Why are Mothers-to-be treated like idiots in the Labour Ward???

[Toothache]

This question has been bugging me for a while. I was already in hospital when I my waters broke with DS. I had been in for a few days with high BP and was 39wks when they broke. It was 3am and waddled to the MW station and told them my waters had gone. They said "No they haven't, just go back to bed"!!!! I INSISTED that my waters HAD broke and they made me hand over my sanitory towel so they could check it. NICE! My waters had broken.
A few hours later the backache kicked in, then contractions. I told them I was in labour and they said "No you're not, it could take hours to get into established labour, go eat your breakfast." As I panted my way through another big contraction then waddled back to bed. Half an hour later I tried to phone DH, midwives STILL insisting that I wasn't in labour. I got a huge contraction and nearly fell in the corridor. A Consultant had some firm words with the Midwives and I was given an internal. I was 4-5 cm dilated and whisked off to the labour ward!!

WHY DIDN'T THEY LISTEN TO ME??????????

Another example:
I got a phonecall from a friend yesterday. Her friend was due her 2nd baby 2 wks from now. She went into labour at home and her boyfriend took her to hopsital. They examined her, told her she wasn't in labour, but that she had a UTI and would kept in for the night. She said "Are you sure, I've had a baby before and this feels like labour". They insisted she wasn't in labour and sent her boyfriend away to fetch her some things. They ran her bath to help with the pain of her "UTI" and 30mins later her baby's head was delivered as she was wrenched from thebath in agony! Healthy 8lb girl. Boyfriend missed everything. .

WHY WHY WHY WHY WHY don't they listen mothers??????

grumble for the day.... anybody else any experience of this?

The start of this thread was why don't they listen to mothers? There are some terribleexamples of poor care posted here but what you won't see is the appalling behaviour of some pregnant women entering the labour ward.
I have admitted women who are apparently about to deliver arriving by ambulance sucking the gas and air for dear life. Once examined, you find the cervix completely closed. No sign of labour. An hour later they are signng themselves out wanting to go home.
There are also lots of women admitted who claim their watres have broken when indeed they have not.
Every case needs to be treated as an individual case, but what I would urge you to remember is that there are a significant number of times where women think they will be induced if they give the correct history.
It can be difficult to separate the 'real' cases from the 'pretend' ones and unfortunately that is the world we live in. Please do not blame the midwives always - you have no idea what cases come through our doors at times.

mears - are these women genuinely mistaking braxton hicks/pre-labour/stress incontinence for the real thing, or, for some reason of their own, do you feel they are deliberately lying?

Unfortunately mummytosteven there are women who enter the labour ward with a mission in mind. There are those who genuinely believe they are in labour and that their waters may have broken. No problem with that atall. There are women who abuse the service however, so much so that you wouldn't believe it!

fair enough Mears. just curious whether it was people like me you were cross at - i.e. coming in at 2cm dilated, but I realise not.

mears i can understand where your coming from but when i was in labour was it realy hard for the student midwife (who i did not ask for and wasnt going to allow because of my complications oh yeah she was on her last delivery and she didnt have a clue what she was doing and that was from the proper midwife) to say ok i will get the midwife now instead i treating me like a child and saying i wouldnt know when it was time to push they would tell me

Absolutely no way mummytosteven. I feel truly sorry for women who believe that they are well established in labour only to find that they have hours to go. Labour can be such a disappointment to many women, that it does not go how they imagined.
I was just trying to put the other side where women knowingly present themselves to the labour ward giving a false history. It can really cloud the issue. There are also women who will not believe they are not in labour who are discharged from the labour suite. They often turn up a week later to get induced because nothing has happened! Then you feel quite vindicated.
Labour is not clear cut, but more often than not we are right with our assessment of what is going on.

