To be pissed off about the politically spun report saying it's more dangerous to give birth at a weekend?

[WhoTheFuckIsSimon]

The stats in the report are woefully lacking in any robustness.

For a start the numbers spoken about are too small to be of statistical significance. Secondly they've taken Tuesday to be the weekday by which the weekend figures are compared to......overlooking the fact that for some stuff they look at actually Thursday is the most dangerous day. They haven't taken into account lots of variables such as birth weight which could affect the perineal trauma stats.

Then the Health spokesperson says this demonstrates weekend staffing levels aren't good enough. The study never looked at staffing levels,,,,,so how can they say that? Every labour ward ive worked on has the same number of staff at a weekend as during the week!

This could put people at risk. A woman is worried her waters have gone on a Sunday may decide to wait till Monday before ringing the hospital as she thinks it's too dangerous to go in at a weekend!

I was induced on a Sunday with DS (no real need to be that day, it could just as easily have been the Saturday or Monday, just that I was exactly 40 weeks on the Sunday).

The obs told me that there are no real differences in the staffing on Sunday so there was no risk attached to being induced on that day. Same happened with a friend whose husband is a surgeon, and he thought that sounded right (plus I think they were unlikely to muck her about in the circumstances).

The only problem I had was that the heating and hot water went off just after they'd started the induction! So it was freezing. Extra annoying because they were going to let me go in the water even though it was an induction because I had been induced so easily with DD (at 38 weeks).

Anyway, my point is that I was certainly told there were no differences in the level of service on a Sunday.

The figures can indeed be reported to support preconceived points of views.

The authors state "Monday’s performance might be substantially affected by quality of care over the weekend for non-same day births. Similarly, for maternal indicators, which are categorised by day of admission, Friday’s performance might also be substantially affected by weekend care."

But when Monday's outcome for perinatal deaths is comparatively good (almost the same as Tuesday, best), the authors don't associate this with the weekend.

And when Weds' outcome is much poorer, they DO associate this with the weekend.

Which looks a lot like confirmation bias.

(NB The figures may indeed show something worth investigating. But ditching the bias would be better.)

I can't understand why the Mirror would push the Tory government's agenda though.

Maybe just for sensationalism.

The numbers of midwives and nurses etc certainly need to go up in general from my experience. I think we can all agree that maternity provision in general and especially aftercare need to improve. From my experience only (so for what it's worth) the thing that would improve the system most is high staffing levels.

ive had both mine at the weekend. the 2nd time there was no beds in the labour ward and i had my baby in a normal bed in a spare ward bay - there was no consultant or paediatrician available - they both needed called out and took 2 hours to respond. could something serious happened in that 2 hours? of course it could have and there was no one else there. I didn't feel the midwives coped well on either occasion and needed more support. so yes I feel the report is correct.

TBH the Op's overreaction to the article annoys me more than the article. Having given birth within an hour of my waters breaking all 3 times I find the concept of waiting it out to avoid the weekend a bit nonsensical.

I think there is an issue with uneven delivery of care and inadequate and inconsistent care all the time. My own personal experience was that this is exacerbated at weekends because hospitals definitely do run from week to week rather than every day being the same sort of treatment day.

My daughter has recently had a major operation which required a 3 week stay in hospital. Our experience really wasn't pleasant. There are just not enough nurses or lower grade nurses to help care. I was doing all personal care and in the end I was even giving all medications. After a week's stay, I asked for her to be discharged as I was doing everything anyway and at least at home we could sleep and have community care in and some respite as she has severe and complex disabilities. They sent us home (thank God as I seriously was considering self discharge) There just were not enough front line staff. It's not the nurses fault but I think it's unfair on both the nurses and patients.

Incidentally, going along antimatters train of thought. Sixteen years ago I also needed an emergency c section after a failed instrumental. The senior consultant was called and performed the surgery. This was a Sunday night. My question 're calling staff in these days, is can they afford to live anywhere near the hospital! :(

I had a weekend birth, and some subsequent issues. When I saw a follow-up NHS physio aat the hospital she said that "oh, no wonder, you gave birth on a Saturday. Most of the patients that I see here have had weekend births". A consultant (NHS but seen privately in my case) said the same about a lost follow up appointment "oh, that'll have been missed as it happened on the weekend" and sorted the issue in two phone calls.

