"I was rushed to see [obstetrician name] who said he could see from my notes that 'we were pissing each other off'"

A mother's experience of Oxford University Hospitals Maternity Services in 2020:

I’m now ready to share my story. I need to disclose that I am medically-qualified, and have previously worked in the obs and gynae department at the JR on a 4-month rotation as a foundation year doctor. I have not practiced clinically for 14 years, for reasons that are not related to my birth story. However, my experience working at OUH informed my desire to ask for an elective c-section for my own child.

I’m aware that others have lost their babies and experienced more considerable trauma than me, and therefore, I feel like a fraud in comparison. My story, which includes a catalogue of poor before and after care, might do what other’s stories have done for me, helping me realise that there was generally a pervasive lack of care at the JR.

My pregnancy was complicated by hyperemesis gravidarum. I was first admitted at 7 weeks, leading to scans to exclude a molar pregnancy or multiple babies. A consultant performed the scan and gave me a rough idea of the likely due date, which seemed consistent with my dates, but I understood that a formal due date had to be based on the 12-weeks scan.

At the 12-week scan, a midwife who was training to do sonography scanned me. I had to ask her to stop during the procedure because she pushed so hard that it was hurting me. She took offence and documented in my notes that she had given an approximate due date that was based on the measurements that day and those taken during my 7-week scan. She also said that the scan had been difficult because of my “body habitus”. I am a normal size 12 woman, who had not been able to eat very much at all for more than 2 months due to the hyperemesis. Therefore, this assertion was entirely unfounded and I assume, documented to protect against future litigation.

At my midwife booking appointment I asked for an elective c-section. I was told it was very unlikely they’d agree, and I’d have to discuss it first with the chief midwife and then [obstetrician name] at the mode of birth clinic. I cancelled these appointments several weeks before I was due to attend because I didn’t have the strength for an argument, and I knew what the Trust’s position on elective c-sections was. My baby was born in June 2020. Most of my antenatal care was cancelled because of the first COVID lockdown and because I was considered “low-risk”.

By 32 weeks, I was getting more out of breath and swollen, so I started tracking my blood pressure and dipsticking my urine. Noticing that my BP had gone up and that I had protein in my wee, I called MAU and was told to go in. When I went in, on my own because partners weren’t allowed, a patronising registrar patted me on the knee and said “You don’t have to be the doctor now. Stop checking yourself. Everything’s fine”.

The next day, I had a call at 7pm saying that I had to return to MAU immediately because there was a worrying blood test. An abrupt midwife was incredulous that I had questions and abruptly said she wouldn’t tell me what was wrong on the phone, but that it was what the “doctors required” - in a very paternalistic tone. In MAU I was told that the blood test showed I had preeclampsia and would have to be admitted straight away.

On the ward round the next day, a consultant explained that the test showed I had a high risk of developing preeclampsia in the next 4 weeks, they couldn’t predict when or how severe it was likely to be, but I didn’t have preeclampsia yet. Therefore, I was to have twice-weekly visits - one for blood tests, CTGs and scans, and one to see a consultant. I complied with this for 2 weeks but then it became apparent that I was deteriorating. However, different people told me different things- some said I could go to term, others said I wouldn’t be able to go beyond 37 weeks.

Over the next couple of weeks, the knee-jerk response to my worsening results was for one of the junior doctors to admit me. I’d stay for a night and be discharged the next day by a consultant, who always seemed happy to allow me to plod along for as long as possible. I was getting fed up going back and forth with no clear plan.

I had another late phone call at 10pm where I was told I had to go to MAU straight away. I was already aware of some of my results and suspected this was another knee-jerk reaction, so I refused to go in and said I would go in in the morning. At the visit, a registrar berated me for not going in. I got upset and asked for my blood pressure to be done after I had calmed down. This, along with my refusal to go in the night before, was documented as evidence of my non-compliance with medical advice. I expressed my anxiety about vaginal deliveries, and the registrar also documented that I had not attended the mode of birth clinic - another “non-compliance” - even though I’d cancelled it with plenty of notice. She decided that I had to see a psychiatrist because “(I) wasn’t ready to be a mother.” I was incredibly hurt by that comment but decided against an individual complaint because, having worked in obs+gynae, I had some understanding of the pressure she was under.

The psychiatrist came to MAU. They documented that I had no acute mental illness or risk factors for post-partum depression or anxiety and that my reasons for wanting a c-section were logical, medically-founded and that I had expressed a clear understanding of the pros and cons of vaginal vs c-section births. I was discharged and had to attend [male obstetrician name]’s clinic the next day at 36 weeks and 3 days.

Before the clinic, I had been working myself into a bit of a state because I anticipated that I was going to have an argument about the timing and mode of birth. When the nurse measured my blood pressure, it was 200/120. I was rushed to see [male obstetrician name] who said he could see from my notes that “we were pissing each other off” and he agreed that I could have a c-section the next day, telling me that it was now medically necessary. My blood pressure returned to where it had been for a couple of weeks (150/90) and I didn’t need any additional medication. When I read my notes following this meeting, I was upset that he’d written “uncontrolled blood pressure due to non-compliance with medical advice. For elective c-section”. I had complied with everything they asked of me apart from that one admission and was concerned that they had offered me the c-section to shut me up, not because it was medically necessary, and that because my daughter would be born slightly early, I was putting her at risk.

