Why are so many women having bad birth experiences?

[MumsnetGuestBlogs]

This week saw the publication of a report from the Care Quality Commision (CQC) which documents the ‘truly shocking’ birth experiences of many women.

One in four women was left alone during their labour or birth at a point when they were anxious or worried, according to the survey of women's experiences of NHS maternity care in England. "Feedback in the comments shows at times a truly shocking picture of experiences that should be the most joyous time in a woman's life, not the most frightening."

In a grim coincidence, I received a letter last week from the Chief Executive of the hospital in which I recently gave birth, responding to a formal complaint I made about my own treatment in the maternity department there.

At eight months pregnant, I suddenly began to haemorrhage badly, and was ambulanced to hospital. Everything happened so quickly that there was no time for my husband or mother, or even a friend, to get there. I was alone, frightened for my life and that of my unborn child, and desperate for reassurance from the midwife - but she was "too busy" to help me understand what was going on, and cross because my admission had "interrupted her lunch".

Immediately after my son was born by emergency C-section, limp and struggling to breathe, he was rushed to intensive care. My husband had arrived just in time for the birth; afterwards, though, we were left alone.

Somewhere in this vast, vast hospital was my tiny, helpless son, who desperately needed his mother - just as desperately as I needed him. Every instinct was telling me to get to my baby, but when the midwife returned I was told that I couldn’t visit him, until my "legs are back working". They wouldn’t take me.

On the postnatal ward, the nightmare continued. I vomited repeatedly in reaction to an antibiotic I was given, causing enormous pain to my still-fresh abdominal wound, but was refused adequate pain relief. I couldn’t get off the bed because I was in so much pain, but was shouted at for not leaving hospital quickly enough. I was desperate to stay with my son, who was still too sick to leave intensive care, and had I been discharged I wouldn’t have been able to manage to get back to the hospital to feed him. I was told this "wasn’t their concern".

With the utmost reluctance, they allowed me to stay one more night - "but after this, no matter what pain you're in, you're leaving". The following morning, the midwife answered the phone in my earshot and pointedly said, "We don’t have any beds right now, because we have some really selfish people here who are refusing to leave".

According to the letter I received from their Chief Executive last week, the midwives "were very upset to hear that this is your recollection of the communication". The letter is littered with phrases such as "We are sorry for your interpretation of events". The chief exec "would like to take this opportunity to thank you for your comments" - but clearly plans to do jack shit about them.

My son’s birth was traumatic - that’s nobody’s fault. But the way I was treated, at a moment when I was terribly afraid and desperate for reassurance, made things infinitely worse; it turned a difficult start to his life into a horrific one. I’m angry that I went through that, and I’m angry that I’ve now been disbelieved. I remember every detail with absolute clarity - though I wish that wasn’t the case.

Why are so many women having such dreadful birth experiences? Four in 10 of the 23,000 women polled by the CQC were unhappy with the quality of care they received. While standards of care in other branches of medicine seem generally to be improving, maternity care appears to be going backwards: the number of women who report being left alone and worried has actually increased since the watchdog last investigated the issue in 2010. Women’s concerns about the treatment they receive during birth are routinely pushed to one side: one in five women felt their worries during labour and birth were not taken seriously.

Birth can and should be a joyous experience - but for too many women, it simply isn’t. Sorry to point out the bleeding obvious, but birth is a uniquely female experience: men can't do it. If they could, though, I suspect the quality of maternity care in this country would improve pretty damn quickly.

[Gooseysgirl]

I recently had DC2 by ELCS (DC1 was EMCS). I would love to have tried for VBAC but I had absolutely no confidence that I would get the 1-1 care I wanted to be comfortable with this choice because of poor staffing levels and lack of space in my hospital (we are in London). In the end I felt the safest option was to have a planned c section... Isn't it a sad day when I felt I had to undergo major abdominal surgery because that way I was guaranteed staff to care for me throughout my delivery. And yes I'm aware of the resources this may have taken from real emergencies but in the end all I cared about was the safe delivery of my baby. And like a PP there is no way we will have a DC3 unless we have a large lottery win and can pay for private care. The post natal care was diabolical, as in the staff were great but clearly overworked and simply not enough of them to provide adequate care! We waited 9 hours to be discharged as that's how long it took the midwife to get the paperwork done - NOT her fault at all, she was looking after loads of other women and just didn't have time!!

