Maternity Care Discussion

[Tissy]

I was asked to move this discussion elsewhere.

For the record, I work in the NHS (not as a midwife) and am pretty fed-up with the slaggings- off that occur with monotonous regularity. No, the system is not perfect, but serves most people well. I have also been on the receiving end and have no serious complaints myself. I am just as horrified as anyone when I read stories like Fio2's, and airing them serves a purpose, not just for the victim but for the perpetrators. Mistakes can only be corrected if they are highlighted.

So, if anyone can be bothered, discuss!

"...maternity care in this country is in a scandlous state - it was terror that drove me to an independent mid-wife for dd2, despite deep-seated beliefs about private healthcare."

"...hatter, that's rather a sweeping statement.

No-one would deny that Fio2 has had a dreadful time, but there are many,many of us who have had pleasurable deliveries on the NHS. In general, maternity care is good. Yes, most hospitals could be pleasanter (if that's a word), but the basic care delivered is of high quality for most people. I have a lot to thank my local maternity unit for- I certainly wouldn't have been helped by an independent midwife!"

"Of course it's a sweeping statement I wasn't going to present a detailed argument in this context. But while I don't want to hi-jack this thread I have to respond as this is something I feel passionately about. Of course many people have had pleasurable experiences but there is plenty of evidence that the basic care is not of a high quality for most people. This is not about individual midwives, most of whom do a fantastic job in difficult circumstances. Nor is it about hospitals being "pleasant". It's about ceasarean rates of over 20 percent. It's about deliveries without intervention at 60 percent (at the midwife centre I used the normal birth rate is 80 per cent). It's about the blanket application of hospital protocols on induction, feotal heart-rate monitoring, the amount of time "allowed" for labour. It's about severe midwife shortages, resulting in many people being left unnattended for long periods of time, often resulting in stress and then interventions.

Choices in child-birth are very limited for many many women. I went to an independent mid-wife firstly because it was the only way I could have continuity of care - ie be attended during the birth by someone who had played a role in my ante-natal care; secondly because my GP refused point blank to have anything to do with me if I had a homebirth; and thirdly because I truly believed (and still do) that the level of stress/deep distress I was experiencing in late pregnancy because neither of these things were available to me, and the only option appeared to be a repeat performance of dd1's birth, was damaging to my health and that of my baby.

There is plenty of research to show that these first two things are instrumental in reducing the likelihood of interventions, in reducing post-natal depression, improving breast-feeding rates. Yet they are not available to the vast majority of women. (In London only 1.3 per cent of births take place outside hospital. ) I believe that this is scandalous. With many apologies to Fio for going off-thread."

Humm, hot potato.

Difficult becuase for a non nhs person all we have to go on is our own experience so maybe thats why you get "slaggings off". People can't help the bad experiences they have had. That said, like Hatter said, this has nothing to do with individual units or m/wifes.

As I've said, I can only speak from personl exp and I have to say its not great. In my first pg I must have seen a different commnunity m/w at every visit - no lie. Second one and this one have only been slightly better.Labour ward staff were pretty good though an agrument about who should stitch me up whilst I waited with my legs in stirrups for 30 mins (change of shift) did not impress.

My biggest moan is the ante-natal ward. Dirty,not enough staff, staff who have to be asked 5 times to rememember things - I feel very sorry for 1st time mums.

Lots of reasons I guess why this is the case - funding etc and I'm sure "it serves most people well" - but what about those it doesn't serve well? Is "most" good enough and is "well" good enough?

Message withdrawn

As I have been mentioned I thought I ought to comment! I had an horrendous time having dd as you know. When I went in to have ds they were just as disorganised and I was releived that I had chosen to have a surgical procedure rather than a highly managed birth as I know very well I wouldnt have received. This hospital I had my children at score very highly in the chartables, have a below 25% c-section rate.

Part 2 the services I receive for my daughter are not adequate, I have to fight and nag for her to be seen - she is 4 we have no diagnosis. I have to wait and agonise over appointments, not knowing what is coming next. Appointments being half yearly instead of 6 weekly. It is not fair and its cruel.

