I attended hospital for a planned caesarean section and stayed for three nights.
In terms of the caesarean section itself I cannot speak more highly of the theatre team. In particular both myself and my boyfriend found the anaesthetist to be excellent. He talked to us throughout and explained what was happening in a reassuring manner.
The issues started once I was transferred to PACU. Our baby’s cord had been clamped too short and part of his skin had also been clamped. As such the paediatrician had to be called to look at him, which meant he had to be taken away from me for some time whilst the issue was resolved. Given the time in PACU was the only time we had with our baby in a relatively private setting (at least until he was 2 days old) I found this very upsetting.
We were then transferred to Norfolk ward and where women who have just had surgery are placed on a shared bay with three other women and babies in the same position. This arrangement is not at all conducive to either bonding with your newborn baby or recovering from surgery. The sections of the bay around each individual bed are pitifully small. My boyfriend had to spend 12 hours a day for the next two days sat on a small, uncomfortable office chair, crammed into the corner of the room. In addition, my baby’s cot kept being banged by any movement in the bed space next to mine.
There was also no privacy whatsoever. The curtains can only provide a limited amount of privacy, but were constantly being opened and often left open by staff, regardless of what you are doing. This included an occasion where I was using a breast pump and a member of staff left the curtain open. This was during visiting hours and a visitor of one of the women opposite me was blatantly watching me whilst I expressed milk. In addition, the curtains make confidentiality impossible as they cannot allow for any sound proofing. I was incredibly upset at numerous times during my stay and I did not particularly want other people to hear this – yet this was inevitable in the cramped and overcrowded environment I was in.
During the afternoon I suffered from a migraine which hugely affected my vision. Thankfully because of the painkillers I was already on I was not in any pain, but I was hugely distressed that I could not see my baby. In addition I was trying to breastfeed my baby, but because my vision was disturbed I could not see what I was doing. I know from many years experience of having migraines that the only thing that will resolve this loss of vision is for me to sleep. In a shared bay this was impossible. It was the middle of visiting time, so there were a huge number of people around. The fluorescent strip lighting was also incredibly unhelpful. In addition the bay was incredibly hot. Together, the light, noise and heat in the room made it impossible to sleep.
I became very upset that I could not see my baby properly, therefore my boyfriend reported the issue to staff and we asked whether I could be moved to a single room. The response from the member of staff concerned was wholly unsympathetic. She did not seem to understand what the issue was and kept offering pain relief, even though I kept saying that was not the issue. She said it was not possible to move me to a single room, but she did not explain why.
I struggled through the next few hours and eventually my vision returned to normal. Unfortunately at around 7pm I then had a second migraine and my vision was disturbed again. I became even more distressed as again it was impossible for me to get the sleep I needed. Again the response from staff was unhelpful. The member of staff concerned again focused on pain relief, despite my explanation that it was my vision that was the problem and not pain. We asked again about a single room so that I could get some sleep, but we were told that this was not allowed on the first night after a caesarean as they needed to keep a close eye on me. I then asked how I was supposed to sleep and the member of staff misunderstood again and seemed to think I was asking her to take my baby away from me so that I could sleep! I was disgusted and made it very clear to her that I definitely did not want my baby taken away from me, I just needed to be somewhere quieter to sleep. The only concession made was to turn off the strip lighting in the room. Not one member of staff asked about my migraines after this and I noticed on my notes that it had been noted that I’d had a headache (inaccurate, they were migraines) and that I had been very demanding – which I feel is grossly unfair. It was also implied in my notes that the migraines were due to me having a lot of visitors (and therefore by implication my own fault). This simply is not true as the only visitors I had other than my boyfriend were my parents, who only visited after I had had the first migraine.
