Why is maternity care so crap in the UK?

[Oohooh]

I’ll start by saying I’m sure some of you have had good experiences, but virtually everyone I know seems to feel their care was substandard, and not just due to pressure on the system.

Particularly if you are induced or have some kind of risk factor it feels like women aren’t listened to or believed if they’re in pain, are denied pain relief, are left to labour for hours without any kind of proactive support or help to avoid instrumental deliveries. Then ignored on the postnatal ward as they struggle to care for the baby.

My first experience was okay-ish although the pain relief took hours to come and they just shrugged their shoulder when it didn’t work rather than offer me anything else. Second time was utterly dire - induced, left in a tiny cubicle behind a curtain until I was 10cm because ‘you’d be making more of a fuss if you were in labour’, midwife lied in my notes (for which I received an apology and she was allowed to carry on), denied pain relief, crucial medications not administered resulting in a poorly baby - just awful. The whole thing felt completely out of control.

And obviously some maternity units are so bad they’re subject to public inquiry.

What’s going on?

Both births I had to wait 6 hrs for an epidural when I had absolutely reached my limit for pain. It felt barbaric, particularly as my body doesn’t progress beyond 5cm without one.

I’m a ‘difficult’ patient. Everyone I know has some form of birth trauma. I did a lot of research prior to giving birth, wrote a consent based birth plan and advocated for myself, loudly.

In order to avoid the ‘cascade of intervention’ I tried to have a home birth, but after being in labour for 5 days and exhausted, they sent me to hospital. Thankfully the staff there were lovely.

2nd birth, at a different hospital, was treated appallingly- midwife said my baby might die and it would be my fault because I couldn’t sit still for continuous monitoring (absolutely no reason for concern, continuous monitoring isn’t even necessary when labouring naturally) another 6 hr wait for pain relief, then threatened with Social Services because I wanted to go home (natural, straight forward birth, no complications, both healthy). I’m always out the door a few hours after birth.

I’m pregnant with no.3 and we are going private for the birth- 10k just to ensure I’m not left screaming in pain indefinitely again. Ridiculous.

By the third baby I stood very firm.
The baby turned late from breech to normal. I only allowed the planned section to be cancelled once the consultant guaranteed I would have an experienced midwife with me for the entire labour.

In the end dd was very late and I was induced. The pessary had little effect. A registrar came along to examine me and I said he could not examine me to break my waters without a discussion post examination and explicit consent. He walked out saying "she knows more about childbirth than me, very rudely". I was clear that he was not to attend me again in any capacity. The midwife apologised for his conduct.

I had another pessary and the midwife said it could be reviewed when there was a shift change.

Hours later my waters broke. Still no sign of Contractions. The midwives wanted to start me on oxytocin and I refused unless an epidural was done first. Which they agreed to. It wasn't a long wait but labour started to get underway. By the time the epidural was in, there was no need to turn on the oxytocin. I delivered an 8lb13oz baby two hours later, with fantastic midwife care and no stitches.

I had to stay in for a few days due to an underlying condition. One post natal midwife was very rude, she asked me who I thought I was taking up a side room (that I was paying for). I asked who she thought she was speaking to and suggested she should read my notes. At the next interaction with her, she was as nice as pie.

In my experience, many midwives are dismissive and think they speak to people rudely and badly. They would not get away with it in any other sector.

The above relates to baby No 3 and I was an old hand by then, in my late 30s and had learnt to take no shit. Taking no shit helps. Regrettably many women do not have that confidence or experience and are significantly more vulnerable than me.

A great deal of the issues relate to the fact that for generations we have been made to feel grateful for the simply spiffing free NHS. Gratitude has been peddled as essential even when care is sub-optimal on the basis of having a free service. When things are packaged as free it takes away the motivation to complain about poor service, poor pain relief and poor clinical standards.

Women have been their own worst enemies in relation to this and there has been thread after thread where a woman who has had a bad experience has been told to sick it up because she and her baby are alive and the NHS is free and we must be grateful it is available.

The NHS in NOT free. It is free at the point of delivery and even where some women are not net contributors their NHS care is funded by those who are net contributors because that is the nature of progressive taxation.

Other first world countries have better systems. The NHS is no longer fit for purpose.

It’s known as horizontal/lateral violence.
https://www.relias.com/blog/what-is-lateral-violence-in-nursing#:~:text=Also%20referred%20to%20as%20horizontal,or%20harmful%20behavior%20between%20coworkers.

I haven’t given birth but going to go out on a limb and say underfunding, understaffing coupled with women’s health generally being taken less seriously and misunderstood.

In my experience this sort if behaviour prevails where groups of women work together at non professional levels. City secretaries were foul in the 80s. In education Hair & Beauty departments are equally foul and toxic. Women whilst wanting equality do not always behave well to each other.

