Conditions that threaten women’s lives in childbirth & pregnancy
Communication with health professionals
Understanding what was happening to them was very important to the women who experienced emergencies in childbirth, and to their partners and families. The timescale of the emergencies varied. In some cases, health professionals had time to explain their condition to the women and families so they were able to understand their condition before the birth of their baby. In other cases, emergencies developed fast so there wasn’t much time for explanations until afterwards. Below we discuss what women and their partners told us about communication with health professionals during the emergency and while they were still in hospital. (See ‘Information, support and support groups’ to see what people told us about their information needs after they went home.)
Several women described good communication with doctors about the emergency, particularly those who had a condition which developed more slowly so there was time for clear explanations and questions beforehand.
Alex found it hard being in hospital for weeks, separated from her two year old daughter. But doctors explained well why it is vital to keep close to an operating theatre if you have placenta praevia.
Alex found it hard being in hospital for weeks, separated from her two year old daughter. But doctors explained well why it is vital to keep close to an operating theatre if you have placenta praevia.
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Is that what he explained that first day when he came to see you or was that later on?
That was later on. They did it very well. They explained the gravity of the situation but not in a way that would have complete… I mean every time, it was almost like a drip feeding process. And I mean, it might not work for everyone, but it worked well for me, because it enabled me to process little things at a time, and you know, the paediatricians came and explained what would happen if the baby was born now, at that point. The anaesthetist came in and explained what he would do, and how the decision would be taken as to whether it would be general anaesthetic or whether it could be done by spinal block and you know, if the extent of my bleeding was massive, you know, whether I’d have to be heavily sedated and in Intensive Care for a number of days. And I remember they did explain from day one the possibility of a hysterectomy and all of that sort of thing. So…
It sounds like communication in the hospital was really good.
Excellent, yes.
Can you just describe that a bit more to me?
How they communicated with me?
Yes. What, what, how it worked.
Well they came to see me every, a registrar or a consultant came to see me every day. I mean some days I felt really lonely in there to be honest. Because they’d come in, any bleeding. No. Fine. And they’d go. And I didn’t require any, anything else. I didn’t require. I mean they listened to the baby every couple of days. But I didn’t need that, if I was in the community, I wouldn’t be having that, or the blood pressure checked every day. So there were some days when I thought, oh I could be anywhere. And they were incredibly busy there. But when I needed things, you know, it was immediate and it was spot on and it was compassionate and it took into account the whole family. They were amazing. And on my never ending list of things to do is to write to the chief executive, just, you know, people always complain and I just…
We had one incident where I felt a doctor had been, had come into the room and hadn’t introduced himself. So I had no idea whether he was a doctor or a cleaner. And that was the only time, the whole time in hospital that I’ve had any, any sort of remote, I mean, you know, the portering staff used to bring me a bacon sandwich every morning. Well, you know, I got a bit bored of their breakfast cereals. They were, I shouldn’t say that, I shall probably get them into trouble. They were outstanding and, you know, as I said before they sort of drip fed information which I found really helpful.
When there were bigger bleeds it was reiterated, so they went through the same procedure again. One time, it was, I think it was two, it was about two days before I ended up delivering. And a girlfriend was over there at the time, and this same consultant who gave me the first explanation was the one on call then. And he went through it again, and he drew diagrams of how they could do various hysterectomies and he left the room, and my girlfriend burst into tears. I said, “What’s wrong?” And she said, “This is so awful.” Oh, you know, you may be get so blasé about it, but you know, the anaesthetist were great, they all, you know, they explain things very clearly. Matter of factly, which is what I needed. And then when they felt I was becoming a bit complacent then they would term things perhaps more strongly. But you know, ultimately everything was left down to me to you know, to the point where I wanted to go out for dinner one night, and he said, “I can’t stop you, but the risks are no more than they’ve been for the last fifty odd nights you’ve been here, and if you bleed, you know, it could be too late.” And I said, “Well okay.” And you know, they communicated very well with each other.
