can we talk about feedback/complaints on birth care? - Page 3

[mommato5]

You got me!

[MsBlack]

mommato5--

this thread, and seeing other discussions about birth loss involving provider mistakes or incompetence...and just from a particular loss in my own life (not a baby, tho)...I know that some losses are REALLY really hard to heal. The loss itself is hard enough to bear. Yet when you pile on mistakes/incompetence and further, feeling barred from justice of some sort, and even further, having to deal with so much resistance/disapproval from others (strangers and even some erstwhile 'friends')--well, this can complicate our acceptance/healing from the loss. The one in my own life, now 9yrs 'done', haunts me at times still--not so much the loss itself, as all those other factors that impacted events and ongoing stuff on so many levels.

I guess I just want to say...from my own experience, healing is possible--and necessary if one is to live life fully into the future. Any loss has it's own course of healing--in your case as in mine (tho different types of loss), that course IS more complicated and the feelings can be bottomless and so lingering. But healing is still possible; we just have to want that more than anything else, we may have to really work at it...again and again. At least, I know this is how it is for me. And I know now that my healing is needed for ME--it is a gift I can only give myself and must do so if I am not to live the rest of my life in the shadow of the past that only hurts me and my loved ones in the present.

One thing that comes clear to me from this and other stories of birth trauma and loss: there is some very awful stuff going on for some. With drs in the hospital, at home w/midwives...doesn't matter. There are going to be providers who operate mainly on ego and are not able to make good decisions at birth and after. There are official and unofficial systems in place to protect those providers--all for the sake of the 'profession at large', even if others see the incompetence/ego of one practitioner.

I guess we can complain--or otherwise take action such as helping to change hospital policies or midwifery laws, with or without making complaint. And we have to live with the fact of provider and institutional ego, incompetence, mistakes....it seems to be a fact of life.

[major_mama11]

Mommato5, I so sorry for your loss. And I'm sorry that nothing has been done by the authorities to stop this person from practicing.

I delivered both my kids in a freestanding birth center with CNM's. With my first, I had a 3-day labor and then a postpartum hemorrhage. I didn't realize that blood spurting against my thigh = not normal! They quickly got me up on the bed, and I received an excruciating but necessary manual placenta extraction, 7 IV sticks due to my flat veins from all the blood loss, and then finally a bolus of IV fluids after the student midwife managed to get a butterfly into my AC. The bleeding eased up after the placenta was out, and I received IM pitocin and a liter of fluids.

The midwives and birth attendants waited around until I was stable, then left me in the care of a postpartum nurse. I was well aware by then that I had hemorrhaged, so I expected to be kept overnight, rather than the usual 6-8 hours. However, at 7 hours after delivery, I was surprised to see that I was going to be sent home within the hour. I was too agreeable to argue, so I just went along with it. I hadn't even peed yet, and had to remind the nurse of this. My BP was slightly below the parameters for sending home, so she took it 2 or 3 times until she got an acceptable number, then sent us home 8 hours out.

I bled quite heavily for the first couple days, passing what I now know were larger than normal clots. Although I was pale and too weak to even stand up for long enough to change a diaper for the first couple days, no follow up labs were ever done to determine how low my hemoglobin had dropped, and the word "hemorrhage" was carefully avoided at pp visits. I felt like I had been hit by a truck for the first 6 weeks, but thought that was normal since I didn't know any different.

I told everyone that I was very happy with the experience, as I felt that I probably would have gotten a c-section had I delivered in a hospital (which I still believe is true, considering my daughter's extremely short cord and the fact that I was at 9.5 cm for 8 hours before delivery).

I chose to deliver at the same birth center with my second child (different CNM this time). I was an RN by this time. At about 32 weeks, we started talking birth plans, and I mentioned that I wanted a saline lock this time just in case I had a repeat hemorrhage. She looked puzzled and said, "What? You didn't hemorrhage." I said, "Uh, yeah I did!" and described the whole experience: the bowl completely full of blood, chux completely soaked from corner to corner in blood, manual extraction, IM pitocin, liter of LR with pitocin, feeling like complete **** for weeks and barely able to stand for days.... The new CNM got very quiet for several minutes and paged through my records. She then said that everything had been recorded just as I said, except for the odd fact that only 300 ml blood loss was recorded, when I clearly lost what the new CNM estimated from my description to be 800+ ml.

