I would have just gone quietly...

AIMS Journal, 2012, Vol 24 No 1

Holly Lyne shares her birth and complaint story

Nearly three years ago my first child was born. I planned a home birth and felt I was really prepared for an amazing experience. I didn't hire a doula because I, naively, believed that, being as prepared as I was and as well informed as I was, I wouldn't need one.

I was wrong.

My son's birth ended up being in theatre by caesarean section at Bradford Royal Infirmary for 'failure to progress', despite the fact that I clearly stated on my birth preferences that I would not consent to a caesarean for this reason. I also stated that I would not consent to amniotomy or vaginal examinations unless medically indicated.

When my community midwife arrived at my home we were both thrilled; she had been almost as excited about my birth plans as I was and I was so happy that she was going to be with me through it. However, almost the first thing out of her mouth was, 'I know you said in your birth plan that you don't want internals, but we have to do one every four hours.' I groaned in response and then consented. I believed I did not have a choice.

The very first examination suggested that my baby was malpositioned, he was facing my right hip. Did my midwife encourage me to stay mobile? Only vaguely. Did she suggest that I climb the stairs sideways? Nope. Did she suggest I perform figure of eight with my hips on my birth ball? No.

She allowed me to labour hard with virtually no support all day, all the while desperate for the relief of my birth pool, which I was told I was 'not allowed' to get into yet as I wasn't yet in active labour. I completely forgot about the TENS machine I had borrowed and, despite walking in circuits around my house for hours on end, my baby remained persistently OT and I became increasingly exhausted, as from the very first contraction at 6am, they were at least every five minutes and intense enough for me to not be able to speak through them.

I count that very long latent phase as labour. It still counts, it was still hard work and it should have been performing an important

function – to get my baby into a good position and get my body ready to birth him.

My 'amazing' community midwife finished her shift and left me with the on-call midwife, whom I had never met before. It was only days after the birth that I found out that this new midwife had only ever attended one home birth before.

I finally reached the golden '4cm' at about 9pm, after about 15 hours of contractions. My amniotic sac was still intact and I hadn't even had a show.

I was 'allowed' to labour in my pool, though the lack of a waterproof sonicaid meant that I was frequently told to stand up or get into uncomfortable positions for the midwife to listen to my baby's heart rate.

After several hours in the pool I asked for the entonox and began to feel the urge to push. Everyone started to get excited and we all believed that we would be meeting the baby soon. It didn't seem unreasonable to me that I might have gone from 4 to 10 cm in 5 hours, except for the fact that the midwives knew that my baby was malpositioned. Should they have taken that into consideration?

Then came the moment that changed everything. The midwife told me that she 'had to' do another routine internal and that I needed to get out of the pool.

Who knows if this disrupted what was genuinely the second stage or not, but I struggled to my bed and was examined only to be told that I was still only 4cm, after several hours. I know now that it is possible that my cervix could have closed up at the intrusion, but I think it is more likely that I had a premature pushing urge due to the baby being malpositioned. Either way, this examination changed the entire course of my labour. It was disheartening, to say the least, to have made so little progress despite all of the hard work and it was so easy for me to say yes when she offered to break my waters. I had no one there to remind me that I didn't want that intervention, no one to remind me of the risks, because you can bet your life that the midwife didn't bother to cover them.

When her face fell I knew what she was going to say, meconium. I was prepared for this one. I was over 42 weeks and I knew that thin meconium staining was not something to worry about and I told her this. I stood my ground when she insisted we transfer. I stood my ground when she scurried from the room to call her supervisor for advice. I stood my ground when she told me that my baby's heart rate had been slightly elevated for the last few readings – I wonder why she didn't mention this right away? I insisted that her and the second midwife, who had been there in the background throughout the night, monitor the heart rate more frequently for a while.

But I couldn't keep standing my ground when she turned to my husband and said 'She is putting your baby's life in danger, we need to take her in.'

When I saw his reaction, and that of my mother, who was also in the room, what else could I do?

From this point on, it's a familiar story. The torturous ride in the ambulance ramping up my adrenaline levels, halting labour. Pushy labour ward staff who tried to insert a routine cannula and give me an epidural without my consent (my husband physically stood between me and the pushy doctor to stop her from proceeding against my will), being repeatedly, but subtly, told how useless my body was and that I 'needed' their help.

