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

Individual rooms would help with the men staying issue.

If you have a door you can close, there's no worrying about a strange man looking in/making a racket etc.

I HATED the PN ward. A total lack of appropriate care and quick responses to a woman buzzing at 3am for assistance, and being kept awake by other babies, buzzers, MWs taking/making phone calls, other women shuffling by is NOT conducive to a quick and safe recovery. I needed DH to stay to help me and he couldn't.

Bounty need removing sharpish too. Where else are you sold to on a hospital ward by a direct marketing company?!

That was to Snozzberry

^ I completely get that. My objection is the removal of visiting hours. I didn't want to sleep feet from strange men. I worried that any women in abusive relationships wouldn't be able to share their fears (possibly one of the first occasions they would be able to) with any of the HCP, because their partner was always there.

I just want women to have a choice.

I desperately wanted an epidural after complications following my first labour but due to lack of staffing and rooms I couldn't. I was supposed to be high risk but ended up on the mlu labouring for two days. More resources are needed. The choice of pain relief should be mine.
My post natal care with my first child was shocking, I was kept in overnight having had a pph and only one person came to see me briefly. No one helped me breast feed. I was ignored. There is a definite lack of bf support.

Babies with tongue ties need to get diagnosed and seen quickly. It's no good making them wait 6 weeks to get snipped.

I think the point about partners on the ward is interesting. On a shared ward the need for privacy is important. But in reality, having dp there was my only chance to get help getting to and from scbu or the kitchen or shower. The staff were simply too busy for that kind of thing.

receive it -I mean receive treatment for Group B Strep.

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

I'd like to be able to choose how and where I deliver my child. I'd like to choose which professionals are available. Most importantly I'd like to revisit my choices toward the end of pregnancy and in early labour if possible, with my choices being specific to me, my circumstances, pregnancy progress, health etc.

I'd like all women to be tested for Group B Strep. And to be able to recieve it early in labour and then go back home to continue to labour if I wish, not to have to stay because they can't be bothered doing admission and discharge paperwork twice.

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

INFORMATION.

There is a real lack of informed consent with regard to procedures surrounding delivering a baby.

Very general information is given which is based on population data, averages, hospital statistics.

There is a real lack of transparency when it looks like a woman might experience a prolonged or difficult labour. She is usually told it's just one of those things, unpredictable, bad luck etc.

But if a first time mum is in labour with a back to back baby which has not engaged, a difficult labour is predictable. An epidural is more likely. An instrumental delivery is likely. An emergency c- section is more likely. Women aren't informed. They just keep going, labouring with no idea that they are fighting against the odds. If they do deliver vaginally, there is a high likelihood of perineal trauma. Why is this kind of information kept from them? Why does noone say, during early labour, "the baby's position and lack of engagement makes an unassisted vaginal delivery unlikely", explain what might happen, give the woman the opportunity to choose an "elective" section?

If I put in my birth plan that I want to discuss the position of the baby and likely outcomes early in labour, would anyone really do this and have a meaningful conversation about possible outcomes, risks and offer me any real choices? I doubt it. The culture is that it's just something we have to get through...

RESOURCES.

There's little point in making any request if the NHS doesn't have the resources to back it up. If I say I want this discussion (above) I might be lucky if it's the right time of day with the right combination of staff...similarly if I requested any tears be sutured by a Consultant Obstetrician.

I would say that key barriers are risk averse policies. Women not being "allowed" to make informed choices if they don't meet the criteria for an MLU or a pool birth, etc. this will only get worse with the removal of supervisors of midwives who historically have been people that women can go to for help and to be their advocate.

Every single baby born should be checked immediately after birth by a fully-trained, experienced person for tongue-tie, both anterior and posterior. If there is tongue tie present, it should be cut immediately (with mother's consent, obv). Then breastfeeding support should be offered for as long as the mother needs it. Not only by peer supporters (I am one) but by fully-trained healthcare professionals who are aware of current guidelines and research.

This would be a relatively cheap.way for the NHS to save a hell of a lot of money in the long term.

I had my second child in hospital, as I was over 2 weeks and had to be induced. (The others were home births.)

Now, my local maternity provision has gone. You have to go the massive hospital in the city 12 miles away.

So, localised provision of birthing centres is very important imo. My town has over 60,000 people and is expanding. I can't really believe we don't deserve our own maternity facilities.

the key barriers to those choices

Lack of info from midwives - women aren't told they have choices. Just because a particular choice is the best choice in the eyes of a MW, it is still the choice of the woman. You cannot make an informed choice without information.

You cannot give informed consent without information.

Information is not given to women routinely - induction, sweeps, blood tests, managed 3rd stages - so many women are not told they have a choice.

