The Midwife crisis. Deliver your own? It is politicians who should be investigated by the police…

There are certain entry requirements to be a midwife. Normally this would be five GCSEs at grade C or above – typically including English language or literature and a science subject – and either two or three A-levels or equivalent. (Health Careers) Midwives can be scapegoated as they are easy to find fault with when there is a disaster, but it is the management, training and the funding which is often really to blame. Deliberately rationing by undercapacity and underinvestment is similar to the way politicians have treated GPs and other parts of the system. It is politicians, not midwives, who should be investigated by the police… In the stampede to downsize staffing we might be asked to deliver our own next..

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Cathy Warwick warned in the Telegraph on 7th Feb 2017: The challenges facing midwifery are immense. No wonder we have a crisis on our hands  and in 2015: Britain’s older midwives are a ticking timebomb that needs defusing – fast

A new report has found that Britain’s ageing midwives are struggling to cope with a rise in births among women over 40. Royal College of Midwives chief Cathy Warwick explains why mums deserve so much better

In numbers | Problems in childbirth

1,1000

The number of maternity claims lodged in England in 2015. A new Rapid Resolution and Redress scheme will investigate complaints and aim to cut settlement time

£509.3m

The amount spent last year by the NHS on resolving legal disputes after mistakes by maternity staff.

4.5 per 1,000 births

The stillbirth rate in England and Wales – one of the worst records in the developed world

37 per cent

The proportion of maternity services deemed “inadequate” or requiring improvement by a Care Quality Commission report

£250,000

The amount pledged towards a pilot aimed at creating new ideas for improving maternity care

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Aaron Leaman in New Zealand reports a similar problem16th May 2017: Stagnant pay and heavy workloads blamed for brewing midwife shortage 

Laura Donelly reports in the Telegraph 26th June 2016: Midwife sacked over new Morecambe Bay death

and now the BBC reports 18th May 2017: Chester hospital baby deaths to be investigated by police and on 20th May 2017: Exclusive: Baby deaths linked to lack of basic midwife training 

Babies are dying and being put at risk of major brain injury because it is “commonplace” for British midwives to qualify without training in use of basic equipment, a senior coroner has warned.

The regulator for midwives has been told to reform the sylllabus for all trainees after a string of deaths of newborns following monitoring failures.

Hospital trusts have been advised to stop recruiting newly qualified midwives until they can prove they can perform foetal heart monitoring.

And every university has been asked to include such training in all midwifery degrees – instead of relying on midwives to go on “E-learning” courses after they qualify.

The action follows a steep rise in compensation claims against the NHS for catastrophic blunders in childbirth.

The number of claims for brain damage and cerebral palsy has tripled in a decade, amid widespread monitoring failures.

The recommendations have emerged following an inquest into the death of baby Billy Willson, who was three days old when he died, after being starved of oxygen at birth.

Even though his mother was identified as a high risk pregancy, midwives failed to spot an abnormality, instead administering drugs which caused the baby to suffer stress and oxygen deprivation.

A newly qualified midwife on her first night shift at Pinderfields Hospital, West Yorkshire, failed to recognise “pathological” signs on the monitor, continuing to increase the dose of drugs which should have been stopped.

The baby was rescuscitated at birth but survived just three days in intensive care, before his death in November 2013.

In evidence to the inquest, the midwife said she had not received appropriate instruction or training in how to interpret monitor readings, during her Midwifery Course at Bradford University and had not finished an “E-learning” programme on the subject.

An expert witness told the inquest that it was “commonplace” for student midwives to qualify without undergoing the essential training.

West Yorkshire coroner David Hinchcliff has now asked Nursing and Midwifery Council (NMC) to take a series of urgent steps to prevent future deaths.

In a second report he warned that “many” inquests have revealed that midwives and doctors lack “core skills” to intepret the monitors.

The regulator  – which has been repeatedly criticised for slow action over a series of maternity scandals – was given a deadline to draw up a plan of action by last week.

Last night the NMC said it had responded to the coroner, and begun “a wholesale review” of the standards student midwives need to reach to become qualified.

spokesman said this would consider the concerns raised about the consistency of training in interpretation of foetal heart monitoring.

In February, the same coroner raised concerns after the death of a baby boy, Maxim Karpovich, in similar circumstances, in March 2015.

He has also written to the heads of the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists callling for action, after midwives and a junior doctor at Leeds General Infirmary failed to detect abormal readings.

Last night Lesley Regan, President of the Royal College of Obstetricians and Gynaecologists, said she shared the coroner’s concerns.

She said: “We have undertaken a full review of our guidance, training programmes and other resources, and are committed to working in collaboration with the Royal College of Midwives to help improve team working in maternity units across the UK.”

Allegations of similar blunders are at the heart of an investigation into the deaths of 15 babies and three mothers at Shrewsbury and Telford NHS trust.

Failures to properly check babies’ heart rates are a factor in at least five of the deaths, prompting the local coroner to write to the trust.

Mothers said their children had died because midwives “couldn’t be bothered” to fulfil basic monitoring tasks, or to act on warnings that babies were in danger.

The concerns come as the NHS attempts to encourage more women to opt for midwife-led care, instead of on traditional labour wards staffed by doctors. Since 2004/5, the value of claims against NHS maternity units for brain damage and cerebral palsy has risen from £354m to £990m, official figures show.

The cases – often linked with a failure to monitor babies’ heart rates, to detect risks of oxygen starvation – fuelled maternity negligence claims of more than £1.2bn in 2015/16.

In total, almost 1,100 maternity claims were lodged, official figures show.

The most expensive involve cases of brain damage and cerebral palsy, where round-the-clock support is often required for life.

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This entry was posted in A Personal View, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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