pressure sores from labour

[Solmum2b]

Hi, recently given birth to my healthy son. However, I am on evened by the care provided by the hospital. I developed three pressure sores while in labour which are still healing 3 weeks labour. I left the hospital with only a cotton pad covering the wound. It has since required daily dressings from a district nurse. Is this malpractice?

That should say 'concerned' about the hospital care I received

Pressure sores? Or some other wounds?

Pressure sores are very rare in healthy people who can move around, what happened?

Where is it? Are you underweight? Tbh I can't imagine that would be a foreseen risk unless you had specific mobility/skin viability issues prior to labour.

How long where you in labour for? And where you lay down in one position the whole time? If you're generally well I'd be very surprised you developed pressure sores

I had an epidural, was allowed to push once fully dilated, then an artery was ruptured in my perineum, lost 2 litres of blood, went to theatre for them to try forceps but it became apparent pretty quickly that I was going to have an emergency c section.
On leaving the theatre the ODP (?) said I had pressure sores. Was given 2 blood transfusions post op. Re pressure sores- the midwives just kept saying how rare it was and that 'I should just let the air get to it' ?? Left hospital with some Secura spray on skin and a cotton pad to cover it on the drive home. Since then - GP and district nurse have been to see me and wound requires daily dressing.

I'm 33- runner, horse rider and swimmer. I laboured for 9.5 hours in the same position and wasn't moved once.

Not labour but my dad got a hideous pressure sore on his bottom after 8 hours of surgery.

His legs had been suspended in the air for surgery (vein replacement) and the staff nurse on duty was horrified the theatre hadn't put him on a pressure mat.

She told him to complain but he wouldn't. Suppose you need to take further advice?

Congrats on your baby and I hope you feel better soon.

In theatre they are a known risk which theatre staff are meant to mitigate as they have prior knowledge that the patient will be immobile for X hours.

However since labour is a constantly moving target, I'm not sure a complaint would be successful. No risk assessment prior to your labour would have pegged pressure sores as a risk.

A complaint would be very effective! In most hospitals pressure sores are a Never event . Certainly in labour. Midwives are taught to be especially aware of the possibility with women who have long epidurals. This should be being investigated via the incident reporting system definitely raise this.

What do the sores look like? I'm surprised that you'd need daily dressings. Unless they are weeping badly the general thought is that changing dressings just disturbs the granulation tissue.

9.5 hours in the same position is far too long.

Do you have a post natal appointment at the hospital? This would be a good time to discuss your concerns. It all sounds very traumatic. The consultant will be able to discuss the medical side of your care and answer any questions.

Usually there is a senior midwife who does debriefs for women who request one. I would ask for this as well. She will be able to take some time to go through everything with you.

What would you like to achieve? An apology? A change in practice? Compensation? If you just want to understand what happened and make sure nobody else develops a pressure sore do say so. I'm sure nobody is pleased or impressed by this.

My SIL did develop one in labour but it was quite superficial and healed well. A midwife should be aware of the risks.

Also another a bit dubious about the wisdom of changing dressings daily. We don't do that in the hospital unless necessary I.e. If the dressing is destroyed by pus or faecal matter. An air permeable dressing should be left alone. The air will get at the wound but the tissue is left undisturbed.

I can vouch that I too developed a superficial pressure sore from being left in same position for hours after epidural in labour. Didn't realise as I couldn't feel it at the time.

I would put a complaint in tbh, pressure damage can happen in a very short space of time. You may well want to speak to a legal person as I imagine you could be entitled to some compensation.

Have you had your bloods checked since being home to check not still anaemic? I would also take a decent multi vitamin and iron tablets to aid wound healing.

Is it definitely a pressure sore or could it be shearing from bearing down?

And I'm very dubious as to why these are being redressed daily. There's no need for it, unless there is heavy exudate which there shouldnt be. Your healing process will be impeded by daily dressings.

Medical malpractice is incredibly specific and no-one on here will be able to give you the advice you need.

Midwife here. Pressure sores in labour, whilst having an epidural are generally considered evidence of substandard care. They are uncommon but avoidable.

Get your OH to photograph them. This is so if you get fobbed off you have evidence.

I would go down the route of a formal complaint. Several reasons for this.
It forces the organisation to investigate and respond to you in writing.
It makes the organisation have a good look at itself and what remedial actions are needed.
It puts it on the corporate agenda of things that should not happen. There might be someone (like me once) working to improve services and needing evidence to get stuff prioritised. Serious complaints are very helpful.
When the CQC come in, they look at complaints and the organisation is held to account.

PALS at your local hospital can help with complaints process.

Thanks for all your responses. It's definitely been classed as a pressure sore, (I have black necrotic tissue in the middle which needs to lift off) dressings now changed once every other day. I have taken photos.

I have written an email to the hospital but not sent it yet. I don't want to sue the hospital, but I do hope that no one else gets this sort of treatment. I think I feel most frustrated by the fact that the midwives simply didn't take this seriously enough and ignored my concerns

It's gone necrotic?! What?!

Have you been tested for any underlying conditions? I would have expected a grade 1 possibly 2 but not an un-gradable necrotic pressure sore in a person with no underlying conditions

Do you know what grade they are?

If it's necrotic it sounds like a grade 4. Grade 3 and above is classed as a Serious Incident in a hospital and is something that shouldn't happen. Ideally the midwives should have called for a tissue viability nurse to come and advise on dressings.

You can't grade necrotic pressure ulcers.

How long where you in hospital for OP? I'm just wondering how they could have possibly got to a stage of necrosis.

Feel awful for you, have the district nurses had the Tissue Viability Specialist out to you? They're the best people to recommend a dressing protocol for you including special dressings they can prescribe that will lift that necrotic tissue away so the healing process can begin.

But a grade 3 or below pressure sore wouldn't have necrosis is what I'm saying. So I thought any pressure sore with necrosis was grade 4 and nhs choices seems to back this up.

I'm a midwife not a nurse so thankfully no expert. Ive only seen one pressure sore in my life and that was after someone had had an epidural for 90 mins. Prior to that she had been mobile and kneeling, so they can develop really quickly and unexpectedly sometimes. If you're on wet sheets with your waters broken and move slightly then a shearing effect on damp skin can cause them. So it's not always hours and hours of prolonged sitting. Where I work I think we're quite proactive and we do assess people in labour and check pressure areas frequently and have to document that we've done this.

Obviously you shouldn't be left on wet sheets in labour and it's why inco pads should be changed frequently but it can be hard to keep you dry in labour if your waters are constantly leaking.

How deep is it?

I see a lot in general nursing. This does sound unusual.