Louisa shares her reasons for not challenging the poor care she received
I recently read a journal article on the AIMS web site called 'So What's Your Problem?' by Alice Charlwood (Vol 21 No1) in which the author was wondering why more women don't complain about poor maternity care. I can't speak for others, but I'd like to share my reasons for not doing so.
With my first child, I had grounds for complaint over my care – I was given oxytocin without my consent without reference to the progression of my labour/strength of contractions and despite it being known my baby was breech. I was told I would on no account be allowed to birth a breech naturally on all fours but needed to do so in stirrups, with a doctor present. When I finally agreed to their constant requests that I sign a caesarean consent form, it took them an hour to find an anaesthetist. However, though I really wanted to, and others suggested it, I did not make a complaint. I could not think about the events of her birth without feeling extremely angry and violent towards the maternity personnel, and I cried uncontrollably whenever I recalled it.
I hated the way that made me feel at a time when I was also getting so much joy and pleasure from my little girl, and I found the memories exhausting in a way that made it hard for me to look after her the way I wanted to for a few hours afterwards. It also affected her to see me upset – even as a tiny baby she reacted to me crying. Therefore, I made a conscious and determined decision to avoid thinking about her birth, and deliberately shut off the memory whenever it started to rear its ugly head.
I knew I had a year from her birth in which to make a complaint, so I revisited the idea close to her first birthday. I looked at the complaints procedure and allowed myself to think about the birth again. I discovered that I was still badly affected by the memory, and thinking about what the complaints procedure involved I realised I would not only be forced to revisit the memory many times if I initiated it, but I might also be required to face the staff I was complaining about, possibly in the building where it had occurred.
Having been to a different maternity hospital recently to visit a relative's new baby and been afflicted with a strong desire to escape, coupled with what could only be described as hatred towards the building and the staff within it, despite them never having done anything to me (or my relative) I did not feel this was something I would be able to deal effectively with. I also realised the procedure was not a quick one and was likely to leave me in a state of apprehension about various decisions at a number of points if the complaint progressed beyond the first letter, especially if it dragged on (as it was likely to do – giving drugs without consent is not taken lightly but the grey area of 'implied consent' could easily raise its ugly head.)
There was also a high likelihood that it would make no difference for the good, so the stress complaining would put on me could be the only tangible outcome from my perspective. Even after a year, I did not feel up to taking this on emotionally.
My daughter had grown into a wonderful toddler who was a source of real joy in our family and not only could I not bear the thought of what my likely emotional turmoil might do to her if I entered the complaints procedure, I also had a fear that if the complaint took over my life (as it might well do if it became a fight) and dominated my emotions I could start to see her differently, as a trigger of my memories rather than the one who made me forget them. I did not want that in any way: her wellbeing was, and is, my primary concern. So, I allowed the deadline to pass.
After four years, I reached a point where the memories did not induce an overwhelming emotional state, and we decided to have another child. The pregnancy brought back a lot of it, mostly in the form of my crying over how I had allowed my own understanding and instincts to be over-ruled, and anger on behalf of my daughter who could so easily have been damaged by the birth. I was very determined that my second birth would be different, and I wrote a long birth plan that detailed exactly how the previous birth had been conducted and how it had affected me. This affected the midwives in charge of my care and they went out of their way to support me (though I think it also helped that I was politely stubborn and proved I knew what I was talking about.)
I have never attempted to rationalise my care, though I have felt very guilty that I did nothing at the time to stop what I knew was very bad practice and needed to think about that very hard before I could stop blaming myself. I have come to terms with it as something that happened which I cannot change, and the birth of my second child, in which I was in complete control, helped a lot to curb the emotional clout of the memories, as well as improving my feelings towards midwives and the maternity building, as my care then was almost the complete opposite. My reasons for not complaining were to ensure my own and my child's wellbeing. I did consider whether a complaint might improve things for others, but I felt my top priority had to be my family and I could not sacrifice them for the sake of those I had not met. One year sounds like a long time, but really it was too short a deadline for me. I was simply unable to deal with recalling the birth for a good few years. I would have made a complaint when my daughter was around three had I had the opportunity, as by then time had dulled the power of the memory enough, but of course it was also no longer possible for any complaint to be officially dealt with.
I'm not even sure anyone knew of the poor care I had received – I was the only constant in the proceedings: staff changed a lot (I'm pretty certain miscommunication on a shift change led to me being given the oxytocin, as one set of midwives had said my labour would be checked in an hour and then oxytocin considered, before they left the room; the next ones to enter were a different pair and simply administered oxytocin without examining me) and often only one staff member was present when things were said and done – so I doubt anyone other than myself was really aware of the actions of everyone else. Certainly no one appeared to think I had had any problems at the time. I learned much later that mothers who have traumatic births are sometimes offered the chance to see a maternity professional soon afterwards, to debrief their experiences. This was not something that was ever offered to me, which I conclude means I was not classed as having had a traumatic birth by hospital staff.
The birth plan I wrote for my second birth, that detailed it all for the first time, seemed to come as a shock to those who read it, including my husband, who had had no idea how I had felt after our daughter's birth as he was another who I wanted to protect from the effects of my memories, and who had a lot of influence over how I was treated the second time round. I don't know if my birth plan had any real effect on how others might have been treated, but for me and my family in isolation I don't think an official complaint would have been anything like as effective.
AIMS Comment from author Alice Charlwood
This is an incredibly interesting and moving response to the article I wrote, and I bet it represents the feelings of quite a lot of mothers who swallow, in this case, overwhelming feelings of distress and anger and guilt for reasons of self-preservation. Louisa comes across as an amazing, strong and capable woman, yet even she could not face pursuing what she saw as a justified complaint even a year and more afterwards. Her story bears out some of the points I made that: (a) embarking on an official complaint may be damaging in a number of ways, not least because somehow it seems utterly at odds with the emotional attachment, joy and satisfaction these mothers are getting from their babies and family life; and (b) official complaints are unlikely to change anything for the better – Louisa thought, with hindsight, that the staff were probably oblivious to the way her first labour was mismanaged because communication was so poor between them at the time.
Louisa's comment that even her husband was surprised and shocked to discover the depth of her emotional turmoil when he read her birth plan, is testament to how good women can be at rescuing others from distress by hiding their true feelings. The cost to herself of doing this must have been very great, but she maintained the necessary facade for four years as she felt the cost of doing otherwise would be intolerable.
There is much for us all to learn from Louisa's account of what happened to her, and not least the way she took more control over her second birth by being, as she puts it, 'politely stubborn' and 'knowing what she was talking about'. This raised a cheer from me as I read it, and I hope it inspires others to do the same.
Making a Complaint
The complaints system might initially seem like an unfathomable maze. The AIMS publication Making a Complaint About Maternity Care provides guidance on how to make a complaint and follow it through. This publication is also available on Kindle
AIMS supports all maternity service users to navigate the system as it exists, and campaigns for a system which truly meets the needs of all. AIMS does not give medical advice, but instead we focus on helping women to find the information that they need to make informed decisions about what is right for them, and support them to have their decisions respected by their health care providers. The AIMS Helpline volunteers will be happy to provide further information and support. Please email firstname.lastname@example.org or ring 0300 365 0663.
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