Background
Methods
Age | Women in sample |
---|---|
<20 | 6 |
20-29 | 7 |
30-39 | 7 |
40+ | 2 |
Ethnicity | |
White (British, Irish, European) | 12 |
Black and minority ethnic (British, Asian, African, Caribbean, Latin American) | 10 |
Parity | |
Primiparous | 18 |
Multiparous | 4 |
Interviewee (pseudonym) | Reason for step up in care (as defined by midwives caring for the women) |
---|---|
Alice | Transfer in due to meconium stained liquor |
Belinda | Transfer into hospital as baby cold on delivery |
Carol | Meconium stained liquor, high blood pressure, undiagnosed breach, caesarean section |
Daphne | Induction of labour |
Edith | Home birth, bleed post partum. 3rd degree tear |
Georgia | Induction as late, long labour, ventouse delivery |
Helen | Unattended birth |
Irene | Baby born quickly on arrival to hospital |
Jo | Crash section, Forceps delivery |
Kate | Trying for vaginal birth after caesarean section, emergency caesarean section |
Lucy | Induction, long labour, ventouse delivery |
Mary | Induction, ventouse delivery, episiotomy, bowel and bladder problems |
Natasha | Breech, failed attempted to turn baby, needed caesarean section |
Olive | Vulval haematoma |
Petra | Ruptured uterus |
Queenie | Difficult delivery, 3rd degree tear |
Rachel | Neonatal death |
Sam | Induction, caesarean section |
Tracy | Post-partum haemorrhage |
Ursula | Midwife unable to hear baby’s heart beat, transfer in |
Violet | Failure to progress, caesarean section |
Wendy | Transfer in for 3rd degree tear |
Theme | Sub-theme |
---|---|
Becoming informed | Multiple sources |
Professional encounters | |
Being a responsible user | |
Cultural, age and language considerations | |
Feeling safe or unsafe and securing help | Vulnerability due to condition |
Relational trust | |
Resources and strategies | |
Professional knows best | |
Family members role in escalating care | |
The legacy of acute perinatal events for women and their trust in institutions | Sense making |
Betrayal |
Results
Becoming informed
Multiple sources
‘I got in touch with friends who had babies here.[..] I asked [the midwife] some questions when I wasn’t quite sure. I read about everything, online or in books because I wanted to prepare, so I was prepared for the worst, you know, just what can happen’ [Helen]
‘I looked at a range of data sources rather than by looking at one single source. Not being a medical professional I’m not really in a position to judge authoritativeness, but I’d look at Wikipedia, at something from a US hospital, something from the UK. I didn’t look into it in great detail but I looked into it in enough detail to feel reassured [Jon, partner of Edith]
‘I remember the NCT lady saying, ‘When you’re in that waiting room, don’t be polite. If you feel like people are not paying attention to you, don’t allow this to happen. Make a fuss, go back to reception and re-announce your presence.’ [James, partner of Queenie]
Professional encounters
‘I love my GP, but he was very quickly nothing to do with the pregnancy. I was put into a midwife system, and the meetings were very perfunctory. It was just, test your urine, test your blood pressure, and fill in the form and book your next appointment for the scan. It felt like it was the bare minimum… of… plotting points’ (Georgia)
‘I do think that if I hadn’t been the kind of person who looks things up… I wouldn’t have been nearly as well-informed… there were lots of things that I discovered from the internet or books that I didn’t find out from the midwives that I saw. The antenatal visits were… quite short and brief, and business like’ (Edith)
Researcher: Did the midwives check with you that you knew about certain things?Interviewee: [Hesitantly] N-no. No. Um… I’m trying to think of an example, but… Um… I was generally pretty healthy, and… I had all, I had the symptoms of pregnancy [Edith]
‘This is what my midwife was telling me every antenatal … clinic, “the moment you go into labour, you have to come to the hospital”, you need to be monitored, you need to see them … if we see the scar is opening we have to rush you to … theatre, we have to remove the baby, and for yourself as well.’
Being a responsible patient
‘With all my questions I felt a bit bad because I saw that there were more people waiting, and seeing people waiting outside and knowing that the midwives were only there two days a week, I felt bad having this list of questions to ask and taking up more time.’ [Wendy]
‘I’d pretty much seen the same midwife, but she had no recollection of me. There wasn’t any… sense of… oh this is my midwife who’s seeing me through. But I didn’t expect that, because you don’t get that on the NHS. And I didn’t really need it. As long as my questions can be answered and someone’s responding, and making sure there’s no oversight of medical difficulties, I didn’t need to be hand-held’.
