Category Archives: Midwives

Midwives are right to revisit received wisdom on what counts as a ‘normal’ birth

Mothers are having fewer children later. This makes them more high risk, and most sensible ones will have whatever form of delivery gives the best chance of a normal child. 

Born Free. Times leader 12th August 2017: Midwives are right to revisit received wisdom on what counts as a ‘normal’ birth

For an event so natural that none of us can avoid it, the business of childbirth has become an unfortunately ideological battleground. Since the 1960s advocates of “natural” birth have been pitted against defenders of medical intervention. The assumption, driven in part by advice from midwives, has been that a natural birth is somehow superior. In an interview with The Times today Cathy Warwick, chief executive of the Royal College of Midwives (RCM), acknowledges that her profession has got the emphasis wrong. There are great benefits to birth without interventions, but they should be pursued in a way that is sensitive to every woman’s situation, not as an article of faith.
For 12 years the RCM, midwives’ professional and representative body, has campaigned, as a matter of policy, for births where the mother enters and completes labour without medical intervention. Avoiding epidurals, forceps, artificially induced labour or a Caesarean section, the RCM argued, was better for mother and child. Yet that orthodoxy has been criticised, on two grounds. First, it can take a psychological toll on mothers. Those who ask for medical intervention because of their own anxieties or past experiences, are often left feeling as if they have failed. The RCM has sensibly decided to scale back the use of value-laden terms such as “normal birth” in favour of more neutral phrases like “physiological birth”.
The second, and more trenchant criticism of old habits is that they risk putting patients in danger. There is some evidence to support this charge. In 2015 an inquiry into a catalogue of unnecessary deaths in a Morecambe Bay hospital found that midwives’ pursuit of normal childbirth “at any cost” was, in part, behind the failures.
James Titcombe, who brought the scandal to national attention after the death of his son, has warned that the pressure for a delivery without medical intervention is rooted not in concern for patient safety, but in ideology. There have been concerns, too, about the role that midwives’ prejudices may have played in a string of deaths at Shrewsbury and Telford Trust.
None of this means that more intervention is always better, or even that it often is. There is value in a physiologically natural birth — the touch of a mother’s skin to her child’s in the moments after delivery helps to build a bond; a profusion of tubes, doctors and medical instruments does not. Caesarean sections come with well established risks. Mothers are vulnerable to the complications of any major surgery, and researchers have found some evidence that babies born this way are more likely to suffer from asthma and obesity in later life.

However, parents are well able to understand these risks and come to a considered view on what is best for them. The dangers are greatest, in any event, when interventions are emergency measures, taken after the failure of a “normal” birth. Better that midwives speak openly and neutrally about the benefits and risks of epidurals, inductions and Caesarean sections, well in advance, to avoid eleventh-hour panics.
Healthcare in Britain mostly compares favourably to that in other countries. Childbirth, however, is the exception. Britain has among the highest infant mortality rates in western Europe. That is all the more reason for midwives to eschew ideology and focus instead on what will work best for mothers and babies.

Mums, you have a 1:200 risk of stillbirth – what can you do about it?

The long term results of rationing midwives and doctors in training…

Mums, you have a 1:200 risk of stillbirth – what can you do about it?

Sorting out the figures from the office of National Statistics is not easy. Comparisons between the 4 different jurisdictions are not obvious. Different countries produce figures in different years and the speciality is changing rapidly. Concentration of specialist services has been shown to work, provided transport links are good. Even remote areas of Canada and Australia can have good figures given the right infrastructure. The latest (2013) BBC report from Wales indicates there is a lot to be done in our poorest region. (Stillbirth rate ‘unacceptably high’ in Wales say AMs) The rates for the different Welsh regions are summarised and available in real time, and show that Cardiff and Vale trust is worse than Hywel Dda. 15 babies a year die daily (The SANDS charity) in the UK. It is time to address this, and locally led midwifery units at a distance from specialist centres may not help. Deprivation and smoking go together…

So what can you do about it? Mums can stop smoking, stop alcohol, stop drugs, reduce weight if obese, eat a better diet, keep active and fit, go to antenatal classes, and meet other mums for support. Moving to a richer area would not affect an individual’s risk, but if moving meant the specialist services for a high risk pregnancy were closer this might be well worth considering… The governments job is to treat populations and the illiberal success of the anti-smoking lobby is a major gain. Going privately may increase your chances of intervention (perverse incentives) and figures for private outcomes are not available from the UK. Australian results suggest worse outcomes.. Its an option not only to make the baby on holiday, but to have it away from home..

