To expect continuity and possibly quality of antenatal care in central London?

[merryberry]

This AIBU is a lot about letting of steam and organsing my thoughts, but if you can make it through this endless post, I would really appreciate your thoughts.

I am 27 weeks pg with dc2. Having just had a poor experience for the nth time at the hands of the NHS. What do you think I might expect/request for the rest of my pregnancy? I have a meeting on Friday with the relevant head of midwifery where I can discuss these concerns.

Problem: shared care between hospital and GP when the relevant professionals NEVER see each other. And where I am asked not to have bloods done at my local GP but go into hospital as the results will get lost otherwise. What's the point? Am I just a burden they are splitting the cost of, or is this supposed to help me someway?

Problem: seeing a midwife in the hospital where I'd like to give birth. I saw one when I was booked, who was working out her notice and didn't know who I would see next (not specifically who, actually which team of midwives). My next appointment with hospital midwives is actually the head of midwifery as she controls access to the midwife led birth centre I'd like to go to. I carefully booked the date months in advance for Thursday pm when I could get childcare, so I could concentrate on the meeting. It's recently been changed to Friday lunchtime when I can't get care, and I couldn't rebook to another date before Xmas. I'm going anyway with ds1 in tow and fingers crossed I can avoid crying in front of him. Am I just being airyfairy to attempt appointments that work around my life, or should I expect my life to work around the appointments?

Problem: seeing a midwife in the community. I can't. I live in the hospital's catchment area, but not the community midwives for the hospital. Anyone heard of this before? Can it be right?

Problem: seeing my GP for antenatal care. He's nice in that space-cadet overworked fashion medics often are, but every time I see him he asks me why I'm not seeing a midwife. (Answer, because you told me I can't). When I last tried to see him for my 22 week appt, I called 10 days in advance of week 22 but couldn't get an appointment for 5 weeks (ie 25 weeks PG). Wonderfully, he called back and said that it was up to me whether I bothered to see someone else at the surgery, he personally thinks that the 22 week check is mainly meaningless and I could save my effort for the 28 week check. So I didn't bother, especially given I'd just had in-patient care at 20 weeks and knew everything relevant was fine (bloods, BP, fetal heartbeat). Was that irresponsible? I was given the impression today by my endocrine consultant that that was a flaky choice/advice.

Problem: conveyor belt care that doesn't work, part 1. Today I had this endocrinolgy consult (every couple of months these happen). I attend a mixed antenatal clinic where there are 30-40 other women waiting for a variety of services. My notes got lost in the melee, after 1.5 hours I politely asked to reschedule as I had to leave, and was there any chance of just doing my bloods before I left? I was treated as if I was absconding from high security by the HCAs, whipped into see the consultant 10 minutes later and told I looked stressed by her! Cue tears and 'I don't trust the NHS, this is not your problem but I can't stand it anymore' breakdown from me. Did a bit of our consult (no blood test for thyroid function, no time). Couldn't stop leaky eye crying all the way home on the sodding bus. Anyway, is this par for the course, or is it worth a complaint/suggestion letter??

Problem: conveyor belt care that doesn't work, part 2. I was in the neighbouring hospital as emergency admission at 20 weeks when an ovarian cyst popped painfully. I was misdiagnosed with D&V despite lack of D or V, had to argue with 3 people for antibiotics (which worked) and was not given an ultrasound during a 60 hour admission (Sat-Mon). Neither were the two suspected ectopic pregnancies over the ward able to have ultrasounds during that time. I got a scan on the Wednesday from my main hospital: was actually my 20 week scan and the sonographer had a look for me and pointed out the remants of the popped cyst. The fact there was no ultrasound at the weekend for a major teaching hospital with a large maternity unit still leaves me blinking. Any thoughts about this?

Is this all fragmented shite that I should agitate about, on my behalf for now, and later on others behalfs? Or should I gird my loins, get over myself, wax my stiff upper lip etc? I think I am being reasonable when I judge it all - the sweet suffering overburdened individual staff members excluded - a steaming pile of shite.

Some important context:

I enjoyed my last labour despite the fact it was poorly managed by A.N.Other central London hospital - I'm not going back there. They dehydrated me, screwed up a simple induction and discharged DS with severe jaundice. He was readmitted to my current choice of hospital 12 hours later into NICU for 8 days. Guess what I'm saying is - 'aw, but you have a healthy baby' is not a cop out for poor care. I didn't have a healthy baby last time round.

I've only recently stopped working clinically, scientifically and managerially for the NHS after 20 years, and again probably know way too much about how it (doesn't) work.

