Yet another baby dies.

[bubble99]

A 12lb baby girl died at West Middlesex hospital three days after a fourteen hour labour. Baby was eventually delivered, blue, with forceps. Obviously a big baby but CTG traces showed it was all going wrong and husband believes his wife should have been given a CS.
What is going on?? Has the government set one of it's "targets" for reducing CS or were Bo and this little girl just the victims of inadequately trained staff.

I am not an NHS basher BTW. I was trained by the NHS, worked for the NHS, have had two fantastic deliveries with the NHS. But something is going wrong. All of these deaths seem to have been so avoidable.

[swiperfox]

What are CTG traces? Is that when they take a sample from the baby's scalp to check oxygen levels? They did this with my DD and told me that her oxygen levels were too low and then gave me a choice of would i like to have a cs or wait and see roughly another 12 hours labour through?????

It's getting ridiculous. I don't understand it.

[melon1]

Agree bubble99 - my friend had a terrible labour, went on for about 46 hours, because the staff wouldn't give her a c-section - she wasn't contracting, baby then couldn't be pushed out, ventouse was used, failed, and as a last resort they finally gave her a c-section because baby was getting distressed - one of the nurses actually told her afterwards a c-section is a last resort because it costs more (operation, recovery etc).

[hunkermunker]

It does seem like they're going all-out to avoid caesareans - I did wonder a little while ago if that was the case. I would hate hate hate to think that these precious babies had died as a result of reducing c-section targets It's very upsetting to me, as I'm sure it is to everybody, that the overriding thing that can be said about these recent deaths is how horribly avoidable if the staff had been more observant and willing to act

[Evesmama]

not again

[QueenEagle]

Surely it's safer to deliver big babies like this by CS or induce them early? Having already had 9lb 4oz and 9lb 14oz babies, my MW and consultant knew ds4 was going to be about 11lb or so and as it was he was 9lb 1oz two weeks early. It would have been a pretty difficult labour if I had been left to go to term and the thought of something going wrong worried me so much it was agreed I would be induced.

Who gives a toss about govt targets when babies lives are on the line?

[LGJ]

Too to make a sensible post.

[pupuce]

I think it is Mears who knows 12lbs born vaginally. One of my friend had a 11lbs at home.
It's not so much the size of the baby which is the issue as the lack of PROPER care and attention by staff... if you have one to one care then someone is watching over you!... it is absolutely appalling what is happening.... I am not convinced that reducing c-sections is what is the problem... though reducing inductions (too early) would probably help.
One of my client had a stillborn baby at 42 weeks, she was only 7lbs and was born blue, lived a few hours,... size was not the issue....

Bubble - have you received the results of Bo's autopsy? can I ask ?

[SenoraPostrophe]

I think it may be a symptom of the general UK tendency to take any new idea to its most extreme.

In Spain, and presumably previously in the UK, intervention rates are very high. In the UK now, rates have been reduced, but perhaps they have been reduced too far.

[JanH]

The politics of childbirth from the Guardian - printed after the story of Jacob.



"they are there to intervene swiftly and safely when it is needed" - oh, we wish

[bubble99]

pupuce. No, nothing definitive. We'll get the full results at the enquiry, we could get them earlier via the GP but the timing will coincide anyway so we'll wait. But "off the record" from the hospital paed. consultant there was nothing wrong with him. They checked blood gasses, after he was delivered, when they were trying to resus him and apparently he just had no reserve left. Bear in mind though that he had been in distress for 7 hours, poor little lad, so I'm not surprised he couldn't survive for any longer. All of his prenatal scans showed nothing abnormal, dopplers/ placental function was good.
If we're told that there was something which would have meant that he wouldn't have survived I will be very surprised. Even if this was the case there were seven hours in which to get him out alive. If he had been delivered alive and then died because of an innate problem then I would probably have felt that his death was "meant to be." As it is I keep seeing his determined little chin and clenched fists that looked as if they had literally fought and fought to get out alive. He was a 7lb7oz baby FFS, not a tiny little prem.