I just wish everyone with a bad experience mad a proper complaint.

Youngest is 15 so all under Labour Gov I think - great pg care in one area appealing postnatal ward lack of care - other areas just awful care.

We did complain - during pg as did my Dsis in an adjacent area and we had proof and our claims upheld in department - the outcome was being told we were right and had suffered inexcusable problems and then got considerable poorer care for rest of pg.

We complained again post birth to manager - as the care in Labour was life threatening poor - it was managed away - would be looked into and had no further response and frankly neither Dsis or I were in a position to do more because as well as babies rest of our lives were going haywire.

Found out much late many mother has made that effort to actually put in written complaint - all managed away only case it went further was case baby died because they weren't listening the mother saying something was wrong. Also weren't only people to find medical notes bore no relation to actual events and written/re-written afterwards.

My DSis child was born with problems needing treatment - 18 month after they should have been sorted she got transfer to another hospital who were so concerned at poor treatment they ask her to complin - as part of that she had to ask for her child medical records - they went missing. We spoke to others - well know issue to point she should have been warned to get notes before mentioning any complaint.

It put my parents off complaining about really poor treatment in latter year in elder care because they feared negative consequences.

I think there are many issue staff retention money but also poor attitude haven't been routed out but covered up and allowed to flourish and spread.

In my local hospital there are no private rooms - all is 6 bed wards postnatal. Although you do get your own room for the delivery of course.

I know of complaints for a respiratory ward who took four hours to give out just paracetamol to a cancer patient .It's not really just women It's the whole of NHS .

Totally agree with others about midwifery and the whole “natural birth” stuff. I was so relieved when the anaesthetists/surgeons/consultant arrived (after 46 hours of labour) and spoke to me like an actual human being. The midwives (bar 1 lovely lady) all acted incredibly disappointed that I wasn’t “performing” and one even said “you’re going to go for a section aren’t you?” and rolled her eyes as she walked away. I understand there are some brilliant midwives out there, and it’s terrible how underfunded maternity services are, but my personal experience was not great.

A midwife can’t be expected to remember everyone’s name.

I gave birth in 2022 and had an awful experience, mainly due to being induced when baby wasn’t ready to come which resulted in forceps and a huge PPH. No idea why the NHS pushes inductions so much because they must end up costing them more than elective c sections. I found nearly all the midwives to be generally unpleasant, one actually was so awful she made me cry. The only people who actually spoke to me nicely were the anaesthetists who did the epidural! The whole system needs an overhaul. Also, my closest nhs hospital is all private rooms/nice facilities, the only positive about the experience, still rated inadequate though.

@StormingNorman perhaps not, but women's names are on their notes and written above their beds. It would be helpful to address women with their names, rather than as "mum" or not at all to at least make sure they have the right woman. Notwithstanding exercising basic courtesy and good manners.

Surely our highly skilled, post graduate educated midwives can manage that. If not, God help us. It would go a long way to dehumanising the process and there is nonexcuse for not being respectful, at all times, and I agree that works both ways.

I was shouted at in labour and post natally, I was also laughed at for being in pain at 1cm. The manner in which midwives too often behave towards women is totally unacceptable. They would not do it if the women were not vulnerable and unlikely to put them back in their box.

I posted already, I had a hysteroscopy in Belgium last week under general anesthesia. Day procedure. I think your experience was unusual.

RomeoRivers, 2 hours research and you're a RM or a Consultant Obstetrician! I hope it doesn't but guess where you'll be going if things start going wrong, NHS or tens of thousands more if you stay private. Your 10 grand will be like a 5 percent deposit on a £200,000 house.

When I was staying on the postnatal ward, the midwife who had looked after us the day before, had a conversation with us about what was going on, when we'd be discharged etc. I went to talk to her again about 10 mins later. She had to ask me what bay and bed I was in as she'd already completely wiped me from her memory (or only knew me as a bay/ bed number). No-one is paying so little attention could provide even adequate care.

You might not think it's part of your remit, but I guarantee there are women out there shitting and pissing themselves now due in part to professional decisions you made during their labour. Indifference to that is to my mind a problem.

Dogma is always a problem.
Medicalization is a problem too.
They can both issues.

In an under resourced service people are more likely to hold to heuristics they feel comfortable with or have become normalized as they don’t have the bandwidth to look or think about the individual patient or really take on board learnings from their practice.

I am one and done because of my experience.

I know there's no such thing as toxic femininity but the health care professionals when I had my first baby displayed a lot of it.

Every morning they would shout 'you're pregnant not sick' to the stuffy rooms of women crying and trying to shuffle about to get some breakfast. Some clung to the walls just to walk.

It was a culture displayed by every single person who worked there of 'woman up, stop moaning.'

I won't go into the details of my birth but this is not a funding problem, it's a culture problem.

