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."

helsbels - home birth with community mw was lovely. Statistically, you are very unlikely to have a problem at home, I think because of lower intervention rates. And if there was any risk, they would transfer you to hospital anyway. If you want to have a homebirth, then go for it! But only if YOU want it - don't be talked into it if you really would prefer to be in hospital. But I would highly recommend it.

lazyeye, you are right that going home early will not impact on cleanliness. There is no excuse for that. If there are not enough cleaners, or they are not doing their jobs properly, a formal complaint should be made by staff and women. I have to say that our unit is clean and their are goevernment guidelines on what is expected.

Back in my student days I used to work part-time as a cleaner. The wages were abysmal. Instead of being given a single ward each to keep clean, the staff were given 2 or even 3 wards. When supervisors carried out checks they were more bothered about the areas that were easy to see so the polishing of the ward floors were seen as more important than the toilets being cleaned.

We were given the same old story that they were short of staff etc yet whenever anyone offered to do overtime on a different shift they were nearly always turned down - unless VIP's were due to visit.

I have seen an awful lot of the NHS recently. I was horrified by my initial treatment - obstetric registrars had never heard of my condition, and I was given some advice which would have been very dangerous if I hadn'tknown to ignore it.
Once I got into the "system" with a consultant who knw what he was talking about, and the best midwife in the world (with the possible exception of mears) I could not fault the treatment and service I am getting - it's just a shame that you have to have quite serious problems with a pregnancy to get the dedicated service I'm getting.
And I'm still going privately for my c-section. I'll be having the same consultant who is treating me in the NHS, but I'll be in hospital for 5 days afterwards in a clean room, with midwifes who have time to help me care for my baby. I do think that it's the post natal care (especially for c-sections) that really is letting the NHS down (particularly in central London). Wards are filthy, there are never enough midwifes, the ones that are there are often agency staff and the decent ones are so stressed by the conditions in which they have to work that they aren't able to do their jobs as well as they want to.
The NHS does do some things brilliantly, but it has to get better at the basics (like cleaning) to fix the terrible image problems it has.

I feel as if I have encountered the best and the worst of the NHS, all in one hospital. There were many things in the maternity service that I would describe as scandalous, covering competence of midwives, to filth and understaffing of post-natal ward, to lack of help with bf, to waste of money by huge mis-management of discharge procedures. (women were giving birth in the shower room upstairs because newly delivered mums could not be moved down to post-natal because people were waiting all day for their notes to be signed off).
However, once DS was discovered to have a significant problem with his leg, the attention at a serious level (under the consultant)has been astounding, and in terms of receiving treatment, I do not believe that it would have been better had we gone private. What was still apparant on the childrens ward was the waste and inefficiency in the wholesale employment of agency nurses who could never find notes, spell place names (not local)etc, the filth of the ward (cleaners who drifted through wafting a filthy cloth over one half of a bed-tray as they went, old food under the beds, awful bathrooms), administrative confusion (had I not been sure of my facts and of a tenacious character, DS would have had to miss one op, and been starved for an unnecessary extra 6 hours before another because of confusion about times and theatre schedules).

This is all in a major 3 starred teaching hospital.

I am in regular web-based contact with parents in America whose children have similir conditions, and I am VERY grateful that I have access to a free integrated system of surgery, physio, orthotics, compared to the juggling act they have to perform, arguing with their insurance co's etc. In the end, I am not bothered by things like the food, but I do feel frustrated that the quality of medecine on offer seems compromised by cost-saving excercises appearing to backfire.

Patients also have a responsibility: in our hospital a third of out patient appointments are not kept: that's a third of consultants clinic time wasted.

My care with ds was fine - but then I was lucky and had private insurance for delivery and post-op care. When I was in for a month before he was born though it was primitive and grubby and the food was horrific. But there is a whole new dept there now (the building noise made it absolutely impossible to sleep during the day for me so it better be good!) so can't say now.
I think a huge prob with NHS is the fact that everyone I know who wanted pain relief had to wait hours for it. For that reason alone (though I do have plenty of others) I would opt for a section and check myself out early.

got a better deal 2nd time around, knew what to expect after c/s so bagsed a private room (shared toilet with one other) early on, but the support was still pretty poor - had to request pain relief even though it was on my notes to be prescribed at regular intervals, also virtually no support for breastfeeding. at least the ready-mixed bottles of formula had disappeared from the midwives' station. positives: I was involved in all decision making (even my crash c/s), especially by consultant, eg how long labour should progress before decision taken on possible c/s, what kind of pain relief, how quickly to get up after the surgery etc. the women on the wards were very hardworking in a difficult situation (a midwife had been assaulted on my ward the previous week & security was noticeably high)

I will include my experiences as well. I had ds1 at the Whittington in London, ante-natally had to wait a very long time for my appts especially for the monitoring (5 hrs was a normal wait). Actual labour was high intervention, but we would both have died if it wasn't, I was in the recovery room for nearly 2 days then up to the post natal ward which was very cramped my cubicle was 3 foot wider than my bed and no longer.