[marthamoo]

One needless death is one too many, obviously - but something is going very wrong here.

[suedonim]

The report I read about this latest baby was that the hospital hadn't picked up that it was a big baby and also that they have no protocol, whether that be CS or other treatment, to deal with big babies when they are spotted. Sad.

[milward]

So sad.

Hope you get the answers you need Bubble xxx

[Chandra]

Regarding big babies... sometimes it's not only that the baby is big but that the space the mother has for the delivery is not big enough. I knew I was likely to have the problem because most children in my family (including me, my sisters, cousins and their children) have born by non-elective cesarean or early induction. But eventhough I insisted about the point, they told me that I should be fine because I was tall (so is the rest of my family so I couldn't really understand), so I trusted all staff that told me it was going to be fine and... it wasn't.

Baby went into distress after a 27hrs long delivery when I failed to dilate more than 8 cm, the baby was deliverd by ventouse after a rather large episiotomy, the doctor who delivered him told me, in her words, that there was absolutely no way that that baby had come out naturally through that space, and I guess she was right as even walking was extremely painful for two months after delivery. When I mentioned this to my ginecologist in Spain and later to a ginecologist friend of mine from MExico, both said that using the height of a mother as a guide to determine the space available for the baby's head to go through was a method that had stoped being used more than 10 yrs ago as it is definitively not reliable (though very cheap and you get "results" immediatly ).

[QueenEagle]

When I saw my GP when I was about 6wks preg, he asked me what my shoe size was. I replied a 7 and he said "well that should be fine then". WTF???

[Chandra]

Something that really shocked me about the services available in my area is that there were only two ultrasound scanners which were obviously no enough. In most countries you expect to get a scan a month, the gyn or obstetrician taking care of you has his own scanner in his office in most cases (and even a 3D one lately). To have only so few scanners for a full county population seems to me like a bit too litle. Sure, many people can say that they are not really needed but surely if they are used regularly all around the world there should a good reason for it, no?

Regarding cleanlines and super bugs, I spent 2 days in the guard and the floor was never cleaned, the floors of the bathrooms were all full of tiny spots of blood. There were worms in the shower and I'm positive that the paediatrician that checked DS palate didn't wash her hands between checking the baby next to us and DS.

[pupuce]

Chandra it's a money issue and by that I mean... it costs too much (and the benefits - I presume statiscally - have not been demonstrated) and in most other countries the way the £££ is organised is different.
I hear that in Ireland you don't get to hear the baby's heartbeat at MW visits.... that's the practice over there,
For example in Belgium where I am from and where all my cousins had their baby, they get more scans but the more scans the more ££ for the OB. Same is true in Switzerland.
Speaking of Belgium where I have many nieces and nephews.... the number of times where their mothers had false scares because of scans ..... it is actually quite sad... they get a scan at OB's office (as of course OB has a scan!) and then she says "Oooh I don't know about that, let me refer you to the scan specialist at uni hospital"... you wait 2 weeks (in fear) to be told by a specialist "all is fine"....
Personally - I think too many scans (unless you know of a problem) is not a great idea.... and I do not believe scans for size.
My current client was told 2 days before delivery that her baby wasn't very big 7lbs 4, she was 8lbs 8... and I ahve seen it reversed too where 2 women were encouraged to be induced because baby was large BOTH babies where under 8lbs 5 at 41 weeks.
They say measurements can be wrong by 10% - in my experience it is often more than 10% (either way though I have seen more over-estimation).

[Jimjams]

terrible.

Having had 3 sections (1st following failed induction, second elective and third following trial of labour) I think the problem is what happens when hospital procedures screw up and no-one takes responsibility for a decision. I know someone who elected to was advised to havea section because of a breech baby. She wanted the baby turned- which was agreed to. It was done in an antenatal clinic just before a shift change and no-one took responsibility for her afterwards. She wasn't monitered until almost an hoour after the turn, the baby was in severe distress and died 9following an emergency section).

