A tale of two births (3)

Please welcome back Afni who is sharing her story of her two pregnancies and her experiences both good and bad as part of a series of blogs related to maternity safety.

Over to Afni….

If it doesn’t rain it pours.

It was around the 5th month when I developed something called Symphysis Pubis Dysfunction (SPD) and hypermobility.  This combination causes severe pain around the pelvic area and makes it difficult to walk, or go upstairs or stand on one leg or turn over in bed.  You know that thing they say about pregnancy being blissful and filled with joy? I wasn’t experiencing much of the bliss or the joy at this point.  So I was referred to a physiotherapist who provided me with a belt and some exercises which, I know I am going to sound so ungrateful, they in fact aggravated the problem!  So I took control again and went to see an osteopath instead.

So dear reader – as you know one of my main anxieties I had was being prescribed and given drugs which I am allergic to. If I do have these I don’t just feel unwell I have an anaphylactic reaction and collapse.  So you can see why I was getting really stressed about the inadvertent administration of the wrong thing.  I was therefore relieved when at month seven I got to see the consultant anaesthetist.  This person completely understood my allergies, my anxieties and assured me by writing in red all over my notes. 

KEY THEME NUMBER THREE – DRUG ALLERGIES NEED TO BE TAKEN SERIOUSLY 

While all drugs can have side effects, some can lead to allergic reactions caused by drug intolerance. Drugs often responsible for allergic reactions include antibiotics, general anaesthesia, and painkillers such as aspirins and ibuprofen.  In certain cases, the reaction can be severe. Each year around 62,000 people are admitted to hospital after experiencing a serious allergic reaction to a drug. Between 2005 and 2013 there were 18,079 of such incidents, which included 6 deaths, and 19 people who were severely harmed.

There are several reasons why people with drug allergy are currently being prescribed or administered drugs that they are allergic to. These include poor clinical documentation of drug allergy, the lack of patient information on drug allergy, and the lack of a routine system in place for people to keep a record of their own drug allergies. To tackle this, NICE has published a new guideline on the diagnosis and management of drug allergy in adults, children and young people.

The guideline recommends that when a person presents with suspected drug allergy, their reaction should be documented in a structured approach. Among the information included should be the generic and proprietary name of the drug or drugs suspected to have caused the reaction including the strength and formulation, a description of the reaction, and the date and time of the reaction.  NICE recommends that paper or electronic prescriptions in any healthcare setting should be standardised and redesigned to record information on which drugs or drug classes to avoid, reducing the risk of drug allergy.  Clinicians should check a person’s drug allergy status and confirm it with them, or their family members or carers as appropriate, before prescribing, dispensing or administering any drug.  If there is a change in drug allergy status, the patient’s medical records should be updated and their GP should be informed.  In addition, clinicians should discuss the person’s suspected drug allergy with them, and their family members or carers as appropriate, and provide structured written information. They should record who provided the information and when. They should also ensure that the person and, their family or carers as appropriate, are aware of the drugs or drug classes that they need to avoid.

I reached month 9! I got there.

Despite everything I was nearly at the end.  But at 39 weeks I am still vomiting and have permanent headaches.  So my new midwife and I agree that I should be admitted to hospital to see if we could progress the labour.  She arranges for me to be admitted.  When I arrive, the receiving midwife is annoyed that the referring midwife hadn’t phoned ahead and makes the assumption that I am suffering from a migraine.  She doesn’t seem to take a detailed history – well she doesn’t ask me anyway.

So dear reader we have finally arrived at the birth.

On admission I was having severe contractions but because I was not dilated was admitted to the pre-labour ward. The pain was excruciating but it took over an hour for any pain relief to be given.  I was told that they didn’t have any gas and air on the pre-labour ward.  I number of things made me feel so unsafe and so uncared for:

  • I was prescribed medications I was allergic to
  • They sent my husband home (before he could give me my hospital bag) because visiting hours had finished
  • I had nothing to eat or drink – you may recall that I have a number of allergies and need a gluten free diet – this was not available on the ward
  • I am in a room all on my own and no one comes when I call

Shortly after sending my husband home I am checked and they realise I am dilated to 5cms so they call my husband back; and to my surprise they also wheel out the gas and air. I am moved to the labour ward.  At this point I am dehydrated, my blood pressure is up because I was stressed and in pain.  The midwife inserted a drip.

In my birth plan I had asked that I would not give birth lying down. The reason for this was not just a preference, it was a necessity.  When lying down I couldn’t push properly because of the hip problems I had.  But the plan was not known, not acknowledged or simply ignored and I was forced into stirrups on the bed; this I believe was the reason why I suffered a second degree tear.

After giving birth I was taken to the post-natal ward and sadly there was still no food for me because no one had ordered any gluten free food for me. By this point I had not eaten for over 18 hours and I was severely dehydrated.  Despite that my husband was not allowed to heat up some gluten free food he had bought in for me.

KEY THEME NUMBER FOUR – PAY ATTENTION TO THE LITTLE THINGS

The little things really really matter, that includes:

  • Failure to respect my feelings or my wishes – not being listened to – in general a lack of patient centred care
  • Understanding that safety is not just about single incidents or issues of avoidable harm such as falls or pressure ulcers; safety is a feeling, an experience. It is also about feeling both emotionally and physically safe
  • Understand your patient’s condition – in my case, hyperemesis and its impact
  • There were some moments that were great; the GP was as always fantastic, some of the midwives too but it is all summed up by one midwife who lives in my memory. I can clearly recall her interrogating me as to why I had changed my midwife during the pregnancy – she was horrified and kept telling me that the midwife I chose to transfer from was one of the best. She left me in floods of tears and didn’t seem to care.