Yet another maternity scandal in the NHS

^I worked in US and saw way more birth injuries there than in the UK.
One big problem there is that if I as a nurse were to question or challenge a doctor I could be sacked pretty quick.^
This is probably very much a local quirk.

Also, you could have 50 doctors with admitting privileges to one obstetric unit, all with their own ideas and foibles. If a woman came in almost in second stage you had to hope for the best that the OB would get there quickly. Back then ( don't know if it is better now) if the nurse ended up delivering the baby, the insurance would quibble about the fees. The doctors would be very put out if they didn't get their money.

The nurse would be very unlikely to do the delivery unless a woman arrived about to deliver in triage. In a great many hospitals you are at guaranteed at least a resident.

I had five deliveries in the US. The first two times my own OB was present for the delivery, in a university hospital. The third baby was delivered by a resident in obstetrics.

I had private insurance. The fee for the entire OB service from first visit to delivery and beyond that to the six week checkup for all three babies even though my OB couldn't get to the third delivery in time was $3,900 a pop.

The hospital also billed - there were room charges, delivery room charges, charges for all sorts of services and medications, from changing sheets to an IV, and the babies also generated charges. The hospital bill was far higher than the doctors' bills. Then on top of that there was an anesthesiologist bill for my first DC.

OTOH, if you were poor, unemployed or black you might be lucky to get through A and E in a government hospital, or you might get poor care or no care at all. Some poor women couldn't afford prenatal care, so already at risk.
Not so.
I had my last two babies with public insurance, through a state administered programme called Kidcare. I delivered my fourth baby in the same university hospital, under the care of the same OB team for my entire pregnancy. As with DC3, a resident was present for the birth itself.

All pregnant women lacking private maternity insurance, including undocumented immigrants (in most states) can qualify for full maternity coverage and coverage for their babies up to age 4 (maybe older).

For DC5, again with Kidcare, my OB practice had moved to a hospital too hard for me to get to so I switched to a midwifery practice in a local hospital. I had continuity of care from the first visit through to the delivery and post natal checkup. I had a private room in the hospital - there are no wards.

I’m so sorry to hear that. Sadly it does seem to be limited to patching a person up a bit, rather than a proper fix.

Lots of variety in the quality of clinicians too.

Thank you @PlantMam, I've already tried accessing help from the NHS many times. It helps for a while but as soon as I show improvement they stop the sessions with a "you're cured" mentality except im not, something will happen and I'm back to square one.

Mammy

It’s been a spectacularly awful time to have a baby for so many reasons. My opposite neighbour had a baby at the end of Feb so avoided the hospital Covid controls. However, all the usual face to face support frameworks have been decimated (we were lucky enough to retain a handful of sure start style centres locally when the majority lost theirs, but they closed overnight due to Covid).

I fully expect the PND figures to be much higher than usual this year, purely due to the multiplication effect of average extra social isolation due to a new born times the lack of the usual support networks.

Just a shit time all round.

(I’ve personally been able to access a bit of PTSD support via self referral direct to Adult Mental
Health services and appointments via video call. Please do the same if you haven’t already! Might be a bit of a wait but better to get the ball rolling than wait).

Its been horrendous to be pregnant during the pandemic. Ive been lucky to be closely monitored due to previous issues in past pregnancies but it still took 4 hospital visits and masses of blood tests after I started collapsing regularly to discover I was severely anaemic (why?)
My son was born via elcs and was extremely ill from birth but was never taken to the nicu like my eldest so I was stuck in the hospital for weeks with no rest or help from family ect. He was home for less than a day when he was rushed back to hospital but not by ambulance as they couldn't spare one for a 3 week old baby.
Hospital were horrified when they saw him as he was limp, grey and on the brink of total collapse. He was transfered to a specialist hospital and had surgery 2 days later and was home 3 days after that, fit and well.
I already have ptsd from my eldests birth (nearly lost him) lost my next 2 and was forced into a medical management of miscarriage against my wishes which left me hemorrhaging in a carpark on my way home, and its only added.
My needs or those of my baby were largely ignored. Covid was always the excuse but frankly I dont think things have changed that much, its still awful

I don't think the midwives who were nurses first are the biggest problem.

There is clearly something very wrong in training and in organisational cultures when it is common for women to be treated with the unkindness and lack of compassion mentioned in the report. So many mentions of it on here too - it's not just isolated midwives or units, it's endemic.

The US, with its most expensive healthcare system in the world, it's culture of litigation, it's obstetrics led care and midwives who were nurses first, has a maternal death rate that is over double the UK death rate. Don't try and blame women's 'lifestyle' factors either, that's just the sort of gaslighting women in S&T have been subject to.

Lots of the things that are being held up here as solutions to the problems of poor maternal care, clearly aren't.

