"Birth of my child and the care provided while in hospital"

My waters broke (SROM – spontaneous rupture of membranes) and active labour did not commence immediately.

Approximately 12 hours after my water broke, due to some reduced movement, I phoned my CMP (Community Midwifery Program) midwife. We discussed the situation and it was recommended that I go into KEMH to be checked by the MFAU (Maternal Fetal Assessment Unit). I expressed concern that if I went into KEMH, even if my baby was healthy, the hospital wouldn’t allow me to go home to attempt to bring on spontaneous labour. My midwife contacted KEMH and discussed my situation and called me back a short time later. I was told that a consultant had agreed that I could return home as my midwife had arranged antibiotics which would be administered by my midwife at 24 hours post SROM to ensure no infection. I understood from my midwife that the consultant wanted it noted that they were reluctant, but were agreeing. Reassured, I headed into KEMH.

Upon arrival at KEMH I was put in a very small room, was seen, and the assessment showed that all was well. I said I would like to return home. By that stage, the consultant had changed and I was informed this would no longer be possible as the new consultant did not agree with the previous consultant’s decision. I did not understand what had changed to mean that the home birth I had been looking forward to would no longer be able to proceed. I expressed my strong preference that I return home and it was explained to me by MFAU midwives that if I return home it would be against medical advice etc. I asked what this meant for my ability to birth and be cared for under the CMP program. The hospital staff were dismissive and said they didn’t know. I felt this response was not good enough as the CMP program sits under KEMH and hospital staff should have found out as it was pertinent to my decision to decline or accept a recommended intervention. My CMP midwife had previously told me not to discharge against medical advice so I acquiesced, and stayed in hospital. As it was late by that stage I did not want to phone my CMP midwife. I was very disappointed that when I attempted to express my viewpoints and preferences that it was required to be filtered via the midwives as the consultant was too busy to speak with me in person.

MFAU midwives explained to me that as my baby was healthy there was no reason for me to be in MFAU and tried to transfer me to the Labour and Birth department. I was told that Labour and Birth department didn’t want me as I wasn’t in active labour so they refused to admit me. I was essentially in limbo. By this stage, I was feeling very disconcerted and unsettled.

I was then asked to commence taking antibiotics due to the SROM without the commencement of active labour. I had previously discussed these antibiotics with my midwife and expressed that I wanted these to commence at 24 hours post SROM if active labour had not commenced. This arrangement was not agreeable to the new consultant. I was then informed by an MFAU midwife that the consultant also wanted me to be induced immediately. I was very, very concerned by this development and explained that I did not want to be induced and that I understood that KEMH’s own policies are for induction at 24 hours post SROM and I asked what had changed in my situation or how was I different that warranted the different approach? There was no explanation other than it was the consultant’s preference. That response did not satisfy me enough to deter from the existing plan and to go against KEMH’s own policies (as had been explained to me). I felt pushed to make a decision without sufficient information. I mentioned that usually I would discuss interventions with my CMP midwife whom I had continuity of care with and was told this was not necessary as a consultant had given advice. I didn’t feel that my preference for continuity of care was understood or respected. I felt that I had no other option but to phone my CMP midwife (quite late at night) to ask for more information and advice on my situation as hospital staff had been unable to provide this. I was frustrated and concerned that my seemingly simple questions could not be answered. Following a discussion with my CMP midwife and between my CMP midwife and the consultant it was agreed that the induction would not commence immediately but again the consultant wanted it noted it was their preference and this was not in line with advice. I was told the consultant was quite insistent on the antibiotics. My CMP midwife explained that I had the right to decline the antibiotics but if I did so it would be highly likely that I would be kept in hospital for quite a few days post birth to monitor for infection. I reluctantly agreed to have the antibiotics administered. I did not feel that when querying hospital staff directly my options (including when pressed on my options to decline) were appropriately explained.

At 2am an MFAU midwife checked in on me (I was still in the very small room at this point) and said that Labour and Birth would not be taking me that night so I would stay in MFAU. I was frustrated that after being admitted to the hospital at approximately 9pm and MFAU had finished their assessments at approximately 10.30pm that it wasn’t until 2am that I was informed where I would be spending the night so I could settle in and go to sleep. I felt very unsettled and did not feel that this was conducive to the spontaneous onset of labour that I hoped would occur.

The following morning MFAU informed me that Labour and Birth still were declining to admit me and didn’t want me as I wasn’t in active labour. I spoke with my CMP midwife on the phone and she recommended that I go for a walk around the hospital to attempt to commence active labour. I asked the MFAU midwife if I was able to go for a walk around the hospital and was told that they would seek permission for me to do so. This was a bit concerning, as my antenatal classes had talked about walking around the hospital as being a good thing to do during labour to move the baby into the right position. I felt stuck in the small MFAU room and explained that I was quite happy to go home and be under the care of my CMP midwife. A short while later I was informed that I had permission to walk around the hospital.

Shortly before 11am, I was admitted to Labour and Birth. Shortly after being admitted a midwife explained that I needed to have a stretch and sweep to attempt to commence active labour and if that wasn’t successful I would need to be induced. I wasn’t clear on whether I was able to decline this intervention and felt that I had no option but to agree. I felt frustrated that I had been in the room for less than 30 minutes to settle in and hadn’t had much chance to bring on spontaneous active labour.

