I want to give constructive feedback to my maternity hospital following unidentified injury - help!

[CanAnyoneAdvise]

I gave birth to DD1 in July - first baby, great experience (no intervention), left hospital 10 hours later with gorgeous girl and small unstitched tear.

A few months down the line I realised there was something not quite right, and two weeks ago a colorectal consultant confirmed that I had sustained serious damage to the muscle between vagina and anus and a) would require reconstructive surgery and b) would have to have elective c-sections in future. I have just about got over the shock, anger and upset.

From my reading, it seems possible that this damage was caused because the first stage of labour went on for too long. I was examined once at 9pm (4cm dilated) and then at 2am (waters were broken, baby emerged quickly all at once, after 10 mins pushing). The ward was incredibly busy and as a first timer I'm sure I wasn't expected to progress so quickly. However, 2 things are in my mind:

1. the first thing said to me on arrival at the ward was "I'm sorry in advance that you won't receive the care you deserve because we're so busy" and
2. I don't want this (if 'this' is even remotely avoidable) to happen to anyone else.

What I also don't want is to sue anyone or get anyone into trouble.

So (at last - I get to my actual question), does anyone have suggestions as to how I could go about this in the best way for both any learning to be learned and without opening myself up to further upset? Also, if anyone has had any experiences of this kind of surgery/injury I'd be really grateful....

Many, many thanks in advance for your advice. Many thanks also to a few people who replied to my post many moons ago urging me to see my doc - thank you SO much.

I don't have any easy answers for you, but firstly just wanted to say how sorry I feel reading your post. It must have been a real shock for you, especially when everything seemed to go so well at the time.

Secondly, it strikes me that you don't seem very clear on why the damage happened. Have you used the listening service at your hospital, where a midwife goes through your notes with you and talks you through what happened at each stage of your labour and why?

It may be that what happened is nobody's fault and so there's nothing you can do to avoid it happening to anyone else. On the other hand, you might find there was one event or course of action which triggered the damage - if so, it's just possible (although I fear unlikely) that you could find a way to raise this with the head of midwives in a way that makes it less likely to happen to other people.

I'm afraid my experience of NHS hospitals is that they are often overstretched, and won't (or can't?) take time to listen to individual patients very much.

I work for the NHS and we certainly do listen to individuals patients - although of course at times we are busy.

I would write to the department, explain if you want to that this is not a formal complaint and that at this stage you don't want to go down this route. Then just tell them what you've said above.

If lack of resources means that patients health is at risk it could be that your case gives the dept the ammunition it needs to argue for more resources.

I'm sure the people concerned with you care will be mortified to hear what has happened to you. If you don't want to write to the dept contact the Patient Advice Liason Service at your hospital (Pals) - ring the s/board and ask for them. They will note your comments and pass them on - and they will get feedback for you.

hi i was wondering how u realised something was not right?
i also left hospital after the birth of my first child in 2005 with a small unstitched tear.
i coulndt sit down for at least 2 months folowing due to the pain i was told this was normal and given weak pain killers (that didnt work)... i dont have any trouble from it now apart from the rare sharp shooting pain but have always wondered if i had some bad muscle damgage.
i am quite worried as im expecting my second child which is due in 4 weeks and dont want to go through the same thing again.

I think your first steps should be to go over your labor notes as tuttifrutti suggested and see if these help explain why this happened to you.

I'm not sure why you feel that your first stage of labour went on too long, it sounds quite quick to me (not saying you are wrong, just not clear from your post). Did the colorectal consultant say it was the long first stage that caused the damage (as a pose to a v. fast second stage)?

I do admire your really positive attitude in dealing with what's happened to you btw and think you are wise to pursue this with the hospital.

Thanks everyone for your posts so far - I will definitely follow things up with my notes etc.

231Bex - I have 2 main symptoms, wind coming out of vagina (as opposed to the lovely fanny fart) and traces of faecal matter in my discharge after having a bowel movement. Hope this helps.

wb - thanks for your post. My post isn't that clear on the first stage part, having re-read it. You're absolutely right in that first stage wasn't long at all in total. However I think I went from 4cm to fully dilated really quickly and that my LO descended fully into the birth canal ready to be delivered well before my 2am exam. Her being there, exerting pressure on the muscle, may have been what caused the damage. I hope this makes more sense.

