Decision Report 201508311

Summary

Ms C complained to us about the care and treatment she received when she was admitted to the Royal Infirmary of Edinburgh with significant pelvic girdle pain (a collection of uncomfortable symptoms that can cause severe pain due to a misalignment or stiffness of the pelvic joints at either the back or front of the pelvis) in the late stages of pregnancy. She also complained that the board did not reasonably respond to her complaints.

We took independent midwifery advice. We found that the care and treatment provided to Ms C in relation to pelvic girdle pain and pitting oedema (a build-up of fluid under the skin that holds the imprint of a finger when pressed) had been appropriate. We also considered that the pain relief provided to her was appropriate, although we acknowledged that pelvic girdle pain is difficult to manage in severe cases. Ms C's pressure areas had been frequently checked in the hospital and the steps taken once the sore skin on her inner thighs had been noted was appropriate and timely.

However, we found that the board had not followed the guidance from NICE (National Institute for Health and Care Excellence) on caesarean sections as they had not provided her with information in order for her to make an informed choice on her mode of delivery given her concerns and anxiety about childbirth at that time. The delivery plan should have been reassessed when Ms C was admitted to hospital with excessive pain and mental health concerns. There was also a delay in providing her with a swivel turntable and other disabled-friendly equipment and the nursing records indicated delays in emptying her catheter. In addition, Ms C should have had an occupational health review prior to discharge to ensure she was safe to manage and care for her baby at home and had the assistance she required. We therefore upheld her complaint.

We found that there was a delay in the board responding to Ms C's complaint. We therefore upheld this aspect of Ms C's complaint.

Recommendations

We recommended that the board:

• ensure that relevant staff in the maternity unit are aware of our decision on the complaint;
• take steps to ensure that the staff are aware of and understand the NICE guidance in relation to requesting a caesarean section;
• provide evidence that steps have been taken to ensure that moving and handling equipment is easily accessible for staff;
• review the maternity ward to ensure that there is suitable disabled access;
• review the discharge arrangements for women with pelvic girdle pain;
• issue a written apology to Ms C for the failings identified; and
• make the staff involved in the handling of Ms C's complaint aware of our decision.