Women's Experience of High Risk Care - Antenatal Advice.

[MrsMac1489]

Hello Lovely people 💕

I'm a midwife working the the UK.

I am putting together a training package, to devise a antenatal class geared towards "high risk" women.

Women who know they will be having or have had their babies on delivery suite/Labour Ward.

We want to know:

• what we could do to prepare you for the experience of high intervention care?
• what shocked or surprised you?
• is too much information a bad thing, or would you rather be prepared?
• Do you have any burning questions about your care that you don't feel confident to ask?

If you're a birth partner you can help too! We'd like information from both sides.

Also, we'd like to know:

• how you perceive your stay in hospital, was it a shock to be an impatient?
• Did you know how long you might have to stay in after having your baby? Or during the induction process?

Please, no naming of the hospitals or specific midwives or doctors. Anonymity will be respected.


Thank you so much for all your help 💕

[ChaoticKate]

That would be really useful. I went to ‘normal’ antenatal classes which really emphasised the ‘natural’ childbirth message although every single couple in the room was a high risk consultant led pregnancy booked for induction. I was completely unprepared. Useful topics would be:

• how an induction is done, including time frames i.e. could spend 3 days in antenatal without actually going into labour.
  
• the difference in contractions in induced labour. I ended up having intense ‘double’ contractions and they were coming at a rate of more than 6 every 10 mins even though I was not even 2cm dilated. My antenatal class had painted a fairly rosy picture of contractions based on natural labour so I thought there was something wrong because what I was experiencing was so different from what had been described.
  
• Episiotomy. I was petrified of this beforehand but actually wasn’t too bad. Demystify what it is and explain that most heal fine and fairly quickly. Having had one I’d much rather that than a tear.
  
• Formula topups. My baby was given these because of her blood glucose as I had GD. Explain that women still need to be trying to feed their baby before a top up to establish their supply. I was in shock after a very tough labour and the midwives were just giving my baby formula every few hours to try and get her to ‘pass’ her blood glucose tests and I didn’t really know what was going on or that I needed to be trying to feed her.
  
• what to expect on the postnatal Ward. Caring for your baby, visitors etc.
  
• An open discussion of worries. There are so many horror stories online because people don’t write about uneventful births.

[triballeader]

For me a specialist midwife who made time to run through all the possible scenrios she could think of whilst the various consultants bought together various teams for a carefully planned c/sec delivery helped.

Mine was a planned c/sec with VwB's for very severe polynepheritis with a baby who had been kicking my kidneys so hard from week 26 my kidneys were massively distended and their function was impaired. This was after a preterm APH em c/sec with life threatening PPH & a VBAC with another severe PPH. I knew the theatre would have an ob's team, a NNICu team, a heamotology team and the renal team [ just in case they had to do urgent kidney surgery to save my kidneys whilst they were in there] Staff had explained the hot bucket of water and weird cannula set up ready to pour through massive amounts of blood and the various drug syringe drives that would be in place BUT no one had warned me about the blood transfusion runner who was on standby to fetch even more blood just outside the theatre as I went in. That totally freaked me out. I had signed the consent form knowing I could die but that kind of underlines how risky this really was. If I did wake up I was booked for ICU. Thankfully I woke in HDU- paniced like crazy because no-one had warned me I would have an oxygen mask over my face. I could not manage to hold a cup let alone a baby as I had that many cannulas in both my arms including the weird wound up line contraption that was in a bucket.
Having the supervisor of midwifes make the time to repeatedly visit me in HDU, explain the equipment till I could take it in and debrief me over my sons delivery as well as all that happened to me in theatre helped.

I would have liked a midwife I knew to have accompanied me into that huge theatre and to have been there when I finally woke up - my husband was not allowed past the the entrance and I was on my own knowing I could very easily die whilst being asked to trust teams of people I did not know to save my sons life and if possible my own. Something as simple as having a friendly hand you can hang onto when its all gone to hell in a handcart would have made such a difference given how very scared I was.
Having someone from the Ob's team bothering to go and tell my poor husband that I was still alive but taking a long time in recovery prior to being moved to HDU would have been nice. My poor bloke had the NNICU team take him our son to see whilst I was still in theatre so they did not know how I was and could not tell him. That left him holding his son for five hours worrying I was dying and that he was not there.
I wanted to b/feed but could not hold my baby. If the supervisor of midwifes had not intervened and helped and showed my husband how to hold his son away from all my equipment and away from my kidneys and c/sec it could not have happened. It would have been easier for staff to bottle fed and send son home with husband rather than keep him next to me during the day and SCBU over night.

