Birth Reflections

[trafficwarden]

I am interested in setting up a birth reflections service in my unit since I read of so many women who are unhappy with the care they receive or need clarification on the events surrounding their baby's birth. As is so often pointed out here, as a labour ward Midwife I rarely see women after the birth so the long term effects are not immediately evident. (This was not the case when I worked in a smaller area where I often met women regularly at the shops or saw them during their subsequent pregnancies and births).

I despair of colleagues who place so little emphasis on holistic care but deem themselves excellent clinicians - they may well be, but if you can't smile, be polite and make sure you are communicating clearly and listening properly you are not doing the job right.

So, since there are a lot of posts saying how good the birth relections service can be - what made it so good? What happened or what would you like to happen? I am reading a lot about birth trauma/PTSD and if there is anything I can do to make life easier for someone and help her get treatment or counselling then I want to do it in the best way. I am in no way qualified to do more than listen and empathise at the moment but I believe that is always a good place to start.

I'm currently 29 weeks pregnant and seeing a counselling mw due to my previous traumatic delivery 4 years ago. It's really helped me to reflect on things, and confirmed my desire to have an ELCS this time. Although she's been fabulous, I do have a few suggestions for you:

• my old notes have got lost and never been available for my appointments (they've now been discovered in a different hospital due to an admin mess up) but they've been requested several times since I first saw anyone at 21 weeks, it's only now their location has been ascertained, so I've seen the counsellor twice and an obstetric registrar twice to supposedly discuss my previous delivery without anyone ever reading the notes! Having them ready and available would have saved my time and theirs.

• my appointments with the counsellor have been on the MLU. One was even in the very room where I laboured last time, a mw tried to put me there today to wait but I refused. That room holds bad memories for me and I don't think that it's an appropriate place for counselling about previous traumatic deliveries.

• I wasn't aware that the service even existed until I requested a CS. All women, particularly those who have suffered traumatic deliveries (although I suppose that everyone's idea of what constitutes a traumatic delivery is different) should be made aware that such a service exists within a few weeks of their delivery.

Sorry for long post and bullet points! Good luck with it, you'll help a lot of women I'm sure.

Traffic, I 'know you' so know you are talking about a service where women have been let down most likely unintentionally by good people who could improve their practice with feedback and information.

However, in my case, the birth reflection service could never work because the SOM was protecting my mw who observed a SHO deliver my baby using fundal pressure but did not write it in the notes. Denial of my experience as cannot have happened since It is not recognised Obstetric practice and implication that I was too vulnerable/drugged/stupid to have remembered correctly was actually what CAUSED my trauma, not the act itself iyswim.

You might need to think about what happens if you get someone with a story like mine and how you might approach it.

My counsellor approached my situation by apologising for it - I refused a ventouse but it was performed anyway - I was drugged up and exhausted and too weak to argue beyond saying that I didn't want it, I wanted to go straight to section - which is what I ended up with anyway. Although without my notes I can't be sure what is documented the counsellor has said it's very unlikely to state my lack of informed consent - she still believes me, apologised for how I was treated and has said if I decide to complain higher about my treatment she'll support me - I don't think I will - 4 years on the SHO and registrar will be long gone and although I still have some anger towards what happened (and even some anger towards myself that I didn't argue further), despite a huge bruise and swollen face dd was born healthy which is the main thing. No one has said that I'm remembering wrong, that's a shocking thing to be told

Thank you both.

Amandine Rather insensitive to ask you to meet in the room from which you had such bad memories and very frustrating about the lost notes. They do appear to get lost in a black hole sometimes. Interesting about not knowing the service existed. How do you think it wuld be perceived if it was widely advertised antenatally? Would it scare women into thinking problems were inevitable? I don't think so but could imagine the hospital admin having other ideas.

