‘I blamed myself for almost dying after birth. Only when I’d nearly lost my mind did I realise I’d been the victim of a catalogue of errors’ – As report lays bare catastrophic maternity care, Jessica Cornwell describes her own experience
- A report reveals that errors may have led to the deaths of more than 200 babies
- Medical notes in the NHS on maternity wards are at the heart of the problem
- Jessica Cornwell lays bare in her own experience of coming close to death
The night I first fell ill — truly, deeply ill, after the birth of my twin boys — I told my husband Callum I felt cold. My heart was beating so rapidly, I told him I was afraid I was going to die. Callum reassured me gently. Perhaps I was experiencing something similar to a panic attack — would a nice hot bath help?
After that I remember nothing. I woke, briefly, on the bathroom floor, naked but wrapped in a white towel, and I could feel somebody’s hands on me, and I remember repeating that I was cold.
At our hospital in London, a female midwife and female doctor took my blood and examined my cervix and said that, three weeks after giving birth, my uterus was infected and I had the beginning of sepsis. I was put on an antibiotic drip.
Looking back, it was at this point that, perhaps, I had a chance to take control of my treatment — and yet between my admission to a ward and the next morning’s rounds, my medical notes were lost. Which meant that when a male doctor visited me, trailing a small crowd of juniors, he was starting from scratch.
Jessica pictured with her sons Will and Arlo. She explains the boys traumatic birth and its aftermath in an NHS maternity unit stretched almost to breaking
Pressing his fingers hard into my groin, this doctor attempted to diagnose me by hurting me. When I did not cry out, he turned to his audience and said with confidence: ‘If she had anything in there’ — he gestured to my womb — ‘she would have jumped a mile.’
There was no internal examination, instead he asked to see my engorged breasts. Opening my gown, bare-handed, he lifted my breasts and examined them in front of his trainees, squeezing and asking if it hurt. When I said it didn’t hurt, he announced there was no evidence of mastitis or infection so he would take the patient off the antibiotics. Exhaustion, the burden of twins, was the cause of my delirium, he said, addressing not me but my husband.
‘No sign of suspected uterine infection,’ this man wrote in my new, blank medical notes.
This is the story of a traumatic birth and its aftermath in an NHS maternity unit stretched almost to breaking.
Medical notes are at the heart of the problem. Notes that were repeatedly wrong or lost. Notes that are routinely withheld from women after birth. Twice, in UK maternity and postnatal wards, in the early spring of 2018, I almost lost my life, and it seemed to me these incorrect or missing notes were symptomatic of a system under strain, a system failing mothers.
The devastating extent of these failings was revealed in March by the Ockenden report into maternity services at the Shrewsbury and Telford NHS Trust.
It found catastrophic errors may have led to the deaths of more than 200 babies and nine mothers, and highlighted 15 areas that needed immediate improvement in maternity services across England.
In my case, as I left hospital the first time, my discharge notes were wrong. When women go home after giving birth they aren’t allowed to keep the thick, orange file they have throughout pregnancy, stuffed with ultrasound scans and growth charts, but are given a few pieces of paper.
Jessica pictured with Will and Arlo as babies. She had a forceps and ventouse delivery with an emergency, lifesaving, manual extraction of her placenta. This was not properly recorded in her hospital notes
Mine said: ‘Normal vaginal delivery. No complications.’ Which was an absurd mischaracterisation. When my husband pointed this out, a midwife apologised and scribbled corrections in the margins. ‘Somebody must have made a mistake,’ she said.
In fact, I gave birth to twins at 38 weeks following an induction. I had a forceps and ventouse delivery with an emergency, life-saving, manual extraction of my placentas, which means a doctor inserted her arm into my womb and tugged them out. I had a haemorrhage, and a second-degree tear, and an episiotomy. I lost 1.6 litres of blood.
The first consequence of my incorrect notes occurred hours after birth, when I fainted in the bathroom. No one had recorded my haemorrhage, and so no one knew why I felt woozy.
A blood transfusion was ordered, but there were delays. The blood was lost, then found, then lost again. When it arrived, the wrong type came, a potentially fatal mistake I caught when the midwife held it up.
After my delivery, the high dependency unit was full, which meant I was sent instead to the postnatal ward. On the second day post-birth, the midwife on the ward told me I could not have my blood transfusion that evening, though the units had arrived.
This, she explained, was because she was managing 29 patients alone and did not have the expertise or time to help me.
In the beginning, I hated this woman; I thought her cruel. Later, when I heard her crying, I realised she, too, was trapped in a system which was breaking her, and there was nothing anyone could do.
Before I go on, I should acknowledge my privilege: I come from a wealthy, creative family — my father is an Emmy award-winning film producer and my grandfather was John le Carre. Before motherhood, I published my first novel to widespread acclaim.
When she returned home from hospital Jessica’s mood darkened into acute paranoia and was worried that she was going to harm her sons
I was an overachiever and an optimist: I’d never had therapy or depression. And yet now it felt I was losing control not only of my physical health, but my mind, too. The night after I was discharged by that male doctor, I began to expel blood and matter as though I was rotting. Callum drove me to another hospital where yet another female doctor took the time to examine me internally and put me on heavy-duty drugs to combat infection.
I was sent home again — and yet I wouldn’t heal. Over the next few months, oral antibiotics worked while I was on them, but as soon as one course finished, the fever returned.
Meanwhile I had two babies to look after. My husband returned to work as a script editor at the BBC, and for weeks I could not leave our tiny home in North London except to see doctors. I began to feel tremendous guilt — what was wrong with my body?
