Guardian article about women being turned away from hospital when in labour

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www.theguardian.com/lifeandstyle/2018/jan/15/i-knew-i-was-in-labour-why-are-women-being-turned-away-from-hospital-during-childbirth

This article is about women being told by midwifes that they are not in labour and being sent home from hospital when they are in labour and the baby is born shortly afterwards.

Is this something that happens a lot? I am pregnant and people with the medical condition I have are more likely to have fast labours.

What I'm getting from this is that you should point blank refuse to leave without being examined.

I think it probably happens a reasonable amount. It was one of my fears when deciding on an ELCS (figured I’d lower the odds anyway)

I too had a terrible first birth where I was ignored and made to feel like an absolute idiot when they should have listened to me. Like a lot of you ladies I was quiet, I obviously should have screamed the place down! I was left with PND and PTSD, lucky me.
I'm expecting DC2 seven years on and I'm about to start hypnobirthing classes and am planning a home birth. I won't go near a hospital now unless I have to

Yes - happened to me with DD1. I was in pain and told to take a painkiller and go home as it was too early and I couldn’t possibly be in labour. The worst regret of my life is that I meekly went away and didn’t insist on being examined.

Our local hospital had a bed crisis in December which resulted in women in labour being turned away from the maternity unit. It wasn't just the maternity unit though, my DH was an inpatient having just had a lung removed and had been in intensive care for a week. As soon as he was back on the normal ward, and there was pressure for his bed to be freed, he was discharged within two days, even though the hospital admitted he should still be in, because he had complications from the surgery. We knew there was another man waiting all day in a corridor for his bed. It's symptomatic of how stretched the NHS is all over. Luckily DH is recovering and hasn't developed any further complications other than the cancer spreading, but that would have happened in or out of hospital. It would have been better for him to have been in for a couple of days longer though.

I’ve been told that if I should get pregnant again I’m to not bother calling at all and just go straight in to the unit as soon as I get a twinge. I had a 40 minute active labour and a 20 minute pushing phase for DS1 and no, the midwives didn’t believe me when I said I had to push! Aside from that, I want to say that the midwives on the ward and the post natal care inhospital was fantastic because so many of you sound like you’ve had shocking midwives!!

As a midwife let me explain to you some of the reasons this happens and why midwives can be so reluctant to check your cervix.

A) Once we know you are in labour you are on a clock of how long you've got to be x centimetres by. All women are different and this leads to women having interventions they don't need because they didn't labour fast enough. If we don't check and don't know it buys you more time.

B) If your waters have broken every single examination increases the risk of infection to you and baby so we don't want to do too many.

C) Sometimes there isn't the staff available or a room free to put you in. If we know you are in labour we need to give you a room or transfer you to another hospital, but there are no staff free to transfer you and you will end up delivering in an ambulance. If we havnt checked and we don't know then it buys us time to free up a room and a midwife to take you.

D) Women come in all day every day thinking they are in labour and they are not, especially those who havnt experienced before. Some women are right many are not so if we examined every woman who thought she was then that's thousands of women having unnecessary examinations.

E) The longer you are in hospital the higher your risk of unnecessary interventions and related problems. Staying at home as long as you can is best for you and gives you a better chance of getting a normal delivery. If you are in early labour you will progress quicker at home in a relaxed environment then you will in hospital so sometimes they delay you coming in or send you home for a bit.

It's not right that women are sent home and give birth of course but midwifes are only human and use their judgment to try and do the best they can with limited staff and limited resources and because of this we sometimes get it wrong.

Should add having said that I would never and don't know anyone who would send someone home who thought they were labouring without checking first. But if they are in early labour home is the best place for them.

the examinations don't take long....but the legal paperwork and documentation is a nightmare. so a quick little two finger check isn't quick and it is potentially harmful.

