Step this way to help shape the future of maternity services in England

[RowanMumsnet]

Hello

As some of you will know, Mumsnet is on the panel of the National Maternity Review, which is an NHS England initiative set up in the wake of the report into the deaths of mothers and babies at the Morecambe Bay hospitals trust.

The remit of the review is to 'assess current maternity care provision and consider how services should be developed to meet the changing needs of women and babies'.

So we'd be really grateful if you could give us your feedback on the following two very broad themes:

Which choices do you wish to be able to make about the maternity care you receive?

What are the key barriers preventing women from making the choices that they wish to?

Thanks - any and all thoughts welcome. (And just FYI, this won't be your only opportunity to feed in, and more detailed feedback systems are going to be launched soon - we'll flag these up as they happen.)

I think women need loads more support in hospital after having given birth. There needs to be massive investment to turn this around properly and provide an adequate number of midwives.

Women need to be supported in their feeding choices not made to feel guilty about ff and pressured to be bf. Those who choose to bf should have support and proper advice.

We need to go back to the days when mothers were taught about things like bathing baby while in hospital.

Babies need to be looked after during the night if the mum wants so she can get som rest. I can think of no other example of a situation where a person goes through a physically exhausting experience like labour which can last for days, or major surgery like a cs, and then made to go straight into the physically gruelling work of caring for a newborn.

Depending on partner's to stay in hospital is not the answer as having them in the ward is very uncomfortable for other women, plus they could be needed to care for other children at home. Some women have no partners or unsupportive partners. They need a proper rest in hospital.

Women who wish to should be kept in hospital for much longer than is currently fashionable.

Ideally all women should be in individual rooms in order to rest as happens in other western, developed countries.

Ps re my above- This is not petty stuff and asking for "luxuries" for mums.

These are basics provided in countries equivalent to ours, which could massively cut pnd and give babies a much better start in life. An adequately rested mother is going to be in a far better position to care for her newborn than one who goes home in a fog of exhaustion.

Which choices do you wish to be able to make about the maternity care you receive?
Women should be given a choice of interventions (with staff explaining pros and cons for each)

One example
On arrested labour at full dilation under epidural, neither mother and baby are in distress:
Choices might be do nothing at all/do nothing then review/augment contractions/use ventouse straight away/use ventouse with episiotomy/use forceps with episiotomy/perform C-section

Another example
Ventouse has failed:
Choices might be try ventouse again/go straight to episiotomy and forceps/consider C-section as opposed to other options

Another example
Waters break first. Mother goes to be checked at hospital. Mother is booked in for an induction 24 hours later if labour hasn't started:
As far as I know, induction can be delayed to 48 hours after waters have broken or refused entirely. This should be discussed before the appointment is made.

What are the key barriers preventing women from making the choices that they wish to?
The power of ideologies. A lack of tolerance and sympathy from a strong minority of staff. The system claims to be woman-centred but is not in reality. It very much depends what agenda the staff caring for you have.

A general lack of awareness of the pelvic floor (definitely amongst the general population but also amongst some midwives) and a societal reluctance (taboo) to discuss problems arising from damage to the pelvic floor.
The onus should be on midwives to first, educate women about the pelvic floor, the natural risks of childbirth on the pelvic floor and the increased risks of instrumental deliveries and multiple vaginal deliveries during antenatal classes; second, enquire about incontinence (both urinary and anal) and prolapse (have you felt like something is about to drop down?) after birth.

I understand why lots of women want the same MW throughout their pregnancy and labour, and can see how that would be an advantage if you have a shortish labour. How would that work for those of us who take days, though? I really wouldn't have wanted the same MW from start to finish for my first, 48 hour job. She'd have been nearly as knackered as I was by the end! Prefer the option of someone who's had a break within the past couple of days.

Also agree with posters above that this would need to be combined with a robust procedure allowing women to change MW if they want. One of the ones I saw antenatally was piss poor. Didn't matter as I only had her for a couple of routine appointments, but would have absolutely hated her to be my 'named midwife'.

