"The good, the bad and the impact"

Background: I was transferred to FSH from another hospital at 35+4 due to lack of appropriate staffing at the other hospital to facilitate a pre-term birth

On arrival to FSH maternal admission unit, it was made clear to me by the admitting RM that it seemed they did not think I needed to be transferred and should have remained in Bunbury, and immediately told me my partner would not be allowed to stay with me – at this time my partner was approx. 50kms from FSH having driven from approx. 350kms away. I stated to the RM that I had been assured by the other hospital that my partner could stay with me, I recall they responded by snapping that they should never have promised that.

I remained at the FSH maternal admission unit overnight, on the morning shift the RM who was allocated to me did not introduce themselves or come to check on me until I pressed the buzzer and requested assistance. I was not once asked about my pain nor offered pain relief. I was informed by the doctor that I was going to be transferred back to the initial hospital that day. Before going for a short walk downstairs with my partner I noted green PV loss on my pad. I buzzed the RM and asked them to check it – they advised to leave the pad in the bathroom and they would check it. On return from the walk and whilst talking with my student RM (who had followed me through my pregnancy) I mentioned to them the PV loss. My student RM advised I should ask for it to be checked, it became apparent to me that the RM had not checked the pad I had left for them to check. The doctor reviewed me and confirmed it was meconium-stained liquor – it was now hours since I had first noticed it and asked for it to be reviewed. My transfer to back to the other hospital was cancelled. I felt that my intuitive knowledge of my body and my pregnancy was completely disregarded, and therefore the pad was not checked.

I was then connected to continuous CTG monitoring and told they would await space in Labour Suite for me to have labour, augmented in the aim of having baby born in a timely manner. In the early evening, I buzzed for an RM and asked if I could go for a brief walk downstairs for some fresh air and then shower, which meant I would be disconnected from the monitoring. The RM said they would check with the doctor. On return the RM told me that the doctor had agreed that if something happens when I’m not on the monitor down there, my baby will die. I found this to be a completely inappropriate and unnecessary. Due to this comment, I walked downstairs for about 15 minutes and then quickly had a shower – I buzzed to have the CTG continuous monitoring reconnected as I was under the impression this was imperative. More than an hour passed before it was reconnected.

Still, I had not been asked about my pain nor offered pain relief.

I had multiple regular medications with me, due to Hyperemesis Gravidarum in pregnancy I was on a number of medications. Nil clinicians had asked about regular medications or charted them – I went ahead and took these medications as usual.

In the middle of the night, a doctor came and advised me I would be transferred to Labour Suite very soon or would need to be considered to be transferred to a different hospital.

An RM collected myself and my partner from the maternal admission unit at approx. midnight and took us to Labour Suite. This RM made me feel cared for, respected and explained everything in detail. It was the first time I felt safe during my stay at FSH. On changeover, another RM took over and made me feel safe, strong and in control of the situation. I felt well supported by this RM and although intervention was required (episiotomy and baby resuscitated and taken to SCN) with the RM’s calm presence I was able to remain calm myself.

During the birth of my baby, I was told by the shift coordinator that I needed an episiotomy urgently – and it wasn’t until the Student RM present clearly expressed that it needed to be explained to me that it was actually explained and I was consented. I appreciate the urgency of the situation but nothing should be done to a woman without her consent.

Baby remained in SCN and I was transferred to the postnatal ward.

Despite my extremely strong feelings about wanting baby to be exclusively breastfed on the advice of the Neonatology team I consented to baby receiving some formula (30ml/kg/day). It upset me that this was increased to 90ml/kg/day without my consent. Furthermore, on baby’s discharge information it states formula was given due to ‘maternal choice’ – this upset me greatly as giving baby formula was the opposite of what would have been my choice, it was due to advice and then the top up cycle that baby was discharge on complementary formula feeds. Please consider rewording this on discharge paperwork.

Multiple times I requested a lactation consultant to meet with me in SCN to assist in latching baby and commencing breastfeeds – this did not happen. Whilst I did end up seeing a LC on the postnatal ward it was briefly and a breastfeed was not observed. I do not feel I was given adequate information about the potential difficulties of breastfeeding a late preterm infant. I felt disempowered to breastfeed my baby and did not have comprehension of how long I would need to be triple feeding for before reaching exclusive breastfeeding.

Furthermore, my baby had a significant tongue tie which needed to be revised at approximately 4 weeks. This was not identified on baby’s going home check when we left FSH. When it was revised 4 weeks later, I was informed by the clinician who revised it that if in fact this had been identified in a timely manner at FSH then likely it could have been revised prior to discharge – I feel that this would have made an enormous difference to my breastfeeding experience. It concerns me greatly that the doctor who completed this going home check did either not have the skills nor the time to identify this tongue tie.

I asked multiple times to see a social worker or welfare officer to assist me with PATS – this did not happen. I was told via telephone by the welfare officer that the required documents had been left on my bedside table at FSH (this was whilst I was at a different hospital with my baby) – on return to FSH I could not locate the documents, further delaying our PATS application.

Given my birthing experience I requested multiple times to see the mental health team to debrief my birth and experience of my baby going to SCN. This did not occur, despite promises from medical team that it would, instead I got convinced to follow up with private psychologist on return home – my private psychologist obviously did not have access to my medical notes from FSH and therefore there were some limitations is how much he was able to assist me in debriefing. My partner and I still struggle to remember and understand why some things happened during our baby’s birth; we are both still dealing with the impact of birth trauma.

My baby was required to be reviewed at a different hospital by the cardiology team – please see a previous careopinion regarding that experience which included the RN escort leaving me without pain relief for 6 – 7hours here.

Finally, the FSH team decided to discharge my baby and myself home to our small rural town which has somewhat limited services. I received a call from my GP who suggested given the circumstances an intra-hospital transfer to a closer hospital would be more appropriate – whilst the FSH team agreed to this it was clear they thought it was unnecessary. I pointed out I felt my baby was jaundiced; the team disagreed. Lucky my GP suggested and arranged this as I required significant assistance with establishing feeding, my episiotomy ended up infected and dehisced and my baby required 24hrs in the billiblanket due to jaundice. It seriously concerns me what would have happened if I had gone home straight from FSH as opposed to an intra-hospital transfer. I believe this highlights a significant need to consider more adequate discharge planning particularly for families who are from rural (and remote) locations.

It has taken me many months to write this – due to unbelievable pain it brings me to think about how I was treated at times during my transfer, labour, birth and discharge. This long-term impact of this experience remains unknown for me but I have truly never felt so disempowered and vulnerable in my whole life during a time which should have been the happiest of my life.

As women we are told “as long as you got a healthy baby” and our experiences birthing are often dismissed. I think it is imperative my case is used as an example of the impact of transfer, intervention and limited support for a woman, her baby and her family