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 think the point about individual en suites is an important one, but minimising visitor use is just a step in the right direction as far as infection control is concerned.

However it would be relatively simple and obvious to put in fathers' toilets on labour wards, wouldn't it?

I had an en suite toilet in all my labours and DH wasn't allowed to use them due to the risk of infection. hey were just for me . \he had to go down the corridor to the public loos.

TYV I completely agree.
Both of my pregnancies have been "high-risk" enough to warrant seeing a consultant every couple of weeks for most of the preg.
This has meant that through both my pregnancies the only contact I had with a midwife was at booking-in.

Cons was lovely but obv concentrates only mainly on the health aspect.
So I had no advice on breastfeeding, delivery, groups for new mums, labour ward tours etc.

To be fair I do have a reasonable amount of knowledge on most of those things (and had two CS anyway) but am presuming there are lots of women in a similar boat - would imagine most diabetic women would fall into this category for instance.

Not sure how best to approach it though - as the medical obstetric clinic I attended used to hideously overrun every week and as I was also having scans and dopplers at most visits I was already spending up to 4 hrs per clinic...don't think I would have appreciated being told I needed to see a midwife as well!

the youngvisiter - yes I definitely felt much better supported outside the MLU. after being left and occasionally listened into on MLU I was actually quite relieved to be stuck on a fetal monitoring belt!

mrsgboring - thinking about it, there definitely sounds like there should have been better provision for families going through traumatic experiences such as stillbirth to avoid situations like you describe with the toilet.

I was quite mollycoddled after a really nasty mc, but the fact the labour ward was relatively empty was a big factor in that. I did see the NHS at its best though - three nights being pampered in a single room with en suite, and midwives popping in to hold my hand and be kind to me. (Prior to that I had been parked near the nurses' station next to the terminal gynae cancer patients, and hardly able to get into the heavily shared bathroom when I needed to due to the heavy bleeding - NHS at its worst? They had originally put me there in case I was upset by seeing newborn babies, but actually I felt a lot happier surrounded by good vibes on the labour ward than next to multiple dying people).

It comes down to staffing and facilities and patient numbers at the end of the day. There don't seem to be enough rooms for women full stop. I say rooms not wards, because I think we need rooms.

"It comes down to staffing and facilities and patient numbers at the end of the day. There don't seem to be enough rooms for women full stop."

I quite agree - I guess my feeling is though, that where resources are tight they should be spent in a way that benefits everyone rather than on the group who, arguably, least need it.

I should add in case it seems like it from this thread that I am not anti-home birth or MLUs at all - far from it, I was extremely happy to be able to take advantage of them for my second pregnancy, I just feel sad that the same level of support is not there (at least at my hospital) for women who can't access the low-risk protocol, or (just as importantly) choose not too. I completely agree with Boffinmum - there is definitely a class issue. At the homebirth coffee mornigns I attended virtually everyone was white and middle-class, which is not representative at all of the area I live in.

As homebirths are supposed to be cheaper, in health economics terms, I have always been baffled as to why low risk people are sent into hospital at all.

I suspect that if that were the case, BoffinMum, then home births wouldn't work out cheaper. The cost comparison was done on a sample of actual births, but of course people weren't randomly assigned to HB or non-HB groups, they were self-selected. I suspect that the people currently choosing HBs are likely to be the cheapest patients wherever they deliver. And I'm not sure if HBs were scaled up to serve nearly everyone if it could be done for as little either. No expert though.

I think also the problem is that many people are conditioned to want to be in hospital, if PCTs were perceived to be pushing people into home birth it would be hugely unpopular, and would only take one unfortunate outcome to cause a press scandal (and a massive law suit).

also I am guessing that it's the case that successful home births are cheaper than the average hospital birth. It would be interesting to know whether the figures take "failed" homebirths into consideration, ie cost of sending a midwife, transferring, then performing a CS or whatever intervention.

Yes, the one I read did take into account the cost of transfers. ITA that there is no way you could force all low risk women to HB (I certainly wouldn't want that!).

My experience was the opposite of many here. In my first low risk pg the care was awful, but fortunately moved areas before the birth (which became high risk so I would have been shoved out of the posh homebirth centre in my old area before I could have admired the wallpaper). In second, high risk pg care was great (although no fancy decor).

I think this was almost entirely due to the areas I lived in each time and the organisation/allocation of antenatal facilities. I think had I been low risk my care would have been good in the area I'm in (despite understaffing and lack of funds). And had I had my second pg in the old area I would almost definitely not have my lovely DS to show for it as the problems would not have been spotted.

Totally agree with theyoungvisiter and have been wondering this my self.

For instance in London UCH has a fancy birth unit just opened but the only people who can use it are people who could have a home birth (low risk women)!

People who need to be in hospital can not use the hospital facility.

More expensive interventions (emergency c-sections, forceps, epidurals etc.) happen as the result of hospital births theyoungvisiter .

Home birth statistically have the risks of these things. Which is why people have home births.

It's a very good question, youngvisiter. Of course women having hospital births should have the same mod cons as midwife-let units.

I was classified as high-risk (I have epilepsy) but managed to talk my way into the midwife-led home from home unit. Had to speak to the director of midwifery to argue my case.

Glad I did in a way as the environment was much nicer and dh was able to stay with me in the delivery room overnight but staffing shortages meant I barely saw a midwife. Luckily had three people with me. By accident, my sisters came along for the car ride to hospital and never went home!

As a result, I had a third-degree tear - no midwife to guide me through transition and pushing. BUT the hospital unit might have been no better as there was only one midwife on there, too.

Do something about it, join your local maternity services liaison committee (MSLC) and tell them what needs to be done. Write letters to your local maternity units. They do listen to complaints and suggestions but need to be told about them.

I have had excellent care with both my pregnancies - both classed as high-risk due to a relatively rare connective tissue disorder.

My first pregnancy I saw a wonderful midwife/consultant team and was delivered in the local hospistal. I had a private room; they let my husband stay overnight on the first night because our son was in the SCBU; I was given extra scans and appts in order to monitor the pregnancy and everything went very smoothly.

My second pregnancy was similar. I saw the same midwife/consultant throughout the pregnancy. I had physio help and support from the first trimester and was admitted for rest from around 32 wks until the baby was born. I had a private room and was very well cared for indeed.

I had a few issues with pain relief the evening/night after my elective section (which was performed on a different ward and where I was looked after by different nurses/midwives) but apart from that, the after care was great.

I've since had excellent postnatal care with intensive physio and support that has made a real difference.

So, I'm afraid I have to disagree with the OP - I was high-risk and I couldn't have had better or more attentive care.