Maternataxi
Ambulance crews, I’m told, really hate getting called out to women in labour. They must do, to be inspired to write touching poems such as this about them. In the words of Big White Taxi Service, “you are not ill, you are in a condition you got yourself into. You should have made proper arrangements like the 160,000 mothers each year”. Don’t get me wrong, of course sometimes being in labour can turn into an emergency, when something goes wrong or things happen a little faster than the mother-to-be anticipated, or if you already know that there’s a problem with your pregnancy and that you need to take an ambulance to hospital when you go into labour. But going into labour in the normal way is not an emergency, and you should NOT plan to call 999 to get to hospital. In those exciting eight months of preparations for the new arrival, between buying miniature booties and popping folic acid, you should also be putting aside a taxi fare and/or getting your friends and relatives on standby to get you to the hospital.
We get a ridiculous number of calls for women in labour, most of whom don’t need an ambulance. Sometimes I even hear a relative on scene saying they won’t go in the ambulance, but they’ll follow in the car. So why don’t they just drive the patient to the hospital? I have no idea. I have a feeling, though, that it’s not all the fault of the callers — often they tell me that the midwife has instructed them to call for an ambulance when the contractions reach X minutes apart, and unless pregnancy turns women into compulsive liars, I suspect midwives have indeed been telling patients this. I think someone should educate the midwives against this.
Unless the woman is having problems or is about to give birth on the spot, most “maternataxi” calls turn out as Green, the lowest priority (or at least they are supposed to — as Reynolds of Random Reality often laments, there is a bug in our software which keeps churning out Reds for calls that should really be Green. But that’s a whole different whinge). This means that a lot of women in labour have a long wait, during which some of them wise up and get in a car, and others ring back every five minutes shouting at me and saying things like “Do you want me to have my baby right here??” to which it is very difficult not to reply “Well, yes — at least then it would be a proper emergency!”
The other day, however, there was a call from a woman who used a special technique to get an ambulance to ferry her to hospital in the early stages of labour. This technique is known as Telling Porkie Pies. As you may remember from a recent post, we have to ask a series of questions that we have already guessed the answer of to ensure that we haven’t missed anything. In the case of a maternity, one of the questions is “Can you see, feel, or touch any part of the baby yet?”
“Yes,” replied the woman — the woman in labour, the woman in labour who was talking calmly with no sign of pain or panic in her voice — “I can feel the head.”
Thinking that she had probably misunderstood the question, I rephrased it, using the word “vagina” and everything.
“I told you — the head is out!” said the woman.
This put me in a difficult position, because from my (admittedly limited) experience of women giving birth I can tell you that they generally cannot talk calmly on the phone whilst the head is emerging from their vaginas. On the other hand — never disbelieve a caller! Expect the unexpected! So I got the caller to summon her sister from the next room, and got the sister to check the vagina, hoping that she would tell me that there is definitely no sign of the head, but instead she told me the same thing: “Yes, I can see the head.”
There was nothing much I could do except take their word for it and press on with the birthing instructions. I sent the sister off to fetch towels, and she returned to the phone after a suspiciously short length of time. I told her to get the pregnant lady on to the bed in the correct position and stripped off, and she told me that she was already in that position. I then told her to place her palm against her sister’s vagina as the baby delivered, and she told me she was doing it. I knew she wasn’t. Don’t ask me how - we don’t have video phones - but I can tell if instructions are actually being followed or if the caller is pretending every single time. Then I waited. And waited. Of course, the head didn’t get any further and during the whole time the mother to be made not a grunt nor a moan. She showed no evidence of having contractions, let alone giving birth.
Then there was a buzz at the door and the man from the FRU burst in, no doubt expecting to see the baby taking his or her first breath, and instead was greeted by a heavily pregnant woman sitting fully clothed on the sofa*.
“I thought you said the head was out?!” he said incredulously.
“Oh no!” said both women in unison, “we said that the labour had just started!”