Following the commencement of active labour, the labour wasn’t adequately progressing and I was asked to sign a waiver or consent form of some kind with no real explanation. I was in no capacity to read the form by that stage and was unable to even sign with my preferred hand. No copy of the form was provided, so to this day, I have no real idea of what I apparently consented to. Given that my husband and next of kin was present I feel that it should have been explained to one or both of us and it would have been appropriate to have been given a copy.

A doctor explained to me that the baby’s heart rate was dropping and we needed to get the baby out quickly. After being told this I was very, very concerned for the health and safety for my baby. I felt panicked and very scared for my baby. After the birth when I was in recovery I spoke to a ward midwife about it and I said that my baby’s heart rate had dropped during labour. The ward midwife responded that it was normal, as babies' heart rates always drop during contractions. I have no idea if the extent of his heart rate dropping was normal or was actually a cause for concern or if at any point my baby’s health and safety was in question. I would recommend that when someone is being transferred to theatre for an emergency delivery, if the doctors are confident the baby will be delivered safely more reassurance is provided during a highly stressful moment. As a minimum, medical professionals should watch their language to avoid panicking the mother.

The attending obstetrician was excellent. They were very calming and quietly and efficiently took control of the room. They ensured that we didn’t have lots of different people firing questions at us constantly (which took some pressure off) and would direct people as to when they could query things. My obstetrician treated me like a person, didn’t have a pre-prepared spiel and spoke to us like people. Nearly every other medical professional that I dealt with would talk about me as the mother and they wouldn’t use my name. My obstetrician called myself and my husband by name which we greatly appreciated.

Following my child’s birth, I don’t feel that the communication with me or my husband was adequate. Particularly when KEMH started having health concerns, the degree of the concern was not adequately conveyed to my husband and I. 24 hours following my child’s birth I was informed by a paediatrician that my child would be transferred to Princess Margaret Hospital. I stated that I had not consented to this and queried why this was necessary and asked if I able to decline. The paediatrician told me I was not able to decline this and it was a requirement. Another doctor overheard this exchange and quietly told my husband that we can choose to decline. I continued to query why the transfer was necessary and why the services couldn’t be carried out at KEMH. The paediatrician couldn’t answer my questions and had to get someone else to explain it to my husband and I.

My child was admitted to PMH (the NICU – Neonatal Intensive Care Unit – treated my child to an exceptional standard) and was transferred back to KEMH the following day. Upon admittance to KEMH, my child was in the SCN (Special Care Nursery). I was informed that my child would need to be bottle-fed every 3 hours. I expressed my intention to establish breastfeeding and requested that I be allowed to finger feed or cup feed my child. These feeding options were recommended during antenatal breastfeeding classes run by KEMH’s parent education. I was told this was not allowed even though I was performing all my child’s ‘cares’.

During my stay at KEMH, I was provided with expressing equipment but the flange sizes that I was provided was far too large which as a first-time mother I was not aware of. Multiple midwives whom assisted me did not pick this up. I would strongly recommend that as a hospital that supports breastfeeding, more training is provided to enable midwives to adequately support mothers who are having difficulties establishing breastfeeding for whatever reason and need to express. Expressing information was not provided (such as the importance of hand compressions and heat during pumping, etc.) which resulted in my expressing efforts being inefficient.

Two specific CMP midwives provided incredible support to my husband, myself and my child. It isn’t enough to say these ladies went above and beyond as it doesn’t adequately explain the extensive degree of emotional, medical and other support provided. When my child was admitted to NICU it was the hardest experience of my life. One of the CMP midwives personally drove from her home to KEMH to assist me with my child being transferred during her evening and was incredibly kind and generous with her time and support. They are both a credit to their profession and my family will always be incredibly grateful for their support. I think it is very important to note that although I gave birth in a theatre surrounded by medical professionals, and my child was cared for by NICU, SCN, etc., that if anything the complications meant that I needed the personal support of known midwives more than ever. When we started having difficulties, having the ability to pick up the phone and speak to someone who knew my husband and I that we trusted was completely invaluable.

Key recommendations

•    CMP program more heavily promoted and encouraged, as support from a known and trusted caregiver is invaluable, especially if the mother experiences difficulties.

•    More breastfeeding training made available to midwives, particularly in effective expressing techniques.

•    Updated antenatal class information – if cup feeding and finger feeding is not allowed in the SCN, this should be made clearer during antenatal classes to avoid mother’s getting their hopes up.

•    Interventions such as induction and stretch and sweep are not pushed upon vulnerable mothers, which was what I believe occurred in my case.

•    Any waivers, declarations required to be signed should be properly explained to the mother OR support person if appropriate. A copy of the document should be provided.

•    Medical professionals should be recommended to use the mother and father’s actual names. Being called ‘the mother’ in my presence made me feel unvalued as an individual person and I felt like I was on an assembly line, so to speak.

•    Families whose children are admitted to NICU or SCN are offered counselling services. This can be a very traumatic and difficult time and the health system should value assisting families with this.