[TweenageAngst]

Shortage of staff. I am a regular nurse but have several labour ward midwife friends in busy London teaching hospitals. They are delivering twice as many babies per annun than the units were designed for and often caring for more than one woman in labour at a time. Very often they work 13 plus hours in a shift and may, if they are really lucky get a 15 minute break during which they gobble a sandwich go to the loo and get back to work.

[ceramicunicorn]

Me and DH are currently saving to pay for next birth to be done privately. I nearly died giving birth to ds. They thought he was breach but had no portable scanner to confirm. I was then left to give birth vaginally to a breach baby on my own apart from dh, midwife came in to cut cord, tell me I didn't need stitches and pointed me to a shower I could walk to down the corridor. I have since had surgery privately for the massive prolapse I suffered due to lack of stitches.

I also received the 'sorry you remember your experience this way' bullshit.

[Grumblelion]

I always got the impression that women in labour are treated quite patronisingly. You're often made to feel like you're making a big fuss about nothing or being a bit of a wuss. The single biggest issue I believe is the staffing, and the fact that the one-to-one care recommended just does not seem to happen because of a shortage of midwives. I was lucky and had midwife and a 3rd year midwifery student. The student did not leave my side at any point and could not have been better. Compare that to my SIL who like me gave birth at "Queens College" and still gets tearful when she talks about my DN's birth, largely because she was left alone, in pain and scared for large chunks of her labour - as in the OP's blog, this was mainly on the ante-natal ward after being induced.

The main problem I had was trying to communicate the special instructions from my consultant written in my notes to the midwives on the labour ward when trying to persuade them to let me come in. The staff on the ward had no access to my notes to see my medical history and didn't even ask how long/far apart my contractions were, when all I knew was that my consultant wanted me to be regularly monitored but the
random woman at the end of the phone wouldn't let me come in.

Post-natal wards are a whole separate issue, I have met no-one who had a positive experience there.

[bigbutsrus1]

All these stories make me so sad. I am a midwife, I work in a relatively small hospital which has "performed" excellent in recent reports. (Not sure how we we do next time though)! I have been a midwife for 11 years and even in this time I have seen the standards drop. From our point of view (which is no excuse) is the services are ridiculously over stretched. For example,, we work in a intergrated system so I could work all day in the community then as I would be on call have to work all night at a home birth or called into the unit as they are under staffed, then we are still expected to try and work a part of the shift the next day. The knock-on effect is awful as the next day we would be short again.

I have always given this job my everything but it seems to never be enough. Doing these kind of hours with the pressure of the job has broken a lot of midwives. We have a huge percent of sickness due to "burn out" or job inflicted mental health problems. Which in turn effects the rest of us as short staffed again! These things do effect the Effectiveness of care given and until the big wigs and government understand this unfortunately I don't see it changing. So sad as the people I work with are fantastic - just they can't be fantastic with no sleep for two days or minimal food. Sounds really dramatic but it is, the services are literally at breaking point because of the cycle that it is stuck in. I want to stay to see it change...to get back what I originally set out to do but with another 30 years ahead of me it is no wonder people leave.