There was, there was only in that early stage, and I ended up saying something where I felt like some of the doctors thought maybe there was a chance I could go home, and I know that in some hospitals they don’t necessarily keep their placenta praevia patients in hospital the whole time. So there was that little at the beginning and I found that really quite stressful, but once I’d said something and once I said in my own head, “Right I need to accept this is where I’m going to be.”
Mandy had acute fatty liver and doctors couldn't stop her bleeding. Good clear communication by doctors helped her and her husband to accept early on about why a hysterectomy was needed.
Mandy had acute fatty liver and doctors couldn't stop her bleeding. Good clear communication by doctors helped her and her husband to accept early on about why a hysterectomy was needed.
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The family obviously went through a very hard time afterwards, because then what happened was the bleeding didn’t stop. The next day in the morning we were told that, you know, they had to do something, because you know, I was, I think up to that point I had something like 14 units of blood. Something like, in the end there was 22 units of blood and 14 units of platelets to help with the clotting.
So the consultants came in and this bit was I felt was very good in the way they handled it. Because they had [husband] and myself and then there was two consultants who were going to sort of look at it. They brought experts in which was wonderful. I’ve seen the notes that they obviously contacted other hospitals to find out how to deal with this. And then they drew out diagrams about what could happen.
So the first option was to brace the wound. Which is I don’t know what they use but something that sort of puts pressure against the inside of the uterus to try and stop where the bleeding is coming from, basically where the placenta had come away. That was where the bleeding was from. So that would be the first operation.
And then what they explained to me very clearly was that if that didn’t work it would need to be a sub-total hysterectomy. So again they explained it in full detail. The ovaries would still be intact, because I was like worried about is that premature sort of, you know, you know, the… I can’t remember what it’s called now, but meant that’s it. So I did think oh gosh, you know, at the age of 28 do I really want that? I obviously clearly understand that there would be no more children.
But it was weird, I think because they’d made it so clear and we felt very supported and my husband was very supportive as well, that it didn’t seem to matter at the time because it was either that or you know, dying basically.
So I think we accepted that quite early on, and even now, we’re very lucky that we’ve got one. You know, we’ve heard, you know, since then we’ve been on other forums and stuff where people have you know, lost babies and then can’t go on to have other children. So we felt ourselves really lucky, so we were fine.
So on the Wednesday afternoon, they obviously took me into theatre and obviously I was out of it then. But I think it was very obviously very tough for the family because I would have gone through the first operation and they kept me sedated until you know, to see how that went and that didn’t work. So what they then did was obviously go ahead with the hysterectomy. But because, you know, they’d gone through that with me, I was sort of expecting, you know, if worse comes to worse that’s what will happen.
Anna developed septicaemia (blood poisoning) after her second son was born. She was put on antibiotics and doctors explained that if they didn't work, they would have to move to 'Plan B', a hysterectomy.
Anna developed septicaemia (blood poisoning) after her second son was born. She was put on antibiotics and doctors explained that if they didn't work, they would have to move to 'Plan B', a hysterectomy.
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All I can remember them telling me is they were going to try and fight it with these antibiotics and then Plan B. I can remember him saying “if not Plan B”, and then I asked about Plan B and that was it. I didn’t really get given an awful lot of information. But I don’t, I think if I had I wouldn’t have remembered it anyway.
Did he tell you what Plan B was?
Yes, that’s when he said; well we’ll have to give you a hysterectomy. Because he looked at me a bit shocked and the nurse said to me, the nurse was there when he said that and she turned round and said, that not many people ask about Plan B, because people can’t handle it. So she said that’s why he looked at you quite surprised. But I don’t, I just wanted to know. I’m glad I did because I had a day and a night to think about it, prepare for it, tell my partner, rather than it being like a “hysterectomy, boom, bye”. You know, I had time to sort of say to him, you know, probably this is what is going to happen. And everyone thought I was being negative, I knew, I knew, you see it was, I knew it was bad because you don’t get admitted to Intensive Care for nothing, but I wasn’t frightened.