Starlight Hello I can see where the system failed you there. It has been said over and over again that when a complaint is made, for whatever reason, that a sincere apology and honest explanantion as soon as possible can be healing in itself. The problem is the admission of blame and that's where management come unstuck with legal implications. I can forsee that being a problem for us and I don't think there's much point if we can't be completely honest. People do make mistakes. Recognising that should be easy - it's what you do about educating them, supervising their practice and trying to prevent it happening again that is important. Obviously being believed is the first thing you would expect but what else did you want to happen? Did you want to meet the people involved or want to avoid them completely? Would it have made a difference to your subsequent feelings if the SOM had been more transparent? I'm genuinely trying to find answers because the response you got just perpetuates the problems I hope to try to avoid.

I would have appreciated a reflections service not because it was traumatic but because I was giving birth in a foreign language and will have DC2 in a different place so will need to transmit info that I don't fully understand myself. It would be much easier for me to see my notes, understand what happened with the aid of a dictionary if necessary and really clarify things, so even for women with normal straightforward births such a service could be hugely beneficial because when you're in the throes of labour things don't really register!

I don't think it necessarily needs to be advertised antenatally. Maybe postnatally either community mws or hvs could make women aware of the service?

What else would I have liked to happen?

Well, an apology would have been fairly major tbh, plus reassurance that that SHO had received additional supervision/a good talking to. I would not have liked to meet him again.

My feelings about the rest are a bit mixed up. I mean the midwife no misery. She should have done better at recording WHAT happened. She made some other mistakes that are quite clearly a result of a VERY short-staffed night. Her shift ended whilst I was labouring and they had to get someone else whikst she went to pick up her children, give them tea and then come back . The 'someone else' changed many times. I spent 6 hours begging for an epidural for an OP baby. There was never any space on the labour ward. The SOM promised to ask my mw about the fundal pressure but assured me that she wouldn't remember my birth.

There are a number of reasons why I didn't persue a complaint. The first is because I saw the SOM very close before to the birth of my second. The SOM was adamant that my second birth would be a 'healing' experience for me, and her summary of my upset being simply 'not being listened to'. I was kind of promised the earth which I had no faith in being given at the time but DID materialise as my next mw 'knew all about me', never left my side and followed some of my less conventional plans.

The second reason, and you probably won't be able to comment on this, is that my cousin is a midwife, and I debriefed a litte with her. She DID take me seriously, assured me that whatever they might have told me, that SOM WOULD be asking my MW who WOULD remember and lessons would be learned. She told me that more would happen that way than if I formally complained as the doctors would close ranks and find a way of blaming everything on the midwives, in particular this one.

My 3rd reason is that my son got an early Dx of ASD immediately after the birth of my dd which I believe was triggered by the way he was birthed. I have no desire to get tied up emotionally or financially in a possible medical negligence case and am fighting far to many professionals already just to get him adequate education and care.

Frakiosaurus That's a useful point about language, even deciphering medical terminology would be useful.

Amandine Do you think mentioning the service or having the information in a discharge leaflet would be OK? I think leaving it up to the MW or HV to mention it to someone who has had an obvious trauma is too vague as the woman herself may feel she needs to talk it over even if everyone else thinks all went "normal".

Starlight Despite having read a lot of your posts I didn't know all that. I'm really sorry you had to go through that. Sounds like the SOM needed some further education herself.

As a summary so far then, what women would find helpful is:

Being able to go through their notes to translate and decipher what is in them.
To be listened to, believed and have acknowledged that if there were shortcomings (for want of a better word just now) they would be investigated further and feedback given to you and the staff involved.
To be a resource for support and referral if you want to take further action or need more therapeutic help.

Anything else? I am really grateful for your help. I'd like to be able to present a clear outline for the service to ensure we get it as close to right as possible from the outset.

There is something else, but i'm not sure how confident midwives/services woukd be with this.

Agpfter my birth with Ds, I asked to see my notes before discharge.

Even though they were on the desk of reception I was told I woukd have to make a formal request with ID and pay £50 and was handed a form to send in.

That added to my feelings of violation.

I made the same request with no.2 and they were handed to me straightaway with the comment 'let us know if there is anything you want explaining or that you don't agree with'. To be honest, they were blardy boring to read .

