"Lack of clear, concise and consistant information."

About: Raigmore Hospital / Maternity care

(as a parent/guardian),

My wife was Diagnosed with gestational diabetes. This was quickly under control by diet and sugars returned to within targets set. Baby was born naturally at 37 +1. We had set on a home birth and at no point was this ruled out by the doctors although they would prefer a hospital birth. It turns out the protocol at Raigmore Hospital is to monitor babies sugars for 24 hours after birth, meaning we were never going to be able to have a home birth. The protocol was never mentioned until the baby was 5 hours old. They would've known this protocol existed since my wife being first diagnosed with gestation diabetes. My point is they should have alerted us to this at the beginning instead of getting our hopes up that we could still home birth.

Point two - the protocol. Now we id have a hospital birth but we nearly didn't as established labour to birth was less than 30 mins. First we were told baby monitored for sugar levels for 24hr from birth(as it said on the NHS monitoring leaflet) Then another nurse stated no its 24hr from first blood. We then had a few low readings and this changed to 24hr of good readings which I completely understand. Then it changed to 3 consistent readings. This then changed again by a different nurse to more than 3 but unsure how many more. Lack of clear consistent facts being given at every stage.

Point 3. readings we were told were to be 3 hours after feeds. I had to go and get the nurse to do it at 4 hours as they hadn't been done. At this point we were told tat they had stopped doing the recordings. When I questioned this as the last info we were told was 3 consistent readings at this point. The nurse checked the notes and said we were right and they were still doing recordings. this was an hour later than planned and the result was 2. 4. just below limits. Would the figure have been ok if checked at the stated time? No one would say. I was annoyed at this one because the nurses weren't even reading the notes. What if it was an important medication that they missed because they didn't look at the notes.

By now my wife was at a very low point as every time a nurse came in it was a different story. To make matters worse we were now told he was slightly Jaundice. 111 at 24hrs Light therapy would be required. They showed us a nice graph with a line showing the level that light therapy would be required against time from birth. O. K I understood this, the to be told that they don't go by this line the go by a reading within 50 of this line above or below. So what is the point of this line, again on an NHS bit of paperwork. if they are going to then ignore it. They should just make the line at the proper cut off level and be done with it. People would understand it then.

All that we want is for some consistency and to have clear concise information. It just seams that every nurse/doctor had their own ways of looking at the results and where to go next, sometimes following set guidelines and at other times not. We need the NHS to be consistent because we are depending on you to do your job and make clear decision so we as the patients know what is actually happening.

Our experience just left us confused and reduced our faith in the NHS. It just made it look like no one really knew what they were doing and just making it up as they went along.

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Response from Maimie Thompson, Head of Public Relations and Engagement, Chief Executive's Office, NHS Highland

picture of Maimie Thompson

Dear gibson38

Thank you very much for your feed-back and I apologise for our delay in responding. I am really sorry that you did not receive consitent and clear information, which understandably, this reduced your confidence in what was going on. On top of this it has had implications around your desire to have a home birth and I appreciate how upsetting this must have been. I have asked a senior colleague in Raigmore Hospital (Kathernine Sutton) to look into this for me to see why our systems and communications have let us down and I will report back. Meanwhile, do please get in touch with me direct if you feel that would be helpful 01463 704722 maimie.thompson@nhs.net

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Response from Sarah Mcleod, lead midwife North and West, NHS Highland

Dear Gibson38,

I was just about to respond to your posting regarding your wife's recent experience at Raigmore Maternity Unit. Maimie beat me to it! I would like to echo Maimie comments on both you and your wife's experience and am also extremely sorry that you endured the disappointment of not being able to have a home birth due to your wife's diagnosis of Gestational Diabetes. As you have very clearly pointed out in your posting you then experienced inconsistency in the care of your new baby in relation to blood sugar levels and the monitoring of jaundice. Again I can well understand how you must have both felt confused and frustrated leading you to a loss of faith in the services offered by NHS Highland.

