Xinyu Addae-Lee | Maternity care under the radar

Reports in the Jamaica Observer some time ago have once again placed maternity care under public scrutiny — from the tragic death of a newborn at Cornwall Regional Hospital to accounts of a difficult start to parenthood involving neonatal intensive care admission. These stories are not just headlines. They reflect deeply personal experiences where families are often left trying to piece together what happened, why it happened, and whether anything could have been done differently.

In many of these situations, a recurring issue emerges, patients feel that something went wrong and the hospital claims that all went according to acceptable practices. There is an obvious disconnect between what patients and families recall and what is recorded in the hospital’s official notes. In medico-legal practice, this gap can determine the outcome of an entire case. Quite simply, what is documented often carries more weight than what is remembered.

For that reason, patients — particularly those navigating labour and delivery — must begin to see themselves not as passive recipients of care but as active participants in the process. Documentation is not about distrust. It is about clarity, accountability, and ultimately, protection.

One of the most effective ways to do this is by keeping a real-time account of events. Labour can be unpredictable and often overwhelming, but even brief notes — whether written or recorded on a phone — can create a powerful timeline. Recording when you arrived at the hospital, when you were first assessed, when pain escalated can later help establish whether there were delays in care or missed opportunities for intervention. Time, in obstetrics, is often everything. In other words, should it come to it, let your record stand against theirs.

Equally important is identifying who is providing your care. Hospitals operate on rotating shifts, and patients may be seen by multiple doctors, nurses, and midwives over a short period. Taking the time to ask for names and roles may feel uncomfortable in the moment, but it is essential. Accountability in healthcare is not abstractIt is tied to individuals making decisions at specific points in time. Without names, it becomes far more difficult to establish responsibility if questions later arise. It can't be based on you feeling something went wrong. We need to identify who went wrong, when, and how.

As such, it is vital to document medications and interventions. Patients are frequently given drips, injections, or tablets without fully understanding what they are or why they are being administered. Simply noting the time a medication was given and what you were told about its purpose can later provide critical insight, particularly in cases involving labour induction, pain management, or complications such as pre-eclampsia. Similarly, keeping track of investigations — whether CTG monitoring, blood tests, or ultrasounds — and what you were told about the results can be invaluable, especially if there are discrepancies between verbal reassurances and documented findings.

Perhaps the most important — and often overlooked — area of documentation is recording requests for help and how those requests were handled. Many obstetric negligence cases hinge not on rare or complex conditions but on failures to respond appropriately to warning signs. If a patient reports reduced foetal movement, worsening pain, or a sense that “something is not right,” and that concern is dismissed or delayed, documenting that interaction can become pivotal. This article will not discuss how often women are ignored, especially in the absence of a labour partner. You can read the previously published article titled " You want babies, give women a better birthing experience."

Despite the importance of this kind of engagement, many patients hesitate. There is a natural tendency to avoid appearing “difficult” or confrontational, particularly in a hospital setting where patients may already feel vulnerable. Asking repeated questions, writing things down, or requesting clarification can feel uncomfortable, as though it might irritate staff or affect the quality of care received. However, the evidence suggests the opposite.

Research has consistently shown that active patient engagement improves healthcare outcomes. Patients who are more engaged — those who ask questions, seek to understand their care, and participate in decision-making — experience better health outcomes and safer care overall. Similarly, The World Health Organization has emphasised that patient involvement is a key component of patient safety, noting that informed and engaged patients help reduce medical errors and improve system accountability.

In addition to personal notes, patients can also use their phones strategically. A quick voice note after an interaction, a message to a partner describing what just happened, or even a time-stamped text expressing concern can later serve as contemporaneous evidence. Having a partner or family member present who can observe, ask questions, and document events is also invaluable, particularly during active labour when the patient may not be in a position to do so.

If, at any point, concerns arise about the quality of care received, request your medical records — commonly referred to as the docket — immediately. This should be done as soon as suspicion arises or before leaving the hospital where possible. There is a long-standing perception in Jamaica that records in contentious cases may become incomplete or difficult to access over time. While this is not universally true, the safest approach is to make an early request, thereby avoiding any potential misplacement of those records later.

It is deeply tragic to lose a loved one or to suffer because of someone else's negligence or recklessness. Being active, alert, informed about the process, documenting what happens, asking questions, are  acts of self-advocacy that may just save your life and the life of your loved one, and in the unfortunate event that something goes wrong, requesting records early and keeping your records safe will stand as an incredible resource to help bring closure to your misfortune.

Dr Xinyu Addae-Lee is a medical doctor and attorney-at-law. Send feedback to reply@consultthedoc.com and columns@gleanerjm.com.