Stories from new mothers: the importance of good communication

As part of a wider piece of work by Healthwatch England and other local Healthwatch across the country, new mothers spoke to us about their experiences of miscommunication (or lack of communication) and a lack of agency.

Miscommunication 

All mothers deserve agency over their maternity care, with the ability to make informed choices. NHS England's Better Births plan states that each mother should have a personalised care and support plan (PCSP). A key part of the personalised care and support plan is good communication, listening to mothers and allowing them to make informed choices.

However, the new mothers we spoke to told us they experienced miscommunication about their care, meaning they didn't have the opportunity to make their needs heard and sometimes needed to understand the care options they were consenting to fully. 

"I never had [the six-week postnatal check]. I know you’re supposed to but the GP never booked anything for me. The midwife never booked anything for me and nobody told me I was meant to book it." Mother interviewed by Healthwatch Bristol.

Miscommunication, or a complete lack of communication, often led to a lack of agency. 

Lack of agency 

Mothers felt that healthcare staff didn't adequately inform them about what they were experiencing or consenting to, didn't consider their wishes, and were treated more like "vessels in the care system than humans." This had knock-on negative impacts on maternal mental health, contributing to doubts, stress and confusion after birth. 

"I found that with every pregnancy I've had, I haven't really understood or had a proper debrief of what happened… I would have liked to know, actually, not even necessarily at the time because I understand that decisions need to be made and things need to happen quickly to ensure that everyone has the healthiest outcome. Afterwards, it would have been really nice to know, actually, why this happened; I don't know what caused the bleeding, and I don't know how much I lost. No, I don't think that I was fully informed, I don't think I was particularly consulted, I just think it felt like I had to go along with whatever I was being told." Mother interviewed by Healthwatch Bristol 

Conditions of better communication 

Continuity of carer

NHS England recognises the effectiveness of continuity of carer in implementing properly informed decision-making. However, as our previous blog details, the mothers we spoke to are not receiving this continuous care. Lack of continuity of carer can exacerbate issues of miscommunication. 

Mothers stated each healthcare professional would tell them something different, or they would find out about something too late. Another mother interviewed by Healthwatch Bristol, whose baby had a heart defect, fell through the gaps and wasn't offered the diagnostic scans she wanted in time, and missed the slot for being able to carry out those scans. Waiting for these scans and not knowing what would happen caused her anxiety. 

Informed choice 

Several mothers highlighted that they had to make decisions in an impaired state, which brings up issues of informed consent. 

For example, one mother who had to have a blood transfusion didn't get an explanation at the time that she wouldn't be able to give blood in the future. Although she would have had the transfusion anyway, that missing information left her with resentment, loss and anxiety, which could have been better mediated. 

"I would have had [the transfusion] anyway, but I would have preferred for them to have explained it to me. I'd always wanted to give blood, it's such a trivial thing, but I never knew that accepting the blood transfusion would mean I would never be able to give blood. It was just kind of like, "You need a blood transfusion." Mother interviewed by Healthwatch Bristol 

What local mothers told us about communication

"No one actually told me what it [postnatal depression] was and said the warning signs to look out for. So you know, you're tired as a new mum, you've got hormones, you're going through all these new experiences and it is hard to decipher what's tiredness and hormones and what's postnatal depression. And it took me to have a panic attack and to collapse on the floor in the house before I thought, oh, okay this is something a bit more than just being a tired, you know tired mum. I need to ask for help...so education from the midwives would have been good. Maybe signs to look out for."

"My midwife appointments were brilliant, my local midwife appointments, so the care received for that I was really happy with. I was seen regularly and given all the advice and help that I wanted."

"We were really realistic about the fact that I'm older, it's a high risk pregnancy, we're going to do whatever the specialists recommend, and they were always really good at explaining why they were suggesting a certain path."

