Step this way to help shape the future of maternity services in England

For me the priorities for DCs birth are: 1) Safety of mother and baby, 2) Positive experience for me (being given information, having my choices supported and being included in decision making), 3) Interventions should be done as needed and only as needed (no reluctance to intervene if necessary and equally no unnecessary interventions. Given those priorities here are the bits of the Which website that are useful and the data that I feel is missing:

1. Safety of mother and baby – The info on ‘cut and tears’ is a good start. However, Calderdale & Huddersfield birth centres have 0% cuts and tears? This info is useless to me as clearly inaccurate.

Birth injuries - A stat on birth injuries to mother and baby and whether these has short or long term health implications would probably be the most useful stat you could give for me to understand safety at my local settings

Average Transfer time – A stat giving the average transfer time over the past year would be useful for birth centres particularly freestanding birth centres as this is a big safety concern (so how long did it actually take women to get to an obstetrician from decision to transfer to handover of notes). The transfer time on the Which website appears to be best case scenario which could be very different to the reality.

2. Positive Experience – I think the only way for me to understand how well women in labour are treated at each setting is for women to rate the hospital and to get comments from women. In my area (Calderdale) there are very few comments from women and they are all very old so they are not useful to me. I think Which need to be more proactive in seeking out womens opinions. We have newborns,. We are very busy. We are very unlikely to go onto a website and write comments off our own backs.

3. Interventions as needed and only as needed - I can easily find out which maternity unit near me has a low induction, c section and assisted delivery rate. I can also guess which maternity units might be more supportive of Elcs or vbac based on stats. However, I am not against interventions if they are necessary for the health of me or my baby and i certainly don’t want reluctance or delays to interventions if there is any danger to my baby or me. In this respect the Which stats don’t help me very much. This would probably need to come from women rating or commenting on the website. It would also maybe be helpful to know the percentage of high medium and low risk women that birth at each setting. As any setting which doesn’t take high risk women would always have a lower c section rate.

The ‘Best Choice for you’ tool they provide is really great! The info about facilities etc are brilliant and the data provided is a great start and far more comprehensive and accessible than anything else I’ve seen but would be much more useful if they could address some of the gaps above.

Review of the Which website coming up....Sorry its long!

I'm not a midwife or anything. Just a woman who's had one baby and is starting to think about birth settings for my second.

Rowan - I'll do a review of the stats on which. I've used them before but I think some things are missing. I'll post it up here in a few days if that's okay?

Which choices do you wish to be able to make about the maternity care you receive?

I had the choice of local hospital, although no one mentioned anything about birthing centres etc at the start of my care. I was low risk initially, so it should have been an option, but it wasn't discussed.

I wasn't given much information during actual labour about how my labour was progressing - my son was back to back, and despite me saying I thought something was wrong from early on, and them not being able to keep a trace on him, they didn't actually explain what was going on until they insisted I was put on the syntocin drip. I'd asked to be kept informed all along, and according to my notes they'd known for a good while.

I would also have liked a more experienced Midwife - I had a recently qualified midwife for most of my labour, and it wasn't until she was relieved at the end of the shift and the more experienced midwife took over that I was told there was a problem and we needed to get things sorted asap (a dr was called and I was prepped immediately for a c-section, but fortunately forceps worked) I dread to think what might have happened if she'd been working later. I've nothing against newly trained medical staff - I know they have to learn, but when a problem arose she didn't do anything about it - I know now that perhaps I could have asked for someone else, but again this isn't something that is discussed.

What are the key barriers preventing women from making the choices that they wish to?

A lack of information - we don't know what we can and can't say no to, and when we're in a vulnerable position anyway it can be difficult to get across what we want. There needs to be more transparency.

I also got the impression I was "taking up their time" by having a long labour (hence the syntocin). Despite me making it abundantly clear from the offset that I struggle with anxiety, no one listened, which made me feel less like I could talk to anyone. It is made obvious from the start that the hospitals are more concerned with the baby than the mother, which puts mother in an awful position. I was made to feel like a bad mother before I left the labour ward - what a great way to start family life!

I might be being stupid but I couldn't actually see what stats this was providing. I wanted to check what fraction of planned C-sections were for medical reasons but couldn't find the number for instance.

A major flaw I picked up on immediately was that it talks about risks of physical damage during childbirth but not mental damage. eg. What is the rate of PTSD on planned C-sections versus not?

Sorry to hear you are finding it difficult. Its good that you have your DH on the case. Best wishes for the future - and feel free to punch anyone who even hints you should just get over it.

Thanks icebeing
I think so, so far anyway. I have been quite emotional but I don't think it helps when every person that visits asks about the birth (as people always do) and it sets me off. I have suffered from depression and had panic attacks in the past so DH is keeping his eye out for signs of me not being myself.

scorpio so sorry to read your experience. Do you think you are actually okay from a MH point of view?

Thanks Rowan it is really good to hear where this data is going and how it fits into planning for the future.

I personally would be very happy to contribute in any way possible on the topic of post traumatic mental health problems associated with either traumatic births or traumatic post natal experiences and will keep my eyes open for this information when it arrives.

Because *

I'd just like to point out how crap my postnatal care has been.
I had dd on the 13/7 an 11lb breech. didn't know this until her bottom was visible. I ended up in theatre after a massive pph.

I was discharged on 15/7 feeling awful but desperately wanting my home comforts.
saw cmw 16/7 at home and then again on 18/7. I had a phone call arranging discharge on the 21/7 and I'm being discharged on 31/7 but don't have an appointment to see anyone inbetween and haven't since the 18/7.

Is it acceptable to see me last at p5 and discharge me at p18 with no appointments inbetween? no one has asked about my mental health, which i think is shocking seeing as I had a traumatic birth and my dd was lifeless for her first 2 minutes.

