"Staffing ratios, burnout and poor patient outcomes"

I want to share my recent experience of giving birth at King Edward Memorial Hospital (KEMH) in Perth, WA. As the only tertiary maternity hospital in the state, I understand KEMH manages all the complex/high-risk pregnancies, in addition to an existing local catchment. My pregnancy was considered low-risk, but I live in the catchment area.

From the very beginning of my journey, I was deeply impressed with the level of written and verbal education provided to support my pregnancy. I felt it had already far surpassed anything offered in the private maternity sector, that I know of. The midwives, AINs, and GP/Obstetrician I saw in the Orange Team were warm, funny, professional, and very knowledgeable. The online antenatal, breastfeeding, and physiotherapy classes were free as I held a Medicare card. I found the classes were easy to locate on the KEMH website and book via Eventbrite.

It was decided between the lovely Dr Nina (Orange Team GP) and myself that for health reasons I would be induced at 39wks +2days. I was excited. The day rolled around, I was induced, moved into active labour, and received an epidural from the Anaesthetics Team. For emerging health reasons for my baby and I, it became apparent that the safest option was to move away from a vaginal delivery, toward the caesarean option. At this point I would like to acknowledge Sue, Jasmine, Praise, Ella (Midwifery Student), the bevvy of green-scrubbed doctors, and the Anaesthetic Team (Kelly and Declan), for guiding me through the induction to caesarean. I felt so cared for and safe through this entire process.

My baby was born in the afternoon the following day via caesarean. After a short stint in recovery, I returned to Ward 5 Obstetrics to convalesce and begin to discover my baby. I was advised to not get out of bed until later in the evening until the effects of the epidural had worn off. It was an incredibly hot night, and the air-conditioning was malfunctioning. I had my baby in my arms, had run out of water, and was overheating. I pressed the call bell for assistance to move my baby back into the bassinet and source water. It took 40 minutes for the call to be answered.

I will note that once the Midwife arrived the care was excellent. She sourced me a free-standing fan, water, provided reassurance on my baby’s temperature, took my obs, and soothed my baby. While waiting for the midwife, I could hear multiple staff assist call bells going off, I believe a sign of medical concern that stems from staff. It was apparent to me that this was a busy night on the ward, and the current staff were seemingly  working incredibly hard to meet the needs of all mothers and babies in their care.

As a consequence of the caesarean, I had an in-dwelling catheter (IDC) inserted to assist with voiding my bladder. The IDC was removed and a ‘trial of void’ was commenced, where I had four hours for my body to return sensation to the bladder, and have an unassisted void (a normal wee). The IDC was removed at in the early morning. From this time, I had a relentless amount of hospital staff visiting, to the point where I could not find the time to eat my breakfast until almost 3 hours later. The care was thorough and I very much appreciated it, but it was overwhelming and by that time I had called my partner, overwhelmed and crying, asking him to come in earlier than planned.

I had building pain at my surgical scar and pressed the call bell to request pain relief. It took one hour for the pain relief to arrive. In this time, I had tried twice to void my bladder unsuccessfully but was limited by the acute pain at my scar. Growing increasingly anxious and tearful, I left the room to physically flag down a Midwife, to tell them I could not void my bladder. By this point the four hour window had lapsed, the consequence being re-insertion of the IDC for a further seven days. From here, it took a further hour for two staff members to be available to re-insert the IDC. By this point, I was in agony. I had retained 1600ml of urine (for context, the average bladder holds 300-600ml at a time).

I sustained a completely preventable bladder stretch injury and faced returning home as a new, first-time mother, with the burden of managing a catheter bag. It has been a massive adjustment returning home with a newborn, managing my post-surgical pain, catheter bag, and establishing a breastfeeding regime. This is not the start I had wanted to my life as a new mum.

I am not writing this extended Care Opinion piece to point blame at any individual. I am taking this time out of being a new mother, as I think it important to share my experience. I see an incredibly dedicated team of health professionals at KEMH, working within an environment that I believe is setting them up for burnout.

I don’t think any health professional would feel good about indirectly contributing to my injury, or not being able to answer a new mum’s call for help for forty minutes, or delaying pain relief for one hour. I believe the staff to patient ratios on those busy nights is not enough, and appears incredibly stressful for staff.

I believe both wards are propped up by individuals consistently going above and beyond their role, to seemingly cover for the gaps at an operational level, which is not sustainable. Unfortunately, I understand the current method of recording patient clinical incidences via DATIX CIMS form requires a diligient individual to stay, often times after their working day has finished, to fill in the form. I don’t see much of an incentive to highlight a clinical incident if it contributed to an already intense working day, and effected little change, as the above issues I hold with my time at KEMH appear to be stemming from an operational level and decisions made by management/people who I understand have not held a clinical caseload.