I’ve just been denied medical management of a failed abortion

[Tinyteatime]

I had a medical termination last Saturday, 7 weeks pregnant after my coil failed. Thought it had passed relatively easily so came away on a short holiday with my family luckily only 1.5 hours away from home. Started heavy bleeding and bad cramps yesterday, came to a&e as as advised by the BPAS clinic as I was flooding a pad and blood leaking through my trousers. Passed some very large clots. Internal scan reveals what they think is a foetal heart beat still in there. I’ve been in hospital one night and they said they would do the surgery on me this morning. I’ve just been told that all the doctors available won’t perform the procedure due to religion. This in the U.K. in 2019, in a hospital that offers abortion services. They’ve said I can stay another night and have it tomorrow, I have a breastfed baby that I’ve already been away from for one night, I’m in pain, bleeding and I’ve already had sepsis last year from a womb infection whilst giving birth so I’ve raised infection risk as a concern. I feel so angry about this. Would they deny women treatment for miscarriage? Or is it because there may still be a foetal heartbeat present? Is it simply because I’ve chosen to end the pregnancy myself? How in an nhs hospital can women be denied healthcare like this?

@quince2figs you really think that a patient in need of emergency surgery would be discharged home from a ward where she was already in a bed, overnight?? Is it not far more likely that the OP was assessed as being stable, that the things she was experiencing were within the expected range following TOP, and that she was simply listed for her choice of surgical management (the other choices being further medical management with pessaries, or 'watch and wait') at the next available opportunity??

It could well have been that the OP attended the next day and was further bumped from the list if more urgent cases presented and there wasn't room. Again, this would be clinically acceptable as long as she remained stable. Luckily this didn't happen, but it does on occasion

Astonishing gaslighting going on here

I'm amazed that wilfully misinterpreting scan results is not considered to be malpractice. I'd still contact a solicitor, OP. No win, no fee and they won't put the case forward if they don't think it's likely to get anywhere. Nothing to lose by doing so.

Yep - because clinicians were refusing to deliver appropriate care, and Op needed to feed her baby.
The other options you mention demonstrate your lack of knowledge - these are for missed miscarriages, not RPOC.

But there's no evidence anybody wilfully misinterpreted anything!!

The doctors who want all the bits they like, but not the awkward, uncomfortable, challenging bits.....well that option isn’t open to women. We get the whole package, and anyone who wants to specialise in providing health care for women needs to be prepared to deal with the whole package too

Would that be the awful uncomfortable bits like:
telling a women the baby she gave birth 2 hours ago has died
the 40 year old who's belly swelling is ovarian cancer and she has 6 weeks to live leaving a husband and an 11 year old
the parents of the patient who has been stabbed
the children of the man who died in exactly the same circumstances as my father (I was sobbing).

do sod off. Do my job for a week and then tell me that I don't do the awkward, uncomfortable challenging bits.

Most people training to be a GP have to rotate through O&G. They don't get an opt out clause of doing the speciality.

she, quite rightly, wants an investigation into what happened and a clear message sent to the people who refused to treat her that their actions were unacceptable, but they weren't. They acted within their duty of care and legal framework.

Nobody is saying the OP shouldn't complain. Nobody is saying her care was gold standard.But it wasn't negligent.

Justchecking I do appreciate your viewpoint but the language you are using is putting the onus on me.

‘Her choice of surgical management’ I was never given the choice. They advised surgery, not me. Had they advised that it would be a satisfactory course of action to go home and wait it out I would have jumped at the chance and my baby wouldn’t have gone without.

Complain about the way I ‘was made to feel’. Well, actually I think this is important, as I was made to feel like a piece of shit and like I was being punished for my choices. However I don’t believe ‘my feelings’ were causing the problems here.

Quince2figs. You are not derailing the thread at all. I didn't want it to become a pro choice/pro life debate but the arguments being had are different and important. I massively appreciate your input.

No they're really not @quince2figs they're appropriate further management for a failed TOP which was what the diagnosis was in the OPs case

Once again, for those two posters who are focusing on the clinical outcome of the OP’s presentation only. There seem to be two different discussions here:

2 posters are insisting that because the OP’s condition was stable, the bleeding settled and she got the care she needed then everything is fine and there’s no reason to make a fuss. And that OP doesn’t have a case for malpractice or negligence, even though OP has stated she wouldn’t complain on that basis.

But - other posters are stating that :
A) clinical decision making shouldn’t be muddied by personal, religious beliefs

• this happened to the OP because her management changed

B) that a unit culture of generally not managing TOPs and its complications is doing women a disservice because abortions are very very common and this complications will be seen frequently

As outlined by quince in gynae settings where A) and B) prevail, eventually there will be a poor clinical outcome.

Absolutely, Bernard - gaslighting! I heard a great analogy recently that working in the NHS is very similar to being in an emotionally abusive long-term relationship.

quince2figs - thanks so much for your posts on this thread.

