Valerie Gommon Midwife’s Blog

Archive for the ‘NHS’ Category

It has been a hard week for Milton Keynes Maternity Unit and for midwifery in general.

Milton Keynes has been severely criticised for staffing shortages which may have led to the death of a baby earlier this year; the Albany Midwifery Practice has been suspended and a midwife hung herself after a baby died.  Tragic.

I trained at Milton Keynes General and I know the staff do a fantastic job under very difficult circumstances – it is obvious that staffing is an issue and this is one of the reasons I left the NHS to work in Independent Practice – I just wanted to be able to give a better standard of care to clients and to give continuity so that women know the midwife who will deliver their baby.  I feel so very sad for the woman and the staff involved.  My only hope is that the service will be better funded as a result, but in the meantime local women will be frightened and this is sad.

Most women will receive safe care in Milton Keynes and from the NHS – the NHS is excellent at delivering acute or emergency care – but what they probably won’t receive is the extra TLC to make the experience special – that is down to the individual midwife and luck depending upon how busy the Unit is.

The excellent Albany Practice in London, which has for many years provided amazing NHS care, has also been closed.  There is a campaign to save it at www.savethealbany.org.uk.

Independent Midwifery is always under threat as the Government insist we must get Professional Indemnity Insurance despite it not being commercially available.  Go to www.kentmidwiferypractice.net to support our campaign.

Midwifery in this country is severely under threat – we must fight to keep midwifery alive!

Sadly a midwife took her own life when a baby she had cared for died.  She mistakenly thought that she was to blame.  How desperately sad that midwives feel so afraid.  We do a difficult job and some babies will die no matter how hard we try to save them.  Midwives, in general, do the job because they care – the vast majority will do their very best for the clients they care for – we need to be supported, not witch hunted and blamed.

I can be contacted at www.3shiresmidwife.co.uk / info@3shiresmidwife.co.uk

From next year the Government has pledged that all women will be offered a choice of where to give birth including at home but so far only half of women are reporting that they were offered a home birth.

A recent survey carried out by www.netmums.com revealed that as many as one-third of all women in NHS hospitals are left alone and worried during, or shortly after childbirth and more than 30 per cent of mums polled received no NHS antenatal classes and 43 per cent did not have access to a midwife on a postnatal ward.

Women who participated in the poll were also very critical of postnatal care, including support offered for breast-feeding, this is despite the fact that the Government is now putting huge investment into improving breastfeeding rates; some women also mentioned that they felt the lack of care had led to postnatal depression.

Cathy Warwick, General Secretary of the Royal College of Midwives (RCM) said maternity services in England are at a critical point; she said that progress was being made. but went on to say that the target to give women a choice of where to give birth looked like it would be missed.  Warwick said surveys suggested full choice was only offered in about 50% of cases.  She also said services were also struggling to cope with the rising birth rate  which has jumped by 20% since 2001.

The RCM say that staffing numbers have increased, but by less than 10%, leaving the health service short of 5,000; they also highlighted that student midwives are finding it difficult to gain employment.

Q.A client of mine has developed a fever due to clogged milk glands (she gave birth 2 weeks ago). She is finding breast-feeding very painful and is concerned about infections.

A.Is it breast that is sore, not nipple area?  If it is the breast, perhaps a red, hot area it sounds like the beginning of mastitis.  It is very important that the woman ensure that her breast is not restricted by clothing or a tight bra, or by squashing her breast as she feeds.

The most important thing is to KEEP feeding.  If necessary perhaps start a couple of feeds on that breast to try to drain the excess milk (but be mindful that the other breast doesn’t become blocked too).  She may develop a fever and flu like symptoms – this can all be managed by just resting and breastfeeding (if caught early).  I suggest she take to bed, be naked with her baby and just rest and feed.  Paracetamol can be taken, as can homeopathy (refer to homoeopath).

Other suggestions are to go into the bath, placing hot flannels on the sore area and to gently massage the breast towards the nipple area to encourage the milk to flow out.  When out of the bath cold compresses can help to relieve the pain.  Some women use quark or cream cheese in a muslin on their breasts.  Also try not to touch the breast (apart from if expressing/feeding) as this encourages the breasts to make more milk.

If the infection really takes hold I suggest she consult a homoeopath/doctor and antibiotics are usually prescribed (if this happens she can still breastfeed).  I had this myself, got the flu symptoms, but managed to stave off full blown mastitis – so it can be done.