I can understand your frustration MTS, and you should not have had a student midwife when you did not want one. Where I work the students are closely supervised - too closely at times I have to say.

mears after i was cheacked over even though i was at high risk i was left with the student midwife until i threatened to do some damage to her if she didnt move please dont get me wrong i have nothing against student midwifes at the end of the day we all start as a student but after loseing my first child through complications and loseing a lot of blood in my secound pregancy to the point where they were in fear of the babys life that i should have been left with a student and i made that very clear but it seemed like no-one wanted to listen

yeah I was fully dilated with ds(now 19months) when I got to the labour ward (id been in labour for nearly 24 hours,but the midwife who examined me wouldnt believe that ds s head was engaged until a second examination one and a half hours after and was very shocked when she realised I was right.Mother knows best-this should be on a poster in every labour room.
I wish I could sack every arrogant midwife who doesent give a woman in labour the respect she deserves

Mears, not sure I understand. Are there really lots of women who turn up knowing they aren't in labour? What's the point of that exactly?

Even if there are bizarre people turning up at maternity units, still doesn't justify the sort of downright disgraceful treatment handed out to many of the women who have posted here. Other branches of medicine don't get away with the paternalistic 'pat the patient on the head and ignore what they are saying' attitude any more, why is maternity an exception?

Edam, you are quite right that women should be treated with respect and that they should be listened to. The point I was trying to make is that a number of women come to the labour ward with symptoms of labour but, when examined, are found not to actually be in labour. There are more of them than the numbers of women who are misdiagnosed in my experience. I have sent women who have believed they are in labour to the ward who have then been discharged home to return a week later. The run up to labour can be really uncomfortable and painful, and I think that women are unprepared for that. There are a number of women who come to the labour ward, convinced they are in labour, but unfortunately are not. However, all women should be treated symapthetically and with respect.

And yes, there are a number of women who turn up knowing they are not in labour who think that we will just 'burst their waters' to get on with it.

mears, I know you are experienced and wise, which is why I am shocked to hear you say that a mother who is "not in labour" should not be in the labor ward. Or complaining about someone "sucking on gas and air." During my first "labor" I spent the first 15 hours at home, then when the pain became unbearable (I have such a high tolerance for pain that I have all my dental work done without any pain relief at all) I had my dh drive me (and my mum) to hospital. Once there I was examined after several hours and told I was NOT in labor and should go home. I don't care what they said, even though I was not effaced and I had not started to dilate, I was in excruciating pain. (And I was fairly sure my waters had broken as I had a trickle, but not a flood) In fact, I did not go home, because I was in far too much pain to stand up, forget about getting in a car for a half hour drive. I did eventually dilate to 7 cm at which point they decided to do an emergency cs. During the actual dilation I was not in as much pain as when I was "not in labor." 3.5 year later I still have nightmares about that labor and the awful, uncaring treatment I got. The fact that I was not officially in labor, should not have prevented me from getting care and attention. I was clearly in pain, but because of understaffing and lack of beds was treated as if I was trying to cheat the system. No one spoke with me, no one read my notes carefully and during my entire pregnancy and labor I never saw the same midwife twice. Perhaps if mothers had better care and information they wouldn't present themselves so early to the hospitals. Why is it ok to waste your gp's time with the common cold, but not to go to hospital when you are going through something as scary as your first labor!

SofiaAmes, you've hit the nail on the head. There may well be mad women turning up in labour wards insisting on being induced when they are nowhere near labour (although why anyone should take up being induced as a hobby is beyond me, and surely proves the need for psychiatric follow up!) - but if a woman is in what she feels is total agony at only 3cm dilated, why shouldn't she get pain relief and treatment? And why shouldn't she be treated with respect and empathy? In any other area of medicine she'd be given care, so why not in labour? What is going on in the labour ward which makes it so different to every other area of hospital care? I'm sure other wards are plagued by mad people manifesting strange desires to receive inappropriate medical treatment, but all the other patients on the ward aren't penalised for those particular patient's behaviour. Why does it happen in labour?

Oh dear, I am not making myself very clear at all.So difficult to do so in type sometimes.

There are women who come to the labour ward who are in severe pain and are not in labour. There are a number of reasons that could be and that needs investigating. And yes they may need pain relief in the interim and that is what we do.

When I talked about the 'sucking on gas and air' and not being in labour, I was giving an example of women I have had personal experience of who, when examined are not in labour, then ask can they have their waters broken. When I say no, because you are not in labour, the need for 'gas and air' has suddenly gone. The pain miraculously disappears and they want to go home. Some women are infact no where near term.

