A tale of two births (4)

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. This blog moves from her first pregnancy and finds her a few years later experiencing her second pregnancy.  Over to Afni….

So dear reader, you have read the story of my first pregnancy – let’s move on to my second.  Well, they say history repeats itself. I had no idea that if you had experienced it in your first pregnancy that I was highly likely to get it again.  So yes, I suffered Hyperemesis in my second pregnancy – in fact it was worse the second time.  This time round I could barely move without feeling or being sick.

My GP was fantastic and not only provided me with the right medication she booked me in to see her very week. As I said before little things really matter – whether they are good or bad.  For example when I attended the GP for my appointments the receptionist would tell the GP as soon as I arrived so that I could be seen as quickly as possible and find me in an empty room so that I could be sick without anyone watching. The GP tried really hard to seek advice from the gynaecologist about what the latest treatment was for hyperemesis. She also tried unsuccessfully to get me admitted.  The gynaecologist said I had to fit the exact criteria for admission.  These in particular were ketones in my urine of more than 3, and severe dehydration.  But despite having lost over 3kgs, my ketones were less than 3.  I found out later that this was the case because of my Asian heritage and baseline low weight.  Some people just simply don’t produce the same level of ketones than others but that doesn’t mean that they are not extremely unwell.

I was booked into see a midwife who this time was sympathetic but didn’t seem to appreciate the urgency of needing to see a consultant for help. Instead she referred me back to the GP.  The GP did her best to help but nothing seemed to control the relentless vomiting.  This is when the depression started.  So one day I had had enough. I took myself off to A&E because I had severe constipation, dehydration, and side effects of the anti-sickness medication.  The A&E staff called the gynaecologist and asked him to come and see me.  He said no, unless my ketones were more than 3.  Even though I could barely pass any urine, when tested the ketones were less than 3. I was sent home.

KEY THEME NUMBER FIVE – SEE THE PATIENT AS A WHOLE

When people are ill in hospital and depend on others to look after them, it is of fundamental importance to them and their families that they will be cared for with kindness and compassion by everyone they come into contact with. If you want to know what it is like being a patient in hospital the best thing to do, is ask them and to listen.  The patient needs to be ‘seen as a person’ – not a set of numbers – so look past the set criteria and look at the patient first and foremost.

If we want to know how a person feels, we must begin by acknowledging the fact that there is one and only one observer stationed at the critical point of view …she is the only person who has even the slightest chance of describing ‘the view from in here’, which is why her claims serve as the gold standard against which all other measures are measured.

[Gilbert D (2006). Stumbling on Happiness. New York: Knopf.]

I finally got to see a consultant who was, after some lengthy arguments, able to get me admitted to hospital. She told me that she had to argue my case with a junior doctor who was somewhat obsessed about the level of ketones in my urine.  I had all the other symptoms of severe constipation, inability to eat for over 48 hours, vomiting even after drinking water, and a weight loss of now 6kgs.  On admission the junior doctor told me that ‘normally we would not admit you but your consultant pulled rank’.

The midwife who admitted me quickly realised I needed intravenous fluids and intravenous anti sickness medication. However, that was as good as it got.  Another ‘Déjà vu’ – I was left alone; no one came to check on me, there was nothing for me to eat even if I could eat, as they had no gluten free food.  The only person I saw was a healthcare assistant. Ironically the board above my bed had ‘hello my name is’ at the very top but nothing else; none of my details, or who I was under or what I was allergic to.

KEY THEME NUMBER SIX – COMPLIANCE IS NOT IMPLEMENTATION

Simply saying that an organisation wants to be the safest in the world or that they have embraced campaigns like ‘hello my name is’ is not enough – it actually has to be implemented and embedded so that it moves from theory to reality.  Implementation is hard to get right. But it is vital that initiatives like ‘hello my name is’ are implemented in the spirit in which they were designed.  Simple compliance is not enough.  It has to be lived and real not just a sign above someone’s bed. As the lovely Kate Granger said…

I firmly believe it is not just about common courtesy, but it runs much deeper. Introductions are about making a human connection between one human being who is suffering and vulnerable, and another human being who wishes to help. They begin therapeutic relationships and can instantly build trust in difficult circumstances.

Kate Granger – http://hellomynameis.org.uk/

I arrived during the day and at the handover between day and night the nurse said she didn’t know why was I was admitted and the healthcare assistant who was the only person I had had contact with couldn’t explain.  Now reader, I don’t want to go on about the negative side of things but as I have said time and time again it is the little things that matter. While I was in hospital at no point did I see anyone wiping the equipment between patients or washing their hands.  That doesn’t mean they didn’t, I just didn’t see them do it and it made me feel really unsafe. Another strange thing was that the healthcare assistant didn’t want any of us to walk to the toilet, preferring for us to use bedpans instead. Believe me when you are feeling sick, have pelvic problems and hypermobility it’s a very hard thing to do to balance on a bed pan!  Also I was provided with DVT stockings to put on – but with no help that too was a major task. Every time I bent down I was either going to be or was sick.

