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Read the answers to your questions about pregnancy and maternity services from Rona McCandlish, the National Professional Maternity Advisor for the Care Quality Commission(59 Posts)
Rona McCandlish, National Professional Maternity Advisor for the Care Quality Commission CQC, is here to answer any questions you may have about maternity services, pregnancy, birth or the postnatal period.
The CQC say “We ensure hospitals, care homes, dental and general practices and other care services in England provide people with safe, effective and high-quality care, and encourage the services to improve.”
Rona began her health care career started in health care as a nursing assistant in Edinburgh forty years ago. She went on to train as a general nurse, and then as a mental health nurse, and finally as a midwife. She has practised continuously as a registered midwife since 1985.
As a registered practicing midwife, Rona advises the CQC about a range of issues relating to maternity. Her varied work includes regularly being part of a team inspecting maternity services; advising CQC’s expert analysts; and meeting parents to talk about care they’ve experienced. Her feedback is then used by the CQC to improve maternity services inspections.
Post your questions for Rona on this thread by 21 June. We’ll then pick 20 questions for Rona to answer. Check the thread again on 30 June, when Rona’s responses will be posted.
This Q&A is sponsored by the CQC.
As a student midwife and previous healthcare assistant who has been involved in preparing for a CQC visit - do you feel organised visits with notice for the hospital gives a true reflection of that trust??
Wouldn't unannounced visits give a truer reflection of staff shortages, musical beds, conveyor belt delivery suites and responsibility for a patients care being passed from pillar to post??
Do you think more money should be spent on frontline staff so as able to give the right level of care to our 'patients' - instead of advertising schemes such as 'better by far', 'saving lives' and other such gimmicks that cost trusts a fortune in rebranding, training and staff.
i also work as a HCA (Healthcare Assistant) i would like to know, why are the NHS pressuring staff in regards of service user care but in the same breath taking away resources that help staff to give the care that is required??
What will happen to Supervision of Midwives when it is no longer legislation?
Who will be there to advocate for women trying to access care choices outside normal pathways?
Who will support midwives to support women?
My question is about allowing partners / men on the maternity wards. It seems more and more hospitals have this policy and a significant number of women (like myself) aren't comfortable with strange men wandering around when they are vulnerable. How does this fit in with the NHS's policy of single sex wards? And how will you ensure that women that would like a single sex ward after birth can have their wishes respected? I would also like to know if this is a cost saving exercise as the midwives on the ward I was on asked where my husband was when I buzzed for them post emergency c section (I'd sent him home for some sleep)
What is the CQC doing to ensure there is proper qualified breastfeeding support on all maternity units whenever needed?
As a public health intervention it makes sense, including financial sense. It is another example where organisational structures do not incentivise the right thing, and the financial benefits are downstream and may accrue, for example, to primary care not the acute sector.
However, this sort of thing is often seen as the fluffy 'icing' on the cake, and therefore an easy target not bother with or cut. The variation between hospitals is massive, with some having funded paid peer supporters 7 days a week, and UNICEF Babyfriendly accreditation, whilst others have none of that and rely solely on overstretched midwives and HCAs, who may not be trained to UNICEF standards.
Also, what is your organisation doing to outlaw Bounty from Mat units? Vulnerable hospital patients should not be a cash cow for private sector marketing.
Oh yes, how do you ensure localities provide integrated care in relation to breastfeeding across antenatal, hospital and community midwives, and health visitors and GPs? It would be amazing to see genuinely patient-centred care with services joined up around the individual.
My husband was left traumatised by my son's birth - i had a large pph, the room filled with people caring for me, but nobody told him what was going on so he was left ignored in the corner, holding a baby and thinking he was watching his wife bleed to death. We have since spoken to many other fathers who had similar experiences. Does the cqa have any guidelines for supporting fathers during birth? I fully understand women should come first but our whole family suffered as a result of the impact this had on us.