After finding out this MAJOR lie in my charting (seriously, why would they have done all those interventions if I only lost 300 ml?!), I thought of transferring care, but felt like I was too far along to switch. So, I delivered my 2nd child at the birth center, and everything went great this time. I stood up after the birth and raved, "I feel soooo good!" I couldn't believe how normal I felt, having delivered w/o a pph!

Looking back, I feel like they did manage my labor and PPH very safely, but I think that once they saw that I was stable, they chose to pretend that I was fine all along, and to chart much less EBL than what I actually had, so that they could go home to the birthday party and such. I don't know that I necessarily needed a transfusion or to be transferred to hospital, but I think I definitely would have benefited from being kept overnight with some more IV fluids to tank me up! I also think it was pretty bad follow up to not even draw a CBC to see how anemic I was afterward. I thought I was a wuss for feeling so weak for so long afterward, until I had a normal birth and felt totally normal afterward.

I never did complain about the lack of follow up, since I didn't realize it was even an issue until 3 years later. And I was very happy with the CNM who delivered my 2nd child. However, if I have any more kids, I plan to deliver at the hospital where I currently work, as I have seen firsthand how natural childbirth-friendly this place is. The nurses are always sooo excited when someone wants to avoid the epidural, and the OBs go along with it since the nurses pretty much unofficially call the shots around here, in low risk deliveries anyway.

[MsBlack]

Wow, what a story! I'm so glad that you and baby made it through in spite of the lack of attentive early postpartum care. Sounds so....hmmm....'off'...to me, that they neither gave you increased pp attention, nor even charted your pph. The first seems unsafe, the second, unethical for many reasons.

When I see that a mama has lost more than the usual amt of blood, at least IF she is acting at all weak/woozy, then I definitely want to be watching her for a longer period after the birth than usual. And not just watching her, but also making sure she is drinking plenty, and getting a lot of wholesome food to eat. With that, I would give very specific instructions to family about the best ways to rebuild blood fast, warning/danger signs to watch for, when to call me or 911--and I'd probably be in contact a lot, with the family (later that same day, visit next day possibly followed by a later ph call that day). I want to know that bleeding is now reducing fast enough, that wooziness/weakness is reducing, give reminders about how much food/drink/supplements should be taken, along with rest. And I want families to understand that this is so important, because 'bleeding can easily lead to more bleeding'.

This means that if you lose enough blood, then you are not going to be able to carry as much oxygen to cells; without good oxygen supply, the uterus will not have good strong contrax to shrink itself back down rapidly--and that can mean more bleeding still. It can become another hemorrhage, without due caution, as late as 2 + wks after birth.

Anyway--so glad to know your next birth went better! I wonder if it might be a good idea to register a complaint now, about the charting issues and the lack of safe followup with your first...?

[liqdsnk2]

I have been lurking on this thread for a while and finally have the courage to post.

As some of you know I gave birth almost 18 months ago at home with a midwife. The birth was the most amazing empowering experience. I don't want to go into detail of what happened after but I ended up with a massive Step A infection and almost died. I was told by my Dr's that Strep A after child birth was what killed women after birth in the 1800's before Dr's knew to wash hands between mothers.

The doctors who treated me wrote a letter to the council in my state about what happened. The Midwifery Council started a investigation agains my midwife. It ended with the Midwife voluntarily surrendering her license. From what I can gather I am not the only women who has had a negative experience with this midwife. I found out a year later that she was also found negligent in 2008 for loosing a baby.

I am grateful that I live in the state that has an active council that looks out for mom and baby. But I feel they need to publicize this info better. If I had know that she was negligent before I would have gone with another midwife.

[MsBlack]

liqdsnk2--

Thanks for posting your story--I do remember reading earlier about your terrible postpartum infection

You bring up a good point about publicizing info on mws who have had complaints brought against them, or have been asked to stop practicing. It seems that this 'lack of full info' is a problem whether the mws are licensed or not, in one's home state. Just the same is true for OBs/other docs--this lack of blanced information about any care-provider makes it hard for families to make informed choices.

