Posts Tagged "NHS"

Musings on a Hospital Stay

Posted by cafebebemama on Nov 30, 2011 in Bebe, Blogger Love, Motherhood, NaBloPoMo | 8 comments

Last week I spent 6 1/2 days in our local hospital in preparation for the delivery of our gorgeous Sam. Until last week, I had never spent any time in hospital other than for the labour/delivery of Ella 3 1/2 years ago. Thankfully, Peterborough City Hospital is only just one year old. The hospital itself is HUGE! I checked in to Maternity Inpatients where they look after pre-labour situations, inductions and post-delivery patients. When I was transported from delivery theatre and recovery back to Maternity Inpatients I ended up slightly car sick thanks to the length of the journey!

I do have to commend Peterborough City Hospital staff, however. My stay in hospital was as pleasant as it could have possibly been. The meals were decent with plenty of gluten-free options and rather yummy puds. The wards were quite large with free televisions (albeit only terrestrial channels) and I can’t fault the cleanliness. When a patient left, within minutes there were several members of the cleaning crew who stripped the bedding, cleaned thoroughly around the bay and left a clean and ready bed in their wake.

In my pre-delivery days, I didn’t cause much trouble for the midwives/staff. Because there wasn’t much wrong with me I was pretty much left on my own which had it’s pros and cons. However, if I needed anything I only had to press my buzzer and someone came very quickly. My stay in the old Peterborough District Hospital was no where near as pleasant, that’s for sure. NHS money has been very well spent in Peterborough City Hospital. I never want to spend any time there again, however, as it’s just not fun to stay in any hospital. Unless it’s The Portland Hospital. I have a feeling it’s pretty fun to stay there.

One of the BEST parts of my stay at hospital was that after leaving recovery, I was transferred back to the Maternity Inpatients ward to fulfill the rest of my stay. Single rooms are available at Peterborough City Hospital (at a cost of £80/day) and I was prepared to pay that to enjoy a bit of peace and quiet. I enquired about that and they informed me that as I had just come out of a planned/emergency c-section, they would want me closest to the midwife station which was not a single room. As I was wheeled into place I found that I was the only person in the 4 bay ward. Another patient was brought in mid-morning on Friday but due to her baby having jaundice, they transferred her and her baby to another ward. I remained the ONLY person in my 4 bed ward for the remainder of my stay! Simply brilliant. I didn’t have to worry about anyone else, feel self-conscious or worry about waking anyone. This was certainly unusual but effectively, I ended up with a “single room” for FREE! Not a bad arrangement.

As I had plenty of time to muse on my hospital stay, I found I learned several things about myself during my 6 1/2 days at Peterborough City Hospital:

• Daytime Telly SUCKS! Particularly daytime terrestrial telly. When you have Freeview channels to distract you can at least count on a bit of music or reality cheese but when your only choices are ITV’s Daybreak, Jeremy Kyle or The Hairy Bikers, television loses its ability to distract pretty quickly. I am pleased to report that I have totally caught up on Neighbours and Home & Away, however. Thank goodness.
• Hospital beds, despite being able to raise and lower, are pretty uncomfortable and the pillows are not terribly sleep-inducing. If you’re spending any length of time in hospital, bring your own pillow. I only thought of this with one day to remain at hospital which was hardly worth it.
• Bring your phone charger! Your mobile will become your lifeline, particularly if you don’t get a lot of visitors. I know some hospitals restrict or even prohibit mobile usage, but if you are permitted, be sure to bring your charger, check your data plan and update any apps and/or music you might find useful and distracting.
• I have been reminded that I am a HORRIBLE beaky-boo! The patient who was in the bay next to me was struggling with gestational diabetes, was not eating and was refusing to take her medication at 34 weeks pregnant. No one came to visit her AT ALL. Any time a midwife and/or social services worker came to visit her to discuss her situation I would become Queen of the Beaky Boos, turn down the volume on my telly and eavesdrop on the conversation. It was far better distraction than the telly, that’s for sure. Wonder if she’s still there??
• I really need to learn how to SHOUT when I am upset, frustrated or fed up. I was so very lonely during my stay with very few visitors which was understandable considering people were working. I felt like I was an after-thought a lot of the time on the ward before we had Sam. I was so quiet and undemanding that I think I was forgotten most of the time. If you want answers to questions, you have to shout. Hospital staff are run off their feet. They don’t have time for much of anything so obviously their priority are the patients who need more attention. If you want to be heard, you have to learn how to SHOUT.