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There is good news in the latest statistics, but the BBC announced yesterday that there was only one country worse in the EU and that was Malta. There is much to be done.. The Times leader on Stillbirths – by Janet Scott of SANDS.

Chris Smyth reports in the Times 21st June 2017: Better care during birth could have prevented hundreds of baby deaths

Three quarters of babies who die or are brain damaged during birth could have been saved with better care, a study has concluded.
Hundreds die each year because mistakes are repeated and hospitals must improve heart-rate monitoring and staff communication, the report by the Royal College of Obstetricians and Gynaecologists said…. almost one in 200 babies is born dead…

and on June 22nd: Stillbirth rates decline for the first time in a decade

Stillbirth rates have started to fall for the first time in a decade, according to figures that underline the importance of pressing hospitals to take action.

In 2015 about 250 babies survived who would have died two years earlier, figures that recorded an 8 per cent drop in stillbirth rates suggest. Experts said that the fall would have to speed up to meet a target to halve stillbirths by 2030.

There are also still big variations, with death rates a third higher in the worst-performing areas than in the best-performing.

The Royal College of Obstetricians and Gynaecologists (RCOG) said yesterday that three quarters of babies who died or were brain damaged at birth could have been saved had they received better care.

It was the latest in a series of reports and safety initiatives underscoring repeated errors in maternity units that have appeared since The Times highlighted complacency in the NHS over stillbirths in 2012. The latest figures suggest that such messages are starting to filter through, with stillbirth rates falling from 4.2 per 1,000 births in 2013 to 3.87 in 2015, according to the most authoritative academic study…

…Overall in the UK the number of stillbirths fell to 3,032 in 2015 from 3,252 the year before, but deaths before and soon after birth still vary around the country, from 5 to 6.5 per 1,000…. Disappointingly, the findings show only a small reduction in neonatal death rates.”

…Deaths within the first week of life were 1.74 per 1,000 in 2015, compared with 1.84 two years before….

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Infant Mortality and Stillbirth in the UK – Parliament UK (2014) .pdf

Infant death rate ‘lowest ever’ recorded – BBC News (best in the affluent areas, and some areas saw worse results).

It does  not help when a charity (Kicks Count) is reported in the South Wales Argus 20th June:  Baby heartbeat detectors should be banned, says pregnancy charity when they really mean for unqualified patients.

In Scotland the Herald on 15th June reported the main reason for improvement: Smoking rate in UK second lowest in Europe after 25 per cent fall …

The long term results of rationing midwives and doctors in training…

“Reducing the ratio (of maternity staff in Surrey) to balance the books is the worst of all decisions.”

Stillbirths in all different UK systems are still too high

50,000 short – not £millions but staff…. 

and now we need more despite Brexit: (Chris Smyth June 22nd – NHS in talks to recruit Indian nurses to deal with staff crisis).

Michael Safi in the Guardian 2014: Babies born in private hospitals ‘more likely’ to have health problems – The Study, which looked at 700,000 ‘low-risk’ births in NSW, suggests higher rates of medical intervention could be the cause

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The Times leader on Stillbirths – by Janet Scott of SANDS.

 

 

 

“Will all those that are not dying please go home!” Rationing hits the headlines..