I also had huge problems trying to establish breastfeeding with my baby and I feel that some of the responses I received from staff on this issue were unhelpful. I also feel that some of the information I was given was inaccurate. During my pre-op appointment I asked whether having a caesarean would affect the initiation of lactation. I was told that it would not make any difference. I was surprised by this as I understood that the hormones released during labour helped to start lactation. I specifically asked if this was the case, to be told it was not and that it was all triggered by skin to skin contact and the baby suckling. What wasn’t explained however was that the opportunity for skin to skin contact would be delayed due to the surgery. Skin to skin contact was something both me and my boyfriend were looking forward to – however this was limited as I was not able to hold my baby until after the surgery was complete and even our time in recovery was interrupted. In addition it was difficult to have skin to skin contact once we returned to Norfolk ward because of the lack of privacy. There was also no opportunity for my boyfriend to have skin to skin contact with our baby because of the lack of space and lack of privacy on the ward.
In addition I soon learned after the birth that there can be a significant delay in lactation commencing after a section. Because I had gestational diabetes I was told that it was essential for my baby to feed within 2 hours of birth. Unfortunately I was only told this approximately 2 hours after he was born – not in advance. We were then faced with a midwife insisting that our baby had to have some formula because he was not able to get any milk from me. This came completely out of the blue for us as we had not been informed of the delay we could expect in me being able to produce milk, or the need for our baby to feed so soon. We were then asked numerous questions about what formula we would prefer, which we did not have any answers to as we had not even considered formula feeding. I found it very upsetting that my baby was being given formula when he was only 2 hours old and that because of the delay in me being able to produce milk, this formula feeding had to continue throughout the first day.
I spent much of the next two days struggling with breastfeeding. The help from staff was inconsistent. It didn’t help that each time I asked for help breastfeeding it was a different member of staff who came and each of them had completely different advice to offer. It was only the day after he was born that I was finally able to produce a few millilitres of colostrum. By this stage my baby was used to having milk poured down his throat from a pipette. I was assured numerous times that this would not affect his ability to breastfeed, however I would disagree with this. Over time my baby latched onto the breast well, but he would not suck. This continued for the first week of my baby’s life – he just expected the milk to flow without him having to do anything, something which he must have learned from being fed through a pipette. This meant that the first week was a very frustrating and emotional experience for me. Breastfeeding was a constant battle and it was clear my baby was not getting enough milk from me, simply because he would not suck. Every midwife I asked for advice informed me my technique was fine, it was just that my baby would not suck. Eventually I dreaded the prospect of feeding my baby and the amount of milk I was producing was hugely affected by the stress of this. I feel overall I should have been provided with better advice in advance about how breastfeeding can be affected by a section and about how important it is for a baby to feed so soon after birth when the mother has had gestational diabetes, so we could have at least prepared for the prospect that we would have to formula feed our baby.
The support I received on my first night in hospital was appallingly bad and contradicted the assertion that I had to remain on a shared bay so that staff could keep an eye on me. Other than the routine obs, the only time a member of staff came near me was when I buzzed for help – both of these could have just have easily been done in a single room, therefore I do not understand why I could not have been moved on that first day when I became ill with migraines.
At around 10pm on the first evening my baby needed feeding. The midwife came to get him out of his cot and assist me with breastfeeding. When it became apparent that he was not sucking she showed me how to hand express – however this failed to produce any milk. She then said that she would leave me to keep trying with my baby and return in 10 minutes to see how we were getting on. 30 minutes passed and I had made no progress with breastfeeding my baby and the midwife had not returned. My baby was increasingly frustrated and I was very upset. In addition, the noise of my baby crying must have been very intrusive for the other women in the room. As the midwife had not returned I rang for help. A second member of staff appeared and I explained I was struggling to breastfeed. Her response frankly astounded me. She offered no help and bluntly stated that I would just have to formula feed him. I would seriously question how this fits with encouraging women to breastfeed their babies. I became very upset and told her that I did not want to feed him formula, I wanted to breastfeed him. The only solution she could offer was to get me a breast pump. She therefore went to fetch one.
