Dear Blank,
I am writing to inform the Royal Women¡¦s Hospital of my extreme dissatisfaction with their services. I transferred to RWH in November last year during a home birth. I was already a client of the hospital having had antenatal screening performed there. The way in which I, my partner, my support woman and my professional midwife, and my baby, were treated was utterly appalling.
Further, and more recently, despite having contacted the Patient Representatives twice in May regarding anomalies in my medical record, they have not responded to me with answers. This too is extremely unsatisfactory. On the first occasion I spoke to XXX and asked her:-
1. Why was the EFM readout not included in my notes? I want to know exactly how much time the monitor was on given the midwife¡¦s assertion that she took it off at my request was not true.
2. Was a specimen taken of cord blood from my son? It is clearly ordered but there is no report and we did not consent to it.
3. What time did the operation start and finish? I know XXX has this information as she referred to it in our conversation and I did not see why it could not be supplied to me.
On the first occasion XXX told me that
1. Readouts were not normally given as clients were not qualified to interpret them. I told her my midwife could do this for me and I wanted the record.
2. She said she would investigate and get back to me.
3. And likewise with this request.
She said she would ring me the following week. A week later, having heard nothing, I rang and spoke to XXX. Ms XXX told me exactly the same information as Ms XXX had the previous week and promised to get back to me. It is now August and she still has not done this. Why not?
I also received two letters in January from staff in the operating theatre. The letter from the two nurses is inadequate in a number of ways.
1. Their disrespectful way of repeatedly referring to Midwife QQQ as ¡§Jane.¡¨
2. The clear implication that their behaviour was caused in some way by Midwife QQQ and her behaviour was somehow inappropriate. This was patently not the case. Midwife QQQ attempted repeatedly to forge a rapport with the theatre staff and despite politely introducing herself, was received with the retort, ¡§My name¡¦s yuck, if you want it for the complaint form.¡¨ She was also subjected to staff complaining about ¡§people wandering about in theatre¡¨ as if she was somehow irresponsible or uneducated about theatre etiquette. This is obviously untrue.
3. Their stating that Midwife QQQ, and they, did not fully understand the early mother-baby contact policy. Midwife QQQ understood it fully, having pursued it with other clients. The nurse who made the final decision stated clearly within hearing of me and my midwife that she did not care if this happened at other times, it was not happening on her ¡§watch¡¨. This was despite my midwife advocating for me and even the support of the obstetrician. This clearly is not a misunderstanding but a deliberate act.
4. There was a racial slur made against the obstetrician in my hearing in theatre. This is not mentioned at all.
5. In concluding their letter, the nurses allege that they sincerely regret any unhappiness they may have caused during the operation. This also shows how little they understand the impact of their indefensible actions. Not only will the pain of this punitive measure stay with me for the rest of my life, it could well have impacted on both Conor and me to disrupt our bonding and therefore open the way to PND particularly given how traumatised I was by the entire hospital experience at this point. It also disrupted his first attempts to breastfeed and since he was sucking furiously on both fists most of the hours without me, I can only assume he was ready to be fed. He was denied this basic right. Given that RWH claims to be a WHO baby-friendly hospital this is truly appalling.
6. The icy atmosphere in the theatre was one of the worst aspects of our experience. I have spoken to other women who have experienced caesareans and staff were kind and respectful, telling them when the operation had begun, and showing them their baby over the curtain before whisking it away to the paed. Staff made the women feel that they were really having a baby and it was to be celebrated. My experience was terrible, silent apart from abusive comments and conducted as if we were an inconvenience. Without us your staff would not have jobs and no one deserves the treatment we received. I did not know who performed the operation until I received the photographs as the obstetrician completely ignored me in theatre.
To clarify some of the difficulties we encountered with staff I have taken the information from your web site about rights and expectations and demonstrated how the hospital did not live up to even basic expectations of politeness. I also include my entire experience, in order, so that it may be tackled as a complete experience and not in discrete chunks for each department. This was not a failure of some people to meet client needs, this was a monumental failure of culture and infrastructure.