Many women on MN have posted about having to look after their new babies overnight soon after having had sections or difficult vaginal births, and how problematic this was for them. We are talking women with many stitches in either abdomen or perineum, sometimes a catheter, still woozy from anaesthesia, frightened of dropping their babies. Sometimes they even resort to having the baby in the bed with them, which poses obvious safety issues due to the impossibility of safe cosleeping in that situation. Given the wholesale abandonment of well baby nurseries, this is an increasingly common problem. Not all women want to room in with their babies or are capable of doing so safely, and there aren't always enough staff to assist them in caring for their babies overnight when they need help to do so. How do you see this problem being solved?
Please don't respond simply with something about rooming in encouraging breastfeeding, as there's nothing to prevent women who want to breastfeed but are unable to safely look after their babies immediately post-birth from leaving the baby in the nursery overnight and having the baby brought to them to feed. This issue is about a lot more than that, particularly since well over a quarter of new mothers do not breastfeed at all.
After a 12 hour labour and with stitches and completely exhausted, the midwife expected me to change the baby's nappy and put on baby's clothes! I didn't even know how to put a nappy on! Seriously, shouldn't there be more one to one help available during this time? How can women be expected to look after a tiny baby after a major operation/traumatic procedure?
I have read on the antenatal pages on mn that in certain locations, home birth is being encouraged, yet it is clear that in other locations it isn't. I recognise that things have changed hugely with regard to the availability of home birth in the last 20 years, but can you explain why some localities encourage it while others don't?
I had disappointingly poor care when I had my first child. We accepted the offer of attending a birth afterthoughts session with a midwife. I was disappointed with this - there was an attitude of "it isn't in your notes, so it didn't happen" with fairly sparce notes and that nothing went wrong except their communication with us. We haven't been alone in finding our local maternity services very resistant to acknowledging poor care. I understand that they don't want to end up with lots of legal claims for negligence. But shouldn't there be a way of maternity service providers learning from the experience of service users and being able to let those parents know that their feedback has been acted on?
I would repeat the question by PenguinsAreAce regarding bounty reps having access to wards. I have heard several accounts of these people invading parents' privacy post-birth and asking very inappropriate questions to parents who have had a traumatic birth experience or suffered a loss. Not to mention that they sell on your details to third parties resulting in lots of junk mail and often tell people that you can only get the child benefit form through them. I put in my birth plan that I didn't want to be approached by a bounty rep. My wishes were not respected.
My next question is around how CQC can look at the treatment of tongue-tie within its inspection methodology. My son was born with a severe tongue tie which meant that he could not breastfeed. We had to wait 2 weeks for the separation procedure to be carried out. Luckily we were able to get breastfeeding established after this, however, I suspect that if we had waited much longer it would not have been possible.
My last question relates to the training of midwives in relation to diagnosis of posterior positioned babies. Despite numerous examinations my baby was only diagnosed as being in posterior position until I reached 9cm after 30+ hours of labour. I ended up having an emergency c section. I know that he was in this position from the outset as my contractions started off so painfully that I was on my hand and knees from the beginning and couldn't speak during the contractions. There were other signs that I think the midwives should have picked up on such as turning up at hospital only 2cm dilated but unable to manage with the pain and clutching my back for the whole labour. I kept being told that the baby was head down but I don't think that the midwives had the skills to determine anything beyond that. To be honest, this has led to me losing confidence in midwifery care and I look forward to being under consultant-led care next time.
Do you feel that there is a shortage of midwives?
I would repeat AbbeyRoadCrossing question. Encouraging partners to stay 24 hrs appears to be an attempt to deal with staff shortages on maternity wards. I spent 11 days on a postnatal ward. Partners were allowed 12 hrs per day and to be honest that was bad enough. The ward was noisy and busy. How come if I was in an I growing toenail it would be unacceptable for me to be on a mixed ward, but post-birth, bleeding, catheterised, leaking milk it's fine for me to be sleeping on a ward with various men? What will the CQC do to ensure the feelings of all maternity patients are respected?