But the people were fantastic - the midwives provided excellent care, helped dh on how to change ds'd first nappy and dress him in his first babygro. Checked with me a couple of times a day that I was managing with the breastfeeding (this was without asking for help). They helped me give ds his first bath, student midwife did wonder what was the point of bathing without soap, senior midwife said to her that soap was not neccessary. Probably the most amazing was that I even got a bed bath while in the recovery room, I had tried to stand up so I could have a proper shower but had to admit defeat.

I suppose what I am trying to say is that under funding of the NHS was responsible for the cramped wards post-natally and the long wait for monitors ante-natally but the people who had to work with these conditions did the very best they could

I haven't read the whole thread but any chance i get i'll gush about my birth
I just wanted to say that i was dreading the hospital stay and had heard good and bad stories but i could not have been luckier! I went in at 5.30ish and got a lovely midwife. She was off duty at 8 but i was close and she stayed. Another midwife took over but she stayed by my side! When they realised that i had meconium when they broke my waters, there was about 5/6 more people in. A doctor and a Paediatrician(?). After i had dd the Doctor said she'd stay and stitch me and i was done in what seemed like minutes! The first midwife gave me a big cuddle and went home and the second stayed and bathed the baby,(a little later), infront of me and dp.
The aftercare was midwife coming nearly every day i think for the first few days!
Just hope and pray i'm as lucky next time as feel saddened by some of your stories +++++

Also, i had a few midwives during my pregnancy but mainly the same one. Thinking back it was not a bad thing to see a few different ones as they have different opinions on certain things and it's good to get a mix.

I was fortunate enough to give birth in the Queen Mother's, Glasgow and the staff were wonderful. There are another two maternity units attached to hospitals elsewhere in the city but the powers that be want to close one arguing that because each is operating at below max percent then it is uneconomic to keep all 3 open. Overcrowding seems to be a factor in Fio2's case and was certainly the case for my friend. Surely by shoving all maternity cases into the two remaining facilities will only increase the problem and result in more stress for staff. The closure of this hospital is a matter for great public debate here. It's closure would affect not only local mums but uk-wide. Mothers with pre-borns diagnosed as having potential problems are likely to be referred to the Queen Mums because of it's physical attachment to the world renowned children's hospital at Yorkhill, thus babies can receive treatment immediately. The official public consultation has not gone well and 99% of the general public and maternity experts are of the opinion that the NHS Greater Glasgow has a hidden agenda to close the hospital anyway ignoring the advice of leading experts in the field.

Sorry to go on for so long but I feel so strongly about this and was wondering if anyone further afield had heard about it.

Experience is like pain. You need to get on top of it straight way. Once the problems begin they escalate unless there is someone around to work very hard to stop a bad situation getting worse.
As has been said loads of times already, if things are going smoothly theres no reason why anyone shouldn't have a good experience because the truth is all NHS professionals have to give a little bit of themselves to make it work.
The trouble is resources are spread very thinly and it doesn't take much to destroy what is very finely balanced.
It is a great shame it is like this and the dabate surrounding the best way to deal with I feel is terminal.

Coming from the States, I thought my NHS birth experience was fantastic. I understand it can be a bit of a lottery and perhaps I was just very lucky. I do think that overall the approach to labour and birth is different in Britain than in the States. Birth is seen as much more of a medical procedure rather than a natural process in Texas and I had never even heard of active birth or home births (except by accident!) before coming to England. You're always in the hospital, on your back on the bed with monitors, drips, epidural, etc. It's also very common to induce birth for convenience. A friend of mine in Dallas was induced two days BEFORE her due date because her OB was going on holiday. That's all fine if that's what you want, but I didn't.

In the end my little boy's birth took a lot of intervention - induced at 10 days overdue due to his size, epidural and finally an emergency section - but I still felt supported and in control through the whole process. Every step was discussed beforehand and if I wanted more time before taking another step (such as the petocin drip and the section) I was allowed it. I was also able to stand up and walk around the room, even with the fetal monitor and drip, which really helped manage the pain.