[BoyMeetsWorld]

Bigbuts ..yes, can see that it must be very hard to work under such conditions. Are the people who man reception / the phone lines also in such shortage as I agree with other posters that often its not even the mws that are the issue but the person who 'allows' you to come in or not on the phone. My 2nd birth ended up a bba purely because it started progressing really fast, I had some bleeding (but not haemorrhaging!) & started feeling the urge to push. I was down for mw led care and had a v trouble free pg. woman on the phone at our local MLU (5 mins away) refused to let us come in as they were too busy to check my bleeding. DH explained I was literally ready to push. They still wouldn't let me come. The nearest consultant led unit is nearly an hour away - I knew if I got in a car baby would be born en route. So as a result he was born in our living room with DH & the lovely paramedics only. I still think its ridiculous the MLU would rather risk a mother & baby's health like that rather than letting them come in. & at every check up since I've been chided for being 'reckless' enough to have an unassisted home birth. Erm - whose fault was that?

[Onesleeptillwembley]

I had two births with fantastic staff. One with terrible, unprofessional, frankly horrible bitches. Poor staff is down to a lot of it.

[bigbutsrus1]

Boymeetsworld... That is so awful! We have a reception but they put woman through to a midwife to speak to. There are bigger units near to us who have closed as no staff to look after woman so they have to go to the next unit. The government have trained loads of midwives but then won't let the hospitals employ them as have restricted the budgets so much. The whole thing is ridiculous, and has awful consequences

[Onesleeptillwembley]

And my daughter in law has one of the laziest, most patronising, community midwives. I'm shocked she's still in a job. If you're in Dewsbury you'll know who I mean.

[PacificDingbat]

I am sorry for everybody who had a bad birth experience because of the care they received.

I think maternity care needs more trained staff, more autonomy for experienced midwives to be less hobbled by guidelines/policies - policies are not worth the paper they a written on if they are not followed up with training/resources/staff/time.
There needs to be more time for good communication - this is always the first thing that goes when staff are overstretched and are expected to be doing 25 things at the same time, 24 of which are bits of compulsory paperwork .

FWIW, I had 4 v different birth experiences in 2 hospitals in the UK in the last 10 years and realise increasinly how lucky I was to remember them all fondly. I did have NO expectations about how things were going to go, but did always feel listened to and had things explained to me.

Onesleep, complain (or get your DiL to complain) about this MW. She'll never change unless issues like this are flagged up. Also your DiL can ask to see another MW if she wishes.

[Onesleeptillwembley]

She's complained, shes not the type to take that. She's also asked then told her to speak to her and deal with her properly. I don't think she's the first, either, but a lot of the attitude is quite subtle, some people will just take it, and the complaints probably don't get the way she actually is across.

[PacificDingbat]

That's horrible, Onesleep. Address concerns to Supervisor of Midwifery?

[lookdeepintotheparka]

I had a similar experience to you Mrs Tiggywinkle - hemorrage and baby very, very poorly after birth (unfortunately with long term consequences too ).

What I found most distressing was not the medical care for both my baby and I which I feel saved both our lives, but the horrible lack of empathy from the doctors whilst she was in intensive care. As parents, we were treated like an inconvenience and we were either told nothing about her condition or too much medical jargon that we couldn't understand.

We were too stressed afterwards to make a complaint but I will never have another baby and talking about birth with others is a no go for me. I feel really sad that for many people, they do not have a good birth experience.

[TheSporkforeatingkyriarchy]

I've had an awful hospital birth and a good hospital birth, a good homebirth and a very awful homebirth. It all came down to the people and how their views affected how they treated me and the situations as they came up.

One of the biggest reliefs of deciding we're done with having more kids physically is that I'll never have to deal with our local antenatal care or postnatal care again. I think that says a lot about major problems in the systems. It often felt like I was no longer an individual with concerns/feelings worth considering.

