Higher infant mortality in out-of -hours births

[foreverastudent]

www.bbc.co.uk/news/health-10631092

I thought that staffing and facilities were the same day and night. Considering most spontaneous labours hapen at night it's totally unacceptable that these babies are not receiving the care they should be.

[StealthPolarBear]

yes, there are only 40 'working hours' in the week and 128 OOH, so if that is the case, that's dreadful.
Not sure what to think about this tbh

[EccentricaGallumbits]

doesn't surprise me at all.

as with the whole NHS the treatment you get depends on the time of day. there are always less, more inexperienced, more knackered staff around atnight and weekends. scanners are often not used out of hours. theatre and surgery teams are at minimum levels.

and never, ever get ill in august.

[bumpsoon]

echoing the august thing , i cannot honestly believe that this is news though , disgusting though it is

[foreverastudent]

To a certain extent I have to disagree with "always less, more inexperienced, more knackered staff around atnight and weekends."

My Mum was the nightshift matron of the labour ward of a medium sized maternity hospital. If anything there were more midwives on at night because there are more births then. The nightshift midwives were certainly not less experienced than the dayshift ones. My Mum slept during the day when she was on nights so I don't think she was any more knackered than the day staff.

It's different for the OBs, though because they work 36 hour on-call shifts.

[ISNT]

I think it's the doctors and that are not around so much out of hours foreverastudent? If these babies are dying then things are obviously not going according to plan, and I imagine that further medical help is being delayed due to having to bleep people/waiting for them to get there/less staff generally being spread around the place.

That was what I assumed when I heard this report anyway.

[TheJollyPirate]

I think this has always been the case. I remember one woman and her husband haranging the hospital and medical staff because they declined to induce her at night when her waters broke (the next morning was horrendously busy so her induction was delayed). She just could not grasp that Induction = higher risk and that night time = less staff to monitor her and her precious baby. Had they bowed to her wishes and induced and the baby died due to short staffing she would have been the first one ranting and raving. Funnily enough I suspect she would have had NO trouble grasping the basics then.

It has always been the case that night time/weekends = less staff.

[traceybath]

There was a feature on this subject on woman's hour recently.

The main problem I recall was the lack of consultants around out of hours.

It seems that their contracts need to be re-done to ensure that they do out of hours but they need to be paid more to do that so it boils down to money.

[expatinscotland]

'as with the whole NHS the treatment you get depends on the time of day. there are always less, more inexperienced, more knackered staff around atnight and weekends. scanners are often not used out of hours. theatre and surgery teams are at minimum levels.'

Yep. True at A&E as well. Lord knows how many die then because consultants paid 6 figures don't want to do weekends and evenings even though they signed up to be doctors, not exactly 9-5 stuff.

[traceybath]

Oh I so agree Expat - I'd like to know about many other jobs where you get paid 6 figures and don't do a considerable amount of overtime.

[pipsy76]

Have I read that article right, it basically states elective c section is much safer for babies than vaginal birth? Or am I missing something?

[Strix]

"The team adjusted for a wide range of factors and excluded babies born via planned caesarean, who are usually delivered during the day.

The team argued that as the risk of death for these babies was so much lower than for those born vaginally, their inclusion could overstate the risks of out-of-hours birth."

So then... did I really just read that... has the NHS just admitted that a planned caesarean is safer then a vaginal birth?

Now THAT was interesting.

And now that we know that out of hours understaffing puts babies at even more risk (although I think most of us already knew that) does it not further support the argument by saying that the way to avoid an out of hours birth is to have a planned caesarean.

[Strix]

I see pipsy beat me to the "post" button.

[MollieO]

I had ds on a Sunday evening. 7 weeks early and born poorly. Fortunately plenty of nurses and doctors around to take care of him. I suppose it depends where you are.

[ISNT]

Maybe planned CS safer for the baby but less safe for the mother?

I know when I had my 2nd CS which was an elective, the risk to the baby of vaginal birth was higher than for the elective. Still even though one was higher risk, the actual risk of both was very low IYSWIM

[DaisySteiner]

They were looking at deaths due to lack of oxygen. Babies born by elective LSCS do indeed have a very low incidence of death due to this particular cause so were excluded from the study.