I spent the night before she was born being consoled by a lovely midwife, who told me being a mother requires you to advocate for your family’s interests, and that was what I’d done. I will always be grateful to her. The next day I was told I would be first on the list. My husband was there early, and I called him to meet me. Before I went into theatre, I overheard the anaesthetist and her assistant say- “do you know about this woman? She’s incredibly anxious”. The other woman said she’d get “her” consent and duly came to me, the only patient in the room. Therefore, I can only assume they were discussing me.

In theatre, the anaesthetist struggled with my epidural. I had shooting pains down one leg after the other, so I knew it was in the wrong position. One of the most difficult memories I have is that, in that moment I mentally prepared myself to feel the surgery because I felt like an inconvenience and told myself I deserved it. Therefore, I was quietly sobbing into the pillow I was hugging, my husband anxiously trying to read my expression. He asked them to check it was ok after I had expressed my concerns. He was told that siting epidurals are difficult and that they needed us both to remain calm. So now he was over-anxious too. The surgery went well. It was the proudest moment of my life, first when my daughter cried immediately, and then when she quietened down after being given back to me. In that moment, I felt she validated my decision to have a c-section and my status as a mother. After spending a few hours in recovery, my husband was asked to leave.

My daughter and I were transferred to the postnatal ward, and there began more atrocious care.

The light switch on my bedside remote control didn’t work, meaning that I could only turn the light on by getting out of bed and reaching up to the switch above it, on the wall. After the op, I couldn’t do that, so I decided to leave the light on all the time. I mentioned it to the staff. They said they would get someone to look at it, but no one came for the four days we were in.

They continued to treat me with contempt. I was admonished for asking for more sanitary towels after using the pack I went in with, I also ran out of the 15 nappies I took in that my NCT course leader assured would be enough, and for asking for clean syringes to express milk.

My biggest issue on post notes was with the infant feeding team. I wanted to breast feed, but my milk didn’t come in until day 4 after my daughter was born. Therefore, I chose to give her formula. They made me feel like a total failure, effectively telling me that my newborn baby was sly enough to reject the breast because she’d realise that the flow of a bottle was quicker. In addition, formula was described as “horrible stuff”, and the goalposts moved every day regarding the volume they expected her to have. At the same time, paeds told me that c-section babies have bellies full of mucus, which means they don’t get hungry and can be prone to hypoglycaemia and jaundice. Therefore, I thought I was doing well to get her to take anything. I was so paranoid that I wasn’t doing enough to encourage my milk flow, that I rigidly followed their advice where, during 3-hr feeding cycle, I attempted the breast first, then resort to formula, then express/pump after my daughter was fed. This meant that I got no rest at all. The midwives had said we could go home on day 3. I refused to put my TED stockings back on after my morning shower that day because my they had cut my feet where my swelling was so bad. The midwife said she document this additional “non-compliance”. I was so angry with everything that I snapped back: “be sure you write why I’ve refused, and maybe ask your doctors to review why my legs are so swollen.”

The paediatric team said we had to stay in for another day so they could do a day 4 weigh in, per their protocols for premature babies.

My daughter was born at 36+4 weeks, but recall that I said there were doubts about her due date. She was a healthy weight (7lb 4oz), and had never been jaundiced or hypoglycaemic. She had also not lost a substantial amount of her birth weight. The paeds SHO said they had no concerns about her, they did not plan any more tests for jaundice or hypoglycaemia, but they couldn’t deviate from the protocols. I asked why I couldn’t take her for daily weigh ins with the community midwife. She became very defensive and said I couldn’t do that. I asked if they intended to feed my daughter with a nasogastric tube if her weight dropped. She said that was too drastic and there were no plans to do that. Therefore, we were only being kept on the ward, sleep-deprived from the noise and from the light being on constantly, to have a weigh in that was not going to change the way my daughter was managed, just to satisfy a protocol.

I asked if I could self-discharge. I was told that that would be seen as a child-protection concern. By this point, I don’t think I was rational. I was paranoid that they had painted me as a non-compliant, unfit mother, and that the paeds team was now mentioning child protection. I insisted on speaking to the paediatric consultant for it to be documented that they did not harbour any child protection concerns about me. A registrar came and she did document that. Again, I realise that I was sleep-deprived, hormonal and not very rational by this point.

The next day I was discharged. Before my infamous MAU meltdown, I was asked to take part in a preeclampsia trial. I’d forgotten I’d agreed to this, so it was a surprise when a cardiologist turned up with an echo machine. He realised that my oedema went up to my chest wall, I had fluid around my heart and thickening of the heart muscle wall. He told me that the obstetric team had undertreated my blood pressure and prescribed additional drugs. I had been telling the midwives that I was feeling out of breath and that I couldn’t pinch up the skin to give the heparin injections because my legs were too swollen. I was told that it was all a pregnancy-related change and attributed to my weight. Again, I felt ignored even though I kept saying that this was not normal for me.

The cardiologist helped me feel vindicated that I hadn’t been complaining unnecessarily, and maybe I was right not to trust the so-called experts. Following these experiences, I have really struggled to identify as a mother. I love my daughter to bits, and I’m better now, but I used to feel like an imposter - as though her real mother would come and collect her one day.

I have also struggled to access healthcare for non-pregnancy issues, because I don’t trust healthcare workers, and when my sister had surgery for endometrial at the JR, I was terrified of bumping into the same doctors or midwives again.

For me, future pregnancies are likely to be complicated by hyperemesis gravidarum and preeclampsia, but the main deterrent is the fear of being treated in that hospital again. Admitting that is so painful because my husband and I would dearly love another.