I was trying to make the point that there are a number of women who are admitted to the labour ward like this so sometimes it can be difficult for the midwives to differentiate.

Can I stress though that I always listen to women and, if I find they are not in labour at the time of admission I hold onto them for a few hours to see what happens. There are a significant number of women who then go to the ward for overnight observation of home if they are happy to do that. On return they often comment that they thought that they were sore before but now that labour has started in earnest, they know the difference.

The labour ward is not the place for women who are not in established labour as research has shown there is a much higher level of intervention which can lead to C/S. There are varying degrees of pain and different ways to manage it. For some women it is the position of the baby that makes it worse, such as posterior positions. Prelabour pains can be very painful in this group. I would like to see more emphasis on 'optimal fetal positioning' antenatally so that women could have encouraged their babies to be in the best position before labour starts.

I am sure I haven't got across very well again what I am trying to explain.

SofiaAmes - your treatment was appalling. To be in such pain and have no-one listen to you would have increased the pain that you had. I totally agree that something should have been done for you. Had you received empathetic treatment you may well have not continued to experience the level of pain you had as I am sure you must have felt frightened that nobody was listening to you and that if this was not labour, how would you possibly be able to cope with 'true' labour. With the pain you are describing, I would not have sent you anywhere.

mears - very interesting what you were saying about positioning - that was my experience. went in to hospital about 1 a.m, found to be 2 cm dilated. i was still 2 cm dilated at 4 a.m, so they kicked me out! when I went back in at 10 a.m - 5 cm dilated, yaay, i was told that the baby was "back to back" and his head was pressing on my cervix, so that was why I had felt so much pain earlier on - my contractions had started being 4 minutes apart at 4 p.m. the previous day, and I had got no sleep at all overnight due to the pain. out of interest, would you have had me kicked out at 4 a.m. for being 2 cm dilated?

mummytosteven - difficult to answer bacuase the answer is not dependant on dilatation of the cervix. You could have been 2cm at 1am with a posterior, thick, partially effaced (thinned) cervix. At 4am you might have been 2cm, with an anterior (to the front), fully effaced thin cerxix. That is quite a change. Also would depend what you contractions were doing. If you were contracting regularly I would have kept you. If you were contracting irregularly I wouldn't have examined you again after only 3 hours anyway. So many variables

There also different strengths of contractions. Depends how long they were lasting.

not sure about the effacement - but I do remember asking at 1 a.m if i was definitely going to "go" soon, and she said i would definitely be giving birth within 24 hours - so i must have been a bit effaced. i think i was having contractions that were 20-30 seconds long - i had phoned up several hours earlier, and was told not to go in yet

Were you given any paracetamol or some other tablet, and encouraged to lie in a bath?

yes, capax and told to have a bath - not complaining at the treatment, coz i realise it is the procedure to boot women out unless they are 3cm dilated, just curious.

We don't have a 3cm rule MTS. The whole picture is taken into account. If the mum is coping with the contractions, I would encourage to go to the ward and come back when labour is more established. If she is not coping, I would keep her.

yes mears, that is exactly what happened. I was in terrible pain and they said I wasn't in labor and it scared the hell out of me to think what worse pain might be coming and there was no one to help and no information or anything.
I'm sorry if I sounded so vehement about things, because I am sure that you would not have treated me as these midwives treated me, but you seem to be fairly unusual in the world of midwifery and I think that's a pity. As I said before, I think that there really needs to be much better preparation of mothers for what to expect and much higher staffing levels of labor wards. Surely they could figure out some system of "on call" that would allow midwives (and doctors) to come in at short notice if a whole lot of mothers show up at the last minute. They seem to be able to figure out this type of stuff for other unpredictable professions like firefighting.

I can totally understand where you are coming from Sofiames. It really is a dilemma in maternity units, the ability to provide adequate staffing in times of peak activity. It is certainly something that is looked at and we have decided that should there be times of excessive numbers of women, community midwives will be called in to help. That doesn't help what happened to you though