Cue noise of, once again, call taker banging head on desk…
*(I am using my imagination here — like I said, no video phones…)
on November 23rd, 2005 at 4:05 pm
That’s extraordinary. Did the bewildered FRU chap realise they had been lying through their teeth and it wasn’t Ambulance Control’s fault?
on November 23rd, 2005 at 4:31 pm
Sad to say, midwives do indeed say this - I think four or five different ones said it to me over eight months. The only time I didn’t interrupt was after I was diagnosed with SPD and instructed not to sit in a car for frivolous purposes (e.g. going shopping), but we still thought she was overreacting. Driving ten minutes to the hospital was certainly not what we considered frivolous - and as it happened I never went into labour [unless you count a month of prodromal] so I was driven in for induction anyway. Two friends had blue-light transfer though (homebirths gone wrong, different reasons) and were very grateful for the service. But their midwives called, both times.
on November 23rd, 2005 at 4:56 pm
I don’t know if the FRU guy realised what was going on. Depends if they started lying to him too. I didn’t hear anything back from it. I’m sure ambulance crews are used to patients exaggerating and realise it’s not just us being useless, although this was an extreme example!
on November 23rd, 2005 at 4:58 pm
Just another case of people taking the NHS for a ride (excuse the pun)!
I don’t know what could be done to minimise this, but in our current society of political correctness gone wrong, I doubt if we can change it. Its just un-fortunate, as someone else might have to pay with their life when a FRU or ambulannce is on taxi service during their emergency.
The Driving Instructor
on November 23rd, 2005 at 5:33 pm
Its a while since I was last in this position, but we did get an ambulance in for the birth of our youngest. In our defence I have to say we didn’t run a car at that time, and local taxi services definitely will not move someone in labour.
If you cut things a little fine the ambulance crew do get rather jumpy - birth in the ambulance apparently means the ambulance is stood down for cleaning. We were transported and ejected very quickly!
on November 23rd, 2005 at 5:37 pm
Taxi services should not object to taking someone to hospital in the early stages of labour. Obviously, they won’t if she’s about to pop! If you’re in the position of having baby incoming and no transport, shop around before the birth for a taxi service that definitely will, or enlist a friend or relative to be on call. If all else fails, calling 999 is preferable to hanging around and giving birth on the sofa, of course.
Ambulances get stood down for cleaning all the time. Patients have a nasty habit of puking, bleeding and otherwise expelling bodily fluids all over them. I’m so glad I only get to hear about it and not smell it.
on November 23rd, 2005 at 5:41 pm
Ooh, can o’ worms!! You know my feelings on this subject……
Can i just say that when it really is going belly up (ha ha) then its no trouble at all to turn up and do our job, we like nothing better than to see a happy mum and healthy baby…. emphasis on the word BABY!! what we dont like are the happy mums struggling to fill the uncomfortable silence that usually descends upon an ambulance en route to the maternity ward, a nice little jolly ride through londons worst traffic, with dad bringing up the rear in the FAMILY saloon. I’ve occaisonally been asked ‘why aren’t you using the nee naws and pretty flashing lights?’ to which it takes all that i am to not snap back ‘why aren’t your contractions every 3mins apart, instead of 3hours?’ instead i usually mumble something about not really being an emergency, and get on the subject of baby names, they get to witter on and i get to stare into space with a look on my face that belies the fact i couldn’t care less.
Arrival at said maternity, and we’re often met with a look of derision from the midwives, one actually asked ‘why did you bring them?’ DUR!! anyway, mum gets the briefest of lectures about calling us and a handy hint of ‘next time get a cab’ ….. Which we all know is pointless because next time they will revert to having the memory span of a goldfish and call us!!! AARRGH!!!!
