"Maternity care"

1. Delay with elective induction caused exhaustion and impacted on remainder of admission.

Scheduled for outpatient induction (cervical balloon catheter) at 20:00  at PRMH. Informed on arrival that the ward and labour suite was very busy. I also experienced further delays in being seen due to appointment scheduled during shift change and handover.

Was informed my cervix was 2cm dilated at community appointment a week prior and this was documented in my notes. Experienced approx 3 hour wait with monitoring that resulted in a final review by midwifery team confirming I was still 2 cm dilated and therefore cervical balloon could not be used. I was asked to return to hospital on the following day.

Upon return for planned membrane rupture I was again informed of labour suite being busy. I was not taken to labour suite for a further 24 hours on ward 72. I was unable to sleep throughout due to other patients and their family members as well as routine medical checks on other patients in ward and felt poorly prepared for elective induction. This exhaustion impacted on remainder of admission.

2. Breastfeeding - mixed messages

Felt the support with my plan was lacking from the moment I gave birth:

Had expressed my wishes for mixed-feeding with breast and powdered milk in my birthing plan. My community midwifes were supportive of this and had given me advice on expressing etc. I felt information given and level of support was not consistent among staff on ward 68.

Transfer from theatre following emergency c-section to ward 68 occurred around nursing shift change. Visibility of staff was low at this time. My partner had returned home to rest so I was alone with my baby. I mentioned to a midwife looking after me that I had not had the opportunity to breastfeed since giving birth. Instead of offering assistance, they were quick to point out that it was more than 3 hours since my birth and said that someone else should have made sure my baby was fed. I was left feeling vulnerable following the birth due to exhaustion and being temporary paralysed from the waist down and unsupported by the staff on ward 68 whist I was supposed to be recovering.

During the next 24 hours I proceeded to ask for support for breastfeeding and was given appliances for expressing milk. I raised concerns that my baby seemed very tired and was not latching on for longer than a few minutes at a time. I was told by the midwife team that this was normal and to continue on.

During day shift I raised concerns again about my baby’s feeding and was offered use of the breast pump. When a midwife brought the equipment they were very abrupt and asked specifically if I was planning to continue to exclusively breast feed. I explained my antenatal plan for mixed-feeding and they responded that I had to know for certain, adding the appliances to go with the breast pump cost £25 each, implying I would be wasting NHS resource if I changed my mind.

Further communication with another midwife was more supportive with breastfeeding. However, when I enquired about discharge plans there was initial reluctance to let me and my baby leave due to concerns about feeding and potential for my baby losing weight (even although it is generally understood that breastfed babies initially lose weight due to milk generally coming in on the 3rd day post pregnancy). There was a fixation on the length of time my baby was feeding for, which did not seem to be a concern with other midwives I had spoken to previously. By the end of my admission I was overwhelmed with the different information I was given regarding breastfeeding from each midwife that was looking after me and decided to switch to formula feeding.

3. Issues regarding quality of care

On my first morning following birth I was handed an Enoxaparin pre-filled injection by a midwife during the drug round and asked - So you know what you are doing with this? It was the first time I had been given the injection, they did not inform me what it was for or offer a demonstration.

In my own experience no one told each patient where to locate milk, where the main desk was or what was the best way to get the attention of the midwife looking after you. I found the attitude of some members of the midwifery team rude and abrupt and demonstrated a lack of empathy.

Open visiting - often more than the advised 2 visitors per bed space allowed onto ward. Made the ward very noisy and disruptive. Would also have a lot of patients/partners and visitors on loudspeaker calls at all times of day. Partners/visitors often brought in food and ate at bedsides. Understandably no other spaces to do so. As a vulnerable female alone with my baby at certain times, it was unsettling having many non patients coming and going into the ward. It also wasn’t clear if any checks were done to make sure individuals were actually visiting patients on the ward before being admitted.

Suggestions: Offer opportunity to wait for labour suite bed at home for low risk patients during busy periods. 

Improve communication of notes regarding feeding plans and consistency of information given regarding breastfeeding. 

Review open visiting policy and limit number of visitors to bedspace to improve safety to patients and limit disruption to others receiving care.