The midwife who cared for us for most of the day and stayed on after the end of her shift in order to come to theatre with us, made us believe that she was on our side. We had a good rapport and I trusted her. She actually criticised the decision to break my waters, stating that she wouldn't have done that at 4cm.

But she was one of the people persuading us that my body wasn't up to the task and, lo and behold, 12 hours after arriving at hospital I was signing the consent form for surgery.

They deliberately ground me down, crushed my belief in myself and my baby, threatened my husband, made us afraid and manipulated us to believe that we were giving informed consent to every intervention under the sun, when really they had decided on the course my labour would take as soon as we arrived and were just nudging me along the path they wanted me to take.

I got a copy of my notes a few months later. There is a wonderful page in there, written by the midwife who took over our care when we arrived at hospital, stating that 'I also explained to Holly and Andrew that I am in no way coersing [sic] them into anything they do not want'. It doesn't take a genius to read between those lines. Obviously myself and my husband expressed concerns to her that we were being manipulated and she denied it, then promptly wrote that line in my notes to cover herself. She soon went off shift and handed us over to the 'nice' midwife who was so 'helpful'.

In the cold hard light of day, when I was struggling to breastfeed my sleepy son who didn't feel like he was mine, I slowly came to realise what they had done to us.

So I initiated the complaints process.

I got the standard reply; the letter said that they were 'sorry that [I felt] that way' and that they understood how 'disappointing' the birth must have been for me. They informed me that they had gone over my notes and that everything they did was correct according to their protocols. Well that's all right then.

I wrote back and told them that this 'apology' wasn't good enough, that they couldn't apologise for my feelings, only for what they had done, and that I wasn't going away until I got that genuine apology. That is really all I wanted and I reassured them of this; I stated that I had no intention of taking legal action: after all, no actual, measurable harm had come to me or my baby [sic] so no court would hear the case anyway.

After a few more unsatisfactory letters from the hospital, who finally admitted their position – that as my baby was malpositioned there was no way he would have been born vaginally – I took it to the Health Services Ombudsman, who, predictably, took the hospital's side in the matter. The hospital didn't do anything wrong, according to my notes.

In my final letter to the hospital I stated that their assertion that a vaginal birth would have been impossible was a self-fulfilling prophecy, that by the staff having that attitude I was correct in stating that I was not fully supported to give birth. They knew that unless my baby moved I would end up in theatre and they did nothing to help me get him to move; they simply pushed me down the path to surgery. I also made the point of letting the hospital know about the Cochrane Review that states 'Routine amniotomy is not recommended for normally progressing labours or in labours which have become prolonged', but I never got a response to that letter.

If they had just apologised I would have just walked away.

But they didn't.

So I joined a campaign group, Airedale Mums, to try to help make sure that this abuse stops and I told my story to the press, a lot.

The heart of my complaint has always been that aside from the emotional blackmail and attempts to assault me, it was the very protocols that they hide behind that led me to my caesarean section. Routine vaginal examinations are pointless at the best of times, but when the information gathered from them isn't even acted upon then what is the point at all? Medical procedures to speed up labour have no place in most births and should absolutely be kept out of the home. If my midwives had kept their hands out of me and encouraged me when my labour was long, instead of offering inappropriate interventions, then my birth story and early motherhood may have been dramatically different.

I would like to acknowledge that in the last three years, great improvements have been made at Bradford Royal Infirmary thanks to the efforts of Consultant Midwife, Alison Brown, and her senior colleagues. Normal birth is high on the agenda. Their induction and caesarean section rates have come down and they are developing a new midwife-led unit.

My second baby was born by repeat caesarean on 28 January this year. I chose to hire an independent midwife and plan a home birth; however when the birth needed help we transferred to Bradford Royal Infirmary. The staff at BRI were extremely respectful of my wishes and facilitated a lotus caesarean birth with very few reservations expressed. I'd like to thank the NHS team for their care and I acknowledge just how far the unit has come since my first son's birth. I trust that women without the watchful care of an independent midwife also receive the same standard of care from the staff at BRI.

The AIMS committee would like to extend huge congratulations to our Social Networking Officer, Holly, and her family Andy, Jack and Alfie. We were delighted to hear that care during Alfie’s birth was a vast improvement on her previous experience. We wish Holly and her family well.