I am the Lead Midwife for a different part of NHS Highland but I am a responder for Patient Opinion hence not responding quite as quickly as I would normally do - please accept my apologies for this. I have contacted my colleague Caron Cruickshank who is a Senior Midwife at Raigmore and has a responsibility for Risk Management. Caron has prepared a preliminary response and will look into the matter in more detail in due course. Caron's response is as follows:

'Absolutely agree that when someone’s care pathway changes the implications of this and should have been explained. Situations change which do affect a woman and her family’s options throughout the ante natal period but as care providers we should respond in such a way as not to give an unrealistic or unattainable choice of care.

Having spoken to staff involved in ante natal care your comments have highlighted a gap with information giving. At present we rely on staff verbally communicating with women their management and that of their babies. Whilst we are often accused of giving out to many leaflets in this instance we should consider a particular information sheet for diabetic women. This is something that we will ask the specific diabetic team to advise us on. That way woman and their families will be prepared for the observations required following delivery.

We have spoken with the ward staff. The guidelines that we have in place for caring for infants of diabetic mothers have recently been updated. The ward staffs do seem to have given some confusing information and we must ensure that there is clearer explanation of the present guidelines.'

Caron is very happy to be contacted should you wish any further information caron.cruickshank@nhs.net In the meantime I will keep in touch with her and provide a further posting in the very near future. You would also be most welcome to contact myself sarah.mcleod2@nhs.net

I hope everything is going well now for your wife and your new baby.

Best wishes.

Sarah McLeod, Lead Midwife North & West (West) Operational Unit, NHS Highland

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Update posted by gibson38 (a parent/guardian)

Thank you both for responding.

Firstly I would like to say that on the whole I have great respect for the NHS. They were fantastic during my own time at Raigmore, and I have always believed that nurses especially are undervalued as the do a very hard job. That doesn't mean that the NHS isnt infallable or improvements can't be made.

As you know welcoming a new arrival in itself is a stressful time. Then to have everything unravel and not really knowing what was happening made what should have been a wonderful time very hard to deal with. The other thing was my daughter who was missing mum now wouldn't stay with anyone and didn't want to led dad out of her sight. It was hard bringing her to hospital as she didn't know what was going on. Because of this the period my wife needed me the most I coudn't be there for her as much as she needed. So hence that long rant above.

One other little thing was a plan of action was eventually made. This involved 30ml top-ups as my wife is breastfeeding. Not what we wanted but an ok compromise. During the night a nurse came to give the top-up, when she came back she was laughing that the little one had taken 50ml. This might have looked ok but it then meant that he didn't want the breastmilk for a longer period after that.

Since writing the initial story though things did improve a bit. A nice paediatrician named Alan actually sat with us and explained things clearly. He listened to our concerns and a plan of action was agreed. I think Alan was the reaason that we could see light at the end of the tunnel and I would like to personally thank him for that. He gave us the clear information that we needed to know what was going on.

Not mentioned in the first part but I would also like to thank the labour suite for their speed and professionalism. We certainly made them work for it and they took it in their stride.

I wanted to respond here to so that the good points could also be seen by everyone reading this story. We appreciate that this is a hard job but during a stressful time for the patient. The communication from the staff is what we need to understand what is going on and make our stay easier.


Response from Sarah Mcleod, lead midwife North and West, NHS Highland

Dear Gibson38,

Many thanks for your positive response particularly regarding your very kind comments about our Paediatrician Alan and Labour Suite staff. I’m not sure if you recall Alan’s surname but if you can perhaps you could let me know I shall personally pass on your comments – we have more than one ‘Alan’ working in our baby unit.

Also if you could like me to explore the issue around ‘top up’s your baby received I would be more than happy to do so as I can understand that this would have been very upsetting for your wife at the time.

Finally I would just like to say that your so right in pointing out how important good communication is at every stage in our patients’ journey, it is vital that we do get this right every time and will strive to do so with the help of patients and families. So please do continue to let us know what you think (a plea to all!).

With very best wishes to you and your family.


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