Missing out on midwife care

[SianandTony]

I think many women when pregnant the first time round think "just go with the flow" and this is how the NHS is. When I saw a wonderful midwife from the east team who came to see me after the birth, I explained id do things ALOT differently if we decide to go for a second....she said to me i should consider a home birth in the future.

I ended up having all the pain relief going when I had my daughter, looking back now the midwife at the hospital kept walking out the room and leaving me on my own, the pain frightened me and there was very little reassurance. had i been supported more i dont think i would have needed the drugs!.

Unfortuantly with the NHS you have to stamp your feet sometimes to get things moving.

[Vangough]

Yes you do have to stamp your feet alot via the NHS, & that is hugely counteractive when you are trying to stay calm and ride painful contractions. A Labour ward should not be an emotional or political battleground, it should be a safe, comforting place for women to deliver their babies. Really, these are the basic requirements. I think there is a very strong argument for a home birth these days - the ultimate safe place. Funny how we have reverted back to how it was done 100 years ago !

Sadly some midwives do leave you in the middle of labour (I was left whilst pushing - NOT good when things start to go wrong!) and I have heard other women opted for epidurals simply because they were frightened and felt unsupported by either dismissive or incompetent midwives. Ultimately so much of this comes down to trust. If you trust your midwife, and can communicate with them on an equal level then you feel empowered & supported. Hardly surprising then that those births tend to be a more positive experience.

I look forward to meeting and getting to know one of these amazing midwives I keep hearing of - I know they are out there !!

[ClareC]

Having been on the labour ward tour at Kings and seen it at what I hope was far from its best, I (at 34 weeks) was quite concerned and discussed my concerns with my midwife. My only real option was to go for a home birth, although by this point all the designated continuous care midwifes were fully booked up. I was advised I could still have a home birth and that there were two teams of midwifes at Kings who were designated for this, I just wouldn't get to meet the midwife fist etc.

I actually decided to change hospitals, I didn't feel confident enough to try for a home birth first time round and had lost a great deal of faith in Kings by this point, not from a medical point of view but from a bedside manner point of view. ie that my fears and feelings did matter.

I ended up booking into an alternate provider hospital at 36 weeks (nothing like last minute) - so far so good in terms of booking in / midwifes ive met / labour tour etc all been faultless. However at 39 weeks I have yet to go through the whole labour part. From my point of view at least I will now be going into it with confidence that they actually care about me as a person and will give me care appropriate to that rather than simply conveyor belt get the baby out free the bed mentality (I may be proven wrong). Ultimately the important part is that the baby is delivered safely and I am OK, however, I think the more relaxed and cared for I feel the easier it should be to safely deliver!

I just wish (as a first timer) you were told about your options and what is available when you are first pregnant when there is the availabilty to book into the continuous care option, by the time you learn about these things (NCT classes for me), they are already fully booked . The annoying part is that I did ask questions and do research, the information was simply not forthcoming from my Dr surgery!

[Vangough]

Do you mind me asking where you have booked into as an alternative hospital?

[ClareC]

Not at all, I am now with St Thomas's.

I am not naive enough to believe that all will be OK because I am there, I know that there are some that have had bad experiences there too (and every other hospital in the country).

What I do know is that I feel relaxed there and confident with the care, I have been impressed with everyone I have seen from midwifes to receptionists, all have been really helpful and made me feel like a person rather than a number. They have been really professional and knowledgable. I just hope it's as good on the big day!!!

For me, knowing I will go there feeling confident they care makes all the difference. :-)

Happy to let you know how it goes....

[EmmaG]

I am one of the very, very lucky ones who's registered with Oakwood. However, even registering with Forest Hill Road Surgery from a friend's address will not guarantee that you get Oakwood as they only take 18 women a month to look after.

What I would suggest is to tell King's you want a home birth and you WILL be attended at home during labour and birth but a midwife. If there is a problem, or you decide mid-labour that you want to have the baby in hospital after all, that attending midwife will accompany you to King's.

[ClareC]

Does anyone know what the catchment area is for these surgery's that are connected to Oakwood / Lanes etc? FH road surgery and ED medical Centre?

Really annoying though because I like my Dr surgery, just wish they too were linked in this way!

[Vangough]

Good luck ClareC, hope all goes well for you, I'd love to hear how things go.

I think you're right, confidence is a major part in all of this.

[SianandTony]

I know this has already been touched on in the ED forum but has anyone had any positive experiences at kings? I wonder how many patients are allocated to one midwife?

vangough i was pretty upset by some aspects of my labour i cant believe you were left on your own when you were pushing. I asked (actually make that shouted :-$) at my husband to get help as i was so frightened and the midwife had a go at him and told him to go back in the room ! the second midwife who came on duty and delievered my little girl was absolutley wonderful, it really was like chalk and cheese.

