Walking the Patch

1. Walking the Patch Royal Sussex County Hospital January - April 2016 Feedback based on responses from 31 new mums on the postnatal ward at Children's centres across the city.

2. Demographics • 24 first time mum's • 7 subsequent babies,1 set of twins • 28 births at RSCH • 2 PRH (ante-natal questions only) • 1 Ante-natal • 12 natural birth, with 1 in water • 6 emergency c-section • 8 assisted • 4 elective c-section

3. Demographics Under 20 4 21-24 0 25-34 14 35-44 6 45+ 1 undisclosed 6 White British 18 Black British 0 White other 8 Latin American 1 Sri Lanka 1 Mixed 1 Undisclosed 2

4. Quantative Feedback: Antenatal Care

9. Qualitative Feedback: Antenatal Care • Been amazing. • We were told the wrong information about the class and couldn't book (English not 1st language). • Main midwife was sensational, unfortunately for my last appointment a student midwife took my measurements and the midwife didn't double check, I contacted my midwife who booked me with another midwife. It was my first time of seeing this midwife and she immediately said 'you've put on some weight haven't you?' this made me feel really small especially as my normal midwife hadn't mentioned about my size before. The website - all easy to find but the information is not helpful there is lots of text it would be better with more actions on what to do. • Midwife answered questions but was not forthcoming with information - she was always running late. • The class was 4 hours, it would have been better if it was longer it felt rushed.

10. Qualitative Feedback: Antenatal Care cont. • My scan showed that I had PCOS and the midwife was supposed to send me for a diabetes check, but she didn't and then another midwife sent me later. • I wasn't told about the whooping cough vacinatation, there were multiple opportunities, my GP told me but it was too late. • Baby was breach, whilst I was pregnant I kept saying to the midwife I could feel the head but I was told not breach,I had a scan late on and baby was so once in labour I had to have a ceasarean section. • More options on feeding - not just breast feeding it wasn't explained to me how to bottle feed - I feel that I was shut down a lot. • Need more midwives available, if my midwife was not there, no one else to see. • Long time in antenatal clinic - under consultant care.

11. Qualitative Feedback: Antenatal Care cont. • They were always in a rush. • Better doctor - GP didin't know system for how to get midwife appointment. • When I asked questions the midwife didn't put anything in the notes, she was always in a rush so I felt that she was not interested. mypregnancymatters website was not working. • Parking. • Waiting time. Grumpy sonographer - baby was in an awkward position they got cross. • I was worrying and they didn't offer more scans - I have polyps and wanted an early scan but I was told that I had to wait until 12 weeks.

12. Quantitative Feedback: Labour and Birth

14. Qualitative Feedback: welcome in unit • I had to come in for induction so I was expected. • Long wait to be seen but not a surprise. • I was induced -quite good. • Triage - I asked for gas and air and was told 'you're only 2 cm's you've got a long way to go' negative comments and patronising. • Rang RSCH(Brighton) in labour - they were on divert to PRH (Haywards Heath) - PRH advised to have a bath -rang back then told back to RSCH, I went in - I had been advised not to as didn't sound far enough along - was doing hypnobirthing - waters went on arrival at triage - was already 6cm. Triage not a private environment. • My waters broke, I went in and was sent home, I went back and they wanted to put me on syntocine which I didn't want. I was left for 12 hours. At midnight the contractions were strong, I was told to wait until the morning then told to have a bath and no pain relief. In the morning I was really dehydrated and my baby had stopped moving, the Dr said I should have had anti-sickness medication. Once I was stabilised everything was fine. They were really busy.

15. Qualitative Feedback - welcome in unit cont. • When I arrived, I knew there was meconium in my waters, they told me that they were busy and so I should go to Haywards Heath, my midwife and GP told me I must go to Brighton, I phoned and was told to go in but when we got there they asked why I was there, they didn't listen. • They kept telling us to go home, I said 'no' told I was not advanced enough , I wouldn't have got home and back and wouldn't have got pain relief. • I got left waiting in triage for 1 and half hours, once I was assessed another 2 hours to be moved upstairs. • I went in, I had strong pain they checked and I was 1cm, I was sent home, the next day 2cm I was told to go and get my bag, a night later they were going to send me home. 2 days later I had a pessary to speed up with an epidural and broke my waters. • I phoned and was told that I was not dilated enough, the contractions were 5 minutes apart, I was told Brighton was full and told to go to Haywards Heath, I gave birth in the car park there.