In the hospital DS was born in, once we were discharged there was no readmittance to the maternity ward. This left DS on a children's ward at less than a week old on a drip. They weren't very good with newborns, or me.
They couldn't get a drip into him without blowing veins in both hands and feet, as apparently ' his veins were so small'...

Surely there should be some research around which demonstrates best outcomes for newborns in various type of hospital ward.

Which choices do you wish to be able to make about the maternity care you receive?

I would have liked the choice for my partner to stay with me and look after the baby...because being left on your own looking after a baby when you are still woozy from a general anaesthetic is an absolutely FUCKING stupid idea.

I am 4 years on from this and STILL paying the price of the trauma caused to me by being expected to cope when in horrible pain, having been cut to pieces, recovering from serious blood loss, and still being within the period of time after GA that they wouldn't, for instance, consider you safe to drive.

I would like....no I DEMAND that women have the choice to RECOVER after childbirth rather than being abandoned with a baby to look after.

Absolutely agree with everything said by morelikeguidelines (today, 12:04 and 12:07). Help and education without judgement or eye-rolling would be incredibly useful.

I, unlike sootballs, am still clearly very angry. I have seen so many other posters on here suffering post traumatic depression or even post traumatic stress disorder. A lot of those cases were poor post natal care rather than labour issues. The shear enormous number of lost hours, days and years is utterly utterly disgraceful.

You sometimes cant control what happens during labour but poor post natal care is totally unnecessary.

Totally agree IceBeing. I had a very traumatic labour and very poor aftercare. I was lucky really to be already seeing a counsellor. She helped me get to grips

... Oops

... With it all. I think if the aftercare had been better, I would have managed the aftermath of the labour a lot better and I would be feeling a lot more positive about considering another child.

Postnatal ward is hell on earth.

No help with breastfeeding, no help to get food if you are bed bound due to section / catheterisation, no help to reach your baby if you're unable to get to her, drugs round being a lottery - if you're awake and able to demand the drugs you require, and are compos mentis enough to keep track of when you last had painkillers, and shift changes meaning that any help you need won't happen until at least an hour after shift change - and even then only if you're top priority. Understaffing was a huge issue on the postnatal ward I was on recently.

The paediatrician who was dealing with DD had been working for 18 hours without a break and was nigh on hysterical, he told us that the entire maternity area of our hospital was unfit for purpose and very unsafe, and that he was complaining to our local MP about it, and he was encouraging all the new mums to complain too. All very well, but not very confidence inspiring to be told this by the doctor looking after your brand new and premature baby. He said he had worked in several countries including India, Somalia, Canada and the Phillipines, DH said 'oh does the uk compare badly then?' And the paed said in a slightly manic and cross eyed manner 'it's the worst! It's worse than anywhere else!'

Just in case the message hasn't got through yet: postnatal care, postnatal care, postnatal care, postnatal care, postnatal care.

I was so badly traumatised by my first birth's aftercare that I struggle to write about it tbh so haven't been very personal. But I had a post partum haemmorage and was barely conscious for the first 48 hours of my son's life, I received no help to breastfeed and nobody passed him to me (I was bed bound, catheterised and in a lot of pain as I wasn't being provided with pain relief other than as hoc morphine injections, which knocked me out and made breastfeeding impossible, nobody told me that would happen and if they'd bothered giving me regular pain relief I wouldn't have been hallucinating and screaming in agony and needing bloody heroin to cope. Overnight support was nil.

Anyone important reading this - just imagine for a moment, your newborn screaming in hunger a foot away from you, you're in the dark and alone, no one is answering when you ring your buzzer repeatedly for hours. Then your baby stops crying because he has given up. You are in agonising pain too and haven't eaten in the last 24 hours. Just please imagine that, then fucking get some money and prioritisation into postnatal care.