I will be writing up our Birth Story very soon where I will share more about my exceptionally positive and entirely different c-section experience compared to Ella’s. But I wanted to give credit where credit is due. Peterborough City Hospital was a wonderful place in which to be cared for even though I didn’t want to be there. They took good care of me and brought Sam safely into the world. On behalf of myself, my husband and my daughter and son, I would like to thank the staff at Peterborough City Hospital and the NHS.

Antenatal Care- What’s Normal?

Posted by cafebebemama on Aug 18, 2011 in Blogging, Motherhood | 10 comments

Yes, I’m at it again. Comparing apples to oranges and wondering about maternity services on all side of the pond and what’s “normal”. Of course, normal is questionable as well, isn’t it? What’s normal for one person is completely abnormal to another. What’s necessary for many may not be necessary for all. It’s hard work to come up with the perfect, Utopian package for maternity care but there are some interesting differences wherever you look.

We all know I am American but I have not had the pleasure of having a baby in the US of A. As most of us know, there is no National Health Care currently in the US. This means that anyone needing medical care of any kind either has to foot the bill themselves or work for an employer who in part or in most will cover the cost of monthly insurance premiums. There is a plethora of private health insurance companies who all have different plans, costs and coverages. On some US health insurance plans, certain aspects of pregnancy/labour/delivery may not be covered. It is then the burden of the individual to pay for those uncovered charges. This is very difficult for many Americans who may possibly end up in debt after unplanned medical expenses.

I am exceptionally grateful that the UK provides us with the NHS. Free medical care for all regardless of income or condition?! Free prescriptions for a year for pregnant women? Free prescriptions for all children until the age of 16? Free contraception? This is a miracle! The US is desperately hoping for a miracle of it’s own.

The other day, I started thinking about my antenatal care for this, my 2nd, pregnancy. It hasn’t been ideal but it hasn’t been horrific either. But what I did realise is that, at 24 weeks pregnant, I have only seen my community midwife TWICE. I won’t see my midwife (whom I really don’t even know and who won’t deliver my baby) again until 28 weeks of pregnancy. So that means, once for the booking in appointment (8 weeks) and once at 16 weeks. That’s it. I have had a Dating Scan in there (11 weeks), an appointment with the consultant at 17 weeks (due to having risk factors with this pregnancy) and an anatomy/anomaly scan at 20 weeks. However, I have not had any antenatal checks since that 16 week appointment. Maybe I’m crazy, but doesn’t that seem a bit off? I know that I am a relatively healthy person but still. Seeing your midwife TWO times in 28 weeks? I don’t know…it just seems too little.

I decided to compare and contrast the standard US “prenatal” care with the NHS standard ante-natal care and UK Private Insurance ante-natal care. Here’s what I found:

• US Pre-Natal Care: 1 appointment with Ob/Gyn or Midwife every 4 weeks until 28 weeks (7 appts); an appointment every two weeks from 28-36 weeks (4 appts); an appointment every week from 36-41 weeks (5); an appointment every few days until delivery = Total (avg) of 16 appointments until close to delivery (also have Dating Scan at 11-13 weeks, Anatomy Scan at 20 weeks; Growth Scan at 32 weeks + multiple blood tests throughout the pregnancy)
• NHS 1st Pregnancy: Booking in appointment with Midwife at 6-8 weeks; 12 week Dating Scan; 14 week bloods; 18 week midwife visit; 20 week Anatomy Scan; visits with midwife at 24, 28, 30, 32, 34, 36, 38, 40, 41 = Total of 11 visits with midwife
• NHS 2nd Pregnancy: Booking in appointment with Midwife at 6-8 weeks; 12 week Dating Scan; 16 week visit with midwife; 20 week Anatomy Scan; visits with midwife at 28, 34, 36, 38, 41 = Total of 7 visits with midwife
• Private Health Care (BUPA- UK): Booking in appointment with midwife/consultant before 10 weeks; 10-13 weeks Dating Scan; Blood Tests for Genetic abnormalities 11-14 weeks; 20 week Anatomy Scan; 28-32 weeks Growth Scan; Midwife Visits at 23, 27, 30, 34, 36, 37, 38, 39, 40, 41 weeks = Total of 11 visits with midwife (The Portland Hospital offers 14 antenatal visits plus scans at 12 weeks, 20 weeks and 32 weeks)
• Of course, these various comparisons are based on a low-risk, healthy pregnancy. No matter where you are, if you fall into a higher-risk category (multiples, health problems for mum/foetus, other risk factors), you would of course receive the additional support and care that was required whether that be through a midwife, consultant, ob/gyn or GP.