[Strix]

It doesn't say that they were looking at babies who dies from lack of oxygen. It just comments that most who did die died from lack of oxygen.

[frasersmummy]

It may not be news bumpsoon

But as a mother of a stillborn son I think anything that highlights infant mortality in this country is a good thing.

It doesnt get talked about enough in my opinion

[Lavitabella]

I am having identical twins and have been told by my consultant that I will have an elected (by them) caesarean.
As it's a higher risk pregnancy they basically need to make sure a consultant is there and with a natural birth you can't guarantee when you will go into labour, so there might not be a consultant around .
I just want 2 healthy babies and am happy to go down the best route for that.

To be honest the amount of time I've waited around in the hospital for antenatal appointments in working hours (2 hours every time) is shocking so can only imagine what it's like the rest of the time!

[DaisySteiner]

Sorry, read a different article which was slightly misleading. They didn't solely look at babies who died due to lack of oxygen, however the increase in risk of death to babies born out of hours was as a result of anoxia, which is why in a subsection analysis babies born by ElLSCS were excluded.

Yes, it may be safer for any individual baby to be born by EllSCS; however the overall risk to the baby is still very low whichever method it is delivered by, yet the risk to the mother, the huge associated cost and the risks to subsequent pregnancies are what is used to justify not offering every woman the option.

[foreverastudent]

Lavitabella- this is terrible. You cant be forced into a c-section or be harrassed because they say they haven't got enough staff.

Every consultant led maternity unit must have a consultant on the premises on-call 24/7.

Could you maybe change to another hospital or make an official complaint about this one?

Are they prepared to take legal responsibility for any complications that might arise that are directly attributable to the ELCS?

[MimsyStarr]

They looked at over one million births in Scotland over the last TWO DECADES. I wonder what out of hours medical staffing arrangements were 10 - 20 years ago in Scotland and it if is any better now. And staff/patient ratios OOH.

I gave birth in Scotland a couple of years ago - was induced and went into established labour on the ward in the early hours. Around 6 am started asking to be taken up to labour ward for pain relief (and some support!) and they kept saying - the day shift will come and get you when they start. No one to fight my corner because I was alone (husband sent home as males not allowed on ward overnight). Finally the morning shift came and got me and when examined on labour ward I was 9 cm. (Baby fine when born later by forceps).

I asked the anaesthetist (who'd been on all night) if they'd had a busy night on labour ward and he said no. I could never work out why they were loathe to send me up to LW when I needed to go. Why I had to fit in with their shifts! Odd behaviour. So I believe completely that the time of day has an effect on your care.

[Strix]

There is a well know MN story of a twin who tragically died as a result of a botched vaginal delivery a few years ago. The errors were largely due to understaffing, if I remember correctly. I think if the consultant is advising a caesarean it is because it is safest method of delivery for these babies, Lavita.

Also, I was in your hspital yesterday and I thought it seemd like a nice hospital, as far as NHS hospitals go. I think you are in good hands.

I had DS at Queen Charlotte who are well know to be an excellent maternity hospital and always waited ages for the appointments.

[DaisySteiner]

"Every consultant led maternity unit must have a consultant on the premises on-call 24/7."

Sorry but that is simply not true. Yes, there must be one on-call, but out of hours it is very unlikely to be on the premises IME.

[foreverastudent]

Well that puts a new slant on the home v hospital birth argument.

[Lavitabella]

I'm happy to have a caesarean, I trust both the consultants who I've spoken to who've said it's safer for babies and I. I'm sure if I demanded a vaginal birth i'd be allowed one.

I found out initially at a private scan on Harley St and the Dr there laughed at me when I said "Caesarean, really?" and he said 'What were you planning? a water birth, at home, whale music" not in a rude way it was quite funny, but just assured me that C section was best and this has since been backed up by 2 consultants and I feel in good hands.

Important thing for me is having 2 healthy babies, labour doesn't sound like much fun either way. Real story is that everyone should be looked after, every time and sadly that is not the case.