I cant receive free prescriptions even though I am a carer and 'cant' work

But my sister was cared for very well. She had Cystic fibrosis and her care was wonderful, apart from the first 3 years of her life. I really cannot fault any care my sister received, they looked after her sooo well. I remember when she had her transplant, the surgeon who she was asigned to was going to Barcelonsa on holiday and was just about to board his flight but his pager beeped for her transplant. He did her transplant. and cancelled his holiday, what dedication he had! Can you imagine the thread on mumsnet...he left me and my kids at the airport for work!

oops just clicked on active conversations and realised it was just about maternity services!

There are some absolutely excellent midwives though, but there are crap ones too, like in any job I suppose

I had a very positive experience with ds1, excellent care throughout maternity and into labour and aftercare. This time so far it has gone fine. I had an 'easy' time though and was a relatively low risk patient and so on. I honbestly thought my local maternity hospital (derby City) was fantastic and could not praise them enough for their help whilst I was in their care.

I have to say that my experience of labour with a prem baby was fine, it was the after care that was quite awful, but I hope that this time round, in a smaller community hospital, it will be better. Rumour is that it is wonderful, caring and individual.

But I must point out that DH and I were discussing this just the other day, about NHS in general, and we both felt that we were lucky to have free emergency care, by dialling 999, also that we have access to treatment locally.

Although the NHS have a bad reputation, and everyone has a terrible story to tell, it is there for us to use. DH's family live in the states, so pay insurance etc, yet still have a story to tell!!!

Sorry for going off thread, we only hear bad stories so much of the time.

Littlerach - I agree that the standard of emergency care on the NHS is brilliant.

But ime the ongoing non-crisis stuff can leave a lot to be desired.

Seems I really started something...my experience with dd1 was pretty bad (tho we're talking about nothing compared with FIO's) I believe I was left for about 4 or 5 hours totally on my own - they sent dh home and left me in my own room - so I really do mean on my own, during which time I fell asleep in the bath having been given tamazepan (sp?). (I say believe cos I concede that it's possible someone put their head round the door while I dozed in the bed later but if they did I was unaware of it)By the early hours of the morning I was extremely scared, crying, in a lot of pain and very very lonely - I was desperate for a hand to hold, for someone to tell me I was ok. When I rang for help and asked for gas and air it took over an hour to come. Unsuprisingly a catalogue of escalating interventions followed. After this experience, and especially when I became pregnant with DD2 I read a lot about maternity care - so I'm not just basing my thoughts on my own experience. Mine was a classic case of a totally ordinary birth made uneccesarily deeply distressing, resulting in (expensive) interventions that could have been avoided. And I know I'm not alone - I've read and heard about many other distressing experiences, including ones triggering PTSD.

It's not just down to purse strings - it's down to political will to change the structure and the way in which we handle birth. It doesn't cost any more for women to be attended at birth by one of a team of two or three midwives that she has seen throughout pregnancy - and most midwives would rather work this way anyway - many say it's more rewarding for them. Thankfully this system of care is being increasingly introduced but slowly.But we still have a highly medicalised approach to childbirth and many people experience the attitude that what they think and feel is not relevant - despite its link with their post-partum health, including mental health, bonding, breast-feeding etc

I'm not in the business of knocking the nhs for the sake of it and certainly not the many individuals who do fantastic work within it. I was seriously ill when pregnant and was stunned by how quickly I was given tests and appointments with consultants and results...it was almost too quick to take it all on board. But maternity care is my bug bear...

I am extremely fortunate to work in an area that does not have a recruitment problem with midwives (although we still moan about being short staffed at times!!). Women have continuity of carer ante/postnatally. During labour they will meet a different midwife but, when audited they did not object to that. They wanted someone skilled and nice to care for them and invariably that is what they got. The upside is that they knew their own midwife well who they met antenatally and who cared for them postnatally.
There is a serious midwife shortage, especially in England, and women's care in some areas is suffering. There is however, a drive on to recruit more midwives to be able to provide the gold standard of one-to-one care in labour.
There is no doubt that good midwifery care reduces the cascade of intervention that leads to operative deliveries. The blind application of hospital protocols is waning in my experience. Protocols are becoming things of the past, with guidelines replacing them based on evidence based practice. NICE guidelines have been produced for antenatal acre and will be produced for intrapartum and postnatal care. The promotion of 'normality' is on everyone's lips.

