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Year: 2015

Birth trauma and PTSD – Raising awareness

by / Birth Trauma, Continuity of Care, Environment and Facilities, Language, Postnatal Care, Pregnancy Complications / Comments Off on Birth trauma and PTSD – Raising awareness

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When people think about post traumatic stress they often think of a soldier, returning from battle traumatised and battered by the ravages of war and the terrible things seen and experienced.

However PTSD doesn’t only affect those affected in the aftermath of war or a terrible natural disaster or violent act. PTSD can also affect someone in circumstances that should be safe, that should be happy, that should be the start of an amazing journey. For some women the birth of their baby can be traumatic and can be a trigger for PTSD that can severely affect their life. It can affect bonding with their baby, relationships with family and friends, doing everyday activities and physical health. So what is birth trauma and PTSD and how can we help and support women that are suffering?

Firstly what is birth trauma?

‘Birth trauma is in the eye of the beholder’ (Cheryl Beck) and this is true. What is traumatic to one woman may not be traumatic to another woman. Each woman’s experience of birth is unique to her and many things can add to a woman feeling her birth was traumatic. For some it maybe that her birth was a truly scary event, she may had been in an emergency situation where her life and that of her baby was at risk. Maybe her labour was very lengthy and very painful. It may be that a woman’s birth had high levels of medical intervention, such as induction, caesarean section, episiotomy, or other medical issues. It may be that a woman gives birth early and her pre-term baby requires care in NICU. Sadly some women have a birth that results in damage or injury to her baby and some lose their babies at birth.

For other women trauma can result from the way she is looked after by the staff responsible for her care both during the birth of her baby but also postnatally. She may feel a loss of control, dignity and privacy. There may have been a lack of information or a woman may feel she wasn’t listened to and her choices not respected or overlooked. She may feel she had medical procedures done without her consent or without proper explanation or that she was left with no choice. Or maybe unkind, cruel words and actions made her feel vulnerable and exposed.

Some women find birth triggers or adds to previous trauma such as rape or domestic abuse.

Often women who feel traumatised from their birth will feel isolated, other women may not understand why she feels traumatised, after all isn’t childbirth a ‘natural thing’? So a woman can feel guilty and somehow ‘weaker’ than other women for being unable to ‘cope’ with birth . She may feel she should be over the ‘birth’ and often well meaning friends and family will say things such as “at least you are ok and you have a healthy baby”. This only confounds the woman’s feelings and makes her feel more isolated and can damage relationships with partners, family members and friends as a woman feels no one understands and so she withdraws deeper into the trauma. Depending on the nature of the trauma a woman may feel unable to have further medical tests such as smear tests. Sex may also be affected as a woman may fear further pregnancies, or even just the act of physical intimacy itself. Many women who suffer birth trauma may struggle to bond with their baby, others become overly anxious of their babies health and wellbeing and constantly worry about every aspect of caring for their newborn.

For a woman that has lost a baby during birth or whose baby has been injured during birth she may experience overwhelming guilt, she may feel like it is her fault that she somehow failed her baby or that she should somehow have prevented it. She may play over and over again the birth in her head seeking answers or ways she could have changed the outcome.

Feeling like they have no voice, are misunderstood and weak many women will seek to hide their true suffering and ‘carry on’, the weight of trauma bearing down on them crushing hope, light and happiness as they try desperately to cling to normality. Everyday tasks become hard and just coping day to day can feel overwhelming. Their physical health too may suffer, as the effects of trauma ravage them mentally. Lack of sleep, trouble eating and the constant struggle all takes its toll. Flashbacks may take them back to the event reliving moments, even smells and conversations causing great distress and anxiety.

So what is PTSD and how does it differ from postnatal depression?

Often women can be wrongly diagnosed with PND when in reality they have PTSD.  While PTSD and PND can overlap as they do have some similar symptoms, they are very different. Its important that a woman receives a correct diagnose so she can have the support, help and therapies she needs. PTSD is the clinical term for a set of normal reactions to a traumatic, scary or bad experience or event. It can occur after a person experiences or witnesses something that was or they perceive to have been life-threatening.

Signs of PTSD include:

  • Feelings of intense fear, helplessness and/or terror.
  • The re-experiencing of the event by recurrent intrusive memories, flashbacks and/or nightmares. The individual will usually feel distressed, anxious or panicky when exposed to anything which remind them of the event.
  • Avoidance of anything that reminds them of the trauma. This can include talking about it, the place where the trauma happened or people that may have been involved in the trauma. (such as hospitals, doctors, healthcare professionals) Even T.V programs or books maybe avoided.
  • Bad memories and flash backs often result in difficulties with sleeping and concentrating, thus affecting daily activities. Sufferers may also feel angry, irritable and be hyper-vigilant or jumpy, easily startled.
  • Suffers may suffer panic attacks, depression and anxiety. They may feel detached, alone and have a sense of something bad may happen to them or their loved ones.

It is important to remember that PTSD is beyond the sufferer’s control. It is the mind’s way of trying to make sense of an extremely scary traumatic experience and are not a sign of an individuals ‘weakness’ or inability to cope. The person cannot just ‘get over it’ or ‘pull themselves together’ or ‘move on’. Rather they need help and support to process not only what has happened to them but also the feelings surrounding it.

So what can help a woman who has suffered birth trauma or PTSD?

For partners, family and friends its important to acknowledge what has happened to the women and her feelings surrounding it. Encourage her to talk about her feelings if she is able to. Help her to see you want to try to understand how she is feeling and that you recognise how traumatised she may feel.  Reassure her that you are there for her and that you will help in anyway you can. You maybe the only person that she trusts. Encourage, commend show compassion and empathy. Emotional support is invaluable, even if it’s just a listening ear or a hug. Realise that there may be things or activities that she may not yet feel ready to do, be patient and show understanding.

Encourage her to get help, whether it be her GP, health visitor, midwife or a charity such as the Birth Trauma association or Mind. This will not be easy as she may have a fear and distrust of telling anyone how she really feels especially a healthcare professional. Reassure her of your support, maybe offering to attend any appointments with her if she wishes. Asking for help will be hard, and so will the time undergoing any therapies being there for her providing emotional support is so important.

Also, helping with daily activities can mean so much, helping her get much needed rest offering to prepare a meal, or to do some shopping can also be invaluable.

Helping someone with PTSD can be difficult and frustrating.Partners and family can feel lost and confused too. Reading up on PTSD can help you understand it and how it can affect someone that is suffering.

Of course some partners too can feel traumatised and suffer from PTSD after seeing the birth of their baby. It is important they too seek help and support.

What about healthcare professionals?

Its important that any healthcare professional’s when supporting a woman after birth build a relationship built on trust. LISTEN, this is the single most important thing to a woman who is suffering. Listening enables you to truly know what she has been through, how she is feeling and whats important to her and her family.  Listening will enable you to know if she is likely to be suffering PTSD or any other perinatal mental health disorder. Listen also to her partner and family, they know her best, if they feel something isn’t right or reach out for your support then be there.  Ask for training in order to help you understand the different types of perinatal mental health issues and know the pathways and any local support available to signpost a women to.  Be careful of language used and do not minimise her feelings or experience.  If you know a woman has had a traumatic birth from postnatal notes etc, ASK, don’t ignore it.

What can a woman who has had birth trauma/PTSD do for herself?

  • Speak to someone, partner, family, friends, midwife, health visitor, GP. Don’t suffer in silence.
  • Remember you are not alone, there are others too that have been affected by birth trauma.
  • Remember you are not to blame.
  • Look after yourself, make sure you rest and eat a good balanced diet. Do things, activities that help you to relax.
  • Know your limitations and what you can do both physically and emotionally.
  • Speak to your hospital about your experience. Some women ask to see their medical notes and discuss exactly what happened to them and why.
  • Seek help and treatment. There are various treatments for PTSD such as counselling, Eye Movement Desensitization and Reprocessing (EMDR), cognitive behavioural therapy (CBT) and medication.
  • Find local support groups or support groups on social media (such as birth trauma facebook support page)

Birth trauma is real and so is PTSD, its important that women get the help and support they need to overcome it. The birth of her baby can affect a woman for the rest of her life, it may not be possible to completely prevent birth trauma but what we can do is support women when things do go wrong and make sure that we show them love, compassion, kindness and help even at the darkest times so they believe that it will be possible to bathe in light again.hafiz-quote1

my story of birth trauma

Emma Jane Sasaru

@ESasaruNHS

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What is a ‘Positive’ birth?

by / Birth Trauma, Continuity of Care, Environment and Facilities, Informed Choice, Postnatal Care / Comments Off on What is a ‘Positive’ birth?

The experience of birth will stay with a woman her whole life time

Ask any women her birth story and she will recount it with easy, there is no experience that can compare to bringing a tiny baby into the arms of a loving family. The effects of a birth experience will stay with a woman her whole life , it can effect her subsequent births, her health, her relationships, sometimes for the rest of her life.