[Pickle]

I've had two positive births at Kings, and two pregnancies in which I was very ill from 30 weeks onwards requiring a lot of monitoring and consultant care (all of which was excellent), and while I appreciate that there are some pretty bad stories on here I think the fact remains that people are more likely to post about their horror stories than the good ones.

[Vangough]

I think that is very true Pickle - it is mainly the bad stories that get talked about, because they are so traumatic. Of course there are good stores - and that goes for all hospitals. However what I would say is that of the good stories I have heard (regarding Kings) most of them were when women were accompanied by their nominated midwife booked via Oakwood or the Lanes etc. My friend who gave birth there (baby no 2) a week ago was registerd with Paxon Green and found herself scared and concerned as the care was disorganised and chaotic, until her nominated midwife turned up and sorted everyone out.

Having said that I have always said that the ante-natal care by the senographers and ante-natal consultants at Kings is fantastic. Also I did have one good midwife for a short time during my experience (even if she did keep leaving me) it's just that that got over-shadowed by the rest of the experience.

Actually I love hearing good stories as that is what I aspire to next time !

[sb]

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[R&A]

sorry if i'm hijacking this thread ... Here's the first of two complaint letters i will be posting to PALS as a few people suggested i should. The second letter will focus on the birth and the first letter on the costly downward spiral poor breastfeeding advice has on new born babies.

LETTER ONE TO PALS REGARDING BREASTFEEDING NEWBORNS AT KINGS

Re: Admission of Ms R&A and baby (dob **/**:** and **/12/09)

I wish to complain about the care I received in your hospital; not about any member of staff, all of whom treated me well, but the system that I was in.

This is what happened to me:

1. I gave birth to my son in hospital on **/12/09.

2. For two days I could not get him to latch on at all to breast feed so he received no colustrum or any other fluids.

3. Blood tests suggested he was dehydrated

4. I asked for him to be given sugar water orally to rehydrate him but this was refused as it is against hospital policy.

5. He became so dehydrated that he was admitted to SCBU for intravenous sugar water.

6. I was finally introduced to an exceptional breast feeding counsellor who helped me to successfully breastfeed

I am a healthy mum and he is a healthy baby. There are clearly two interventions that could have prevented an ITU admission here. Firstly, if anyone had been able to successfully show me how to latch him on from the start then he would not have become dehydrated. Secondly, if we had been allowed to rehydrate him orally once he had become dehydrated he would not have needed intravenous rehydration.

I am particularly baffled by the argument that giving oral fluids is banned because it might undermine breastfeeding. What undermined breastfeeding in this situation was:

1. Not being taught how to do it.

2. Having the baby removed from mum to SCBU.

3. Having him use up all his energy screaming about blood tests and intravenous insertions that he was too exhausted to feed.

I urge you to reconsider your hospital policy on rehydration. A fortune is being wasted on ITU beds for healthy children (?We see this all the time?), let alone the unpleasantness and risk that an ITU admission entails. Please can you consider spending some of the money saved on ITU on having a breastfeeding counsellor on the post natal ward or training at least some of your midwives to be breastfeeding counsellors.

Yours faithfully,

Ms R&A

[Sqiggles]

Sorry, a bit late to join this, but I used the Birth centre in Tooting for my first and I used the same midwife (Jacqui Tompkins)(who by then had gone independent) for my second. It was siginificantly cheaper using the midwife directly. In my view, some of the best money I have ever spent - two fantastic home births, amazing care pre and post natal, etc etc.

If you do go down this route, then I would recommend using the find a midwife function on www.independentmidwives.org.uk, and speak to a few of them. I did speak to a couple that would not have worked for me, because there is a lot of personal chemistry involved.

[Vangough]

Thanks Squiggles, I have spoken to independent midwives but as they have no legal jurisdiction or intervention power at Kings they could not stop me being left in a corridor or toilet for hours on end either....although I rather think they would shout about it ALOT louder than I was capable of at the time !

Trouble is because of what happened last time I need cast iron guarantees this time and at the moment the only option that gives me that is the Birth Centre, and I have to pay :'( So its good to hear yet another great report on the Birth Centre !

R&A - I think you should write to PALS if you feel strongly about what happened to you and your baby. Not being able to breastfeed is very distressing for all concerned. Certainly my complaints were taken seriously so I hope they listen to you. Good luck.

[sb]

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[Vangough]

sb

http://www.birthcentre.com/ check them out - they have graduated fees depending on when you start ante-natal care with them. It is pricey though !

[buggie]

while not a midwife, as a nurse in an ED dept I often have to deal with issues of demand higher than capacity allows.