I just want to express my admiration for your refreshing attitude in this litigation society! I do so hope that your reconstructive surgery restores normal function.

Yes, I understand now - thanks. It does sound like the amount of monitoring you received was insufficient (when I delivered ds1 internals were every 4 hours for first deliveries BUT they checked on you every 15 min, timed contractions etc so should have had a better idea regarding progression). That would make sense if they were really busy but is not really acceptable.

Good luck both with the surgery and with taking this up with the hospital.

Sorry to hear of your problems, cananyoneadvise.

It sounds like you have a recto-vaginal fistula given the symptoms you describe.
It is not well known that women can have severe damage to the anal sphincter or the rectal mucosa technically resulting in a 3rd or 4th degree tear whild still having an intact perineum, but it is one of the many risks of childbirth.

It does not sound like your labour went on too long (4cm to delivered in 5 hours is very good progress) and 10 mins pushing is excellent, and so it seems that your labour has pretty much been textbook, and any midwife would be very happy having been involved in your birth.

Our hospitals latest guidelines (apparently taken from NICE guidelines) for second stage with an epidural are that women can have 1hour at fully dilated and 2 hours pushing, and 2nd stage should be completed within 4 hours and yourentire labour was not much longer that this. This means that the babys head can be sitting very low in the pelvis for up to 4 hours with no expectation of damage. So I really cant see how the surgeon can think that the baby low in the pelvis will have caused this damage to you. It is what we are designed to do.

To get to the point - I think that for you, it would be a great idea to go over your notes with someone, but I dont think you will get any answers there, and writing a letter to the midwives will probably not acheive much, as it sounds completely unavoidable. If you have letters to, and meetings with the midwife / supervisor of midwives etc, then it is a complaint and will be dealt with as such, and of course it is going to be upsetting for you and the staff invoved.

Im sorry if this is not a very positive post, but it really does sound like you have been both incredibly lucky in your delivery and very unlucky in the consequences of childbirth.

You poor thing. DS's birth (March 2004) resulted in a rectovaginal fistula which was finally repaired in November 2006. I am impressed by your cool-headed approach; I wanted to murder everyone concerned, or at least sue them till their eyes watered, but I went through the hospital's PALS unit and they were brilliant. I had a long session with a midwife where she went through my notes in great detail, and an equally long follow-up session with the consultant obstetrician who delivered DS, during which he explained exactly why he'd made the decisions he made - and more importantly, apologised wholeheartedly. Let me know if you want to talk about the repair surgery; I am completely recovered now!

Hello, I do think that there tends to be a bit of a unspoken battle of politics between gynaecologists and mid-wives. Gynaes always say that the first stage/second stage went on too long. And by definition, most of the problems that they see could probably have been avoided by c-sections.

I honestly don't think, from what you have said, that there was any problem with your treatment on the maternity ward. What didn't happen, that you feel should have happened?

MP and Mintpurple, I have to say I agree - my obstetrician made a very convincing case for fistulae being a rare, but "normal" consequence of vaginal birth. DS was delivered with Keilland's forceps, which obviously increases the risk of damage. However, I am certain that no-one did anything "wrong" during my labour, and that what happened was just one of those things.

I think that it is just one of those sad things that some women have bad tears during normal childbirth. However the midwife who delivered you failed to spot a serious tear. This is really important that she is made aware of this as she can change her practice to ensure that she does not do something similar in the future. You can write a complaint letter without suing, don't worry about getting someone in to trouble, she needs to know and in most units would be supported to improve her practice. As a midwife myself I worry about this and therefore check perineums and vaginas carefully after birth although it is sometimes really really difficult if the woman is too sensitive to be touched. In that case I would advise her that this sort of thing can happen and that she should see someone asap if she feels that it is not right.

Can I be very rude and ask a question on this thread?

I have my six week check tomorrow but gave birth 10 weeks ago. I had a forceps delivery resulting in a 3rd degree tear and since then have no feeling of a 'full' bladder. I have to go to the toilet regularly as I don't know when I need to go. I also pass wind through my vagina. Would this be the same as cananyoneadvise?