If it is the nipple area it is probably more about the position of the baby – she will need to look at this again, or get help – getting the baby to have a big wide open mouth prior to attaching.  For further information I suggest you look at www.breastfeeding.nhs.uk www.nct.org.uk www.laleche.org.uk or www.abm.me.uk

Doulas

Posted on: August 9, 2009

Yesterday someone asked me for my opinion on Doulas, so here goes.

 www.doula.org.uk defines a doula as:

“Doula” (pronounced “doola”) is a Greek word meaning “woman servant or caregiver”. It now refers to an experienced woman who offers emotional and practical support to a woman (or couple) before, during and after childbirth. A doula believes in “mothering the mother” – enabling a woman to have the most satisfying and empowered time that she can during pregnancy, birth and the early days as a new mum. This type of support also helps the whole family to relax and enjoy the experience.

It is tricky to define my feelings about Doulas.  I guess I actually started out as a doula, as I attended the births of several friends in the context of being a birth supporter (although the term doula was not in common usage then). I absolutely feel that the best person to support a labouring woman is another woman who has given birth herself (that said I have met some excellent male midwives … hello Mark and Kevin and I also know some fantastic midwives who haven’t had children themselves). My personal experience with doulas is limited, but has generally been positive – as a midwife I am always happy that a woman is supported by those she feels comfortable with and indeed it can be very helpful to me, however I am also aware that some midwives have had negative experiences of doulas who perhaps have been in conflict with the midwife (and I am sure that some midwives may view doulas less favourably than me).

I find myself slightly uncomfortable with the doulas role partly I guess because I feel that if midwives are doing a good job the midwife would be supporting her client; but also I am concerned that we may be using “untrained” support i.e. doulas or maternity care assistants in place of midwives and this may not be appropriate.  I am increasingly hearing that the role of maternity care assistants (MCAs) is being extended – again, this evokes completely mixed feelings as I know MCAs can be excellent and they should not attempt anything that they have not been trained for, but they are not midwives and have not taken a three year training course.  Are they being used as cheap labour?  Will they miss vital signs and symptoms because of their lack of training?  I don’t know.

There are many positives to employing a doula, for example they will help with domestic duties for example cooking, shopping etc and this may well be beneficial, they are certainly cheaper than hiring an Independent Midwife like myself but their role is different.  For a woman planning a NHS hospital birth where the midwife may well also be caring for other clients it is a way of ensuring that the woman is not left alone and this will be supportive for the woman and her partner.

So I guess my jury is out on this one – I guess it is down to your personal circumstances.

Last week nurse Margaret Haywood was struck of the nurses register by the Nursing and Midwifery Council (NMC) -the professional body for nurses and midwives in the UK.

Between December 2004 and May 2005 Ms Haywood worked as a bank nurse on on Peel and Stewart ward at the Royal Sussex County Hospital in Brighton during this time she kept a diary and undertook secret filming on behalf on the BBC television programme Panorama and a documentary was screened in July 2005.

Ms Haywood, a nurse with 20 years experience, was accused and found guilty of:

(i) Raising concerns about patient care in the BBC Panorama documentary “Under Cover Nurse” when you should have reported the concerns in accordance with Trust policy;

(ii) Breaching patient confidentiality.

The actions of the NMC have caused strong reactions, the union Unite accused the NMC of being ‘heavy handed’ in its treatment of Ms Haywood.

Karen Reay, Unite’s officer for health, said: ‘We can’t have a culture where ‘whistle blowers’ feel intimated into not legitimately reporting wrong doing and bad practice in the NHS. We need a safe environment for ‘whistle blowers’ who feel that they can complain without losing their livelihood.

‘There appears to be a number of extenuating circumstances in the case of Margaret Haywood and the NMC could have imposed a lesser punishment than that of being struck off.’

‘The NMC exists as a regulatory body to protect patients and clients first and foremost, and not the alleged failings of members of the nursing profession in caring for the elderly.’

Ms Haywood admitted breaching patient confidentiality, but said that she had agreed to film undercover inside the Royal Sussex Hospital in Brighton to highlight the awful conditions on the wards.

The programme’s producer Elizabeth Bloor had told the tribunal that “there was an over-arching public interest” in the footage being broadcast.  At the time of the filming the hospital had serious problems with the lowest “star” rating, an £8 million deficit and was receiving complaints about the standards of care given.

After the Panorama programme concerns about standards of care were raised in the House of Commons after the programme and Sussex University Hospitals NHS Trust issued a public apology admitting “serious lapses in the quality of care”.

