Do childbirth stories like this make you angry?

[PeaceAndHope]

www.southwalesargus.co.uk/news/9580615.___We_want_answers_over_baby___s_brain_damage______Newport_parents/

This is the gist of what happened:

"Mrs Hard says she had been classed as ?high-risk? due to her previous pregnancy with eight-year-old daughter Reagan.

She had suffered from preeclampsia and a placental abruption which led to her giving birth by emergency Caesarean and left both her and her daughter fighting for their lives.Mrs Hard also suffers from a bowel disorder, therefore she was wary when she fell pregnant with Casey and says she asked to give birth by Caesarean section.

But Mrs Hard says consultants and doctors took a different view and opposed a Caesarean right up until two days before Casey?s birth when Mrs Hard saw a consultant at the Royal Gwent Hospital.

She says the hospital then carried out a full cervical sweep. Mrs Hard suspects that this might have started her labour, though she was not due until November 16.

She claims the consultant told her she would be booked in for a Caesarean section.

But Mrs Hard was suffering pains and went back into hospital on the afternoon of November 8.Despite yet more pleas for a caesarean straight away, she claims no action was taken and, at 1am on the Wednesday morning, Mrs Hard gave birth to Casey in what Mrs Hard says was a traumatic natural birth.

She said: ?It felt like they just had to wrench him out.?

When Casey was born, Mr and Mrs Hard say he was very white and had a very weak cry ?like a kitten?.

He was also having tremors and had a weak right side and his right hand was bigger than his left.

After some tests, including an X-ray on his right hand, the family were allowed home on November 11 and were told Casey would be seen at a follow-up appointment in four to six weeks.

But Casey was screaming constantly, prompting the family to take him to the hospital?s accident and emergency department on December 27.

This led to Casey undergoing an MRI scan on January 18, and the parents were told the devastating news on January 24.

Casey has brain damage to his right cerebral hemisphere and his left frontal lobe.

Doctors said this was due to a lack of oxygen and blood supply at birth.

Doctors have said he will be disabled mentally and physically but the parents will have to wait to see how Casey is affected as he gets older.

Mr Hard, who has also had to deal with another blow after he was diagnosed with a brain tumour eight days after Casey?s birth which he is due to have removed next month, said: ?When I found out we were having a boy I was looking forward to taking him to football and things like that.

?Now all I?m hoping for is that he will be able to walk and talk.?

Mrs Hard added: ?In all my scans he was perfectly healthy.

?We truly believe if I?d had the Caesarean, he would be ok.

?We are so lucky to have him but this could have been avoided.?

Mr and Mrs Hard have placed a formal complaint with the Aneurin Bevan Health Board about what happened within the past few weeks."

I am shocked. I knew that getting a primary elcs was difficult, but I always assumed that if you had already had a CS you got to decide between a repeat CS and a VBAC. I never knew that someone could be forced into a VBAC

I don't think women should be forced into either a repeat CS or a VBAC. I think both options come with a substantial set of risks and each woman must decide independently which she prefers.

Maybe I take these things a little too seriously, but stories like this one make me lose sleep.

That sounds terrible

That is awful, poor woman and family!

Yes! Very angry. Considering her history and the trauma she was going through, she should have been given a CS. No if, no buts! Disgraceful!

How awful!

Poor woman. All the family.

But I would still like to hear the story from the point of view of the hcp caring for her, because I strongly doubt it's as cut and dried as this article suggests. It does hint that the baby may have had congenital abnormalities (asymmetrical growth). Also what the issues were with her bowel problems (for all we know it may have been a reason to avoid abdominal surgery rather than a reason to avoid vaginal birth).

So in short - wouldn't want to sit in judgement on the basis of what's written here.

I second shagmundfreud. Very sad for all the family, but without knowing more I wouldn't want to attribute on blame, especially seeing as it doesn't seem to be just one doctor's opinion or actions that caused this.

In addition to what shagmund saysm given that she wanted a second ELCS (and quite rightly so) why consent to a VE and sweep?

