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:
“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.
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.
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.”
“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.”
“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.”
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:
What could have been better about the care you received?
As one of two breastfeeding champions for the NHS Change Day MatExp Campaign, I find myself talking a lot about maternity services. It is strange one for me, as although I speak to mums all the time about their maternity experiences, I actually have very little personal knowledge of giving birth on the NHS. With my first baby, I knew from the start that I wanted a homebirth. I had been following a homebirth email forum since before I got pregnant and had gained the impression that the NHS would make my life as difficult as possible if I decided to give birth that way (especially as a first time mum) so we opted to use an independent midwife. This was totally the right decision for me as I suffer from anxiety and have issues around loss of control so needed continuity of care and to be able to do things my way.
Second time around we couldn’t afford another IM, so we started out with the NHS. We wanted another homebirth and this time I was fairly confident that I could get the birth I wanted, being a lot more knowledgeable and also having already given birth at home. However, a few weeks in to my pregnancy a friend of mine told me about OnetoOne Midwives. Their service was exactly what I was looking for, and I was lucky that in 2013 I was able to self refer to them from Trafford. The lovely OnetoOne team looked after me from then on.
Sadly, when I was 38 weeks pregnant a routine check of baby’s heartbeat revealed an anomaly, and a week of scans and tests later gave us the diagnosis that our baby had Hypoplastic Left Heart Syndrome. Not only was homebirth off the cards but it wasn’t certain we would take our baby home at all. You can read all about our experiences with David here, but in terms of my #MatExp the staff at St Mary’s Hospital in Manchester were fantastic. I had a c-section, and as everyone was focusing on getting David out and into NICU, it was the most medicalised birth you can imagine, but I still felt respected and cared for, with things being explained to me every step of the way. Special mention goes to midwife Della and anaesthetist Andrew Heck who provided the kind of care that makes any maternity experience a positive one.
So going back to that first birth with my gorgeous big boy Edward, let me tell you my birth story as I wrote it back in 2011:
Birth Story – Edward Calvert enters the world
On Monday 31st January I was 42+1 and we were at the hospital for monitoring. We had agreed to be monitored to make sure that baby and I were still healthy, but knew that we didn’t want to book an induction just yet. We had a scan to check on the function of the placenta and then had 30 minutes of monitoring to check on baby’s heart rate, his movements and my pulse. Our lovely Independent Midwife Verena was with me the whole time, and confirmed that the monitoring showed no problems for either of us. We then had to wait to see a young obstetrician who outlined the hospital’s policy for women who had gone past 42 weeks. She confirmed that she would like to book me in to be induced, or failing that she would like me to come in for daily monitoring.
We confirmed that we understood the reasons for her requests but said that we would prefer to come back for monitoring on the Wednesday, and not to book an induction just yet. She respected our choices but due to her being fairly junior requested that we wait whilst she speak to a consultant. A lovely consultant then came to speak to us, and was more than happy to accept our choices once he had confirmed with us that we understood the situation.
That evening I made a concerted effort to relax and get myself into a good mental place to give birth. Having done a sweep that morning, Verena confirmed that everything was ready for me to go into labour – we just needed some contractions! So I lay down on the day bed in the nursery, put the lights down low, asked Phil to come and sit quietly with me and focused on putting myself into my relaxed state as taught by the hypnobirthing CD. Phil sat and read whilst I relaxed for half an hour.
At the end of that time, I asked Phil to get me a glass of water. No sooner had he left the room than I felt a pop and was pretty convinced that my waters had broken. I waited until he came back just in case I had lots of fluid, but when he helped me to stand up I only had enough fluid to soak a small patch into my jeans. I went to the loo and confirmed that the waters were not a bad colour, nor did they appear to contain any meconium. Phil phoned Verena and she said that most women go into labour within 24 hours of their waters breaking, so things should start to get going any time. This was 9:30pm.
At 10:00pm I felt what I was pretty sure was my first contraction, so I made a tentative note of it. I continued doing a jigsaw puzzle downstairs and just noted each contraction as it came, as at this early stage they weren’t painful. They were regular though, coming every 5 minutes from the start, and Phil phoned Verena to let her know what was happening. The contractions became painful fairly shortly, to the point where I had to concentrate through each one. Phil started filling the birth pool just before midnight, as he knew he could keep it warm so thought it best to make sure it was ready. He then phoned Verena at 12:30am to tell her that my contractions were getting stronger and were lasting around 40 seconds. She arrived at our house with Sara (second midwife) at 1:30am, by which time I was feeling a bit nauseous with the contractions and my back was aching. I was standing in the nursery, leaning on the day bed through the contractions, with my wave music on and watching a slide show of photos on the laptop that I had put together in advance to keep me cheerful!
