How on earth midwives?

[Sleeplessem]

How on Earth are you doing your jobs? It must be bloody gut wrenching and terrifying!

Read this today (below)…. There are no words. It’s obviously not just that area either. I’m a pregnant lady with my 2nd and it’s really easy to get frustrated by the poor care (sorry but in some instances it is quite poor from a continuity point of view and at least personally a few things are getting forgotten or left off as a result, although obviously a result of severe understaffing and over working) but you read stuff like this and it just makes me so mad, it’s just a disaster waiting to happen and then all the ‘blame’ will fall on that one midwife who’s trying their best under impossible circumstances.

Also in my area, during the last 18 months inductions have increased a huge amount (the amount they ‘allow’ you to go over has also reduced from 14 days to 10 and 7 in some places, do we think that’s partly due to the fact the trusts are trying to ensure staffing?

www.itv.com/news/meridian/2021-10-15/unsafe-staffing-levels-found-in-east-kent-maternity-inspection

I retired after 28 years of being a midwife and things have changed so much. Definitely more intervention and complex cases , also midwives now taking on work which used to be done by doctors for example the initial examination of the newborn. There is a lot of bullying in the profession and I don’t know what the answer to this is. Staff shortages are horrendous at the moment but I know most midwives put their heart and soul into the job.

Unsurprisingly, a bit of defensiveness on the thread from midwives.

She didn’t spot it. She palpated my abdomen and even I could tell it was most likely his head; it was huge end moving about underneath my ribcage! But she said it was probably his knee.

That’s crap. It shows a lack of inquisitiveness, observational skills, technique and, perhaps, experience.

I don’t have my antenatal notes at home as they take them off you after you’ve given birth (why?) but I actually think that appointment was at 36 weeks, not 35. I wasn’t due to have another one after that before giving birth so when they’d have found out he WAS breech, heaven knows.

IANAM but don’t babies usually turn themselves if they’re still breech at 35-36 weeks? My son was (fairly obviously) transverse at 37 weeks and there were some discussions about a c-section, but he turned head down about a week later and stayed that way. Of course if he had remained transverse a section would have been the only option, but none of the HCPs I spoke to thought it was particularly likely.

@Piglet89

Unsurprisingly, a bit of defensiveness on the thread from midwives.

She didn’t spot it. She palpated my abdomen and even I could tell it was most likely his head; it was huge end moving about underneath my ribcage! But she said it was probably his knee.

That’s crap. It shows a lack of inquisitiveness, observational skills, technique and, perhaps, experience.

I don’t have my antenatal notes at home as they take them off you after you’ve given birth (why?) but I actually think that appointment was at 36 weeks, not 35. I wasn’t due to have another one after that before giving birth so when they’d have found out he WAS breech, heaven knows.

Not defensive at all just explaining. I’ve had undiagnosed breeches come into Labour ward, labouring. They have an emergency c section or occasionally they proceed with a vaginal breech if that’s what they want. Usually it’s very obvious on vaginal examination that your not feeling a head, I’ve seen babies confirmed breech on ultrasound at 38 weeks come for elective a few days later and are now cephalic, I’ve also had babies confirmed as cephalic at 37/38 weeks on ultrasound come in as a breech. Babies turn, these things happen. Palpation is subjective and sometimes we get it wrong, also what I feel may differ from the next person, similar to vaginal examination findings.

Your maternity notes are taken to be filed in your main hospital notes, they are legally kept for 25 years. You can request a copy if you want them.

@Piglet89 you can do a sars request for them, i did for mine. Although you might not like what you read, just a heads up, there was quite a few fibs in mine xx

It’s hardly defensive to point out that it’s not expected for your baby to be identified as breech by 35/40? 36/40 is when it’s becomes important to be sure about presentation, and if I have any doubts at that point then we do a bedside scan.

This is exactly what I mean. Calling a colleague crap because she didn’t identify a breech (at 35 weeks!). Midwives miss breeches, babies turn unexpectedly, consultant miss breeches believe it or not. Everyone will miss a breech at some point in their career, it’s not crap. It’s just an occupational hazard.

Also, you have appts at 36, 38, 40 and 41 weeks (if still pregnant) so you must have been very very late on if you had no further appts planned.

@AndThenInTheEnd as I explained in a later post, I am actually fairly sure it was at 36 week appointment it went undiagnosed. It’s not good enough and women should be able to demand better.

I don’t recall any further antenatal appointments in my notes past that 36 week one.

It should have been picked up, plain and simple: any explanations otherwise are obfuscation and diversions.

Fine. I hope it’s made you feel better to come on to a thread full of exhausted demoralised midwives fighting a broken system and do a “but what about meeeee my midwife was CRAP” (and? What’s that got to do with the thread?) and that you got what you wanted out of it.

only earlier this week I was arguing with another poster who was complaining about the facilities that are available on a consultant led unit. Fuck the facilities, I'd give birth on a cold floor if it meant there were enough midwives for everyone.

That was me @mummyh2016

Interestingly you negated to mention that many midwives on my thread not only agreed with me, but said better facilities would actually save money in the long run.

You also negated to mention that you didn’t give birth on a cold floor, you had a lovely MLU experience despite going to great lengths to argue this shouldn’t be available to other people to ‘save money’.

All very well saying you’d do X, Y and Z when you actually did the total opposite!

[quote Piglet89]@AndThenInTheEnd as I explained in a later post, I am actually fairly sure it was at 36 week appointment it went undiagnosed. It’s not good enough and women should be able to demand better.

