Submission - Review of Maternity Services - Ellen Somma – 11 February 2021

Ellen Somma – 11 February 2021

Please find my thoughts and experiences re the Jersey maternity services below.

I've had two children at the maternity unit. My first in August 2015 and my second in September 2020. I've also had 3 miscarriages.

Pregnancy loss / EPU

My first pregnancy ended in miscarriage. Scans are not given prior to 12 weeks and so I paid for a private scan with [member of staff] when I was nearly 11 weeks. I'd had minimal pregnancy symptoms and was anxious that something was wrong. Sadly my suspicions proved correct and she diagnosed me as having had a missed marriage. At the time I had private health insurance and so was able to have d&c the following day. [member of staff] was absolutely wonderful, she was so kind in her handling of me.

When I became pregnant a second time, I was understandably anxious. Not feeling I could wait until 12 weeks for a scan, I again paid privately for a scan with [member of staff] when I was about 7 weeks pregnant. Sadly history has repeated itself and I'd had another missed miscarriage. I did not have to have an operation this time though and miscarried naturally within the week.

I became pregnant a 3rd time just weeks after my second miscarriage. Because I had not had a period in between the miscarriage and pregnancy, my doctor referred me to the EPU for an early pregnancy scan. After a successful first scan, I was then scanned every 2 weeks until I reached 12 weeks. These scans really helped give me reassurance after my two previous losses.

When I was pregnant for a fourth time in 2019 my anxiety that I'd have another miscarriage was high. I visited my GP because I was finding is hard to work because of my anxiety. My GP referred me to the EPU again. Sadly this pregnancy also resulted in another miscarriage, although I had to go for 3 weekly scans to have the miscarriage confirmed. Once it was confirmed I was offered medical management by taking misoprostol.

My experience of the medical management at the EPU was not overly positive. There was a lot of waiting around in a waiting room which was difficult as I obviously felt very emotional and it wasn't at all private. There was also a lot of repeating myself to various people explaining what had happened and why I was there - again not really something that's nice to do given the circumstances. After I was given the tablets I was under the impression I could go home but I was told I needed someone to take my vitals before I could leave. I was left waiting for well over an hour because they were very busy, eventually I was seen but by then I was distressed to find that the miscarriage had started. I ran to my car and burst into tears as I was on my own and bleeding. It really wasn't a nice experience. The waiting around to have my blood pressure taken was the worst bit because it meant I wasn't at home when the miscarriage started.

When I got pregnant the fifth time I went straight to my GP and asked to be referred to the EPU due to my previous losses. After a first successful scan I was scanned every two weeks. Again, this was hugely reassuring and I'm not sure how I would have coped had I had to wait until 12 weeks.

During my various experiences with the EPU I'll always be grateful for the kindness shown by [members of staff]. Both of whom treated me sensitively and sympathetically and it was much appreciated.

I know not every pregnant women can be offered early scans for reassurance purposes but to me, those early scans played a huge part in helping me manage my anxiety during those early weeks. I personally think reassurance scans should be offered to women who have had miscarriages as they can have a huge positive effect on mental health during pregnancy.

The other thing I'd like to see is better support for women who have had miscarriages. It's so distressing to think there might be something wrong but told that unless you have 3 consecutive miscarriages nothing can be done and that's that. My GP did refer me to adult mental health after my third miscarriage because she thought I'd benefit from grief counselling. It took months, but eventually I got some help but that was all initiated by me reaching out to my GP. It would be far better if there were actual support services offered through the hospital when a miscarriage is confirmed.

Antenatal care

During my third pregnancy (first successful pregnancy) I suffered terrible anxiety. I was under the EPU for the first 12 weeks but then just under regular antenatal care. I didn't feel like the antenatal unit gave me the help I needed in relation to the anxiety I had over the pregnancy due to my previous miscarriages. It was a very difficult time for me and I ended up paying several hundred pounds to see [member of staff] privately for extra scans throughout the pregnancy because I was just so overwhelmed with the fear that the pregnancy would go wrong. I think if I'd been given better support for managing my anxiety I wouldn't have felt like I needed to pay for extra scans.

For my fifth pregnancy (second successful pregnancy) I suffered from anxiety again but this time I felt like I was offered the support I needed by antenatal. The midwives sympathised with my losses and made me feel like they understood my anxiety. I was even referred to a psychologist at adult mental health for the last few weeks of my pregnancy and it really helped.

I definitely saw a really positive improvement in the way my anxiety was treated the second time around which is great. I was very glad to have that extra support and I'm sure other women who have had similar experiences would be too.

My pregnancy in 2020 was obviously during the pandemic. It was a strange time but I never felt that my antenatal care was compromised at all. If anything, I found the midwives more attentive and I was offered extra scans and monitoring when I was concerned about baby movements. This was very reassuring because I did have a fear that I might not be seen unless something was deemed urgent' but that was most definitely not the case.

The care from [member of staff] during my last pregnancy was also excellent. She listened to all my concerns and made me feel safe and reassured - especially given the strange circumstances of COVID.

