To leave maternity ward without red book?

[SOPH781]

So, I'm due in hospital for an elective c-section this week. This is my second ECS and with my first I was ready to leave the next day. Baby was great, I felt great - no pain etc. However, the midwives were not happy about me leaving so early and told me that I had to wait for the red book. They kept me waiting for something like 14 hours - it felt like they were holding me hostage/punishing me for wanting to discharge myself!

I chose to wait for it as I was unsure if I would be able to get the red book from somewhere else and I was aware of its importance. I've asked my current midwife and she didn't know if I would be able to get it later down the line. Have any of you had experience of this? Were you able to collect your red book at a later date?

Thank you

Pissing myself laughing at 'service industry' 😂😂😂😂

I agree with AF.

I had my second elcs 8 weeks ago. Not only was the pain worse than the first one, I also developed pre eclampsia 48 hours after DS was born. I wouldn't be in any rush to leave if I were you.
Btw the care I received was exemplary and the reason the pre eclampsia was picked up before anything nasty happened.

With eldest we got it with 1st home visit. Remained empty though as I didn't fill it out. With ds2 we got given one in the hospital. I binned it when we got home and then got given another on the 1st home visit (which also got binned). With dd the mw didn't have any left when she did the 1st home visit, so we never got one.

I work within this 'service industry' . In terms of discharge planning we need to take some responsibility for managing expectations eg the time this takes in terms of paperwork/dispensing medications. I always explain to women that the process takes time and as an acute unit, I have to prioritise urgent care needs which may further delay their discharge. Of course women are entirely able to take their own discharge at any point but this may not be clinically recommended. The red book can always come via the community midwife.

I was kept in for a week and didn't get the red book until the community midwife's first home visit which I think was on day 10.

I am more shocked that they let people out so early. It used to be 10 days, then 7, then 5 and now two days tops.

It's major surgery. Perhaps I'm wrong and it is perfectly safe to allow people to go home after major surgery so quickly, especially with a newborn to care for as well but it alway worries me a little how quick they turf people out.

As a front line HCP I can promise you that although the NHS provides a service it is most definetly not a service industry. There is a big difference (not aimed at you OP).

If what you say happened to you last time happened as you think and they just held your red book to ransom to stop you leaving then by all means ask to see the ward sister because that's not on. People have the perfect right to make informed choices about their care even if that includes making decisions against medical advice.

However if discharge is delayed because midwives are either busy with other women or because they're waiting for drugs, paed checks, Dr check then that is not the fault of the midwives. However again hospitals are not prisons and you can choose to leave without checks, without drugs, etc.

And yes even though it might make sense to discharge people when it's busy to free beds sometimes it really isn't that easy. If ive got a poorly lady with high bp, a baby that won't feed and I need to help with breastfeeding, a woman in early labour who wants support and drugs, a baby who needs IV antibiotics, a high risk woman who needs a monitoring (ctg) I may not have the time to spend 30mins plus doing a discharge.

Toddler climbing all over me post CS was quite helpful - I had a nasty infection with lots of pain and nothing to see, after toddler trampoline-act, infection burst, lots of blood but yippee no pain. Quick dash back to the ward and all sorted.
I don't blame OP for wanting to go home as soon as poss, I know I did, no reflection on the staff just wanted home. They were somewhat over-subscribed that weekend anyway so everyone was getting an early pass.

It's major surgery. Perhaps I'm wrong and it is perfectly safe to allow people to go home after major surgery so quickly, especially with a newborn to care for as well but it alway worries me a little how quick they turf people out.

It's the nature of postnatal wards nowadays. Busy, noisy, stifling hot, minimal help with babies from staff. When I had DC2 last year, fathers were allowed to stay on the ward until 11pm, presumably to provide help to mothers and free up overstretched staff.

Postnatal wards just aren't conducive to rest and recovery, even after abdominal surgery, and women are almost always better off at home (assuming they're medically well) where they have a much better chance of some rest and some sleep.

In addition to comments by vague care continues at home through community midwife. Some hospitals now undertake EMCS as day cases with no overnight stay.

I meant Elective not emergency CS

I accidentally left without DD's. I was properly discharged and everything and had all the other paperwork the lovely midwife who discharged me had just moved hospitals and didn't realise I didn't already have it as in her old hospital it would have been given to me on the doctor's round, I didn't think to ask as DD was my first baby, and I'd quite a rough few days/week (tricky birth). We called the unit when we got home and the midwife who did our first home visit brought it. No biggie. Fwiw maybe see how you feel after as there is NO WAY you could have persuaded me to leave hospital the day after my c-section (not that they'd have wanted to let me anyway). Breast feeding wasn't established yet, I was bruised and sore from a lengthy pre c-section labour and tbh I really wanted and appreciated the additional care from the midwives.

Though maybe an elective is a little different, as you know what you're in for and no labour. Mine was an emergency and pretty nasty (though 100% worth it for DD obviously!)

I think the lack of help is the crux of it- if there would be enough staff to provide a bit of hands on help with the babies people would stay longer but depending on circumstances it's easier at home.

I got mine from my HV. It was a girl one and therefore all the charts didn't work for DS.

Seeing as rcog guidelines say that hourly resp observations should be done for 24 hours following a spinal I'm amazed any sections are done as day cases. I know plenty of places do next day discharge now but even that is seen as cutting edge by most hospitals who still do day 2 discharges.

Have just double checked and looks like I'm wrong where I work we use morphine so need to do hourly obs for 24hrs but if a PCA is used obs only need to be done for two hours after the operation. I might suggest at work we change to PCAs.

To pick up on pp's points I'm a bit shocked some people didn't have regular observations - DD and I were seen every hour for the first 24, then every 3. Take vague's point re the noise on wards - I was lucky enough to have a private room and might have felt differently if I didn't.

ProseccoPoppy we were seen a couple of times a day, definitely not every hour. Were there any complications in your case?

It wasn't entirely straightforward tbh. Waters went first so antibiotic drip during labour, then induction drugs to try to speed everything up, which didn't really work, eventual emergency CS almost 48 hours after waters went and after well over 24 hours in active labour, contractions quite close together for most of it. DD and I were both pretty strung out and not in a great state and I think they wanted to check for infection (GBS risk) and after effects of all the pain relief and antibiotics etc so we were probably checked unusually frequently but I still thought you got checked quite a bit as friends with more "normal" births were checked every 3-4 hours.

I had a home birth and they didn't leave a red book, I got it from the HV a couple of days later!

That sounds exhausting! I think they left the checking mostly to the partners really, I definitely didn't get checked at night.
Massive difference between hospitals/ LAs then.