Another 30 minutes passed and the second member of staff also did not return. By this stage I had been trying to feed my baby for over an hour with no success and no support. I therefore rang for help again. A third member of staff arrived. I explained to her that the midwife and second member of staff had failed to return as promised. This third member of staff replied by asking what I expected the staff to do about it! I explained to her that if someone said they would return to help then I expected them to do so. She replied that there was nothing they could do because they were understaffed. It was clear there was only three members of staff on duty at night, but I believe this may be the established staffing level at night, because the two subsequent nights had the same number of staff on duty. I therefore question whether this member of staff was being honest with me about being understaffed. I would seriously question however whether three members of staff on a ward full of women who’ve had sections is enough. Surely the other postnatal wards do not run on any fewer staff than this at night, yet Norfolk ward has more dependent patients.
Anyway, this third member of staff did eventually return with a breast pump, however I was still unable to express any milk and the midwife eventually returned to give formula to my baby. Overall I was very upset at the lack of support I received that night, and particularly the blasé attitude shown by staff towards my desire to breastfeed. I noticed that the other women in the bay were formula feeding their babies and were being attended to much quicker that I was whenever they buzzed for formula to be brought to them – each time it was brought to them immediately, whereas I was just left to it, even though the staff knew I was struggling. I can only imagine this was because it was easier to deal with women who are formula feeding.
That night I did not sleep at all. The room was too hot and too noisy. I even had earplugs in, but still failed to get any sleep. I cannot see how anyone can sleep in a shared bay, where there is generally at least one baby crying, or at least one buzzer going off, or at least one member of staff in dealing with a patient. I’d be very interested to know how the hospital feels this environment is at all suitable to people recovering from surgery.
The next day generally the support from staff was better, however there were still some issues occurring that caused me concern. I was assisted in getting up for a shower at around 6am that morning. The staff member who helped me placed a sheet on the bathroom floor and gave me towels to use. She advised me to leave these items on the bathroom floor as she did not want me to bend to pick them up. Needless to say, as this was less than 24 hours after having a baby, the towels and sheet were stained with blood after I had used them. I left them on the floor as instructed only to find that they were then left there for the rest of the morning. Each time I went to this shared bathroom, the towels and sheet with my blood on them were still on the floor. This was unpleasant enough for me, never mind anyone else having to use the bathroom. In addition, there was a jug full of urine left in the corner of the bathroom for much of the day, which was frankly disgusting. Also, there were no sanitary disposal bags in which to put used pads, so they were put in the bin without being wrapped, which meant they all stuck together. As you can imagine this was very unpleasant every time I had to dispose of a pad. I cannot understand why a postnatal ward does not have an adequate supply of sanitary disposal bags. The bathroom was finally cleaned at 1pm that afternoon, however the jug of urine was still there for the duration of the afternoon.
There were also some other incidents that were of concern. We had been asking for our baby to be bathed on the day he was born, but were told because he had a low temperature he would have to wait until the next day. The next morning I asked again only to be told very bluntly that the nursery nurse was very busy and I would have to wait until the end of the day. Less than 10 minutes later the nursery nurse arrived in my bay and one of the ladies opposite me asked if her baby could be bathed. The nursery nurse bathed her baby there and then, which left me upset about why I had been so rudely told my baby would have to wait. I therefore asked the nursery nurse myself and she confirmed she would bathe him. She then got tied up somewhere else, but thankfully another member of staff bathed him for us.
A member of staff also brought a clean pair of stockings for me to wear that day. She told me not to struggle trying to put these on myself and that someone would come and help me put them on. Several hours later I was still waiting and eventually I had to tell a member of staff that I was still waiting. Finally a member of staff came to ask me if I had passed urine into a jug. I informed her I had not and asked if I needed to. She asked me if anyone had asked me to pass urine into a jug and I informed her they had not. Shortly afterwards I was changing my baby’s nappy and found a jug next to his cot. Obviously someone had brought it to my bed but had failed to inform me that they had even brought it, never mind what it was for.