In my last pregnancy, the antenatal midwife, who knew I'd been abused in a medical setting and found hospital very stressful and had previously supported me, decided to try convince me about a hospital birth because 'how nice the new environments are, you should see how lovely they are in the hospital video'. My previously valid concerns turned into 'they knew best/any other medical professional would do that' and went on about the new paint job - seriously. She eventually started talking about all the dangers my kids 'would be more aware of if something happened' - right in front of said children (my oldest spent the last month of my last pregnancy afraid I was going to bleed to death at any moment because I wasn't in hospital at that moment because of that midwife) in a manner that felt like she wanted my son, who was 7, to convince me when all I'd asked for was more information and some time to decide. Neither the hospital videos or the pamphlets she gave answered any of my questions and midwife was no help at all - no stats or options, just scare stories and talking about how lovely the new redecoration made the hospital feel. I still get angry at how stressful she made the end of my pregnancy, even though the hospital staff treated me mostly well (though the hugging me while trying to get me to change my mind in front of a dozen students felt quite insincere).

[NumptyNameChange]

agree with whoever said they have no ideal of the scale of the problems due to so few of us having the energy or will or time to complain.

i was too busy trying to undo the damage that had been done to breastfeeding by their incompetence and attending appointments to establish that yes i did need a secondary repair due to incompetence and coping with the further disruptions that caused to breastfeeding and the whole new levels of pain to deal with that complaining was just not even on the table even for a usually assertive and articulate person like me who isn't intimidated by authority figures.

i won't bore everyone but the incompetence i encountered and that was actually totally evidenced because they were so incompetent they even recorded the stupidity without realising it was unbelievable. yet funnily enough i was too busy to sue.

i am assured that if i had sued i would have been compensated and heads would have rolled. too late for that now though - my son is 6 and healthy despite their best efforts.

[DoYouLikeMyBaubles]

It saddens me that there are so many midwives out there who are amazing, and then there are those who let the women down, the whole profession down and thus tar the whole lot with their bad practice.

I have a lot of midwife friends, they've had to train for a long time and gone through life changing processes to get to where they are and they don't take that for granted. Midwives are now trained to care holistically, you can actively see the difference from a midwife who embraces this holistic care and one who just thinks of it as 'baby out, mother done, go home'.

I hear stories almost everyday from fellow nurses and midwives who want to leave the profession because they are unable to do their jobs properly, and feel they are letting their clients/patients down. Whether this be staffing issues, reams of paperwork to be filled in, lack of support from management, and being overworked and burning out.

We need to get back to the very basics, which of course is to provide care.

We need more staff, more support, and we need to be able to identify those who shouldn't be in the profession and make them answer for their mistakes, that have led or facilitated to someones bad experience.

[EauRougemasTree]

I did try to talk about the birth with a community MW that visited when DD2 was a couple of days old. I was told "you've got a healthy baby, what have you got to complain about?" and regarding my birth plan: "you women, always setting yourselves up for disappointment".

So glad DH has been for the snip and I never have to go through all that again.

[funnyvalentine]

I have had two hospital births with postnatal hospital stays. Both times, the individual midwives were brilliant, reassuring, competent professional etc. But I think the systems in place don't work all that well. The midwives are run off their feet and protocols and procedures aren't transparent so you have no idea why something is happening unless you can ask the right questions.

The worst bit was the postnatal stay as a low-risk patient. You're basically ignored because the staff are too busy dealing with high risk patients (absolutely not blaming the staff here - of course if staffing levels are low they should focus on those who need it most).

[NotCitrus]

I had good care for my first birth, despite rarely seeing the same MW. Long hard labour, over 50 staff involved, all fine. Appalling postnatal care. I complained eventually, got fobbed off.

When pregnant again ended up with PTSD and physical symptoms and needing a lot of care from GPs, MW, psych team, specialists... all of which would have been less likely to be needed if postnatal care had been adequate the first time.

One MW apologised profusely, acknowledged that should not have happened to me and explained what the hospital and new management had done to improve matters, mainly moving from night staff being 90% agency temps to 90% rota staff. That being believed helped a lot - where else is it acceptable to call a client a liar when they talk about their experiences - and thankfully the second time both birth and postnatal care were faultless. And that care probably saves the NHS money downstream but hey, that's a different budget.

