10 Jun 2012

Thoughts on hospital design

The worst stay in hospital I've ever had (and I've had eight, two of which were taking care of my poorly eldest) was immediately after the birth of my first child. I was an inpatient for just 16 hours, on the ward for 12 of those hours, and I loathed it.
The hospital was an old one, built in the 70s and never massively updated. The obstetric area was split into antenatal assessment, central delivery suite and antenatal longstay/postnatal. I had care on all three of these areas across my two pregnancies.
The antenatal assessment unit was shared with the abortion clinic and women's gynae/urodynamic department. I went there once for a scan with my eldest and twice for assessment with my youngest. He wasn't growing properly. They failed to identify a cause, and he was born with two true knots in his cord. This should have been seen on scan. He nearly died when he was being born. Thankfully he didn't, and I'm glad I was able to have him at home instead of by caesarean at 38 weeks.

Central Delivery Suite was amazing. I had multiple observations done there, and I delivered my eldest there, 90ish minutes after arriving. They kept me waiting 20 minutes when I got there, and I needed to push. Not the snappiest service, but once I was pushing, all was fine. They also stitched me up after the birth of my youngest. Ambulance transfer after you've managed to have a (miraculous) safe homebirth is a bit gutting, but they got me a comfortable bed to lie on and left me to it, discharging me after 6 hours.

However, the antenatal longstay/postnatal ward was dreadful. In modern hospitals, the two are kept broadly separate. If you're pregnant and in hospital for more than a day, there's probably something amiss and you don't want to be hearing newborns cry all day.
I was put in a four bed bay with two other women and newborns. One had been there a week while her baby was in SCBU and went home fairly early. The other was a spanish lady who was on her third baby and quite indignant about not being immediately discharged. I had asked for 6 hour discharge, but had torn quite badly after having a large baby. They wanted me to stay in overnight (he was born just after 4am) and I was vehemently against this. I went on the ward at 9am, and saw a midwife at 11am and 2pm. Then a paediatrician came and did newborn obs and declared that since my baby had been fast asleep for 5 hours and thus not fed (despite feeding 3 times in the first 5 hours), there was something wrong with him and we'd have to stay in.
We tried to wake him up to feed him, but he was having none of it. He'd had a fast, wet delivery and was snotty, sicky and tired.
No midwives came to see us. A snotty auxillary told us that we wouldn't be allowed home til feeding established. The window was wide open and it was freezing (he was born in March). I kept closing the curtains to try and sleep - they kept opening them. I had a fluorescent light over my head that I couldn't switch off. I couldn't sleep, and hadn't slept for over 36 hours by then (and had delivered a baby!). The food was dreadful - dried out pizza and chips, with no ketchup, and a tiny pot of jelly. Had I known I was allowed to bring my own food in, I would have sent my husband out for a McDonalds, but nobody told me that.
Eventually, they rang the 8pm gong to tell all the fathers to bugger off and I burst into tears. My husband went and found a midwife and bellowed at her. She was head of delivery, and tried to persuade me to stay in overnight, so I said I would self discharge. Finally, a midwife came round and checked me over (for the first time in over 6 hours) and said that it was totally normal for newborns to sleep after birth, and the paediatrician was wrong. We got home at 10pm and lo! The baby woke up and fed every half hour for the whole night.
Newborns are not easy, but if I'd been allowed home, or to stay on CDS, I would've slept and I would have coped and maybe I wouldn't have had postnatal depression.

The postnatal stay was the reason I had a planned homebirth second time round, and when I had to go into hospital afterwards, I asked to remain on CDS.

My best hospital stay wasn't for me, I was in with my eldest, who was having a tonsillectomy. He had them out in a brand new hospital, with a very well designed children's ward. He was in a four bed bay, designed in a cross shape, rather than 2 facing 2. There was loads of room and toys for him to play with and the whole bay was closed off with a nursing bay and locked door. When he went to theatre, he walked down, rather than go on a huge scary bed. He sat on my knee while they cannulated him and sat and watched when they anaesthetised him. It was nothing like the various general anaesthetics I had as a child, where I was gassed twice because I was hysterical and terrified. I was older than him, and more aware, but being stuck on a huge bed while men fiddle about round your hands and arms and everyone's dressed in scrubs is SCARY. However, he took it like a pro.

My current OU unit is on hospital design, and deisgn really makes a difference. Being treated (or ignored) in an overbright, cold, friendless room when you're feeling weak, battered and emotional is horrible. It's not really treatment at all - any medicinal benefit I was supposed to get from the 'rest' was lost.  I don't class uncomplicated childbirth as something to be overmedicalised: the key to a fast recovery is good food, supportive company, and good quality rest (even if it's in small doses). I got none of these the first time.

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