I am skeptical about this story. (The study is not the same as the story.) There seems to be strong political motivation to get the greater-risk-at-weekends narrative into the media and the media are just lapping it up without providing any balanced coverage.

This follows the hospitals-are-weekend-deathtraps from a few weeks ago:

fullfact.org/health/hospital_deaths_weekend_seven_day_nhs-45095?utm_source=dlvr.it&utm_medium=twitter

There will be proportionally more risky births at weekends because the planned c sections will be on weekdays.

Interesting link, nauticant.

Yesterday's BMJ report uses day of birth as the reference point, not day of admission or death.

That study in your link uses, IIUC, day of admission as its reference point, not day of death. If it had chosen day of death, that's highest in hospitals on Wednesdays.

Fair enough, each of these studies had to choose something as the reference point, and they weren't related studies.

But there's clearly a lot of scope for reporting the stats to fit the pre-conceived story.

I heard on the radio this morning the study sample was 1.3 million births. So certainly big enough to be representative.

The (I think) chief O&G doctor also said that it can be difficult to extract anything meaningful from it because the majority of deaths in maternity are stillbirths, and they actually occur a few days before its known about (sorry if I've not put this correctly).

Regardless of the political spin, I do think staffing levels in general needs to be increased in maternity.

But there's clearly a lot of scope for reporting the stats to fit the pre-conceived story.

Yes, that's the point I was making. Watching politicians hammer home whenever possible the hospitals-are-weekend-deathtraps line when the studies are more nuanced shows we should be cautious.

(Nice use of pre-conceived in this context.)

Another article on the same topic:
www.telegraph.co.uk/news/health/news/12014087/Babies-more-likely-to-die-if-born-in-NHS-hospitals-at-weekend.html

This may be unrelated, but the study/BBC also talks about the mothers, not just the babies.

I have been told (by a few nurses) that because of the way midwives are trained these days, mothers are put more at risk. This is because back in the day you would train as a nurse, and then specialise as a midwife. This way, you were experienced in treating both baby and mother, and all the co-morbidities that the mother may have which could cause complications in pregnancy and birth.

These days people can do a direct access course to midwifery and so they don't have the basic grounding in nursing. This means that while they are fantastic with the baby, the mother doesn't get the same care.

I wonder if that ^^ contributes to the feeling of whatever damage is done to the woman during birth (tears with instruments, post-birth trauma etc) the woman is just expected to live with it and not complain, and be grateful the baby was okay. When really the aim should be to repair the woman's injuries so she doesn't need to suffer incontinence/painful sex/etc for the rest of her life.

Also as pointed out on R4 in most still births the baby has died days before delivery...

The only thing the report shows is that it's safer to be born on a Monday or a Tuesday. The authors don't address what the cause may be but I feel there should have Been better communication from the publishers to the media to avoid the hysteria media headlines.

The authors compare weekend mortality rates to rates on a Tuesday. Why? Why pick the best day. Why not point out Thursday is the worst

@AyeAmarok: That is well possible. The statistics for maternal mortality and infant mortality differ quite a lot from country to country. White Russia has the lowest mortality for mothers (1 in 100 000 live births) but a slightly worse one for children (1,9 in 100 000 live births)

Great Britain has a mortality rate of 2,4 for children, but a whopping 8,0 for mothers!

I'm sorry Aye but that is a load of absolute bollocks. I'm direct midwifery trained and I have had LOADS of high risk experience with women who have previous health conditions. We get taught all this on the course, plus a lot of the problems women have are a direct result of pregnancy. Being a nurse isn't necessarily going to help you care for a woman with pre-eclampsia or PPH. Yeah we care about the baby's health, but I've just qualified and we were very much focused on the woman and her care - we don't just ignore women's injuries! Midwifery is much more about working with women than babies and anyone who thinks otherwise doesn't have a clue what the job actually involves.

