By
Sara Frattolillo, mother and communications manager at Mieux-Naître in Laval
Amélie Blanchette, mother, doula and perinatal intervention consultant at Mieux-Naître in Laval
With the generous participation of Josée Laperle, Executive Director of the Centre d’assistance et d’accompagnement aux plaintes de Laval (CAAP)
What recourse do we have if we are dissatisfied with the care and services we receive during our pregnancy or childbirth? Can we file a complaint? To whom and how?
We met with Josée Laperle from Laval’s Centre d’assistance et d’accompagnement aux plaintes (CAAP).
S.F.: Starting with the basics, what is a complaint and how does it work?
J.L.: A complaint arises when there is a discrepancy between our expectations and our perception of the services or care received. In concrete terms, it’s a written or verbal request for change. In each CISSS or CIUSSS, one person is responsible for receiving complaints: the Complaints Commissioner.
The complaint form details the situation and explains expectations, as this is what guides the process: What would you like to see changed? Once the complaint has been lodged, the Commissioner generally meets with all those concerned to hear their side of the story. She has 45 days to issue her conclusions and recommendations.
If the complainant is not satisfied, they have a 2nd recourse, to the Québec Ombudsman.
S.F.: Why file a complaint? What are the benefits of this process?
J.L.: The purpose of the complaints system is to improve the healthcare network. In most cases, the benefits will be for others, because we may not receive the same service from the same person in the future… but if no one says it, no one knows it and nothing will change.
At CAAP, we also find that filing a complaint can help us make peace with our history. In the complaint process, we first put the person’s words in writing after listening, without judgment. Then comes the stage of reading the complaint. This often helps and can help the person heal because they feel like their experience has been backed up.
S.F.: What are the criteria for an admissible complaint?
J.L.: As soon as there’s a discrepancy between the quality of the service received and expectations, there are grounds for complaint, if the person has the time, energy and motivation to do so. Nor is there any maximum time limit. The user must make the complaint to be allowed (except for complaints about medical practices, which can be made by a relative).
S.F.: What are the potential consequences?
J. L.: The commissioner has the power of recommendation, but cannot directly dismiss a person or strike him or her off the professional register. There can be no financial compensation either. We generally recommend:
- Training courses
- Reminders to the team to respect existing protocols
- A revision of approach, practice, or protocols
It is also possible for the doctor to stop treating the complainant, stipulating a breach of trust.
S.F.: What is CAAP?
J.L.: Complaint assistance and support centers are community organizations you can turn to for help and support in filing your complaint. Services are free and confidential. Every region of Quebec has a Complaints Assistance and Support Centre.
S.F.: Here are a few case studies written by Amélie Blanchette, outlining some real-life situations. What are your comments and recommendations after reading them?
Situation number one (typical “cascade of interventions” situation):
“I went to my follow-up appointment at 37 weeks and 3 days, and my pregnancy is normal, with no particular concerns. My doctor suggested checking the state of my cervix, and I wanted to know if there had been any change. During the examination, I found it long (at least 45 seconds) and quite painful. Following the examination, my doctor told me that my cervix was 1 cm open and that he had “massaged it to help a little”. I think I’ve had a detachment of the membranes without my knowledge or consent.
Comment by Josée Laperle:
J. L.: If interventions are carried out without asking for your consent, it’s not legal. If you think you’ve had an operation, don’t hesitate to ask questions and seek clarification. Many people don’t dare, for fear of offending others or appearing “complicated”. But it’s your right to know. It’s a reflex you should develop. The fact of not knowing whether the operation took place causes a lot of questioning afterwards. CAAP works to make women aware of the importance of asking questions and asserting themselves.
Afterwards, I had irregular contractions all evening and all night, which prevented me from sleeping. The next morning, they were still going on. We decided to go to the hospital. On arrival, the examination showed that my cervix had changed very little, only 1.5 cm. So we went home, exhausted and disappointed.
I’d been told I wasn’t “really in labor”, but the contractions continued. Around 10 p.m., we went back to the hospital and, on the way, my waters broke, so we stayed there. The contractions were still every 7-8 minutes and stronger than before. At the examination, I was very disappointed, because despite the 24 hours of contractions that had just passed, my cervix was only 2 cm open… I took my courage in both hands, and went through as many contractions as I could until around 4 a.m..
After almost 48 hours without sleep, I was discouraged and asked for an epidural. It was wonderful; I was able to get some rest! However, the contractions were getting farther apart, so I was given a drug to increase my contractions. That’s when we started to worry, because my baby’s heart was often decelerating.
When I went for my check-up, the good news was that I was at 9 cm! But the doctor looked worried, because of my baby’s heart. He asked me to try and push. I did, but I couldn’t feel anything, I tried to push, but I don’t think it was effective, because the nurse was talking to me very loudly: “You’re not pushing well, you have to listen to me! If you don’t push any better than this, we’ll have to do a caesarean, your baby is tired”.