Flisspaps:

The lady had been requesting a CS from the get-go, but her repeated requests were denied. Even when she got to the hospital, instead of giving her the CS she had requested, they ignored her requests.

As for the VE and sweep, I'm sure you realise that many times if the woman is already experiencing contractions a VE is performed even before a CS to check how far along she is. If during the process of a VE they performed a sweep, I doubt there was much she could do other than complain about it (which I'm sure she did). When the sweep resulted in labour pains she kept requesting a repeat CS and her requests were still ignored. As a result she had to deliver vaginally.

Shagmunfreud:
I will credit the lady with sufficient intelligence to realise what will make her bowel problems worse- a CS or a VB. I'm sure she means she had some level of incontinence or piles, both of which can be made worse with attempting a VB. She wouldn't have requested a CS on the grounds of a disorder which can be made worse by it, nor would she have gone on record to say something based on assumptions.Let's not fall into the trap of assuming that the patient is always the idiot.

The issue for me isn't what caused the problems for the baby as much as it is that a woman's justified decision regarding her mode of delivery was denied.
She had already had a CS for her previous delivery and did not wish to take the risks associated with a trial of labour. Every woman has the right to decide whether she wants a repeat CS or a VBAC- neither requests should be overruled based on hospital policy or doctor's preferences.

I also find it concerning that the baby was born blue and not breathing properly. He had a feeble cry and concerning vitals. All these things make me almost certain that even if the mode of delivery isn't fully to blame, it certainly played a part.

PeaceAndHope I understand that she had requested a CS from the start and had been refused (which IMO was appalling, given her history)

However, your OP does say: She says the hospital then carried out a full cervical sweep. Mrs Hard suspects that this might have started her labour, though she was not due until November 16. which I took as she wasn't contracting prior to the VE or sweep as she thought the sweep was what put her into labour, whereas your point is based on her already being in labour at the time of the procedure IYSWIM.

It was me asking 'out loud' to be honest - I agree she should have been given a CS upon request anyway, and that any procedure including a sweep should not be performed without explicit, informed consent rather than just doing it anyway 'while they're up there'!

"I will credit the lady with sufficient intelligence to realise what will make her bowel problems worse- a CS or a VB"

But it may not need 'common sense' to know this - it may need clinical knowledge.

"I'm sure she means she had some level of incontinence or piles"

But you don't know this, so it's unreasonable of you to speculate.

"I also find it concerning that the baby was born blue and not breathing properly.He had a feeble cry and concerning vitals. All these things make me almost certain that even if the mode of delivery isn't fully to blame, it certainly played a part"

Why does it make you certain?

Babies are also born blue and not breathing after planned c/s.

Really -you just don't know. It may be that the mother herself doesn't know what part the mode of birth played in the baby's condition afterwards, or the doctors themselves.

That's why I think speculation is a bit pointless.

On the subject of whether mothers should be allowed to choose mode of birth regardless of any clinical issues - well, I can see the point you're making.

However, the NHS is under a lot of pressure right now, and despite the new NICE guidelines on c/s, doctors may still feel compelled to promote whatever mode of birth they feel is most clinically appropriate as well as being affordable for the hospital. I'm not saying this is ideal or desirable, but it's understandable given the way things are in the NHS at the moment.

However, the NHS is under a lot of pressure right now, and despite the new NICE guidelines on c/s, doctors may still feel compelled to promote whatever mode of birth they feel is most clinically appropriate as well as being affordable for the hospital.

Yes, but informed consent would only have cost a little bit more time and not money, and it doesn't sound as though she was fully informed.

Flisspaps:

I agree. It's quite appalling for them to have done a sweep without her consent.

Shagmunfreud:

No, it does not require clinical knowledge. Research on the internet and a consultation or two with a GP can be sufficient to inform a woman that piles, fecal incontinence, anal sphincter damage and majority of other bowel disorders are risks associated with VB, not CS.