Thank you for reading all this. War and Peace it ain't.

Well, my first thoughts are that this is shit, but that won't come as news to you.

Yes, you probably do know too much about the way the NHS doesn't work, but your judgement about what constitutes poor quality of care is the same as mine: lost notes, broken appointments, doctors and midwives who don't have a clue who you are and why you're there.

Do you think discussing it at a senior level will make a difference?

totally sympathise, it all seemed really familiar to my experience in london, esp the 'shared care' (aka no one taking responsibility) nightmare. I worked in the NHS too and I think having had that experience made it worse as I knew if I wasn't hearing about test results ect it meant I was lost in the system, rather than everything was ok.

Looks like the above should be sent to the PCT Chief Executive... hope the meet with the head of midwifery goes ok.

I completely sympathise with everything you've said here. Unfortunately, I think the majority of women giving birth in London NHS hospitals feel the same. I'd bet my bottom dollar that those who haven't had a 'lacking' (ie. fairly shit) experience of the NHS have had very straightforward pregnancies and quick, uncomplicated deliveries, so effectively didn't have to rely much on the medical profession for anything much.

I do think it's worth writing letters of complaint (or as you've arranged, seeing the head of midwifery), if only to get your own thoughts organised and (sadly) to log your dissatisfaction if for any reason in the future you need to refer back to it if things go wrong in any way. Whether it will make any difference to the level of care you receive...I don't know.

My personal story:

I was stunned at the completely crap midwifery care I received throughout my pregnancy. In a total of 14 appointments I saw no fewer than 12 midwives. Nobody knew my name, and most of the time, they had barely read my notes and I was explaining the same thing over and over week in week out. Their handover from one week to the next was non existent, so that both times when I turned up to have my Anti-D injection they didn?t have it, meaning I was given it a fortnight late both times. They never once weighed me (when I asked to be weighed they said I didn?t need to be, that I was fine), and I was never offered testing for gestational diabetes. (Infact, I put on over four stone in weight and had a 10lb baby, which coupled with other symptoms, led my GP to believe that I had suffered gestational diabetes without knowing it ? a dangerous condition that could have badly affected my and my baby.) I suffered from excruciating Symphysis Pubis Disorder, and couldn?t walk without crutches after 35 weeks of pregnancy, yet the midwives were dismissive and I was told it was ?just part of being pregnant?. At the time, I remember feeling quite let down and thinking ?surely people came into midwifery to actually care for pregnant women??, but I put it down to a badly over-stretched and under-resourced, inner-London NHS practice, and tried to keep my chin up. In retrospect, this was all preparation for the treatment I would receive during my son's birth. My son was one of the 'at least you've got a lovely, healthy baby!' babies...but my whole experience in A.N Other London hospital was shockingly bad. From negligent, incompetent midwives to horrible brusque nurses to patronising consultants - the whole thing left me feeling traumatised. I dread ever giving birth in an NHS hospital again.

Another epic post, and I could have gone on much longer!

YANBU - but I don't know how to advise you, I'm afraid.

Gizmo, honestly I don't think it will make a generic difference, I think the services are too far gone at all levels to be stitched back together. I am willing post-4th trimester to make some efforts to help improve the situation. Not right now, got enough on.

And I don't know about complaining at a senior level for my own case for the next few months. Will it make things worse? I don't know what are reasonable expectations anymore? TBH, I think mine are very low. I'd manage with conveyor belt style shared care etc, no continuity, if only I had any trust left it was actually safe. When my safetly feels so threatened now though, I do need some assurances. God I feel sorry for this HoM landed with me on Friday with overtired toddler and years of maternity care woes stacked up!

It's hard isn't it? You can put up with all the disorganisation and fecklessness to a point, but when you begin to worry about the level of medical care you and your baby will receive it's a whole other ball game. I discharged myself early from hospital after my son was born because I just didn't feel we were safe there. I had to tell three different shifts of staff that my Anti-D injection needed to be administered after my son was born. I finally had it 71 hours after he was born after getting out of bed (with drip and catheter attached!) and having strong words with the midwife on duty After 72 hours it isn't effective, and any future pregnancies could be threatened (I have just had a m/c and still have a niggling worry about this...). The final straw was letting a midwife take my son away 'to give me a rest' and finding him on his own in a mobile cot in the middle of a busy hallway with the 'security' doors wide open. I checked out immediately.