So what is a positive birth? What can we do to help women have a positive birth?

As with all things in life choice is very important and this is no different when it comes to birth. Choice is so important for women and should be the foundation of any birth. Women should be aware of their choices and what is available for them. Is there a midwife led unit she can use? Will she be able to have a home birth? What about free birthing? Can she elect to have a cesarean section? These are all things a woman may wish to consider when choosing how to have her baby. Consider how much thought may go into the purchase of a pram. I know couples that have spent months researching and looking at all the different prams available. Shouldn’t we be helping and making sure that just as much thought and research is going into the choices for birth?

What’s also important is accurate evidence based information that will enable a women to make an informed choice. How far from a hospital is she if she chooses a home birth? What are the risks of a cesarean section and the results for future pregnancies? What actually is free birthing? Why has it been recommended to have the baby in a hospital? By good communication and giving accurate information women can be helped to make a informed choice that is right for them and their baby.

So what makes a birth positive?

Think about a day or an event that you enjoyed lately that you view as positive. What made it positive? Maybe it was who was there, or the place you went or what you did. Does a positive event mean that it always goes to plan with everything prefect? No, sometimes even when things don’t go to plan they are still positive. Will everyone have the same view of what is positive and does everyone view the same experiences as positive? Chances are what you find positive someone else wont. So when it comes to birth it is very individual. Every woman has her own view of what a positive birth is.

Picture for a moment a woman, she was desperately looking forward to the birth of her baby, however something went wrong and her beautiful baby was born sleeping. Now she is pregnant again, she is racked with fear, anxiety fills every day as she worries about the safety of her baby. She desires control, needs reassurance of medical staff and the technology they process. For this woman her choice for her birth is a cesarean, her baby delivered, well and alive in a controlled way, at her choosing. As her baby is lifted from her body and she hears the cry of her newborn baby relief, joy and hope fills her heart. This is her positive birth.

Now picture a woman whose previous birth was traumatic an emergency cesarean with much medical interventions. Her recovery was long and feeding was difficult. But this time she wishes to stay at home as long as she can. She wants to trust her body to birth her baby and believe that she can safely bring her little one into the world. She wants calmness and solitude and as little intervention as possible. So she hires a doula that supports her at home till the journey to hospital.  Once there in a room thats dark and quiet, with time and the support of her partner she births her baby on all fours into her own hands and she feels at peace. This is her positive birth.

Then there’s the woman that is terrified of birth, of hospitals and doctors. Abused as a child she has trouble trusting people. Yet tears are streaming down her face as she holds her newborn baby, with her is a midwife she trusts and she feels safe in the beautiful room of her local midwife lead unit. Around her are her things that bring her comfort and peace. Her favourite song is playing as the warm waters of birth pool lap around her soothing her tired body. This is her positive birth.

A positive birth will be different for every woman, what matters is what birth means to her. It’s important that a woman’s choice is supported and her wishes understood and as far as possible she is able to have the birth she wishes.

Of course sometimes things don’t go as planned and the birth a woman wants and has planned may not happen. However we can still make sure that it is positive. How?

Firstly communication. Always should a woman know what is happening and why. Explaining what is happening gives the woman confidence and builds trust with those who are caring for her. Understanding the things happening too her will easy anxiety and lessen fear. Don’t forget communication means listening too!

Secondly choice. No matter what is happening the woman still should be given choices. Allowing a woman to have choice even in difficult situations means we give control back to her and her birth.

Thirdly, dignity, respect and compassion feed positivity. Always should a woman feel that she has been treated with dignity by everyone around her. Small things like asking before doing checks and saying please and thank you go a long way. A woman should never be judged or labeled. Respect should be shown her and her choices and her concerns and fears. It maybe that her choices are difficult for us to understand but still they are hers and we must respect them. Never should a woman be spoken to unkindly or her needs ignored.

What about Compassion?

‘Compassion is the emotion that one feels in response to the suffering of others that motivates a desire to help. Compassion is really the act of going out of your way to help physical, spiritual, or emotional hurts or pains of another’

Compassion should move those who support a woman in birth to go out of their way to help her.  She is someone’s wife, sister, daughter, she has her own story, feelings, needs, fears, concerns. Care should be individual for each woman taking into account her personality, her background, her current situation. This may sound like an impossible task but is it? Ask yourself if it was you what would you want? More importantly as we said at the outset if the way a woman births stays with her her whole life time then we must do everything we can to make her birth positive. so that she looks back on it and remembers that those around her did everything they could to make her feel loved. images (15)

Emma Jane Sasaru

@ESasaruNHS

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The many faces of birth

by / About MatExp, Continuity of Care, Informed Choice, Language, Postnatal Care / Comments Off on The many faces of birth

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Ive seen lately many discussions on birth and it got me thinking. Birth has many faces and no one situation prevails, it is as individual to each woman, baby and family as a fingerprint. Often things such a ‘risk’, ‘normal’ and ‘natural’ are mentioned along with ‘informed choice’ and ‘statistics’. All this can be banded about and yet is birth really that simple?

Of course the answer is no, birth can be very straight forward but it can also be very complicated and so providing care, support while respecting individual choice can be difficult. What do I mean?

Well I can see there are many faces to birth. Firstly the ‘positive natural’ side of birth that we hear so much about. As I trained as a doula I learnt so much about the human body its ability to birth and ways that a woman can help herself during the stages of labouring. I truly believe that giving birth can be a wonderful, momentous, truly beautiful event during which a woman can, by listening to her body, birth her baby safely anywhere she wishes. In fact women have been doing exactly that for thousands of years. There are many things women find helpful while in the stages of labour such as hypnotherapy, relaxation techniques, massage as well as the right environment and support. Providing information for women and helping them believe in themselves and their bodies is very important. This is often not always the case in antenatal classes where much emphasis can be on pain relief and types of interventions rather than working with your body, by keeping active etc.

However, working with women who have experienced birth trauma I also see that we must be cautious. Why?

When birth goes well and is the experience a woman hoped for it is amazing. Many times however I have heard women say that when things have not gone to plan or birth has taken a different journey to the one they had envisioned they have felt like a failure. When her baby comes early, or a labour becomes complicated, when hypnobirthing hasn’t worked or when a women hasn’t been able to give birth vaginally and birth ends in a caesarean she may feel her body has failed her. I have personally heard many women voice that they feel let down, that the reality of birth wasn’t explained to them and that they felt unprepared and almost lulled into a false sense of security believing that their birth would go to plan if they just believed it and nature would do the rest. This however doesn’t always happen, birth sometimes takes a different turn, or a woman may not manage labour like she thought she would. Sometimes there is medical complications or emergencies. When a woman doesn’t have the birth she wanted then comments like ‘whats wrong with me’ or ‘why did I fail’, ‘what what did I do wrong’ or ‘I regret my birth’ often are said. This can then result in the pursuit of the ultimate ideal birth. Or for some women it can result in a feeling of despair and sometimes trauma.

So how do we empower women but also at the same time not give a unrealistic view of birth?

The key here is knowledge that is evidence based but also realistic and takes into account each woman, her wishes, her choices but also her history, previous births and health.

We also must never put one form of birth on a pedestal as the ultimate to be achieved and as a sort of goal or prize to be attained. Why are women that have laboured for hours, attempting to birth vaginally but going on to have caesareans feeling like failures? In fact why is any woman who has had a baby feeling like failure? When did it happen that one way of birth equals success and another failure? I read recently a women asking for support after going on a facebook page where women were discussing the length of their labours and competing with each other on how long they laboured before they accepted any pain relief. The woman in question had suffered a long labour, then a episiotomy, then forceps, then a caesarean because her baby was firmly wedged and in distress. Why was she seeking support? Because she felt a failure for having accepted pain relief during her labour.

I feel like a failure

Women are then often let down after birth, when birth hasn’t gone as planned women are told “you have a healthy baby, thats all that matters” but this is not true. Birth has a profound effect upon a woman and her family, there must be support after. Emotionally it can take time to process birth and with a new baby to care for it can be overwhelming. Expectations abound as does advice. Time spent with a women reflecting on her birth can be invaluable, sometimes there can be so much emphasis on the birth itself that little time is given to thinking about after. Especially where birth has been traumatic is it important that it is acknowledged and support be offered. Reflecting on good experiences is also important as it enables learning what helps and supports a woman and helps improve care given. Its important that women know it is ok to be disappointed with their birth experience but it doesn’t mean that their birth was any less an amazing event.

This brings me on to another side of birth, the medical side and in particular healthcare professionals.

