How can we improve postnatal hospital care in Scotland?

[ohmygoditsasausagedog]

I can’t stop thinking about all of the awful experiences women have had on postnatal wards from this thread:

www.mumsnet.com/Talk/am_i_being_unreasonable/4213664-Losing-my-mind-on-postnatal-ward?pg=1

I posted about my own recent experience in a Scottish maternity hospital:

I had a dreadful experience on the postnatal ward last year. I developed sepsis after my c-section and although my medical treatment saved my life, the caring aspect was non-existent.

I collapsed after they tried to get me up. I was seriously considered for transfer to the high dependency unit, but I begged to stay because I was terrified my baby would get covid there.

Many (not all) of the midwives and care assistants made it very clear that my illness was an inconvenience to them. They left me hooked up to a pulse oximeter overnight, the alarm went off every time I fell asleep because my sats were dropping. Absolute torture to be kept awake like that and pretty unpleasant for the women I was sharing the bay with. I was offered no additional support considering I had been gravely unwell. They wouldn’t test me for covid even though I had a fever and low oxygen sats. This was very concerning considering I did test positive not long after I left hospital - they didn’t even put me in a private room to reduce transmission!

Nobody thought to suggest my sleepy baby should be fed while I was delirious with fever. He was struggling with this latch and we were put on the 3-hour feed, top up, express programme. This again was torture for me recovering from major surgery and a severe illness. My husband was only allowed in for 1 hour a day. I was told off a lot for doing things wrong.

We were all packed and ready to leave when we were told he’d lost a fraction too much weight and we’d have to stay. I don’t think I’ve ever cried so much. I asked to self discharge, but was told they’d make me leave my baby. Blatantly untrue, but it scared me enough to not kick up a fuss. The next 24 were torture and I was so desperate I became suicidal.

Formula saved us and baby put on weight and we left the next day.

After talking with people in the real world, it seems that sadly this is not a unique experience.

I think that this needs to be brought to the attention of the Scottish government. Would anyone else be comfortable with sharing their experiences and help come up with some realistic ways to improve things?

Some ideas mainly drawn from my personal experience:

• A commitment that all new maternity units should have mostly private rooms (like almost all the other patients have in the QEUH)

• All beds to have a laminated card explaining the ward policies

• Comfortable armchairs with each bed to support breastfeeding

• Meals to be brought to postnatal patients (I know it’s good for you to move around after giving birth. It’s also good to move around after a hip replacement, but we don’t force those patients to walk down the corridor so they can eat)

• I am sure some of the poor care is due to lack of staffing/funding. Does anyone have experience with this and have ideas for what can improve it?

I'm sure many midwives are just doing their best under difficult circumstances. What could we campaign for that could help?

I don't think it's always down to lack of staff. I'd qualify firstly that my DC are 20 and 19 now. I was at Simpson just before it closed so although the many broken pieces of equipment impacted, I appreciate that they were no longer spending money on it.

I had 2 sections, the first unplanned after 36 hour labour and with a large baby stuck back to back, bordering for a blood transfusion. I'm not going to comment on birth care and I can't fault it really, both pregnancies.

After DS1 was born, I was left with the spinal tube still in my back, a bed that wouldn't go up so I had to reach up to try to get my almost 10lb baby out the cot. No support with breast feeding, missing out drug runs, no opportunity to wash even my hands having been in labour and surgery and handling a newborn. Had to wait to get compression leg things off to go for a shower while DH watched baby. Told off by ward supervisor for wanting some water to wash baby after he was continuously being sick on himself etc etc. I ended up checking out against medical advice as it was pointless being there. There was no atmosphere of caring at all.

13 months later I'm back in the same ward after another section. Different staff and completely different experience. This time I've got no curtain and no working light. Arrived back on the ward and given a bed bath, they took baby away after he was a bit fussy and needing changed after a night feed, brought him back when he was hungry but had given him a wash and clipped his nails.

The staff encouraged folk to watch each others baby to allow them to go get washed etc without having to wait for a visitor.

There weren't more staff, the ward was just as busy, just a more caring atmosphere. I still left after 2 days but with their blessing and support.

Sorry you had such a bad time @ohmygoditsasausagedog - it took me 3 years to get over the stress flashbacks of having dc1.

Mostly what people do remember is the lack of care and kindness on wards, across so many nhs experiences.

Agree with what wax said the pre birth care was wonderful, and so was the post birth at home midwife and GP support. It really was the hospital post part in care that was awful.

I'm sorry to hear about your awful experience OP. My experience on the post natal ward was absolutely nothing like yours, but it was the bleak spot in otherwise absolutely exceptional care. The only uncaring midwives I ever came across in 3 pregnancies and births were both on the post natal ward, those experiences were 5 years apart.