Oh Coastingit there are some sad stories on here but that is so awful. Hugs to you and to all of us who've gone through this shit. It just shouldn't be like this.

Oh Coastingit that's horrendous.

Sorry to hear that coast it mirrors my experience only even worse with the bonus of hallucinations....

Can I stress again how much damage this does to women, families and children? The effects can literally last a life time....and depression / PTSD can be fatal if not treated...and we all now how well funded treatment is for mental health disorders!

I had forgotten not being able to reach the call button after my section. I was in a room by myself, they didn't bring me food or drinks.
DH spent most of the day with me for the two days I was in, arriving after 'breakfast - which I didn't get. He brought me in sandwiches, fruit, drinks,etc.
I was desperate to get out.

On the other thread, one MNer suggested an ultrasound during labour. I think that sounds brilliant as it would give everyone advanced notice if the baby was heading the wrong way, about to get stuck etc.

DS was back to back but they didn't realise until after he was came out the wrong way. This could have given us the advanced notice we needed to make a properly informed choice.

Prompted by the thread about the impact of damage from forceps delivery on maternal quality of life, I would really really like birth outcome studies to include longer term impacts and more generally impacts on the mother.

If the mother isn't dead, her outcomes don't really get recorded in studies of birth. For example it's just not reliably recorded whether the mother has long term issues with incontinence, numbness, fertility etc as a result of the birth. Effective recording of the issues is a critical step to doing something about them.

Agree with the people who said about a separate ward for the mums of babies in NICU. With DS4 I spent the whole time walking what felt like miles between my bed, the milk kitchen and NICU while the other mums laid in bed breastfeeding. With DS5 I was in so much pain from the EMCS that I needed 30mg of morphine before I could face the long walk to NICU. Of course by the time the pain was manageable I was too dizzy to walk.

Also agree with decent postnatal care. I had PND with all 5 of my children and there was no plan in place to try and prevent it happening with dc's 2, 3, 4 and 5. My youngest is 13 months old and all I get is a quick "keep taking the max dose of tablets and book another appointment in a month" from the gp.

Post-natal care. Yes. And less of the patronising attitude. I too was left in a bed unable to move due to injury, with my poor baby screaming for attention. I couldn't get to him. No one would help me.

The morning after the birth a HCA told me to go and get breakfast. I said 'I can't walk'. She said, 'Well, you won't get any breakfast then, will you?'

Thankfully a physiotherapist eventually turned up and shouted at them all, but the 12 hours after I gave birth were the worst of my life. Of course I also ended up with PND.

mumsnet - - PLEASE PLEASE PLEASE get midwives and Drs to listen to women's requests during labour. Many midwives/Drs only allow your requests if it suits their own ideologies. I've heard far too many stories about women being denied pain relief, access to an obstetrician if things don't appear to be going well. Women are just told 'no'. There can be a discussion of pros and cons or why a certain action isn't advisable but not an outright 'no' and the woman's decision should always be final.

Moreover we need to think about how incidents of poor care can be reported and dealt with. New mums are very busy and therefore may be less likely to put in a complaint even if unhappy with their care. Also, the complaints system is reliant on an internal investigation by people who are likely to protect their own or, worse still, may also have the attitude that women should just do as they are told in labour. Maybe every woman should be asked for feedback on their experience and any requests that were denied without proper explanation should be investigated independently.

Next it needs to be taken MUCH MUCH MORE SERIOUSLY when a woman is denied her request during labour. If it is proven that the woman was not included in decisions the midwife or doctor concerned should expect a disciplinary.