From your web site:
Your expectations
A good patient does not mean a quiet patient
You can:
„h Ask questions
„h Keep asking questions until you understand what you want to know
„h Tell everyone involved in your care what you need
„h Tell someone if you have a problem. Ask for an interpreter if you need one.
The hospital staff want to do the best they can for you. Telling us that you have a problem helps us to improve your care.
This was patently not adhered to in my experience of the hospital. Even in my antenatal contact with the hospital for blood tests. When I asked a question about what a test was for, the reply was ¡§Everyone has one.¡¨ This is not a helpful response. During the time I spent in the labour ward the staff would not answer our questions, would not listen to what we needed and wanted and would not respond when told that their behaviour was unhelpful. The midwife strode away when challenged about her attitude to us saying, ¡§I can¡¦t listen to this, I have more important things to do.¡¨
Patient rights
As a patient of The Royal Women's Hospital you have the right to:
„h Receive the best care available
I do not believe that this happened at all particularly since I waited five hours for appropriate pain relief.
„h Be treated with respect
I was not treated respectfully by the staff in the labour ward or the operating theatre or recovery.
„h Have as much privacy as possible
I had staff I did not know and was not introduced to coming into the room where I was scantily clad and in distress. This could be prevented. Why were our names not on the door like they were for other clients in the labour ward?
„h Expect confidentiality about your care
I received this.
„h Receive available information about your medical condition
We could not get information about what was happening in the hospital or about proposed management of my labour.
„h Seek a second opinion about your medical condition
NA
„h Participate in decisions which affect your well-being
I was not given a choice about pain relief for my operation, having my baby in recovery with me, having ARM, or constant EFM.
„h Be informed to your satisfaction about your treatment before you give your consent
I was not told exactly what constituted a caesarean and therefore did not give informed consent. I was not consulted about how my labour was to be managed. There was never a clear message given to us about proposed management.
„h Enquire about the costs of your care before admission
NA
„h Be accompanied by a support person at most times
I was accompanied by my midwife who was also treated appallingly in the operating theatre. She was also treated disrespectfully when her notes on my labour were ignored as though she were not an equal professional with hospital staff.
„h Seek the assistance of a professional qualified interpreter
„h Accept or refuse student involvement in your treatment
„h Be informed about available hospital and other support services
NA
„h Be offered time to ask questions
I was not given information or the chance to ask questions about the caesarean. It is not my responsibility as a consumer to initiate this discussion with the doctor. It is their job to tell me exactly what will happen and seek my informed consent for the procedures involved.
„h Be offered time to consider the information supplied
There was no information supplied other than a list of risks many of which were not evidence-based.
„h Refuse any treatment and services you are not comfortable with
I cried out in pain and told the obstetrician to take her hand out of my vagina but she ignored me. I was given morphine suppositories without my consent or knowledge. I was given syntocin in 3rd stage without my consent or knowledge. I did not know my baby¡¦s cord blood would be tested and therefore did not consent to it. I did not want ARM or EFM but despite actively disagreeing with EFM it was repeatedly strapped onto me without permission. We were initially told it would be on for 10 ¡V 20 minutes. It was on for 40 minutes the first time and then strapped onto me at various times without even asking me.
The Hospital will endeavour to:
„h Respect your needs and rights
Clearly this did not happen.
„h Give you clear information about your medical condition and treatment
Clearly this did not happen.
„h Offer you advice and support
I did not receive sympathetic support from any staff except the two midwives on the ward the following day. Staff to this point had been rude, disrespectful, and unhelpful ¡V except the anaesthetist who was kind, professional and supportive.
Obtaining consent is poorly conducted in your hospital. A doctor asks (not always clearly and not necessarily to my face, in my experience) if they can perform a VE. While they have their hand inside the woman, they ¡§ask¡¨ if they can perform another procedure or even more than one procedure. How is this appropriate? Before the VE is commenced a conversation needs to take place like this:-
Hello, my name is ABC XYZ. How are you feeling at the moment? (wait for responses and actually listen to them as if they are meaningful ¡V they are!) If a VE is thought necessary continue like this:-
I feel that I need to investigate what¡¦s happening with your labour. It seems (for example) that your labour has slowed and I need to ascertain why. One of the things that helps with this is to perform a vaginal examination. How do you feel about that?