To be fair those that care for women often come in for a lot of criticism. Sometimes this is justified, I myself had very poor care after the birth of my daughter, however many are trying hard under very difficult circumstances to provide care in birth that is kind, compassionate and patient centred. Empowering women can be hard in a hospital environment. Rooms are often bright, clinical areas with lots of equipment with many staff coming and going. Language often used such as ‘failure to progress’ or ‘allowed’ does little to build confidence. Midwife led units while providing the lovely environment for birth and being available for things like water births often have such strict guidelines that few women qualify to use them. Even if women do qualify at the slightest issue they are often transferred to hospital causing anxiety and concern. At a recent support group nearly all the moms there said they had started labouring in a MLU but was transferred over to hospital. They all stated they would not try to use a MLU again as they felt there was no point as they would likely just be transferred over.

What is the reason for this almost ‘over concern’?

Im not a midwife or an obstetrician but I would imagine that being responsible for the safe birth of a baby is a heavy responsibility. No one wants anything to go wrong or a women or her baby to suffer any problems. However birth can be risky and unpredictable and so in the hast to make it as safe as possible it has in many ways become over medicalised. Rather than risk injury or death of a women or her baby doctors or midwives may err on the side of caution preferring to monitor and whisk baby out at any sign of a problem. Having procedures and policies in place makes staff feel safe and processing medical training they may see things from a very different angle to the family they are caring for. Add into this the risk of litigation when things do go wrong and it can be a mix that doesn’t allow for much movement. A woman may make a choice on her birth but if things go wrong doctors and staff may still face questioning and litigation. It may also be hard to accept that a woman is indeed making an informed choice if it seems to go against the very medical guidelines that have been set in place to keep her safe. Because of this much of the ‘natural’ way of birthing has been lost in a sea of trying to make everything ‘safe’ by checks more checks and even more checks. Of course for some this has meant the saving of their life or that of their baby, however for others it has meant they haven’t had the birth experience they wanted.

No one wants anything to go wrong

If a women came to you as a doctor requesting a vaginal birth after multiple complicated pregnancies that had resulted in caesareans likely the answer you would jump to would be to advise against it. Everything you know, have experienced, and trained for, as well as all the polices and guidance around you would be screaming in your head that this was not the best idea for this woman. But what if that was that woman’s desire and choice? What if she felt informed and educated. What if she felt she was aware of the risks?

Which leads onto another face of birth.

How far do we feel women should be able to ‘choose’ how they give birth? When everything is clearly pointing to great risk to her and her baby, or if pursuing that choice could have the potential to cause issues how do we then support a woman in her choice, showing respect and dignity but at the same time mitigate risk? Do we allow a woman to birth as she wishes knowing that it may not be safe for her and her baby?

There may be no clear answer to this and this is where the waters become muddy. It is true that a woman has the choice and control of her own body and baby. But also those caring for her have a responsibility too. Informed choice must truly be that, an informed choice. As women the onus is upon us to make sure that we truly are educating ourselves on birth before making a choice. That includes not only the way to help our bodies birth our babies but also to make sure we are prepared for the situations when that may not be possible. As women we should not try to live up to any ‘ideals’ of what a birth should or shouldn’t be. It is your birth, it is your body, it is your family, does it really matter what anyone else has or hasn’t done? Of course not every woman does this or wishes to do this and is happy to follow the recommendations of her doctor for her care, trusting that they know what is best for her and her baby. Again that must be respected and should not be looked down upon or a woman made to feel guilty because she has chosen to do so. We must also remember that we are then responsible for our choices and so its important that we truly are making a choice that is informed and evidence based.

Likewise those that care for women must be mindful of the woman. Communication is the key. Finding out what her choices are, why she has chosen certain things. Look at a woman as a whole person with her own thoughts, ideas, needs, wants and desires. This is very challenging and may seem impossible. But only by doing so can correct information and support be given that relates to that women and her circumstances. Language is very important as is respecting choice. It can be easy to say ‘but that’s what we have always advised, suggested’, but challenge your knowledge and seek to always learn more and improve care given. Fear of litigation is very real however that fear can lead to being over cautious, leaving no room for choice or movement or consideration of  individual requests. Also important is consent. No matter what the situation it is very important that a woman gives consent. Ive lost count of the amount of women who have voiced that they had procedures done to them during birth that they did not consent to but felt they had no choice. Communicating why, and making sure that a woman fully understands and consents to anything done to her cannot be overly stated.

Birth may have many faces, the woman, her family, those that care for her and other women and their experiences, but what matters is the woman herself. Teamwork, communication, consent and dignity all play a part. Women and staff who care for a women need a good relationship built on trust.

Failure has no place in birth, because no woman fails but only does her best in the circumstances she finds herself in. Birth is not a competition or a race, it isn’t the same journey for any two women in fact for any two babies. Birth is individual, wonderful and breathtaking, sometimes it can be difficult and heartbreaking but, if women are at the centre, if a women are the motive, the passion, the love, then everyone will always strive to make every woman’s birth the best it can be for HER, no matter what that may be, because for every women that will be something different.

As women yes believe in yourself and your body and your ability to birth your baby, but also be prepared that sometimes things don’t go to plan. That doesn’t mean your choices are gone, or that you have failed or that your experience is somehow less than anyone else’s. It just means your birth journey changed but with help, support and care it can still be a beautiful journey.

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Emma Jane Sasaru

@ESasaruNHS

 

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Why the wonderful #matexp has given me hope

by / About MatExp, Birth Trauma, Informed Choice, MatExp and Me, The #MatExp Journey / Comments Off on Why the wonderful #matexp has given me hope

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Imagine, a consultant, a midwife, a doula, a support worker, a commissioner, a campaigner and a mother all coming together to help support and improve maternity services for all women and their families.

Wonderful you may say, but will this really ever happen you may wonder? The answer is yes!

#MatExp is a wonderful grassroots campaign using the Whose Shoes?® approach to help identify and help improve our national maternity services. By means of workshops in local hospitals users of maternity services are brought together with others to join conversations about their experiences of maternity care and share what really made a difference to them personally and their experience and talk about ways that care can be improved. These workshops enable health care professionals (in and beyond the NHS) and local communities to listen and work in partnership with women and their families to find ways to improve local and national maternity services. Anyone can take part whether your a maternity service user, partner, community group or NHS staff, from chief executive to volunteer all are welcome to attend and share. Also on twitter using the hashtag #Matexp there are many amazing people sharing personal stories, experiences, achievements and ways they are actively trying to improve care both in there local hospitals but nationally too.

I personally have been involved in a #Matexp campaign for NHS change day. It was action 5 – ‘life with a new baby’ as breastfeeding champion along with the lovely Helen Calvert. Personally for me #Matexp has been really wonderful and something im proud to be part of. After suffering poor care with my first birth and subsequent birth trauma and PTSD, #Matexp has given me hope.

Hope that things can change.

Hope that women will be the centre of maternity care.

Hope that the culture of birth and our maternity services will improve.

Hope that the voices of women will finally be heard.

As part of #Matexp I have made contact with some amazing people such a Flo, Gill, Rachel and Helen as well as fantastic midwives such as Jenny and mothers such as Leigh. All are doing amazing things to improve services for women often after personal experiences. Knowing that there are so many people who genuinely want to work to improve services and make care better and who truly value women has helped me heal and also restored my belief in maternity care. It has given me the opportunity to to tell my story and then feel part of improving things to make care given better for others something I am so passionate about. It has also given me confidence to be bold and change things in my own job and NHS trust as I feel supported by some amazing people. Seeing their successes has spurred me on and helped me believe that we can all make a difference.

More importantly #Matexp has given me hope. Hope that one day we will provide a maternity experience that is individualised, respectful, gives dignity and allows for informed choice. That puts a woman, her baby, her family and their needs first. It will mean birth experiences that do not result in trauma but that even under difficult circumstances will make a woman feel loved, protected and supported. Yes I have hope, because finally not only has my voice been heard but the voices of women everywhere will be heard, no matter who they are, what they do, or what choices they made. Why is this so important, because your birth experience stays with with you the good and the bad, it can have a profound effect on you as a family as you start on your journey as parents. All women, babies and families are special and deserving of the best maternity care possible. So join in, get involved and share your stories and your ideas. There’s exciting times a head in #Matexp and together we can make a difference.
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Emma Jane Sasaru

@ESasaruNHS

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#MatExp and NHS change day – a call to action to support Breastfeeding

by / About MatExp, Feeding, Informed Choice / Comments Off on #MatExp and NHS change day – a call to action to support Breastfeeding

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Helen Calvert and I are the breastfeeding champions for the NHS Change Day #MatExp campaign. What on earth does that mean I hear you ask? It means that we have the privilege of being part of a powerful grassroots campaign using the Whose Shoes?® approach to identify and share best practice across the nation’s maternity services and look at ways we can improve these services for women and their families. The campaign has already been triggering discussions about what needs to improve to make sure women and their families have the care that is right for them. You can read all about it here: http://changeday.nhs.uk/campaigns/matexp/