“SIGH” it keeps us in a job, and we invariably get a cup of tea out of it.
on November 23rd, 2005 at 5:45 pm
Mark, tiger balm under the nose is fantastic at masking smells, unless of course you have a cold, then it burns and you have to peel your crewmate from the ceiling
on November 23rd, 2005 at 10:08 pm
I’ve got a book of stupid calls made to the emergency services in the States, and one page details a woman who phoned to say she was giving birth right there and then. The calltaker asked if she could see any part of the baby, and she said she didn’t know because she still had all her clothes on. She was told to take them off so she could check for the emergence of the head, and apparently she said in reply that there was no way she was going to undress, as she “didn’t want the paramedics to see her cootchie”. I mean, what the?
If you are in labour, at what point should you go to the hospital?
on November 23rd, 2005 at 10:14 pm
I used to run as a volunteer EMT in Alaska; the only people who called ambulances were those who were genuinely ill/injured etc., or those who had good health insurance; there weren’t that many in the latter group.
Anyone who has ever had the misfortune to need medical treatment in USA knows how much it costs. Many people in UK have no idea how much they would have to pay for an ambulance to take them to hospital. Give them a bill, and they’d go into shock and actually need the ambulance they’d called for!
on November 23rd, 2005 at 10:19 pm
If you are in labour, at what point should you go to the hospital?
Pass. Ask a midwife. I think I’ve heard people saying it’s when the contractions reach five minutes apart, but I could be wrong.
I wish we could bill people for their maternataxis! It would pay for a good few new ambulances!
on November 23rd, 2005 at 11:31 pm
Grooooooaaaaan….
I’m a midwife, and I definitely. Do. Not. Tell. People. To. Call. An. Ambulance. And neither did anyone I ever worked with during my training. Oh, and I was on the midwife end of a woman claiming to have the head already out… we got a midwife to go and see her, stat… and in the meantime she decided she was actually going to just turn up at the unit, unannounced. So that’s LAS and midwife time wasted. Really annoys me, sooo much… because also, when we need ambulances as midwives, we REALLY need them. So to know they might be delayed because they are answering a call to someone who has had Braxton Hicks (practice) contractions for 3 days, it pisses me off. And then people pitch up on an ambulance trolley or chair, expecting to be seen NOW and actually, sometimes, they really aren’t a priority and if they had rung in advance we would have told them to stay at home, but once they call an ambulance, I think we have to accept them. Grr. Rant over.
Caveat: sometimes you do need an ambulance, when people have precipitate labours, are alone and in strong labour very quickly, or in some circumstances where the woman is totally unsupported or if there is severe bleeding. These are rare circumstances though.
Oh, and you should really stay at home in labour till a) you can’t take any more and need pain relief (if your contractions last 20 seconds and you can talk through them, take 2 paracetamol and have a bath. We won’t do anything different for you). Or b) your contractions are 3 to 4 in 10 minutes, lasting about 40 seconds to a minute each. And you are timing from the START of one contraction to the START of the next. This is for first babies. For those who’ve had babies before we want you in when they are 2-3 in 10 minutes and similar strength, cos it’s usually a bit quicker and we don’t like you delivering in the lift, it makes a mess and there’s not enough lifts for them to be out of action.
on November 23rd, 2005 at 11:38 pm
I’m sure some midwives must tell women to call ambulances, or there’s a lot of lying women out there. And the last thing I want to do is suggest all women are liars
Glad to hear you’re not one of the offending midwives, though!
on November 24th, 2005 at 12:09 am
When we had our first (just over a year ago), none of the midwives told us to call an ambulance. We ended up going in (in our car) 3 times - once for waters breaking, once for contractions that weren’t bad enough, then for the real thing.