What do we do about this? The way things seem to work, it can be very hard to discover some very important things about our care-providers. I have heard about, and experienced so many instances where people only find out after their own disaster, about other, similar disasters involving certain birth or health providers. It does not seem we'll receive informed-enough choice in care by relying on care-providers and their professional organizations to give it to us.

Making complaints is definitely one way to get some action, and I'm glad that some of you have gone that way for sure. And I wonder--what else can we do, toward safe informed choices? We have to find ways to discover that balance of information about care providers and care choices, so that we have fewer complaints to make! And happier experiences to report.

[rnchrista]

Originally Posted by MsBlack

Oh dear...I've seen how this can be a problem in homebirth--have heard some families and mws both talk about this. Families complaining about a mw doing this, mws complaining that their clients 'don't want to be there for me, though I give so much'...oy. And I've seen myself do the same at times, catching myself going on about me if I'm under stress. At least, if it has something to do with the world of midwifery. No one has complained--and have hired me again. For me, it's been something I would catch myself doing and stop, turning back to mama's care with 'nuff about me, sorry!' I think since the topic was the midwifery world, it was more ok than if I'd just been talking about messy divorce or something...they are generally interested in the world of midwifery and know that it can be stressful at times (legal, medical, or community issues that can arise; mws are few, and fams want to help keep it available however they can). But while I've been grateful for my clients' indulgence, I know it's still not ok and have worked to eliminate it. Your comments were a good kick in the patootie for me!

Just wanted to clarify, if my midwife had been talking to me about midwifery stuff, I would have been interested in that. I think the mutual exchange of information is one of the things that sets a midwife/client relationship apart from an OB/client one. But, the midwife should still remain somewhat professional about what she's discussing. My prenatals were spent hearing about my midwife's nights at the bar, what kind of underwear she wore, and her sex life. Along with that came the shirts that revealed way too much clevage, heavy perfume, long fake nails, etc.
It was a very unprofessional situation all around.

[MsBlack]

Originally Posted by rnchrista

Just wanted to clarify, if my midwife had been talking to me about midwifery stuff, I would have been interested in that. I think the mutual exchange of information is one of the things that sets a midwife/client relationship apart from an OB/client one. But, the midwife should still remain somewhat professional about what she's discussing. My prenatals were spent hearing about my midwife's nights at the bar, what kind of underwear she wore, and her sex life. Along with that came the shirts that revealed way too much clevage, heavy perfume, long fake nails, etc.
It was a very unprofessional situation all around.

I appreciate the clarification...and feel a bit less guilty because well, at least I've never gone THERE!

Easy to see why this was not so great for you. I'm kind of blown away--I've heard various things from ppl about 'unprofessional stuff' their mw did/said, but never anything quite like this. Wow.

[Bluegoat]

I had my third baby nine months ago, after two sections. I had a GP and was overseen by an OB, who felt that it was ok for me to have a "trial of labour". I was clear about a few things I wanted - no hep-lock, no constant monitoring, and a few others. They had me sign a waiver about the hep-lock, and seemed to have no problem with the other things.

As we got closer to the birth, the OB became less helpful - constantly going on about how my pelvis was narrow and that caused the dystocia in the other births (which wasn't the issue anyway) and how I likely would end up with another section. Bla bla bla.

I went into the hospital after about 10 hours of labour because I was vomiting and shaking, at about 5 cm, and things were going well. The intermittent monitoring showed things were fine, I was handling labour well with help from my doula, etc. The only thing was she and I thought the baby might not be in the most advantageous position, because I was having back pain and feeling like grunting, even though I was not anyware near second stage.

Well, suddenly the OB and Gp swooped in, and told me that the OB had to go, and so the Chief OB would be in charge, and he said I had to have a hep lock and internal monitoring, or he would send me on an hour long trip in the ambulance to a bigger hospital. They implied that I could die, and the OB said I had a 10% chance of death, and on and on. They actually yelled at me while I was having contractions. Yada yada.