I don’t recall any further antenatal appointments in my notes past that 36 week one.

It should have been picked up, plain and simple: any explanations otherwise are obfuscation and diversions.[/quote]
Demand better?! Our trust trialled a 36/40 routine ultrasound for all women, did it pick up breeches? Yes.. Did it also confirm cephalic babies that then turned breech at a later date? Absolutely.

A midwife doesn’t have X-ray vision, you are literally palpating through skin, fat tissue, and fluid feeling for hard round structures, blind. Of course no midwife or even consultant is going to get it spot on 100%.

From now on I’m DEMANDING a faultless service wherever I go and whatever I do as god forbid a human makes a human error during their working day. You’re just proving my point perfectly so thank you.

@Piglet89 of course they aren’t. Clinicians in any part of healthcare miss things all the time. As long as it was identified by the time you gave birth (ie on triage at admission so appropriate action could be taken) then it’s one of those things.
Midwives do a fantastic job. It had two completely different births and postnatal experiences but throughout the treatment from the midwife despite being overworked stressed and criticised constantly for the smallest things was fabulous.

@Piglet89

Well given you went private you can’t really make a ‘case’ out of your story as you can’t say one way or another whether the breech would’ve been subsequently detected. I think using your story as ‘proof’ of midwife incompetence is unfair.

The trust I worked for won't even scan for breech until 37 weeks.

If I diagnose at 36+6, they still won't accept the referral.

The attitude of deeming someone incompetent because it wasn't picked up at 35 weeks is vile. This kind of shit is why lots of us have left.

Don’t you think though all midwives on this thread, the perception not picking up on a breech baby at 36 weeks as ‘negligent’ when actually babies constantly toss and turn even up til 39+ weeks is an example of patient ignorance (meant in the nicest possible way, you can’t be totally in the know on processes completely out of your remit) that could be addressed really simply with expectation setting at appointments, particularly at booking and maybe a few handy notes on this kind of thing in that badger app.

With my first it was such a shock how ‘hands off’ the care model is here as most of my exposure to depictions of maternity services came from American sources and they have a totally different model of care to us in the UK?

Someone posted up thread about being happy to give birth on a cold floor, don’t be daft, not you wouldn’t nor should you have to.

Patient ignorance - please.

Even if babies do turn (sometimes several times) after 36 weeks, I want to KNOW what position my baby is in as early as it’s possible (after a certain point) so I can be fully informed and know what decisions might have to be made later down the line.

I want to be involved in my care, not have a system decide “she doesn’t need to know because things might (or might not) change later.

This kind of attitude is so patronising.

But it’s perfectly normal for babies to be breech until quite late on particularly for a first pregnancy @Piglet89

At what point should women be informed of the baby’s position? 20 weeks? 30? All it would do is cause unnecessary worry.

“All it would do is cause unnecessary worry”.

That’s just an assumption about how a patient might respond to a piece of information. Women have the right to be informed about their care - not have important pieces of information kept from them.

Tell me the facts and then explain why I don’t need to worry about them. Don’t keep me in the dark.

@Piglet89

“All it would do is cause unnecessary worry”.

That’s just an assumption about how a patient might respond to a piece of information. Women have the right to be informed about their care - not have important pieces of information kept from them.

Tell me the facts and then explain why I don’t need to worry about them. Don’t keep me in the dark.

Piglet, it’s not really about information being withheld from you, it’s about the fact spending the money collating it before a certain point is costly and pointless.

But Piglet, from what PP said, your baby could well have been head down at your appointment, and then turned breech before delivery. In which case, a breech presentation wasn’t ‘missed’ at 36 weeks. You just don’t know, and there’s no way to find out. You seem to be assuming your midwife was wrong without any evidence.

First it was “they don’t tell you because they don’t want to worry you”.

Then it was:

“Collating the information patients should have a right to know is too costly”.

Which is it?

I mean, the second argument is completely wafer thin anyway: how costly is it really to collate that info?

In any event, I apparently made the cardinal sin of expecting an obvious breech to be picked up fairly late in my pregnancy.

The midwife noticed the huge bump moving at the top and misdiagnosed it as being a knee - and categorically said he was in the right position. At least say “not sure”: don’t just make a really shit guess and move on.

Trust me; he was head up at the appointment. Even I strongly suspected the huge head-like bump moving under my ribs was a head.

@Piglet89 both. Collating information at a time when it isn’t a reliable indicator of what will happen at the end of the pregnancy is both costly and needlessly worrying.

I assume it is costly as every woman would need a second opinion or a scan?

She may or may not have underperformed in not picking up your breech, but I think you’re taking it a bit harder than you should be.

I agree @Piglet89 great to be involved in your own care and drive your own care, no way should any decisions be made on your behalf without your consent (your consent should be sought for everything and all options presented to you) but again with love and respect if you’re not medical you aren’t going to have the specific knowledge on how to interpret somethings and sometimes too much info is worrying.

Plus at all appointments from 28 weeks my tummy was palpated and the midwife would write in my notes the presentation, although I was told to pay no mind to it until term. Surely you get that without a scan there is a margin of error. Either way one midwife missing a breech presentation doesn’t abrogate underfunding and overworking and with the greatest of respect that is a cocktail that will inevitably lead to far more adverse outcomes than a breech baby

with love and respect if you’re not medical you aren’t going to have the specific knowledge on how to interpret somethings and sometimes too much info is worrying.

As i have Said before a) give me the information
B) explain to me how I should interpret that information.

I’m an intelligent person - I think I can handle it.

What about people less intelligent than you @Piglet89 ?