"Midwifery services in Kirkcaldy and Edinburgh"

My feedback is about the care I received while pregnant with my second child and his birth inMarch 2019. However, for context, I am going to provide information about the birth of my first child in December 2016.

My first child was born at Simpsons at Royal Infirmary Edinburgh.  The care I received from my community midwife was excellent and I felt well supported. I was assessed at Simpsons in the early hours after having regular contractions for more than 48 hours.  I was told that I was still in the early stages of labour, was given a sweep and went home.  I experienced some bleeding after the sweep but nothing that concerned me.  I was also happy to go home as my aim was to go to the hospital as late as possible as I wanted the best chance at an intervention free birth. 

I had a previously arranged midwife appointment in the afternoon, which I attended.  The midwife said I was 4 cm dilated and that I should go to the hospital, she informed them I was on my way.  That midwife also gave me another sweep.  When I arrived at the midwife led unit, I was bleeding again after the second sweep and was told that I had to go upstairs to the labour ward.  A consultant was asked to assess me.  She said she wanted to break my waters, before carrying out the internal examination.  I really did not want this to be done so asked her to perform the examination first and then we could decide what to do.  During the examination she went right ahead and broke my waters without saying anything, I don’t think she had any intention of performing an examination and discussing what she thought should happen next.  I was obviously furious and the consultant swiftly left.  I was put on the oxytocin drip and strapped up to be monitored continuously.  I was very keen to be mobile during my labour but the continuous monitoring sensor kept losing my sons heartbeat which caused unnecessary concern.  A clip was then attached to my son’s head to monitor his heartbeat that way.  I found this quite uncomfortable but I can understand why it was done.  A second round of oxytocin did nothing to progress my labour and around 6 am the next day I was given the choice of another round of oxytocin or a c-section – I was dilated to 3-4 cm.  By this point, I hadn’t slept at all for 3 full days and was exceptionally tired with the sleep deprivation.  I opted to admit defeat and had a c-section.  After feeling that everything that had happened up to that point was out of my control, I was glad to be given a choice as to how to proceed.  I was very disappointed at having a c-section and it significantly affected my early days as a new mum.  In hind-sight, I don’t think the c-section was necessary (there was never any sign of distress in my son) but being so sleep deprived left me with no other reasonable option that I was aware of.

When I became pregnant with my second child, I was very keen to try for a VBAC and was encouraged that this is what the midwives and consultants also want to encourage.  Again, I wanted the best chance at a low intervention birth.  I had the same community midwife and again the care she provided was excellent.  I was keen to labour in water (as I had been the first time) but I was told that I would not be able to use the midwife led unit (where the majority of the birthing pools are) as I was considered “high risk” because of the previous c-section.  I understood that the risk came from the possibility of my c-section scar rupturing.  I wasn’t really happy about this as I knew there were only 2 rooms on the labour ward with birthing pools so there would be a pretty good chance that these rooms might not be available to me as they could be in use.  I met with a consultant as is standard practice to discuss my birthing options.  During this discussion she told me again that I would not be able to use the midwife led unit, despite expressing that this was what I would choose had it been available.  I was also told that continuous monitoring and a cannula in my hand would be standard care for a VBAC woman.  I had read before my meeting with the consultant that this was the standard care for VBAC women so I expressed that I was not keen to have a cannula (for the off chance that it may be needed) and I was not keen on continuous monitoring because I wanted to use the birthing pool and from my previous experience with the sensor losing the heartbeat signal.  I also told her that I was aware I was classed as “high risk” because of the <0.2% chance of my scar rupturing during labour.  I was told to consider having the cannula and that continuous monitoring could be done wirelessly in the pool (and that it was surprising that there were problems with the signal first time around as I was “slim” and it’s not usually a problem).  After the meeting I went away and read every piece of information I could find (NHS guidelines, research in the literature, patient information leaflets from NHS boards all over the UK) about the risk of scar rupture (<0.2%) and the care provided to VBAC women.  I had to dedicate a significant amount of time to this but I was really not happy with the options I had been given about where and how I could labour in the hospital.  My community midwife knew how I felt about this and tried to put me in touch with someone at Simpsons she thought might be open to discussing the possibility of getting access to the midwife led unit.  That person never got back to me.  