The NHS should not be written off as substandard maternity care. As always there will be areas where care needs to be improved. There is a recognition that improvements need to be made and women are instrumental in highlighting any deficit in service.

There are many areas

My community MW's have always been excellent. With ds1 I would see one of 3 MW's at my GP's surgery and they were lovely. With ds2 I saw only one MW and again he was lovely. No question was ever too trivial or petty and, as I had to take ds1 with me to appointments my MW ensured that I didn't have any unnecessary visits.

The care during my long labour with ds1 was great. I was confined to the bed but well cared-for. The after-care was awful. I suspected that something was wrong with ds1 but no-one would even look at him. When he was eventually transferred to the SCBU 3 days later the nurse there refused to allow him back on the post-natal ward because she believed that he's been seriously neglected.

Ds2 was also induced. Worryingly there were 4 of us being induced at the same time and only one m/w to look after us all. I don't know if this contributed to the fact that I was the only woman that night who avoided a c/s.

The maternity units seem to be seriously understaffed and the MW's overworked.

having done a lot of reading on this subject both for my studies (psychotherapy did paper on pnd) and in the lead up to the birth of my ds my thoughts are:
in normal pregnancies and normal deliveries care should be midwife lead and home based.
home birth should be promoted (but not rammed down the throats of women who would feel safer in hospital)
there should be continuity of care with each woman being allocated up to four midwives who will be caring for her throughout pregnancy, during labour and post-natally. labour is absolutely no place for meeting a new midwife.
woman should be informed about their choices: this includes proper information about what can go wrong with interventions that are not strictly medically necessary.
women who do want pain relief should not have to wait for it for hours.
care should be taken to allow a woman and her birth partner time alone and in private both during and immediately after labour if at all possible. birth partners (male or female) should be able to be accommodated in hospital and certainly never sent home unless they want to go.
i could go on and on and on.
there is definitely a midwife shortage in london. units cannot function properly if they are grossly understaffed.
nhs staff are usually extremely well trained, dedicated, wonderful people. but birth is a journey and a process and labour does not benefit from any kind of 'production line' pressures brought to bear becuase of understaffing, financial considerations or worst of all, fear of prosecution for negligence.
imho the nhs falls down pretty seriously in terms of the care afforded women during their pregnancies, in labour and afterwards.
i feel that this is becuase of the staff shortage mentioned previously, but also becuase of a culture whereby obstetricians (sp?) are seen as 'boss' and midwives and the women they work with are disregarded at the slightest hint of anything in any way not running like clockwork.
i feel angry that only women who can afford to pay privately for independent midwives, who are able to be with them throughout their pregnancies and during labour and afterwards whether at home or in hospital can guarantee the kind of care that we all deserve. that is not to say that many women who go through the nhs do not have positive experiences, but it is a lottery and far far too many do not.
if women in this country got together and spoke out about this making it a top priority maybe something would be done. until then change i'm afraid will be all too slow.

i'm sorry for the megarant. but i feel extremely strongly about this subject.

would be interested to hear from anybody else who also does...maybe we could start a lobby group (of women rather than midwives) campaigning for better maternity services in the uk.
x

I'm with Hatter. I know there's a drive on to recruit more midwives, but in reality numbers are falling quite drastically. I started looking at this a few years ago, and I think we can fairly describe it as a crisis in midwifery in the UK, unfortunately.

The main reasons I opted for a home birth with dd2 were that I just wanted some chance of continuity, and I wanted to avoid an unnecessary Caesarian. Even with a community team I didn't know who I'd end up with, but the idea of just turning up at hospital and having whoever happened to be on duty - maybe wonderful, maybe not - absolutely terrified me.

Thanks for all these comments- didn't think anyone would bother!