16. Qualitative Feedback - welcome in unit cont. • I was being induced but no bed ready for me when Iarrived for the induction. • More clinical than I would have liked, however baby born at 33 weeks after waters broke spontaneously so when I got to hospital it was 'all hands on deck'. • Midwife thought that I wasn't ready to come in, an hour later I wasn't coping came back in, told I was dilated 6cm, I hadn't been listened to. • More personal, it was very busy. We had to wait 30 minutes and no one came to the room. • Really bad - my waters broke in the morning, 5 hours later I went in and they were full. Contractions started I went in in a lot of pain, they checked my cervix - so rough I was sick. They tried to check the heart beat but couldn't on the monitor, it was broken but they didn't explain. I was given pain killers and sent home. I went back in and told to lie on my side for 4 hours and not allowed to move so I wet myself. • They said 'you've only had contractions for a short while, we may send you home, just lay there' once they saw the length of the contractions they realised and told me it would take hours - my baby was born within 3 hours of this. • When I first got there they wanted to send us home, said that I hadn't dilated, I had meconium one hour later so I was able to stay.

17. Qualitative Feedback: labour and birth • Good apart from tear. • I was left in recovery for 3.5 hours after the birth with no indication of what was happening or when /if I would be moved. • had an interpreter who was there throughout - very happy with them. • Had to get out of pool so midwife could check - then unable to get back in without someone helping to get in. second midwife arrived and helped with positions to get baby born without interventions. • I went straight into the pool, they made sure that I was comfortable and to buzz if I needed anyone, as soon as I buzzed someone was there. • Fantastic. • Some good, some not. I asked not to have a student, I was left with a student I fainted in the pool room she didn't know what to do, eventually my partner pulled the emergency cord. • I was left for 4 hours fully dilated. • My partner suffers from anxiety - we asked for me to be checked hourly and they didn't, I wasn't checked from 2am-6am. Just before the birth I told them that I needed to push but was told that I didn't.

18. Labour and birth cont. • Stressful - due to early arrival. • Very good care - felt well planned, not rushed, all calm. • People are busy and stressed. • The first midwife was not so good, after the shift change the midwife was better.

19. Qualitative Feedback: decisions about care • Community midwifehad pre-prepared me that it may end in a ceasarean section as time went on with the induction process. I felt forced into an induction in the first place and was not told that once the induction had started it could not be stopped and could lead to a ceasaean section. • I had to argue with the community midwife for ceasarean section - had previously agreed with Dr but not happy midwife tried to change my mind - second ceasarean section. • Not happy about having to give up the pool - water was working. • Because my baby was breach they weren't that confident. • They were against me having an epidural. • Said that they were going to break my waters, then pessary, I said that I didn't want a pessary but they gave it anyway. Different people said different things.

20. Qualitative Feedback: decisions about care cont. • I didn't get told anything, Iwas only offered an epidural no pain relief, I think this is to dowith my age (young). After the birth the midwife and supervisor came in and said 'she (the midwife) delivered 2 babies tonight', I felt left. • I was feeling that something was wrong - meconium they didn't tell me what was going on, they didn't listen to me as if they didn't want to scare me - not honest. • My plan stated anything but assissted delivery, had ventous - Dr made the decision not the midwife.

21. Quantitative feedback: postnatal care

22. Qualitative feedback: postnatal care • All been good. • Mixed - some are amazing, others patronising - the cannula was loose so I kept asking for it to be removed, I was told that they are really busy and will come back, we asked again and told again how busy they are so my partner said 'you said you'd come back' and the midwife huffed! • I was ill after the birth, I asked for a private room as I'd had a bad experience (haemorrage) I was told there was not a private room as these are for women who have had a ceasarean section, even though they were empty - I was in hospital for 5 days I was prepared to pay but was told I couldn't. • Others needed more help than me, I got in the shower by myself with my baby, I was fine. • Very busy, they were doing their best. I had to ask a lot of times for pain relief. • There was a male midwife, I came around from the general anaesthetic - I was a bit shocked. • No observations, no one checked or spoke to me, midwives changed shifts no one came over. Discharge took hours.

23. Qualitative feedback: postnatal care cont. • I got left - said would keep an eye on me, I was bleeding and only one person checked all evening. • I lost 2 pints of blood, they left me in the blood, I asked to have a bath and they wouldn't let me. • I had my baby at 6am and was told that I would be out by 6pm, then 8pm, then at 10pm I was told that my partner had to go and I would be discharged in the morning. Another dad on the ward stayed all niight. I was upset - I had been talked down to by a midwife. • Medication not always given at correct intervals - have had to remind them for the need for injections. • Baby in TMBU - conflict over meal times, expressing for baby on TMBU and needing to be checked on post natal. • Some staff are lovely but some are awful. Seemed very busy at the weekend. I have moved rooms 4 times since giving birth. Pain releif not given on Saturday night - I couldn't move Sunday morning. • They are short handed, busy so there is a lot of waiting. • You can feel that they are busy, but work hard. • They are very busy, there was another lady in the 4 bay ward with a chest infection - I don't understand why she was not moved to a private room.