There are 8 existing #MatExp Change Day actions, and we are focusing on #MatExp5 – Life With A New Baby, and in particular breastfeeding: http://changeday.nhs.uk/campaigns/matexp/matexp-improving-maternity-experience-just/

Anyone familiar with this blog will know that I suffered birth trauma with my first daughter and I am very passionate about improving maternity and perinatal care for women and their families that is patient centred and supportive of their choices. I work as a breastfeeding peer support worker for the NHS helping families in Neonatal, hospital and community. I also volunteer for the BfN and am a trained Doula. I write my blog to raise awareness of birth trauma and Perinatal mental health, reduce stigma and help others. I am passionate about supporting women in their breastfeeding journey especially those that have had pre-term babies. You can read about my story here http://changeday.nhs.uk/story35/

Helen started the #hospitalbreastfeeding campaign on Twitter following her experiences of breastfeeding her younger son, David, who has a congenital heart defect. This campaign led to the launch of Helen’s website, http://www.heartmummy.co.uk, which has key messages to help medical professionals to understand what’s in it for them when it comes to supporting breastfeeding in wards and departments. It provides much needed information to help healthcare professionals provide support to breastfeeding mom’s especially with sick vulnerable babies. Helen tirelessly campaigns to raise awareness for families with children who have a heart defect and also to support moms in their breastfeeding journey.

So what is it that we would like you to do?

Well, firstly, why not log an action on the NHS Change Day website, where “we give ourselves permission to make the changes we can make, share them, and inspire others”? What’s lovely is this is for anyone. Most of us come into contact with women and babies, so simple things like a simple smile to a new mother or a kind word or deed can make a difference.

If you are working in maternity services or are passionate about supporting women and their families and are going to log an action, do so under the #Matexp campaign. There are a few actions to choose from, why not go for something that will make a change to the breastfeeding experience of UK families? Actions can be as simple as you like, what matters is they are personal to you.

Here are our suggestions, and how to log your action. Your action could be to:

  1. Look outside of the NHS for breastfeeding information to use to support families.[Best beginnings, BfN, UNICEF, ABM, La Leche League, kellymom, Dr Jack Newman etc.]
  2. Always remember that breastfeeding is more likely to be possible than impossible. Just keep this in mind every day and see how it changes your approach to families who want to breastfeed.
  3. Follow the RCN’s guidelines for supporting breastfeeding on paediatric wards: http://www.rcn.org.uk/__data/assets/pdf_file/0017/270161/003544.pdf
  4. Download and share the posters from heartmummy.co.uk – simple messages and guidance explaining how breastfeeding can be a key part of a child’s medical care.
  5. Support all families to make an informed choice by giving accurate evidence based information regarding breastfeeding.
  6. Encourage each other to support a mom whatever her feeding choice.
  7. Help the wards/places we work in to reach out/work towards Unicef baby friendly accreditation. Use the resources they provide and makes sure the culture reflects those standards.
  8. Not to use the term Breast is Best, but seek to normalise breastfeeding as the biological norm.
  9. Always introduce yourself #hellomynameis and explain who you are and your role. Be friendly, give of your time, listen and remember that each is an individual trying hard to do the best for their babies. Smile!
  10. Think about language, what we say matters. Make sure we are not undermining breastfeeding, causing a woman to doubt her ability to care for her baby.

To log your action go to : http://changeday.nhs.uk/campaigns/matexp/ scroll down and click on the light bulb that says action. Then follow the instructions. Put #MatExp5 in the title of your action to link it to our area of the campaign if you would like to, and don’t forget to tweet and share your action once you’ve written it!

Also you can join or set up one of the maternity workshops that are going to be running around the country. These workshops give the opportunity for all, whether staff or service users, to engage, share ideas, and look at ways to improve our maternity services.

What are we hoping to achieve?

When we spoke to women a few core things became clear, they wanted clear consistent advice on breastfeeding, good support in hospital and lots of encouragement and support. They spoke about respect for their choices and not having things forced on them by healthcare professionals and how sometimes all the wanted was for someone to say “well done’.

The standard of care we see in our maternity units needs to improve. To do this we must all work together, staff and service users, men and women. We all want women and families to be supported in their choices and have the best possible care. The maternity experience a woman has can stay with her all her life, as can the support she receives to feed her baby. We owe it to women and their families to make a change. What matters is real people, real families and real lives. Women should be equal partners in their maternity care their voices need to be heard so that the maternity experience meets individual needs. Dignity and respect must govern all we do. Maybe we can only make small changes or pledge small actions, but when they all join up together that means big changes for women, for families, for us all.

Thank you Emma and Helen

Emma’s change day action: http://changeday.nhs.uk/user_action/ive-got-involved-in-the-matexp-actions/

Helens change day action: http://changeday.nhs.uk/user_action/matexp5-encouraging-support-for-breastfeeding-on-childrens-wards/

 

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#MatExp Survey – The Results Are In!

by / The #MatExp Journey / Comments Off on #MatExp Survey – The Results Are In!

As you will have seen, I have been sharing maternity experiences on this blog from women I know.  Some good, some bad, some unacceptable.  But all anonymous.  And it occurred to me that this was somewhat unfair on the birth professionals working to support pregnant women, many of whom I have become friends with on Twitter.  So I thought it would be good to be able to share the other side of the story, the thoughts and views of the birth professionals, who have also been afforded the luxury of anonymity.  Thus the #MatExp survey was born!

Just F****** Do It!
Just F****** Do It!

As with everything I do, I JFDI it one evening (thank you for that phrase Florence Wilcock!) and popped it up on Twitter.  To my great delight, I have had 150 responses from midwives, student midwives, independent midwives, doulas, obstetricians, anaesthetists, antenatal teachers and other birth professionals.  Thank you to everyone who has taken part, your input is much appreciated.

This is the split of respondents:

Question 1
Question 1

We also had responses from a neonatal registrar, a perinatal psychiatrist, three midwifery lecturers / educators, a research midwife, two hypnobirthing instructors, an anaesthetist and three antenatal teachers.  Many are new to their profession, many have been supporting women for one, two or three decades, and one respondent has been a birth professional for 43 years.

The first thing I wanted to know was “What is the best thing about your job?”  The vast majority of respondents talked about the women they work with and being able to support them as being the best part of their role.  One student midwife caught the general mood with the comment “Supporting women and being there for them no matter what.”  Responses included:

“Witnessing the women I support find their strength and power. Witnessing the love between the couple and the birth of a new little family.” (Doula)

“Being a part of a woman and family’s journey into parenthood.” (Independent Midwife)

“Being part of the transformation of woman to mother” (NHS Midwife)

“Supporting and empowering women, whatever the outcome of their pregnancy” (Obstetrician)

“Making a difference to women. To be present & witness to most beautiful time in life” (Student Midwife)

“Seeing women empowered and birth partners knowing their role and both having calm births” (Hypnobirthing Instructor)

“Privileged to be part of the miracle” (Obstetrician)

Unsurprisingly, the independent midwives found that being able to offer continuity of care and build a relationship with the women they support to be one of the best parts of their job.  Many of the obstetricians felt that the best part of their role was “averting danger”, “saving lives”, “helping women to have as healthy a pregnancy and birth as possible”, but also “working with women caring for them at such a life changing moment in their lives” and “being able to reduce anxiety with appropriate explanation”.  A fair few of the doulas talked about “witnessing the women I support find their strength and power” and “empowering women”.  One explained that the best part of her job is voluntary work “with vulnerable women – asylum seekers, poverty, isolation – who may not otherwise feel worthy of advocacy”.

The word “support” comes up a lot in the responses of NHS midwives, and wonderful comments such as “Making a special time, simply awesome!!!”, “Having the honour and privilege of being a part of a very special time in people’s lives” and “working with the women through an amazing experience”.  The student midwives made similar comments, but I particularly liked these two responses:

“The list is endless, but one that currently stands out is being able to turn it around when a woman is panicking in labour and giving them confidence in their own body to give birth! Saying a few words of reassurance and visibly seeing the change is incredible.”

“Supporting women on their journey whatever their circumstances or choices and feeling a sense of fullfillment when you know you’ve made a difference to someone’s pregnancy/birth.”

So from these inspiring comments from people who clearly adore their jobs, we move on to the question “What is the biggest challenge currently facing your profession?”  Overwhelmingly the response was NOT ENOUGH MIDWIVES!  My recent blog post explores the experience from a woman’s point of view when a unit is short staffed. This really is the biggest challenge as far as these respondents are concerned.  Closely followed by fear – “The fear of litigation and professional accountability. The wake of the kirkup report savages midwives and their portrayal is unfair. We may all be tarred with the same brush. Normality is under attack again.”  For midwives, morale is also a concern – “we are CONSTANTLY being told what we are doing wrong. Such a culture of fear.”

