The Hospital: C4

Hear hear, Eric. My experience of being a "young" single mum (I was 19 when I got pregnant, so hardly a young teenager) was that I was treated like an irresponsible cretin by every HCP I came into contact with. I've banged on about it all on BT enough times, but suffice it to say that some of the choice things that I was told during my spectacularly badly managed labour were "what do you expect? You single youngsters never can deal with it" (when saying that epidural hadn't worked, which it never did) and "well, that's another young life ruined before it's started" (one midwife to another, gesturing to my newborn son, in front of me) and whilst up on the ward I was referred to as "Mrs Layabout" because "it'll upset the other mothers if we call you Miss"

Things have changed a lot in the last 16 years. The community midwives I work closely with, including with teenage mums in the past, are fantastic and treat everyone well in my experience. Would I want to guarantee that every hospital midwife is always empathic, non-judgemental and culturally aware (and all that stuff that one is supposed to be)? Nah, don't believe it for a minute. The whole "we're busy" thing is given as an excuse and maternity services are horribly stretched, we all know that, but I still don't see that there are any time or resource implications in treating people like humans rather than like the sh1t on your shoe.

The NHS culture has a lot to do with this, and I know I've said this before and all ? The heirarchical thing seems to be alive and well, and the patients are often at the bottom of the heap. It does make me sad whenever I see parents who have been through NCT classes with me at reunions and they tell me about how their choices have been greeted with snorts of derision (literally) by the people who should be looking after them. I'm not talking about people going in with 5 page birth plans detailing which track of the whale music they want at which point, but completely reasonable things IMO. R-A I agree with you about choice, as long as it really is informed choice, not informed compliance or "choices" which people are bullied into by emotional blackmail ("If you have a homebirth your baby will die" for example). IMO you can make an informed choice to have a GA LSCS (whether you can make that decision, ie whether it's open to you is a whole other issue) but someone making that "choice" out of ignorance or because their fears haven't been addressed is no choice at all.

Anyway, I've not watched the programme yet - I'll catch it on 4OD when the toddler is otherwise occupied a bit later on.

WPLS about the culture.

I was lucky that during the actual birth process I felt I was included in the decision making process, and that it was therefore a positive experience, but antenatal appointments were something else. I was treated as though I was a stupid schoolgirl by a consultant (well, by his registrar, who was the same age as me). I'm an intelligent, well-educated woman, who had done her research and yet I left feeling humiliated and downtrodden - and I'm still cross about it 2 years later. And don't even start me on post-natal care or breastfeeding support.

Which is all a shame because I know that there are many, many caring, compassionate people working in the NHS, who are doing it for all the right reasons.

A note on birth plans - in my opinion, they are enormously useful for making the mother and birth partner think through different scenarios, how they would act, what they would do, how they would feel. One risk, however, is that the mother/partner assumes that the healthcare professionals have read it and taken it on board, so then don't challenge or ask questions. The other, as you say, is that people end up with fixed views of birth. I don't think we should get rid of them, though. Perhaps more counselling about what they mean/what might happen is in order?

Perhaps, also, people would feel less determined to detail their ideal birth if there were fewer cases of people feeling traumatised over their births because they felt they were given no choices or had no control. Of course it's vital that we end up with a healthy mum and a healthy baby, but that doesn't mean that the mother's wishes should be ignored or that she should not be consulted.

I felt and still do feel that I failed my kids because I ended up with 2 c-sections. The disparity between my birth plan and the actual events was just immense. I was not in control at any point in time, and part of it was down to my own laziness, but part of it was down to (particularly in my second labour - attempted VBAC) to the continual monitoring and lack of freedom to move, about which I didn't have much choice.

I saw some of this program. The girl who was obese and complaining about needles with a fcuking piercing in her face needed a slap. I turned over.

<disclaimer> I did not see the programme but

when I did my antenatal classes there was a teenage couple who were pleasant and clearly eager to learn but the mum to be was adamant that if she needed pain relief it was GA or nothing because she was frightened of needles. I did point out that a GA required needles and that a GA had much greater risks and she wouldn't see her baby but she was very fixed in her mind.

I don't know what the outcome was for her but her fear of epidural and opiate injections was very real and the mws would have some fight to persuade her. She didn't want gas and air because her mum said it didn't work.

Any discussion the mws or obs would have had with her would have been simplistic to say the least, her understanding and knowledge were so poor and her fear so large - to criticise this girl for wasting NHS resources or making a stupid choice would be pretty pointless imo.

It was not laziness <slap> Nor have you failed anyone <slap> You had two really traumatic experiences but they were not your fault. Quite apart from anything else that happened to you, the lack of control is horrible - it's demeaning and it's very scary. ?

The continuous monitoring is a real problem for a lot of women. I do accept that there is a need for it in some cases (though there are many others where intermittent monitoring is as good), but even then, there must be ways of doing it whilst keeping women mobile.

It depends quite a lot, I think - my mate was continuously monitored because of rocketing blood pressure but still managed to labour and birth off the bed because the wires went 6 foot and she used that space.