Obviously, in the US you’re paying for the care you receive and if you choose to go private in the UK (as long as private will cover your pregnancy care which it doesn’t always), you will be paying for the care you receive. What I don’t understand is why, on the NHS, is a first pregnancy one standard of care and a second pregnancy an entirely different standard of care? So if you’ve already “been there, done that” you don’t need to have the same amount of time with medical professionals? Yes, I know that provided you are a healthy woman with low risk you generally won’t need a lot of “intervention” the second time around. But shouldn’t you have the same access if you want it? Every pregnancy is different. You may have different symptoms and/or difficulties associated with a second pregnancy. You may have more stress and challenges the second time around as you’re already looking after one child. Maybe the “breeze” that was your first pregnancy won’t be the same with your second?

Yes, in most cases, you can ring up your midwife and speak to them over the phone about your concerns or even schedule an “unauthorised” appointment to talk about any niggles. But it seems to me that regardless of 1st or 9th pregnancy, you should be provided with the same standard of care unless you choose to opt out of it. What do you think? Did you feel that your antenatal visits were pointless and unnecessary? Would you have appreciated more time with your midwife? Did your community midwife (the one you saw for antenatal visits) attend to you for labour and delivery as well? Were you fortunate enough to have a medical problem diagnosed and thus treated as a result of your antenatal visits?

**Due to previous displeasure with me bringing up the topic of antenatal care on the NHS, I would like to reiterate that I am eternally grateful for the NHS care which has been afforded me and my family and for which I have not had to pay out of pocket although I have contributed to through my taxes and NI contributions as a result of being gainfully employed in the UK for more than a few years. I am not criticising the NHS but QUESTIONING the services which are provided to us which any tax-paying resident is entitled to do.**

***I would also like to acknowledge that the NHS provides midwife visits for several weeks IN THE HOME immediately following delivery of your baby and a Health Visitor will continue to see you IN THE HOME until you both feel that you are fully prepared to be discharged to your local surgery. This would NEVER happen in the US. Once you leave hospital with your baby in the US you’re on your own. The NHS scores mega-points with this highly beneficial service.***

In Praise of Midwives

Posted by cafebebemama on Jul 27, 2011 in Motherhood | 4 comments

It’s no secret that I’ve been critical of MY experience with the NHS in this, my second pregnancy. I’ve been frustrated, let down and disappointed with the lack of interest or attention to me, particularly as it is my second pregnancy. But this has been MY experience in MY corner of the Shires in England. It has been suggested to me that I don’t deserve to criticise the NHS and/or Midwives because a) I’m American, b) It’s the NHS, it’s free so shut up already, and c) All of the above. However, I am of the firm belief that if something isn’t right, whether it be with medical care or another life issue, you need to stand up for yourself and get the resolution you deserve.

After my frustrations with my midwife care, I rang my local surgery, found out who I needed to speak to so I could register a complaint and did so. I spoke, at lenth, with the Community Midwife Manager for my area, explained my issues, frustrations and anger and was listened to. She was most apologetic and assured me that steps would be taken to further educate the midwives in my area. She promised me that she would follow up on some of my queries and she did! I then received almost daily communication from my midwife, updating me on the test results that I was eagerly anticipating (it took 9 of the 10 days to get the results).

Due to one of the two midwives at our surgery being signed off with illness, my surgery has been the recipient of “locum” midwives travelling from Grantham to assist the midwife at our surgery with appointments. I was due to see one of the visiting midwives at my 16 week appointment but my midwife made sure that I would see HER and not a visiting midwife. They were obviously trying to meet my needs and I was very appreciative of that effort. Mind you, I won’t see my midwife again until I am 28 weeks along due to the difference in midwife visits in a second pregnancy (7 visits in 2nd pregnancies versus 10 visits in 1st pregnancies). That seems a long time to go without monitoring, in my humble opinion, but if something became troublesome, I could ring and speak to a midwife at either my surgery or my local hospital.