Astonishing gaslighting going on here

Absofuckinglutely. On a feminist forum, of all places.

My apologies OP, I thought you'd been told that the other hospital wouldn't have considered any further interventions until at least 2 weeks had passed and that you'd realised that would have been a course of action open to you

I think there is enough evidence for an investigation. He took a very long time to complete the scan, tried to get OP to agree she saw a heartbeat that wasn't there and claimed it would be an abortion despite the pregnancy clearly being non viable. Either he was trying to find what he wanted to and lied when he didn't or he was so bad at conducting ultrasounds he had no business conducting one in the first place, never mind using his findings to determine patient care, and should at the very least have asked someone else to check his findings. I'm surprised that's not considered malpractice.

It is!

There are often a depressing number of medics who self importantly blunder on to threads like this blustering and criticising an OP for not appreciating their superior knowledge and expertise and having the effrontery to expect sensitive and safe medical care.
It's always a relief when knowledgable and empathic medics like quince2figs rock up to remind us all what effective practioners sound like.

There are often a depressing number of medics who self importantly blunder on to threads like this blustering and criticising an OP for not appreciating their superior knowledge and expertise and having the effrontery to expect sensitive and safe medical care. It's always a relief when knowledgable and empathic medics like quince2figs rock up to remind us all what effective practioners sound like.

Seconded.

I completely agree there are 2 separate discussions here.

Whether or not doctors should be allowed to opt out of TOP is very much open to debate. However, at present this is allowed and so wouldn't be a basis to complain. I would definitely express my feelings over this to the trust involved if I were in OPs place

Whether the OP has been a victim of negligence and malpractice is highly unlikely. The OP has said she recognises this

My annoyance is with the stream of posters insisting she has been a victim of negligence and suggesting she should sue on this basis. Suing the NHS is a long, and potentially distressing process and all those suggesting she does this on the basis of the clinical care she received are really not doing her any favours, but are simply setting her up for further heartache unnecessarily

Justchecking I phoned my local hospital early pregnancy unit in desperation as they had done my very 1st scan and told me to call them if I had any complications of my termination. I spoke to a midwife, not a consultant, and they said that their standard plan would be to advise a 2 week wait before surgery on retained products. They had not seen me or reviewed me clinically, and said they could not advise my case specifically over the phone, obviously. Given that the hospital I was actually in and the doctors I had actually seen had advised surgery as the best course of action, I took that advice. Now I am starting to wonder if you really are a doctor if you would truly advise a patient to discharge themselves based on a phone call, rather than advice of a doctor who had actually reviewed their case in person.

I've said my piece, I only really care about whether or not the OP has been able to appreciate the other side of the case from a medics perspective so she can go into any complaints from the right angle in order to get the best outcome.

OP if you want to take your complaint further then PALS are the people to help you. I think you've already spoken to them.

I wish you the best of luck with it all, and I really hope it helps you find some purpose in what has genuinely been a very shitty experience for you x

@justchecking1 Can you just stop it please. One person suggested OP sue for malpractice on page 21, and you have now mentioned it more times than anyone else on this thread.

No of course I wouldn't. I thought that the current hospital had explained the first hospitals stance as an example of what other courses of action you could take. I hadn't realised that had been phone advice you'd received from hospital 1

Many, many posters have said this is negligence not just one. Anyway, I'll bow out now.

That’s right OP - most often retained products cause either annoying but not hazardous continued moderate bleeding after the initial 72h, or no symptoms (only picked up on a follow up pregnancy test). These rarely need surgery, but should still mean full clinical assessment and prophylactic oral antibiotics in some cases.
You had a collapsed sac, which means greater volume of products, much more likely to cause emergency situation of very heavy, life-threatening bleeding.....which you experienced. Luckily your body managed to cope and the bleeding stopped.

Oh, and don’t bother with PALS -you already did involve them and they backed up the legally and clinically incorrect view that these doctors could withold care. Straight to the consultant in charge of your care and clinical director.

If an acute gynae unit/ward has enough doctors who won’t operate in OP’s circumstances then I’d have concerns that the culture of that unit will affect clinical practice.

If patient X has RPOC after pregnancy and is bleeding the same amount as someone in OP’s position but gets operated on because Drs A and B willdo that then patients like OP will get shunted down a, “let’s hold off if we can and refer/wait for Dr C clinical pathway”.

If Dr C doesn’t work all the time or this the only one then this becomes, “We don’t deal with these issues here. You need to wait for tomorrow's list. We only surgically manage this degree of bleeding in patients where we feel personally comfortable”. Sure, for a patient who is then admitted to the ward and monitored almost always that will be ok. But that doesn’t mean it’s the correct clinical decision and it doesn’t safeguard against another, more catastrophic bleed.