to complain about midwife (internal/assault)

[Hensinthehedgerow]

I'm sorry if this is in the wrong section. I'm in search of some opinions. This may not sound like much to complain about to some people. But this has really affected me and my marriage and I can't seem to move on.

In summary, I had a birth plan, it said no internal examinations and everything done needs to be explained to me. I thought she was doing an external examination, but instead did an internal which was very painful and basically in public view after my husband had been sent out of the room. I wish I had kicked her in the head and screamed and called the police, but I was holding my newborn baby and didn't I want to cry, I can't sleep.

I raised these issues with the som who said it shouldn't have happened an that she would speak to the midwives. Then emailed me to say the midwives agreed more communication would have been helpful to me wft

I have no idea if making a formal complaint will help. But can't let this go. Aibu to complain. The midwives were horrible and essentially bullied my husband. I guess it's wwyd? Sorry for the ramble.

As a former HCP I'm hoping a lot of people on this thread are just keyboard warriors :( When people share experiences like this you need to take it as an opportunity to reflect on your own practice and make sure there's no room for catastrophic miscommunication of this sort, not minimise and try to justify shoddy practice.

There is no excuse for not explaining to someone you're doing an internal! I used to work in gynae and "check" does NOT mean internal to me. Some women cannot tolerate internals for various reasons, it's possible to arrange light sedation for example which allows some women to relax enough for vital exams.

OP, I'm so sorry this has happened. Please see if you can access some help, might you have PTSD? Where I live there are specialist midwives for traumatic birth, maybe a chat with someone like that would be a good starting point? And keep complaining, I don't think that's quite adequate from the som.

Why wouldn't you complain frogwatcher? I find it very odd that you would just accept any treatment dished out to you, even though it made you "sick with fear" when it could have been easily avoided by the dentist taking 30 seconds to explain what was happening/get consent. It really isn't too much to ask.

god there are some depressing attitudes on this thread.

the midwife should have got the ops informed consent, it does sound like miscommunication inthe midwife said 'she was going to check' but the op didnt realise that meant an internal examination. but the midwife has a responsibilty to make sure her patients do understand and are giving informed consent.

seems to me that when it comes to preg and childbirth there is still a put up and shut up attitude and you should just let hcp do what they want and be grateful to get a baby atthe end of it. consent is often not sought and i had numerous drs state what would happen, when i questioned if something was necessary ie a sweep/internal/induction etc etc they seem suprised and at times annoyed.

informed consent shouldnt be too much to ask for!

I hope AlanMoore and DoingTheSwanThing's post inspire a bit of confidence that some (most?) HCPs do take consent and basic rights seriously.

Hens I realise I am somewhat late to the debate you've sparked off here but I wanted to lend my support to you and agree you should complain in an official capacity.

I was lucky enough to have fabulous midwives when I had my first baby recently. I had no birth plan etc but at no point did I feel like I wasn't fully informed about every step and procedure. This is how a labour and post-birth experience should be, so I wrote a letter thanking the midwives for this experience.

However, I did end up writing a letter of complaint too as something happened to me during aftercare which almost ruined the whole experience. A midwife who was supposed to help learn to breast feed used such awful accusatory language when it wasn't going positively that I was in tears, before snatching my baby out of hands claiming he looked jaundiced and took him away to another room. I couldn't move quickly because of my stitches and felt totally helpless. My baby had been checked by the paediatrician a few minutes before so I knew he wasn't jaundiced. That experience led to me being extremely over protective of my baby and I felt like a failure due to difficulties with breast feeding.

My (rather long winded) point is this: being in hospital should be safe and you should come out feeling cared for. Do complain - you should have known exactly what was going to happen before you were examined. If there had been an emergency you still should have been informed or more senior staff would have been called. The response to your initial complaint was wholly inadequate due to the wishes already stated in your medical notes.

I hope you are able to move forward and enjoy your baby.

maja00 - I wouldn't complain because I am lucky that I have a lovely NHS dentist who actually is pretty good. They are just doing their job and generally explain everything they do. I slip up in my job and accept that others do too (and do not believe anybody who says they don't on a daily basis however small) and I forgive mistakes. If they were deliberately neglectful or malicious that would be different.

OP

Your comments

"I wish I had kicked her in the head and screamed and called the police" and
"you are the reason the NHS terrifies me. I hope you were reported and sacked"

go a long way to removing any sympathy/credibility you have. You simply sound vindictive and not someone looking for a good way forward. What do you want? Someone's head on a platter?

Its not exactly the case that HCPs have nothing to worry about in a case of refused consent though.

They also have to be able to show that the patient was informed of possible risks/consequences of not having the intervention/treatment.

Which means it wouldn't have been enough for the midwife to have accepted "No" for an answer, she would have needed to go through the potential consequences (which may also come across as bullying/coercion - ie. if you don't do this, this could happen).

I don't like the system the way it is (used to work within healthcare, although not midwifery), but I do think there is not enough backup for HCPs about how they can accept a 'No' whilst still protecting themselves. Perhaps even leaflets (giving pros/cons of not having an intervention) or simple opt-out forms would make a difference.

its not a small slip up when they fail to gain informed consent tho. its a major failing and should not happen.

A similar internal examination saved me from a massive haemorrhage after child birth. I remember being vaguely confused and very irritated when a nurse quickly followed by a doctor gave me internal examinations.

I went on to lose so much blood - massive clots and I think the medical professionals were just doing their jobs and trying to assess.

By the way, I am also a mother with a couple fairly traumatic birth experiences under my belt, and by no means think all HCPs are angels (nor devils, just human). And agree that there is no excuse for bypassing consent.