I would like to say, however, in all of the palavar that has come from me bringing up my difficulties, I am most appreciative of the NHS and Midwives in the UK. It is free, it is accessible, it is here to serve EVERYONE no matter your ability to afford it. We are lucky and I consider myself part of that “we”; I have contributed financially to this country and have entered and remained in this country through all of the legal (and financial) channels necessary. I cannot afford private health insurance so I am indeed grateful that my family and myself are cared for despite that.

Being a midwife in the NHS is not easy. I have spoken to midwives who spent 20+ years in the NHS. After having to spend too many years telling their patients, “I’m sorry” because they couldn’t give the time they needed or the services they deserved they felt forced to leave the NHS to be able to do the job they so loved. Midwives in the UK are well educated and trained but can be restricted by lack of funding and government cuts. In England, according to a recent Panorama documentary, there is 1 midwife for every 33 births which is 5 more births/women than the government recommended 1 midwife to 28 births. There is a midwife shortage in the UK and England in particular which has led to a decrease in services provided and, some may suggest, dangerous situations taking place daily in NHS hospitals.

“One Born Every 40 Seconds” was a very interesting study into the state of midwifery in the UK. The programme discovered documents that showed that the deaths of 17 women in London in the last 18 months could have been avoided with proper maternity care. I watched this programme with a great deal of interest as I’ve brought up issues about maternity services and care on this blog. I’m not pointing a finger at midwives as they are simply doing the best job they can given the resources available to them. However, I think we, as a nation, need to seriously look into the state of midwife care in the UK to ensure that every woman gets the care that they rightfully deserve. Women shouldn’t have to be privileged or re-mortgage their house to afford efficient and effective maternity care. Midwives know this. Perhaps the government needs to listen more carefully?

When I gave birth to Ella, the midwife care we received was seemless. We went through 2 shift changes in our 24+ hours of labour and delivery however, we were only left alone on a few occasions and were attended to by a senior midwife and student midwife for the entire labour and delivery. I did not know any of the midwives who attended our labour and delivery but they were all attentive and kind and took very good care of me. The labour and delivery themselves were not pleasant but I do not fault the medical professionals for this. I am eternally grateful for the thorough care which we received through delivery of our precious daughter. I am hopeful that the second time around things will be a bit less traumatic but again, have faith in the midwife staff at our local hospital. They are to be commended for their efforts on a daily basis. I only hope that the government can see fit to listen to the women who are raising their voices and find a way to provide even better maternity care to its residents.

Not too posh to push at The Portland

Posted by cafebebemama on Jul 18, 2011 in Blogging, Motherhood | 16 comments

On 7 July I was part of a select group of BritMums bloggers who were invited to The Portland Hospital to learn more about their Maternity and Paediatric Services. Being 19 weeks pregnant and having had more than my fair share of antenatal frustrations with the NHS this time around, I was more than a little curious to learn more about the “infamous” Portland Hospital.

What did I know of The Portland before attending this blogger event? Well, I knew that celebrities and people with loads of money went to The Portland to have their babies. I had heard that most of the deliveries at The Portland were c-sections for celebs who were “too posh to push”. I thought that The Portland was inaccessible for patients like me.

Let me tell you…I was wrong! For instance, did you know that The Portland has an extensive Midwife-Led Unit which takes women through their antenatal care and has a tag-line of “An Empowering Choice”? The Midwife Led service empowers women by working in partnership with women and their partners, offering evidence based choices on all aspects of care, individualises care according to need, proactively supports women’s choices and enables women by becoming their advocates.

The Portland Hospital’s Midwife Led Delivery Service is carried out by a team of 6 dedicated midwives who provide continuity of care, compassion, support and clinical expertise throughout pregnancy, labour, birth and the postnatal period. The Portand midwives carry out antenatal care and classes for all women as well as labour and delivery care for established mothers. The midwives also provide full back up of medical and obstetric staff if a problem occurs during pregnancy, labour or the postnatal period including 24 hours access to advice and support. In addition to a very flexible appointment schedule, The Portland Midwives also run active birth workshops and hypnobirthing training for the MANY who are most definitely not too posh to push at The Portland.