I yelled back a bit. But in the end I just gave up I told them to do another section. I think about it all the time, and all the things I could have done instead, but I was tired and it just seemed easier. I'm not really brave about labour, and that was too much for me.

Anyway, I have thought about complaining to the College of Physicians and Surgeons about the OB and Chief of Obstetrics. (The GP apologized, and I am willing to accept that - I also think she was probably put in a difficult spot.)

I haven't because I am scared of being told that I am stupid, or that they did the right thing, or not being able to support my thoughts about why it was wrong. Also, I am not sure that it is really the right forum for this complaint. Or that nothing will come of it. I am not good at confrontation when I have a lot of emotions, and this would kind of be the epitome of that.

[MsBlack]

Oh Bluegoat--I'm so sorry you had to go through that bullying, and needlessly be forced to give up your birth to that bullying!

I hope others will chime in, but for myself, I do hope you will complain. That sort of bullying is simply UNACCEPTABLE! It is not necessary, and as you well know it only makes things worse for mamas starting their journey with a new baby. I can see how you would not complain about the GP--you are likely right that she had no control over events at that point. But the OB who bullied you definitely needs to know how hurtful he was. And the hospital needs to know that they should do something to prevent such bullying in future.

Take your time, and maybe seek some help from people who might be able to assist you in forming the words for your complaint (in writing, to avoid face to face confrontation) and figuring out where it needs to go. It can be so valuable to a mama to speak out about her abuse....and nothing will change in the medical world if no one ever does speak out.

Sending you healing thoughts, and all the best as you consider what to do about this issue.

[Christine4kiddos]

Ms Black,
Love the thread!!!
Although I live in a state with regulations, certification, and a separate council, there doesn't seem to be a way for prospective clients to receive full disclosure on a midwife's stats. I would hope that people would be honest, but we all know that this doesn't happen.
And I cringe to think of the number of "incidents" that need to take place BEFORE action is taken. It burns my butt to hear a midwife being described as a "loose cannon" (by her peers)... of the midwifery community KNOWING that sketchy behavior going on, but no one doing anything. It is more than sad that babies must die or moms almost die, before anything is done to curtail dangerous midwifery.

On another thought, I have heard women praise a midwife who "didn't care if they went past 42 weeks" or "didn't care if she'd had 2 c/s and wanted to VBAC" because the mom thought that this meant she was a good midwife, trusting birth. A midwife who doesn't CARE about this and other things, needs to be looked at more closely. A midwife needs to be upfront about protocols, scope of practice and show a willingness to work within the community standard of care. A good midwife must be able to EXPLAIN why or why not a certain situation is worrisome, etc.

I hope all women/families who have a complaint about the care they've received to let their midwife know... and if there is no resolution, to bring it to the attention of the certifying body where they live or state midwifery organization. This information should be readily accessible in your chosen midwife's informed consent agreement. In the event of significant morbidity/mortality, it is especially important to write down everything that happened, in your own words.. using a timeline if possible.

[MsBlack]

Originally Posted by Christine4kiddos

Ms Black,
Love the thread!!!
Although I live in a state with regulations, certification, and a separate council, there doesn't seem to be a way for prospective clients to receive full disclosure on a midwife's stats. I would hope that people would be honest, but we all know that this doesn't happen.
And I cringe to think of the number of "incidents" that need to take place BEFORE action is taken. It burns my butt to hear a midwife being described as a "loose cannon" (by her peers)... of the midwifery community KNOWING that sketchy behavior going on, but no one doing anything. It is more than sad that babies must die or moms almost die, before anything is done to curtail dangerous midwifery.

On another thought, I have heard women praise a midwife who "didn't care if they went past 42 weeks" or "didn't care if she'd had 2 c/s and wanted to VBAC" because the mom thought that this meant she was a good midwife, trusting birth. A midwife who doesn't CARE about this and other things, needs to be looked at more closely. A midwife needs to be upfront about protocols, scope of practice and show a willingness to work within the community standard of care. A good midwife must be able to EXPLAIN why or why not a certain situation is worrisome, etc.

