What one group of mothers feels the National Maternity Review Team should know

I am delighted to introduce Helen Calvert, mother, play-group leader and campaigner, who positively supports parents and maternity services. Helen's post is number 5 of my #FlamingJune action for #MatExp, to inform the National Maternity Review team of key issues, and she actively sought out the views of parents using social media.  Thank you Helen! 

For the last 3½ years I have been running a Facebook group for mums.  What began as a way of talking privately to my “mum” friends has turned into a group of over 1,500 mothers across the country. 

 A desire to share some of the birth stories from my group was what first drew me to #MatExp and I have since become more involved in the campaign.  As one of her ACTIONS for #FlamingJune Sheena Byrom is publishing a series of blog posts about what the National Maternity Review Team should know, and she asked me to contribute.

 Last week I asked the group “what would you like the National Maternity Review Team to know so that they can improve maternity care for UK families?”  The group has no particular emphasis when it comes to birth plans or feeding choices – the only things we have in common are that we are mothers and we have Facebook accounts.

 What is important to us?  What makes a difference?

• Continuity of Care
• Individualised Care
• Presentation and Provision of Information
• Listening, Respect, Control
• Compassion and Communication
• Collaborative Working
• Postnatal Care
• Breastfeeding Support

 Continuity of Care

This theme was probably the strongest.  Women want to know the people who are delivering their babies, they are unhappy with having to explain their story over and over again and with receiving conflicting advice and opinions from a number of different birth professionals.  Group members talked about building relationships with their midwives, knowing the professionals helping them to give birth and getting to know a small team.  This is currently not the reality, with one mum commenting “I didn't recognise anyone at the birth”.  Some families are choosing homebirth precisely because the homebirth team available is a smaller team and it is more likely that they will know the community midwife who attends their labour.

 Continuity throughout pregnancy, birth and the postnatal period is what women are so keen to experience, but even continuity and consistency whilst in hospital would be a step forward.  One group member explained:

“I feel continuity is a major factor too!  I was on a lot of strong painkillers postnatally and every time there was a new shift they questioned why & wouldn't give them to me until they checked (I was in agony by the time they came around again crying in pain!). Then they’d realise a consultant had ok'd it. I felt like they didn't read notes well & looked at me like I was a druggy! So knowing your patient prior to seeing them could be a good one / better handovers?”

With birth being such a personal and individual experience, and with very few women feeling comfortable discussing their mental and gynaecological health with a stranger, continuity of care can only improve outcomes.  As one woman commented:

“Without continuity it's so hard to build a decent relationship with your midwife, and therefore it's just not easy to be open with them and they with you. I think it's vital for mums.”

 Individualised Care  

As a partner to continuity is the idea of care being provided with the individual in mind.  The current feeling is that there a “boxes” pregnant women are forced into, and once you are in a “box” your care is structured accordingly, with little thought to your individual circumstances, personality, fears and wishes.  An understanding of what is important to that particular family can make a huge difference to their maternity experience.

 “...the midwives there (Ashford Hospital) knew that I was gutted I'd not got my home birth and so they basically recreated a home birth atmosphere for us (dimmed lighting, blankets, left us alone together) it was an altogether lovely experience and didn't feel high risk at all.”

Individualised care is even more important when a family have been told that their baby is seriously ill:

“I didn't fit into any box with my first born due to his antenatally diagnosed exomphalos (and postnatally diagnosed diaphragmatic hernia). Antenatal classes were all relevant but I felt so aloof. Who is giving birth at x? Who is giving birth at y? If complications arise you'll go from x to y so if you want to have a look around y then book that in (then we were shown round hospital x). But poor old me couldn't put my hand up as I was being induced at hospital z. Also in the breastfeeding class, no consideration was given to breastfeeding a baby in NICU. I had to speak to them at the end. And they didn't know much. We didn't fit in. Maybe specific antenatal classes for people in our boat at specialist centres would be better than the ordinary ones?”

Presentation and Provision of Information

Mothers talked about having to seek out information for themselves, and having to ask “am I allowed...?”  Antenatal classes were discussed and it was suggested that they focus more on birth as a normal bodily function and how hormones and environment play their part.