I had to battle with my midwife to transfer to hospital from the birth centre when I felt signs of baby distress were being ignored. The midwife refused my request with no attempt to understand my concerns. I had to be very very persistent to get her to agree and then she purposefully delayed the transfer by 1.5 hours and refused to accompany us in the ambulance. As far as I'm aware she didn't even get a disciplinary for this not even when my complaint was upheld (according to the complaint response she just got a reminder that her duty of care is until handover to the obstetrician). At hospital the staff included me in all decision making and were wonderful once I arrived there. If it's possible for the hospital staff to discuss options with me in an emergency situation (unfortunately my instincts that something was wrong were correct) there is no excuse for a midwife in a non-emergency situation to not listen to a woman. I don't want more women to go through this!!!

Apologies as I haven't been able to read the preceding posts in detail, which feels a bit wrong as many people have clearly taken the time to share very difficult experiences.

I think there are real mixed messages that go to pregnant women/new parents around 'trust your instinct/you have the right to choose' versus 'we know better than you.' For example, when you contact triage in labour, does the midwife who answers the phone take the time to really suss out what's going on for you, or are they dismissive and cold (which surely risks missing important information?).

At a very basic level, midwives and other professionals (including those giving postnatal breastfeeding advice on the ward) should all be giving evidence-led advice - I wouldn't expect them all to be saying exactly the same thing, but the level of variation I've found is unacceptable. I was told so many different things about when to go in amongst other issues that it was bewildering and disempowering at a time when I was scared and vulnerable. I'm sure I'm not the only one. I would have loved to use the MLU with my second baby, but felt fobbed off and was too sheepish to elbow my way in in time and as it was only just missed giving birth in triage - there wouldn't have been time to fill the pool!

And it seemed to be pot luck whether you got care from a compassionate midwife or one who seemed to think that by being in their ward you were an inconvenience (there were more of the former, but that's still not good enough!). I understand the concept of compassion fatigue, but some people seem to lack basic kindness and empathy.

Obviously units are under massive pressure but when I struggled to be admitted with my first baby the advice around what should be happening with me changed several times - it felt like that was more due to what was going on in the ward than what was best for us. The pressure also seems to lead to a 'tick-boxy' approach from both antenatal and postnatal professionals, including health visitors.

I should also say that I too was extremely grateful that my partner was able to stay on the postnatal ward first time round, I'd be very sad if that stopped across the board. It would be great if hospitals could find a way to manage the privacy of patients with their need for support - not that partners should be unpaid healthcare assistants!

My two experiences of childbirth weren't entirely negative by any means but really hope that this review will work to ensure that all women get a good experience.

Sorry, sort of off topic, but if a call button is out of reach that is a serious breach of protocol which can potentially have fatal results and a complaint should be made immediately.

I worked on revamping a unit a few years back. An elderly gentleman had a feeding peg put in but it was miset and he had 48 hours worth of food pumped into his stomach in an hour. The call button was out of reach so he couldn't call help and sadly he died. Nurses must make sure the call button is in reach and are in breach of their duty if they don't. Complain, complain, complain and make a big fuss if necessary.

Define out of reach though? If I had been able to turn and stretch I could have managed it easily. Having just had a section, this was impossible.
And as for being able to pour a jug of water into a beaker...

Agree with everyone else that I had no choice. Being browbeaten into signing a consent form when I was exhausted and hadn't been licensing relief wasn't me making a "choice". Also being lied to about the treatment that I'd received; a tear does not result in a scar with a perfect line up the vagina ending in a j shape in the perineum, and they would have known at the time that there was no way to do an instrumental birth without an episiotomy, they just agreed not to do one to shut me up (and lied then on the notes).

Also agree that there should be proper follow up studies, I had a demanding new born and was in no state to complain, and as they'd lied on my notes it would have been fruitless anyway as they would have just closed ranks. There's a good chance that I'll need major surgery after menopause, a c section would have been much cheaper in the long run, but I was a "success" as the baby cameo out vaginally, and never mind how much I cost the nhs in the future as a result of the damage they caused, that isn't recorded.

I also think that there's a lot of paternalism in the system. I wasn't a rational human being with rights and dignity, I was a sausage in a sausage factory, an inconvenient piece of meat.