"I think sometimes they’re so kind of focused on what they’re doing and what the outcome needs to be that they forget to explain it to you so you feel a little bit like, I don’t know, out of the loop, like you don’t know what’s happening to yourself. I definitely found that first time round as well, like half of the stuff that happened I didn’t know about until after I read my notes and looked it up on the internet and realised 'oh, that’s that!' But this time I did know more of what went on but I’m not necessarily sure if it’s because anyone explained it to me. I think it’s just more that I had the experience of it so I thought 'oh, this is what happened last time, it’s this'. So I think that’s probably something that could be improved on. I think explaining everything step by step as it happens, I think is really important."

Accessible information 

Mothers, especially during the COVID-19 pandemic, were often on their own during labour. This exacerbated difficulties in understanding processes, as they did not have someone to explain and advocate on their behalf, leading to confusion that could only be processed post-birth.

One mother had dyslexia, which meant she could not properly read the document she was given with information about an emergency c-section. She did not know what she was consenting to. 

"This doctor comes in with all this paperwork, and she's like, 'Oh, so these are the side effects. Oh, don't - oh, it's alright. It's alright. You could lose your uterus, but it's okay, that's only-' And I'm like, 'what is going on?' Like, I remember signing for the C-section afterwards, like, a few weeks after, when I was a bit more in my right mind, I was like, 'as if I was able- like, as if they let me sign to that in the state I was in,' you know what I mean, like, without anyone present." Mother interviewed by Healthwatch Wirral 

This contradicts the right to receive healthcare in the formats people can understand, as the Accessible Information Standard of 2016 states. We have highlighted people's rights to accessible healthcare through our Your Care, Your Way campaign. 

Listening 

Good communication doesn't just refer to properly conveying information but also to listening to mothers' wishes and responding accordingly. This mother was told she had to have an epidural, which she didn't want to. 

"I was very against having an epidural. I don't like medical intervention. I don't feel safe. And being that vulnerable, I had to feel safe. Because I wasn't in control of anything, nothing had gone to plan. The doctor was there shouting at me. And he was like, 'You need an epidural.' I was like, 'I can't, I don't, I refuse.' And he's like, 'Well, you need one, so you're gonna have to have one.'" Mother interviewed by Healthwatch Wirral

Some mothers had to ask somebody to advocate for them, such as a partner or a caring midwife. 

"I saw two midwives quite early on. […] I was assessed a further time by a midwife, but then I never at any point saw a doctor, and I don't think I needed to at that point. But, it was not until my friend who was a doctor within the hospital went, 'No, this is ridiculous, she needs to be seen.'" Mother interviewed by Healthwatch Brighton and Hove

The role of signposting 

Mothers told us services didn't signpost them to teams or organisations they should contact for specific types of care, leaving them adrift with additional stress. 

"There wasn't one place I could go and look through all the support I could get and I could pick out what was right for me. It just felt like it’s a bit scattered all over the place and I had to do a lot of research to find Bluebell the first time as well." Mother interviewed by Healthwatch Bristol

Policy context

Personalised care 

"Personalised care" was one of the key principles for maternity services set out by the Better Births report in 2016 and was reiterated in the Long Term Plan in 2019.

The recently released three-year maternity delivery plan for maternity and neonatal services emphasises "listening to and working with women" as a key theme, detailing the importance of "care that is personalised", including clear choices, open and honest dialogue, and involving birthing parents through a family integrated care approach.

We also know that continuity of carer can give mothers a sense of empowerment and agency and build lasting relationships with the same health professionals. Yet as we highlighted in our previous blog focused on continuity of carer, the national target date for continuity of carer has been suspended in light of the unprecedented workforce challenges faced by maternity services.

Resource issues to deliver personalised care 

The three-year delivery plan states that personalised care will be provided by "empowering maternity and neonatal […] by providing the time, training, tools, and information, to deliver the ambitions above". Yet the suspension of continuity of care targets indicates that maternity and neonatal staff do not have the necessary resources to consistently deliver the level of compassion, information, and one-to-one support needed.