In the UK you are legally entitled to have dignified, respectful and personalised care as you birth your baby and begin to breastfeed. You are also protected in law from discrimination. Unfortunately, sometimes, people do not receive a good standard of care from their healthcare providers and they suffer emotional and physical pain as a direct result. When this happens, there are a number of different ways that you can offer constructive feedback and/or make a formal complaint and/or seek further advice.
Infant Feeding Team support
If you are still in hospital and you don’t feel that you are getting the support that you need with breastfeeding, you can ask if there is an Infant Feeding Coordinator (IFC) to speak to. Not all healthcare Trusts employ an IFC, but if they do, they should offer to arrange extra breastfeeding support for you. If you don’t feel ready to talk to anyone while still in hospital, you may be able to make an appointment to go back and chat to the IFC. Some mothers find that just being able to discuss their experience, feel listened to, and hear that things will eventually improve helps them to come to terms with what happened, without feeling the need to take things further.
Some healthcare Trusts offer a postnatal listening or debriefing service where you can talk to a different healthcare professional about your experience of pregnancy, birth and breastfeeding. You can offer feedback about how it all made you feel and suggestions for what should change in the future. This can be a learning opportunity for the healthcare professionals involved. If you feel that the healthcare Trust practitioners would benefit from updated training, please do tell them that. Sometimes, funding for training is restricted and Trusts can be more receptive to facilitating more training if the requests are coming not just from the staff, but from members of the public too.
It is entirely understandable that if you feel extremely let down by the healthcare professionals who were supposed to look after you, you will not want to go back to that Trust and will want to consider other options. Some independent midwives and doulas (working privately outside of the NHS) also offer a debriefing service. La Leche League Leaders are all accredited breastfeeding counsellors and can also provide a free, safe, non-judgemental and caring space, on the phone or at a group meeting, to listen to your earlier feeding experiences while supporting you with your current breastfeeding relationship.
Maternity Voices partnerships
Once you have found a rhythm with breastfeeding your baby, you might decide that you would like to contribute some feedback about maternity services at a community level. One way to do this is to join your local Maternity Voices Partnership (MPV). An MVP is a local NHS working group of women and families, commissioners and maternity service staff, collaborating to review and develop local maternity care. It is led by an independent lay chair who ensures service users are represented and heard. It is maintained (set up and funded by, and reports annually to) a local NHS body, usually the Clinical Commissioning Group or Local Maternity System.
An MVP uses both a formal committee structure, with written agendas and formal minutes of discussions and decisions, alongside principles of participatory co-design and co-production e.g: regular break-out sessions, small group work and community events. To join your MVP you need to have been a user of maternity care within the last 5 years, or a representative of a charity or a local interest group. You can read more about MVPs here http://nationalmaternityvoices.org.uk/ and here http://nationalmaternityvoices.org.uk/toolkit-for-mvps/setting-up-an-mvp/for-service-users
You might want to consider making a formal complaint to the local NHS Trust. Trusts will have information about where to send your complaint to on their website, and/or you can send it to the Patient Advice and Liaison Service for the Trust (PALS).
The first step in a formal complaint process is to complain directly to the hospital. Normally, a formal complaint under the NHS complaints procedure must be made within 12 months of the date of treatment. If this deadline has passed, it is possible for this to be extended if you had good reasons for not complaining before (for example because of the trauma), but it is important that you outline these clearly. If this is the case, it is still possible to investigate the complaint fairly and effectively.
If you choose to make a formal complaint, the main thing is to write as full a description of what happened as possible, and to be clear about what you want to happen as a result of the complaint.
You might find the following tips helpful in writing your complaint (you will need to make clear that you want to make a “formal” complaint):
- Keep your letter as clear and brief as possible, with numbered paragraphs about each complaint.
- Make sure you explain clearly what you think the hospital has done wrong.
- Explain what impact this has had on you and your family.
- Set out what you want them to do to put things right.
- Keep a copy of your complaint and note the date you sent it for future reference.
- Keep other letters/notes of meetings relevant to your complaint in a folder with your complaint.
- Get the contact details of anyone you speak to in the Complaints Team and make a note of any calls with them.
Parliamentary and Health Services Ombudsman and Clinical Commissioning Group
If you don’t receive a response to your complaint or you receive a response that you feel is inadequate, you can then take your complaint further to the Health Ombudsman. Details can be found here https://www.ombudsman.org.uk You can also complain to your regional Clinical Commissioning Group (CCG) who is made out of the people who commission health service providers for your area. A representative from the CCG will also sit on your local Maternity Voices Partnership committee.