Personally, while I completely acknowledge that there are all kinds of issues around staffing and funding, I also feel that a 3 year direct entry training for midwifery is just not enough. Back in my day we had to do 3 years general nursing, a year of nursing experience, then a year of midwifery. Towards the end of my training they were extending the year for midwifery training to 18 months because a year wasn't thought to be sufficient.

@endofthelinefinally - I agree 100% with this assessment.

This is how midwifery is done in the US. You do your B.Sc. in nursing first, then obtain your RN licensure, and then you earn a masters degree in nursing (MSN - takes two years) or a DNP degree (Doctor of Nursing Practice - takes 3-4 years) with a specialisation in midwifery. Practicum hours are required in both programmes. Altogether a CNM in most US states may have spent up to 8 years in formal third level education, with practical hours included, before looking for your first job as a fully qualified nurse midwife.

I would also like to put out a plea for continuity of care all through pregnancy and delivery and after care, as happens for the most part in the US.

People who enabled the culture and practice there should be prosecuted.

This is the key question @BackwardsGoing (and I’m so sorry you were treated so brutally).

I read the report in The Independent and, by the end of it, couldn’t even pick which half dozen paragraphs were the most horrific. I couldn’t comprehend how such a culture came to be. Because it wasn’t just discouraging c sections (virtually all maternity units to that) it was a culture of making decisions that were dangerous and negligent and everyone knew it. I just can’t imagine an ideology taking hold to the extent that women and babies were maimed and killed.

I’ve participated in dozens of discussions around maternity care on MN over the years. We all know that women are treated horribly in maternity units and have been for decades. Shrewsbury is next level, though.

This is so distressing. The NHS culture of coercion and cover-ups is not limited to maternity care, but it is worse in areas with structural power imbalances like women's healthcare and mental healthcare.

Litigation is used because there is no other way to be heard, it is not the cause of doctors who consider honesty, integrity, and legally value consent optional extras to be disregarded.

NHS does not care about its patients or the devastating harm it causes people, it cares about preserving its own power and status.

It is a choice to protect staff instead of the vulnerable people they were supposed to help. And I have no qualms about condemning every single person who makes that choice.

My first birth in hospital was dreadful, only complicated because I was left alone for hours, scared. My second, at home was downright dangerous due to the midwives - one was yanking on my cord, one was screaming at me and then gave me medication that I had refused to consent to - she waited until DH, the other midwife and double were out of the room and then did it anyway. Neither noticed/cared about the state of the baby who had aspirated meconium.

Third time round I had an independent midwife who was very experienced, who was with me from first twinge and who knew me, my history, my wants as she had done all my antenatal care. That's what women need - one woman, one midwife. Domino care. Same midwife from checking in to post natal checks. At your side throughout labour. The problem is that it's expensive - the type of expense an accountant can see rather than the high CS rate and birth injuries and PND that are underreported and cost less than OWOM. And we are but women, after all.

Personally, while I completely acknowledge that there are all kinds of issues around staffing and funding, I also feel that a 3 year direct entry training for midwifery is just not enough. Back in my day we had to do 3 years general nursing, a year of nursing experience, then a year of midwifery. Towards the end of my training they were extending the year for midwifery training to 18 months because a year wasn't thought to be sufficient.
By the time I embarked on my midwifery course I had a year of post qualifying experience in hospital and in the community. I was used to running a ward and visiting patients in their homes.
What scares me is that there are more and more women with existing medical conditions having babies now, so back ground knowledge and experience is important.

I've just read Janice Turner's column in today's Times and I am so sad and appalled at the stories of what happened. Those poor women & their babies x how does this kind of thing happen in modern times? 😢

I can’t face typing my own horrific story from my first child. Being mocked for wetting myself when my waters had gone to being left alone in severe pain.

I have a relatively severe birth injury I live with.

I don’t know how to fix the system but it’s getting worse

Thanks @teezletangler

Well, they didn't look totally young, but they may have been late qualifiers. It actually scares me how bad it was really because either: 1) having examined me lots of times vaginally, they couldn't tell that my baby was stuck and would not be descending, despite me telling them several times that there was no downward pressure and no descent, so they were just insisting regardless, which really means incompetence and those midwives should not have been working with pregnant women without consultant supervision on next steps; and/or 2) they just wanted to push me to the brink just in case because they were desperate to avoid a section.

On 2) the junior doctor they called in when the midwives were refusing access to the consultant refused to let me see him until I signed a forceps consent form as well as a section one - faced with two obstructive midwives and a junior doctor I signed. I retracted my consent as soon as I got to theatre and saw the consultant and told him that I had signed under duress, because I was forced to and I would only consent to forceps if he told me it was a good decision for baby and me. He said it absolutely was not and even with forceps there was absolutely no chance of a vaginal birth. If it was that clear cut to him, but the midwives couldn't tell surely that indicates that the midwifes I had should not be supervising a birth like mine (growth scan showing bigger than average, baby back to back) - there was no discussion of baby size or positioning. Just following a "standard protocol" which I am sure RCOG and NICE agree with in the majority of cases, but the issue in my view is that women are not seen as individuals.