Labouring women are a more complex population than 30 years ago - older, less fit, more likely to have survived with disabilities etc - and it needs to be recognised that care is needed possibly more than previously.

[NumptyNameChange]

in some ways more care was actually given post natally before due to babies being off in the nursery and mothers getting to rest.

i'm glad i had my baby with me the whole time (i was forced to stay in for over four days and it was hell) but it obviously is more strain on women than when babies were whisked off and women got to rest and women with bad wounds via tears or repairs or through CS weren't abandoned to cope with the pain and mobility issues as well as trying to care for a new born baby.

if i ever had another birth i would desperately hope to be able to have a homebirth, if forced not to i would discharge myself and go home immediately even if i had to fight them for it.

[NumptyNameChange]

oh and being high dependency but having no spaces for high dependencies therefore getting dumped on a normal ward and ignored doesn't help.

i can't imagine another situation where a HD patient would just be dumped elsewhere without extra obs etc being put in place. it is hard not to think that it is because it's a 'woman's issue' and therefore not taken seriously when you just cannot imagine it in another context.

[FightingOverImaginaryIcecream]

When our postnatal group were at the pub (so DC around a year old) we all got talking about our birth experiences and realised 3 or 4 of us had horrendous memories of the same MW. She was unkind, unpleasant, bullying, physically far more forceful then necessary with newborns and women who had just given birth, and none of us had complained at the time as we were all too shell-shocked from birth and suddenly having a baby for the first time.

I wish I had complained but, a year after the event, it already felt too late. Maybe this MW just had a bad couple of months, but if 3/4 out of 8 of us were that effected by her, assuming a shift pattern which meant she was actually at the hospital less than 50% of the time, she must have traumatised hundreds (thousands?) of women in her career. Amazing how one person in the wrong job can make such a difference to so many...

[NK5BM3]

I had a great experience with no1 ironically perhaps because he was a planned c section due to placenta praevia. At 30 weeks I had contractions on a Sunday, was fortunate to be told to go to the hospital and was actually met by the head of OB/gyn (on duty on a Sunday?) - the mw I rang at my local mlu actually rang through to them to tell them we were coming.

I had DS at 39 weeks v healthy, no complications other than the usual c section recovery etcetc. Transfered to the above mentioned mlu 3 days later and stayed another 2 days to help establish bf.

Dc2 - had a vbac. But not without everything being tried on me. Mw weren't interested, only the last one who managed to get baby out was the one who also understood I had a previous c section which was planned therefore I had no idea what labour is having never experienced it but now with a scar I can't labour for too long.

I had to have a blood transfusion, made to feel guilty about it as they are really too busy to get it ordered for me (they said that I should really have a transfusion in the day time but they started me 2 nights later at 11pm because someone didn't order the blood in time because they were too busy (er yes so you really should tend to me so that I can be discharged earlier!!).

Other post natal issues like not getting my DD's hearing check done (the usual check) and not being able to check the records (which were on the shelf behind her desk)... Dd ended up getting her hearing check after we were discharged from hospital because we met the head of audiology who happened to be a mum who we knew thru nursery!!! She rang me at home having bumped into dh at nursery who told her the story!!

[Nessalina]

I had a slightly different experience of the maternity unit of my local hospital (Leeds General Infirmary), because I was in for a managed medical termination at 16 weeks (due to abnormalities). They have a separate suite behind the main mat unit for bereavement cases, but MW are the same team.
We had 3 different MW & a student MW over the 24hr period that we were in, and they were absolutely marvellous: sympathetic; cheerful; attentive; caring; tactful. Everything me & DH needed at a really difficult time. I was pretty terrified about the whole thing, but it went more smoothly and was much less distressing than it could have been because the care was very good.
I have to say, I was surprised, as I'd just assumed NHS = a bit crap, but not the case for us, although obviously it was not a standard birth experience. Every one of the MW said they hoped to see me back again in better circumstances, and I feel confident that when I'm there for the real deal the care will be good.