Postpartum aggravation

AIMS Journal 2013, Vol 25, No 2

Alicja Piotrowska describes her experiences of postnatal intervention

We found out we were having our first baby in September 2010. I was a healthy 23 year old, and my partner and I felt very happy and relaxed about it. We both wanted a natural home birthwith no stress and minimal intervention. We felt confident that everything was going to be fine and trusted in birth as a natural process.

During the pregnancy I chose to decline ultrasound scans and doppler to detect fetal heart. I was Rhesus negative while my partner’s blood group was positive, andI chose to decline Anti-D injections during the pregnancy, accepting only the one at 72 hours post-partum. I had no other health risks.

Our midwife was one of, if not the, most oversubscribed midwives in Leeds, with a caseload of over 100. She was very detached in her interaction with me; she couldn’t remember who I was over the phone and got my name wrong. When my partner came in to an appointment with me she didn’t acknowledge him at all: basically we felt she couldn’t care less. We employed a doula, went to NCT antenatal classes and did a lot of birth-related research. Because we were unhappy with our midwife, our doula arranged for us to meet up with the manager of the midwives towards the end of the pregnancy to discuss our situation and birth plan. After meeting with her, we agreed for her to replace our previous midwife for the remainder of the pregnancy.

On 3 May 2011, I went into labour, and from 12am until just after 4.30am I was in active labour, waiting for the midwives to arrive to check my progress so I could push.

The midwives arrived at our house at 4.10am, came upstairs at 4.30am and our daughter Rosa-Maria was born at 5.00am after only 20 minutes of pushing. At 05:15 the placenta was delivered, a cord sample taken in order to check for antibodies as I hadn’t received the Anti-D injection and my partner and I went to bed with our baby, where basic checks of my temperature and blood pressure, along with temperature and weight of baby were done.

We were very tired and very happy.

In terms of my experience of labour and birth, I had a great time. I was very vocal and relaxed and enjoyed the whole process, although I couldn’t understand why the midwives took so long to come up and tell me how dilated I was. The midwives seemed very unsure of what was happening and very uncertain of themselves and the situation. In the birth notes they have written, ‘can hear screams upstairs.’ We read the birth notes after the birth and noticed they had circled me as ‘High Risk’, and had called the maternity supervisor before going upstairs tosee me, she had advised them to document everything – still not sure why they thought I was high risk – perhaps because I had had no scans, and because my baby was back to back (potentially) and it was at our house. The midwives stayed in the background as I birthed Rosa and my partner caught her. The birth itself was a very positive experience, I felt no stress and the moment that Rosa-Maria was born was a very happy one.

What happened over the next three days changed the experience of a good birth into one of harassment and anxiety.

We went to sleep after the birth of Rosa-Maria and basic checks at 7am. At 9am we received a voicemailsaying the sample taken from the cord had shown a raised result so we needed to go into the hospital to have some more blood tests done on Rosa-Maria to check SRB (bilirubin) levels. At 10am our new midwifeand manager of midwives called to tell us the situation again, that we needed to go in to make sure Rosa-Maria didn’t need treatment. We asked whether the blood tests could be performed at home, as we were very tired and needed rest; we were told that the blood tests must be done at the hospital as the SRB needed to be intravenous and only a paediatrician could perform the test.

We told the midwife we would go into hospital in a bit; we needed to eat and sleep first, as we’d been up all night. We then slept. At 3:36pm we got another call from her, now exerting more pressure on us, talking about the worst-case scenario, that Rosa could get brain damage, that we must go in straightaway. We asked her for more details regarding the condition of haemolytic disease of the newborn, and we noted that Rosa was not symptomatic at all, being very pink and looking in perfect health. We repeated that we would go in, but within reasonable time; we were not going to rush in after having been up all night. I could see and feel that Rosa was fine and that the test was a routine one. We spoke to the hospital to get more information and again they threatened us with the worst-case scenario, and mentioned calling social ser vices if we didn’t go in. At no point had we said we wouldn’t go in. At 6pm we arranged for our doula to pick us up to take us to hospital; we arrived at 7.30pm, where there was no sense of emergency. We saw the paediatrician who performed some checks on Rosa, taking three heel-prick tests – no intravenous test – and asked us to wait an hour for the results. We decided to go home and wait for the results by phone.

No one offered me the Anti-D injection.

We got home and at 10pm we went to bed, exhausted, after eating, and at 10:40pm we received a call from the paediatrician giving us the all-clear on the bilirubin levels. We turned our phones on silent and settled for the night.Soon after this, at 11:17pm, there was a missed call from the paediatrician, this time with results from the other blood tests (PCV – packed cell volume), saying the results were raised and they wanted us to come back in immediately for further tests, this time intravenous. We were asleep and missed the call.

At about 3am there was loud banging on the door downstairs, repeatedly. This sound made my stomach turn. Rosa was not even 24 hours old and it was our first night together. We were completely exhausted and did not answer the door, and after several series of continued, loud bangs it stopped. It completely unsettled all of us and Rosa was crying throughout the night; none of us could settle. At 7:30am we found a note from a different midwife who had been sent by the neonatal consultant, telling us we must go to the hospital at the latest by 7am to perform more tests on Rosa and at9:41am the midwifery manager left a voicemail telling us we must go in for more tests as the results were ‘quite abnormal’.

