Postmortem results today - need opinions

[Appleseed365]

Our darling daughter died at 40 weeks. Full term.

We are devastated by the loss and asked for a full pm which we received today some 10 weeks on from me giving birth to her.

The cause was IUGR or restricted growth in the last trimester due to the placenta not feeding her properly. If it had been detected by the midwife and I was induced at say 38 weeks I would still have my darling daughter and not a box of ashes.

The independent midwife we hired for our home birth and care never once measured my tummy during my check ups. If she had she would have detected that I was not getting bigger. I mentioned it to her that I didn't appear larger but she dismissed this as unimportant as every body is different as I was a very low risk mum being a professional climbing instructor and very healthy mum to be.

The issue is that in my notes she DID write down sizes of my stomach in my notes. She NEVER measured me. If she had and had plotted this and noticed the slow down I may have had a scan and it would have detected the placenta problem.

Is is STANDARD practice within the NHS to measure at every appointment? Or is this something that is advised but does not happen as routine?

I am 39 and this was to be our first child. I am positive I will try again with my darling husband, I just feel that my midwife was either just following her procedures or was wholly incompetent - why manufacture numbers if no measurements were actually taken?

Tonight I an angry, confused and sad. I miss my darling girl and now feel that my actions or lack of conformity caused her death.

If its not standard practice to measure then why not...

Thanks for reading ladies... I wish you all well in where ever you are in your pregnancies, your losses and your lives.

Here's to happier times.

Xx

Oh Appleseed that is so heartbreaking, I can't imagine how you must be feeling. My heart goes out to you. I went into labour at 36 wks with my DS so don't know about the last month, but I did get measured at every other midwife apt. I have heard about NHS counseling for women in your situation which would maybe help more officially answer your questions.
Thinking of you x

apple I am so sorry for the loss of your angel

I have not yet made it that far into any of my 4 pregnancies to be able to advise you but wanted to send my love and sympathy, I know nothing will bring her back but I hope you get some answers that help, even if just a little xx

I'm so sorry. I'm just wondering if she added the measurements after your loss? As you say it doesn't make sense to make them up - if you genuinely forgot on one visit you would make sure to do them the next. I hope you get some answers.

:( so sorry for your loss, from personal experience I was never measured, my dd1 had IUGR I kept telling the community midwife I didnt think I was big enough but she dismissed it, when I went in to hospital for something to do with my pre eclampsia one of the midwives there said I was small and scanned me.

Be kind to yourself

Sorry :( I was never measured either ...

Ladies thank you...

Dear Elsie was 6.5 lbs when born 4 days after she died. So not tiny... Not huge though. You are so right that it won't brewing her back... Just feel so angry tonight and sad and my arms ache and me heart feels like its breaking that I could have done something to save her. I let her down y'know?

My midwife may have written in the sizes post death... Not sure. It's such a pity (scandal?) that measurements are not standard procedure to flag an issue that could then be looked into with a simple scan in late pregnancy.

I hope we can have another baby and I pray that I will be able to be forward facing and not take this heaviness into my next pregnancy should I be lucky enough to get pregnant...

We shall see...

Thanks for listening.

Xx

Sorry for your loss.

If the midwife didnt measure you then where do the numbers come from?

Your midwife should be registered with the NMC, they might be able to help you further if you have concerns about standards of care.

Hi so sorry to hear about your daughter, my daughter was still born last april, its her birthday this friday. She died from a knot in her cord.

I was measured at every midwife appointment from 24 weeks, at 28 weeks I was measuring 36 so they sent me for a growth scan. I believe this to be common practice.

Did you bring this up with your consultant? I'm guessing a consultant read out the post mortem results to you. I would ring them up and have a chat, to try and understand why the midwife did not measure you and also to put your mind at rest that this will not happen again.
If it is common practice not to measure in your area then I would want to know why that is the case and how something like this can be stopped in future pregnancies.

Once again so sorry that you are going through this, its something no parent needs to go through, be gentle with yourself.

Apple . I'm so sorry. Please don't think you let Elsie down.

I am so sorry for your loss. I understand why you need answers even if it won't bring her back.
If you look up NICE antenatal care guidelines you will be able to see the guidance re measuring, it is called the symphasis fundal height (SFH). If your midwife didn't ever take a tape measure and measure you but has recorded that she did, well that is very serious and really needs reporting/looking into as it is falsified records.
What was your dd's name?

you didnt let her down, you couldnt have known, please be kind to yourself.

appleseed I am so sorry. Your post is lovely and it's so wrong that you don't now have your beautiful baby. What a terrible thing to happen and how you must long for your girl.

I don't remember being measured regularly with either of my DCs but I did have regular scans at the end for other issues so perhaps that's why they weren't bothering to measure as well.

You are already a mummy who did everything she could have done for her beloved baby. She will always be with you and I wish you courage for your path ahead.

I am so sorry for your unfair loss of your much loved daugher Elsie. What a lovely name!

I cannot remember having my bump measured regularly in the 4 pregnancies of mine that led to live births. It is my understanding, that measurements with tapemeasure and potentially done by different people, are very unreliable. I was an older mum (albeit healthy and a non-smoker and had my kids aged 37 to 44) and also had 4 early MCs which ment I had more scans than usual. With my DS4 the scans looked specifically at placental function - he was born at term and weighed 6lbs 10oz, so was not exactly a bruiser and much slighter than his sibs.

Once the hurt is not quite so raw and acute any more, consider asking for a debrief with your consultant and bring everything up that strikes you as strange.
I am a GP and documenting anything that has not actually been done is at the very least professional misconduct.