I had my baby in mears'unit, and although there were a few niggles, I can honestly say that I wouldn't describe anything that happened to me as scandalous.

I didn't see the same midwife twice antenatally, but to be honest, that wasn't a major problem- they were all nice, and it didn't matter to me who did the doppler scans, and blood tests, and belly-feelings. I had a section planned from about 20 weeks, and it all went fine. The hospital was clean, the food not too bad, and post-op care a little scanty, but adequate.

Only got my own experience to speak of but I had two wonderful experiences with the NHS.

First time I was in the consultant led unit and had 3 different MWs due to shirt changeovers, stayed in one night and was visited on the ward by the MW who was 2nd with me and had helped me through the worst parts of labour but missed the birth as she wanted to see what I'd had and if I was OK.

Second time I went to the community unit. I live in a different county to the hospital so the community MWs I saw weren't there for the birth but that never bothered me. I had just the one MW as they did a 12 hour shift and I was only there for 11 hours. She was brilliant, really kind, left us alone but made sure she checked up on us, was never far away. She discouraged me from getting into bed, brought a birthing ball, would've got me anything I think. She was very pro-breastfeeding and skin to skin contact.

I was encouraged to follow my gut feel which was that I didn't want an epidural, I received no unecessary intervention, I was well cared for. My wishes regarding breastfeeding and how long to stay in for were followed and it was suggested that I would be a good candidate for a home birth should I have a third, if that was something I would consider.

I feel really sorry that this doesn't seem to be the norm but, like I say, I can only comment on my own experiences, which were overwhelmingly positive.

i won't bore everyone with my birth story here - but my experience with ds has led me to opt for independent midwives this time. enough said.

i live in inner london, served by the central london teaching hospitals (like MI) and crisis is exactly the word i'd use to describe the situation.

while i did encounter some fantastic midwives, unfortunately i also encountered some v. inexperienced and incompentent ones during my ante-natal care and labour.

while the nhs is a wonderful institution and worth protecting, and there are many dedicated, experienced, knowledgeable professionals working within it - it shouldn't be beyond criticism and neither should the (i'm sure) small minority of staff who are just not up to the job.

I received absolutley fantastic NHS care with ds. I have diabetes, so had a lot of appointments throughout my pregnancy. I always saw the same team of diabetologists/obstetricians, & grew really friendly with them by the end. I was treated as an equal partner in my own care throughout the whole process. When they were planning my induction date they purposely chose a Monday night as Tuesday was the day this team spent in the labour suite.

I had the same midwife with me constantly for the whole of her shift, as well as a very keen medical student who stayed 3 extra hours 'til ds was delivered. I ended up having a pretty interventional time, but that was only to be expected really, as I was induced at 39 weeks & ds wasn't ready to come out so took his time. He was born just after midnight, & the first people to see me the next morning (dp & parents there for the birth) were my 2 consultants who popped in to say congratulations. They were just lovely.

OK, the hospital was too hot & they wanted to keep us in longer as ds was a ventouse delivery so we had to discharge ourselves after 24 hours, but I was very very happy with the care I received. I think the NHS receives a lot of stick, & there are lots of things about the provision which aren't perfect, but it makes me shudder to imagine what kind of alternative system we might end up with under the new Tory plans for instance.

Tissy I must have lower standards than you - I thought the food in the same hospital was great
Also the quality of midwifery care was spectacularly good in each of my three births

Post natal help at home was so good I eventiually asked them to stop coming - it was just too much.

Generally, if you survey people, those who haven't seen a doc or had any healthcare in the last year are far more negative about the NHS than those who have. Which suggests there's an image problem. I'm not suggesting any of the appalling stories you hear about dreadful standards of care for pregnant/labouring women in particular aren't completely true (I made a formal complaint about one aspect of my delivery), just that in general people's perception of the NHS is far worse than reality. Because we have this unique system, any failings tend to be blamed on 'the NHS' and people start looking for solutions to do funding - should we have insurance-based systems like other countries, for instance. I'd suggest that's not the issue - if you look at other countries there are valid criticisms of their healthcare systems as well. (A friend of mine who had her baby in Belgium tells me docs there won't let you go a day over 40 weeks/ in France you only have one nurse to three patients on intensive care as opposed to one-to-one here). Many people interested in healthcare are arguing that we should design the system around the patient, not expect the patient to fit into the system. But it's a long hard slog getting there, which involves fighting some very powerful vested interests.