One message that came through strongly was that families would like to be given their birth notes as standard.  It is so important that parents can understand what has happened to them and to their baby.  Finding out that baby was back-to-back, that you had a PPH, that there were complications that made physiological birth unlikely – all of this is important for women and surely it is their right to know these details?

“For me the one thing I'd like to see change is for everyone to be given the option of having a copy of their notes when they are discharged from hospital. In hindsight, I felt like a bit of a failure after the birth and I was so fearful of giving birth again. If I'd known more about what had actually happened I'd have realised that I did blooming well under the circumstances. It was only after support from others on this group that I pushed to get access to my notes and I finally gained a bit more confidence.”

Listening, Respect, Control

Many women discussed feeling as though the midwives had not listened to them – had dismissed their pain, had questioned their stage of labour, even questioning whether their waters had really broken or whether they had wet themselves.  These women felt patronised, belittled and ignored.  There were also examples of women's concerns being dismissed leading to serious health complications for them and their babies.  Feeling as though they are listened to and are in control of their own birth experiences is very important to women. 

“I know both my pregnancies and births were full of complications, but there were still opportunities that I feel were missed, that could have given me more control and allowed me to lead my labours more effectively.”

Compassion and Communication 

The experiences where compassion was lacking were, for me, the hardest to read.  The language used, the way that some women are spoken to, the way that some are treated – at this vulnerable and important time – never ceases to shock me. 

“When I threw up I got told off for not using the sick bowl which was in the bathroom. To clean it up she took the sheet from the bed and swirled it round with her foot and left it all on the floor.”

All women deserve compassion and understanding, but this is never more true than when a woman's notes include the information that she has been a victim of abuse

“The matron I had post-delivery was very damaging - especially as I've been abused and find physical contact difficult. She would literally pinch my nipple into my baby's mouth and leave me not caring when I said it hurt.”

When care HAS been compassionate and communication effective, this is what the family remembers.  Women spoke about their midwife putting them at their ease, being someone they could talk to about anything, being patient and giving hugs and reassurance.

 “I know it’s a day-to-day thing for midwives to see women in labour but it isn't a day-to-day experience being in labour.”

Collaborative Working

There was some discussion of how midwives and consultants work together, and how this can be improved.  Women want to see the knowledge of these two groups combined, rather than used as a tug of war between professions.  What is most concerning is those women who appear to be caught in the middle of professional disagreement:

“My midwife and consultant openly disagreed on my treatment, to the point where the midwife told me she didn't agree with him and he was wrong and she refused to carry out the treatment plan he had recorded on my notes.”

Postnatal Care

Very few women had poor experiences antenatally, but postnatal care is the area most cited as being problematic.  The lack of time that midwives have to help with feeding and to give advice, especially to first time mums who will be anxious about things the midwives might see as “minor”, e.g. how to cope with the cord stub whilst changing nappies.  Many mums felt abandoned postnatally – after all of the preparation for birth, classes and discussions, once baby arrived they were alone. 

Two issues came through strongly:

 ·       The problem of fathers and partners being sent home from postnatal wards

·       The handover between midwives and health visitors

 “On the first night of OUR baby being in the world he had to miss it coz he wasn't allowed to stay.”

“I was solely responsible for baby after going through labour and I needed his support.”

“The handover to health visitors needs to be much slower and more gradual. With my first, I felt I'd barely given birth before I was shunted over to some other service that I had barely heard of and certainly didn't understand. I didn't have any faith in myself and was in no condition to form a trusting relationship with some new random professional.”

Mental health was also discussed, with one mother explaining that the noise on the postnatal ward made it impossible for her to sleep, and this sleep deprivation coupled with anxiety led to postpartum psychosis.  “Someone should have noticed my deterioration and tears.”

Breastfeeding Support

As always, breastfeeding support was said to be lacking.  Families are sent home too soon without a full feed being observed, and are then often readmitted or switch to formula feeding due to weight loss, nipple pain or a lack of understanding of what are normal breastfeeding patterns.

“All I wanted was for someone to just stop and really talk to me and address the issues, someone who ACTUALLY knew what they were talking about in terms of breastfeeding, not someone who was just going to come in to try and patch over the issues and tick me off as job done.”

I hope that these views from a range of geographical areas and different types of women are of use to the National Maternity Review Team.  I hope that ordinary, extraordinary and everyday maternity experiences can help to change childbirth in the UK.

Helen Calvert 2015

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