I also loved the home visits after the birth. We have nothing like this in the States. I actually cried during the last visit because I knew I would really miss my midwives! I was with a clinic with six midwives and, as it happened, the lady who assisted at the final stage of the labour was the only midwife I hadn't met. She was lovely though and I was really glad to have her there when they did the section. The surgeon was excellent but my midwives were all very warm, motherly women and that was a great comfort.

I felt like the whole pregnancy and birth was treated in a very repectful, gentle manner. This was new to me after the very clinical approach in Texas. My birth experience wasn't perfect but it was all in all a very positive experience and I look forward to doing it all again.

I'd also like to say that I very much like having a Health Visitor with a clinic twice a week. Again in my experience, we have nothing like this in Texas. I've met so many other moms through the clinic and really appreciate having the HV available for questions I might not feel warrant a doctor's appointment. I find the whole NHS support network quite amazing. I couldn't count the times we've called NHS Direct in the middle of the night!

I would hate and be terrified of a home birth personally, but do agree that women who want them should be supported in that choice on the nhs.

Ime experience, the postnatal aspect lets down the NHS. I had no complaints about my AN care and delivery but PN was a different kettle of fish. Nothing was explained, you had to find out everything for yourself, from where breakfast was served to where clean nappies were stored.

The worst aspect for me was that I was quite ill postnatally and the noise and disturbance on the ward was atrocious, with far too many visitors, people with flash cameras and so on. The staff themselves were nice enough, there just weren't enough of them. I left hospital feeling somewhat dazed and confused and in fact the MW assigned to me apologised for my treatment.

The home PN care was excellent, with my MW coming in for ages after the usual cutoff date because dd wasn't gaining weight.

The cleaning problem is because the Conservative government contracted cleaning out. So cleaners aren't employed and directed by the hospital any more. Instead you get people on poverty pay employed by companies that don't care about training and make a profit out of cutting corners ? making people use the same mop for surgical areas and lavatories/wards/waiting rooms. And somehow nurses either don't feel they have the power or don't feel it's their responsibility to shout about dirty wards/loos. And don't get me started about nurses/docs/visitors not bothering to wash their hands or use disinfectant even when it is clearly provided at the entrance to wards...
Hoxtonchick, I don't work in the NHS, I'm just a journalist but a specialist in health. I commission investigations into healthcare as part of an independent campaigning organisation that works, amongst other things, on health policy.

eddm, I work for an independent health policy think tank as a researcher. Maybe we might encounter each other in real life...?

Well you could always email me via contact another talker and all will be revealed! Coincidentally ciscovered yesterday one of my very good friends is also a MN addict (someone else told me) now trying to work out her MN id...

E-mail sent!

Like most people, I have only my own personal experiences of the nhs to refer to, but I found the care I received when I had dd (now 2 months old) at St John's in Livingston first-class. Although the unit was full to bursting when I went into labour, I was never presurised into having interventions to speed things up and at no time did I feel as though I was on a 'production line'. I had a midwife(and student midwife) with me at all times and both were brilliant. Post-natal care was excellent. The ward was clean and the staff were kind and helpful but not obtrusive. Although dd is my 4th child and I chose to leave after 24 hours, I didn't feel pressurised to leave earlier than I felt I needed to and could have stayed in longer. Even the food was okay. I also got the feeling that staff morale was high and that despite difficulties, such as the unit being so busy, they remained positive.
However, I do appreciate, that compared to many people I was lucky and that that not everyone has the same good experience.
I was also fortunate in that I had a choice of where to have dd although this was partly because I happened to live in an area equidistant from 3 maternity units and also because I knew that I could choose. Many other women I know either weren't aware that they had a choice or, because of the distances involved, only one hospital was a viable option.
Finally, re the question of continuity of care, in the area where I live women are attended by the same team of midwives both ante-natally (at the local clinics), whilst in labour at hospital and post-natally in hosptial and at home so that by the time you go into labour you will, in theory, anyway have met the midwive who attends you in labour. Although I had dd in a hospital in another NHS Trust's area and therefore didn't have these midwives in labour, I saw the same ones both ante-natlly and once I came home.

Hoxtonchick, you may remember we talked about meeting for lunch in Lincoln's Inn Fields in May. I want to move into public health research, concentrating on child health, and would love a chance to talk to you about it. If you feel like it, could you contact me via 'contact another talker'?

I've e-mailed you too, OldieMum. Apologies for the thread hi-jack!

Me again.... OldieMum, I tried to e-mail you via C.A.T. but I think mumsnet has your work e-mail address which you're not checking. It might be easier if you e-mail me on hoxtonchick (at) hotmail (dot) com. Hope that makes sense...