Cultural, age and language considerations
‘I had antenatal lessons but they didn’t really help. The way they talk about the pain to what it was, was really different. I think that in young people’s cases they should have special lessons, like a course or something that when you are going to give birth they explain more in details to young people ‘cause we don’t know. Some of us don’t even know how we got pregnant’. [Jo]
‘I wasn’t here, first day, so for my wife it was bit tough that day’ [Steve, partner of Carol]
‘All night long before I don’t sleep. I don’t know who is coming, not my language, will I be handed questions I don’t know? [But this midwife B called this translator]. With translator on the phone, she is very good, all very quick, a lot question I understand, like about me, am I sick, about heart, about family’ [Carol].
Feeling safe or unsafe and securing help
Vulnerability due to condition
‘In my mind I was like “oh my God I am going to die what is wrong with me”, there were so many people in theatre cause I heard them bringing in some machines. I lost so much blood [..] One of the midwives started crying, I didn’t mind cause I couldn’t cry, she was doing it for me’. [Olive]
‘I was really exhausted but had just given birth, I put this down to the fact that I’d pushed hard for a long time. I was feeling fairly out of it but nobody seemed alarmed by it. I remember saying, ‘Oh I feel like I’m in the room but not in the room,’ but… I’ve never given birth before so I didn’t know that that was unusual’ [Tracy]
Relational trust
‘I didn’t have any time hardly where the midwife wasn’t with me. I’d got in the ambulance, by the time she’d got in the lift it was literally five minutes, when we did get [to the hospital] I was very dependent on [midwife, C], I found that, because I knew her as well, she kept me so calm and very focused’ [Alice]
‘The midwife was really good. She used to check me all the time, if the baby was OK, if I was OK. She was really good and friendly to me, all my family liked her, she helped me a lot. If I get pregnant again I’ll call her. She was there for me’ [Belinda]
‘I went into [my birth] experience with total trust and confidence in my midwife. I don’t say you couldn’t have built that up with someone that you’d just met, but because she was part of the caseload team I went with everything that she suggested. The fact that I felt part of this trusted community set-up gave me extra trust and confidence, and also meant that during the complications, I felt less scared because she was there’ [Tracy]
‘I passed out and woke up sitting up with tubes and stuff sticking out of my hand. [..]The midwives made sure I knew what was going on, they made sure I was comfortable and they listened to me as well, that was important and the fact that they were there the whole time’ [Lucy]
Resources and strategies
‘The ambulance people were here, ‘What’s the problem?’ I say, ‘I’m overdue, I’ve seen blood, and I have a scar which needs monitoring. So I need to go to the hospital.’ They said, ‘We can’t take you to the hospital, call the hospital while we are still here, talk to them, let us hear what they are saying.’ I called the hospital and the midwife said, ‘don’t worry, put some water in the bath tub and make a cup of tea and sit in there.’ I said, ‘I was told that the moment I go into labour I should come to the hospital, I need to be monitored.’ The midwife told me, ‘OK, let the ambulance people bring you over to the hospital’.
‘The ambulance people gave my notes to the [labour ward] receptionist. I waited. I’m in pain. After some time I was like, God, it’s another hour nobody has come to see me, what’s happening? I talked to the receptionist. I told her, ‘Look, I was brought here by ambulance, I’m in pain, I’m overdue, and I have a scar which needs monitoring.’ She told me, ‘You see those two ladies stood there? They came before you.’ I couldn’t understand what was going on. Those ladies were heavily pregnant but they were not in pain, they were stood with their partners, there I was down on the floor’
‘We got to the reception desk and the receptionist said, ‘I need the notes.’ Her attitude was just terrible. Obviously in the rush to get me out, the notes had fallen [out of the bag]. My husband hadn’t noticed. She wouldn’t let us in without the notes’ [Rachel]
The professional knows best
‘[We had been sent home]. The midwife had said it takes at least ten hours because every centimetre takes an hour. And then the pain was getting different, I was bleeding like slimy blood, and my partner called the hospital and they were like, ‘Oh that’s still OK, she doesn’t need to come in yet’. He didn’t challenge this because we trusted them and it wasn’t even… near ten hours’ [Helen].