Verena put the TENS machine on for me and that was beneficial although it felt strange to begin with. She checked me over, blood pressure etc. and also had a listen to baby’s heart. All fine, and my contractions were now a bit more spaced out (this often happens when the midwives arrive!) so Verena told me that I was definitely in early labour but that I wasn’t in ‘established’ labour as yet. She and Sara left at 3:00am and said they’d be back in the morning, but obviously we should call them if anything changed or if we needed support.
I spent the rest of the night kneeling on pillows, leaning against our bed and breathing through each contraction – they were now pretty painful and I was using the TENS machine through each one. I was only comfortable kneeling up, I couldn’t lie down at all, so I was dozing between contractions with my head on the bed. Phil got some sleep in the bed beside me, and I remember looking at him snoozing comfortably and being fairly resentful of how cosy he looked! I was sick a couple of times in the night, and Phil woke up to play pass the parcel with various bowls and receptacles! I woke him finally around 6:00am as I was fed up with dealing with the contractions by myself and I needed some support. We tried putting me in the shower to run warm water over my back, and Phil braced his arm against the tiles and I hung onto him during each contraction. Phil then phoned Verena at 7:30am to say that my contractions were every 3-4 minutes apart and were more intense – we definitely needed her to come back! Verena said that I could get into the pool if I felt it would help, and I got in as soon as I could! Was still only comfortable kneeling up so knelt in the pool, leaning over the side, and hanging on to the handles during contractions. I didn’t want to be touched at all whilst contracting, so poor Phil didn’t really feel like he could offer any comfort, but of course he was being fantastic and very encouraging.
Verena and Sara arrived back at 9:00am and put a warm, wet towel across my back to help with the backache. In my labour notes it says that I looked very relaxed but said that I didn’t feel it – I think I looked relaxed coz I was exhausted and was only awake coz I was contracting! Verena had a listen to baby’s heart – thankfully her equipment was waterproof so she could just pop the device into the pool and have a listen between contractions.
At 9:30am Verena told me that I was in or close to transition, i.e. the change between the first stage of labour and the second stage where you can start to get the baby out! I remember being delighted at hearing that, but am surprised reading the notes that it was 9:30am – I would have thought it was later in the morning that she told me that. You lose all sense of time in labour! Verena gave me a homeopathic remedy to help cope with the backache and exhaustion, and they all encouraged me to drink plenty of water. Unfortunately I couldn’t face much food, which was a shame as I desperately needed the energy.
Just before 11:00am I started to feel the urge to push, and got a bit more vocal during my contractions! Phil and Sara had been doing excellent work keeping the pool water warm and the midwives continued to monitor baby, but all this was background to me as my life was all about the contractions. I had a cup of sweet tea as everyone kept encouraging me to get in anything that could give me some energy. Verena has put down in my labour notes that Cleo the cat turned up outside the nursery door at this point to have a concerned yowl, but she wasn’t allowed in the room. I do remember hearing her make her presence felt! It was around this point that I began to push a little during contractions – not a choice, just something my body felt it was time to do. By 11:30am I was getting a strong urge to push with every contraction.
Ten minutes later, Phil lit some candles and Verena noted they were all getting ready to meet baby. I am of course taking all of these timings from my labour notes – I had very little idea of what was going on and certainly no clue of time! It was all about getting through the contractions and resting as much as possible in between. Verena thought a change of position might help with the pushing, so I stood up in the pool supported by Phil. All the signs were good that baby was ready to come, and everyone was encouraging me to push and telling me how well I was doing. I went back to kneeling in the pool and Verena has put in my notes that I was pushing very effectively. I remember it was bloody hard work!
At 12:30pm Verena gave me another homeopathic remedy to help with the pushing and I continued to use all of my efforts. At 12:50pm Verena has made a note to say that when she was listening to baby’s heart “baby trying to kickbox my hand away as if to say go away, I am coming out!!”. I changed position again so that I was lying on my side in the pool, still with my head on the side – change of position suggested by the midwives as all the efforts at pushing were not getting baby “round the u-bend” as they put it! I then tried squatting in the pool, but complained that the contractions were not long enough to give me enough time to push effectively – I was getting in perhaps three good pushes and then the contraction subsided when I felt I could do with just one more push to make it effective! Verena gave me a homeopathic remedy to assist with this (all of these remedies were with my consent of course).