When I listened to Midwife Stella (@MidwifeStella on Twitter) and Midwife Sian at our presentation on 7 July, I was very nearly tearful over the amazing standards of care that are provided for pregnant women at The Portland. EVERY WOMAN should have this standard of care. Midwife Stella had been an NHS midwife for 20+years and loved every moment of her time as an NHS Midwife. But stretched budgets and cuts in funding made her job as an NHS midwife very challenging indeed. She chose to become a midwife at The Portland to be able to give her patients the care they deserved. This is a sad statement about the NHS. Wonderfully trained, caring and competent midwives are being forced to leave the NHS which just perpetuates the vicious cycle of lower standards of antenatal and maternal care in the UK.

I related the story of a good friend who, in an NHS hospital, had demanded to have an epidural, as is her right. She was put off a multitude of times by the midwives until it was too late. When I told Midwife Stella about this she replied with one word: RESOURCES. More than likely, there would have only been one (possibly) trainee/resident anaesthetist for the whole of the hospital. Giving epidurals is low on the importance scales when only one anaesthetist is available for any and all emergencies. More than likely the midwives had no choice but to try to convince the mother-to-be that she should wait for the epidural because the anaesthetist was not available. Due to NHS funding cuts the hospitals are struggling to provide the services that patients should have because they simply don’t have the resources to cope.

Yes, at The Portland, you are paying for what you get. And you do get THE BEST. As you should. If I had thought about it properly I would have started saving for The Portland two years ago. Would you like to know what antenatal services you are given when you pay for The Portland?

• 14+ Antenatal appointments (NHS- 1st pregnancy=10 visits/ 2nd pregnancy=7 visits)
• All routine blood tests
• Three Ultrasound Scans: a) The combined test at 12 weeks; b) The Anatomy Scan at 20 weeks; c) The Growth Scan at 32 weeks
• Active Birth Workshops and Hypnobirthing Classes
• 1-1 Debriefing and Counselling sessions for PTSD
• Access to complementary therapies at The Portand Hospital
• Referral pathway to other medical personnel if required- Consultant Obstetricians, Anaesthetists, Fetal Medicine Consultants
• Newborn examination by the Resident Paediatrician
• Averages costs for all antenatal + delivery care (first 48 hours including delivery) in midwife led unit range between £7,250-9,250 + supplemental costs depending on individual situations/labour & delivery circumstances

This is what every woman should have. In this, my second pregnancy, I had an appointment at 8 weeks for my “booking in”. My next appointment with the midwives was not until 16 weeks. Inbetween those appointments I had my “combined test” scan and blood tests at 12 weeks. Due to shoddy admin I never received an appointment for my consultant referral (due to risk factors) until I called and got my own appointment on 4 July (17 weeks). We have our 20 week anatomy scan this Wednesday and then I will not see another medical professional of any sort until 15 September when I am 28 weeks pregnant. My next appointment with the consultant is not until 36 weeks (9 November). This is antenatal care on the NHS. I don’t pay for it. I know there is a trade off but particularly when a woman is pregnant for the 2nd time, why should they receive any less care as a first-time pregnant mother? Surely we all deserve the same amount of time and care from our midwives but it seems that the NHS thinks not. Been there, done that…apparently?!

I’ve carried on too long but will be blogging more about our visit to The Portland. Perhaps paying for medical care is not such a bad idea after all? What are your thoughts? If you could afford it, would you pay for antenatal care at The Portland?

I leave you with a sneak peek of one of the rooms at The Portland and the Nursery where babies are cared for (and taken during the night so Mummies can get some rest).

*The Portland paid for our travel to London in addition to treating us to a wonderful 3-course lunch and goody bag upon leaving. The words, sentiments and wishes of this post are mine and mine alone.*

Labour & Delivery: My Choice

Posted by cafebebemama on Jul 13, 2011 in Motherhood | 16 comments

The birth of my first child, Ella, was not a pleasant one. Thankfully there was not one thing wrong with Ella and she never stressed or suffered a bit. Unlike her Mummy. Ella was nearly 2 weeks overdue. We were scheduled for induction on Sunday 1 June, 2008. Ella was born Tuesday 3 June, 2008 by emergency c-section at 1:50am after induction, Syntocinon, Epidural x many and failure to progress at 3cm. Following her delivery I lost 1.5litres of blood and was left weak, pale and fairly miserable.