Its all going the get worse….“Will all those that are not dying please go home!” Rationing hits the headlines again and again whilst denied by government.. More and more Health Service employees realise the truth and are voting with their feet. Katie Gibbons reported 2nd August – “Exodus of paramedics causes 999 crisis” and nobody cares…The Perverse Incentive to deny is evident in the fact that none of the paramedics or the midwives (see below) will get even get an exit interview, so their masters will not hear the truth.

Rob Merrick reports in the Independent firstly on 18th October: Jeremy Hunt tells NHS Bosses who are “rationing” not to make ‘easy’ choices

The Health Secretary also dropped his claim that the NHS had been given all the money it requested – admitting it was only enough to “get going” on a restructuring plan

19th October 2016: Theresa May fails to rule out possible casualty department closures in hunt for ‘efficiencies’

Challenged by Jeremy Corbyn, the Prime Minister said key decisions must be made ‘at local level’

and the Guernsey Press on the same day reports: Charity calls on Jeremy Hunt over pledge to ‘step in’ where care is rationed

A fertility charity has called on the Health Secretary to take action after he promised to “step in” where care was being rationed.

Laura Donnelly in The Telegraph on 19th October reports: NHS spending will drop per head despite ageing population and growing demand, says chief executive 

…Officials said it is unclear whether a per capita cut to the health budget has ever happened before in the NHS’ entire 68-year history….The NHS last year recorded the biggest deficit in its history, at £2.45bn, and hospitals across the country are drawing up plans to try and make services “sustainable”….

“We are looking after one million more over 75s than were were five years ago and in five years time we will be looking after another million over 75s in England and that produces massive pressure on the NHS front line.

“People working in hospitals have never been busier, people in GP practices and in the social care sector the same.”

The Health Secretary refused to be drawn on recent reports that Theresa May has said the health service will see no increase in funding, or on whether the Autumn statement will see a boost for social care.

Mr Hunt said all areas of the NHS needed to make “painful and difficult efficiency savings”. But he said this should not mean denying patients the care they needed.

“I don’t at all accept that in order to make these efficiency savings we need to reduce the quality of care for patients,” he said….

Mr Hunt pledged to intervene, if the local NHS took decisions to ration care for patients.

“When we do hear of occasions that we think are the wrong choice has been made – where an  efficiency saving has been proposed that we think would impact negatively on care – then we step in,” he said.

He said improvements in safety and quality of care would save the NHS money, in the long run.

“If you get an infection when you are having a hip replaced that will cost theNHS £100,000 to sort out as well as being incredibly painful and horrible and for the patient concerned,” he said.

Improvements in cancer care would save NHS funds, as well as lives, he suggested.  “We know its two to three times cheaper to catch cancer at stage one rather than stage three or four,” he told the select committee.

Guernsey Press: Government to step in if local NHS chiefs make ‘wrong choices’ over care

The Government will step in when it thinks local NHS leaders have made the “wrong choices” about care being rationed in the health service, the Health Secretary has warned.

The Times reports 19th October: Midwives quit over dangerous work conditions and Kate Gibbons reports that “A third of ambulances miss emergency response targets”

Civil Unrest starts in Enfield? This site began life on 15th October 2016: Defend Enfield NHS – Their strap line is “Will all those that are not dying please go home!” 

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The long term results of rationing midwives and doctors in training…

Two items in the news today (Sunday Times – Sarah Kate-Templeton 15th October 2016) reveal the long term results of rationing midwives and doctors in training. When you control the supply side completely, and have many years notice to plan, this is irresponsible government. It represents a collusion of denial. Market forces are giving the government a problem, but they control the market..

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NHS breaches (forced to bust) pay cap for locum doctors

NHS hospitals have had to pay up to £155 an hour for doctors despite a cap introduced last year on the amount trusts could spend on agency locums.

One hospital in the north of England paid more than £10,000 a week for three locum agency doctors. Two locum agency doctors between them racked up more than 4,400 hours over a year, which equates to them each working more than eight hours every weekday.

This weekend NHS Improvement, the hospitals regulator, warned that while the government cap had succeeded in reducing the amount the NHS spent on agency nurses, trusts were still overriding the limits, sometimes paying double the permitted agency rates…..