The next morning there was no breakfast for me because no one had ordered a gluten free breakfast and I was given raw oats which unfortunately unbeknown to me had been cross contaminated with some wheat and I had an allergic reaction to them. I could feel the reaction coming on and buzzed for attention – but no one came and I was panicking not sure how bad it was going to be so I ended up taking my own anti-histamine.  When they did eventually come I told them what had happened and they didn’t seem that fussed; there was no further monitoring to check if I was recovering.  When I was finally seen by a gynaecologist he said…

I think it’s safer if you are not in hospital’

He prescribed some medication and discharged me.  On discharge I checked the drugs provided and not all of them were there; also there was no discharge letter.  I waited for the missing drugs.  There were three types of anti-sickness pills and it was only when I bumped into one of the nurses on the way out did I get told not to take them all at once.  That they were supposed to be staggered but that had not been made clear to me.  It’s weird isn’t it, you become very passive as a patient and I often wonder what if she hadn’t done that.  I could easily have overdosed.

KEY THEME NUMBER SEVEN – COMMUNICATON REALLY IS AT THE HEART OF EVERYTHING

Encouraging conversation doesn’t mean asking people to shout louder to be heard.

As Margaret Wheatley once said,

“I believe we can change the world if we start listening to one another again”

Wheatley M (2009) Turning to one another; simple conversations to restore hope for the future San Francisco: Berrett-Koehler Publishers Inc.

Time, it’s one of the greatest causes of communication breakdown in every area of the NHS. A study by BMJ Quality & Safety this year found that 66% of nurses felt they didn’t have time to comfort or talk to their patients on their last shift.  As part of the Sign up to Safety campaign they have been raising awareness about the importance of communication via the #justaskme film ([1] )  You can read much more about conversations to create safety in many of the blogs here at:  www.suzettewoodward.org

or at www.signuptosafety.nhs.uk

[1] (https://www.england.nhs.uk/signuptosafety/justaskme/talking-about-talking/)

After my admission I talked to my GP and we both decided I needed to try a completely different hospital. I had chosen to go to the same hospital as my first born because I naively thought it would be different from my first experience.  But it seems that the culture of that first hospital was pervasive and that nothing had changed.  I was therefore transferred to another hospital.

And this was when I finally realised what good looks like.

Everything about this hospital was fantastic. The booking-in was methodical, everyone completely understood hyperemesis, I was referred immediately for counselling to help with depressive symptoms of nausea, referred to another physio for the Symphysis Pubis Dysfunction, and referred to an anaesthetist who also had a clear understand about my allergies. They all put a clear plan together.

It felt individualised, it felt personal, it felt like I was truly being cared for.

I was updated by phone and text on a regular basis by so many including the anaesthetist who kept reassuring me about the plan.  The team also understood the impact of my ethnicity on issues like hyperemesis and on the growth development chart for the baby.

I progressed towards my second birth with a much calmer mentality. I felt safe.

At the birth the team were methodical, supportive and structured and they put allergy alerts everywhere. Nothing was too much trouble.  I was not forced to lie down – everything felt like a completely different experience that I so wished that I had had in my first pregnancy.  This was true partnership care – we made decisions together.   My family were involved and also commented on how professional everyone was and how clean it all was.  On admission the midwife immediately alerted the anaesthetist so that they could be on standby if I had any problems. Nothing was rushed during or after birth.  My husband was also cared for and allowed to heat up the gluten free food he bought in for me so that I didn’t get any cross contamination.

The crucial thing here is that this wasn’t just one midwife or one doctor – this was everyone. The culture right across this organisation had truly embedded a culture of safety and caring.

KEY THEME NUMBER EIGHT – CULTURE – HOW IT IS NOT JUST ONE PERSON IT IS EVERYONE

A positive safety culture is where EVERYONE within an organisation has a constant and active awareness of safety. The culture of an organisation is the way people behave; their beliefs, values, attitudes, norms, and unspoken assumptions and working practices together with entrenched processes that shape how people behave and work together. It is a very powerful force and something that can remain even when teams change and individual staff move on.  An organisation with a safety culture is one where patient safety is at the forefront of everyone’s minds; not only when delivering healthcare but also when setting objectives, developing processes and procedures, purchasing new products and equipment, and redesigning clinics, wards, departments and hospitals. It influences the overall vision, mission and goals of an organisation.  That is, it influences everything you do.

A positive safety culture will help NHS organisations to achieve improvements across the board.  This requires changes at all levels of the NHS. It is vital that all those who work in and use the NHS; clinicians, managers, accountants, porters, receptionists, allied healthcare practitioners, patients, families and carers – ask themselves how they can help to improve the safety of patient care.

The leadership of any organisation is central to setting the values and beliefs of an organisation’s culture. The chief executive, the board and directors and leaders throughout the organisation therefore have a vital role to play in building a safety culture. They need to establish an environment where the whole organisation embeds the values of caring, kindness, compassion and all of the other themes throughout my blogs:

KEY THEME NUMBER ONE – BEING LISTENED TO

KEY THEME NUMBER TWO – TAKING CONTROL AND TRUE PARTNERSHIP WORKING

KEY THEME NUMBER THREE – PREVENTION IS ALWAYS BETTER THAN CURE

KEY THEME NUMBER FOUR – PAY ATTENTION TO THE LITTLE THINGS

KEY THEME NUMBER FIVE – SEE THE PATIENT AS A WHOLE

KEY THEME NUMBER SIX – COMPLIANCE IS NOT IMPLEMENTATION

KEY THEME NUMBER SEVEN – COMMUNICATON REALLY IS AT THE HEART OF EVERYTHING

KEY THEME NUMBER EIGHT – CULTURE – HOW IT IS NOT JUST ONE PERSON IT IS EVERYONE

Thank you from the bottom of my heart for taking the time to read my story.

Afni