Although the examples mentioned are indeed foolish piss-taking twonks, I would add the caveat that you can read, listen and learn all you like but with a first baby, there’s really nothing to measure the pain/fear against so you don’t know how much worse it can get. This explains why we went in and got sent home (only 2cm dilated - we thought we’d left it until the last safe moment!) and may explain why some people call ambulances. Just remember that you professionals may see hundreds of labours/births but the first one is pretty scary.
on November 24th, 2005 at 4:34 am
Are all calls to 999 recorded? If so, couldn’t the women be charged with making a false call?
on November 24th, 2005 at 6:31 am
Theoretically, yes, but in practice only people who made repeated hoaxes get into any trouble.
on November 24th, 2005 at 11:43 am
I believe the Fire Brigade now charge for false alarms (where possible) and, I suspect, non-emergency calls; so gone are the days when you could call them to rescue your cat that’s got stuck up a tree!
on November 24th, 2005 at 11:57 am
*She said in reply that there was no way she was going to undress, as she “didn’t want the paramedics to see her cootchie”.*
If you’re in labour, you rarely give a flying do-dar who sees you and in what state!!!!
on November 24th, 2005 at 12:53 pm
She couldn’t have been that far gone then, could she? Either that or the book was lying. Apparently all these calls were genuine, but it’s probably rubbish …
on November 24th, 2005 at 2:27 pm
Why do only repeated hoaxers get into trouble?
It would be interesting to see what percentage of fire alarms are false, compared to the number of unnecessary calls you get for an ambulance. Admitidly, with the fire brigade it’s either burning or not, while sometimes the line between needing an ambulance or making your way to the hospital/doctore yourself is a litte blurred.
However, when you have a clear case of someone lying to get an ambulance faster, surely there should be some consequences other than the ambulance crew giving you angry looks.
on November 24th, 2005 at 2:34 pm
Why do only repeated hoaxers get into trouble?
No idea. I wish they’d get all of the little blighters. I think the trouble with fining people who call for rubbish might put some people off ringing, though. Perhaps a standard call out charge for ambulances of a token fiver would help? It would put off those who are using us as a taxi, and is cheap for a genuine emergency.
on November 24th, 2005 at 4:36 pm
It’s a long time since I had my first - in the Netherlands. When I went for a regular check up, I was told, yes the waters had broken, I was partly dilated, but no rush, go home and make your way to hospital when the contractions are 4 minutes apart. Some time later, husband drove me in, midwife met us there and said baby was delivered 4/5 hours later. Ambulance?? Never suggested or offered (actually neither was anaesthetic - but that’s another tale).
on November 25th, 2005 at 2:16 am
As an OAP., here in La La Land, I get a 100$ charge, upfront, or I can take a taxi for 10 bucks plus TIP. In Order not to pay, have no wallet. and no address then I be taken for an hour’s run to the County Hospital. Fortunately I never tested the truth of this as the last time I needed hopital treatment {minor infarction] it was easier to take a cab.
on November 25th, 2005 at 2:21 am
Those women who claimed the baby was “coming out” would be a shoo-in for a fraud charge, though, as you have them on tape lying to the dispatcher, and the paramedics can testify that the baby was not, in fact, visible when they arrived.
on November 25th, 2005 at 3:34 pm
Here in the USA one of the ways people can get free rides to the hospital is a handy little benefit called MEDICAID. MEDICAID is supposed to be for people who are financially disadvantaged (poor) but is really for just about everyone who doesn’t care to work for a living (in which case you get NO benefits). If you have MEDICAID your ride to the hospital is FREE and we don’t get to refuse service to anyone who claims to have even the most vague medical complaint. Labor is a medical complaint and FREE is much cheaper than the cost of a taxi. It is not unusual for us to arrive at the address and find a woman standing at the curb with a suitcase. These women are almost always MEDICAID recipients. For some strange reason people with no insurance or people who have jobs and insurance seem to choose to drive themselves to the hospital when in labor.
on November 26th, 2005 at 2:11 pm
In my opinion, people who make hoax calls or exaggerate their symptoms to get an ambulance get off far too lightly. I think the Powers That Be should employ a few people to deal with any reports from EMDs and crews and contact the people involved, issuing warnings and/or contacting the police. At the moment no-one exists, and EMDs and crews don’t want to get involved with “telling people off”, especially when there’s a queue of genuine calls waiting to be answered.
on November 26th, 2005 at 3:34 pm
Good point re how scary a first labour is, and I would not in any way dispute this. This is why I would push for a midwifery service that can provide early labour assessment at home (as I do in my own practice) which leads to less hospital admissions and ‘false alarms’ and also less unnecessary ambulance calls.
