"My birth at FBC/KEMH and follow up care"

I had an uncomplicated pregnancy which ended in a complicated birth and postpartum experience. My care was via the Family Birth Centre at KEMH, although during my birth I was transferred to the main hospital due to lack of progress. I enjoyed this model of care and could not fault the knowledge of the midwives I saw, I never had to wait long for appointments either. I was a little disappointed that when my primary midwife was on leave for several of our appointments, in her absence we saw a different midwife each time. I would have hoped when a primary midwife is not available the person filling in is consistent, so I did not entirely get the continuity of care experience I had hoped for, but understand sometimes these things are unavoidable. Given my labour was long, I went through multiple midwives shifts on the day and ended with FBC midwife Shardalee, who we thankfully knew, delivering our baby. I was really grateful at how the transfer to the main hospital was handled, I felt reassured and cared for.

After an episiotomy, forceps delivery, 3a tear and shoulder dystocia the recovery was very challenging in a way I wasn't prepared for after expecting a straightforward physiological birth. The extensive care and attentiveness from all of the doctors, midwives and allied health professionals during my hospital admission were very thorough, and I found almost everyone to be concerned and kind. Dr Clifford seemed to do an excellent job with my 3a tear repair as the tear healed well despite later dehiscence of my episiotomy.

My only complaint during my initial hospital admission was how my pain relief was managed at times. I found that there was limited information about what pain relief I could ask for, at what doses or what frequency. I found on some shifts I had to constantly ask for pain medication and that it didn't seem to come often enough or stay on top of things in a manageable way. I found getting out of bed to get my baby or go to the bathroom excruciating. I didn't sleep during most of my hospital admission as I just couldn't find a comfortable position that didn't hurt me. I experienced some unhelpful comments like "some pain is expected" when expressing my concerns that the pain relief wasn't adequate, as if I expected to be in no pain at all. I'm not sure that the level of pain I was experiencing was fully understood or taken seriously. When trying to change positions or get out of bed I was often in tears - it was worse than my labour which had been unmedicated until I was 9cm dilated. It seemed that many midwives on shift understood I had a 3a tear, but not how complicated it was and that there was also a significant degree of pain from the shoulder dystocia manoeuvres. There were also times I asked for pain relief, and it took 30 minutes or more to arrive, during which time the pain just became more and more unbearable. I was relieved to be discharged so I could return home and take pain relief as needed. I am sure this is no individual midwives fault and that they were simply very busy, but it did add to the trauma and I would encourage the hospital to ensure wards are adequately staffed so midwives can respond to patient requests in a timely manner. Despite the policy that partners are generally not able to stay overnight, we were supported for my husband to stay as I was not coping during this time with the level of pain and trauma after my birth experience, so this was very appreciated.

After being discharged, I found the care and debrief from Shardalee at home over the following days very valuable.

I then experienced further complications when my episiotomy wound broke down and was infected, then reopened a second time after restitching. Over several weeks and multiple admissions I was taken care of by many doctors, but in particular Dr Mathias and Dr Allison who were so compassionate and reassuring. I am grateful for Dr Marthia's knowledge and Dr Allison's kind demeanor. I also appreciate that my husband was able to be with me on the day surgery ward and we were given a breast pump so I didn't have to worry about my breastfed baby while going back for my repair. There was a comment made by a staff member on the day surgery ward that we should keep our baby quiet/avoid drawing attention to her as some patients were on the ward for miscarriages or abortions, which I appreciate and felt very compassionate towards but it seemed inappropriate to make this our responsibility. I imagine a better system would be for those with sensitive concerns to be given more privacy so they aren't confronted by babies in a difficult time.

The follow up on my wound concerns was tricky at times, as the only way to seek review was via the emergency department which often meant lengthy waits with my newborn in tow, so I'd also give the feedback that there could be a better process for ongoing wound follow up/infection concerns rather than waiting at emergency, otherwise ideally a much shorter wait if this is the only pathway.

I can't fault the expertise of all staff at the FBC and KEMH and felt overall I was very well cared for. I can only imagine that the few concerns I had could be addressed by additional staffing/support for staff or some changes to policy.