I agree with twothirdsamidwife, surely unannounced visits should be the norm? I was fortunate to come across some very caring older midwives during my hospital stays with ds and dd. However, I also had theatre staff and midwives having a stand up argument across my bed at the door of the ward as I was lying powerless with a spinal block clutching my newborn as to whether I was getting a bed in the ward?
Similarly, my discharge was delayed because the ward was shut at visiting time as the midwives hadn't had their break.It seemed as if more emphasis was placed on ward politics as opposed to patient care.
My maternity hospital has historically been understaffed and this was flagged as a concern at their last inspection. After a recruitment drive they're now staffed to the CQC advised safe ratios but the local commissioning group are refusing to fund at that level creating a budget deficit. Why are the commissioning group allowed to choose to only fund below what the CQC has determined to be a safe amount of midwives?
On the postnatal ward after the birth of my third child I witnessed the following:
A first time, very young mum, after a traumatic, fast and early birth (with no birthing partner present) asking the bounty lady to hurry up and finish the photos on three separate occasions so that she could breastfeed her baby ( the second feed of the baby's life). Each time the bounty lady bought for more time to finish the photos ( taking an additional 10 minutes). The young woman had not even passed urine after the birth yet.
This young woman was in absolutely not fit mental or physical state to deal with a bounty rep, as I imagine is the case for the vast majority of women on post natal ward.
Why are they allowed in the ward at all? When will women's and baby's needs come first in this issue?
And with all due respect, please don't give me the standard answer of; we have few complaints, and women like the service being offered.
What does the CQC do to check/audit that patients are informed of their right to choose a c-section, and that the risks associated with vaginal birth are also explained during the consent process?
Does the CQC require a target for reducing the number of c-sections. If so, on what clinical evidence?
I would echo concerns about the Bounty Reps. Post Natal wards are no place for private marketing companies to be hawking their wares to vulnerable women. My local hospital has a sign up telling women to 'look out for their friendly rep' after they've given birth. This is hugely inappropriate as the service provides little to nothing of use for women and is solely a cash making exercise for the NHS yet I know several people with, frankly, horror stories about the hassle they have received from the reps at what should be a private and personal time. What is your organisation doing to look into this?
What are you doing to promote informed consent from mothers?
I often hear "I wasn't allowed. .." or "the midwives wouldn't let me....." or even " i don't know what happened ".
Midwives should be fully advising of all benefits and risks and making sure mothers understand the decision to consent or not is theirs (mother).
Also, what is your organisation doing to outlaw Bounty from Mat units? Vulnerable hospital patients should not be a cash cow for private sector marketing.
I agree with the Bounty questions. It also concerns me that in both my pregnancies at 2 different hospitals the midwives have given me the Bounty pack and encouraged to sign up without making it clear that it's a marketing company. Many women think it's endorsed by the NHS and the products are recommended, and I'm not surprised as the midwives give that impression. Could we have more transparency and honesty from midwives about what Bounty actually is please?
For my most recent pregnancy (DC3) I had excellent patient-centred pregnancy, home delivery and post-natal care with One 2 One Midwives (here) who are a private company offering NHS services. They appear to be pioneers in areas such as hypnobirthing, delayed cord clamping, physiological third stage, etc.
The quality of care available with a familiar face in one's own home and very frequent contact (more than double what I would have had under my local hospital) was fantastic. I am evangelical about the benefits to the pregnant/post-natal woman and her child. Without going into detail, it's quite possible the relationship I had with my assigned midwife saved my life.
However I understand there are issues regarding the funding of such services - although on paper a One2One pregnancy is cheaper to the NHS than a hospital-led birth, the complications of when payments are made to service providers can mean a Trust provides maternity services without getting paid for them.
Anyway, tl;dr version:
I had a home birth with a midwife from a private company paid for by the NHS and I thought it was great.
(1) What is the future of home birthing in the UK?
(2) What place will private companies have in driving innovation and improvement in maternity services within the NHS?
Yy to questions of consent. A friend who is 39+ with DC4 asked me this week if she's allowed to refuse consent eg induction or CS, for example where two doctors are not in agreement. I was pretty horrified that she didn't know she was allowed to refuse.
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