For obstetricians the challenges are different.  Comments included:

“Letting the lawyers decide what information we say and letting them take an additional cut. When the press report a 5.2 million payout the lawyers award themselves a further 6 figure payout.”

“More and more ‘high risk’ women embarking on pregnancies.”

“Too much focus on everything EXCEPT caring for patients!”

“Unnecessary obstetric intervention”

For doulas, they are struggling with a lack of awareness of their role and “dispelling the myth that only the wealthy can afford us”.  Lack of awareness from families – “People understanding what support we can provide and the value of it” – and from medical professionals – “Being misunderstood – doulas work alongside NOT in place of HCP”.  Some respondents even felt that there is resistance to doulas amongst the medical community.

Where student midwives are concerned, the biggest challenges include:

“Feeling left alone and overwhelmed when its busy because my mentors are rushed off their feet.”

“Bullying… NHS culture”

“Working with midwives who don’t use up to date evidence such a optimal cord clamping”

“Guidelines that seem to have very little evidence base.”

“Bad attitudes, both to those in our care and to each other!”

The over-medicalisation of birth was also mentioned by many respondents.

So what can birth professionals do to meet these challenges? The #MatExp campaign is all about action, and everyone being able to make a difference.  Respondents were asked “What do you feel you personally can do to face that challenge?”

Whilst some said “not a lot”, “not sure” and “nothing”, most felt that they had ways to meet the challenges they faced.  Answers included the simple “keep on caring”, “keep going” and “raise awareness”.  Others said:

“By empowering women to have a voice and question these [hospital procedures]. Also, working together with OBs and MWs to also understand their point of view and what challenges they face. So we can all change this together.” (Doula)

“With 3 colleagues I have set up a social  enterprise to provide a caseload midwifery service through NHS commissioning at tariff – the battle is to get it accepted by those who resist changing the status quo” (Independent Midwife)

“Keep going, keep trying to provide compassionate, excellent, evidence-based care, serve the women in my care as best as I can doing my best every shift” (NHS Midwife)

“Not resign myself to that’s how things have to be, think about ways to improve and make suggestions, continue to make every contact with women as positive as possible” (NHS Midwife)

“Show by example how important it is to respect and listen to a woman at all stages of antenatal, labour and postnatal care.” (Doula)

“Ensure that I act within my own values despite others in my environment, find support and positivity from like minded individuals. I love Twitter for that!” (Student Midwife)

“Train our midwives to the highest level to avoid litigation. Test their knowledge to ensure they’ve learned from the training.   Keep on asking for more staff and bigger units. Never give up!!” (NHS Midwife)

“Trying to individualise care and support women’s choices  Positive birth” (Obstetrician)

“I need to remember I’m a student and should be supernumerary. I need to speak up more to make sure I’m learning each day rather than doing what I know or making beds.” (Student Midwife)

“Continue to practise in the best interests of women rather than defensively and vote against abolition of supervision” (NHS Midwife)

“Try as far as possible to support ‘normal birth’, educate women about the risks of high BMI pregnancies etc.” (Obstetrician)

“Be prepared with an abundance of solid evidence” (Student Midwife)

“Keep my heart strong, separate the bigger picture from the day to day interactions of care, do mindfulness, be compassionate to self, inspire trust in women’s bodies” (Student Midwife)

On a personal note, I particularly like the doula who is determined to be “rigorously evidence-based, and relentlessly compassionate.”

I was keen to see how many of the respondents were aware of the #MatExp Campaign.  Many would be of course as the survey started out being publicised to people I knew on Twitter, many of whom I have linked up with due to #MatExp.  It gradually worked its way out of that community though, and by the time the survey closed the split was as follows:

Awareness of #MatExp
Awareness of #MatExp

The orange line is “I have heard of it but don’t know a lot about it”.

I then outlined the aims of #MatExp as they appear on the NHS Change Day website

NHS Change Day
NHS Change Day
Aims of #MatExp
Aims of #MatExp

The next question was “What do you feel you can do to support these aims?”  Many respondents felt that renewed or continued work with their MSLC (Maternity Services Liaison Committee) was the answer.  Others simply want to “spread the word” and “let mums know”.  Other comments included:

“I encourage women to speak up about things they’re not happy with. Raise it at a higher level if you have to, use the SoM or similar. Empower women so they don’t feel intimidated by professionals telling them what they are and are not ‘allowed’ to do.” (Doula)

“Ensure patient feedback is received acknowledged and acted upon. Continue daily ward visits” (NHS Midwife)

“Support AIMS [Association for Improvements in the Maternity Services]” (Independent Midwife)

“Keep banging the drum for parity of esteem for maternal mental health” (Perinatal Psychiatrist)

“Keep raising awareness on Facebook, hold antenatal classes, tell all the women I come across everything is in their power – try to banish the word ‘allow'” (NHS Midwife)

“Probably the friends and family questionnaires would help and I can make sure these are handed out.” (Student Midwife)

“As a researcher I can help to make maternity service user views more visible and I am also doing a lot of work around ways to increase opportunities for service users to get involved in research/maternity service improvement activities.  I am also very interested in the idea of co-creation in research (so working alongside service users and frontline staff to develop, do and use research). Part of the work I am involved with at the moment involves empowering pregnant women and midwives to use research evidence more effectively.” (Research Midwife)

“I’m an increasing Twitter user. Social media seems to be the way forward” (NHS Midwife)

The next question looked at the specific areas that the #MatExp campaign covers, including the area for which I am one of the champions: “Life with a new baby”. The full list is:

Skin-to-skin – see Jenny Clarke’s video

Optimal cord clamping – meet Amanda, optimal cord clamping champion

How does lithotomy feel as a woman in labour – read about obstetrician Florence Wilcock’s NHS Change Day lithotomy challenge

Language used towards pregnant women (e.g. “failed induction”, “poor maternal effort”) – this area is championed for the campaign by Leigh Kendall

Life with a new baby – including perinatal mental health and breastfeeding.  Read about Rosey PND&Me and also the blog post that Emma Sasaru and I put together on supporting breastfeeding.

Informed Choice – see this example of risk being explained in a user accessible way

Respondents were asked to rank these areas in order of importance and the results were:

Order of importance
Order of importance

A couple of respondents had (very fair) specific comments on the above question, namely “our unit is already changing skin to skin and delayed cord clamping, hence their low ranking, otherwise I would have placed them higher, my next project is to reduce the use of lithotomy” (Obstetrician) and “it is impossible to rate these in order. In general they each impact on each other, by improving informed choice you are creating a healthier postnatal environment etc. so rankings don’t mean that skin to skin is the least important” (NHS Midwife).

The response to the next question was fairly definite!

Importance of feedback
Importance of feedback

Finally, I asked “If you could change one thing about maternity care in the UK what would it be?”  Staffing levels were mentioned again by a lot of respondents, as was caseloading / one to one care.  Many of the answers were also indicative of the tensions between different birth professions and professionals:

“For more medical staff to witness natural birth.” (Doula)

“Doctors and midwives respecting each other” (NHS Midwife)

“Obstetricians” (NHS Midwife)

“If we loved and treated our colleagues better, collaborated and supported each other, we’d be a happier, more efficient more compassionate and passionate workforce- and this would filter through to the women we support” (NHS Midwife)

“Reduce obgyn lead care.” (Doula)

“NCT didn’t have such a negative influence on women. No one failed because they didn’t have a vaginal birth. A lot of what is taught is inaccurate and based on personal opinion which is not informed choice.” (NHS Midwife)

“Slow down the relentless overuse of induction…encourage/ optimise midwife led care home birth and birth centres and caseloading model of care.” (Student Midwife)

“Don’t always go and try to enforce your procedures. Listen to women. Use of language for the purpose of influencing a labouring woman into accepting the best thing for hospital such as I witnessed: ” This baby has had enough” is very detrimental, and to say the least, manipulative.” (Doula)

“I would offer a single additional session to antenatal classes/NCT classes etc about the reasons for medical interventions in labour and the risks and benefits. It is unbelievable that in an age of information, when women have spent time with midwives and NCT instructors, we still regularly see birth plans that say “don’t want forceps unless necessary”! It immediately disadvantages obstetricians and puts them on the back foot, as we not only are seen as “the bad guys” for forcing these interventions on women, but often have a matter of minutes to explain the risks and benefits in an urgent situation, which is frankly laughable. Obstetric trainees should be involved in antenatal education; just a single group session on the what, when and why of CTGs, forceps, FBS and Caesarean would I think remove a lot of the fear from women and help those for whom labour does not progress smoothly to feel more empowered and informed.” (Obstetrician)

“More trust in women to make the right choices for themselves. Less bullying and misinformation.” (Independent Midwife)

“Obs and midwifery attitudes to each other.” (Anaesthetist)

I would also like to highlight this heartfelt plea from an NHS Midwife: “I don’t even know where to start… Let’s be compassionate again – let’s treat EVERY woman like our sister. Even the smelly, rude, unpleasant ones. Let’s try.”