I was exhausted, in shock at the banging on the door and the relentless phone calls and messages telling us we needed to go in for tests and potential treatment, knowing instinctively that Rosa was absolutely fine. We decided to speak to the midwifery manager and the hospital to tell them that we would go in again, but we needed some respite, as what Rosa and I needed more than tests was some time to ourselves. From this point I stopped answering my phone, and my partner negotiated with Pat and the hospital, explaining that we would go in, but not straightaway, and that when we did go in, we would be seen to immediately, we would not be waiting around.

At 4pm returning from the park, I went to bed while my partner made some food, but was woken at 5pm with more banging on the door and raised voices downstairs. Not again! Rosa was asleep so I went down to find another midwife had interrupted my partner cooking, telling him she’d come to do a postnatal check-up on me, and telling him that we needed to go into hospital. We confirmed with her that we would go into hospital once we’d eaten, which she was preventing us from doing. She began to ask me about my pelvic floor exercises, and I asked her whether we could leave the check for another time. She continued to ask questions regardless of this, which I answered as quickly as I could, and eventually she left, posting a letter through the door saying the following:

Sorry Alicja.
I know you need family time but just to clarify – you will need to attend Ward 56 for blood testing also – wasn’t sure if I made that clear. See you Sunday. Enjoy your baby in the meantime.
Carole

After this I saw on my phone missed calls, texts and voicemails from a number of NHS figures; one text was from the midwifery manager, telling us she was sending round a midwife for the postnatal check-up, explaining why she had turned up and acted the way she did.

At this point we spoke to AIMS, via referral from our doula and we were advised to document everything that happens, and given points on ways in which to deal with and speak with the NHS; to give them time frames within which to contact us, and that anything outside of these time frames we considered harassment.

At 9pm we went into hospital, and the paediatrician performed more physical checks on Rosa, suggesting that the day before she hadn’t done a full check-up. Intravenous blood was taken from the left hand; a heel prick was taken to check serum bilirubin (SBR) levels (it is routine when raised bilirubin levels are found to perform the same test for the next 3-4 days to see if the levels rise or fall); treatment lines were explained to us and documented. Rosa’s results at 15 hrs of age were only a little outside of the normal range.

Anti-D injection and blood test were administered to me. We arranged for the results to be given over the phone, and gave contact hours. At 11:30pm we arrived home to receive a call saying the results of PCV were all fine and that the SBR levels had decreased again. The next day was Thursday; Rosa was two days old; we had one call from a midwife to perform the SBR test. AIMS had sent us contact details for a haematologist and a senior independent midwife, who we contacted on Friday, and they were able to give us more information and reassurance that the haemoglobin levels were, in fact, fine.

On the Friday we had Rosa’s results again and it was agreed that no more SBR tests were necessary. We had one more postnatal visit on Sunday 8 May and that was the end of the initial postnatal checks with the NHS.

We felt harassed and bullied during the first few days of our baby’s life. Despite the fact that we agreed to go into hospital on the day of her birth, the intravenous blood test that we had been told was necessary wasn’t done, so we could have stayed at home and they could have performed the blood test at home, relieving us of all the time spent on the phone, all the hassle and pressure. The staff didn’t perform a full paediatric check on Rosa and didn’t give me the Anti-D injection. When we got home that night, they gave us the all-clear when they hadn’t received all of the test results.

When the second set of results came back on the first night, and they sent a midwife banging on the door in the middle of the night to tell us to go in immediately, we believe this was to cover themselves in case anything did happen to Rosa, as it would have been their fault for giving us the all-clear before all the results were back.

The midwives we were in contact with on 3 and 4 May were extremely bullying, aggressive, and insensitive towards us and our situation. They were constantly threatening us with the worst-case scenario as if it was happening at the time. They exerted unreasonable pressure on us and did not listen to what we had to say. We were patronised by the hospital staff over the phone and during the first visit to the hospital, who treated us as if we were very strange for acting the way we did.

We believe that the midwifery manager took our situation personally: firstly, because she had taken over from our previous midwife, and perhaps saw us as one of those ‘special cases’ due to the fact we had had no scans and were very clear that we wanted a natural birth, and secondly, because she was going on holiday the next day and wanted to have the whole thing sorted. She became extremely impatient with us. Over the phone to my partner she expressed her frustration that we wouldn’t just do what she said, that she was going on holiday the next day and was looking forward to it all being over and done with.

I feel as though, after all the hard work we did in preparation for and during the birth to ensure it would be natural, we were robbed of the very special time of the first days with our daughter. We worked hard to ensure that we would allow our baby to arrive in her own time, which she did, and I focus on this, in face of what happened so soon after her arrival. I am sure that if we had a midwife who listened rather than bullied, the situation would have been very different.

The SBR and PCV test results were both only of borderline concern. Rosa’s bilirubin levels were always well below the threshold for recommending treatment, and Rosa showed practically no sign of jaundice, which was documented by both the paediatrician and the midwives who came to see us on the third day. The fact that the midwifery manager referred to the PCV results as ‘quite abnormal’ does not pertain to the actual results, which were only slightly outside the normal range. Our daughter was always fine, never jaundiced, and we were never against having any tests performed to confirm this.

We are shocked at how the NHS responded to and dealt with our situation. At no point did we ever say we would not go in to hospital. We said we would go in, within a reasonable time, once we had rest. It was the NHS that prevented us from getting any rest, because they were constantly calling, threatening and harassing us.

My partner and I are very grateful to AIMS for the support they gave us during this time. It helped us to manage the situation and prevent any further harassment, and it has given us the information we need to be able to deal with the NHS effectively in the future.

Alicja Piotrowska