Very well put eddm. Do you work in the field?

I think this is really interesting stuff. In my post yesterday I meant to say that the post natal care was bad, not ante-natal, and its interesting to see how many other woman thought the labour part was well managed but fell down post-natally, which is a shame because it colours your whole view of the event.

I don't know the answers of course, I just find it so odd that they seem to get the basics wrong. Why is my hospital so dirty? I'm not a mad cleany type woman, God knows my house is a mess, but even I can see hospital toilets have to be clean. I was quite scared the last time I was in. Surely this is basic stuff??

Postnatal care is certainly the Cinderalla of maternity serives. However, there is a belief that women are staying in too long, unecessarily. If you have a normal straightforward delivery, should you go home ASAP? Since childbirth should be looked at as a normal life event, why should women stay in hospital after delivery (unless ofcourse it has been a C/S or other assisted delivery).
Homes are cleaner, you have your own toilet, own food and own bed. If midwives could concentrate the care in hospital to those who need it, would that be better?

I'd love there to be more choice about when you can leave the hospital. Although you technically CAN go when you want to, there's a lot of guilt placed on new mothers when professionals say things like "You can leave if you want to but you'll have to sign this form to say that you went against our advice".

In an ideal world I think women with problem-free deliveries should be allowed to leave the same day if they want to, and those who prefer to stay for another night should be able to.

This is interesting - my community m/w is encouraging me to have a home birth this time (2nd child - perfectly straight forward first labour) but I am terrified by the thought of not being in hospital if anything should go wrong also because I had such a positive experience last time I feel that I would rather be there. There was one m/w who was not as 'caring' as the others but I think it was just her bad luck that she turned up just before I started pushing so I don't think anyone would have been my best friend at that time. Has anyone had a home birth with community m/w - is it scary?

Probably Mears yeah, but does that mean the place is cleaner for those that are in there because they need to? Not sure it automatically follows - they need to look at why it isn't clean now. Its not the m/wifes and nursing staff that clean is it so sending everyone home isn't going to help.

Anyway, maybe this cleanliness thing isn't the real issue. Take your point about straightforward deliveries going home soon & in my (limited) exp most women want to get home esp if it is a subsequent birth. I'll be looking to get home quick if this one is straightforward. Can understand 1st time mums maybe wanting to stick around a bit longer. With my 2nd I was in a bay with 3 other mums who had had nasty sections. I was the only one with a vaginal deliver. I got outta there pretty quick - felt like a malingerer.

As I said earlier, its hard to base a broad arugment on limited personal exp. I just got the feeling in my unit there was a real problem with morale - there wasn't a feeling of committment to providing a quality service. I'm not saying this was there fault - there is probably little to give them that morale, but its a shame.

Well, on the whole I'm happy with my experiences. If I'm honest, there were things I grumbled about with ds - rubbish food, wrong decisions made (eg to induce while already in labour!), but my baby was born healthy, and the midwife who was excellent avoided any sort of instrument delivery, despite the doctors all muttering about ventouse or caesareans. There was also a student mw, who, I believe did make mistakes, but also stayed a good 2 hours after the end of her shift, so that she could be there at the birth. Which I thought was really sweet.

With dd, I knew much more about what I wanted, and the community mw was fantastic. Because dd was home birth, my mw delivered her, even though she was 14 days over. I had to see a consultant, who was totally happy for me to go over the 12 day cut off - just checked everything was fine, and said I could do what I wanted, and he would support me. The post-natal care was excellent - when I had worries I could phone 24 hours and they would phone back within 15 minutes, which they did.

I've heard some horror stories about births in France - a friend of mine had a dreadful experience! I don't want to go into details, but it really did sound like the dark ages.