I would have said yes to that.
We can manage your labour a number of ways. If I find while examining you that your membranes are intact, I may suggest that you have them ruptured to speed labour up. The pros and cons of that are as follows. How do you feel about that?
I would have said no to this without compelling reasons or discussion with my own midwife.
I could also insert a foetal scalp monitor into the baby¡¦s head while I¡¦m examining you. The pros and cons are as follows. How do you feel about that?
I would have said no to this also.
OK. So you are happy for me to perform a vaginal exam, but you do not want your membranes ruptured or a foetal scalp monitor inserted. Do I have that right? Please let me know if there¡¦s anything I can do to make the VE easier for you. I understand that it can be painful. I will wait until you let me know that it¡¦s ok to proceed and I¡¦ll be as gentle as I can.
I would have said thank you and cooperated to the best of my ability given that I was in pain.
If I had been treated with this kind of respect my experience would have been completely different.
The following are questions which need to be addressed by RWH.
1. Why were staff routinely evasive, rude and patronising to me, my partner, my midwife and my support person?
2. Why did they insist on asking my partner questions about my labour when I had a professional midwife with me?
3. Why were my midwife¡¦s notes and expertise ignored?
4. Why was constant monitoring considered vital despite it causing me immense pain? Regular doppler checks are perfectly adequate and associated with better outcomes for mothers and babies.
5. Why was the monitor attached to me on several occasions without my consent?
6. Why does XXX's record state she removed the monitor at my request and only had it on occasionally when it was on constantly? Both my partner and QQQ were required to force it into my body at various times, for long periods, causing me great pain which was not considered important.
7. Why is there no mention in the midwife¡¦s record of the repeated offers of pethidine to me? This was declined due to its poor record in helping labour pain and its effect on the foetus.
8. Why did Dr XXX not seek to discuss her proposed management before performing a VE for a fetal scalp monitor? She would have had to rupture my membranes to do this but she didn¡¦t even mention that part of the procedure.
9. Why did Dr ZZZ not introduce herself to me? I had no idea what her name was until I received my discharge summary.
10. Why did she not seek my informed consent when giving me a VE? She scanned the faces of my partner, support person and midwife but did not directly ask me.
11. Why did she not stop examining me when I cried out for her to stop as she was causing me immense pain?
12. Why did she not apologise for causing me immense pain?
13. Why did she not discuss with me, before inserting her fingers, that she wanted to perform an amniotomy and why?
14. What was the purpose of the amniotomy given the position of my baby and the fact that he was stuck? I gave consent under duress to this in the hope that the hospital would get me some pain relief and take care of me.
15. Why did she augment my labour without my consent with ARM and without any pain relief despite how painful my contractions became after her actions?
16. Why did she repeatedly pat my belly without my permission? If this was an attempt to be pleasant, it was rude, patronising and inappropriate, especially given how she was behaving towards me.
17. Why would the staff not communicate about the long wait and why did they feel it necessary to call a security officer?
18. Why did I have to wait almost 5 hours before appropriate pain relief became available?
19. Since my baby was in a position which made vaginal birth very difficult and potentially dangerous, and I was exhausted, why was I expected to wait yet another 4 hours from when my epidural was administered to see what might happen? No VE was offered at this time to see what, if any, progress I had made in the intervening hours with the massive contractions I had endured.
20. Why did Dr ZZZ say to me ¡§You can¡¦t come in here demanding a caesarean with the first niggling pains of labour.¡¨ when I had been in documented labour for about 26 hours before I saw her and strong labour since 4pm?
21. Why, when it is clear from comparing the reports, that my baby was going backwards, was there no attention paid to this but an insistence on my waiting to see what happened?
22. Why was I not given information about the actual operation? I was given poorly evidenced risks for the surgery but not told what the surgery actually entailed.
23. Why was I not consulted about post-operative pain relief? I was not asked about receiving suppositories as pain relief or what kind of drugs were available to me despite what was provided being drugs that pass into breast milk.
24. Why was I not told that forceps might be employed to remove my baby? Something else I found out from the photographs before I received my medical record.
