Teaching resources

Transfer from critical care

Key Learning Points
  • Women who have suffered a near miss feel different from other new mothers. They feel more supported when information about their condition has been handed over between staff and the team in the new setting show they are fully aware of what they have experienced.
  • Transfer, from intensive care, while a positive step, can be difficult. Although there appears no idea solution to step-down care:               

                - women who go to a high dependency area alongside a labour ward find this helpful

                - if women are in high dependency care for an extended period, policies which allow

                  visits from the wider family, e.g. grandparents, are appreciated

  • Similarly, women can find transfer to the postnatal ward challenging:

               - if possible, a side-room is the most comfortable place for women who have

                 experienced a near-miss to be cared for

               - if side–rooms are not available, a clear explanation of the reason for this is helpful

               - some women will experience significant problems with caring for themselves and

                 their new baby in a side-room and will need extra help 

  • Personal support and empathy from individual staff members makes a real difference to how women cope with transfer and recovery.
Once women start to recover from their life-threatening condition – either from surgery or some time in high dependency or intensive care units – they will need to be transferred to less acute care. The women we interviewed told us that this transfer, while being a positive step towards getting well, and going home, was often very difficult for them, the beginning of a new battle.
Women who have suffered a near miss feel different from other new mothers.  “When you are a woman who has given birth, but has these other complications its like you are an anomaly. You don’t fit anywhere in the system.” (Paula). They often felt that once they were transferred there was little appreciation of what they had been through during delivery.
 
Where
When they no longer need intensive care, it was often hard for staff to know where would be an appropriate place to send these women while they recovered enough to be able to go home. Some were sent to post-natal wards, others to labour wards. Women experienced problems with both, suggesting that there was not necessarily one approach that was best for everyone.
 
Some women were offered a single room to give them space and quiet to recover from their trauma. Most women appreciated the privacy.
Others found being in a room of their own very isolating, and felt that it was hard to get the attention of staff when they needed it. Lisa felt that staff were rushed off their feet and not that interested. “I was the girl who had been through that ‘awful incident’. I was ‘her in there’ and people would breeze in, do something and breeze out again. They wouldn’t want to speak to me because they didn’t want to talk about it, so I was left on my own for most of it.”
 
Support
Women who are recovering from a near miss are struggling both with their physical recovery, and becoming a new mum, sometimes for the first time. As Paula said, “I understood completely that their priority was, you know, I had almost died and their priority was to work out what the long term impact of that was. I understood that from a clinical point of view. But I did feel that there was this kind of gulf of understanding for, as well as being a patient with these medical needs, I was also a new Mum.”
 
Positive experiences of support
Some women had a positive experience of their transfer to another part of the hospital. Alice was in intensive care after she had amniotic fluid embolism (AFE). She was transferred to her own room where felt the care she received was very good.
 
Some felt that once they had been transferred, staff in the new setting expected too much of them, especially in terms of looking after their newborn, and were unaware of what they had been through. Women still felt weak and overwhelmed.
Others felt that there was a lack of support. Lisa was recovering from a hysterectomy and was unable to lift her baby. Staff were very busy, “And I’d have to sit there looking at her in the crib, and couldn’t pick her up.” Belinda had appendicitis and then a caesarean section to deliver her daughter at 34 weeks. “I do remember the NICU staff being quite nasty about the fact that I never saw the baby, but the problem was I couldn’t actually wheel myself up to another part of the hospital to go and see the baby.”
 
Several women were upset by the inflexibility of visiting arrangements after their near miss. Amy was upset that her parents were not allowed in to see her after her post-partum haemorrhage while she was on the high-dependency unit. She was desperate to see them so pushed to be transferred to another ward, “which in hindsight was a mistake….I think that is one of the biggest things that they’re just not geared up to do.” 

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