Last year the NHS spent more than £72m on agency, overtime and bank midwives, according to a report by the Royal College of Midwives (RCM). The RCM says that, for the same cost, 3,318 full-time midwives could have been employed.

The report found that, in December 2015, NHS hospitals spent an average of £50.58 an hour on agency midwives….

Mothers face 30-mile trips to give birth

Hundreds of mothers booked into their local maternity units have had to give birth in towns more than 30 miles away because the hospital closest to them had temporarily closed.

The maternity units were either full or too short-staffed to admit the women. During one closure of maternity units at Cambridge University Hospitals NHS Trust, which lasted for 3½ days, 22 women due to give birth in the city had to have their babies in a range of towns including Norwich, Ipswich, Bedford and Harlow, Essex.

In Chester, women due to give birth had to travel to hospitals up to 32 miles away in north Wales.

The Royal College of Midwives will highlight the problem at its annual conference this week.

Jon Skewes, a director of the royal college, said: “Senior midwives are telling us that they are having to close units because of staffing shortages and the increasing demands on the services that often simply do not have the resource to cope.”….

“Reducing the ratio (of maternity staff in Surrey) to balance the books is the worst of all decisions.”

If Trust Boards and Directors are to be pilloried or dismissed for falling standards, then they have no option other than to close down services. The choice between quality and cost is no longer allowed, (By CQC or patients) so rationing has to increase… So lets make it ethical and explicit. The real risk in continuing denial of the need to ration, is that when it comes, it will be a knee-jerk co-payment system, across an NHS Region, and unfair to the poorest and most diabled.

Kate Gibbons in The Times reported 13 days ago: NHS cuts threaten hospital closures

James Watkins in GetSurrey reports  20th August: Royal Surrey plan to cut midwife numbers amid growing tensions over financial crisis 

and on 23rd August the BBC news reports: Debt-hit Royal Surrey hospital cuts maternity staffing

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Several midwife vacancies are to be left unfilled at a major hospital that is trying to save £22m.

The Royal Surrey County hospital in Guildford has warned of “some very difficult decisions and changes to working practice”.

It is cutting its midwife-to-mother ratio but insisted “patient safety, standards and care will not be affected”.

A former NHS trust chairman Roy Lilley said it “was a very bad idea”.

“They are sailing very close to the wind by reducing staffing levels. Unfortunately, finding extra midwives (when you need them) is very difficult, you have to resort to emergency agency arrangements which cost the earth or you simply do not get them.

“Reducing the ratio to balance the books is the worst of all decisions.”

The hospital trust said under the ratio, there would be one midwife per 30 mothers, rather than 29.

Retired NHS midwife Val Clarke, from Epsom, said: “It is very worrying. This can only impact on the mothers. When you are very busy, you are unable to give the level of care to each mother that they should be receiving.”

In a statement, Royal Surrey said: “The safety of our patients is our primary concern and as such we measure our midwife acuity levels on a daily basis.”

The trust said the ratio change was “not driven” by its need to make savings, but came from a “normal monthly process” of reviewing nursing and midwifery numbers.

But it also warned: “This year, the trust needs to save over £22m, which means… making some very difficult decisions and changes to working practice.”

Local hospital campaigner Karin Peluso told BBC Surrey: “If this continues at the Royal Surrey and they start slashing at the frontline services, key personnel like midwives, then the hospital could be on a very slippery slope.”

In April, regulator NHS Improvement began an inquiry after the trust recorded an annual deficit of £11m.

It said the trust has since agreed to develop long and short term plans to improve its finances “without impacting on patient care”.