Midwife on the postnatal ward is routinely caring for 8-12 women PLUS 8-12 babies (more if the woman has twins). So it's 16-24 human lives and 16-24 different care plans in a spaceof a 12.5 shift(including 1 hour lunch break which the midwife is lucky to take). The reason your midwife had to double check your name is not due to lack of care or professionalism. I can assure you of that as I used to work as a postnatal midwife myself. This insane ratio of women to midwives was set up in the 1970s when women used to stay on the postnatal ward for 10 days and far fewer women had Caesareans. Please don't blame the midwives, we are are doing what we can with the resources that we've got (those of us that are still in the profession).

I understand there are staffing problems but if the midwives have no idea who you are (it wasn't just she didn't know my name- no midwife referred to me by name during my 4 days on the ward so I suspect none knew that- she had no idea why I was there, how long I'd been there, what my needs were or baby's needs) they simply cannot provide any care.

I spent three days there for "feeding support" and only one midwife turned up to help once; I had to ask repeatedly for my catheter to be removed because there were no staff to empty the bag so I was just lying there, desperate for a piss with a full bag attached. That's a lack of care that goes beyond low staffing - even if she had 10 other women to look after, surely you could still be seen for 5 or 10 minutes every 4 or so hours?

I remember when I went in for a planned c-section and I didn’t have any kind of admission paperwork completed and I was just plonked on a bed and told I’d be going down in a few hours.

The day after my c-section I was taking my medication as I have epilepsy and a history of SVT and a midwife saw me taking it and she said, “what are you taking?”

When I told her she was really confused and said, “I didn’t know you had those conditions, you can’t take your own tablets you need them to be prescribed by us so we can give them to you.”

I was horrified. The whole reason for my section was because of my epilepsy and heart concerns and they had no clue about them! I can’t tell you how bemused I felt at the fact one of their patients had epilepsy and previous SVT (taking beta blockers) and they didn’t even know.

Do they not read medical notes at all?!

And the worst part was, when it came to take my next dose on the next shift, I buzzed the midwife looking after me to ask for them, and she had no idea about it either. It hasn’t even been handed over to her.

I told her not to worry about it and used my own supply from my hand bag again. I also took my own paracetamol and ibuprofen when needed as they never appeared with those when I asked either.

I didn’t find midwives to be very caring. Mostly they were overbearing and dismissive, eye rolls, huffing tutting. Being blamed for being in labour, in pain and terrified. Understaffing is probably the cause of this burnout overall. But I’m so glad I never have to go through labour again.

@Kosenrufugirl interesting point about the ratio being set up in the 70s when women stayed in hospotal for 10 days and mostly hadn't had caesareans.

My mother stayed for a week in 1960, when the length of time was cut from 10 days to one week.

The principle reason why care is bad is because women have put up with it on the basis of having had a free birth. There is a despicable culture of gratefulness around the NHS because people think it is free. It is not.

Every woman needs to formally complain about poor care and copy their MPs.

I am sorry to hear about your experience, it sounds truly awful. I work in a good hospital, midwives on the postnatal ward only get allocated 8 women and 8 babies each. The managers will pull all strings to get the postnatal ward shifts covered. As a result it's a popular hospital to have a baby and to work. Still it's 16 human lives and 16 different care plans per midwife. If the woman needs breastfeeding support that baby is probably not pooing and weeing and so at risk of excessive weight loss and jaundice. Baby also needs vital signs and wellbeing check. You had a different care plan - vital signs, pain relief, mobilising, catheter removal (it's my guess). Devide 16 human lives into 12 hours - realistically how many minutes can you spend with each patient after allowing for documentation (which is a legal requirement) and ad hoc tasks for example delivering discharge talk, calling neonatal doctor to come and review a baby, fetching formula from to fridge to a mum who wants it or answering a dad's query "When are we going to be discharged?" I repeat mine is a good hospital, with only 8 women and 8 babies per midwife. 12 and 12 is routine in many other hospitals. I only lasted 1.5 years on the postnatal ward, I have dyslexia and I got occupational health plan to move to another department. My friend started having panic attacks and quit midwifery altogether. I wish things were better with maternity care. It's not going to happen until it's funded better

A variety of factors!

Understaffing certainly seems to be one.

The ideological nature of some midwifery practice - explaining not offering pain relief etc.

Increased medical intervention meaning more complicated labour eg inductions and instrumental births.

My birth sounds like your second one OP - induced, left in a curtained cubicle on a ward to labour, no pain relief, refused to check my progress, no privacy, had to beg for a room, birth pool not available, failed epidural, uncaring midwives, days-long labour, forceps, birth injuries, no post-natal care on ward etc. Even weird basic stuff like not being provided with food or drink.

The impression I got was that as long as we
were both alive, anything else wasn’t really seen as important. The majority of women I know have had similar experiences.