I was honoured this week to have a guest blog post published on my employer NHS England’s website for all to see! The comments and feedback I have received about the post have been wonderful, and I am sharing it here too for everybody to read. You can visit NHS England to read this and other guest blogs from some very knowledgeable people on some truly fascinating topics. (Please note that all guest blogs, including my own, represent the author’s own views and not necessarily those of NHS England).
I was moved to write the post by the introduction of the NHS Friends and Family Test (FFT) for Maternity Services. This is essentially a little feedback card that new mums would be asked to complete at three points in their maternity care – at around 36 weeks of pregnancy to comment on their antenatal care, before being discharged from hospital or birthing centre regarding their care during labour and immediate postnatal period, and on being transferred from the care of a midwife to that of a health visitor, normally around 10 days after delivery.
The purpose of the FFT is to gain immediate insights into the care women are receiving and act accordingly on any issues raised. My post, however, looks into why it is so important for women to be listened to and have their opinions respected not just after the event, but also during, and the effect that lack of real choice in childbirth can have on the psychological wellbeing of mums.
I hope you enjoy it – and please let me know if you can identify with it. It’s good to talk.
The Optimistic Mum: why choice in maternity care isn’t always an option
This month has seen the launch of the NHS Friends and Family Test (FFT) for maternity services. The FFT is seen as a vital tool for allowing patients a voice to comment on the care they have received, and enabling any issues identified to be acted on quickly. Empowering patients and respecting their opinions is high on the NHS agenda these days, but why is this perhaps even more important when it comes to pregnant women and new mums?
Having a baby is not the same as having an illness; it is a normal human life event which in a low risk pregnancy should allow the woman to enjoy as little medical intervention as possible. That being said, not all pregnancies can be considered low risk, and it is down to the expertise of our midwives and doctors to ensure every woman receives the care appropriate to their circumstances.
Part of the empowerment of patients means offering them choices and involvement in decisions about their care, but all too often for pregnant women, their circumstances mean these choices can be taken away from them.
I had always planned to have my son at my local hospital obstetric unit and was happy with this decision. I wanted to use a birthing pool and as a first time mum I had a wonderfully relaxing (and probably wildly optimistic) birth planned out in my head.
Then at 36 weeks I developed pre-eclampsia.
My water birth went out the window. There would be no natural birth for me and the choices open to me became increasingly diminished. The remainder of my pregnancy was planned out for me and I had to go along with it.
Once I had passed 37 weeks, after almost a week on an antenatal ward, the decision was made to induce my labour. I spent over 24 hours in a curtained cubicle on the induction suite, waiting for a delivery room to become free. I was kept waiting as long as necessary whilst woman after woman in advanced labour jumped the queue ahead of me.
When my time finally came, my clinical circumstances dictated a highly medicalised labour I never really wanted but felt like I had no choice about. I had to have total faith in the staff caring for me – and they were without exception really wonderful and knowledgeable people. Everything progressed so quickly that the only pain relief I was able to have was gas and air. I was confined to a bed with a drip to force my contractions in one arm, a blood pressure cuff on the other, and a foetal monitor strapped across my stomach the entire time. Nobody would choose this.
Pregnancy is exciting and daunting, exhilarating and exhausting, filled with expectation and wrought with confusion. The way a woman is treated throughout it and her perception of her own experience can have a huge psychological effect which can have far-reaching consequences.
Reflecting on my own experience, the latter stages of my pregnancy and particularly my labour were scary events. I felt like I had no control over what was happening to me. Fortunately, my son was born safely and healthy, and we spent four days on a postnatal ward where I received more exemplary care from the supportive staff, preparing me well for going home. However, many women who feel they have had a negative birth experience don’t always move on from it so easily.
It is at this extremely emotional time that women will be asked to complete one part of the maternity FFT and I think the honest and useful feedback to be gained from the answers provided at this time will be a real eye-opener for a lot of maternity units.
If I had been asked my opinion at the time of my son’s birth I might have been highly critical of the lack of shared decision making and personal choice offered to me – but how could I criticise the caring and supportive midwives; the ability of the doctors to prioritise the safe delivery of my baby over my own ideal birth; the valuable help I received from the postnatal nurses to recover after such a stressful and exhausting labour?
I hope that mums won’t shy away from giving valid criticism of their care if necessary but that also they will give credit where it is due and realise that successfully delivering a healthy baby, as I was lucky enough to do, is the outcome that everybody would choose, regardless of how you achieve it. However, maternity providers need to be aware that some mums will need more support and should recognise where this is the case, enabling women to feel optimistic about, not afraid of, future pregnancies.