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Stillbirths in all different UK systems are still too high

Holland seems to be developing a less unequal society than the UK and Great Britain. It’s unified and (Rationing and models) overtly rationed health care system may be part of the reason. With 4 different health systems, all independent, and based on different ideologies and therefore priorities we cannot expect much change. The power of a universal and unified mutual is evident in the Dutch Medical system. One of the biggest problems in the UK is that political boundaries are not coincident with Health trust / CCG boundaries. In rural areas especially, this tempts MPs (and WAMs in Wales) to side with the protesters against change(s), which they interpret as threatening. In my case they speak for “little Pembrokeshire” rather than the “big Hywel Dda trust“. The utilitarian approach needed, and endorsed by Trust Boards, is therefore undermined. Planning for longer term and with less conflict should be possible with fewer political representatives who represent CCG areas, and a Proportional Representation system of government.

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Senay Boztas and Bojan Pancevski in the Sunday Times 7th Feb 2016 report: Dutch slash death rate as UK lags behind

Holland has achieved a dramatic reduction in its stillbirth rate by putting women at the centre of 24-hour-a-day maternity care.

According to a report published by The Lancet last month, there has been an average annual fall in stillbirths of 6.8% in Holland since 2000, compared with 1.4% in Britain.

With a stillbirth rate of 1.8 per 1,000 births in 2015, Holland is ranked third best in the world. The UK is 21st with a rate of 2.9.

Yet in 2000 the stillbirth rate in Holland was 5.3. It was only after a steering group was set up to look at the problem in 2008 that the tide was turned.

The subsequent report, A Good Beginning, demanded seven changes: putting mother and baby “in the starring role”, noting that “healthy old age begins in the womb”, ensuring a well informed pregnancy, joint responsibility across healthcare bodies, extra help for vulnerable women, avoiding women giving birth alone and 24-hour availability for urgent care within 15 minutes.

Jan Jaap Erwich, professor of obstetrics at the University Medical Centre in Groningen, set up a national audit programme in 2010 where every stillbirth was analysed so lessons could be learnt.

“We ensured better working together, with lower thresholds for midwives discussing patients with hospitals and making better paths of care for individuals,” said Erwich, who suggested Britain could benefit from more ultrasound machines.

Karlijn van Driel, of the KNOV Dutch midwives’ association, said: “In the past 15 years a lot has happened. There’s lots of attention given to women in vulnerable situations, attention to lifestyle factors such as stopping smoking, good measurement to see whether babies are growing enough and midwives and obstetricians now work intensively together.”

The success of Croatia, ranked fifth in The Lancet study, is attributed to a well integrated four-tier healthcare system combining local and regional care.

Dr Milan Stanojevic, a neonatology specialist in Zagreb, said: “We have relatively cheap but well organised perinatal healthcare. More than 95% of women in Croatia make more than eight visits to their gynaecologists during pregnancy . . . Every year we also analyse and evaluate trends in perinatal mortality so that we can respond more effectively.”

Even the Kings Fund want us the “Think about Rationing”.

The democratic deficit. Applies to health as well as devolution, and to leaving the EU. The first honest party should get public support.

Join the Liberal Democrats now. Change the future for the UK Health Systems!

 

 

50,000 short – not £millions but staff….

Covert rationing of places in training for Medics, Nurses and others has come home to roost. It is too late for this next decade. We need to plan for the next one, and to avoid the same continuing mistakes.

The times reports today 5th Feb 2016 the end of Chris Smyth’s article on “ditching reforms” ….

The NHS has failed to plan its workforce effectively ( Productivity in NHS hospitals ), with a shortfall of 50,000 clinical staff, the National Audit Office has warned. A report from the spending watchdog also said government plans to cap agency staff rates to get soaring temp costs under control, were unlikely to work.

Sophie Borland for the Mail reports: Report warns the NHS is short of 50,000 doctors, nurses and other staff – written by Lord Carter, a Labour Peer, this is critical of manpower planning, but who was in office 15 years ago, when the missing staff should have been offered places at Medical Schools? Labour. The FT – Carter report paints grim picture of NHS – FT.com

Getwestlondon reports 7th Jan 2016:West London NHS trusts facing up to 30% nursing staff shortage

Stroud Life14 Jan 2016 Staff shortage forces NHS chiefs to close Stroud Hospital department