Birth experience - maternity unit

I had a difficult first labour. My baby was back-to-back (extremely painful!) and I was also very nauseous and frequently sick. My main midwife who I had for the majority of the time, I found to be a little cold and abrupt if I'm honest. After several hours the sickness and the pain became too much for me and I said I wanted an epidural. I felt like the midwife was trying to put me off having it. She listed all the cons and said it would slow my labour down. She also kept on saying how well I was coping despite me telling her I was in a huge amount of pain! When she brought an information sheet about the epidural, she gave it to my husband and not to me. He was put off the idea and was discouraging me from having it and I felt like the midwife was on his side more than mine. I feel very strongly that the decision to have pain relief should be mine and mine alone and that my husband should not have been involved and I would have appreciated it if the midwife had supported me in my choice more.

At the time I didn't feel strong enough to fight for the epidural so tried other methods of pain relief (pethidine, gas and air) before my husband finally saw that the pain was too much for me and supported me getting the epidural. Unfortunately I had to wait quite a while for the anaesthetist to be available to give it to me.

My son had to be delivered by forceps in the end. I know that the epidural did slow my labour down but I also do think that I was just too exhausted to push effectively because I'd had to wait so long for the epidural and endured so much pain and sickness.

The second time I gave birth (just 4 months ago) I found the experience much better. I was induced due to my concerns over reduced movements and felt well taken care of and was regularly monitored as I waited for labour to kick in. My main midwife on the day was [member of staff] and she was absolutely fantastic. She was extremely reassuring and caring and this time, she brought up the options of pain relief (rather than me having to ask) and when I said I wanted an epidural she was supportive of my choice and I received it quickly afterwards. I was lucky enough to have [member of staff] for the duration of my labour and she really made my birth experience special. All the midwives were lovely.

My main thing I'd like to see is that pain relief options be given without bias. I have other friends who had experiences similar to me, where they felt their midwife was against' them having an epidural. This makes mothers-to-be feel judged and also like they are not fully in control of their own bodies. I also know of friends who had to wait a long time (like me) to receive their epidural because the anaesthetist wasn't available. I have one friend who missed out on one altogether for this reason. I believe that women shouldn't have to wait or miss out on pain relief while giving birth and that a dedicated anaesthetist should be on hand specifically for the maternity unit.

Maternity unit facilities

There is no doubt that the facilities on the maternity unit are rather basic and past their prime. The delivery rooms are very clinical looking and not the most inviting. I was lucky enough to be able to get a private room with both my stays. The private rooms are very basic but it was nice to have the privacy of my own room and also have full control over the windows and fan as it is unbearably hot on the unit!

I found the food was decent. I think it's unfair to have massively high expectations of food that has to be produced for large quantities of people. There was always one choice on the menu that suited me and the sandwiches at lunch were nice.

The fact that a new hospital and new maternity facilities is being built is great. For me personally, it would be nice to see the new maternity unit be more inviting and less clinical. Even having comfy chairs to sit on when you're out of bed to breastfeed on or for partners to sit / sleep on would be an improvement. More availability of private rooms would be good too. I was lucky that I managed to get one both times but I know lots of friends who missed out.

Breastfeeding support in the maternity unit and afterwards

After my son was born I was determined to breastfeed. My mother advised me to stay in hospital until I had got the hang of it. I'm so glad I took that advice as my son refused one of my breasts and without the help of the wonderful midwives I think I would have given up if I'd gone home too quick. I buzzed for help at every feed and they showed me endless patience and support and when I left a couple of days later, he was successfully feeding from both breasts. I can't fault the help I received breastfeeding that first time.

With my second baby I didn't get loads of support with breastfeeding as I think there was an assumption that because I'd done it before, I knew what I was doing. That was true to an extent but it had been 5 years since I'd had my first baby and I didn't feel as confident as I think they assumed I would. I would have still welcomed breastfeeding support after my second child.

I think there is definitely insufficient breastfeeding support for mothers - especially after you've taken your baby home. The midwives in hospital gave me a great start but I struggled so much as a new mum to breastfeed in the first few weeks and there really was very little support. Health visitors / unity midwives say it shouldn't hurt if you're doing it properly, but I don't know anyone who didn't experience some discomfort (pain!) in those early weeks. Being told that, just makes new mums feel like they're getting it wrong. Also the only advice I got seemed to be about getting the latch right. They'd observe me feeding and say it was a good latch, yet I was still feeling pain so it wasn't overly helpful. The only reason I breastfed for a year with my first was because of the support my own mother gave to me, without her I would have almost certainly given up. Not everyone has that family support though.

Breastfeeding has so many benefits for both the mother and baby and most mums who have managed to do it, will tell you it's one of the hardest bits of new motherhood. That surely indicates that robust support should be given to mums to help them in their breastfeeding journey.

There is also so much misinformation out there and unnecessary panicking about breastfed babies weight gain. It's very normal for breastfed babies to lose weight initially but it can feel like you're failing your baby. Women need support to see them past these hurdles. And those hurdles don't just end when your baby is no longer a newborn. I've struggled at many different stages of my baby's life and needed help, like when he had teeth and bit me and then when he got bigger and it was a battle to feed him because he'd get so distracted. Breastfeeding help needs to extend beyond the first few weeks.

I hope that some of the above is useful. Apologies for any grammatical errors! I've written this on my phone while feeding my baby!