I am certain that some midwives do tell their clients to call ambulances; this may be because they sadly don’t trust the women to know if they are in labour, and a BBA through lack of information is not going to be looked on kindly.
Additionally, we have noticed in London that the number of maternataxis has gone up considerably since the congestion charge was brought in; the hospital is inside the CC zone, whereas most of our women are not. £8 plus parking, or ‘free’? I know what I would choose. (Personally would choose home birth so slightly theoretical statement!).
on November 26th, 2005 at 4:03 pm
Claire, I wonder if the insistence of my local MWs on the desirability of ambulances comes from the fear of BBA? We’re somewhat rural although genuinely only 10 minutes from the hospital in all but the worst peak-hour traffic. Perhaps they’ve been yelled at too often for letting us poor country women make our own way in from the depths of the fields… (ooh-arr).
Bah. I’ve to go in for an elective section next time anyway (no VBAC for me for too many reasons) so it’s not something I need to deal with.
on November 26th, 2005 at 4:43 pm
I have read all these comments with interest and would agree whole-heartedly with Scribbler. What I would also say is that not everyone’s pain thresholds are the same and some of us live in rural areas around 20 miles from the nearest hospital. I have to say that my labour up until when the second stage started was pain-free and then I would only describe it as being ‘extremely uncomfortable’. I had been checked the day before in the morning when my waters had broken (hospital protocol) and sent home at 3cm. Waddled around all day and had an uncomfortable night. Rang in the next morning when very uncomfortable - but not having what I would term ‘contractions’ - ‘Oh come in in around 2 hours time’ (to suit them rather than me, I suspect). 6th sense told me that I really shouldn’t be at home so we drove to hospital which took around 30 mins. Checked on arrival - 10cms dilated; with an undiagnosed breech, then second stage started, so straight into theatre for emergency section as baby’s heart beat was dipping and not recovering. In terms of measuring my contractions, I wasn’t able to as I couldn’t feel them until the second stage.
I have since spoken to one woman who had her baby in the hospital car park and another who had hers in her kitchen, then had to wait for about 20 mins for midwives to arrive.
Whilst I appreciate that the system gets alot of abuse, ‘one size’ doesn’t always fit all. Incidentally, the community midwife service in rural areas isn’t as comprehensive as it is in large cities, so hospital is the only place to go if you have any concerns or need checking.
on November 26th, 2005 at 4:57 pm
The rural areas thing doesn’t apply in London, though. We don’t have any rural areas. Wherever you are in London, there’s a hospital within five miles. Some of these women are just a few minutes’ walk from the hospital. Yeah, I can understand the women are scared, but surely they know labour will be painful and scary? It’s not like it’s happened out of the blue!
on November 28th, 2005 at 12:17 am
Totall agree, Mark. YES, I understand that labour is scary, whether you’ve done it never or 10 times it will still hold some element of scariness. But if you are in London or indeed any major city, and a lot of other places, you are not that far from a healthcare facility. I think that misinformation is to blame a lot- no, dear, your baby actually isn’t going to be born with 2 contractions and no warning. Even people who have BBAs tend to have some CONTRACTIONS before giving birth. It isn’t like Holby! Having worked somewhere where we really were 40 minutes from some of our women, I wouldn’t ever send someone home if they lived a long way away and didn’t want to have to do the journey twice, if they were in early labour. But I wouldn’t advise them to call an ambulance to get in- if you live in the middle of the country you have the means to get out for everyday life, for shopping etc, so you have the means to get to hospital. And it isn’t as if you have no time to plan your journey; you have the best part of 9 months…
on November 28th, 2005 at 8:35 pm
Ref Claire’s comment, well, I was sent home in early labour and in traffic, the journey to the hospital can take over 1 hour. Fortunately, the journey on the day our son was born was made early in the morning before morning rush hour. I’d be interested in how you define ‘not too far from a health care facility’.