Not turned away, but despite saying I was in extreme pain not believed because trainee midwife examined me and said I was 4cm. She kept getting annoyed I wouldn’t stand still for her examinations etc and was screaming. Clearly something was wrong because I was 10cm about 20 mins later delivering our stillborn son. She was also the only one of all the hospital staff we saw that day who didn’t come to see us after, and then lied (and got caught out for her lies) in the post mortem.
Many many midwives are amazing I’m sure. But the culture of patronising pregnant women and assuming they know better than us is a bit endemic.
Subsequent pregnancy - consultant led. My consultant never talked down to me the way midwives consistently did during the first one. It’s something about not taking pregnant women seriously that really really bothers me. Don’t know if it would have saved my son obviously but that she didn’t take my pain seriously was symptomatic of culture.

Charolais Mon 15-Jan-18 22:17:44
Here in the U.S it has been my experience that when you go into labour you go and see your obstetrician or his mid-wife and if they believe you are in actual labour they send you to the hospital, where you will be admitted. It’s nice because by the time you get there they are expecting you and have room ready.

My experience here in the US has been slightly different.
For starters, OB/GYNs can be women

You have an OB/GYN or midwife team throughout pregnancy and for your delivery.
You phone your OB/GYN or midwife team if you think you are in labour, day or night. They do not ask you to go to their office. This has been my experience in two different hospitals, and with an OB team and MW team. This is the same whether you are privately insured or a Medicaid patient.

If out of office hours their answering service will have your OB/MW call you back. The advantage of a team practice is that someone will always be on call.

They assess how things are going, and will call the hospital where they have admitting privileges to warn of your arrival. It is your call in the final analysis whether to go in or wait at home, and they obv tell you to take traffic conditions into account, but they will advise you to go when contractions get to (for example) a steady five minutes apart, but this depends on your history if you have any.

Even so, they are normally banking on a gradual and steady progression to contractions two minutes apart. My own OB talked to me on the phone at about 8 o'clock the morning DD2 was born, and we agreed I would shoot for a noon arrival at the hospital, where she would be waiting. I was feeling ok, able to speak, was feeding DD1 and DS breakfast, but definitely in labour.

By 9 o'clock I was unable to speak and could barely walk. exH banged on a neighbour's door and asked if their teenage DD was willing to babysit DD1 and DS for a few hours, hustled me down two flights of stairs, into the car, and off we went. We passed another hospital on our way but decided since it was a Saturday (light traffic) we would continue to the one where my OB practiced, with fingers crossed. Waters broke in the reception area, I was triaged, taken straight to delivery suite and DD2 was born approx 40 minutes after we left home. A spotty young lab tech entered the room as I was starting to push, to do my admitting blood draw. I yelled, 'No way, get out!' The OB resident did a great job, taking orders from my OB on the phone. She arrived in time to supervise the mopping up and congratulate me on our choice of name (same as her sister's apparently).

CatchingBabies - that is all ludicrous.
'What we don't know can't hurt you' is the opposite of a medically sound approach.

Your focus on avoiding interventions is very clear. Interventions are the result of evaluation and conscious decisions. They don't just happen - they shouldn't just 'happen'. Interventions are sometimes absolutely necessary.

Women should be checked. Yes, checking takes time and resources. But you are working in a hospital - this is what hospitals and their resources are for. And yes, checking can result in infection - but it is done in other systems to check dilation, and it is absolutely necessary, because delivering in a waiting room or a toilet or attended only by a birthing partner or inexperienced nurse is in nobody's best interests. Same goes for potentially leaving babies in distress during labour - you have to check in order to avoid this. Nobody is suggesting a manual exam, with no gloves, every fifteen minutes.

All this talk of 'buying time' - not all patients have time.

You are describing chaos, attention to very fine details while the purpose of the maternity unit is forgotten.

I was already in hospital when waters broke, nobody bothered to examine me, refused to let my husband come and be with me. By time they examined me as I asked for pain relief I was already at least 6 cm, they messed about trying to get me up to labour ward and I was ready to push. Annoys me that they never looked at me Straight away as husband only just made the birth and my mum missed it completely.

CatchingBabies - the purpose of the Maternity unit is to safely deliver live children to live mothers in the best possible physical and mental condition that can be managed.