It really annoys me when you get nurses saying things like this, who normally have never worked in maternity. I hate this us vs. them mentality. I've equally heard the view that nurses are TOO focused on ill health and the woman being a good little patient who does as she's told rather than treating pregnancy and childbirth as a normal, physiological event which it often is. That's not my opinion by the way, but one I've heard. Plus, there are still midwives who are nurse trained. Not as many but they're out there but they only have 18 months to get all their numbers whereas we have 3 years. This means that they're often running into rooms at the end of their course to catch babies to get the required numbers, and what are they going to learn about labour care from that? I'm not saying this always happens or that it doesn't happen to 3 year students but I was lucky enough to get my births in plenty of time so I had loads of time to spend looking after high risk and ill women. I've looked after women with PE, pneumonia, post cardiac arrest, severe pre-eclampsia etc. I slogged my guts out for 3 years to learn how to look after the well and the unwell woman and to be told all I care about is looking after cute widdle babies really winds me up!!!!!!

Anyway, that's my rant of the day over. As for the actual topic, I have noticed we seem to be more short staffed at night. Can't say I've noticed a difference between staffing levels at the weekend and during the week, but I've worked mostly nights this year and haven't done many day shifts. We called one of the consultants in for a serious incident on a Thursday evening once and he refused to come but he did eventually after being shouted at down the phone. I don't really understand the correlation about the tearing, unless they're implying that consultants cause less tears which makes sense. But I've rarely seen a consultant undertake an instrumental delivery - in fact, I can't remember a time where it's ever happened bar once because the registrar was in theatre.

However, I do think perhaps community midwives should be more available at the weekend. When I was placed in community and worked at the weekend it was sometimes treated as a bit of a doss day if we didn't have many visits. Women are told they can only ring Mon-Fri where I trained so I don't know if that would make an impact but they know they can ring the hospital if they need advice.

Happy to be told it's bollocks Pandora It was just my head wondering if there could be a link between this study and anecdotes I hear from nurses.

There are loads of nurses with various methods of training in my circle (I'm not one), the older ones complain about the new nurses not having enough experience of X,Y,Z, and the younger ones don't think the older ones have a clue as they don't have as many degree qualifications! I hear both sides. The truth will lie somewhere in the middle, as always.

But while of course I don't think any midwives just ignore women's injuries, I do think that there is a problem that needs to be addressed here.

Sorry to make it a feminist issue but I wholeheartedly believe that if something caused the same number of men to have to go through life unable to have sex, being incontinent, unable to sit down without pain, recurring internal tears etc then there would be more treatment offered (and quicker), and less hoop jumping to get it. You only have to read threads on here to see the number of women with serious injuries who are told by HCP to stop complaining and be grateful, and sent on her way.

My baby was stillborn on a Saturday evening whilst I was in hospital waiting for a c section to be performed on the Monday.
I received very poor care.I wasn't listened to when I said I couldn't feel my baby kicking anymore.I will feel forever angry about what happened but what can I do? There is no going back.
If I had been admitted at the start of the week then my daughter may have had a good chance of survival.She was a very low birth weight but this wasn't an excuse to kill her off.Sometimes I wonder if I was deliberately
Not listened to in order to save money as the intensive care that she would have needed would have been very expensive.

What a horrible article.

I so wish these newspapers were held to account for the shite they peddle. What other possible outcome be to that article than to cause pregnant women upset and stress?

Oh Thesecretfleece I'm so sorry

So sorry fleece that is awful

Firstly want to say how sorry I am to Fleece.

Ive been reading some of the responses on theBMJ website and I think they can probably articulate the flaws in the research better than I can. here

howabout. Of course if you go into labour after your waters breaking you will go into hospital. I was thinking more of the women who have their waters break but labour doesn't start.

Similarly women who may have reduced movements or feel a bit unwell. Something like this could put them off seeking help for 24hours.

A&e depts are already reporting that this is happening since Hunt hid the headlines saying you're more likely to die if you go into hospital at a weekend. There have been cases recently where people have had chest pain over the weekend and not come into a&e until Monday. When asked why they said it was because they didn't think it was safe.