"Emotional care in labour"

My husband and myself were sent to Royal Alexandria Hospital (RAH) Paisley by the Mid Argyll Community Midwife team for the birth of our first baby as my blood pressure was too high to remain in the local area to give birth.

At the time I had been having sporadic contractions for 2 and a half days and had been unable to sleep for 2 nights. With more regular and stronger contractions appearing on the second night we had called the local midwife the following morning. I was advised that I was 3-4 cm dilated and that the best option as my blood pressure was slightly high was to be transferred to RAH. We were advised by our local midwife to get some breakfast and then proceed straight to RAH. From our location just outside Lochgilphead this is over a two-hour drive. 

We arrived at Paisley around lunchtime and went straight to the Maternity Unit at RAH. By this time my contractions although still present had tapered off and were not progressing. We then spent several hours being assessed in triage. When assessed my blood pressure had lowered back to a normal level and blood tests confirmed that I did not have the condition pre-eclampsia. We were then given the option to either be transferred to the ward were my waters would be broken that day so that my contractions would hopefully progress and I would go into established labour or to be transferred to the ward and to wait until the next day where if nothing happened over night established labour could be initiated. We chose to be transferred to the ward were my waters would be broken that day to hopefully initiate established labour. 

From the moment we entered Triage at RAH I was not treated and cared for in the same warm, comforting and supportive style that I had become accustomed from the local midwifes at Mid Argyll. Firstly, the positives and negatives of the options for the progression of my care were not explained to us. When we asked the doctor for further information we were met with a closed answer that did not advise us with our decision any further. Secondly, following being told I no longer had raised blood pressure and my blood test results were fine I was not advised why I now had to be transferred to the labour ward to give birth (I had previously been assessed as low risk green pathway for my pregnancy and had planned to give birth at Mid Argyll Community Hospital). When I asked whether I could give birth in the Community Maternity Unit at Paisley I was met with a cynical response from the doctor about me wanting a water birth. Thirdly, there seemed to be a mix up of communication between staff about what was actually happening with us. One member of staff seemed to think we were being transferred to the ward to wait to the next day when this was not the option we had agreed. Overall, we were treated as if we were an inconvenience because I was not in established labour and couldn’t be sent home due to the distance of where we lived.

We were then transferred to the ward where we had been advised we may only ‘be a short time as they were relatively quiet,’ and then my waters could be broken. At the most we were advised ‘we would not have to wait any longer than midnight.’ At this point is was late afternoon. Due to the journey and the wait in triage we had eaten very little all day. I had not been able to keep my breakfast down and had eaten a few snacks in the car and my husband had only eaten breakfast. We asked if it was possible for me to have some food and advised that I would need a gluten free meal as I have wheat intolerance. We were told that as they had not been aware of a gluten free meal being required that this would probably not be possible. However, thanks to one of the midwives a small meal was sourced. However, when the meal arrived it was tiny and definitely didn’t make up for having only eaten a few snacks all day. No one seemed to take into account the distance we had travelled and that I hadn’t eaten a proper meal since the previous evening. This made me feel increasingly stressed over the prospect of giving birth having not eaten properly. All I kept thinking was ‘how am I going to find the energy to do this the last time I ate normally was nearly 24 hours ago?’ Add to that the stress and concern for my husband who did not go any further than the hospital shop for a sandwich because we were told we might not be in the ward long.

 

We were then left in limbo with me feeling abandoned and scared facing the prospect of giving birth having not slept for nearly three days, and not having eaten properly for 24 hours. Although we were told I should try and rest I felt like I didn’t know what to do for the best. I didn’t know whether to move around to get things going as I couldn’t sleep and hadn’t been able to for days as every time I would start to fall asleep a contraction would wake me or to try and eat as many snacks as possible in case I was called down. I was a first-time mother who had never been in hospital before, was miles away from my local area, being treated as an inconvenience. Yes, I may not have been in established labour but I was treated as though nothing had even started even though I was still experiencing regular contractions. Essentially at the point I needed some emotional care none was provided. Is not part of a midwife’s job to provide emotional as well as physical support and care?

Late in the evening around ten I was told that as things weren’t progressing and that they didn’t have any capacity downstairs that I would have to wait till the next day, although I could possibly be called in the night. I understand that there are safety implications and that the number of women giving birth can’t be controlled but why say to a couple you’re not very busy and you’ll have them down by midnight when a promise cannot be necessarily met?

To cut a long story short my body had different ideas and my body went into established labour itself around one in the morning. Space was then made available for me and although my wishes to move around, make a relaxing environment, and only use gas and air were not always fully supported by the first set of midwives had present at my birth I can not fault the two midwives who due to a shift change took over in the last hour before my daughter was born. This is particularly true of the midwife who delivered my daughter who handled the birth with exceptional professionalism.

After the birth and back on the ward having lost over a litre of blood and having not eaten apart from the toast provided after birth (my own gluten free bread), we then encountered the inability for the hospital again to provide me with food and meet my dietary requirements. Having not ate properly at this stage for a day and a half we were told we had missed lunch and therefore I would have to wait till dinner time. Is this really the way to care and treat women who have just given birth – by starving them? Although a request was put in by the midwives for a gluten free meal for dinner, when the meals arrived there was no gluten free meal available. Luckily one of the normal options of meat and vegetables I could eat minus the gravy. I was then able to muddle through the 24 hours I stayed on the ward by eating my own bread, snacks and any breakfast options I knew were gluten free. Eventually on the day I went home a gluten free lunch actually arrived. The lack of ability to be provided with a simple dietary request during my post-natal care only added to the negative experience and stress encountered the day before at RAH Paisley.

Finally I would also like to highlight that in the 21st century my husband and myself were shocked and appalled at the way male partners are treated by the hospital. The midwives in our local area encouraged prospective father’s involvement and understood their presence and support actually relaxes a woman in labour. At RAH it seemed to be the complete opposite they were treated like second class citizens. Male partners are an integral support for a woman throughout pregnancy and especially when their partner is about to give birth. Just because they are not in established labour does not mean they do not need the support of their partner. Not being able to stay on the ward with their partners after nine in the evening just adds to prospective stress for the woman and undermines the involvement and role of men in the birth of their children.

Overall the experience of using the maternity services at RAH has left me feeling traumatised, let down, and angry at a National Health Service which I have always trusted and supported. If I do ever go on to have a second child I will dread the prospect of having to face starvation, lack of communication and explanation of medical situations, and being treated as an inconvenience with no understanding of the distance some of its patients travel to access their services.