Who can I speak to?

[saccrofolium]

I had a big PPH the last time I gave birth. It's in my notes as 2litres although the midwife and haematologist attending said they thought it was more. There are huge gaps in my memory of that time - I think I fainted a couple of times and was spaced out on drugs too.

I'd like to request my notes and go over them with someone. We've since moved house and I'm nowhere near that hospital. Is it possible to speak to someone else about it and go through my notes, or is that not the done thing?

[WhatEverItIsIDidntDoIt]

You can request to read your notes at any time but your local hospital will not provide someone to go through them with you. I had a similar issue and when I went to view my notes none of it was comprehensible. I still don't know what happened to me during my labour.

[saccrofolium]

Oh dear! So note taking is proprietary to the hospital it took place at?

[Wommer]

Watching with interest.. I also lost alot of blood - 2l+ and have very hazy memories of the birth.
My DH has been great at talking me through what he remembers - can you birth partner help maybe?
Would like to get a copy of my notes though.

[saccrofolium]

Wommer my husband was there but things got very frantic so he was sent away, and had to listen to them desperately paging my consultant who had left for the day. I think he was nearly as freaked out as me. I wasn't scared at the time because of the drugs but afterwards I wonder whether or not I was a near-miss.
(My husband was sent off for a fag to a secret nursey smoking hatch on the roof! )

[Wommer]

Lol at the smoking hatch :)

I know I was a near miss and feel quite odd that I have no real memories of it - we had panic buttons pressed and loads of people running in etc - it's like it all happened to somebody else completely.

As you say in our sort of cases it's waaaay harder for the partners! The recovery though (was a giant episiotomy which caused my issues) was something I'll never forget!

[saccrofolium]

Wow that's some laceration! Am clenching! You poor thing - mine was all internal as I'd had a c section and my uterus didnt clamp down properly. I had loads of additional risk factors but I don't know to what extent that was taken into account.
I was under a haematologist for a seperate issue and saw him after I'd delivered and told him that my haemoglobin had dropped to 3 during the bleed, he said that if I hadn't had a transfusion I'd be "pushing up daisies". I've known him for years and that frightened me.
But I don't want to go back to the original hospital and consultant - I'd like fresh eyes on it.
How did your DH take it all? Do pm me if you like as I know this can be very raw. x

[Flumpyflumps]

I had a midwife come to my house with the whole file and go through it all line by line, explaining why decision were made and by who.

It was really helpful in getting over the emergency situation and near death scenarios that arose, they said to me they have had women coming back 20 years later and they still do this for everyone.

Guess it depends where you live and what they will provide

[saccrofolium]

That's the thing - I delivered out of area. I do know midwife, on a professional basis - I wonder would she go through my notes with me?

[saccrofolium]

And your midwife is right about people carrying these things for years - my mother still gets upset when she describes my birth - and I'm in my 40s now.

[mayhew]

Its quite normal to want to understand what happened by reviewing the notes but slightly complicated by your moving away.

You can request to go thorough the notes with a senior midwife. This allows you to ask further questions that might come up as you go through them. Since your haemaglobin dropped so low, it is also likely the service did a routine case review looking at how the emergency was managed.

Alternatively,you can request a photocopy of your notes for which a fee of up to £50 can be charged and then go through them with your midwife friend.It can be hard for someone outside that unit to "decode" the notes as each place has its own style of record-keeping.

Write a letter to the Head of midwifery for that service with your request. Give your full name, date of birth and date of your baby's delivery so that they can trace the notes.

[saccrofolium]

Thanks Mayhew that's interesting, especially about a case review - under what circumstances do they normally do that?

I'll write to them this week - it's over a year since it happened but it plays on my mind from time to time.

[inadreamworld]

Poor you. I think they should go through your notes with you if you ask.

Stupid question perhaps but how much blood do you have to lose after giving birth to be in danger of death/need a transfusion? Does anyone know?

I had a pph too after a normal vaginal delivery - my notes said lost 1 litre and 250ml of blood (sneaked a look at the notes when midwife came to check me after I had returned home). Felt dizzy with racing heart and couldn't walk immediately after the birth but didn't need any blood and iron levels got back up to normal pretty quickly. Am having 2nd baby in about 6 weeks or so so hope I don't haemmorage again.

[mayhew]

A routine case review is done whenever a serious complication occurs. It does not mean anyone was at fault but a means of checking that it was managed correctly and identifying any learning points. All units have a drill for serious PPH and they would check it was followed.

Its not done for every PPH but for the most serious ones ie those over 2000ml. If your Hb truly was 3, then that would usually qualify.

[saccrofolium]

During the frantic bit, I was quite chilled, obviously with the benefit of opiates but also because I knew that the birth bit was over. I was fascinated by what was going on - I worked for years in Near Patient Testing and was asking how they were getting various results so fast, including a haemoglobin and I remember the anaesthetist saying "it's 3." And I was laughing at them putting "caramel sauce" on my drip!
The lead midwife and the registrar were arguing and she was shouting at him to slow down. There seemed to be a plan in place and someone went to get the defibrillator and I remember thinking "poor bugger, I hope they're alright."
My husband was sent out and there are whole bits where I don't know what happened. I was in recovery for 24 hours and I think it was the following morning when my consultant reappeared, looking a bit rattled. I think that's the bit I'd like cleared up - should he have come back, or should he have left it in the hands of his more junior staff? This wasn't a teaching hospital and although I'm sure there were other consultant obstetricians in the building, I didn't see any of them, to my knowledge.
Am rambling now but it's things like this that I wonder about. [ blush]

[mayhew]

During a very scary situation it is a normal human response to be suprisingly calm. I think its a helpful adaptation so that we can deal with a lifethreatening crisis, so we can still think and act where panic would stop us. Think of those moments where you think "oh, the car is skidding, I'd better not brake" and then later you experience the fear.

We are also calmer if we have practiced the response, in theory or actually done it eg the skidding analogy.In maternity, we practice for baby resuscitation and, of course, PPH, amongst other things. Maybe the mw was trying to slow, and calm, the reg, so that they could follow their local drill together.

I had a client who had a major PPH and woke up in ITU. She was a nurse so knew immediately that something serious had happened, yet felt really calm. Thinking, well, I feel ok, so whatever was wrong must now be sorted. Then the consultant came to see her. He got emotional when explaining what had happened and that made her connect with the scariness of the situation for the first time. It was only then that she started to feel upset.

I think when you have a debrief, you should also involve your OH. His memories will be different and his fear at the time for you will have been very acute. It can cause a problem for couples if they are unable to discuss a scary birth and acknowledge how each of them felt, and feel about it now.