Michel Odent advises the sections from a labour that has been allowed to start naturally are the safest form of section in the majority of cases (obv not for something like placenta praevia). He adviises early recourse to section. This happened in my last labour (because I'd had 2 previous sections) and worked well.

I wouldn't be surprised if there was some target (there is isn't htere?)

[Jimjams]

I agree about size. I was told that ds2 was a major whopper- consultant had a prod and said "nah don't believe it this is not a huge baby"- he was right ds2 was under 8lbs.

[chickenchowmein]

My sister had a 12lb baby which is unusual for our family as most of the babies have been under 7lb, she was huge though towards the end of her pregnancy and told to expect a baby between 11 -12lb. She had a very difficult labour and the baby was eventually born by ventouse. Thankfully the baby was born alive and well but unfortunately her left arm was damaged in the delivery and she was told at the time that it would be unlikely that she would ever be able to use it. She is now 3 years old and with the help of physio she can use her arm to a certain extent. The awful thing is is that the hospital blamed my sister for the situation, they said that she knew the baby was large (my sister is only 5foot) and that it was her responsibility to have requested a c-section. I had thought that it was the medical team who are supposed to advise you on the safest delivery, obviously not!

[morningpaper]

JJ> the problem is what happens when hospital
JJ> procedures screw up and no-one takes
JJ> responsibility for a decision

I think this is the key to ALL nursing problems, and is perhaps COMPLETELY unavoidable. I think it is in the nature of nursing that the job is so stressful that one of the ways of dealing with that stress is to develop a culture of passing-responsibility. In nursing, this is psychologically passed UP which is why nurses (and public) tend to blame the highest-ranking member present (in midwifery, the Consultant) when things go wrong. The fact is, of course, that things will always go wrong because no one knows the outcome of all potential routes of actions. But we won't accept even 99% correct decisions, of course, because the 1% wrong decision is so awful in the case in point. So we ourselves (as a defense mechanism) look to the person who is responsible to lay the blame at their feet.

That's why, in essense, nursing is so stressful - because someone has to take responsibility for people dying. Which in turn leads to a culture of dissipating/passing responsibility. It's a way of coping.

(Not passing comment on this or other cases, as I have neither the knowledge or expertise to do so - merely agreeing with JimJam's spot-on analysis!)

[SkiBunnyFlummy]

I think the point was they didn't know the baby was big.

The parents main issue was that there should be procedures in place to find out if baby is big or not to enable caesarean to be offered.

Often midwives do say if babies are big or not but they are usually wrong, it is just a hunch thing.

Babies are getting bigger and bigger due to the high nutrition levels in this country I think

[SkiBunnyFlummy]

Also from what I gather from reading organisations like NCT are campaigning to bring down c-section rate but doctors are still inclined to use it. Why? Because more likelihood of a live baby and less likelihood of legal action. Doctors really have to cover their backs these days as people like to sue them for not being perfect. So they take the safest option - often recommending c-section when it may not really be necessary.

[LIZS]

Slight digression but in response to some of the comments below. I also think such screw ups are due to a lack of continuity of care and therefore individual responsibility to a patient, as was hinted at further down. In Switzerland yes the intervention rate may be higher, the system is privately run and money related but you see an Ob/Gyn from the beginning for Antenatal care(or even before pregnancy) and, if you so choose and it is possible, that same OB/Gyn can attend you in labour and postnatally. If they are not there in person , for what ever reason, the midwives can phone them for advice. The buck stops there.

You then don't get different midwives per antenatal visit, meeting the person who is going to deliver your baby for the first time during labour, or SHO's on long shifts making uncertain and rushed decisions. You know that you have someone who has an understanding of your history and wishes, plus experience, making the decisions. That is not to say they are all of the same calibre and you do hear worrying stories here too.

It was only by having had experience of both systems that the value of such continuity of care really hit home - that could be equally valid for midwife-led care as well as drs.