Informed Choice

Don’t call me high risk! #MyPositivePregnancy

31 May 2015 by Susanne Remic / Birth Trauma, Informed Choice, Pregnancy Complications / Comments Off

This post was written during my 4th pregnancy, my journey towards a VBA3C. Throughout this pregnancy I was fit and healthy yet classed as high risk due to having had three previous c-sections.

Don’t call me high risk.

Don’t take heed of the warnings that spew out into the papers at an alarming rate. A VBAC is not a disease, or a dirty word. A woman who has had a c section is not ‘risky business’. I am a woman who wants to give birth to her baby. To feel her baby. To be awake to see her baby take the first breath, open their eyes onto this world and feel their skin against mine. I am a woman who wants to be one of the first people to hold her baby. I am a woman who wants to sit up and hold her baby. To feed her baby with arms that feel the life within. I am a woman who wants to tell the world her baby’s name; not discover it for herself when she wakes.

Don’t call me high risk. Don’t greet my intentions with raised eyebrows and furrowed smiles. Don’t assume that my intentions will not be ‘allowed’. Don’t deny me the chance to be normal for once.

This weekend I came across this article by Milli Hill (@millihill) and I found myself nodding along to almost every word.

When my body screamed out to me that my son was on his way, the ‘High Risk’ label echoed the cry and we called the hospital straight away, as we’d been told. We went straight in, as we were told. We never questioned a thing and we never assumed that we were anything but high risk. The fact that I was labelled as High Risk left me in no doubt- what I was doing was scary. I wanted no part of it. But in actual fact, lots of women have a VBAC, and the fact that we didn’t should not be held against me.

This time, I am a woman striving for a VBA3C. And supposedly higher risk than ever before. And yet I feel more positive this time than I ever have. Whether it is age, experience, or having come to a point of peace with what has gone before, I do not know. But I do not feel scared. I do not feel High Risk. I feel like a woman who passes a mirror and catches sight of her swollen body and smiles, stops to capture the moment; when once I would have collapsed inside.

I feel like a woman with a life growing inside. I feel special. I feel on the edge of something wonderful. I feel strong. Strong enough to question decisions that are made for me. Strong enough to face the fear that I know will come as the weeks pass by. Strong enough to cast aside my label and just be a woman giving birth. For once.

That is my positive pregnancy. It’s taken four attempts to get here and I’m going to hold on to it.

To find out more about #MyPositivePregnancy, #TeamMama and Mama Academy,please click here. You can also read about the Made to Measure campaign here and if you have a moment, please sign the petition urging all UK trusts to help save 1000 babies by adopting The Perinatal Institute’s GAP programme.

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What is a ‘Positive’ birth?

30 May 2015 by Emma Sasaru / Birth Trauma, Continuity of Care, Environment and Facilities, Informed Choice, Postnatal Care / Comments Off

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

30 May 2015 by Emma Sasaru / About MatExp, Continuity of Care, Informed Choice, Language, Postnatal Care / Comments Off

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

29 May 2015 by Emma Sasaru / About MatExp, Birth Trauma, Informed Choice, MatExp and Me, The #MatExp Journey / Comments Off

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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

29 May 2015 by Emma Sasaru / About MatExp, Feeding, Informed Choice / Comments Off

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:

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.]
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.
Follow the RCN’s guidelines for supporting breastfeeding on paediatric wards: http://www.rcn.org.uk/__data/assets/pdf_file/0017/270161/003544.pdf
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.
Support all families to make an informed choice by giving accurate evidence based information regarding breastfeeding.
Encourage each other to support a mom whatever her feeding choice.
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.
Not to use the term Breast is Best, but seek to normalise breastfeeding as the biological norm.
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!
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 – A Midwife’s View

29 May 2015 by Helen Calvert / Informed Choice, Postnatal Care / Comments Off

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.

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