It was becoming clear that a change was needed as we weren’t progressing despite my best efforts at pushing. I therefore got out of the pool just after 1:30pm – this was incredibly hard as moving during a contraction was impossible so it was finding the time between them to get me out and moving! Phil and Verena half carried me into the bathroom and sat me on the loo, as this is a natural place to push and this is often an option used in homebirth. I told them “he is coming” and I think I must have felt him crowning (i.e. the head pushing its way out) at this point. Unfortunately, although the head started to emerge it then retreated back again (not unusual) which was of course discouraging each time it happened as each time I knew I had to get it back again! The midwives moved me onto all fours on the floor of the bathroom and got some towels ready to catch the baby.
At 1:50pm baby’s head was born – I remember Verena saying “we have eyes, we have a nose, we have a mouth” and I just felt so relieved as I knew his head was finally out and couldn’t go back in again! Verena has noted down that baby was “blowing bubbles” and he looked just like Phil! What I remember very clearly is thinking, okay I have a moment’s respite now before I need to push out his shoulders, and at that point baby decided to have a look around the bathroom. The sensation of him moving his head is indescribable – I think I asked him to stop, or maybe I just thought it, but I didn’t appreciate his enthusiasm at that point!
Three minutes after his head was born the rest of baby emerged – he had his hand up by his face which could explain why pushing him out had been such hard work. He lay on the floor looking up at me, I was on all fours looking down at him and both of us were a little stunned! He needed a bit of a rub with the towels to get him going, and then he cried and was clearly fine and healthy. Verena asked if I wanted to hold him, and I realized that yes I did – it hadn’t occurred to me, I was too stunned!
Baby and I had some skin-to-skin time and the midwives helped me to sit up on the toilet, as I had been kneeling up almost continuously since the night before and my legs were shaking and exhausted. Unfortunately, as I moved to sit up there was a gush of blood – nothing to cause concern, but it did make a pretty effective mess of the bathroom. Thank goodness we were in a room that was easy to clean! Verena took some photos of me and baby, and of Phil with the two of us – these pics will never see the light of day as I look unbelievably awful – but I also look pretty happy!
The cord stopped pulsating but I felt a bit dizzy so they helped me to lie down on some towels and pillows on the landing, still with baby cuddled up with me, and they then tied the cord with our homemade cord ties. Phil cut the cord and said “I declare this baby open” – he was in very high spirits! Sara had made tea and brought up some biscuits so we all had a snack – she hadn’t been able to get in the bathroom as Phil and Verena were in there with me so she missed the actual birth, but could hear it all happening from outside the door! Whilst I had a nibble of something to eat Phil had his first cuddle with baby… and we agreed to call him Edward.
Phil had taken off his T-shirt so he could have skin-to-skin with Edward, and Verena was attending to me as I still needed to birth the placenta. I was contracting slightly and Verena was asking me if I could push out the placenta, but bizarrely I had completely lost the notion of how to push! I just couldn’t work out how to do it! Verena moved me into a couple of different positions again, but by 2:45pm the placenta still hadn’t arrived, so I agreed to the syntometrine injection to encourage the process. Verena gave me the injection and then the placenta arrived about a minute later, so it would have come of its own accord anyway but there you go. I didn’t suffer any nausea with the syntometrine so no harm done.
Verena then helped me to have a quick shower, followed by me being helped into bed – bliss! Verena examined me and said that I had a small tear but that I didn’t need any stitches. By 3:30pm Verena had helped me to latch on Edward for his first feed, whilst lying together in the bed. Very special moment. Phil was making sure everyone had refreshments and they were all encouraging me to have orange juice and things rich in iron due to my blood loss. Verena asked if I wanted to eat a little of the placenta, which I know sounds gross, but I had considered it prior to labour. I agreed as it is a very iron-rich product, and Verena gave me three or four tiny pieces that I washed down with water.
Edward was weighed and checked over – he came in at 8lbs 13oz. Verena and Sara made sure we were all happy and healthy, gave us some advice for the first night, reassured us they would be back tomorrow then they left the house just before 5:00pm. The Calvert family were left together and couldn’t have been happier.