Why don't high-risk women get better support?

[theyoungvisiter]

This is somethign I have been thinking about for a while but I was prompted to start this thread by a post on another thread (about breastfeeding).

My perception is that high-risk women are being completely let down by the system, their medical needs are being met but their holistic needs are being completely overlooked, while low-risk women are receiving much better all-round treatment. This seems mad to me and completely arse about tit - it's established that difficult births lead to higher rates of PND and lower rates of bfing - surely everyone needs all round care, but high-risk women especially?

My own experience bears this out - I have had two births with completely different experiences.

In my first pregnancy I was put into a high-risk protocol. I saw a different health professional for every single appointment, the only person I saw more than once was the (extremely busy) consultant who did my scans. I did not have a named midwife and the community phone was rarely answered so I had no-one to go to with my worries. I had to schlep over to the hospital for many of my appointments involving a very long commute and extremely long waits. During my labour I was attended by 6 different midwives, and was left alone for quite long periods. Afterwards DH was sent home and I was left alone on the ward and offered no help with breastfeeding. I received 2 post-natal visits from a midwife who again, I had never met before. We were all safe and well at the end of it but it was very far from ideal care.

My second pregnancy by contrast was a dream experience - I had a home birth and was able to have most of my antenatal appointments at home as well - far easier with a toddler to amuse and I could lie on the sofa and watch TV while waiting! I had a named midwife who I saw throughout my pregnancy, she was part of a small team and when she was away I saw one of her colleagues. They had regular coffee mornings so I was able to get to know the whole team. I had my midwife's mobile number and could call her at any time with any queries. When I went into labour I had met both my midwives before and the midwife who delivered my baby visited me afterwards for 21 days before signing me off.

The homebirth/hospital birth contrast may be extreme, but it's also almost invariably the case that the low-risk birthing centre is soothingly decorated, well-equipped, with en suite bathrooms and facilities for partners to stay, while the high-risk wards are Victorian, shabbily decorated with shared bathrooms and little support.

I don't understand why the NHS seems to think that low-risk women deserve soft lighting and one-to-one midwife care, while high-risk women should shut up, put their feet in the stirrups and be glad their baby is alive?

What does anyone else think?

I should have added - both births were with the same hospital - the only difference was that I was classed as low-risk in one pregnancy and high-risk in the other.

IME your 2nd expereince is unusual even for a low risk pregnancy. Sadly due to staff shortages its very unusual to see the same m/w more than twice antenatally and your labour and p/n experiences also sound standard. Guess this varies from area to area but can certainly be typical here.

When I was pg (low risk) I saw a different m/w at every antenatal appt, had at least 5 different m/ws when I was in labour and was left alone for long periods. I only saw a m/w on the p/n ward if I buzzed and even then they never stayed to help with b/f.

I do think that my 2nd experience was unusual and that I was really lucky - but it does seem to be a trend to make the low-risk birth experience as nice as possible in multiple ways but abandon the high-risk birth as being unsolveably horrible.

For eg my hospital is planning to open a MW led birthing suite, which will have homely decor, adjustable lighting, a deep bath for pain relief, soft chairs for your partner etc. However only low-risk women will be allowed in there.

I just don't understand why ALL the suites can't be equipped with adjustable lighting and comfy chairs? Or failing that (I presume money is an issue) why not equip the suite but open it up to all women? Is there something that says a comfy chair in the room is likely to endanger the baby?!

And why don't midwives take notice of what another midwife has advised.

I am almost 37 weeks with my first so have nothing to compare my experience to, but have a tendency to agree anyway!

I'm classified as 'high risk' due to PIH and a maternal history of pre eclampsia. I'm on medication for BP and home monitoring. TBH, no-one seems to know what to do with me! My midwife won't schedule me routine check-ups as she says I should be covered by the consultant led team at the hospital, however at my last appt there, after waiting for 1 1/2 hours to be seen (by an SHO) they simply said, 'everything seems fine, come back in 4 weeks!' Which will make me 38+4 when they will discuss my induction at term. I have never seen a consultant or even a reg.