I have had a consultation with a senior midwife and she agreed me that a VBAC was unlikely to be successful (success for me not being a VBAC at all costs but being not ripped from the inside out or ending in an emergency section) for me, with a baby of over 8lb or poorly positioned. Plus there is no scope for me to be induced having had a section. Accordingly, given my baby was nearly 10lb at 2 weeks overdue, there is really no point me going over 39 weeks and expecting a vaginal birth, so unless I go into labour at 37/38 weeks I will have a section knowing it is best for me. I really have done a lot of research on my personal odds. Plus, just as a matter of principle, I would never put myself in the hands of midwives to decide when to throw in the towel again - I just don't think they have my best interests at heart, it's just a competition to avoid a section.

Janice turner on this in the Times today:

www.thetimes.co.uk/article/a-caesarean-should-never-be-seen-as-failure-0bxp6m5gh?shareToken=cf285c46628122f1b26ae42045cedfef

...totally agree re a no-blame system. Blame just leads to defensiveness and unwillingness/inability to learn, as well as fear amongst staff- and that leads to (often very poor) defensive practice. The Kirkup report made clear that mistakes in practice are actually expected; HCPs are only human after all. The real problem arises when no one learns from them.

What incentive is there to learn from mistakes?

Answer: There is none.

Your assumptions about 'blame' and what it leads to are completely wrong. A sturdy culture of defensiveness and refusal to learn from mistakes, along with fear of speaking up, has gone unchallenged for years in a 'no-blame' environment.

In a hierarchical society, in a branch of healthcare directly affecting only women, including young and less well-off women, there is absolutely no incentive to learn from mistakes.

The only leverage women have here is tort law. Refraining from appeal to the law is a huge mistake that only benefits those wielding power in the healthcare setting.

As well as these (often unnecessary) heartbreaking stories, the NHS is funding a lot of (also probably unnecessary) gynaecological surgeries and rehabilitation therapies from childbirth traumas, like reconstruction surgeries following botched episiotomies, fistulae, haemorrhoids, PTSD counselling, physiotherapy, bladder reconstruction, etc....

@Plantmam I'd recommend AIMS (Association for Improvements in Maternity Services), Birthrights or White Ribbon Alliance- the last one is more global in nature.

@Lastnamefirst thanks, I feel l strongly that reform of the the whole system is a feminist issue. I hesitate to bring the gender debate in, but I am against the push towards gender neutral language in maternity services because this is so obviously a women's rights issue. FGS how do we fight for improvements if we don't even name or acknowledge the root of the problem?

@vaccinationstation that sounds like a terrible experience, especially postnatal. In labour it sounds like perhaps you had less experienced midwives. You want to have a good skill mix on each shift, but often you do get younger midwives in hospital and the more experienced ones are in community or 9-5 jobs. This was an issue in my hospital when I was a new midwife and it can leave you feeling a little unsupported. I do think UK clinical guidelines (NICE and RCOG) are generally very good and very robust, and they are often used to inform practice in other countries. However how they are interpreted/used in different trusts really varies. So many things affect VBAC success, I'd hope a consultant has reviewed your specific chance of success with you!

Struggling to read this at the moment (bit close to home).

Can anyone direct me towards some suitable orgs for Christmas donations? Interested in supporting those that could help with legal action as well as those who support bereaved or otherwise traumatised women directly.

Thanks @Hardbackwriter, I've spent a lot of time observing various units I've worked in and thinking about these issues. I don't think continuity is that much more expensive overall, because it's a redeployment of existing staff (you'd need fewer core staff in the hospitals for instance). And if it leads to better outcomes, it could theoretically be cheaper I suppose. However it's challenging to implement as it doesn't work for a lot of people, for many reasons. The evidence shows that teams of up to 6 midwives still improves outcomes; to me that sounds like a reasonable number of people to share the on-call responsibilities and not burn out.

@DaisiesandButtercups totally agree re a no-blame system. Blame just leads to defensiveness and unwillingness/inability to learn, as well as fear amongst staff- and that leads to (often very poor) defensive practice. The Kirkup report made clear that mistakes in practice are actually expected; HCPs are only human after all. The real problem arises when no one learns from them.

I also agree that a lot of midwives feel they cannot speak up, either to more experienced colleagues or especially consultants. It is so challenging if relationships are not respectful. I noted that in the Shrewsbury report, the obstetric care comes in for as much criticism as the midwifery care, if not more.

That was a response to teazletangler ar 19:50!

I think this is such an insightful and well written post. You are right - maternity care is misogynistic. People always say that it can’t be as most of people who work in maternity are women, but it is and you have summarised it perfectly. I’d pick you as my midwife!