[Dinosauratemydaffodils]

I started on the MLU with my first (who got stuck at full dilation, refused to budge for forceps and ended up being an emcs) but I really don't think there is such a thing as too much information.

I was put on the drip because he wasn't properly on the cervix but no one explained that until after he arrived nor did anyone explain the risks of having your waters leaking for so long or that it likely meant a longer hospital stay/possibly NICU stay for him. I didn't give informed consent for my section because I was so exhausted, drugged, dehydrated and feverish (waters had been broken for 81 hours and I'd been contracting in my back for 75 of them) and I couldn't read the consent form. I'd been telling them he was stuck for hours but no one would discuss interventions with me until we needed them NOW by which time I struggling to recall my date of birth.

Depending on why they are high risk, being told where the NICU is, what the visiting hours are etc. My son ended up going down at 9pm, I was allowed to carry on thinking the NICU was in the children's hospital next to the maternity hospital until 7am the following morning so spent the night lying awake feeling I'd failed him so much crying to myself. That night and the state I was in with my emcs did a massive amount of harm both to my mental state and my relationship with my son.

Staff. I know it's hard with shifts etc but the midwife I'd had all night left me in theatre with a bunch of strangers before my son was born. The midwife who replaced her didn't even introduce herself, just tried to hand me a wrapped up baby around 10 minutes after he was born (no one told me he'd been born/showed him to me before his checks etc and then I passed out). The contrast between that and my emcs with my daughter where the staff made me feel safe and supported can't be more extreme.

[BaconCrispsGone]

I'm an as much info as possible type.
I definitely want to know all the 'rules' for my labour, can I eat, move about, etc and the reasons for them.
I found the wards really bad for keeping me informed. I missed dinner because I was told the wrong time, I never knew when to expect medication or monitoring, I had to wander around aimlessly the first morning til I found breakfast...
I was induced and on the ward with contractions all night, which was pretty miserable, the only thing the midwives did was tell me off for moving and disturbing the monitors. Something as simple as a sheet of tips on dealing with pain and positions I could try would've helped a lot.

[SiolGhoraidh]

This is a great idea. Like a lot of other women, my NCT classes really pushed the natural birth aspect with minimal pain relief. So far, 4 women have had their babies from the group - two inductions, one EMCS and two episiotomies. I think we would all have benefited from knowing a bit more about care for higher intervention labours.

I will be on the delivery suite for my birth (mainly for MH and higher BMI), and I don't feel there is any such thing as TMI.
I would like to know who is likely to be there, what interventions will be offered and in what order if the birth is not proceeding to plan. Will they insist on continuous monitoring, can I move around, will I get pain relief when I ask for it etc.

A lot of it could be covered when I go in, but it's important to tell me stuff before it happens. I know there are no guarantees for how a birth could go, but it concerns me that sometimes the mother is just treated as a patient, not a participant!

[butunlikely]

I wasn't high risk but another NCTer here - found myself walking to the operating theatre for an emcs after an undiagnosed breech with no idea what was happening and, I believe, as a result everything came crashing down after the section, I hyperventilated and got so dizzy they had to take the baby to my husband. I felt so out of control because I had no information (I was also knackered).

If someone had described ALL of the reasons you could end up with a section - not just imply it would be your fault which is what our terrible NCT teacher essentially did - and describe the procedure in depth, I think I'd have been OK. I'd also have had the confidence in the 3 days of labour at home to question why I was stalling instead of meekly going to the MLU and accepting that they wouldn't examine me because 'the more natural the better'. I get that that wouldn't happen to someone who was high risk, but the principle of giving women confidence to question what is happening even if they are on the more 'medical' birth pathway is important.

Yes there is an aspect of not wanting to scare people, but I'm in the 'more information (FACTS) is better' camp.