My hospital had a telemetry (?) system ie, wireless monitoring, available so that might help women if it was more widely available. But the mws had difficulty finding my son's heart beat in all but one position, so it didn't make much difference to me.

There are a couple of telemetry units at my hospital, and the monitors do have long wires, but I think there are still a lot of cases where the inference (or outright suggestion) is that you shouldn't move too much. Also, I think there's a psychological factor once you can hear the heartbeat - I remember how the sound of C's heartbeat became a real focal point to me and so doing anything that would have resulted in losing that signal would have been worrying for me (though of course by this stage I was epiduralled up so wasn't moving anyway)

I couldn't hear the heart beat so that wasn't really a factor but I could understand why it would be.

I am sure this isn't true of all mws but certainly in my experience, while I was in early labour the mws treated monitoring almost as a doping agent - they put a monitor on and then could walk away. No interest in whether you found that position painful, no interest in the actual results of the monitoring and so on. I was told, you need to sit still for 20 mins - After an hour of sitting through small but really painful contractions in one position, I had to send H to find the mw and ask if I could get up now. They had pulled curtain around and then completely forgotten about me ?

Later on I had too many mws/obs around for this to happen but I do wonder how common this kind of monitoring=time to ignore patient is and if it happens in more advanced labour if the woman doesn't shout up...

I wonder the same Zeb. I was lucky, because we have domino care, so the midwife had been at home with me then came into hospital with me. Once we were in, she only had me to care for. She was so good at home too - she could see I wasn't in established labour but I was too scared to let her leave the house so she sat downstairs with MrH for about 4 hours. Poor MrH ?

Well, as you know continuous monitoring shouldn't be used as routine, though it bloody is still ? I was told I "had" to have an admission trace done when I went in with Isaac despite the fact that it shouldn't be done and in many cases does bugger all except cause unnecessary interventions.

I think CTG is one of my sticking points about this labour actually. I still can't hear one of those damn machines picking up a fetal heartbeat without getting flashbacks.

Hear hear. I had continuous monitoring in my first labour due to high BP and it was OK. I was on a drip so couldn't really move about anyway. Apparently the hospital do have a couple of telemetry units but I never got a sniff of one.

However the default position where I delivered (consultant led unit in a hospital which also has a MW led unit) is that "you're here because you're deemed high risk (due solely to my weight in my case) therefore you'll have continuous monitoring unless you can prove you don't need it". As opposed to the default position being intermittent monitoring, with a step up to continuous if need be.

I was "allowed" intermittent monitoring in my 2nd labour but I only got it because I mentioned in my birth plan I'd wanted that. Otherwise it would have been on the bed hooked up to the monitor and given I was on that for 15 mins before I delivered, if that experience would have been typical of the rest of the labour it would have taken my pain from excruciating to beyond unbearable.

Hear hear. I had continuous monitoring in my first labour due to high BP and it was OK. I was on a drip so couldn't really move about anyway. Apparently the hospital do have a couple of telemetry units but I never got a sniff of one.

However the default position where I delivered (consultant led unit in a hospital which also has a MW led unit) is that "you're here because you're deemed high risk (due solely to my weight in my case) therefore you'll have continuous monitoring unless you can prove you don't need it". As opposed to the default position being intermittent monitoring, with a step up to continuous if need be.

I was "allowed" intermittent monitoring in my 2nd labour but I only got it because I mentioned in my birth plan I'd wanted that. Otherwise it would have been on the bed hooked up to the monitor and given I was on that for 15 mins before I delivered, if that experience would have been typical of the rest of the labour it would have taken my pain from excruciating to beyond unbearable.

You can refuse, of course, but it's quite hard to make that call. What are the real risks of refusing? And even if the risks of refusing are tiny when you have regular midwife care, what about when they're too busy to come back and see you more than once every two hours?

I'm goign to need to research this before next time.

Ach. My inner midwife is now just calling me louder and louder.

I keep coming back to thinking about training.

I would be SOOOOO much nicer and more understanding than your average midwife, oho yes.

Well, I was told MW would come back every 15 mins to monitor my baby's heartbeat using the sonicaid. But it wasn't anywhere near as often as that, I think she came back after an hour and put me on the continuous trace for 15 mins, then came back and delivered my baby a few mins later. Jonathan was born with a knot in his umbilical cord and I've tried hard just to not think about the "what ifs" ie what if it had constricted and deprived him of oxygen and we wouldn't have known as we weren't being monitored every 15 mins. She was rushed off her feet, she had delivered 3 babies in 10 minutes ? . But what is the point of continuous monitoring either, if you are just shoved on a monitor and forgotten about for 2 hours? I suppose then in those circumstances if it looked to you/your partner that the heart rate was dropping off you'd hit the emergency button and someone would come. But that's not really satisfactory either.

I think I'm definitely having a homebirth next time! ?

absolutley. My BIl is educated and generally sensible. In the last 4 years he has got 4 women pregnant. I can't get my head around his surprise at the last one (and the only one which was kept) I actually think hes vile, but if he doesn't "get" it then I can't begin to think about explaining it to teenagers.