Teaching resources

Follow up and counselling

Key Learning Points
  • Women who had a follow-up review at the hospital found this a positive experience to help their understanding and recovery
  • Where follow up was not offered women felt abandoned and were left with questions
  • Women noted a number of things that were particularly helpful elements of the follow up review'

             - seeing and talking through their notes

             - answering questions about future pregnancies

             - sensitivity about the place where the review was conducted' returning to

               the antenatal clinic or labour ward or even hospital could be upsetting

             - flexible timing of the follow-up review' some women were not ready for this until

               several months or even years after the event

             - an offer of counselling was helpful to some

  • The follow-up programme with intensive care unit staff that some women were involved with was considered a good model
Acknowledging that they had been through a traumatic event, and offering follow up after the emergency, was very helpful for some women after a near miss.
 
Follow up helps understanding and recovery
It is good practice for women to be offered a follow up meeting with the hospital, several weeks after discharge. This can act as a “debrief” providing women with the opportunity to understand the chain of medical events that occurred. As women were often unconscious for a large part of their emergency, these meetings can help them piece together what has happened to them.
Where follow up was not offered women felt abandoned, and left with questions. Women who were not offered follow up felt a lack of closure and were left with questions about the future. Henrietta had a post partum haemorrhage and said, “In terms of closing it off it would have been nice for somebody to sort of say what had happened and explain it a bit more, I guess. And yes, and to know if there was going to be anything in the future that might be an issue or not.”
Seeing and talking through their notes can be helpful to women 
Women sometimes asked for copies of their notes to help understand what had happened. They felt ready for this at varying times, some almost immediately after they went home, others years later. Even though sometimes there were bits of information missing, on the whole, going through these notes, either on their own or with a medical professional, was really helpful. Some recommended going through them with someone who wasn’t involved in their care.
Follow up can answer questions about future pregnancies
Some women were pleased to have the opportunity to discuss future pregnancies with doctors and the risks there might be. Other women who had had life threatening events were very concerned about getting pregnant again.
Where follow up takes place is important
Some women found it difficult going back into the maternity department, or ante-natal clinic, to have their follow up. It stirred up memories of the traumatic event.

When follow up takes place needs to be flexible & open ended 
Women felt they needed follow up at different times. Some felt that 6 weeks was too soon and felt the need to revisit and try and understand more about their experiences further down the line. Often their child’s first birthday (and the anniversary of their trauma) stirs up emotions.
Counselling 
Some women were offered counseling, which was often very valuable. There was great variation in when the women felt ready to talk about their experiences. While some women felt ready quite soon, others were not ready for a few months or even over a year.

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