J.L.: The way the nurse addresses the mother is not acceptable and is an important element to highlight in the complaint.
So I gave it my all… at one point, my partner saw the doctor take out scissors, and the doctor cut me.
J.L.: We’re faced with a system that often informs us, rather than asking us. The person giving birth should have given her consent before the doctor performed the episiotomy.
He didn’t say anything to me, but afterwards he said he had to, that the baby had to come out. I realized later that he had given me an episiotomy…. and he took my baby out with forceps.
At the time, I was happy, because I was afraid for my baby. My baby was tired and needed help breathing during his first hour of life, so he left with my partner to be cared for while the doctor stitched me up. Oh yes, while he was stitching me up, it hurt like hell and I told the doctor, but he didn’t believe me.
J.L.: Once again, the approach here is inadequate. The person giving birth has the right to receive quality care. Not to believe her is highly unprofessional.
After all, I was having an epidural. I wasn’t supposed to be in pain! He continued to stitch me up… But 7 days later, my scar is still very sore, I have a lot of swelling, and my baby is having trouble sucking on my right breast. I wonder if all this is due to the forceps, and the episiotomy…. and the fact that we were separated for the first hour. I also wonder if my story could have been different without the stripping at the beginning, for which I was not consulted. Since the birth, my partner hasn’t been able to sleep much, and often cries when he talks about the birth. I think he was very scared. I’m not sure he’s doing very well. He’s afraid of taking the baby… and I think a lot about the whole thing. I even dream about it at night…
J.L.: Here we see the consequences of not feeling listened to: anger, worry, frustration and regret. In a complaint like this, the commissioner could make recommendations to the staff, but could also recommend that the parents be referred to a support group, a psychosocial support service.
Situation number two
“After I gave birth, I hesitated to give my baby vitamin K. I wanted someone to explain to me what the treatment consisted of and what its benefits were. I wanted someone to explain what the treatment did and how it helped. I was told right away that without it, my baby could die and that I would be responsible not to give it.
J.L.: The right to information was not respected here. The person giving birth didn’t have the space to give free and informed consent.
So I gave it away. It scared me.”
Situation number three
“When I wanted to talk about our birth wishes, at around 35 weeks, my doctor told me she didn’t need to read them, as I couldn’t control the progress of the birth anyway, and if the team made any decisions, it would be for the best. I handed her my sheet anyway and watched as she pushed it away from the file and put it in the garbage can.”
J.L: The complaint is probably not admissible here, as the wrongdoing was probably committed in an outpatient clinic. The Commissioner does not investigate complaints about situations outside hospitals/CLSCs. In this situation, a complaint to the Collège des médecins would be advisable.
Situation number four
“During the birth, which was very quick, I wanted to keep moving freely until my baby was born. The nurses asked me to lie on my back “because that’s how we do it here” and that if I wanted to give birth any other way, “I should have gone to the ‘Maison de Naissance‘”. I continued to push on all fours, because that’s how I felt comfortable and capable. Every time a new person entered the room, she would question and try to convince me to get on my back. But it hurt so much more if I put myself in a different position! I said I couldn’t do it. When the doctor arrived, she allowed me to push a little more on all fours, but told me that afterwards she’d need me to get on my back, because if she started working like that, she’d have back problems. I felt guilty, a bit whimsical. So I turned onto my back and gave birth to my baby.
J. L.: It’s an interesting situation, because although the user has the right to participate in care, the doctor can also refuse certain requests. The line between the two can sometimes be blurred. In this situation, would it be possible to find an alternative, another doctor present who would accept this request?
Authors’ note: It should be noted here that the relevant health authorities recommend that people giving birth should be able to choose the position that suits them during pushing, in order to promote physiological childbirth. This refusal by the doctor is contrary to current recommendations.
Even though my baby is healthy I feel a bit incompetent…”
Situation number five
“During childbirth, every time I had a vaginal exam, it hurt like hell. I asked to have them less often, but was told I had no choice.
J.L : That’s not true… you always have a choice, you can say no. And refusal must be respected.
I remember during one of the exams, I was screaming that I was in pain, to remove their fingers, but the person stood there and told me that it wasn’t their fingers that were hurting me, but my contractions.”
Let’s be clear: all of the above situations could be the subject of a complaint. Many are also obstetrical and gynecological violence (OGV). The Regroupement Naissances Respectées defines obstetrical and gynecological violence (OGV) as “systemic/institutional and gendered violence on the continuum of sexual violence. It is a set of gestures, words and medical acts that compromise the physical and mental integrity of women and people giving birth in a more or less severe way.”
The complaints process is an opportunity to regain power and to highlight the failings of the system so that it can change! Let’s seize it!