I have been refused a tour of the unit as this includes the MLU which I will not be allowed into. I am not allowed to attend the active birthing class as I will be induced (despite the possibility of me going into labout naturally before EDD and wanting to attemp a natural birth).

By contrast, a 'low risk' friend due 3 days after me has had wonderful treatment, though she is in a different area.

firstontheway - that's exactly the kind of thing I mean.

Being refused the active birthing class seems completely shocking to me - what is their rational for this? You can use all the same techniques in an induced birth. I was induced with my first and spent most of the time on a birthing ball and moving around.

As far as I know it's just becuase the classes are 'oversubscribed' and so therefore you can only get a place if you are booked into the MLU, not if you need to go to the consultant care delievery suite. VERY annoying!

TBH I feel quite lucky in that I'm a nurse and therefore have an idea about how things in the NHS are run, and know to do my own research and question the way things have been done with me. For example, at my last appt they were trying to push me out of the door, but I felt confident enough to insist I saw a reg and made him sit down and talk me through what the plan was with my care. I also made him listen to the baby's heartbeat, feel for the position of the baby and measure me, as this had not been done for 3 weeks due to no midwife appt. (As this point baby was breech)

I feel sorry for the women who take what doctors say as gospel and invest so much trust in them, as very often poor communication between health care professionals means vital things are missed.

Actually I think that borders on discrimination - to allow some sets of women access to antenatal classes and not others.

High-risk women are even more in need of strategies to manage pain, ask questions etc, as they are far more likely to have interventions. Obviously some parts of the class might not be applicable to some women under consultant care, but is that really justification to withold access to the classes altogether?

It seems to me that once you have a tick in certain categories the maternity services just write you off with a kind of "best she can expect is a healthy baby" attitude.

Nabster what was your experience?

just getting this on my TIO list - havne;t much time to post but if you search for posts of mine including 'high risk' you'll get a bit of my cross-making saga

my birth was ace due to some very strong-willed midwives fighting off the docs but the aftercare left a lot to be desired

Mrsbadger - I did search but you have a lot of posts with "high risk" in them - lots about uncooked egg which I don't suppose are related to your birth experience! I gather it was something to do with a clotting disorder - is that right?

Hedgewitch - that terrible - about the GP I mean. What are you going to do? Even a low-risk case is supposed to be seen more often than that - surely?

I think the problem is often that with high-risk pregnancies the entire focus is on your medical problem and the rest of your pregnancy and birth tends to get swept aside.

TYV you've exactly articulated what I think too. I've been boilingly mad about what I know and reading these awful stories just compounds it.

Our local hospital has just opened a MLU - it has ensuite rooms, mood lighting etc. etc. Delivery Suite actually has little alcoves in all the rooms where bathrooms were supposed to be put in but a funding crisis at the time it was built meant most of them were just left as cupboards (where they now put the birthing balls )

Now, I apologise for my language, but why the FUCK has the hospital been able to build a swanky new unit with all the jazz in it, which you're only allowed in if you're basically fine, but hasn't done anything about this deficiency in DS, the only place where any woman can give birth if she so chooses? I had to deliver my first DC stillborn. As all the loos on Delivery Suite have nasty, anti-male notices on them telling fathers to sod off and use the facilities in the foyer, my poor DH had to leave me during labour and go out to where all the proud balloon toting daddies were, then buzz to be let back in - a round trip of about 15 mins or so - every time he wanted a pee. I still seethe at the thought of this four years on.

The MLU also has windows with natural daylight, which upsets me tremendously. I know that DS can't do much about its structural makeup, but I keep having traumatic flashbacks about having to go back into the dark room to give birth (am due again in 8 weeks - this time expecting a room full of paediatricians and resus equipment oh joy! At least, I hope it will be joy.)

I just don't get it. I know I have never had a "normal" birth experience, having had stillborn DD, very nervous birth with DS (though nothing wrong except induction because of my history) and now sick DC3 but I just don't GET why if you're a happy confident parent expecting a healthy baby after a straightforward birth, you can't just be satisfied with that, instead of somehow requiring coloured mood lighting, a room with a view and a nice sofa for your DH to lie on.

God I could pour out bile on this subject for a month and a day.

