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Care Opinion

My labour experience

Posted By glasgowcitymama

"My labour experience"

About: Maternity care (wards 68, 72 &73) / Labour suite

(as a service user),

I was induced for pre-eclampsia and my baby required continuous electrical monitoring during labour. However, the wireless connection to the heart rate monitor intermittently failed and a hard wired connection (cable) could not be located in the labour suite.

During the search for the cable I was told repeatedly to stay on my back, a position which increased my pain to an unmanageable level. I had until this time laboured well on my knees and without pain relief, up to 8cm dilation. My request for pain relief went unheeded by distracted staff.

The missing cable was never found and I progressed to the second stage of labour. At this point staff still couldn't monitor my daughter's heart rate continuously. For this reason, I was told that they would need to perform a forceps delivery. I felt I had no option but to say yes, since they couldn’t tell for certain what was happening with my daughter. I felt violated. My body was going to be surgically cut and my baby extracted by assisted means because of an IT issue and missing equipment.

This was also my first labour and I didn’t know to question their actions. Note, my daughter's heart rate was monitored intermittently when the wireless connection worked and at no time were there any indications that she was in distress. I pushed well and, thankfully, ventouse extraction was sufficient to deliver my daughter. At the time I was never informed of this change of plan to ventuose. My second stage of labour was 13 mins total.

I found that the hospital procedures and facilities are not geared towards natural birth (they didn't have birthing balls and stools when we requested). If women want a natural birth and faster recovery, they should not be afraid to be more assertive during labour regarding their birth wishes.

Medical interventions like assisted delivery are an easier 'route out' for hospital staff, but not for the mother and her long term recovery. There are also risks with ventouse for the baby which were not explained during the procedure. Take time to educate yourself before childbirth, and I strongly recommend having a doula.

My impression was that The Princess Royal tend to eliminate risks by overcorrecting and they introduce medical interventions which have no bearing on postnatal quality of life (long or short term).

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Responses

Response from Victoria Mazzoni, Interim Clinical Services Manager, Obstetrics, NHS Greater Glasgow & Clyde 2 years ago
Victoria Mazzoni
Interim Clinical Services Manager, Obstetrics,
NHS Greater Glasgow & Clyde

Submitted on 29/07/2021 at 14:15
Published on Care Opinion at 14:15

Dear Glasgowcitymama,

Thank-you for taking the time to post your feedback within Care Opinion and I was so sorry to read that the care that you received during the birth of your daughter did not meet your expectations and that you found your mobility was impeded.

I was very disappointed to learn that you felt that the hospital procedures and facilities were not geared towards facilitating natural birth and specifically concerned that during the birth of your daughter a wired transducer cable could not be sourced. I would wish to reassure you that following on from your experience I have checked and labour ward currently have no deficit in available fetal monitoring equipment and every fetal monitor has available wired and wireless transducers.

I have discussed your experience with the staff and ward manager within labour ward who have highlighted that they will continue to monitor that each labour room is fully equipped with any repairs or deficits procured timeously.

I would also wish to reassure you that there is a full range of birthing balls, mats and support aids available within labour ward and the antenatal ward within Princess Royal Maternity. There are two low risk birthing rooms with birthing pools available for Mums which are specifically equipped with birthing aids to support low risk birth. I am sorry that these facilities or aids were not made available to you when you requested and I have fed this information back to the staff within these areas and have requested that the ward managers continue to monitor their availability and usage.

The midwives and staff within the unit take pride in assuring that all women's birth plans can be accommodated safely and any deviations or options are discussed in partnership with them. I am genuinely sorry that this was not your experience and would welcome the opportunity to discuss how we could have improved on this with you. My number is 0141 201 3336.

I hope you have now recovered from the delivery of your daughter and are now able to enjoy this special time together as a new family,

Kind regards,

Vicki Mazzoni

Lead Midwife

Princess Royal Maternity

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Update posted by glasgowcitymama (a service user)

Dear Vicki,

Thank you for the invite to share my thoughts on how my experience could have been improved.

Firstly, I would recommend NICE guidelines for 'care through labour' and 'fetal monitoring during labour': https://pathways.nice.org.uk/pathways/intrapartum-care. Pathway last updated: 20 April 2021

NICE recommend that when a woman is having continuous cardiotocography medical staff should:

-Ensure that the focus of care remains on the woman rather than the cardiotocograph trace

This was not the case for me, since the change of shift and for 2 hours up to the delivery of my daughter the midwives did not speak directly to myself or my husband. Other than to repeatedly tell me to stay on my back while they dealt with faulty equipment and missing cables.

- Remain with the woman in order to continue providing one-to-one support

As above, also my requests for pain relief went unheeded. I received no support from distracted staff.

- Encourage and help the woman to be as mobile as possible and to change position as often as she wishes monitor the condition of the woman and the baby, and take prompt action if required.

Again my wishes to give birth kneeling went unheeded and I was put into a position which increased my pain. My wish to remain mobile during labour was also detailed in my written birth plan. When I was admitted to the labour suite I spoke to my midwife about this but, after the shift changes and tea break relief this information was disregarded and my birth plan remained unread.

- Do not make any decision about a woman's care in labour on the basis of cardiotocography findings alone, but also take into account: her preferences her report of how she is feeling her report of the baby's movements assessment of her wellbeing and behaviour maternal observations

My inclusion in any decision making process was non-existent. I wasn’t presented with accurate choices or information regarding my care and my body. I consented to the use of forceps, but I was given no other choice. I was told that because they could not monitor my daughter’s heart rate they would need to intervene. This choice of words is leading a labouring mother to make a decision towards intervention – surgically cutting a woman and using forceps.

When the wireless equipment did pick up my daughter’s heart rate, all be it intermittently, my daughter’s cardiotocography trace was ‘normal’. Again refer NICE guidelines for Management based on interpretation of cardiotocograph traces. They recommend ‘usual care’ and to ‘talk to the woman and her birth companion(s) about what is happening’. There was no direct communication with myself or my partner about my care after staff changes.

According to Public Health Scotland (published in 2015), the Princess Royal Maternity has the lowest rate of spontaneous (natural) births, highest use of vacuum, and second highest rate for induced delivery, and with all other intervention rates significantly further away from the national average. These statistics reaffirm my experience at the hospital where intervention seems to be the norm. I am of the impression that PRM doesn’t have the equipment, infrastructure and cultural support for natural birth.

Yours Sincerely,

GlasgowCityMama

Response from Victoria Mazzoni, Interim Clinical Services Manager, Obstetrics, NHS Greater Glasgow & Clyde 2 years ago
Victoria Mazzoni
Interim Clinical Services Manager, Obstetrics,
NHS Greater Glasgow & Clyde

Submitted on 10/08/2021 at 17:38
Published on Care Opinion at 17:38

Dear Glasgowcitymana,

I am extremely sorry that in your occasion we have been unable to meet your expectations or those outlined within your birth plan. I would wish to reassure you that at the time when you first contacted us and following on from your original post this was fed back to the staff involved in your care within labour ward.

I would also wish to reassure you that I would not find it acceptable that a lack of functioning or available equipment would impact on a women's method of delivery or positioning in labour. Equipment is checked daily within the department and I have requested that following on from your original complaint additional wired transducers were purchased, in addition to those available in each delivery room, to ensure that spares are always available and this event couldn't occur again. Please be assured that I will continue to monitor this.

Again I am sorry that you remain disappointed in your care and I extend my invitation for you to contact me should you wish to discuss further,

Kind regards,

Vicki Mazzoni

Lead Midwife

PRM

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