Sometimes the obstetric emergency developed so quickly that there was little time for explanations. Even so, women appreciated calm reassurance from medical staff, and the opportunity to ask more questions once the emergency was over. Karen had an emergency hysterectomy. She described a “steady stream” of doctors coming to see her when she was in intensive care even though she hadn’t yet grasped the seriousness of what had happened to her.
When she started to haemorrhage (heavy uncontrolled bleeding) after her son was born, the midwife reassured Natalie's husband that everything was under control and sat holding her hand while the emergency team dealt with the bleeding.
When she started to haemorrhage (heavy uncontrolled bleeding) after her son was born, the midwife reassured Natalie's husband that everything was under control and sat holding her hand while the emergency team dealt with the bleeding.
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During the delivery itself she was absolutely great. I mean she was everything I wanted in my midwife. She understood what I wanted, was very hands off, very relaxed, made suggestions if she felt it would help, but it was entirely up to me. So communication up until that point was great. When it all kicked off I think they were more concerned about making sure I was stable. So initially there was pretty much no communication. It was just like, I think she did say to my husband, “I’ve got to press the red button. It’s going to get very busy in here, very quickly. But keep calm. It’s under control. You’ve got no need to worry.” So she pre-warned him about what was going to happen. So he said that he felt as reassured as you can be when you’re wife’s passed out next to you, about what was going to happen, and I do have some recollection of after the first, when they’d got their monitoring machines up and running, so they could check my stats I do vaguely recall someone sitting next to me holding my hand, and just saying, “It’s all right, you know, it’s going to fine. Just they need to get some blood into you.” And I don’t actually remember all of what she said. It’s more a memory present of there being somebody next to me, kind of trying to reassure me. So there was after that initial flurry of activity, I’m fairly certain that there was someone with me, trying to keep me calm. Which I greatly appreciated. And I think it was actually my midwife. I think at that point, they had kind of let the people from upstairs, the main delivery unit had come down and taken over the case and I think she was, sidelined, but her role was then about caring for my emotional needs, rather than my physical needs and they were there to look after my physical needs. That’s my understanding anyway.
And afterwards, rubbish. But then you know, I understand how under staffed the postnatal wards can be and I was fully prepared for that going in [baby noisy]. I had no expectation that I was going to have good post natal care in the midwifery, on the ward, through experience with my friends.
And actually I’m being harsh because whilst I was in recovery the doctor that did my internal compressions came to me, and she explained what she’d been doing and she said, “My name is such and such. I, you know, was on the team recovering you…” I said, “Yes, you were doing my internal compressions weren’t you?” She said, “I’m really sorry about that, but I had to do that to stem the bleeding. It was very important.” I mean she was lovely, she was, and I really appreciated her coming to talk to me, because she could have gone off at the end of her shift and not bothered.
After her haemorrhage and hysterectomy, doctors came to talk to Alison like a 'normal person' and answered her questions honestly. It was important to know that she mattered and wasn't just another number.
After her haemorrhage and hysterectomy, doctors came to talk to Alison like a 'normal person' and answered her questions honestly. It was important to know that she mattered and wasn't just another number.
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They were pretty good actually. And they were just good at talking to me, about, like a normal person, rather than you know, and answering my questions honestly. When, when my son was a couple of days old, yes, the head anaesthetist at the hospital came to talk to me, because there was a big meeting that afternoon and they were going to be discussing my case, and he wanted to come and talk to me and find, just have met me, and let me know they were going to be talking about me, and find out a little bit more about what had happened and, and I just, those little things like that, doesn’t take a huge amount of time out of somebody’s day, but it actually just makes you feel that you’re important, you know, you matter that you’re not just another number, or a statistic or whatever makes you feel value. You know, like you, not valued because you’re a patient, but do you know what I mean. Its, that they’re not just doing their job because they have to, that they actually care.