Much love and strength to you and your DH.

Apple, firstly I want to say that I'm very sorry about your daughter.

It is standard practice to measure fundal height at appts after 28 weeks. Your midwife even though she's independent will have a supervisor of midwives. All midwives must have a supervisor, she can't be registered unless she has one and has annual meetings. This isn't a manager like a normal manager/supervisor role but something unique to midwifery.

Her supervisor is likely to be a midwife at a hospital near to where she is based. If you want to take this further then ringing or writing to the hospital and asking to speak to a supervisor of midwives would be a good starting point.

Not taking measurements isn't very good practice. Though as an independent midwife she doesn't have to follow local protocols, etc that the hospital would have in place. A lot of experienced community midwives did grumble when measuring with a tape measure was brought in. They said they were experienced enough to detect a problem with the size of the baby by feel. Perhaps your midwife also believed this? But she certainly shouldn't have fabricated anything in your notes afterwards. The problem now though is that if she is prepared to make figures up she will probably also be prepared to lie and say that she did measure you and that the figures were always there. Falsifying records is very serious.

I just want you to be prepared that if you did take things further that she may well lie. I'm so sorry.

Apple , I was measured at every appointment. Perhaps it depends upon where you are in the country.

I so sorry to post and run and not sure if this it this info may help or make things worse and I am so so sorry if it is the latter. NICE antenatal care guidance
(p 21) states symphysis fundal height should be measured at every ante natal appointment.
Please discuss this with your consultant though as NICE is just guidance and obviously I don't know the full circumstances of your antenatal care.

apple so sorry you and your husband have had to go through this i am measured regularly from 16 weeks, my sister had IUGR with my nephew and was being scanned weekly in last trimester they ended up delivering him at 37 weeks because he;d stopped growing he was 4lb 5oz born but is fine now because my sister was monitored so closely, imo if your midwife felt the need to write down the measurements then she should have Actually been taking them, highky negligent in my eyes, i hope your getting lots of RL support at this sad time xxx

Thank you vivalabeaver.

I suspect my midwife was of the belief that everyone looks different in pregnancy and that she didn't need to measure to know I was fine and the baby was growing well. She had over 30 years experience and like it appears here, if I had been in the care of an NHS midwife there is no saying the outcome would be different as the NICE guidelines are just that, guidelines.

It's just so hard to take, knowing my darling Elsie nearly made it, she really did, and that She felt compelled to write down numbers that were simply made up.

I want to focus on the future and not take things further at this stage... The midwife wanted to know the outcome of the pm. Don't think I will bother with that yet for fear she may not survive the meeting...

Thank you for your info, I really appreciate it.

X

Pacific, thank you for your opinion. Like I mentioned to beaver, it's just so hard to swallow... And falsifying documents is serious misconduct. She never once measured me with a tape... I will in the fullness of time contact her possibly via the consultant.

Today is a new day and darling Elsie will be nestled close to our hearts forever.

Have a good day ladies.

All my love and thank you for all your replies. I really really appreciate it.

Xx

I'm sorry for your loss, I was measured at every appointment from 24 weeks x

I am so sorry to hear of your loss.

Fwiw, I had an IM but also went to all my nhs apps. I was being monitored by about 6 different midwives and measured every week, sometimes twice a week. Around months 7-8 the measurements stayed the same for about 4 weeks, and my IM was pestering the hospital for me to get an extra growth scan... Hospital policy was that the measurements were still (just about) within guidelines and two NHS midwives told me the measurements are pretty inexact anyway, as baby sometimes stretches out sideways, different people find the pelvic bone slightly differently, etc. so ime there's quite a strong likelihood it wouldn't have been acted on even if you were measured. Also, induction at 39 weeks isn't risk free. Have you asked your IM why she didn't use a tape measure? You must talk to her about it, and her supervisor if you aren't happy or think she's falsified your records. IMs can't get insurance so are very vulnerable when things go wrong. Normally this makes them super cautious, so I'm surprised if she didn't do everything she was supposed to. Maybe if you talk to her you can get a better sense of whether you really believe she was negligent or not. It must have been awful for you I am so sorry.

I'm so sorry for the loss of your darling daughter Elsie. Your love for her shines through your words.

I had both of my pregnancies in different countries, neither in the UK, so can't tell you what's normal practice, but you have lots of good advice above.
I just wanted to add that with my first pregnancy, I was measured at every appointment in the third trimester. My measurements pretty much stayed the same, and at one point even went down with the tape measure, even though I knew I was getting bigger and my weekly scans were showing normal growth. I remember asking my obstetrician about this, and her saying there were so many variables, the main one being that babies shift positions. I'm telling you in the hope it will help you with your 'what ifs'. You have no reason to ever think you failed her ever.

However, I would say that falsifying records is a different matter, and very serious indeed. If you chose to pursue this further, then that's totally understandable. You need to do everything that feels right for you and your DH right now. Allow yourself to feel the whole range of emotions except guilt. You have no reason to feel guilt.

With my husband and I, our issue had always been conception as I had ovarian cancer a number of years ago. It took us six years to conceive our son. My second pregnancy just ended in a miscarriage two weeks ago. The pain I'm in pales in comparison to your circumstances, but I've learnt that beyond conception, the process is still incredibly flawed and complicated and risky. It's awful how little these things are spoken about, but my one piece of advice here is that Mumsnet is your friend at this time.

You'll always love Elsie and you'll always remember Elise. I'm sure that with time will come acceptance. You sound like a very strong woman, and I'm sure you'll find happiness again, hopefully with another dear baby.

Xxx.