But is this a service that might help women.

Ah now there's a major sticking point. Writing notes on the computer rather than on paper is one of the biggest moans staff have at the moment. And they are incredibly difficult to access in a chronological manner. Medical records departments can print off sections but I am an old fashioned pen and paper lover so I do have issues with this.
Yet another pertinent point for me to bring up. I'm getting quite inspired!

Have to be brief, as have to feed DD her lunch!
Firstly, I was very impressed and heartened by your attitude and what you wrote in your original post.
I agree with posters who have said that a frank apology goes one hell of a long way. I was refused a Birth Reflections Meeting because I had 'left it too long' (about 8 months post birth). I ended up writing a letter of formal complaint. The constant wriggling out of any sense of responsibility for what happened, the constant justifying of their position and the steps they had taken, the inability to say "we're sorry this happened" was very very irritating.
My specialist gynae team patching me up afterwards have said that mistakes were made in my care and that I should have been given ELCS. I also sought information from the manufacturers of the suture used to stitch me up, which again showed that the hospital made a mistake. I was fobbed off with a patronising comment about how it can be very confusing for patients when medical practitioners come out with contradictory advice and that I shouldn't believe everything that manufacturers say about their products. And, according to my highly specialised gynae surgeon, they misquoted research erroneously using it in favour of their position, when in fact it demonstrated the opposite. They also cast severe doubts on my surgeon's ability to do one of the repairs he wants to do, which is extremely unprofessional. They said the repair is not possible and no one does it. They are wrong.

I guess all this can be summed up as follows: it is so much more helpful and beneficial to adopt an open and sympathetic attitude, rather than a defensive, adversarial, hostile and patronising one.

Final point, then I really must feed DD - don't have a cut-off date for Birth Reflections Meetings. Women should be able to come and discuss what happened whenever they need to. Often the immediate shock of a traumatic birth will only ease enough for a woman to both want to and feel able to discuss her birth back in the hospital where it took place many months after the event. Similarly, the full extent of birth injuries may not become apparent until many months have passed.

One of my particular bug bears is that I am convinced that many traumatic births get recorded as complete successes in the labour units in which they took place because staff are only looking at the short term picture. I think that women who subsequently pitch up and say, 'no this amazing VB (or whatever it was) you say I had was a disaster for me and is ruining my life' should be able to have this recorded somewhere and that this should form part of some official audit or something. As a wider project maybe GP practices and all gynae/incontinence (and even orthopaedic) units should share data on women who pitch up with birth injuries with the maternity units where they gave birth. How would you know that a woman you delivered is subsequently diagnosed with prolapse, fractured coccyx, faecal incontinecne?

DD's fish burning - must go!

I agree with no time limit. I don't think I realised just how much dd's birth had affected me until I became pregnant again 4 years later and realised that I had to give birth again (well obviously I realised before but you know what I mean !), and became adamant that I wanted a elcs. I saw a registrar at 21 weeks who referred me to the counselling mw. I initially only accepted the appointment to add weight to my argument but once I walked back onto the MLU and realised what room I was waiting outside I became a wreck. Luckily I've now got a section date, and hopefully my notes are being picked up and returned to the right hospital today (the counsellor is making the 20 mile round trip herself to collect them rather than risk them going missing again) so that on Monday I can actually read them. I'm not sure if I'll get any answers but I need to know what happened to clear the fuzz in my head - after 4 hours of pushing, a night of no sleep, and pethidine it's all a blur, I just remember the agony and complete loss of control, and an extremely arrogant SHO talking over my head about me to the mw when I refused the ventouse, which I may or may not have signed consent for - I would have signed anything at that point but I have no idea what that form said.

Cardamomginger Thank you. I'm sorry you had to go through all that and had so little support and hope the surgery was a success. You make some excellent points which I will do my best to address with management. Sorry, I don't have time to go into each in detail but wanted to say thank you for sharing.
Amandine Your counsellor sounds like she is helping a lot. Hope reading your notes is catharthic.