Some women felt that communication was could have been better. Kerry and Sarah both had placenta praevia but in contrast to Alex did not feel doctors had explained to them the risks of haemorrhage or hysterectomy.
Sarah wished someone had explained beforehand she might need a hysterectomy after placenta praevia. She felt doctors explained it afterwards in very clinical terms, without appreciating what a devastating experience it was.
Sarah wished someone had explained beforehand she might need a hysterectomy after placenta praevia. She felt doctors explained it afterwards in very clinical terms, without appreciating what a devastating experience it was.
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I feel that with such a traumatic event, that you know, you’d, I don’t know, you’d expect them to get. That there should be some sort of counsellor or somebody to come in and talk you through sort of some awful experience, you know. Because this was really a complete devastating life changing experience. And it as treated very clinically. But basically I should just be grateful that I’m alive and that’s the end of that. You know, my consultant came in to see me, who was a man, I will point that out. Came in to see me, because that… Friday I was still in HDU on the Friday. I was transferred back to the maternity’s version of HDU on the Saturday. He came in to see me on the Sunday and had said to me. “How do I feel about having a hysterectomy?” And I said, “Well I don’t really know yet.” And he said, “Oh well, you know, its better that you’re alive without a womb then to be dead with a womb.” Which is true, but at the same time it’s a really, you know, loads of people want to say things to you as well afterwards. It was like, you know, oh well, you’ve got three children, so that’s okay. You know, there’s lots of ways people… because it’s because uncomfortable. It’s a really uncomfortable thing for other people. Because you don’t… like you go to a Mum and toddler group, and, you know, you’re the one that’s had a hysterectomy. So no one wants to say anything. Other people feel uncomfortable with the fact that if they’re pregnant, it’s a really, it’s not a very nice place to be for a while, and you feel bad, because you’re just, you do feel quite resentful at the same… They have reason to be kind of wary, because you do feel, it’s an awful feeling. It’s that, it’s a real, it’s a real empty sort of feeling.
And I was very ill afterwards. I went home very quickly afterwards more on my insistence than anyone else’s. I just didn’t feel that being in the hospital, I wasn’t having any medications or anything, and that I just needed to get home to my daughters husband, and try and get back some normality that I’d already been away for two months.
Kerry felt doctors should have sat her down and explained the risks and dangers of her placenta praevia to her.
Kerry felt doctors should have sat her down and explained the risks and dangers of her placenta praevia to her.
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I think that they should have, the day that they diagnosed the placenta praevia I think they should have sat me down and told exactly what it meant, and the dangers and the risks. No one ever put a bit danger on it. But obviously I looked it up myself and realised that there’s different grades of placenta praevia. It can be marginal. It can be a little but it can be complete. And then when I read the complete I thought wow. And it just made me think little things like if this was years ago before they had scans, I would be dead. Because no one would know that that baby cannot come out any other way, you know, then me and the baby would be dead. Or they wouldn’t understand why I was bleeding and it just, it’s a scary thought you know. I do think we’re really lucky that we have got the medical things we’ve got today. But I just wish they’d have told me a lot more and the way they carried on, on the emergency, I thought wow it is serious. It was all the consultants were there. It was a consultant anaesthetist and I thought… so it is serious. And why did they… I sometimes felt like it was, I hated going back to the hospital with the bleeds because the midwives were so, “Put yourself on the bed.”, and it was kind of, “oh it’s her again.” That’s how I got to the point of feeling, “oh she’s back again”.
Kate felt that after her emergency the communication between staff on different shifts could have been better.
Several partners we spoke to pointed out the importance of doctors using clear language when speaking to them. Craig said, “I don’t want to hear medical talk, you know, you’ve used big long words that I have no idea what they mean. Is my wife going to be OK?” But being open and honest about the situation was also important.