Mrsboring that's terrible - I am crossing my fingers for a really good experience for you this time xx

and sorry, a small but inappropriate rofl at the "en suite birthing ball storage facilities". Sorry love, you can't have a pee but here's a birthing ball if that's any good?

PHW how annoying for you - hope maybe there might be some cancellations?

Yes, it is a bit roffle, the birthing ball thing, isn't it? And thanks for the good wishes.

PHW, I can't get in to see midwife either - mine is off on long term sick, the locum (or whatever you might call her) refuses to put any extra in her clinic so it's down to my poor hardworking GP to pick up the slack.

This certainly was the situation on the ward when I was there a few weeks ago with SPD. Except I felt there was a social class issue as well. Mothers from poorer backgrounds seemed to be over-represented amongst 'high-risk' patients, because they had not always taken good care of themselves in pg as much as anything else. Despite the fact they had usually not been to classes, and had no clue what was happening to them, they were left alone to languish in labour in a monstrously undignfied fashion flat on their backs strapped to monitors behind paper curtains in public, yet trying not to make too much noise, and only taken up to the ward at the last minute because of understaffing. Yummy mummies bypassed this and got single rooms with birthing pools and mood lighting and more TLC.

sorry tyv

it started here

continued here

and ended (joyously) here

mrsg - sorry that you and your husband were treated so dreadfully re:toilet facilities.

Re:MLU - I was in there at the start of labour (was a risky PG from mental health point of view, but not physically) and there really was very little TLC - just a mw popping in every hour to listen in then disappearing off again. I was actually much happier (and there was better lighting) in the consultant led unit (got transferred up due to complications).

The maternity hospital care was brilliant for my mental health problems. GP was useless, only prepared to refer me to equally useless practice counsellor, whereas the maternity hospital made sure I had extra appointments with consultant and a disability. support midwife to talk to, and arranged a quick psychiatrist referral. Aftercare on the ward was another matter though

awww, MrsB, glad it all ended well .

That's interesting totalchaos - so you felt better supported in the "high-risk" environment?

I certainly felt my medical needs were extremely well taken care of in my first pg - in fact my consultant was amazing and completely punctillious - but the bigger picture was somehow missing and I felt that the midwives wanted to wash their hands of me once I'd been "handed over" to the consultant.

the toilet thing is weird isn't it - there were the same notices up on the shared facilities in the labour ward I was in.

I mean, ok, as a labouring woman you wouldn't want to have to queue for the toilets behind dozens of chatty dads but realistically who's going to be in a labour ward toilet apart from the partner of a labouring woman? So one per woman, max, and realistically they are going to take MUCH less time to pee than a labouring woman.

My DH also had to go and use the facilities in the main hospital and while this wasn't nearly as distressing as poor MrsBoring's husband's experience, it was annoying when I just wanted him back by my side as quick as poss.

Visitors are not supposed to use Patients' toilets because of the risk of infection, eg norovirus.

but surely your birthing partner isn't quite in the category of a normal visitor? I can see you can't have loads of people traipsing through but a birthing partner is a bit different - there's only one per woman after all.

Plus I would have thought the major risk as far as that went would be shared toilets at all. If they really think toilets are a major risk of infection they ought to install en suites for all delivery rooms.

I should say that the staff were utterly wonderful and I had lots of help and support both times. It's just the building is a hole and instead of improving it, they've built a spanking new one only for healthy people which bugs the hell out of me.

Boffinmum, what you say about there being a class divide rings very true to me too.

I would like to know what the NCT et al are doing about all this - it seems to me that they have in the past been enormously helpful in changing attitudes in obstetric care, but now seem totally focused on home births, MLUs and the like, which, for some people are never going to be an option. Perhaps if I find the energy I will bug them about it.

I guess I am really lucky.

I am high risk due to diabetes (that I had before the pregnancy occurred).

I see one of 2 endocrinologists every two weeks and a OB once a month, until I'm 28 weeks when it will go to every two weeks.

I have also met most of the midwife team, one of whom will do my delivery when the time comes.

I am in Northern Ireland.

And I think if you are not content with your care, you need to complain. Write a letter. Tell them! Don't just take it. Nothing will change if no one says anything.