All through the day me and my boyfriend were asking about being moved to a single room. We were consistently told that I would be moved to a room that day as because I’d had my section first the previous day I would be first to be moved to a single room. These promises continued throughout the day to as late as 7pm, after which we heard nothing. It was only when my boyfriend asked when leaving at 9pm that we were informed that a room was not available after all. This news left me distraught, to the point where I could not stop crying and was even on the verge of asking my boyfriend to return so that I could discharge myself and return home immediately.
To make matters worse, a women was moved into the next bed space who was incredibly noisy. She was constantly either on her phone or eating crisps. In addition, the other two women in the bay were watching two different television channels. The noise in the bay was therefore worse than ever. At around 10pm the midwife on duty came to give me my medication and she then spent a considerable amount of time with me trying to calm me down. She was the first person to explain that I had not been given a room because some emergencies had come in, but that I should get a room the next day. I highlighted that I would be going home the next day as I had been told I would only need to be there for 2 nights, however she then informed me that I would not be allowed home the next day because my baby was not feeding properly. Not one other member of staff during the day had informed me of this and it upset me even more that not only would I have to stay in the bay, but I also was now being told I would not be able to go home as expected.
I explained to the midwife that I had felt completely unsupported during the previous night and she promised this would not happen again. I also explained how difficult I was finding the bay environment and that I had been told all day I would be moved to a single room. She spent much of her night shift with me and supported me hugely with trying to feed my baby. She managed to calm me down and encouraged me to try and get some sleep. Unfortunately again I found this impossible because of the level of noise (even with earplugs in) and by 1.30am I had to get up because of backache and have a bath. After my bath I spent much of the rest of the night with the midwife in the patient’s lounge either trying to breastfeed my baby or expressing milk to feed him by pipette. Unfortunately because I was still not producing very much milk, my baby still had to be topped up with formula. The midwife encouraged me to go back to bed to try and get some sleep as she felt my staying awake had become a kind of mania. I went back to bed at 7am and I did manage to fall asleep from the sheer exhaustion of not having had any sleep for 48 hours.
When I woke up just over half an hour later I felt dreadful. I felt weak and nauseous and unable to get out of bed. The senior midwife on duty came in shortly afterwards to give me my medication. I burst into tears because I felt so tired and she acknowledged that I was suffering with exhaustion because I had not slept again. I told her this was to be expected as I could not understand how anyone could sleep in such an environment. She told me that a single room would be ready for me that morning however I highlighted to her that we had been told this several times the day before and a room had not materialised. I told her that I would therefore be going home that day. She informed me that I would end up being readmitted if I went home, but I explained that I simply could not bear to be in the bay any longer and I did not believe I would get a single room after all the promises. She assured me she would sort out a single room for me and thankfully at 10am that morning I was finally moved to a single room.
The difference was like night and day. We finally had the privacy and the space to bond with our baby and I had the peace and quiet I needed to get some desperately needed sleep.
Overall I found my stay in Jessop wing very upsetting. As such I made a formal complaint to the Trust. The complaint was handled very badly. They ignored my initial email, even though it was later proved they had received it. After my second email they stated they would investigate my complaint and arranged to meet with me to discuss the investigation. When I met with the Matron it was clear they had not conducted any investigations. Although they were very apologetic I explained that I wanted assurances that actual changes would be made to ensure others did not have similar experiences.
In particular it had been highlighted to me after my discharge, that if you have a planned caesarean on a Friday then it takes longer to be transferred to a single room. This is because the shared bay onto which new patients are admitted does not need to be vacated until Monday morning and as such I believe that some staff leave the women there all weekend as it makes their jobs easier (rather than transferring women based on their care needs). It was admitted in the meeting that if I had had my baby on Monday – Thursday I would have been moved within 24 hours. The Matron stated that this may have been to another shared bay and she did not accept that patients having their babies on Fridays have to wait longer to be moved to a single room. However the ward manager then admitted that they always try to avoid moving patients from one shared bay to another shared bay.
At the end of the meeting they agreed that they would put together an action plan and they would update me on this after another 2 months. This never happened. I ended up referring my complaint to the health service ombudsman and it was only after they became involved that the Trust then followed up the action plan, which had clearly not been completed.