I had reason to write to my head of midwifery at around 34 weeks with a complaint which I copied to my MP, the RCM and the head of the Trust. This produced a soothing letter and the issue I was complaining about got sorted, but I'm in an area where the management of midwifery services is a bit more straightforward than yours I think.

If you're worried about becoming emotional, perhaps something written might be the order of the day. What, specifically, do you want to happen for you? It's often tempting to try and fix the whole system, whereas it's actually more fruitful to just concentrate on pushing for the care which is your right.

merryberry, no advice really, but wanted to add sympathy/empathy - I'm 24.5 with first, and went for my midwife's appt this morning. She seemed surprised I was seeing her and not my GP - but having never done this before and not having had it explained to me at any point, I had no idea that I was supposed to be seeing my GP for shared-care appts (and any case, the hospital had booked me in without my requesting the appt ... ). After I asked her about the possibility of a home birth (partly because I feel uncomfortable with the mat care at the hospital), she told me that although I was in the catchment area for the hospital (EGA) I was not in the catchment area for their community midwives (is this the same as the problem you have?) and that if I wanted to have a home birth, I would have to transfer myself to another hospital (Homerton). The whole thing is exhausting, confusing and unconducive to a stress-free pregnancy ...

LoveAngelGabriel, my god, someone else such similar woes. I am sorry to hear it, did you manage to complain at all last time round? I didn't, because my dc1 was born on the day of london bombings and my AN Other hospital took a lot of casualties in while I was post-natal: I've never been sure how much that lock down of the hossie and the staff travel effected our situation.

But you know what? You sound like you might know how i feel with this increasing sense of terror about having to have another NHS birth experience soon. I've just realised that that is what is building up in me

Yes gledhill - it doesn't help at all anymore, having insider knowledge, does it?

Merryberry, do you think you might contemplate a homebirth?

I had a rather woeful time with DS1 (although nowhere near as bad as yours or Loveangel's) and decided that a homebirth would be a much better bet, purely because I knew I would get one midwife who would be able to concentrate on me throughout labour. Which worked very well.

Of course it won't help with your antenatal problems I'm afraid.

Thank you for your input, have to go to ds now then out to singing group. Ironically, it's a charity concert for the NICU of the hospital which didn't have ultrasound...don't expect our thrupennce ha'penny is going to help overmuch?

I look forward to getting back to you all tomorrow.

Not sure why you can't see a MW

I was sort of out of area so just had to go a bit further to see the MWs at a different antenatal clinic

I don't see the problem with shared care as you have your notes and all the checks are routine and your GP should be able to do them

Merryberry - I didn't complain in writing, and I bitterly regret it. I suffered from very bad PND after my son's birth and I felt unable to calmly and rationally express how I felt about the whole thing (I was too busy screeching at my poor husband and crying into my pillow!).

Also, I moved to a different area of London not long after my son was born and found the local clinic and Health Visitor care in the new area as completely disorganised and mad as the antenatal care had been in the old area - sad and disheartening, and leads one to to believe it is a wide spread problem. The hospital in the new area was also pretty grim. I haven't had experience of it's maternity unit, but I was treated as a gynae in patient and my God if I had been a News of The Screws-type hack I could have written a great expose of the filthy wards and incompetent staff. Depressing stuff.

merryberry, i COMPLETELY sympathise with you, I felt exactly the same way in my pgcy #2 last year. Completely in despair at the lack of continuity, and the fact that I didn't feel my concerns were being noted at all. I had terrible insomnia, which combined with work and a toddler, was totally killing me and I think in retrospect I was suffering from ante natal depression, as I felt completely desperate for much of the time, couldn't see how I could get through to the end of my pregnancy, was worried I wouldn't bond with my baby, thought I was going mad, etc, etc, etc. The final straw for me came at my 28 week midwife check... she asked me how I was, and I was struggling with tears and trying to articulate some of all of this that was going through me, and she asked me "have you had any bleeding"? I said no, but... and she wrote "patient fine" in my notes. I then had to try and tell her that no, this patient wasn't really fine, I was exhausted, was sleeping 2-3 hours a night, and not sure I was going to get through another 2-3 months or whatever it was. She said "try to get a bit more sleep" (!!!!!!!!) and asked if I had ever tried having a glass of hot milk before going to bed.

Anyway, went home, feeling totally desperate, and in the end, we scraped together all of our cash, and I jumped ship to the private system. Found myself a lovely ob/gyn who listened to all my concerns, helped me with my birth plan (was also dreading labour #2), was NEVER patronising, always had time for me, and from the moment we signed up with him, I felt 10000 times better. Had a fab birth, feel positively nostalgic about it, thinking back. An altogether different, more positive experience.

