When childbirth goes badly wrong: one woman’s account

Nilufer Atik has written a striking account of her experience of PTSD after childbirth. Atik was in labour for 53 hours, after which she was given an emergency caesarean.

But it shouldn’t have happened like that. Atik’s labour started with contractions that were “sharp and hard, beginning four minutes apart and lasting between 50 to 90 seconds each time.” The hospital – St George’s in Tooting – told her not to come in because she wasn’t in active labour. She stayed at home in increasing pain for 19 hours until eventually she could stand it no longer. At hospital:

“I was taken to a pre-delivery bay and more torturous hours passed with the contractions increasing in intensity and frequency. I cried out for pain relief and was given the powerful painkiller pethidine four times (most women are only allowed two injections) but it did little to help. With no sleep, food or water, and feeling so exhausted I could barely speak, I became fearful that, if the baby did come, I wouldn’t have the energy to push him out.”

She was eventually given an epidural, followed by a caesarean section when the baby appeared in distress. But the most remarkable part of her story is this:

“Poor Milo was in a bad birthing position with his back against mine and his head hyperextended. It meant not only that my labour was much more painful than it should have been, but I would never have been able to deliver him vaginally. His head was blocking my cervix from dilating, which was why I was having contractions for so long with no progress.”

The time that Atik spent in labour was wasted – physiologically, she wasn’t able to give birth. Why staff at St George’s didn’t realise this is an interesting question, but it may have been to do with the fact that when Atik arrived at the hospital in labour, the maternity ward was extremely busy.

Two weeks ago an NCT survey found that, in the Guardian’s words, “A chronic shortage of midwives across the UK means women in labour are left feeling unsafe and frightened or as if they are being treated ‘like cattle’ or ‘on a conveyor belt’.” It’s not just lack of midwives, it’s a lack of space: one woman even described giving birth on the antenatal ward, because there was no room on the delivery ward.

It’s been said so often that NHS services are at breaking point that perhaps nobody takes it seriously any more. But cases like Atik’s show that the seriousness and the urgency of the problem. When midwives are overworked, the quality of care for women is never going to be good enough. Women will suffer unnecessarily, as Atik did, and may as a result experience physical trauma or psychological trauma that will need treatment later on. Sometimes, babies will die.

 

 

Half of maternity units putting mothers and babies at risk

A story in today’s Mail makes for grim reading.

The paper has analysed inspection reports of the maternity services in 150 hospital trusts. Of those, the

Care Quality Commission (CQC) rated the safety aspect of 65 of those as “requiring improvement” and of 13 as “inadequate”. (The Mail’s report focuses on the safety ratings – the figures for the overall ratings are slightly different, with only eight rated inadequate.)

At those 13 hospitals, women and their babies are receiving poor care that may be putting their lives at risk.

Here’s an excerpt from the CQC’s report on the Addenbrookes maternity unit, carried out in September 2015:

“We found serious concerns regarding the safety arrangements in the maternity services which were not replicated in the gynaecology service. These related to the environment, equipment, lack of recording of risk assessments and substantial midwife shortages. There were continued thematic incidents reported, relating to fetal heart rate (FHR) monitoring, with limited evidence of changes in practice to improve safety. We found that the suitability, safety and maintenance of many types of equipment throughout maternity services were unsuitable.”

It goes on, alarmingly:

“In the birthing unit, the environment was also found to be unsafe owing to poor ventilation whereby high Nitrous Oxide (gas and air) levels exceeded the safe “Work Exposure Level” (WEL) which the trust had known about since 2013. In maternity, numerous and essential patient risk assessments including venous thromboembolism (VTE) and early warning score (EWS) assessments were not being completed. Staff raised concerns to us that the maternity record system was potentially unsafe due to a combination of electronic and paper records being in use and being used inconsistently.”

Most of these problems could be put right with proper staffing: the NHS urgently needs more midwives and obstetricians. But we also need to look at the cultural attitudes towards safety in the NHS. There is no good reason for not acting on the poor ventilation at Addenbrooke’s, or for the failure, reported by the CQC, to log incidents correctly at Wexham Park Hospital: “Incidents were not always being reported and there were accusations of improper downgrading of their severity alongside suggestions of defensive practice.”

The recent Cumberlege Review made important recommendations on safety. But this has happened before (not least in the RCOG’s Safer Childbirth report in 2007), and nothing has changed. At Morecambe Bay, 11 babies, and one mother, died unnecessarily over a nine-year period. Judging from the evidence of the CQC, we may be seeing yet more tragedies like Morecambe Bay.