Along with a number of #MatExp participants on Twitter, I have been saying that respect and compassion are two vital elements of a positive birth experience, regardless of vaginal birth, c-section, place of birth and so on.  This comment from a doula certainly chimes with my personal view on what could change in UK maternity care: “I’d like it to be less of a lottery, some professionals are kind, supportive, informed, happy to discuss options with women. Some are not. On the same wards, in the same hospitals too. I’d like the good experiences that many have to be normal for all. The feedback I get is this comes down to how the woman is treated rather than the final outcome of the birth experience.”

Maya Angelou
Maya Angelou

The full results of the survey have been passed to Florence Wilcock, #FabObs of the #MatExp campaign.

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#MatExp at 36+2 – dangerously understaffed

by / Birth Trauma, Environment and Facilities, Postnatal Care / Comments Off on #MatExp at 36+2 – dangerously understaffed

One final blog post in this initial round of #MatExp feedback from my Facebook group.  Once again, this story is told in the mum’s own words….

“I had a very straightforward pregnancy and was expecting to to go overdue (I was born 14 days late).

My waters broke at 36 + 2 with absolutely no warning, I’d had some indigestion earlier in the day but that had gone by the evening and I was out for dinner with my partner, his Grandad and his Grandad’s friends. We live in Manchester and the meal was in Wakefield, my waters going was very obvious and completely mortifying but luckily I was wearing black jeans and restaurant floor was pretty dark. We called Pinderfields Hospital (a couple of miles from the restaurant) who said to come in as my waters had gone before 37 weeks.  I got to the hospital at about 9.30pm and I was hooked up to a monitor for 2 hours which confirmed that the baby’s heartbeat was fine. They were clearly very busy but at about midnight I was examined and they also confirmed that I was not in labour, I wasn’t having any pain at this stage. They said that because I was early I would have to be induced within 24 hours if it didn’t happen naturally or I could go back to Manchester where they have a different policy and they’d let me go to 37 weeks (not sure this was true). They said they couldn’t advise us to move to Manchester but they didn’t think it would be a problem.  I felt pretty confident as I wasn’t having any contractions and I’d been reassured by the monitoring. I was also worried about the baby being small and so I was keen to go to 37 weeks if possible. All my notes, stuff for hospital etc was all in Manchester. 

St Mary's Hospital, Manchester
St Mary’s Hospital, Manchester


We decided to leave and waited 2 hours for a discharge letter (during this time we drove to a nearby garage for water and haribo) eventually they said they’d call St Mary’s instead and we left, the journey only took about 40 minutes and we got to St. Mary’s at 3.30am. I’d started to feel pains in the car and by the time we arrived at St Mary’s these were 3-4 mins apart. They weren’t strong and seemed quite bearable but I had no idea whether they were ‘proper’ contractions. I told them this when we arrived and they were quite dismissive, they said someone would talk to me about pain relief after a doctor had seen me and I couldn’t do anything before seeing a doctor as I was now high risk.

I was then told to wait in a small, hot triage room and my partner was sent home (an hour round trip) for my notes. Over the next three hours nurses came in periodically (never the same one twice) and I was put on a monitor for a while. I asked if I could moved to a room with a pool (as in my vague birth plan) but we were told we couldn’t have one, then I asked for a normal bath or shower but I was told I couldn’t have anything until a doctor had seen me. It felt like I was left for a really, really long time. I didn’t have anything practical with me (other than my kindle) and was still in my jeans and boots. Contractions were getting more frequent, I kept sending my partner out to see if someone could come and either no one was there or they told him no one was free, a nurse eventually gave me two paracetamol. 

Finally, three hours after we arrived I told him that he had to make someone come, I still didn’t know whether I was properly in labour and I wasn’t sure I would be able to cope with the pain. I felt like I needed the loo but it was a huge effort to make it down the corridor to the patient toilets. I was starting to think that I was in labour, but if not I definitely wanted all the pain relief available! I’d had about 20 minutes of quite serious pain and I had heard stories of people being in labour for days. Finally, at about 7 am a doctor arrived to examine me and told me I was fully dilated (which was a huge relief) and then it all happened really fast. 

I was rushed round to the birthing suite where there were two midwives, they hooked me up to gas and air but then said I couldn’t have it as I had to push. I was flat on my back and in quite an uncomfortable position, I felt like it was too late to move and no one asked if I wanted to, even though I was staring at a ‘natural birth positions’ poster all the way through. The pushing was quite painful but much easier to cope with as I knew it would be nearly over. I heard a loud pop and (I think) I cracked a rib. That was the most painful bit. The pushing stage was very short and in 15 minutes the baby was out. I had a second degree tear but didn’t feel it at all at the time. As I was pushing the midwife told me that I was going to tear which I didn’t find particularly helpful. 

They put the baby straight on me and it was amazing, I felt much less tearful than I had expected as I think I was in shock. After about 5 minutes we looked and saw that she was a girl (we didn’t know beforehand). To our relief, she was obviously not tiny even though she was early and when she was weighed we were told that she was 7lb 5oz. I think I had an injection and the placenta was out very soon afterwards, I wasn’t paying much attention. The next few hours were brilliant but then I did start to get sore, they were still waiting for a doctor to sew me up and in the end it wasn’t done until 4 hours after the birth. I had gas and air while the local anaesthetic was going in.

The stiches felt fine until the local anaesthetic wore off and then the pain was unbelievable, far worse than any part of the labour, I fainted and then lost a lot of blood. I was given paracetamol (again) without being examined and told, quite patronisingly, that I could expect it to hurt for a while. I tried to explain that it was too much pain to cope with but probably wasn’t very coherent. At this point my partner had baby (with no real clue what to do) and was trying to get someone to help as I kept fainting. I didn’t want to take her as I was so shaky I was worried I’d fall off the bed. Eventually, after a couple of hours a midwife looked at my stitches and said that there was a haematoma the size of her fist (nice) which was pushing out all the stitches. They said this would have to be drained and my stitches redone but by that time I didn’t care, I was just so happy that they were going to do something about the pain. I was told that I could have an epidural (finally!) for the procedure. I was supposed to be waiting for a slot in theatre but another midwife came in to borrow some equipment and noticed that I had lost a lot more blood. She went to get someone who was looking after me and then they said I would have to have a general anaesthetic because of the blood loss. I was rushed round to theatre where I was knocked out. They sorted out the stitches and gave me a blood transfusion.

I came round a few hours later and spent the first night on the high dependancy unit. This was (comparatively) brilliant as I had my own room and a nurse there most of the time. I had drips in both hands and my ribs and stitches were very, very painful so it was fantastic to have someone help lift my daughter out of the cot. Unfortunately after that we were taken to the ward and that was just awful.

My little girl hadn’t been able to breastfeed as she had a tongue tie, this was recognised straight away but we didn’t see the same midwife twice and they kept saying that she might manage it anyway. Because she was early she was being cup fed formula as they were monitoring something (possibly blood sugar) and my milk hadn’t come in. I ended up staying in for 5 nights trying to establish feeding but baby just wasn’t interested and when she did latch on she couldn’t suck. We were told she had to be either breastfeeding successfully or bottle feeding, we couldn’t go home cup feeding. I was so exhausted after 4 nights on the ward that we just decided to bottle feed her to get out of hospital. 

The time in hospital seems like such a blur as I was just so tired, my partner, mum etc all helped as much as they could during the day but I was still left alone from 8pm until 10am every night with almost no support. Sometimes there was a midwife around to help during the night but often not and with painful ribs/stitches I did feel like I needed help. Baby didn’t settle unless she was on me (which I knew was totally normal) and I fell asleep like that several times. Being back home was amazing, I was finally able to sleep for more than 20 minutes and I was able to enjoy my baby. 

The midwives that looked after me were all lovely but they were dangerously understaffed, I rarely saw the same one twice and I think this caused problems afterwards, I had to explain about Anna’s tongue tie every time someone tried to help with feeding and almost everyone mentioned that residual pain relief from labour was probably causing her feeding problems without bothering to look and see that I hadn’t had any. 

Being on the ward with no support was dangerous, I would never have fallen asleep with my baby on me in such a precarious position at home because I could have had her in the bed with me and I would have had support, or someone to take her so I could nap for 20 minutes. 14 hours is too long to have to look after a newborn with no help and in unfamiliar surroundings. Allowing partners to stay overnight would have changed the whole experience for me, even having a shorter period with no partners/visitors (e.g 12-6am) would have been so much better, 6 hours is manageable. 