Things are often done TO them and not WITH them.

I strongly suspect this is because of an underfunded, understaffed, overstretched maternity service overall, not a lack of care or desire by MWs to provide a really good, individual service.

Which choices do I wish women to be able to make?

Fully informed choices.

Choices about place of birth - home, MLU or CLU and the right to choose for themselves regardless of their risk category provided they have all the info (I was high risk but chose a home birth, not all women know they can do that).

Choices about tests - the right to decline tests (eg blood tests, urine tests, scans, being weighed) - and being fully informed of the risks/benefits/necessity of any tests (I declined blood tests in my 2nd pregnancy)

Choices about induction and not being presented with a date for induction as an automatic step at 40+10.

Choices about physiological third stages vs managed 3rd stages.

Oh hell yes, food. Even though my DD and I were healthy, she screamed if I put her down and I couldn't get up (never mind walk) due to EMCS and being catheterised. It would have been nice if someone had brought me some food instead of simply calling into the 6-bed bay "lunch is in the kitchen".

I also wish I'd known more about the realities of lochia. I thought it was just like a heavy period for a long time. It WAS like a period for about a week and a half, then stopped. Then came back when DD was 16 days old - it was like pouring rain. Went to A&E, they were a bit at me, but checked me out and sent me home, whereupon I passed a clot the size of my fist. All this is apparently normal and nothing to make a fuss about, but it was the single most terrifying thing in my entire pregnancy/birth.

Oh yes and while I am on the subject, meals which are an appropriate size and type for women whose bodies are recovering from a marathon effort and/or major surgery, while probably trying to ebf another hungry little person. This does NOT mean a single cardboard sandwich. Some fresh fruit would be great, too.

Allowing partners to stay overnight needs to be scrapped. No other wards are mixed, let alone when the patient is at her most vulnerable. The strange partner of the woman opposite stayed 24/7 and outrightedly stared at me as I tried to establish breastfeeding, thanks to the ward's delightful open curtain policy. After a traumatic birth, I was too exhausted and upset to complain. The partners also used to eat the food at the communal kitchen bit, often leaving the latecomers with no dinner. Partners weren't meant to be fed, but it was all nudge nudge wink wink with the people serving.

Maternity wards need to feel like they belong to the new mothers.

Also better breastfeeding support. Not one person checked my latch. Luckily DD fed with no issues (except the usual cracked nipples, agony when she fed etc) but I should still have been asked how it was going, and checked. The furthest I ever came to discussing it was when the midwife ticked the breastfeeding box on her first home visit.

P.s. I've some.stories t make your hair stand on end ^ but my primary aim is to both help.reduce the stillbirth and neonatal death rate but to focus also on those who survive but are left with lifelong disabilities who are often forgotten.

MN - this is a subject I'm passionate about, because due to poor care my dd1 was left with something called hypoxic ischemic encephalopathy. Her brain was irrevocably damaged during labour because of proven negligence and she is disabled with epilepsy.

and it was avoidable

Yup.

But I'm over the anger and rage and now just want to petition for better care. But the EoE NHS team have fobbed me off for over a year as patient liaison despite me travelling hundreds of miles to attend meetings.

Can I help?

Ditto - it was always such an issue if you missed your pain relief or your meals. Even though my room was specifically a side room for women with babies in NICU. I wouldn't have thought it was rocket science that the women with babies in NICU/SCBU might not be at their bed all the time. I'm not saying they should chase around the hospital to find you, but it would have been more reassuring if you weren't treated as if you missed the drugs run deliberately just to annoy the nursing staff...

That would have perfect!

Snap taleggio. I also missed most of my meals, pain relief and postnatal checks because I was always in the scbu attempting to breastfeed dd. I think a special room for mums whose babies were in scbu / nicu would have helped a lot.

I got stuck on a ward, everyone else had their babies and mine was in NICU. It was horrible. DS was a 5 minute walk away for a fully able person. It would probably have taken me 20-30 minutes of a lot of pain to shuffle there by myself.

I used to get my husband to take me down in a wheelchair. I did then get shouted at by one of the nurses in the NICU that I should be walking, and the doctor would get really cross with me if they saw me walking. I explained about my 4th degree tear but to no avail. So my husband used to wheel me down to the door, and I would shuffle inside pretending I had shuffled the whole way.

She was so pleased I had "listened" to her, she then was really nice to me and helped me to get breast feeding started.

There were some lovely nurses/midwives that we met but there were some real shockers as well. A little bit of sympathy would have gone a long way!

Oh yes I agree that postnatal care was appalling and without doubt the worst part of maternity care. However I don't think more choice is what is needed there, just a decent, respectful level of care wherever you are.