While obviously it's in no means ideal to be waiting for a room to labour in, remember that the rooms are full because of other ladies (quite probably in a more advanced stage than yourselves) rather than the midwife's keeping them empty for the sake of it.

It could well be that they are feeling even more stressed than you because their trying to work out how best to resolve the situation. (imagine how stressed you are in the situation and then magnify it x the number of women in labour there at the time).

In my dept, it is always our aim to keep patients as well informed as we can and to tell them what our plans are - obviously on a labour ward this is more difficult as labour timings can't be predicted.

Independent midwifes/group midwifes are free of this stress as they don't have the management issues the unit midwifes have.

Prob just being bit hypersensitive, but as a health professional, the lack of thought of how difficult our job is at times concerns me, however, to re-iterate, please write about any negative experiences to the PAL's team as am sure these often highlight problems and are listened to more than staff expressing the same concerns.

[Ann]

On Christmas Day 2009, I've been reliably informed, by 4pm King's saw the safe arrival of no less than 25 babies. I'm not sure what the final total was but I think it illustrates the logistical task the labour ward staff sometimes contend with; as indeed do A&E staff like buggie. I'm sure your department has felt the brunt of this cold weather also and no doubt you have all risen to the task.

Buggie does make a good point in that the case-loading groups like The Lanes, Brierly and Oakwood can and do, limit their numbers; in other words they never have more women than they can comfortably look after.

I believe New Years Day at King's labour ward was pretty busy too, shall keep you posted if details arise!

[Cora]

Ann, do you know what would be a 'comfortable' number of births for Kings in a 24hr period? I.e That the midwife team on duty would feel happy that the system was working and that care was not being compromised due to being overstretched. Just interested no hidden agenda.....

[Ann]

I think it averages about 15 to 20, but as it's impossible to predict who's going into labour and when, labour wards have to be prepared as best they can.

Of course safety must never be compromised but King's do their best not to close and turn labouring women away, which would be a comforting thought to me just now if I was due to have a baby with the present conditions on the roads.

[SianandTony]

R&A I can understand your concerns regarding the lack of breast feeding support at kings after giving birth. I gave birth in within another health trust I asked for advice on the ward the ward and no one came round to help. My daughter was actually latching on well whilst i was in hospital, it was when i got home i really got home the problems started. my daughter was really distressed at night and i didnt realise that she was just hungry. it was only till a community midwife came round and help me feed did things get better.

i think the system is quick enough to throw out leaflets and books on breast feeding and its benefits when mums actually needs PRACTICAL help and guidance, which there appears to be a lack of?

Do kings not offer breast feeding classes for mums to be? I attended an NHS one and i did find it to be very useful.

[Smiler]

RE. Kings, the problem seems to be too much demand / not enough staff. But knowing that doesn't make it easier for those who experience problems.

[R&A]

Breastfeeding advice at kings:

My experience was half hearted attempts at showing me how to breastfeed. The advice was that i was 'doing fine' yet somehow my baby ended up in special care for dehydration... the advice and help i received from a counsellor arranged by the special care unit was second to none and completely different to the advice i had been given by the midwives on the ward.

Labour ward at kings:

My experience of the labour ward was pretty minimal as i was only there for the delivery of the baby (20 minutes). I was kept in the antenatal ward for the whole of my labour because i was not deemed to be in 'established' labour, despite sounding like a horse and rocking backwards and forwards on my own in the toilet next to the reception where the midwives were happily sitting and chatting at 3am in the morning. The ward was half empty that night - the staff were not busy...

Pain relief at kings:

i was refused an epidural because i was 'too early' and then because i was 'too late' in the labour process. I don?t' understand why it's not up to me whether i get pain relief or not? Surely it's my pain? Despite the doctor having said i could have one the midwives just said 'no one told us she was having one'

I'm really angry about this one because i specifically asked for an epidural 12 hours before i went into labour (i was in hospital because my waters broke early), during the labour and at the end of the labour. Yet i did not receive an epidural in fact i was just point blank refused on ALL occasions.

[sillywoman]

R&A

There is a window of opportunity during which a woman in labour can have an epidural for pain relief. You usually have to be in established labour (3 or 4cms dilated) before you can have one, & once you reach about 9cms - depending on how quickly the labour is progressing - it's probably too late. Epidurals are really only useful in the first stage. If you're rapidly approaching second stage (pushing) then there's really no point as it probably won't help you, will reduce your ability to push effectively, and thereby increase the likelihood of you needing forceps, ventouse or even a C-section. Obviously I don't know your particular circumstances, but it sounds as though you had the misfortune to ask too early & then again, too late in the process. :'( for you.

HTH with understanding why things might have happened the way they did?