Am really trying to think of practical solutions, unpick the 'why' of the situation a bit more.

I think it's fine, and very necessary, for an HCP to go through the risks of refusing something (and the risks of accepting it!) when gaining informed consent. "Do as you're told or your baby might die" is coercion and bullying, "I want to do X because of Y, if I don't do it then there's a very small risk/50% chance/likelihood of Z happening. The other alternative is ABC" is giving someone enough information to make their own decision.

Right, if op had refused the examination, the mw would calmly explain to her why it was so important and see if there is anything that could make it easier. If op still said no mw would get senior staff involved. If still a no then a no. All clearly documented and at the patients own risk.

It's not a rare occurrence for patients to decline treatment!

It really does depend on the culture of the hospital/ward you're in AlanMoore (having rotated around quite a few myself).

Not all senior staff are willing to come to the bedside, and in some places I've been unfortunate enough to witness a very heavy-handed top down approach (I don't have time for this, just get it done, etc.)

It absolutely shouldn't be that way, and I do think a lot of old-fashioned practices are essentially passed down to the newer graduates by force/bullying, again which shouldn't happen... but does!

I think empowering junior staff to be able to deal with "No" better, would be a good start.

Relatives can give consent especially with regards to children. and not all parents are lucky enough to be at the bedside when decisions have to be made and consent sought. And many elderly patients do have EPoA and similar legal setups in place. In MH the issues around consent are even more complex- I have had to wearily explain time and time again why HCP's cannot use the MHA to enforce physical treatment upon somebody with a MI. So I am aware that HCP's are not 'Angels' (yuck to that term-an excuse to pay poorly and treat like shit when you get into vocation speak). However should the OP have kicked the MW in the head, it'd have been blamed upon the birth process as opposed to appalling attitudes/behaviour. Doesn't excuse the lack of seeking explicit consent and failure to make crystal clear why every procedure/interaction is being suggested.

And yes, it is a team discussion re consent and medical/nursing actions required. That much should be implicit within the setting that Nurse and people like us work in. That kind of doesn't need to be said really....

How much detail do you feel you want when consenting to procedures? Totally genuine question to everyone here.

It sounds like the whole attitude of the staff was the problem too. You can't be like that even you are working with pregnant /labouring or post natal women. (Shouldn't be like it with anyone obviously but there's no denying that the very nature of pregnancy and birth does make women extremely vulnerable)

If you can't be kind , considerate and respectful then you are in the wrong department. I don't buy the " busy or rushed excuse either I had many an internal examination during pregnancy and even at midnight in a&e when it was busy and she appeared to be the only dr available to anyone, there was one dr who I had a few times who never ever failed to be kind gentle and explain everything despite looking exhausted and frazzled. So it is possible. Just a shame the maternity ward staff weren't more like her.

You just can't treat people the way the op and her husband were treated. It's wrong.

I'm thinking of a small A5 or so sized card with 3 Pros/Cons/Alternatives columns.

At the bottom circle 'I do' or 'I do not' consent, plus signature.

Again, just trying to visualise a system that would work better, and might help remove the fear/lack of information to hand that might be driving some staff (especially junior).

I would have loved to have a simple bit of information presented to me like this when I was being pressured into an epidural in my younger, more naïve days.

I am a qualified nursing sister though haven't practised in last few years.

however I have never ever not explained any procedure to a patient, unconscious or otherwise. I have never ever presumed consent to anything.

the only time I have ever helped to restrain a patient was a very drunk man who had punched the attending doctor and that was self defence.

in my experience people react very well to warm, calm, full explanations and also in my experience people 'kick off' in hospital because they are scared and vulnerable and do NOT need restraint or assault they need kindness and care.

op please complain.

Glad I'm not a midwife. Kicked in the head. Charming.

Many illnesses/symptomatology can cause confusion and aggression totally unresponsive to reason (cerebral oedema for one).

I have worked in MH for 23 yrs and have never been assaulted. I have felt very unsafe and threatened but never assaulted. Pointing out reasons for (not excuses) for what happened and defending a fellow professional against hysterical calls for their sacking does not mean I am an apologist for failure to follow ones professional code of conduct.

Restraint to avoid a person injuring themselves is not the same as restraint to impose compliance. There is a difference.

I'm glad you're not a midwife either viviennemary, you're failure to understand why a woman may use emotive language after being assaulted demonstrates a complete lack of empathy.

Op, it was an assault, you have every right to feel the way you feel and don't ever listen to anyone who tells you to just be grateful you have a healthy baby. It's nonsense- of course you're grateful for your baby, you're just not grateful for the assault which occurred directly afterwards and why the hell would you be!?

I assumed (perhaps incorrectly) that the kick to the head comment was a reference back to the recent thread where the OP said that she didn't understand how someone could ever have an internal without consent, surely you would just kick the person in the head and move away, or something to the effect. It was a long recent thread.

I think you've been amazingly balanced on this thread, Mignonette and think some people are misunderstanding what you're trying to say - which is that failure to obtain consent is always wrong in the situation in which the OP found herself.

You are also defending nurse, who was unfairly leaped upon for saying that she performs procedures in a&e without consent - when those situations are entirely different from the OPs.

I completely agree with everything you've said.

I am sorry this happened to you, Hen, and I completely understand how violating it must have been - particularly when you explicitly asked to have things explained to you at every step. That request should be standard procedure anyway - and the fact that it didn't happen despite you having taken to trouble to ask for it specifically is particularly awful. I would definitely complain so that midwives in that unit can get some training about what consent is.

I hope you feel better soon and that having support on here and in real life makes you feel that your feelings are valid. They are.

Yes euro hick it was a reference to that thread as I was anxious that might have been the response