Maternity Experience

Postnatal Care

#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 – 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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