I hope all women/families who have a complaint about the care they've received to let their midwife know... and if there is no resolution, to bring it to the attention of the certifying body where they live or state midwifery organization. This information should be readily accessible in your chosen midwife's informed consent agreement. In the event of significant morbidity/mortality, it is especially important to write down everything that happened, in your own words.. using a timeline if possible.

Thanks for posting, Christine4kiddos--

You raise some good points, although I'd like to address a couple of them.

one is, it's very hard to receive full disclosure from any care provider, anywhere--not just hb mws. Heck, I went into my local hospital a year ago in search of some stats--csec, epidural and induction rate generally (for the hospital, not for any particular OB, even) and was given a runaround with high suspicion. Basically "who are you and why do you want to know?" What? Does that matter? Are not these issues pretty much public information? Apparently not. I was conveniently given the ph number of 'the person in charge of that' who refused to return my calls. I didn't try all that hard to make contact--for me, the message sent was pretty clear: we don't want people to know, we have our reasons for concealing this info from the general public.

In fact it's starting to look to me like the hb midwifery world is taking more and more cues from the med world in this respect. I mean, if docs and hospitals don't give full disclosure, why should we? Not that I like this, not by any means. Just trying to provide some balance of perspective here.

Also--as for 'my mw doesn't care if I go past 42wks, have had 2 or more csecs...etc': I think that families might express it that way, but it doesn't necessarily mean that their mw put it that way to them. A mw might not be particularly alarmed by postdates or multiple CS, for example-- if she is aware of the research and knows how to monitor elevated risk in such situations, has good backup, etc. That is, NOT practicing 'blind trust' but 'informed trust' in birth. As long as her clients are being informed and making their own choices, this by itself should not be a problem...but families might say 'my mw doesn't care about those things' only as a form of shorthand, when in fact quite possibly their mw DOES care, very much--only that she practices evidence based care with individual women/babies, rather than applying 'general stats' to everyone in a blanket way.

To me, the difference is important. And I very much DO urge families to know that difference and make sure they know their mw's (or OB's) thinking and study on 'higher risk' situations. I would no more want a care provider who ONLY goes by the 'accepted guidelines' (usually too conservative in a blanket way, rather than examined case-by-case), than I'd want one who soothed me with 'I trust birth' noises while ignoring risk. KWIM?

I think it's true that too often, midwives and midwifery orgs practice too great of a protectionism of the questionable practitioners--tho I have seen this just as true of the medical world. Of course, I don't care as much what the med world is doing, as I care about the midwiery world! But I have seen that in some areas, the mws and their orgs do not take complaints seriously enough--and this really irks me no end.

Still--in any situation, the most power lies in the hands of the families, IMO. If families will make their stories known to the providers AND to their overseeing orgs, changes can occur. If families don't complain, nothing will change. For various reasons, making complaints occurs too seldom--and poor OB or mw practice is allowed to continue by silent complicity.

[PseudoDiva]

I was just thinking about my birth today, for the umpteenth time.  I am nearly 10 months PP with my first DS.  I'm glad this thread existed.

I had planned a homebirth with a midwife whom I thought would be very supportive.  I was 11 days late.  She had scheduled a trip which she claimed was a "contractual obligation" with another client out of state.  As luck would have it, my water broke 6 hours after she flew out of state.  In her place she sent 2 doulas, both of whom I had met, neither of which ended up being qualified in any way.   

I labored on my own for 7 hours.  I had gone immediately into hard labor.  I know this because I had been having false labor for weeks.  Finally the doulas showed up but they acted like they didn't want to be there.  I had the instinct to lean back.  They kept telling me not to.  When my son was finally born (in the hospital, we transferred and he was born 100% naturally) his head was really molded, as if he had been stuck for hours.  If they had let me follow my instincts I might have been better off.

I was furious at the neglect I experienced at the hands of this midwife.  She was incredibly flippant about my safety and the safety of our son.  I shudder when I think of all the things that could have gone wrong.  Thank God she has moved out of state so I never have to deal with her again.  I did write to her and tell her how I felt about 3-4 months PP.  She wrote back and said: "I could argue with you on many points but I am not going to" and that was the end of it.

I never confronted the doulas.  Up until today I was friends with them on Facebook, but frankly I just don't want to deal with them at all.  Maybe I do need to tell them how I felt.  