It must be bease dd is my 9th baby and I "know what I'm doing"

What is the out come of this thread MNHQ?

There are clearly several themes developing and several willing activists...so what happens now?

Sorry MNHQ!

Got another one bit for you that relates to something I posted above about the lack of maternal mental health services and Trusts not even having plans to implement a strategy.

I was just perusing the NICE guidance on Antenatal and postnatal mental health: clinical management and service guidance which was updated in Dec 2014.

I noticed this point in the recommendations:
The organisation of services
• Clinical networks should be established for perinatal mental health services, managed by a coordinating board of healthcare professionals, commissioners, managers, and service users and carers. These networks should provide:
? a specialist multidisciplinary perinatal service in each locality, which provides direct services, consultation and advice to maternity services, other mental health services and community services; in areas of high morbidity these services may be provided by separate specialist perinatal teams
? access to specialist expert advice on the risks and benefits of psychotropic medication during pregnancy and breastfeeding
? clear referral and management protocols for services across all levels of the existing stepped?care frameworks for mental health problems, to ensure effective transfer of information and continuity of care
? pathways of care for service users, with defined roles and competencies for all professional groups involved. [2007]

Great! This is a fantastic guideline. Except that this recommendation was made in 2007 and the two reports I mentioned previously highlighted that this guidance appears to have been completely ignored for OVER SEVEN YEARS.

I'd dearly like to know why this is the case.

red hi - we have been on many labour and postnatal threads together and I am glad you have come on this one to add your perspective.

Applauding RedToothbrush.

Just seen this thread about requesting an Elcs, which says that its stamped in big letters that THIS TRUST WILL NOT PERFORM AN ELECTIVE CAESARIAN SECTION FOR NON MEDICAL REASONS

I think this should be banned as it has profound implications for those who have cause for an ELCS on mental health grounds.

90% of the thread I see on the subject the OP is not aware or does not recognise the fact that mental health IS a medical reason. (The clue is in the health bit of mental health) Trusts are quite deliberately exploiting this and trying to put off women from making a request by bullying tactics. This is a group of women who are vulnerable and actually need MORE support, rather than being marginalised and actively dismissed without even getting the chance to discuss how they feel.

I think that a request for an ELCS generally should be treated more as a red flag to needing more support (even if that does not mean mental health intervention or counselling) rather than something that should be treated with such utter contempt.

The reason that this is happening is because of the persistence of this 'too posh to push' attitude rather than doing what the 2003 select committee recommended which was to closely examine maternal requests. The worst bit is that NICE did look at available research this in their CS guidance which seemed to be at odds with the 'too posh too push' myth yet this is still being ignored.

Trusts are very much relying on 'The Daily Mail effect' allowing them to take this approach and have such policies because they are supported by certain sections of popular thought rather than being led by the Institute that is supposed to advice on best practice and policy for optimum health outcomes.

I personally think this type of behaviour is a dereliction of duty. It fails women and it pushes some to seek out alternative hospitals who are more sympathetic to their cause. However this means the Trust in question gets nice shiny stats whereas their neighbour who is doing the right thing by women gets hard questions asked about it, which is not right on any level. Or women feel they have no option but to go private. Again meaning that those less able and having the least access to the most appropriate care.

Similar arguments about using populist politics against women instead of following the research and recommendations can be made about the cutting of provision of home births too. Won't someone think of the poor babies that are not harmed any more or any less for women who have already had one baby. Those utterly selfish women, draining the NHS by having a cheaper birth.

Why are we not holding Trusts that are behaving in this way accountable?

What about an annual random sampling of women who had birthed at the maternity unit in the previous 2 years. Asking questions about their care before during and after labour, including things like whether they felt their decisions were respected, postnatal care, their feelings about their care, and any birth injuries for mother and baby (short and long term). Questions would need careful thought. But if they published something like this about my local maternity units I would definitely use it when choosing where to birth and hopefully maternity units would shift some of their focus to achieving good scores on this survey which would increase woman-centred care. I'm no expert on this so its just an idea for the experts to consider...

Excellent post, RedToothbrush. I always like your posts, I've come across them a lot - unsurprising as my DD was born in July last year so we must have both been reading the same threads :)

Incidentally, DD was born by EMCS because her head was too big for my (fully dilated) cervix. Her birth was very similar to my own, except my poor mother had a grade four tear and episiotomy with ventouse. I'm sure that EMCS was easier to recover from, not least because it was less mentally traumatic than I imagine a damaging vaginal birth to be.

If I am ever pregnant again (unlikely, though it is possible IVF will work again for us), I will be requesting an ELCS. It doesn't seem likely to me that a VBAC is likely to be successful or trauma-free (physically or mentally). At least having already had a section hopefully means I'd have more chance of being granted another, but I'm not at all sure why hope should come into medical treatment.

I have to agree with the level of backside covering that goes on when it comes to your notes etc. I had a debrief and was amazed at some of the things one midwife had written on my notes. There were massive discrepancies for example the number of hours in labour was wrong. 8 hours were missing. Also my reason for transfer to hospital was 'request for epidural' whereas I was told I was going for 'failure to progress'. A subsequent complaint (about a different issue) confirmed the reason was actually the latter contrary to the notes. These are not minor errors. The discrepancies are so big that i find it hard to believe these are just unfortunate errors. Women need an independent body where we can share concerns about our care that will hold the people concerned to account. People within the system are proactively covering their own backs with the notes. A complaint to the nhs trust simply initiates a rapid cover up. It's pointless asking the same people who provided the poor care to investigate themselves.

And my first birth was nowhere near textbooks. The notes however were.