The purpose is not to reduce interventions (although preventing infections is a worthy goal). If interventions are necessary they should be performed. And the “clock” that labouring women are put on is based on research by qualified professionals. Ignoring the clock and RCOG recommendations based on this folk wisdom that babies come naturally and that deliveries were so much better prior to this purported medicalisation of labour is frankly idiotic. Many women can and do deliver vaginally with minimal pain relief at home or in birthing centres. But many women have traumatic births sometimes with poor outcomes because of not being listened to by poorly trained midwives who are under the impression that they know best (and in this case apparently better than NICE guidelines etc).

Haven't read the full thread but I'm tearing up - out of pure fury - reading the Guardian article. And extremely telling that the Royal College of Midwives couldn't even be arsed to provide a comment.

This has happened to so many women I know - including one doctor - which, although it wasn't so bad it meant they gave birth in a lift, did mean they were denied the epidurals they were requested.

It was one of the biggest factors in my decision to go private although ultimately I ended up with an ELCS anyway.

Obviously that's unfortunately not possible for most women but the takeaway is you MUST be prepared to be your own advocate, to listen to your body, and to refuse to leave if it doesn't feel right.

I planned a home birth, in part because I didn't want have to go through assessment and turn-away.
When the midwife arrived early my home she said I was not yet at the stage where I'd be admitted to hospital and to call her back out when contractions were 'long enough'

They never were. I laboured and delivered in my bed. But still glad I wasn't en route to hospital which would have been the alternative.

Wow, didn't realise how special DS2 was.
We didn't contact a midwife til after he was born, but ambulance control and the paramedics were absolutely outstanding. DS2 was delivered within 30 seconds of the ambulance pulling up.

DS1 the midwife suggested I went home, but were happy when I said no. He arrived 2 hrs later.

I'm not having no 3, but a planned homebirth has been proposed for any future pregnancies (by the midwives - I understand they don't really like BBA babies!). For those of you with quick previous births and low risk pregnancies, is that something that has been considered?

The documentation is not a nightmare. I can write a ve up in under a minute....

Ve with consent, cervix posterior, 1cm dilated, 2 cm long, firm. Fhhr 130bpm following ve. Advised to go home, happy to do so. Aware to ring back if any concerns, srom, pv bleed or when tightenings are 1 in 4.

Happened with my second child

They did suggest i go home with 3rd child too. He was born an hour later. I had refused, they were trying to find somewhere for me to be for all the hours etc.

I've never had a birth complicatiin but my planned home births have both been cancelled due to staffing. Or the lack.

@VivaLeBeaver 👏🏾👏🏾👏🏾

I wish you'd been there when I'd had my first! I was told I couldn't be in labour. Then they hooked me up to a monitor...oh actually! And I was taken round to DS ASAP. I'd laboured at Home for 17h and even though it was my first I could feel things had changed.

Yes. I was sent home both times despite being in labour (and according to official guidelines needing to be admitted) and told to come back again later. The second time they refused to even examine me the first time they sent me home. Apparently my waters breaking wasn't enough of clue. The only women they took seriously were the ones mooing like cows every time they had a contraction.

They told me to stay at home and have a bath with my first born. I ignored them and went up, good job as well because I was 9cm. Apparently I took the last room.

With my second I had a homebirth the Midwife’s came as soon as I called.

My third the the me refused to put me though to the homebirth team as I wasn’t in labour I rang the other number to find they had just been called out to someone else. I went in even though apparently not in labour. My baby was born within 45minutes.

They seem to think of you can talk and not scream though contractions just breath you can’t possibly be close to delivery. I also don’t contract regularly which really messes with their heads even though it’s in my notes they still didn’t believe me with number three.

I think the issue is that women in labour do not get listened to.

I was induced due to PROM with my first child and within 10 mins of coming off the monitor I was having contractions two minutes apart. The midwives didn’t belive I was in labour as I wasn’t screaming, although the I was telling them my contractions were incredibly painful, and I wouldn’t even be 3cm dilated (they wouldn’t examine me) 30 later I told them I was pushing and the found I was 10cm! According to my notes I spent 1 hour in active labour (which they must have made up as during my labour I was repeatedly told I wasn’t in labour!)