[MsBlack]

So sorry you had to experience that, PsuedoDiva!

I really really  hope you will complain to whomever is appropriate--the care providers themselves, for sure--but also any board that oversees them.  Even if your mw moved out of state, it might not be too late to make a complaint to her licensing board in your state.  The doulas may also have certifying orgs that will want to know of this birth.  And by the way, if you paid your mw in full, then she totally owes you $$ for failing to provide a trained mw to take her place after she left.  The fact that she left you in that position, and then had the nerve to blow off your complaints as well, seems just wrong to me.  Now I don't know what agreements you had together, what contracts or payments were made--but all of that is something to consider.

Are you still in CA, as indicated here?  Was your birth in CA?  If so, then the licensing board will surely want to know of this malpractice and violation of the mw laws.  If not, but you and mw were both in another state that licenses mws, the same would hold true.  As a hb mw and a mom who had 3 unassisted births, I can tell you that I know birth works just fine most of the time, with or without a trained professional in attendance.  But I can also say that how moms feel about their birthing situation makes all the difference!  If you'd planned a UC with only a doula in attendance, things would be different.  But having planned for a mw, then be attended by doulas only, would be likely to make any mom more stressed during labor --when her own and baby's health so relies upon mom being relaxed and confident.  And it does seem very possible that these doulas contributed to your birth difficulties by not respecting your birth instincts with respect to positioning--seems they were going on 'usual tricks and methods of the trade' without being in tune with YOU, in YOUR labor. 

Anyway...I do hope you'll complain somehow to someone.  The worst of this continues at home and hospital, primarily because families find it so hard to sound off when their care was abusive or lacking in some necessary way.  We can only cause this to change by telling others what is not ok, what our complaints are, and not letting anyone blow us off.  I know mws who also refuse to hear out client complaints with an open heart and mind--try to blame the client, or do as your mw did--claim that even if she may have been wrong, SHE also has complaints about you.  But this amazes me totally.  I have found that by listening, owning any errors I may have made, hearing out a client's feelings and affirming them somehow, we are usually together able to find a way to resolution.  I don't get many complaints, and none have been this serious (as yours)--but I try so hard to acknowledge families, to work through the  issues and feelings with them, take them seriously.  Most go ahead and hire me again--because they appreciate my honesty and concern--and see that I work to learn from every experience.  But I hear far too many stories like yours--and of course, I hear them as a family's new mw--they are certainly not going back to the one who betrayed them somehow, and are not telling their friends good things about that other mw!  Still, it is hard to know that most of those families never do complain about their care (except to me, and I can't do anything about it but sympathise)--because by not doing so, they are allowing the lack of good care, and the lack of professional integrity, to continue. 

If you are willing to consider making a complaint, I am more than happy to support you in tangible ways as I am able to.  PM for more info.

And may your next birth be much happier for you and LO both!

[PseudoDiva]

I'm going to PM you...

[mwherbs]

Interesting thread.
Major_momma 11 I wanted to comment on this. "The midwives and birth attendants waited around until I was stable, then left me in the care of a postpartum nurse. I was well aware by then that I had hemorrhaged, so I expected to be kept overnight, rather than the usual 6-8 hours. However, at 7 hours after delivery, I was surprised to see that I was going to be sent home within the hour. I was too agreeable to argue, so I just went along with it. I hadn't even peed yet, and had to remind the nurse of this. My BP was slightly below the parameters for sending home, so she took it 2 or 3 times until she got an acceptable number, then sent us home 8 hours out. "


In my state, in order to keep patients for a certain number of hours total, institutions have to qualify as a certain type of care facility , birth centers try to keep just under that deadline so they don't have to become a hospital or nursing home with all that intails , and I think that they would have had to transfer you to the hospital in order to keep you longer. I would encourage you to talk to or send a note to the attending midwife for that birth, she needs to revise her protocols for post hemorrhage care, like a second assessment before release to go home, and maybe even figuring out how to keep someone longer or set up some home visits, and/or RX a postpartum doula...
Take care

[mommato5]

Good. Now we need to get the rest of the negligent ones off the "streets".