‘My water colour change. Then I call. And the midwife said, ‘what colour is it?’ I say, ‘It’s green’ She said ‘Wait for me, I’m coming nine-thirty’. This for us strange because what I read, when you have this colour you must straightaway go to hospital. And… and the midwife says, ‘No, wait, like four, after four hours I am coming.’ And we scared, oh my God, what? Four hours? This is too long’ [Carol]
‘I had never had a baby, I don’t know anything. I was thinking like they have been delivering babies for long time so they know what they are doing’ [Mary]
‘I knew most of my waters went … they just said “no your waters is fine”. I was saying “yes some my waters have gone, I told you” what could I do? They didn’t believe me, I had no choice’ [Kate]
‘After my birth a midwife said they should move me back into the hot room and I’m like ‘I am not moving because I was numb from the neck all the way down and my baby was crying and he was hot’, and then we got into a big argument and then she said “what do I know about kids after all I am young” so I just felt really judged … when.. my foster carer wasn’t there and my sister was gone’ [Jo]
‘We felt that the same person didn’t see the baby, Patrick, twice; and for completely understandable reasons they didn’t come when we were told they would. After 72 hours we were told that we might have to stay a bit longer. We felt that Patrick was actually going to be fine at home, and we would know enough to ring up the hospital ourselves. I remember indicating very strongly that… we were going to go home and the doctor was… fine about it in the end’ [Jon, partner of Edith]
‘Being a first-time mum I knew there was something not right but I didn’t want to be one of them ones to run straight up to A&E. So I rang NHS Direct and a nurse rung me back, I put the phone up to the baby, you could hear her rattling, she was gasping for breath really badly. The nurse said, ‘It just sounds like she’s got the snuffles.’ I said, ‘But it’s not.’ The GP said, ‘She’s got the snuffles, there’s nothing wrong with her’. It was no help to me whatsoever, so I carried on keeping her cool … it got to half six in the morning and we said, ‘Look, something’s not right, we need to go to the hospital’
Family members’ role in escalating care
‘There was not enough [staff] to help you, they left you for hours. You could press the buzzer and no one would come… I was breaking down and needing help and no one was there to support me or help me. My husband was home with our other son’ [Kate]
‘I kept on asking the midwives [about the vulval swelling] and they were like “it is fine, it is fine.” [..] ‘My mum was getting quite worried, “this is not right I have never seen this”. The doctors were like “yeah, it is normal.” And then one of my Aunties came, she looked at it and said “Oh my god your uterus is going to explode.” I was so scared. At that time they weren’t giving me antibiotics or tablets for the swelling. It was only after my Auntie and my mom complained to them that they started to give me antibiotics and everything’ [Olive]
The legacy of acute perinatal events for women and their trust in institutions
Sense making
‘At the time you’re so grateful to get out of it alive that you don’t think, why did nobody pick up for two hours that I was having an internal haemorrhage? Should they have picked up my blood pressure perhaps a bit more? A bit earlier? It ended up that I ended up losing three litres of blood so that’s seven pints of blood’ [Tracy]
‘It’s hard to say, because I’m not in the medical profession myself, I don’t know whether there was more time they could have given my baby in hospital. Or maybe she could have got a bit more of a health check when she came out of hospital. Or maybe when the midwife come round, check her out a little bit more thoroughly. I’m just thinking… if I knew that there was, you know, there was something wrong with the child I was quite surprised how no one else, didn’t pick up on it, you know? [Alice]
A sense of betrayal
‘The midwife said to me [the ventouse delivery] would help me push cause I couldn’t push […] But, afterwards I was like why did you say “yes” cause the cut was really bad and I wasn’t happy with it. My back passage.. if I have to open my bowels, I have to stay there for two hours waiting and they say “you can not push”. But it is fine. My baby is fine and I am fine’ [Mary]
‘I was just so embarrassed that I was so wet, my shoes were squelching, I was making so much noise, and they were watching me. Yet this is a caring profession, they should have jumped up and helped me’ [Rachel]
‘Didn’t I look like someone who is in pain? I don’t know. Did the receptionist want some money from me? I don’t know. I just ask questions and I have to answer them … by myself… Was I supposed to tell the ambulance, ‘Look, don’t leave me here, take me to another hospital’? I don’t think so. I don’t know’ [Petra]
‘[The midwife] should have picked up the urgency at home, that things were moving quickly, and even if she didn’t believe me she should have worked with me, she should have listened to me, and she should have placated my fears by checking me when I got in there, by examining me when I was asking her to. She’s… working with me to deliver a baby, we’re supposed to be a team, she’s not supposed to be telling me what to do and telling me when I’m wrong’ [Rachel]
‘[Now] even the people who are qualified do their jobs, I don’t trust them, even if I go to the GP [..] I don’t think he’s doing the right thing on me’ [Petra]