In discussions about different birth plan risks - comparing the likelihood of maternal and perinatal mortality and morbidity outcomes - you won't often hear the risk that is 'your maternity ward care'.
And yet this is a risk I've talked about in the past - because when you plan a vaginal birth in the UK, you don't know what the staffing levels will be like in the maternity ward you enter, how many other women will be there with you, or what level of experience your carers (midwives or doctors) will have. It's an unpredictable risk that is all too often unrecognized.
I raise it again tonight because, published anonymously in the Daily Mail this weekend, a London midwife has written, 'The secret midwife: Psychotic mothers, exhausted doctors and nurses asleep on the job: A whistleblower reveals the desperate truth behind those rose-tinted TV shows'.
There are many worrying issues and stories, but the one that struck me is this:
"In the next bed, I have Claire, a 38-year-old woman who has been on the ward for six days. She’s already been on the ward far too long. It turns out she’s a lawyer, and no, she can’t possibly leave.
She says she felt frightened and confused by her birth experience, no one had explained what was happening, and she ended up having emergency caesarean section. She’s physically well, but emotionally shaky. No one has given her the time and attention she needs. She’s angry, upset and wants to complain. I do what I can, and she goes home with the promise of a referral to our counsellors. The significant few who need more time and help to come to terms with their birth experience are often bypassed – because we need the bed space."
Clearly, 'Claire' feels that she has not received an acceptable level of care, and while obviously I have no way of knowing what birth plan she wanted from the outset, I can't help but notice a very familiar scenario:
Advanced maternal age. Likely first time mother. Emergency cesarean outcome.
Now, IF this woman had asked for - or wouldn't have minded - a planned cesarean birth, the cost of her birth to the NHS would definitely have been lower, her experience might have been better, and the workload of the midwife in this story might have been lighter. But my guess is that a planned cesarean didn't come up in antenatal discussion, and the woman was left confused because she'd been led to believe her birth would be completely 'normal'.
And ironically, the frightening thing is that her experience is all too normal for women in England: 15% end up needing an emergency cesarean. It's just that Claire, together with another >97,000 women, was expecting a very different normal to the one that was she experienced...