My local trust (Grampian) used to have a monthly forum with professional and lay members to discuss maternity care. I'm not sure if it still exists due to Covid but they did make changes in the wards as a result of that forum. You could check if your hospital has something similar?

By the way I don't think this is exclusively a Scottish problem. Lots of friends in England have had similar experiences.

@undermycatsthumb

Thank you for suggesting the forum to discuss maternity care - I’ll look into it. I also had wonderful care during prenatal, delivery and postnatal once I was home.

I agree completely that this is a problem throughout the U.K. I suppose I am naively hopeful that it might be easier to improve things if we take a Scotland-specific approach and appeal directly to the Scottish government?

I had a rather good experience of NHS maternity care more than two years ago. The birth itself was short so can't say anything about the post natal ward because they let us stay in the birthing room for the 5 to 6 hours after the birth.

The midwife who delivered my baby stayed and extra hour or so after her shift because she didn't want to abandon me in the middle of birthing. And although she was a bit bossy the decisions she made were right in hindsight!

It was a pregnancy and birth without complications and in the birthing suite rather than the labour ward. My first birth was abroad and a very unpleasant experience so I was dreading the second, but found the NHS system less interventionist and overall better.

Callisto1 With my second DC I didn't have to go to the post natal ward either, I was able to stay in the birthing room until discharged. It was an entirely positive experience. With DC1 and 3 I did have to go to the postnatal ward, and both times it was unpleasant. Not bad on the scale of the OP's experience, but unpleasant. The point is that generally NHS pre and postnatal care is great, but the postnatal wards are a very bleak spot in otherwise good care. And that's what needs looking at.

I was in a postnatal ward for a week while my baby was in ICU. I wish I had requested a move to an empty ward or a private room but was in a traumatised state and just did as I was told. It was a horrible experience. The ward was full of mothers and babies, one mum was clearly mentally ill and was convinced that her baby hated her. All were bottle feeding and had huge family groups round, it was always busy.
My son was in an incubator in ICU and would cry and cry and no one would tell me- I went through once and he had a dummy taped to his mouth. I would much rather have been in there with him trying to settle him, especially as I was expressing and bringing syringes of milk through to him. God, it was awful! This was in 2013, not the bad old days.

I think you've probably come up with some very good points in your original post OP.

I wouldn't say my experience was awful but the wards were absolutely mobbed and the staff were rushed off their feet. On the first night I was kept in the midwife unit as there wasn't a bed on the ward, it was fine in that we had privacy but the staff weren't overly experienced in the post natal side of things and I didn't get great support with feeding. Then when I was transferred to the ward it was very loud overnight - the woman next to me had her partner and both her parents with her... her partner and her dad were snoring very loudly... Everyone in that ward had their curtains pulled around and I don't think I ever even saw any of the other mothers. And if I rang my bell it sounded throughout the whole room and they'd then the staff would have to come in and shout to ask who was buzzing - it made me extremely reluctant to do so!!

I was then readmitted 2 days later for support with feeding and was given a private room. The support at this stage from midwives, doctors and the infant feeding team was absolutely amazing. So I guess in my limited experience... I'm going to say I'd strongly advocate for private rooms.

@undermycatsthumb good point. The postnatal ward I was on after DC1 (born abroad) sounds very similar to what people describe here.

They don't allow partners to stay overnight, but you have no privacy when people visit. And no curtains or screens so if you want to go to the loo you have to wander half naked in your gown past a bunch of strangers. Same with brestfeeding. They left my epidural in for nearly 2 days because they had no anaesthesist to take it out so I could not shower after birth. One of the midwives got really cross with me because I pressed the button at the wrong time (no one explained that you were not supposed to press it when a midwife was already in the room!). One of the matrons insisted I had to walk about, because it was good for me. I was in excruciating pain from stitches and had hardly slept for 3 days. But walk I had to. Some of the midwives were really nice and helpful so in the 3 days I was in I learned who to talk to and who to avoid. The system they have requires you to stay in the ward until all the baby checks are complete, but most of the staff for those don't work weekends. They let us go in the end after promising we'd do a double cloth nappy until we had the hip check (there is no history of family hip problems).

To sum it up after this essay I think labour wards are horrible not just in Scotland or UK. But at least here you can avoid them. I think to improve the situation we need to move away from wards all together.

Yes Callisto that sounds very similar and equally awful. I don't know if it's all that easy to avoid them here - I think you and I might have both been lucky to have given birth at quiet times when we could stay in the birthing room - though I know a lot of people who have chosen home birth not so much to avoid giving birth in hospital but to avoid the post natal ward!