I am so sorry this has happened to you and that it has taken so long to get the courage to get it sorted out. Glad MN could help there though

I am lucky enough not to have the medical problems you have had but just to reassure (not sure if that is the right word) you my 2nd stage was much longer and with only 2 exams in about 10 hours. 26 hour Labout in total. I think there must be another explanation, perhaps some women are just more prone to this happenning? I think you need to go over the Birth records for your own sake and then speak to the Hospital if you still want answers.

I also think it is great you are not wanting to Sue. The NHS must spend Millions defending claims when the money could be going into rectifying the problems to prevent future reoccurances.

I hope your Surgery goes well.

muppetgirl: why not start a new thread and see if anyone can advise?

Do you have a copy of your notes now? If you have someone talk you through why each decision was made or what options were available at the time it may help you feel happier with the outcome (if that's at all possible) You're very brave and I admire you.

Wow, thanks for all these great posts - very very much appreciated.

In my OP I referred to the first stage being too long, whereas what I really meant is that I think I progressed very quickly, which wasn't realised because I was only examined twice, once at 4cm and again immediately before delivery.

I agree with what everyone's said really. Perhaps you can have a predisposition to such injuries and ironically with more exams maybe I would have been pushing for longer and suffered a different type of injury. We'll never know.

I guess at the moment the big link for me is this injury and the fact that my delivery was so very quick - in my mind I should have starting pushing earlier rather my LO practically fall out (she literally did fall out onto the bed when the midwife was getting things ready!). However I'm the first to admit that I am no expert, so I don't know how easy/hard it is to identify this sort of damage and to identify how/why it happened. Like most things it's probably a confluence of factors.

Also - my thoughts as outlined in my post are really my own, neither gynae or consultant have said why they thought this had happened.

Bluestocking - thanks for posting! I am so pleased to hear you are fully recovered. The horrible bit for me at the moment is the aversion I feel to intimacy with the symptoms etc. Childbirth leaves you feeling strange enough in terms of my body, without feeling yuck. Then there's how I'm going to cope with the wind issue when I go back to work in a few weeks.... we shall see. Really helps to hear from someone who has been through it. Thank you

Muppetgirl: in case you don't start your own thread.

I too had a forceps delivery and second degree tearing, and was left with no bladder sensation at all (not incontinent but couldn't feel if needed to go or not). No vaginal wind though.

My midwife was very concerned and arranged for me to go back to the hospital to see the consultant (gynalogical-urinary I think). Luckily in my case things slowly got back to normal before I had to do this (about 10 -14 days after birth).

Anyway, please bring this up at your appointment and ask for a referral. What you are experiencing is not normal.

Wb - have just got back from Drs (6 week check although I gave birth 10 weeks ago) he's referred me to a Gynaecologist as he agrees with you that all is not well. Thanks for your post

Coincidentally dug out photocopies of my first birthnotes this morning (2nd baby due in, cripes, 6 weeks max). This post has reminded me of the experience, although I was stitched up afterwards. I wanted natural birth but 1st stage was almsot too quick for my body to cope with, 2nd stage DS got stuck, banging head on my pelvis. Ended up with forceps delivery with epidural. In all the blur I was not aware why I was in theatre so long afterwards - turned out that I had an epesiotomy (spelling?) which then ripped round to a 3rd degree.
I had no idea until consultant came round the next day and drew a diagram of the damage to me and to this day I still suffer from rectal bleeding after toilet.
Consultant consequently recommended C Sections from now on (hence digging out notes for hospital meeting soon).
I wasn't angry with them for the epesiotomy as it must have been necessary, and it wasn't their fault I happened to rip further causing much more damage. I do wish they told me immediately afterwards what was happening. Sure, I couldn't do anything about it.

I do think they worry about telling you anything in case of litigation...

Hi, I would be really interested in hearing your recovery story. I am looking for some ray of hope as I have been diagnosed with a rectovaginal fistula following a 4th degree tear. I have been suffering from post natal depression and cant believe this happened to me. It has been just 3 weeks since I gave birth and I have not enjoyed time with my baby yet. My symptoms are wind from the front and faeces in my discharge. It is so distressing. I cant see a light at the end of the tunnel at the moment and life seems extremely gloomy but really hoping to hear and looking desperately for a positive recovery story.