24. Qualitative feedback: Support with feeding baby • Not much support, waiting for someone to come. • Went to drop ins had good support from midwives but not checked for tongue tie and gave up feeding 6 weeks as was told repeatedly that the latch was good but it still hurt and wasn't right. • One nursery nurse was really helpful, she stayed with me for 2 hours. • The latch was checked, all worked well, advised to move her mouth and that helped. • There was no continuity I had to explain each time, they hadn't read my notes before seeing us. My baby kept being sick, I told the midwife she said 'all babies are sick' I told the next midwife who said the same, my daughter then lost 20% of her body weight by day 3 and was floppy so sent to TMBU. They had wanted to discharge me on day 2 but I was insistent that we stayed. • We had to chase them. • Because I lost a lot of blood I didn't have an option. • One midwife helped when I first had my baby, then no more, turned out my baby had tongue tie.

25. Qualitative feedback: Voluntary breastfeeding peer supporters • Brilliant. • She checked and said all fine. • Really brilliant. • They were great. • Amazing. • Lovely.

26. Quantative Feedback: Cleanliness and Friendliness

27. Qualitative feedback: Cleanliness and friendliness • Toilets dirty. • Happy with them both. • All been informative, sensitive and there when we needed them. • The toliets tend to get dirty. • There was food under the bed! • I know it's an old building, maternity unit is ok but the general corridors are not. • Trainee who midwife stayed with us during labour was lovely. • Bed sheets changed every other day, could be daily. Changing minds a lot and being left. • Majority of staff really good. • Some midwives lovely, others are awful. • General staff are smelly (not midwives). • It's dusty and the toilets could be cleaned more frequently.

30. Qualitative feedback: Bounty • ok to tell her to leave me alone. • A bit weird - I was not with it then someone was trying to sell me photos. • she wasn't pushy. • She offered to take pictures of baby upstairs on TMBU, happy to have bag of stuff but nothing else. • Not my favourite. • Packs are full of rubbish - spam mail and things to buy.

31. Best thing about the care you received? • Felt secure and safe. • Everything. • Excellent, hospital good. • Really supportive, 3 day induction. • Midwife at Tarner children's centre, midwife during delivery. • Midwives. • I'm happy and baby is happy. • Community midwife and delivery. • Midwives in the community - antenatal care. • Overall positive experience, fantastic support from health visitors and aftercare in general. • The midwife who helped me with the birth of my baby. • The midwife during birth the language that she used and her support - really positive. • They were really supportive when things started to go wrong they were sensitive to tell us the options, they were very calm.

32. Best thing about the care you received? cont. • Some midwives made me feel really special. • Labour care - really good. • Giving birth - there were 2 midwives there all the time. • Community midwife and post natal community midwife. • All really nice. • Everyone has been really helpful. • Some lovely midwives. • Midwife on 1st antenatal appointment. • Midwives generally. • How hands on it's been. Let me be in control. • They've put up with us! • Ceasarean section - everyone kept us informed, it was very quick. • Midwife in delivery suite.

33. If there was anything you could change about the care you received... • Food. • Pain relief, was refused pethidine/gas and air for 6 hours - had to wait until moved from antenatal ward to delivery suite even though by that stage my waters had broken and the contractions were regular and painful - unable to have codeine as allergic so no other options. • Communication. • Triage - needs to change. • Midwife sticking to Dr decision and not changing. • More early intervention so I didn't get so ill - I was using hypnobirthing but they said that I wasn't in labour. • I had to get a taxi to the hospital from home during labour, if I'd known I would be able to stay I would have gone earlier when I was more comfortable. • Dad's can't stay.

34. If there was anything you could change about the care you received... cont, • Community midwife listening to me. Time with the same midwife on post natal as they were different each time. • Discharge - after birth non-existent. • No student midwife being left on her own. • When in hospital come and see you more. • Hospital be more friendly, involve the parents. • Better communication - birth honesty. • The floor that it's on. • More doctor visits. • A specific taxi company to use to get to hospital whilst in labour. Canteen for food.

35. Anything else you’d like to add ? • Friendly, professional. • The wards are noisy - people chatting with their partners during the night with no respect for others - I raised this and was told this isn't an ill ward so unfortunately they can't do anything about it. • More monitoring in antenatal ward and listening to me. • My waters didn't break, due to this the midwives in triage were pushing me back. • Brilliant I felt really well cared for. • Overall - really good and positive. • I thought there would be my community midwife during birth which I'd have preferred. • It could be improved.

36. Anything else you’d like to add ? cont. • No orange juice - I've got low iron so want orange juice for absorption - should be available. • Thank you to everyone. • Brilliant overall. • Having a side room, because of my health problems being offered this is really good. • Microwave for dad's to have hot food. Overall good - really happy, the midwife when Iwas induced was really friendly. • More staff. • Whilst on the post natal ward during our 'Walk the Patch' session we overheard a conversation between and consultant and a senior member of the midwifery team. The consultant talked about a couple as 'battle axe's partner' and then asked the midwife why they had not been put in a side room - the language was both disrespectful to the couple and undermines the authority and professionalism of the midwife.