Yes, I do have the means to get out for everyday life, but am not sure if I would drive myself 20 miles to hospital whilst in established labour - maybe you feel differently!
I am sure that in an Ideal World all expectant mothers would know exactly what to do, what to expect and have planned their trip to hospital for The Big Day with military precision and left exactly enough time not to inconvenience the medical staff TOO much by pitching up too early, but life’s not like that and an Ideal World is a very, very small place.
Incidentally, if so many women are turning up at hospital far too early, and abusing the Ambulance service along the way, then what does that say about the quality of the information they are given by the various health professionals they see during their Antenatal care? Maybe the key to ensuring the most appropriate use of resources is to educate women more effectively, give them support over the ‘phone or send a midwife out to check them (I believe this happens in part of West Berks) so they come into hospital at the point at which staff feel is appropriate. Hardly rocket science!
on December 2nd, 2005 at 12:01 am
Anthea- that’s what I just said! We should be doing checks at home and giving proper antenatal care so that people have a rough idea of what is likely to be the time to come in (when contractions are 3-4 in 10 mins, strong) and when to stay at home (when you have a show).
And if you live in the country, or the city, you can plan for how you will get to hospital. I’m sorry but NOBODY is that disorganised that they can’t work out that at some point they will have to be transported from home to hospital and how long that is likely to take. Just today I looked after someone who lived an hour away; she was in early labour, we didn’t send her home. If she had only lived round the corner maybe we would have.
Anthea, I’m sorry if you were sent home in that situation- but if it was a case that you really should have been at home, it was the failure to provide support to you so you didn’t need to make a needless journey that was the problem and not that you were sent home in traffic.
on December 2nd, 2005 at 9:11 pm
Hi Claire - they sent me home because they didn’t have any beds….. in fact, they told me to go shopping! Hospital protocol was to check women when their waters broke. Whilst I was there they told me I was having contractions - which I couldn’t feel and to be honest, I didn’t really feel anything until I reached the transition stage and then only really, really uncomfortable. I didn’t get a sense of anything happening until the second stage and by then it was a full blown emergency. Don’t push, they told me - don’t push! - what do you mean don’t push?!!! Horrible, horrible experience. My point is that how do you define ’strong’, I didn’t feel anything ’strong’ in my first stage and everybody’s interpretation of pain and discomfort is different. BTW I was told that I have a ‘high pain threshold’ so that might have something to do with my experience!
Incidentally, my second child is due in Jan and I have to say how dumbed down the Antenatal care is now (NICE guidelines) - women are seen so infrequently, I wouldn’t have thought that much gets picked up at routine appointments. This is a shame and undoubtedly leads to women not feeling supported or given enough information and requiring reassurance in others ways (maybe by calling an Ambulance when in early labour?????).
Where I am, I can only contact my Community Midwife between 0900 and 0930 and they work a shift pattern as you’d expect, so even if you call between those times, you can’t always reach your midwife - it’s not possible to leave a message for her outside of this time and the only means of contacting anyone remotely concerned with Midwifery in the area is to bleep them at a hospital that I won’t be delivering at! Great service! Things won’t change until more resources are made available and that’s just not going to happen.
on December 4th, 2005 at 4:21 pm
Anthea, that is terrible… adn I thought our service was lacking…
I would urge people to get involved in the ‘one mother one midwife’ campaign; having a named person that you can get hold of and get to know. It is shocking that people can’t get hold of a midwife when necessary and downright dangerous too- story in the Telegraph today of someone who died of a postnatal infection because nobody saw her in time or recognised the early symptoms.
http://www.onemotheronemidwife.org.uk/
on January 2nd, 2006 at 4:51 am
Every 999 call is a lie until arrival