That everyone involved does, or feels that they can, pay attention to what the mother wants - not that they are more focused on statistics, guidelines and targets to meet.

So if a very low risk woman wants to be in the CLU and have an epidural, they should be able to (if there is room), not encouraged to do without as they are low risk

So if a first time mother is adamant that she wants an elective, she should be able to

Birth will be one of the most painful, intrusive, emotional and rewarding experiences of any woman's life. To me it shouldn't sit as neatly within guidelines as some other medical experiences do - none of this "we aim for X% of women to have a VBAC". I believe the woman giving birth is the one who should be allowed to make any safe medical decision, whether it is to have pain relief or not, whether it is to labour on an MLU or a CLU.

Basically, stop making women fight for an epidural or an elcs. I don't think maternity care services probably understand how many women are out there scared of getting pregnant again because they had such a hideous first birth but know they can't just ask for, and easily get, an ELCS.

I also agree with previous comments about the post-labour ward. Some are utterly shocking and yes, as PP says, it seems that if you have a nice labour you get to enjoy your home-from-home private room for some peace and quiet alone, but if you've had a crap labour you get stuck on a public ward. It's lose-lose.

Also no information was ever provided on mixed feeding. Plenty of people do it but it is presented as such a dichotomy between breast and bottle.

Maybe there needs to be a proper acknowledgement that you just have to do the best you can with breast feeding whether that's none at all, breast now then bottle later, a mix of the two, or exclusive.

Maybe if mixed feeding were discussed, more people might stick at breast feeding for longer.

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

I wish they had given me the knowledge to make an informed choice about childbirth. No one mentioned forceps and ventuouse other than that they happen in an emergency. Certainly there was no discussion about associated long term health risks. C sections were only mentioned as something to avoid.

DS was back to back. They didn't spot it despite having all the classic signs of a back to back labour. I ended up with an episiotomy, forceps, 4th degree tear (3.5 yrs later, I'm still having physio for this), and our baby rushed to NICU as he struggled to breathe.

I wish I had been able to make the choice between forceps and EMCS at the time his heart beat dropped. Maybe the outcome would still have been poor but at least I would have made the choice. In fact (particularly as I am gene positive for Huntingtons Disease and therefore highly likely to have continence problems in the future), I wish someone had properly explained the risks of vaginal delivery, instrumental births and c sections from the start rather than constantly focusing so much on pushing me towards a not always achievable 'ideal' of waterbirth, gas and air, skin to skin, home that day which was so far removed from actually did happen for me. I am not convinced I would have chosen a vaginal delivery had I properly realised the real risks.

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

Lack of appropriate information being given to women about childbirth and the real risks still happening stops them from making an informed choice.

Lack of evidence-based knowledge around the risks of childbirth stops this information being given in the first place.

There's so much pressure to achieve this ideal birth, that no one wants to discuss the very real risks of childbirth (neither practitioners nor pregnant women). An acknowledgment that you can do all the yoga, breathing techniques, hypnotherapy you like and it still might not be enough. Things go wrong, and birth plans should focus more on what the woman wants if things go wrong (with a discussion of the risks at that time) than what they want if things go right.

So many times I have heard people say that when the delivery goes wrong, the birth plan goes out of the window. If the birth plan was properly thought through (including what happens when things go wrong - e.g. would the woman prefer instrumental or c section?), then the birth plan could actually be really useful. What is the point of a birth plan if it is not to cover the unexpected?

I had to really fight for diamorphine when I was in absolute agony and completely exhausted because I stupidly wrote down "water birth" and "gas and air" in the pain management sections of my birth plan. The midwife kept asking if I was sure, kept asking me to wait a bit longer... I so wanted that waterbirth with gas and air, I would never even have thought to ask for the diamorphine if I actually thought I could manage without. It took a lot for me to admit things were not going according to "my plan", they should have sat up and listened to what I was saying a lot earlier than they did.

Proper aftercare for all women. Not just focused on the baby and not just the 6 week check. Proper referrals for all those who want it to physios and whoever else is needed to help guide us with pelvic floor exercises to prevent issues in older age. The barrier here is obviously money but it would save money in the long term to deal with these things now rather than wait for it all just to get worse. Without this aftercare, women can't make the right choices about future pregnancies.

Some practitioners' attitudes. My original colorectal surgeon said to "blame my son for my injuries". Honestly, the fact that he said this (whether it was half a joke or not) really offended me, and I never truly engaged with his team at all after that. Also, they didn't listen to me when I said I didn't want my incontinence "solution" to be using pessaries for the rest of my life. I have moved house since then and luckily for me, my new practitioners are brilliant. Proper physio has really helped, I see an understanding colorectal surgeon for a check up every six months, and I'm actually on top of it all at the moment without a pessary in sight.