The outcome was perfectly safe and healthy for Ella. The outcome for me was not. It was a thoroughly miserable experience, the whole of my labour and delivery, and is one that I look back on through partially closed eyes. I don’t like to talk about it; I don’t really like to think about it. The only bright spot was when they pulled Ella from me (which I couldn’t see) and I heard a quiet cry and they said “It’s a GIRL!” That was the one bright spot. The rest was horrible.

Before being induced with waves of Syntocinon in the early afternoon of 2 June, 2008, I was offered an Epidural. I chose that for my pain relief but unfortunately the epidural was “patchy” which left me with partial feeling down the right side of my body. I couldn’t feel the full force of contractions but I could feel pain and was ridiculously uncomfortable for the duration. The midwives continued to top up my epidural and then attempted to get the epidural to flow to the right side of my body by turning me slightly to the right so the epidural could “drift”. Fun. I was uncomfortable, couldn’t find a suitable position in which to be propped up (I couldn’t lay down because of the epidural) and couldn’t rest at all. The epidural and Syntocinon drip began around 1:00pm. Ella wasn’t delivered until 1:50am. I was chock-a-block of drugs for 12 hours. No wonder I was a mess.

For a long time after Ella’s birth I didn’t want to talk about what I had gone through. I still don’t like to share my “war story” but I have found a few women who went through similar situations which is slightly comforting. We didn’t necessarily plan to have a 2nd child but from the moment I knew I was pregnant with this baby, I’ve been fretting over what this labour and delivery experience might be like. I know that there’s every possibility that this labour and delivery will be entirely different. I’m not willing to take that gamble however.

I’m fully aware of the risks of a repeat c-section. I’m also fully aware of the risks of trying for a VBAC and “failing” and ending up in the same situation (if not worse) as last time. It’s my choice. I WANT an elective c-section. I want to know when this baby is going to be born so I can prepare Ella, our family and myself. I want to be calm about this delivery. I want it to be a positive experience where I am in control and am fully prepared for everything. I think the risks and side-effects will be less horrific if the delivery is a calm and cool one and not an “emergency” situation. Is this not my right on the NHS? I’m not “too posh to push”. I want an elective c-section because I feel it will be a far safer option for me and for my baby. I am choosing this.

I knew that my chances of getting an elective c-section were slim when I went for my referral appointment with the consultant on 4 July. The NHS hospitals like to keep their “natural birth rates” low. Peterborough City Hospital is no exception. When I sat in the appointment with my consultant, she shared with me, when I mentioned the desire for high natural birth rates, that Peterborough has one of the highest natural birth rates in the area. Woo hoo. Shall we throw a party?

I persevered, however. I pled my case. I related my first labour and delivery experiences. I mentioned all of the risks that I knew were possible. I told her that I had fully researched and was educated about the risks and after-effects of a repeat c-section. I related my feelings about such a negative first labour and delivery. I told her that I wanted a positive birth experience for what will be my final birth experience. I didn’t cry…I was prepared, educated and firm in my decision.

She agreed with me. But…she didn’t schedule me for an elective c-section YET. I will have an appointment with her at 36 weeks (9 November…God that seems a long way away) where we will again talk about where I am and how I feel. I will hopefully get a scheduled date then. I do not want to wait until I go into labour naturally. I want to be in control. Maybe I’m nuts. Maybe it would be entirely different. But this is what I want and I feel that I am entitled to get what I want. I will never have the perfect, Utopian, midwife-led birth that everyone dreams of. Because of my previous c-section and additional risk factors, if I go into labour on my own, I will immediately go to the monitored midwife unit where I’ll be strapped up to every monitor under the sun to make sure nothing goes wrong with this delivery. Previous experience tells me that intervention and me don’t mix.

I’ve carried on far too long here but I feel the need to get this out. What are your thoughts? Should women have a choice in how they labour and deliver? Why should the NHS have a say in your personal labour and delivery experience? What experience did you have and did it affect your subsequent deliveries? Feel free to share…