The actions of the NMC appear to raise questions for NHS staff about how they are able to expose inadequacies in our healthcare system, particularly as Ms Haywood indicated that she had attempted to discuss concerns with her manager with little effect.

www.timesonline.co.uk/tol/life_and_style/health/article6106326.ece

www.nursingtimes.net/nmc-defends-decision-to-strike-off-undercover-nurse-margaret-haywood/5000608.article

I have just learnt that the Royal College of Nursing (RCN) www.rcn.org.uk and an organisation called CAUSE (Campaign Against Unnecessary Suspensions and Exclusions in the NHS (UK)) www.suspension-nhs are fully supporting Ms Haywood stating that a “grave miscarriage of justice” has taken place.  There is also a petition in support of Ms Haywood at www.gopetition.com/online/27030.html

Well what a surprise, new research “Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births” http://www.rcog.org.uk/news/bjog-release-new-figures-safety-home-births has found that homebirth is safe for low-risk women.  These findings echo the work of Marjorie Tew way back in 1986 British Journal Obstet Gynaecol 1986 Jul;93(7):659-74

This large scale research from the Netherlands – which has a high rate of home births – found no difference in death rates of either mothers or babies in 530,000 births.

Low-risk women in the study were defined as those who had no known complications – such as a baby in breech or one with a congenital abnormality, or a previous caesarean section; additionally the researchers noted the importance of both highly-trained midwives who knew when to refer a home birth to hospital as well as rapid transportation.

I wholeheartedly support the initiative of the Dutch midwives, and also that of the Albany midwives (based in Peckham, South London) http://www.albanymidwives.org.uk – midwives attend a woman at home in labour and together they decide whether to stay at home or transfer to hospital.  If all is well many mothers opt to labour and give birth at home, but if she prefers to transfer her midwife will accompany her into hospital.

In my Independent Midwifery Practice www.3shiresmidwife.co.uk this is pretty much what happens.  Mothers often plan a homebirth, but know that they can transfer at any point if they wish, conversely if they plan a hospital birth and change their mind I will care for them at home.  Indeed many of my clients would not be considered “low-risk” but these women believe that by staying at home they are more likely to give birth without interference.

The number of mothers giving birth at home in the UK has been rising since it reached a low in 1988; currently only 2.7% of births occur at home in England and Wales.  Our government has pledged to give all women the option of a home birth by the end of this year. At present just 2.7% of births in England and Wales take place at home, but there are considerable regional variations – so we have a huge way to go in achieving this.

Louise Silverton, deputy general secretary of the Royal College of Midwives, said, the study was “a major step forward in showing that home is as safe as hospital, for low risk women giving birth when support services are in place, but she also acknowledged that ” the NHS is simply not set up to meet the potential demand for home births”, she went on to say that there needs to be a major increase in the number of midwives.  My experience fully supports this fact, sadly I am regularly hearing of women being denied a homebirth on the grounds of inadequate staffing – this is outrageous and women need to be campaigning and lobbying for better maternity services (www.aims.org.uk; www.onemotheronemidwife.org.uk; www.kentmidwiferypractice.net)

Further reading

www.nhs.uk/news/2009/04April/Pages/HomeBirthSafe.aspx
http://news.bbc.co.uk/go/pr/fr/-/1/hi/health/7998417.stm
www.independent.co.uk/opinion/commentators/annalisa-barbieri-i-gave-birth-at-home-ndash-and-heres-why-1669309.html

Teenage pregnancy is something that I have already written about, see my blog on 1st January https://midwifevalerie.wordpress.com/page/3/

Tonight the subject was re-visited by Channel 4 in the programme The Hospital www.channel4.com/programmes/the-hospital/episode-guide/series-1/episode-2 the programme claimed to explore the cost of teenage mothers to an already stretched health service.

The programme states that 46,000 pregnant teens registered in the UK last year – the highest number in Europe – and questioning whether young people fail to take responsibility for their own health; and asks can the NHS afford to maintain its founding principle of free healthcare at the point of delivery?  The programme was filmed at City Hospital in Birmingham where 10 new pregnant teenage girls register at the maternity unit each week.

Whilst fully acknowledging the difficulties faced by both staff and these young women the programme really raised the question of “informed consent” for me.  Whilst it was true that one of the young women did get her wish to have a general anaesthetic for her caesarean (against medical advice) I was left feeling that these young women were short changed when for example the staff told the young women “we are going to do induce you with a tablet”.  I appreciate that the film may have been edited but it did leave me with the feeling that these women were not active partners in their care.

Of course, for me as an Independent Midwife and having the luxury of additional time it is easy to be critical of an NHS system which is stretched to the limits, but it did strike me as a missed opportunity to involve the young women in the decision making.  I also felt that there were some sweeping statements, for example although many of these women were at increased risks during their pregnancy, I do not believe that age alone is a risk factor.  Many young women will have healthy pregnancies and will progress to have normal births – I believe that late teens/early twenties can be a physically good time to have a baby providing that the couple are emotionally and financially ready.


Twitter