"Paediatrician care"

I gave birth to my baby in May. I had an excellent birth experience and was under the care of midwives and nurses only. Unfortunately my baby ‘breathed up’ the first night they were born and on investigation the next morning it was found that they had raised CRP (~13 I believe). I’m impressed and thankful with the care team for being diligent to investigate this and find out that there was something going on in my baby's bloods.

That day we were introduced to the paediatrician on the ward who would explain the findings and treatment/management options. Mind you, I laboured through the night for 12 hours 48 hours before this, and obviously didn’t sleep very much the first night with my newborn. Anyway, it was explained to us that my baby's CRP level was borderline for any intervention and we could adopt a wait and see approach or start IV antibiotics straight away.

We told the doctor we were happy to leave the decision in their hands and they are the doctor. This doctor told us about their senior positions and some other titles. A wait and see approach was adopted but the next day our baby's CRP jumped up to 54 so they were then started on IVABs. The days that followed were stressful and confusing and frankly awful for the baby, myself, and my husband.

Nursing staff were surprised at the management from the paediatrician and at least two practitioners said that they’d never seen a CRP level of 13 go down on its own before, I.e. would usually always be treated straight away. This, plus some googling about what different levels of CRP indicate, caused me to be angry and upset about my baby's care.I felt that the paediatrician had essentially chosen to experiment on my baby, even though that was probably not the case.

I do believe any other doctor would probably have advised to start treatment straight away. I was not prepared for the inconsistency in staff opinion on the ward. I believe the delay in treatment probably lead to a longer hospital stay for my baby and I, they needed antibiotics for 4 days to bring their CRP level under 10.

5 days after I had given birth we were met on the ward by the same paediatrician and two junior doctors to discuss where things were at. My husband and another relative were also present. I sat quietly with an unsmiling expression while listening to the doctor explain about my baby's blood cultures and summary of management so far. I believe the doctor picked up that I looked angry and asked why. Given the opportunity I explained that I was disappointed with my baby's care and I tried to explain why.

I felt that there was no benefit in delaying antibiotics and a proper risk-benefit analysis wasn’t done. It seemed to me that the doctor took offence to this and started, in my opinion, arguing with me. At one point I said something along the lines of “staying in hospital for so long and having a sick baby has been so stressful I could cry but I’m trying to stay calm,” to which I recall the doctor replied go ahead and cry then.

I recall the doctor also said at one point that they felt threatened for their safety, which to me felt like clear gaslighting because I was sitting on the bed and they were standing a few meters away with the junior doctors by their side and we were just talking, not even with raised voices. My husband spoke up at this point and moved the conversation on to ask about what was next for our baby as the doctor was happy for our baby to be discharged. We wanted to know whether or not our baby should continue to take antibiotics as this was suggested as an option. We were confused because the doctor said our baby could go home without oral ABs or they could write a script for them to take some. We kept asking what did the doctor think we should do, what is the best thing for our baby, and I recall they said directly, I don’t care.

Eventually we understood what the doctor was saying about my baby's blood cultures coming up with no bacteria - I.e. there is nothing to treat. But there was no explanation offered for why their CRP levels were high and jumped up without treatment initially. 

I did apologise to the doctor for offending them (by being disappointed with the management) because I’m sure they're generally amazing at their job and has probably saved countless lives, but the clinical decision making in my baby's case was questionable to me, and then the way I felt treated as a disgruntled patient was awful. I don’t believe a sleep-deprived first-time mother who is expressing dissatisfaction about her baby's care should be treated that way. In my opinion, this consultant seemed defensive, argumentative, and lacked empathy. Even though my critique could have been more gracious I was proud of standing up for myself and my baby and staying in control of my emotions.

In the weeks after this I thought to myself that the culture between consultants, doctors in training, and the rest of the medical team must be pretty appalling based on my experience. If some nurses thought my baby should have been treated straight away, how on earth would they be able to challenge that consultant’s opinion? How will care ever be optimised with that kind of culture?