Was this what motherhood was — learning to live with sickness and pain? And the pain was almost constant. Sometimes it transformed into a knot inside my pelvis. Sometimes it shuddered up my back. Sometimes it raged through me in hot bursts.
My mood darkened into acute paranoia. I refused to bathe my babies, convinced one would drown. I obsessed about bacteria in the bottles I pumped milk into. I was convinced one of my babies would cease to breathe in their sleep. I asked whomever I was with, which was mostly Callum, urgently, obsessively, every five minutes, to check on them.
A woman who suffers birth trauma lives with it every day. Her ‘birth experience’ is not a pencilled note, written in haste, secreted away. It is alive and real and present
‘Are they breathing?’ I would ask. Even when I was holding them.
In my memories of this period, I am always alone. I had Callum, my mother-in-law, two good friends who travelled hundreds of miles to look after me. But I felt numb. To make matters worse, Callum was euphoric. Fatherhood suited him, which built a gulf between us. We argued.
Six weeks after the babies were born, one of my friends told a health visitor I needed help. I was given a questionnaire, which centred on my emotional state, my relationship to my children and my vulnerability to suicidal thoughts. Like many who take this survey, I lied about suicidal thoughts. I thought if I told her I was having them, she’d institutionalise me and take my children away.
When I finished, it was clear I was not, to use the medical euphemism, Doing Well. The health visitor referred me for postnatal depression, but warned the wait for a therapist, through local services, could last three months
It took more than 70 days of pills for my infection to go. At one point, eight weeks after the birth, doctors debated a hysterectomy. But I refused to be re-admitted to hospital and, in the end, the drugs — and the rest my extended family gave me by caring for the babies — cured me, at least physically.
But questions remained. A woman who suffers birth trauma lives with it every day. Her ‘birth experience’ is not a pencilled note, written in haste, secreted away. It is alive and real and present.
Seven months after the birth of my sons, via the therapist I was finally seeing for postnatal depression and postpartum PTSD, I was offered what’s called a post-birth debrief, where a trained midwife goes over those notes with you.
It was discovered that important information in Jessica’s hospital notes was not were it should have been. The words placenta accreta were written in her orange file, but not in her digital records
On the eighth floor of my birth hospital, I sat in a room with a table bearing two stacks of orange folders. The stack to the left of the consultant midwife had been read before I arrived, the stack to her right was for future appointments.
It was from this file I learnt the name of my condition, and the fact I had one. Placenta accreta, she read with surprise. An extremely rare condition, affecting 1.7 out of 10,000 pregnancies.
Placenta accreta, explained the midwife, impacts the cellular structure of the placenta, causing the organ to spread like a cancer, eating into the lining of the uterus such that the placenta cannot dislodge after birth. One in 14 women with accreta dies.
There was more. According to my notes, when the doctor ripped one of the placentas from my body, she hadn’t got all of it, which meant I was at an increased risk of infection. This is why I was suffering. I felt sick. How did I not know this? How did none of the doctors who treated me know this?
Because, said the midwife, the words placenta accreta were written in my orange file, but not in my digital records.
I asked how this was possible and she sighed. As information was transferred from one format to another, she presumed, a human error occurred.
On she went, at quite a clip. The accreta would leave me with a high risk of infertility, she said, especially if the damage had been worsened by infections — which leave scars in the uterine lining.
My nausea turned to anger. The fact is, I had blamed myself for it all. I blamed myself for being sick, for having ‘poor hygiene’, as one GP said. I felt guilty for inventing things, for feeling overwhelmed, for needing to lie down when I walked too far, for hurting when I picked up or played with my boys.
Would I have been less hard on myself, less ashamed by my helplessness, by my inadequacy, if I had understood the gravity of the condition? Would I have felt less self-loathing as a mother?
Yes. One hundred per cent. Why had I not been allowed to keep my paper maternity folder, I asked the consultant midwife. Surely, the information in that folder was important. The kinds of details I had a right to know?
She shuffled awkwardly. The folder, she said, did not belong to me. It belonged to the hospital.
I felt my anger grow. If losing medical notes happens once, I told her, it is a mistake. If it happens multiple times, to the same woman, in rapid succession, it is systemic.
‘Perhaps,’ I said, ‘my care would have been managed better if two words had appeared on my notes: placenta accreta.’
She apologised, agreed mistakes had been made and pledged to review my case internally.
Although mistakes had been made, Jessica says that she was grateful to hospital as the majority of midwives and specialists who treated her and fought hard to save her life
Yet I could not remain angry with her. She was a woman under fire, beleaguered by cuts to the NHS, forced to confront, day in, day out, the mountain of human suffering in her stack of files.
Each belonged to a mother who would come in that day asking questions about a birth that had gone wrong. The collective trauma manifest in that stack of files can’t have been easy to shoulder. How many tragedies did they contain? Losses that dwarfed my own?
What was important, then, was simply the following: I had a name for what had happened to me. And naming helped.
As I left the hospital, something new settled in my body. I was grateful to this place I had long vilified. Yes, serious mistakes had been made, but the majority of midwives and specialists who treated me had fought hard to save my life.
Despite all I had suffered, I had not vanished as a mother. I survived. I would go home to my children, hold them close and express that gratitude.
- Adapted from Birth Notes: A Memoir Of Recovery by Jessica Cornwell, published by Virago at £18.99. © Jessica Cornwell 2022. To order a copy for £17.09 (offer valid to May 26, 2022; UK P&P free on orders over £20), visit mailshop.co.uk/ books or call 020 3176 2937.
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