While doing my research I found a publication that had come from midwives based at Victoria Royal Infirmary in Kirkcaldy.  They had published the outcomes of VBAC women who had used their midwife led unit.  I contacted someone at the midwife led unit, with little hope of getting a response, about the possibility of giving birth in their midwife led unit.  I was surprised when she rang me a day later and had a meeting with a consultant in Fife arranged for the following week (I was about 32 weeks pregnant at this point).  She was very sympathetic with my previous experience and my desire for the opportunity to have a low intervention birth.  Both her and the consultant had a completely different approach to the consultant I saw in Edinburgh and acknowledged the fact that I understood why NHS guidance suggests continuous monitoring and a cannula for VBAC women, as well as consultant led care, but that I saw a <0.2% probability of a scar rupture as a risk I was willing to take to avoid the extra intervention. 

It was agreed that I could use the midwife led unit in Kirkcaldy when I went into labour and that I would be treated as a low risk patient (except for the previous c-section, I would have been considered low risk), i.e. no need for continuous monitoring.  The midwife let unit in Kirkcaldy only has one birthing pool with another on the labour ward.  I was told that it would be very unlikely that the pool room would be in use when I needed it but that if it was, I could have midwife led care in the pool room on the labour ward.  This was exactly the outcome I had hoped for but had almost lost hope of getting.  Having to thoroughly research standard practice and what other NHS boards did, took a significant effort and the thought of having intervention from the start of my labour experience in the hospital caused me a lot of stress.  While I’m not sure the outcome would have been different first time round, the cascade of intervention from the minute I entered the hospital significantly reduced my chances of having a natural intervention free birth.  I wanted to avoid this at all costs.

In the end, I saw thr consultant at 39 weeks for a sweep (she was keen that I didn’t go far past my due date as that would trigger intervention according to NHS guidance).  My contractions started a day before my due date and I saw the consultant for a second sweep two days later. I had already told her about the severe sleep deprived start to motherhood after my first labour experience and that one of my main priorities this time was to avoid that.  She provided me with Co-codamol when asked so that I could try to sleep through contractions (I wish I had known this was an option first time around).  Again, I was hoping to go to the hospital when well into established labour (keeping in mind the extra distance I had to travel to Kirkcaldy).  I went to Kirkcaldy in the early hours and was assessed to be 7 cm dilated. The pool room was in use in the midwife led unit so I used the room on the labour ward but had midwife led care.  My dilation stalled at just short of 10 cm so I agreed to have my waters broken.  There was meconium in the fluid and the midwife advised that I should have a cannula installed, I refused this (I did have to be quite forceful about this which was unfortunate).  I was also strapped up to the continuous monitor at this point, again, the heartbeat kept being lost.  My son was born, naturally, a short time after with no further intervention.

I had a much more positive birth the second time around and I attribute that to the fact I was given access to the midwife led birthing unit in Kirkcaldy and because I was allowed me to be part of the decision making process for my care, acknowledging the fact that I was fully informed about the risks involved with my choices.  I was dreading having to go to the labour ward at Edinburgh as I did not feel confident that I wouldn’t experience a cascade of intervention as was the case during my first birth. 

I think it is a disgrace that I could receive the care I wanted in Kirkcaldy but not in Edinburgh.  The two hospitals are pretty similar in terms of where the midwife led unit is located – in Edinburgh it is on the floor below the labour ward and in Kirkcaldy it is along a corridor.  I do not accept that there is significantly more risk using the midwife led unit in Edinburgh as the labour ward is a lift ride away.  The only reason I thought to contact Kirkcaldy was because I am familiar with searching the literature for medical information, people without my experience from my line of work would likely not even think to do so, and would therefore not have the options I had available to me.  

I am very grateful to the staff and and the midwifes who looked after me in Kirkcaldy (Sarah, Debbie and Kerry) for the positive birth I had hoped for and experienced.  If I decide to have a third child, I will go back to Kirkcaldy without a doubt.

The day after I gave birth I was made aware of the changes to the NICE recommendations for VBAC women (Intrapartum care for women with existing medical conditions or obstetric complications and their babies Mar 19) – no cannula and no continuous monitoring.  I hope that this has already been adopted by NHS Lothian.  I also hope that the consultants in Edinburgh adopt a more personalised approach to the care they provide to the women they see.  When I saw the consultant in Edinburgh there was no discussion about the possibilities of using the birthing centre, it was a flat no.  If NHS Fife can have that approach, there is no reason NHS Lothian can’t have the same approach.

Finally, I seriously considered making a formal complaint about the consultant in Edinburgh who broke my waters despite both me and my partner explicitly asking her not to do that.  However, by the time I got home from the hospital I had a full week sleep deficit and a new baby to look after.  There was no possibility I could have found the time or the energy to make a complaint and that is the only reason I didn’t do so.