Friends in the US say the post natal experience is amazing, but obviously there are a whole host of other problems with healthcare delivery there so probably not a great parallel.

I do wonder, though, why postnatal wards can be so ubiquitously awful. Understaffing might be a part of it, but after DC3 the ward was very quiet and yet the midwife was awful to me (to the extent that the porter who brought me up commented on it). Visitors are a huge problem too, and the throwing open the curtains culture - actually this was one of the changes implemented as part of the forum I mentioned upthread; that women's choice to have their curtains closed would be respected. It seems bonkers that should ever have been in question...

Someone upthread mentions private rooms and I think that would solve the privacy issue. I wish that partners could stay overnight so mothers could sleep and get help with lifting/changing babies. With private rooms that would be easier.

Before I had my first baby I thought staying on the ward would help my recovery after labour, because I would get a hand with the baby and I could rest. The reality was the complete opposite sadly.

As far as I know (been a while since I looked at the plans) the new maternity hospital in Aberdeen they are currently building will be all private rooms. I think that will help a lot. I had my 2nd in Aberdeen in 2018 and had a private room thanks to my awesome consultant, made a big difference.

I've had 2 emergency sections there and always had food brought to me (apart from most of the time with dc1 when I was in Nicu and managed 3 meals in 3 days) so there is obviously some individual hospital policy going on there.

Yes I had a private room in the US with dc1 and it was so much better. The hospital cafe food was no better though!

I've had a bad experience in 2010 and an even worse one in 2014.

Will try to keep as brief as possible...

2010 - didn't believe I was in labour. Left in the reception, down on my hands and knees in front of other couples waiting on scans. Feeling major urges to push. I was about 3 minutes away from pulling my knickers down there and then when my mum showed up and demanded I be examined. They did and immediately sent me to labour ward.

Ward - honestly horrendous. Four of us. One sadly a heroine addict who left for hours, came back off her face and dropped her baby off the side of the bed. If you've never heard the sound of a baby withdrawing from heroine you're lucky. Imagine a seagull being tortured and you're close. No sleep. Constant visitors and no privacy. Kept me in for a full week because I was 17?! No other issues with me or baby (aside from stitches).

2014 - same thing happened with them refusing to take me to labour ward even though I kept telling them I labour very quickly (2 hours first time around!).

Ward - Had baby at 8pm discharged next morning. I wasn't going through that again.

Nearly dying -
Constant sore leg in the days after birth.
Midwife said pulled a muscle during birth.
Health visitor suggested sciatica and sent me to doc.
Doc confirmed sciatica, gave me exercises.
Pain getting worse and leg swelling.
Called doc again - nothing to worry about.
By this point I'm limping into the doctors surgery with the help of my stepdad - no appointment avail so won't see me.
Get home call NHS 24 who said they'd send doc to my house.
2am doctor comes, takes one look at leg and calls an ambulance, suspected DVT.
Left in triage for hours where I developed a PE.
Rushed to ICU.

I was then put back on the postnatal ward and it was HELL. I went from a size 10 in pregnancy to a month later size 6 being loose on me. And that wasn't the illness - it was the fact the food is completely inedible and even if you WANT to eat, because you're starving, you'll probably miss it because you'll spend hours waiting around in corridors for scans etc.

They wouldn't let me out to get a coffee or go to the hospital shop etc, because the baby was a patient and couldn't leave. But the baby wasn't a patient, I was the patient, and if I'd been on a ward with everyone else with the same problem I actually would have received an ounce of CARE.

Because I spent a month there it was just a constant stream of women in and out, some labouring loudly at all hours of the night, extended families with balloons and children running riot, newborns (mine was 2-6 weeks old by this point) crying, filthy shared toilet / shower which seems like the best thing in the world when you've just given birth but post three weeks it loses it's sparkle.

Two weeks after the DVT, and me complaining multiple times that the pain was still awful, someone finally got a sling thing from the proper ward and elevated my leg. Instant relief. Not one person had thought to mention this for two weeks.

They also did the thing OP said where they'd keep the thing on me and it would go off all night. Torture.

There is probably more but I've genuinely blocked as much of it out as possible. By the end I was seriously depressed. I couldn't see a light at the end of the tunnel and cried every day.

I think the whole system needs a complete overhaul to be honest. We need to redefine the approach to post natal care - all aspects of it!

When did it become so "get on with it"??

Care after general births isn't great - but when you add any sort of complication to the mix like forceps, sections, post birth complications etc, it really is abysmal.