25. Why was I not consulted about syntometrine for stage three?
26. Did I, or did I not, have a vaginal swab? Julie Campbell thought that I must have since she believes it is usually part of the procedure but it is not mentioned in my medical record.
27. Why is the surgeon¡¦s record of the operation inaccurate? My wound was lengthened, and the surgeon attempted manual removal of the baby before forceps.
28. Why did XXX tell me that the operation was completely normal and without incident when my observing midwife could see this was not the case?
29. Why was my baby not with me in recovery as it was not an emergency c-sec? His Apgars were perfectly fine, I was in no danger and it is hospital policy. This left me open to even greater risk of PND after the trauma of hospital treatment to that point. The hospital can never give me back the first 2 hours of my child¡¦s life and it is a pain I will carry for the rest of mine.
30. Why was one nurse able to override my wishes, as advocated by my midwife, the approval of the obstetrician, and hospital policy which purports to support skin-to-skin contact after labour?
31. Why did theatre staff treat me and my midwife so rudely and disrespectfully? This was not helped by the letters I received which attempt to blame my midwife and do not address their many examples of poor behaviour.
32. Why did my private midwife have to ask repeatedly for my partner to be in the theatre before the operation began?
33. Why was a nurse in theatre aggressive and antagonistic to my midwife and me? When Midwife QQQ attempted to defuse the situation the nurse said, ¡§Yuck's my name if you want it for the complaint form.¡¨ This was after Midwife QQQ had tried to introduce herself in the hope of securing better relations and a better atmosphere for my experience.
34. Why did Dr ZZZ not speak to me or my partner in theatre to keep us informed of what was happening and when? I found out who performed the procedure on having my photographs developed.
35. Why did a nurse shout at me to take my hand off my belly before the operation had even begun? She shouted, ¡§Take your hand off that!¡¨
36. Why was there a racial slur against the obstetrician in theatre?
37. Why was I considered to have no pain in recovery despite clearly stating where I had some discomfort?
38. Was Conor¡¦s cord blood tested without our knowledge or consent? Why is there no report from it in my notes? I have the right to accept or refuse procedures on behalf of my child.
39. Why are my records stating both emergency and elective caesarean?
40. Why does the surgeon¡¦s record give ¡§maternal exhaustion¡¨ as the primary indication and ¡§patient¡¦s request¡¨ as secondary when it was because he was in deep transverse arrest?
41. Why do my records state I received both a spinal and an epidural?
42. Why is there a record of ¡¥skin contact¡¦ with my baby when my only meeting with him entailed me being about to see him and kiss his fingers? This is not skin contact in any meaningful way.
43. Why is Conor described as having 2 umbilical arteries when I have video footage of there clearly being 3?
44. Why is my GBS state described as negative when actually it was unknown? In other places of my record it is correctly described.
45. Why was I given drugs to take after the c-sec that are specifically contraindicated in breastfeeding? As I was leaving the hospital I was given Tramadol and Voltaren to take for pain. I specifically asked Dr HHH if these would pass into my breast milk and he clearly stated they would not. Had he told me the truth, I would have asked for further explanation and different drugs. These have been demonstrated to pass into breast milk and into babies.
46. Why does the midwife state that an ¡¥indepth discussion¡¦ of LUCSC occurred when it did not? All that took place was a listing of possible complications, not a discussion and no useful or relevant information was given to me. The midwife was not even present at that time.
47. After leaving the hospital I received 2 letters from staff members purporting to be apologies but in reality blaming my midwife and clearly showing no comprehension of the damage caused by separating a perfectly healthy baby and mother. If I am to receive an apology, which is fully warranted, it ought to be respectful, responsible and genuine. These letters were none of these.
I want staff to read my story and know that each time they are thoughtless or less than caring with a labouring woman they risk her mental health and the wellbeing of her baby. We all deserve better treatment than I received and I hope that by drawing this experience to your attention that staff will begin to change the kind of culture that causes this appalling state of affairs. I deeply resent that I have had to spend a vast proportion of the time of my son¡¦s early life recovering from how I was treated instead of being able to fully celebrate the new life we created. My partner and I, as well as Midwife QQQ, are owed genuine apologies by RWH.
Yours sincerely,
Janet Fraser