When his partner was critically ill with amniotic fluid embolism (amniotic fluid enters the mother's blood stream), James just wanted a clear 'meat and potatoes' explanation of what her chances were.
When his partner was critically ill with amniotic fluid embolism (amniotic fluid enters the mother's blood stream), James just wanted a clear 'meat and potatoes' explanation of what her chances were.
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And then kind of being escorted out of the theatre with [daughter]. Was it [daughter], or was it one of those wheel along kind of things or… and me being taken to this room and being sat there with this nurse. And, it’s so funny, because this would have been really clear at one time. I just remember being in this room and then someone, I can’t even remember if it was the consultant or not. For some reason in my head, I’ve got a bloke and a woman both coming in and talking to me, and it might have been that a nurse came in and then the consultant. There was a female came in. Kind of saying a bit of what the problem was. I don’t remember what, what they said the problem, but I can remember me saying, I remember it being kind of you know, very vague medical speak, and I actually had to say at the end, “So there’s a chance she won’t make it?” I think I just wanted a meat and potatoes kind of conversation. I didn’t want some fancy words. I kind of, “What, so there’s a chance she won’t make it?” And, and they actually said, “Yes.” I can’t remember if I said, “What is the chance… the situation.” I remember, I mean my head, sort of it was 50/50 as if that was kind of what I’d been told. That wasn’t something I had worked out, because I didn’t have enough information for that, so I think they would have said, it’s sort of 50/50. But that, that information only came because I’ve asked for it.
Several people we spoke to stressed the importance of clear communication. It was important to be listened to, not to be treated as a number and to feel that the staff actually cared about them. Mark (whose wife was rushed to hospital for an emergency caesarean after a placental abruption where the placenta separates from the lining of the womb) felt someone should have taken the time to fill him in on what was happening as he was waiting for news of her surgery. “I’m a pretty sturdy guy, so I could withstand it. But someone who was not quite as robust as me might have gone to pieces at that point not knowing what was going on.” Kerry felt that midwives and doctors just talked over her. “I think they just forget the patient is there, and they talk around you and you’re left there and you think…..what are they talking about?”
Sometimes it was the little things that made a big difference to women and their partners. When the consultant rubbed Naomi’s cheek and reassured her that she would look after her just before she had a general anaesthetic to deliver her baby, it made a big difference to her.
Alex was in hospital for 8 weeks with placenta praevia before her baby was delivered. She felt that being well informed by doctors really helped her understand why it was important to stay in hospital.
Alex was in hospital for 8 weeks with placenta praevia before her baby was delivered. She felt that being well informed by doctors really helped her understand why it was important to stay in hospital.
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And what was the value of being informed? Did that help you cope with it better or …?
Yes. It enabled me to understand where they were coming from really. Because you do sort of get, well surely this is a bit over the top, and I guess because the bleeds I had weren’t particularly big bleeds. You think, well, you know, I got here. If it happens again I’ll just come back. And… it was that one explanation from the midwife that said, you know, when she talked about the blood dripping onto the floor and then I think [doctor] saying the last patient he had who had a big one like this was, he said, “He’d been on that night, she said do I really have to stay?” And he said… “Well it’s up to you, I think you ought to.” And he said he went home, and before he got home he got a call, “Come back. She’s had a massive bleed.” And she’d lost half the circulation to her body or something by the time… So it’s those sorts of stories that you think oh well okay that makes sense. And you know, he said to me, “We probably see one grade four a year. You know, it’s not as if it… we’re…” You know, but you feel a bit guilty wasting public funds and a room and it could be… It was funny, they would do the hospital tours to the expectant parents, and I’ve obviously I heard about five of them a week and they were coming round, and as they walked past my end of the ward. “This is the ante natal room. You might have to come in, stay for a couple of nights if you’ve got high blood pressure and then you get to go home.” And if felt like you know, no it’s a lie, they keep you here forever [laughs].
Last reviewed April 2016.
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