Really don't see why one needs to go private and pay a LOT of £££ to be able to feel looked after, but that's the way it seems to be (I am also a central london girl). I was very lucky to have a fab and very supportive gp, who was great at helping me deal with my very very black feelings, but certainly not having to dread the labour as much was a massive help.

I think if we hadn't been able to go private, or if I hadn't found an nice ob/gyn to look after me at that relatively late stage, I would have tried to find an independant midwife or doula or SOMEONE to provide SOME element of continuity of care. Gizmo is right, you need to concentrate on looking after yourself and your needs, rather than trying to put right a system that in my experience seems to be getting worse rather than better. Sorry for the long rambling, it's just that I might as well have written this post last year....

You're doing really well merryberry, in spite of all the crap that seems to be going on.

It's especially tough when you've been on the other side in the NHS and know what you would expect in the same situation.

I do hope the HoM is sympathetic and helpful on Friday.

You have my sympathy - i have no experience of london hospitals as a maternity patient - but my grandfather was in one recently and his treatment was appalling.

My parents wrote a letter to the PCT, and copied to various others including the local MP. They got a reply and subsequent apology for his treatment. (I wont go into details as it was very upsetting and I couldn't believe that people could treat other humans like this).

However we hope that the letter did some good and so I think it is definatley worth complaining. You might help others as well as yourself.

YANBU to expect quality and continuity of care... but i very much doubt whether you will get it.

i went to independent midwives for dd having had a crappy experience with nhs first time round.

oh and as for "sweet suffering overburdened individual staff members" the "system" isn't an excuse for the ignorance, gradgrindian attitudes to labouring women and the inevitable "so what?" shrugs if you question any aspect of the process routinely exhibited by some (not all) staff members.

Magic, have 10 mins before leaving.
Gizmo, homebirth not really an option: we?ve got 3 storeys of steeps twisting stairs I don?t want to manage in labour, I?m not in the catchment area for any hospital?s community midwives and dp and I both still cling to the feeling that as I?m 40 and, um, large it?s best to be close to help as possible.
LoveAndSqualor: yes, exactly that problem. Except I can?t get transfer to Homerton as I don?t live east-ish.
TheBlonde, yes it sounds so simple doesn?t it ? except my GP often doesn?t have appts available (am going to book all others for next year in tomorrow!) and doesn?t seem to think I need the routine care prescribed in this PCT! And when I do pitch up for appts, they routinely get them wrong. Plus like others have said, you end up just doing the basics, repeating yourself and not actually getting CARED for.
LAG, I am sorry to hear you are had a rough time. It does sound like its pretty widespread doesn?t it.
Orangina ? we have contemplated the whole scrape the barrel for funds for private birth scenario. What was the bottom line for you? How much did it cost? Did you have a straightforward PG and birth then? I?m pretty sure that we?re going to have to get some kind of late booking for doula/midwife, someone to back me and dp up.
Michie40, I am very close to complaining this time round, before things go wrong. I think you are right. I really sorry to hear about your granddad, I hope your complaint made you all feel better and the next person in his situation be better cared for!
Bossykate, oh, I hear you. And I pull the muppets up with no reservation at all when they are being muppets.

actually love and squalor, you may have seen me this am and i may have seen you: was there from 0940 til 1130 with cute blonde 2 year old boy. i was wearing grey and looking cheerful until i tried to leave and they got heavy on me!

God this is all so familiar, not just for my pregnancy but also in everything to do with the hospital care my elderly and sick parents are receiving at the moment.

It isn't the doctors and nurses, it is the system. Managing your way through it is an absolute nightmare and for sick, elderly, uneducated people (as my parents are) it is impossible.

My sister and I are spending masses of time negotiating admin, red tape, misunderstandings, mis-communication, contradicting communication at the moment.

I just thought all hospitals were like this in the UK not just London ones - am I wrong?

YANBU and its not just central London where ante-natal care is shite. I would complain -I wish I did after my DD's birth.

merryberry you poor thing. Pregnancy is meant to be a happy time isn't it? Not a stressful one marred by visits to these uncaring 'professionals'. I was in Lambeth where the standard of 'care' was shocking and actually considered moving to my parents' place up north coz i was so scared.

I ended up using www.birthcentre.com/ in Tooting. It was the best decision I ever made (apart from moving out of london!)

Sorry for the unnecassary use of 'coz' was just typing my literal thoughts!

This is the care that you should be getting. When you complain and please do, cite it. I have found it very effective. (Just read the exec summary)