raising a complaint. Personally I debated whether I wanted to prolong my dealings with the hospital and carry on thinking about upsetting events. Eventually I put that against not complaining, which in my view meant the hospital would never know what was said/done/not done and therefore never change its ways.
In the end I complained fully aware that the best I would get for myself was an apology (which I got) but that if other patients had complained/complain in the future there would be a pattern appearing, raising the chances of a change. This latter point seemed important to me and I therefore complained.

[3littlefrogs]

Actually - your care was poor inasmuch as you should not have been allowed to have a bath with ruptured membranes, and, you should have been seen by the consultant as soon as you complained of pain.

I don't know who you mean by "they", but when I was working as a midwife i would have been getting the consultant back to you as soon as you mentioned pain.

Were you in a private hospital?

[MrsPatrickDempsey]

Really glad your little one is doing well.

It's a really tricky one. It sounds as if your labour was quite fast and the confusion may have stemmed from the fact that lots of women don't go into labour immediately after their waters go prematurely.

We're you given the steroid injection to mature baby's lungs? Delaying labour with the IV drip is usually only given if in established labour to give the injection time to work. It is never intended that the drip stops labour for days or weeks as it can have unwanted side effects.

It is not good that you weren't listened too and I think lack of care and compassion should form the basis of a complaint rather than challenging the clinical decision making perhaps.

[Theyvallgone]

Congrats on your little boy - I'm glad he's doing well :)

Did you have any steroids? Usually the only point of giving tocolytics (contraction stoppers!) is to allow steroids enough time to get into your system, after this there is no point. They can be given as a tablet you maybe had this?

Xx

[SoonToBeSix]

Yes I think you misunderstood what they meant by stopping your contractions.

[IAmAPaleontologist]

i would suggest that your first port of call is to ask for a debrief and to see your notes. They will be able to talk through your notes with you and you can discuss your feelings. Once you have done that you will have a much better idea of whether or not there is an issue with the care you were given.

[NoRoomForALittleOne]

I have to say that although your care was poor, it is unlikely that having the drugs to stop your contractions would have prevented your NICU stay. Once your waters have gone, if your start contracting then the drugs may or may not hold off contractions for long enough for steroids to be administered and given time to work. It is highly unlikely that your labour would have stopped and not re-started until they wanted to induce you. Having said that, they could and should at least have listened, taken you seriously and tried. It is harder to measure strength of contractions earlier on in pregnancy and you don't need to contract as much for a premmie baby. Even if you only had pain in your back and thighs, that can be indicative of pre-term labour and needs to be taken seriously in someone who has PPROMed. They didn't give you a proper internal because that is normal in pre-term labour as a way of minimising infection risk. I wasn't given an internal until I was 7cm and very clearly in labour. They wanted to see how I was progressing and assess for presentation. I then wasn't examined again as baby was visible when my body started pushing for me.

[minipie]

Glad your baby is doing well

As regards stopping labour:

My waters went at 33+6, on the verge of 34+0. Contractions started an hour later and DD was born later that night.

I was told that they would not try to stop contractions because at 34 weeks, the risks to the baby of the drugs to try to stop the contractions are worse than the risks of being born early. I had something to slow down labour (to enable steroids to take effect and to enable me to be transferred to another hospital) but not to stop it.

33-34 weeks I think is a borderline period and different people have different views - during this period some medical people will think that it's better to try to stop contractions, some will think that it's better to let the baby be born.

Perhaps when your waters initially went, you were 33+1 and at that point the balance was in favour of stopping the contractions, but by the time your contractions actually started (or someone realised they had really started) you were 33+3 and that was just over the borderline? Or maybe the team you saw on the second day had a different view from the doctor you saw first.

So, overall, I think there may be a reasonable explanation as to why you weren't given the labour stopping injection, ie it may have been a deliberate decision not an oversight.

Another issue is that that the drugs to stop labour often don't work. If they did, there would be far fewer prem births. So, please don't think that your baby could have avoided being prem if only you'd had this drug - that probably isn't the case.

However there are certainly points of complaint, in particular

• the advice re the bath, sounds a bit dodgy to me though I'm not an expert
  

• the fact that you weren't being properly monitored, nobody realised you were in proper labour and they wouldn't do an internal (wtf?! why not?). I am really surprised by this.
  

• did you have steroids and IV antibiotics? You should have done.

[minipie]

Cross posted with NoRoom. Didn't realise that about internals after PPROM - that does explain that one though I agree with you that they should have realised prem contractions don't present the same as full term ones.

[3littlefrogs]

It is important to remember that midwives are trained and qualified to deal with labour and delivery at term.

When looking after a woman in possible preterm labour, they are supposed to get medical assistance from an obstetrician.

Hence my question about who the op means when she says "they" when referring to the staff.

[minipie]

Hmm 3 thinking back, I remember a doctor seeing me when my waters broke and then when contractions started - to explain why they weren't going to try to stop the contractions - and a doctor was there for the actual birth.

In between however it was definitely midwives, no doctor present (though I guess the midwives may have been checked with a doctor behind the scenes). Was this wrong?

[3littlefrogs]

Not necessarily wrong - but a preterm labour is an obstetrician case, not a midwifery case.

There are "rules" WRT midwifery practice, particularly around defined areas of responsibility and getting advice from the obstetrician appropriately.

This was drummed into us relentlessly when I did my midwifery training back in the 70s.

[Theyvallgone]

In normal full term labour a midwife can be the lead carer for you and make decisions with you about your care.
In premature labour, a Dr will need to be involved (this does not necessarily mean you will physically see one) to make medical decisions, but you will still be cared for by a midwife - who is fully competent and qualified to deal with preterm labour.

Often discussions are held over the phone or in the office, and unfortunately if these discussions aren't shared with you you may feel your care was lacking. This is why it could be a good idea to have a debrief with your notes to find out what happened and when.