Write to your MP or Assembly Member
You can copy your complaint letter or send a different version of it to your local MP or Assembly Member.
La Leche League GB cannot give you any legal advice, but there are many established firms of solicitors across the UK who have respected clinical negligence departments and you can send them an email about seeking possible advice.
Clinical negligence lawyers will be looking to see whether the care given by the Hospital was negligent, either because the individual health care professionals were negligent – i.e. not acting in line with their duties or in line with how other professionals would have behaved in the same situation – or due to another explanation. The solicitor would then also be looking to assess the damage done to you, both physical and psychological, and whether a clear link, called “causation”, between the negligent care and the damage could be proved.
If your complaint is about a specific individual healthcare practitioner, you can also complain to the General Medical Council (GMC) or to the Nursing and Midwifery Council for nurses and midwives (NMC). You will need to get the specific name and professional NHS pin number of the healthcare practitioner whom you feel let you down and could benefit from more training. The healthcare Trust can be asked to give you this and they should comply. You can then follow this link to make your complaint about the midwife to the GMC: https://www.gmc-uk.org/about/get-involved/complaints-and-feedback-about-our-service/how-to-raise-complaint
You have a right under the Data protection act 1998 and under Article 8 of the European Convention on Human Rights to access your own health records. You can ask your GP, midwife, doctor or health visitor informally, at any time, whether they can obtain your records for you to view in person at the GP’s surgery or hospital.There is sometimes a fee to pay to be given a copy of your notes to take away.
You can also submit a formal written request, known as a ‘subject access request’, to view your notes under the Data Protection Act 1998. This is usually sent to the NHS Trust’s medical records manager or the GP surgery’s practice manager. The address will be available on the website of the relevant NHS Trust or Health Board.
You and your partner, if s/he has parental responsibility for your child, also have a right of access to your child’s medical records.
The Information Commissioner provides standard letters that you can use to make a request. You can read more about that here: https://ico.org.uk
Ongoing support for your physical and mental health needs
It can help to get as much support as possible for your own physical and mental health needs. You can contact your health visitor and/or GP if you feel that you need more support.
La Leche League meetings (both online and face to face) can offer a warm and accepting place to talk about your experiences as a new mother with birth and breastfeeding. All meetings are confidential, and the Leader will facilitate the meeting to ensure that everyone who wants to has the chance to talk. There is no pressure to talk at all if you would prefer to sit and listen. Many of the people who attend La Leche League meetings (including the Leaders), have faced considerable challenges with feeding their babies and with becoming a new parent at one time or another and the atmosphere is accepting and respectful. Leaders are also able to listen and support you with breastfeeding on the phone, over email, text and social media groups. Please remember that Leaders are volunteers too and will offer you as much support and information as they can, whilst meeting the needs of their own children and family.
There are several other charitable organisations which also focus on offering support with birth and post-natal trauma, such as Make Birth Better and the Birth Trauma Association. For help with your legal rights you can also contact Maternity Action (https://maternityaction.org.uk/) and Birthrights (https://www.birthrights.org.uk/)
Summary of your legal rights around birth and breastfeeding
You have a right to choose the circumstances of your birth and how to feed your baby, including choosing to have a home or caesarean birth. This right can only be limited if the limitation is lawful, necessary and proportionate at the time that you give birth. (This comes from Article 8 of the European Convention of Human Rights – the right to a private life which includes the right to make decisions around your own body).
You have a right to make your own decisions about your body under English common law (caselaw). The most important case about this right is called Montgomery v Lanarkshire Healthboard. It sets out how health professionals need to make time to have a full and respectful dialogue with you about the risks and benefits of all care options that they are recommending to you. This also includes breastfeeding and the different ways that you can feed supplemental milks to your baby. Care should always be individualised to your own and to your baby’s personal health circumstances.
You and your baby have the right to be given respectful and dignified care at all times. Or to put it another way, you have the right under article 3 of the European Convention of Human Rights not to be subjected to inhuman and degrading treatment. This is a right which cannot be limited at all.
The European Convention rights are within UK law because they are enshrined in the UK Human Rights Act 1998. This Act places responsibilities on all public bodies across the UK to protect and uphold individual’s human rights. Public bodies include all NHS hospitals and all of their staff.
Written by Johanna Rhys-Davies with input from Anna Burbidge and Eva Williams, July 2020