Can you actually list some valid bowel disorders that can be made significantly worse after a CS or are you just making assumptions that such a condition exists? Even if it does, as an adult the lady is free to decide which option she prefers. It is ridiculous to even imagine that she would be ignorant enough to repeatedly beg for a procedure that has the potential to worsen her condition.

You seem to be of the opinion that it is correct to force a woman to have a VBAC in order to save the forever hard-up NHS some money.

I hope the NHS is happy with the £800 they saved on this lady's CS, because they'll probably end up spending 10 times that amount to treat this baby who may have been saved if a CS was performed. I realise that a CS may not have prevented this outcome, but then again it may have. The NICE guidelines you are referring to are based on research that preferring a VB because it is cheaper is a false economy-the complications caused by a VB cost the NHS millions every year to treat. These include surgery for pelvic organ prolapse, incontinence, repairing botched episiotomies and tears, treatment for facial nerve palsy, erb's palsy, brain damage, cerebral palsy and many other such conditions which require a lot of funds to treat.

Peace - are you a friend of the woman in the article? Or the mother herself?

You seem to have an intimate knowledge of her health beyond anything which is apparent from the article.

Or is this just another thread to campaign for elcs on demand on the NHS? There have been a few of those recently.

shagmundfreud:

I don't know the lady. A friend emailed me the article and I decided to start a thread about it. I have compassion and respect for other women's choices which you seem to lack severely.You've made it quite clear the NHS was correct to refuse her a CS and that she must clearly be some misinformed person blaming her child's problems on unrelated factors.

I have no idea about any campaigns started on here recently, because I logged in for the first time in months a couple of days ago.

You didn't answer my question by the way. What bowel disorder do you think she could have possibly had which makes a CS an unsuitable option?

Actually I haven't given a firm opinion either way.

I don't know the details of the story other than what's provided in the article enough, and these are very sketchy.

"she must clearly be some misinformed person blaming her child's problems on unrelated factors."

I said nothing of the sort, only that it's not clear from the article that any sort of clinical review of the case has taken place, therefore I'd assume that the parents themselves don't necessarily have all the answers.

You do know don't you that it's sometimes very difficult for doctors to proportion how much damage in a child can be attributed to events during birth and how much to problems not picked up in pregnancy? This has been the case with the children of two friends of mine, born after difficult deliveries, but later found out to have obscure genetic disorders.

I'm not an expert on bowel disorders, and I assume you're not either? However, I do know that women who have scarring on the bowel from previous surgery may be more at risk of obstruction or adhesions following c/s.

Anyway, I do take on board the issue raised by the article of informed consent, because from the way it is told, it does seem that the mother was given a sweep without proper consent. It's also not acceptable if a mother feels she is not being listened to by medics and midwives caring for her.

Articles like this do nothing to help the situation, merely inflame public opinion. There just isn't enough information to make any kind of judgement.

Given the information in the article I would think that there was a communication issue between the woman and her carers. If she wanted an elective LUSCS and was denied it antenatally she should have got a second opinion. There is no mention of how this standoff had occurred.
The article states the Consultant told her she would be booked for LUSCS but there is no mention of her being given a date despite the fact she was 38+5. Did she not ask when it would happen? Was it written in her notes? We don't know.

I also fail to understand why she agreed to a VE and endured a "full sweep" from the hospital (not the consultant but the inanimate hospital). Poor reporting again.

The baby was reported as being white and with a weak cry like a kitten. Did the baby need resuscitation? Were cord blood gases taken to indicate if "lack of oxygen" were involved? We don't know and it is notoriously difficult to state when an assault on the brain occurred without such vital information. The difference in size of the baby's hands is something I cannot think of a reason for due to labour.
The parents are reported as saying they are sure the baby would have been OK if she had had the caesarean. This is the eternal question asked in litigation cases and sadly it's often impossible to say.

I have questioned the points which jump out at me from the article that show we cannot read this and say right or wrong without knowing the details. That does not take away from the fundamental issue of choice for mode of delivery which it would appear this woman was denied. No woman should be forced to undergo VBAC.