I’m very aware that I was incredibly lucky to have an ‘easy’ birth (and my daughter is heathy and wonderful) but I’m still so angry about how I was treated, I think a lot if the fear and difficulty I had was purely due to the treatment in hospital and not the birth process at all – so unnecessary.” 

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#MatExp – Caught in the Middle

by / Continuity of Care, Environment and Facilities, Pregnancy Complications / Comments Off on #MatExp – Caught in the Middle

I am very grateful to yet another member of my Facebook group for providing me with her maternity experience to share with you.  In her own words…..

OnetoOne Midwives
OnetoOne Midwives

“My antenatal experiences with my NHS midwife and one consultant led to me transferring to the One-to-One Midwifery Service from about 30 weeks into my second pregnancy. The main issues I had with the NHS were:

    The cold and distant manner of the midwife
    The total lack of concern or questioning when I declined the breastfeeding DVD (as a natural term breastfeeder with my older son, with intention to tandem feed, I felt I didn’t need it – the midwife simply moved on to the next item and made no attempt to find out why I didn’t take the DVD. I found this shocking.)
    At a consultant appointment the consultant informed me that she had booked me in for an induction on my due date, due to my maternal age. No discussion. told her that that would not be happening.
    I had my heart set on a MLU, natural water birth, and I raised the issue of booking an induction without discussion or my consent issue with my MW. Her response was that I will do as the consultant decides. At this point I referred myself to One-to-One.
    Final point – one slightly raised blood pressure reading triggered off me being designated a high risk pregnancy, so I would have found myself on the consultant led side of things to give birth. Another big driver to move service. My BP was fine throughout the remainder of my pregnancy (with the help of Labetelol).

The whole experience was very ‘tick boxey’, with little or no consideration of the overall picture i.e. my health and fitness, my wishes, previous birth etc. I was very disappointed by the apparent lack of breastfeeding promotion.

So I had my second baby by natural home water birth, with the support of One-to-One Midwives. I ended up in hospital for ten days postnatally with HELLP Syndrome. One issue arising there was the strained relationship, and lack of joined up care provision, between the NHS staff and One-to-One. Before transferring myself to One-to-One, I had heard from a fellow NCT Refresher class Mum, that she had had a bad experience in this regard also.

Arrowe Park Hospital
Arrowe Park Hospital

I was transferred via ambulance to Arrowe Park Hospital following the birth of my daughter in April 2014, with what turned out to be HELLP Syndrome. My daughter came with me. We were in for a total of ten nights.

Although I was a patient, my daughter was not. This became a problem when she needed to have her 72 hour check. In the initial stages, my partner was doing the communicating with my One-to-One midwife; and she told us that my baby would have to be taken to an alternative venue for the check by noon on the Saturday. I was in no fit state to add to the discussion, being quite poorly and ‘not with it’.

Ostensibly One-to-One staff were not allowed on the hospital premises to carry out the check; NHS staff could not do it as my daughter was not a patient. I did become involved in the discussions when Saturday morning arrived, my partner was trying to arrange child care for our older child (not easy as we have no family close by), and it dawned on me that my newborn baby was about to be taken away from me. Breastfeeding aside, that would be traumatic for all involved – baby, me and Dad!

Bearing in mind that the main issue for me was dangerously high blood pressure at that point, I was drawn into having direct telephone conversations with One-to-One, and quite heated talks with NHS staff – who made out that there was absolutely no way One-to-One could come into the hospital to do the checks – no insurance I think was the issue from memory? As my baby was not a patient then they definitely could not perform the check – to do so would generate a second NHS number for her, which I was told would have the potential to cause us problems when trying to register her birth. The systems would not be able to cope with it. We felt that systems were taking priority over the well-being of our newborn baby.

In the end a One-to-One midwife did come into the hospital to do the check. There was an uncomfortable atmosphere between the two sets of staff.

On a side note, my daughter was diagnosed with a mild tongue tie and a referral supposedly made. In fact no appointment ever came through. Fortunately the tongue tie was never an issue.

My One-to-One midwife came to see me in hospital on a number of occasions; each time I picked up on tension between the parties.

Apart from the stress around my daughter’s check, I have to say that the majority of the care I received on the labour ward was fantastic. Apart from one incident where I suffered a huge loss of dignity and lack of respect or concern for my personal space and being. In fact I felt totally humiliated. It happened on my final night at Arrowe Park (so day ten of my stay); I was rushed down from the maternity ward to the labour ward as my blood pressure was so high. I was given intravenous drugs to bring it down; it would have been a trip to the cardiac unit if this had not worked. I needed the toilet – and not just a wee. I was told I had to remain on the bed and my request to use a commode was refused. So I had to use a pot under the sheets. Except the sheet was inadequate and I knew that I wasn’t covered up. So I tried to throw my dressing gown over my knees. People were coming and going in and out of the room. I had a sudden moment of realisation of the total indignity of the situation – people could well have been able to see me trying to have a poo, knees up in the air, largely uncovered. I cried. I just wanted to go home, with my baby.”

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#MatExp – A Midwife’s View

by / Informed Choice, Postnatal Care / Comments Off on #MatExp – A Midwife’s View

As promised in my first MatExp feedback post, I have more stories to share with you.  Today I have pleasure in sharing the maternity experience of a mum with a different perspective on the care she received, as she has worked as a midwife.  In her own words:

Wythenshawe Hospital MLU
Wythenshawe Hospital MLU

“There was nothing truly awful to say about my care, I was just a bit disappointed. I couldn’t take my old consultant hat off so kept thinking about the improvements that were needed and where would I start?! I’ll try and outline the issues as I saw them as briefly as my general verbosity will allow!

Good points first! All 5 midwives I met antenatally and the 2 postnatally were very nice and cheery. The appointments ran pretty much on time and the postnatal visits happened when they said. The antenatal classes were really good. Pitched at just the right level and even my husband enjoyed them. Although there wasn’t much time for socialising, the midwife orchestrated a no pressure way for us to swap contact details and as a result I have made a really good friend. They told me about the Cherubs group, which was good. The handover to the health visitors seemed pretty smooth. Oh yes – this is the best one! My experience of giving birth at the Wythenshawe midwife led unit was fantastic. Every aspect was exactly what we needed and we felt cared for and very special, which is difficult to achieve in a busy unit like that.

Ok, now the not so good! At my booking it was presumed I was ‘low-risk’ (which I am, but the midwife would not have known that). All of the information about care etc was given prior to finding out if that care was going to be appropriate for me or not. I was only asked about ‘me’ at the end and this was a very tick-box exercise. Don’t get me wrong, I know from experience how tough it is to do a booking visit in an hour (or even an hour and a half), but it is possible to individualise the discussion and make the woman feel that this is about the service fitting around her needs rather than her just fitting into the service. Despite the presumption about my low risk status I was not told about my birth place options. The midwife said ‘so you’ll be coming to Macclesfield, right?’ And ticked the place of birth discussion box! Home birth was barely mentioned and the option of using the local midwife led unit was not mentioned at all at any of my appointments, including my longer birth planning appointment. I found out (through Google) about the Wythenshawe MLU at 39 weeks (as I was new to the area I didn’t know where hospitals were and what provision they had).

Thankfully Wythenshawe were excellent – booked me in the next day, gave me a tour of the unit and I had an excellent experience of intrapartum care there.

In general, the information provision was poor. Despite quite long ‘chats’ about topics like the weather, the midwife’s daughter’s pram choices, new granddaughter, for example, little time was spent on birth planning info, breastfeeding info etc. so I don’t think this was a ‘time’ issue. There were no discussions, I was just told how things would be. For example, “we won’t let you go past 41+5 weeks”, “we will induce you”, etc. It made me very worried for women who are not aware of the concept of informed choice, or who are aware but are too polite / nervous / grateful to ask what their options are. I am aware that some of this could have been down to the fact I was a midwife. But actually I don’t think the 2 midwives I told remembered this (I could tell from the way one of them briefly explained Vitamin K to me), so I’m fairly sure I saw an accurate picture of the care most women get.

Probably the most notable thing was an issue with growth measurements. I was measuring slightly under (2cms below my gestation) for 2 consecutive appointments. I hadn’t been that worried until over the next 2 weeks between appointments I felt like I hadn’t grown at all. I said this to the midwife at my 36 week appointment who measured me and said that I measured 36cms so no need to worry. However, she had not actually found my fundus (top of the uterus) and just put her tape measure to my sternum, where my fundus should have been at that gestation. Only, the whole point was that it was not there! It was much lower – 4cms lower, and I had not grown at all in the past 2 weeks, as I suspected. The midwife was a little embarrassed (understandably) when I pointed this out. She flippantly remarked that she could make those measurements anything she wanted to, so they were pointless. After some discussion she referred me to a consultant, who referred me for a scan as she was concerned about the growth. In the end it was all fine, baby was bang on average weight. But that wasn’t the point, a truly compromised baby could have been missed.

I also had a problem with the way they gathered feedback. They were doing the Government’s ‘friends and family test’ and gave out cards for feedback. No problem there. However the midwife handed it to me in an appointment and insisted on me doing it there and then in front of her. So no anonymity and no chance of honest, useful feedback. I refused to do this, but I was accosted by the receptionist at my next appointment and was jokingly told that I was not allowed to leave until I filled it in. This time it was the receptionist watching (not so bad), but it had my initials pre-written on the top of my card. I was honest in my brief feedback, but felt very uncomfortable about it, which I’m sure most women would.

My postnatal care was pretty lacking. On the day after I came home I received a phone call to see how I was and to arrange an appointment on day 3 (actually day 4). This is pretty standard practice now and is a change from all women getting a home visit the day after they get home. I don’t have a problem with this as services need to be individualised and not all women want or need a visit, a phone call will do. But the call was not used to find out if I felt I needed a visit, it was to tell me that there would be no visit until day 4. Then a few clinical questions were fired at me! Again, I was fine, but what if I hadn’t have been? The day 4 visit was a whirlwind. I was still in bed, so my dad let the midwife in and showed her upstairs. By the time I met her in the nursery she had said 3 times that she was “only here to weigh the baby”. She set her stall out early that she would not be staying long! Baby had put on weight, so she said well done and left after quickly asking about my blood loss, whether I’d pooed and giving me the contact phone number. I could tell she was busy (it was a Saturday, skeleton staff and she had visits all over Cheshire), so I didn’t dare ask anything!

So, that’s it! I’m afraid to say that I think this might be pretty typical. It probably says more about the model of care, the resources in the team and the workload than the individual midwives. It’s not easy, but individualised, supportive, positive, evidence-based care can be given in a busy NHS maternity service.

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#MatExp – The Good, The Bad and The Unacceptable

by / Environment and Facilities, Language, Pregnancy Complications / Comments Off on #MatExp – The Good, The Bad and The Unacceptable

When I first came across Florence and Gill and the MatExp Campaign, I knew my group would have a lot of maternity experiences to provide to them.  We are always discussing and sharing birth stories, and when I asked them for their feedback it came in abundance.  Their stories, from all round the UK, have been passed on to Florence and Gill, and also to Jeanne, midwifery lecturer at Salford University.  I have permission to share an initial snapshot with you here, to give you a flavour of the ordinary maternity experiences that are happening around the country and which, for the most part, do not get formally discussed once they are over.

The Good

This was the hardest section to find quotes for.  Not, thankfully, because I didn’t have any good birth experiences to work with, but because I was looking for quotations praising the midwives.  But when you read a positive birth story the midwives are rarely mentioned.  They are there, and their actions are noted, but they do not receive praise for their interventions, because a positive birth story is about the mother: her experience, her actions and her achievement.  Rest assured there are plenty of positive stories being shared amongst us, but in terms of positive feedback there is only a little:

“Although I ended up with a c-section after induction, pre eclampsia and gestational diabetes plus a lengthy hospital stay, I only have good things to say about my experience.  At all points I felt they were doing the best for me and my baby.  I loved the fact that, during my stay in hospital, when midwives asked you how you were feeding they always responded ‘bottle feeding, brilliant’ or ‘breastfeeding, brilliant’ – there was no obvious preference amongst the staff but they were very supportive of either.”

“When I got the epidural I had a lovely midwife waiting with me for the drip to work.  I really appreciated her calm, kind attitude – she was so so lovely and I think the fact that it was one to one care made it amazing.  I felt so well cared for.  When I started to push everyone was SO LOVELY and I felt very in control.  It was when they said I needed forceps I started to lose it a bit but they were still lovely even though I was throwing the F-word around a bit by now.  I was transferred to theatre and started to get a bit scared, but again my midwife was very reassuring.  I had a spinal block which sadly went too high and I started to suffocate. I had to have a GA and I was very frightened but seriously, all praise to the staff, they were so calm and kind.  The consultant offered me a debrief appointment and I went to it about twelve weeks later – it helped me process everything.  Whilst it wasn’t a great experience I feel the hospital did everything they could to help me and safeguard my emotional health following a scary time.”

“I had excellent care in my second pregnancy with the same midwife all the way through; wonderful home water birth and excellent postnatal care, including breastfeeding support.  A great example of how important it is having the same person looking after you and building a relationship.”

What we really want in pregnancy!
What we really want in pregnancy!

The Bad

“While being assessed I gave permission to be examined vaginally on arrival to assess my progress.  On finishing the exam the midwife said ‘you’re a good 4-5cm dilated already so I gave you a good stretch whilst I was there to speed it up.’  I had not been asked if I would like a cervical stretch.  I did not give my permission for a cervical stretch.”

“Both myself and a friend progressed very quickly once the induction took and struggled to cope with intense pains that came every minute or less.  Both of us had dismissive midwives who offered no explanation as to why the pain was so intense and why we could have no painkillers other than paracetamol.  We were both told to go to sleep (as if!) and told that if we couldn’t cope now how would we cope when labour was established – which was terrifying!                                                    Both of us coped just fine on gas and air.”

“Breastfeeding support was rubbish.  My husband showed me how to manually express milk after reading the breastfeeding book.  The support workers just shoved my boob in baby’s mouth but I didn’t understand how I was supposed to do it when they weren’t there.”

“…..another midwife was lovely and kind and murmured comforting words as she fixed the belts and monitoring equipment, then left me behind the screen.  Bossy midwife then came along and yanked back the screen, announcing that she ‘liked to see her ladies when there are being monitored.’ So I was sat with my jeans so low that my pubic hair was showing, my whole bump exposed, while a couple of women I didn’t know and their partners tried to look anywhere but at me.  I had very little shame by that point but this upset me.  It felt like punishment.”

Always use your
Always use your “B.R.A.I.N.”

 

“With my 4th baby I was still keen to have a homebirth but requested a growth scan near my due date to monitor baby’s size and check it would be safe [due to previous shoulder dystocia]. This was refused. They ‘didn’t do growth scans’. I could have a homebirth but not a scan. I repeated the request to other midwives but nobody suggested referring me or even seemed to care. I eventually found a midwife who took me seriously and referred me to the consultant. When I eventually got my hospital appointment I saw a registrar who honestly didn’t seem to know what he was doing. He said I couldn’t have a growth scan but refused homebirth in case I had shoulder dystocia again.  After another appointment I insisted I saw the actual consultant. The consultant said I couldn’t have a scan but agreed to do a sweep 1 week before my due date. In the end, I asked about a due date induction to reduce the risk of the baby getting too big as I was so frustrated at this point and nervous of baby getting stuck again. They seemed surprised but agreed, so that’s what we did.”

 

 

 

The Unacceptable

Despite the draw of a catchy title, I refused to refer to any of these experiences as “ugly”.  A new life entering the world is never ugly.  But I feel that “unacceptable” is appropriate for these two experiences, and I hope that you do too:

“My midwife asked, whilst examining me to see how far dilated I was, if I’d like a sweep.  I was in agony so I said no.  She did it anyway.  I screamed and hubby said he had never seen me look so pained before or since.  She only said ‘done now’.”

“All going smoothly until I haemorrhaged.  I was rushed to delivery and the consultants managed to stem the bleeding, with a review scheduled to decide if theatre was necessary.  There was a question mark over retained placenta/products. The placenta was torn and was not confirmed as complete. I had another procedure to stem another heavy bleed with the review still scheduled for later in the day.  A junior consultant came and decided that they weren’t going to take me to theatre that day despite still having heavy bleeding.  I had not been given any food or drink (other than water) since the previous evening.  This was 2pm on Saturday.

After this, I didn’t see a midwife (nor anyone else) for hours.  My room had blood covered surgical instruments left on the side plus the swabs etc from the procedures, my catheter came out and I was left in a soaked bed for what seemed like a long time plus the bleeding was still very bad.  My buzzer was not answered for long periods of time. I was eventually transferred to a ward at around 8pm.  Once on the ward, I continued to bleed and clot heavily.  The midwife said this was normal.  My obs were low but I didn’t want a blood transfusion unless absolutely necessary.  There was no further mention of retained placenta/products and I was allowed home after 3 days.

This resulted in four and a half weeks later being rushed to surgery to have the retained products removed.  This was after 3 separate haemorrhages which again the community midwives said just needed monitoring.  I was lucky that I didn’t get an infection.  The advice in A&E was that I should have called an ambulance.”

I have a lot more #MatExp feedback to share, too much for one blog post.  I will put up more soon.  For now I will leave you with this illustration of the discussions at a recent Families & Midwives Together Conference I attended at Salford University:

Families & Midwives Together
Families & Midwives Together

What could have been better about the care you received?

 

Helen Calvert. 2015

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