I have heard about tugging on placenta before - leading to heomorage!!!

[elizaregina]

www.dailymail.co.uk/health/article-2198725/Wife-bleeds-death-midwife-persuades-homebirth-inquest-hears.html

And that never happens in hospital does it?

oh no sheela,

It does happen in hospital, I had never heard of it at a HB birth before....

I was interested to hear that a consultant said it should never be " tugged", if this is so - and I assume part of training, I just wonder what MW are doing...tugging at it.

This interests me as my local hospital has a nasty rep for plancenta being left in, and women ending up in intensive care with all sorts of life threatening problems!

It just seems so simple and yet lives are being put at risk and a life lost here due to placenta being tugged!

It's hard to comment constructively when you don't have all the details but delivering a placenta by controlled cord traction, which is the most common method in hospitals, can look quite forceful to someone who has never seen it before but it should not be tugged, which to me sounds like jerky movements. The process is of steady downward traction on the cord with support from the other hand on the suprapubic area over the lower part of the uterus. It is a skill and has to be learned properly and you have to recognise when the placenta has separated and when there is too much resistance to continue. A previous CS increases the risk of an adherent placenta. Examining the placenta is also very important - small ragged bits of membrane do tend to come out naturally but any doubt about completeness needs to be followed up.
What a tragedy for the family.

Examining the placenta is also very important

Of course!!! And in proper light???

I am just astounded by this mw.....

Can or will she be barred from practising?

30% is a large chunk isnt it?

I would def say my MW did the down traction, i would not say mine tugged in anyway shape or form on mine...and that was my first baby, however a friend at another hosp on her second child - said hers was most def tugged. she then heomorraged and ended up in intensive care.

I don't trust what papers say anyway but this is awful :(

It's basic practice to ensure all the placenta is out.

Where's the part where she was brainwashed though? The headline says it but no further details.

Yes, you do need good light to see properly and 30% is a huge amount to miss. If these facts are confirmed at the inquest, I would think she would be investigated by the NMC, be put on restricted practice and have to undergo retraining. As an Independent MW I think she would have to find a hospital willing to carry out that supervision. Not an expert on this but it's what springs to mind.

You cannot judge the midwife, you weren't there and as it was just her and the husband it is her word against his. Tragedies happen even in hospital and post partum haemorage due to retained placenta can happen in hospital too.

I for one know this midwife personally and am deeply distressed at the way she is being portrayed as an unprofessional negligent professional. My DC3 was one of the last babies she delivered before the tragedy and I was still in her care when it happened. She was one of the best midwives I ever come accross very knowledgeable, very caring and compationate and up to date on many many subject. She was aware of all complications that could have happened and used to talk the ladies in care through what could happen, what she would do if it did etc...
As for brainwashing people I am amazed at that claim. She (and other independent midwives I interviewed) spend a long time going through what it meant to engage an independent midwive and explaining the consequences to the families in a non forceful way. I just cannot imagine her "brainwashing" someone into doing something they didn't as she was pro-choice and was very respectfull of her clients's choice.

I am very sorry for the family's loss and I can imagine how devastating it might be it is a real tragedy. But jfor people on this forum to pass judgement without knowing the full facts is unfair.

And if you are wondering about my placenta, she did examine it, in full light and also asked me if I wanted to see it.

Finally when you choose an independent midwife, trust is essential as you are aware that your life and your baby are in the midwife's hands. My DH and I made our enquiries and she had an excellent track records.

Would I chose to entrust my life and that of my baby to her if I had a fourth? Absolutely 100% yes.

End of rant.

Here here lifeistooshort.

Tugging on the placenta in one persons opinion is controlled cord traction in another persons opinion.

Sad sad sad case, for all involved.

Absolutely very sad case for all those concerned and in any event only those in that room will even know or be close to know what happened and this won't bring the poor mother back

lifeistooshort I hope you don't think I was passing judgement on this MW as that was not my intention. I was answering questions about the process. and I explained that to a non professional it can look forceful without the technique being wrong. Also, I answered a question on what action might be taken on the MW's practice IF the inquest upheld these allegations. People don't generally know what happens after they see the sensational headlines and it is common for knee jerk reactions to such an emotive case. If my attempts at clarity seem judgemental, I apologise.

Yep, PPHs happen in hospitals too. And if they're left untreated and a woman dies because of that, then the hospital rightly gets sued.

I do not understand how a third of a placenta could be overlooked and why no ambulance was called.

My mum nearly died after they pulled on the cord to get the placenta out after the birth of my sister and left half of it there. She hemorrhaged pints and pints of blood. I am amazed they still do this.

trafficwarden no don't worry it wasn't your post. Your explanation was very clear and fair.

It is such a sad story. This midwife was warm, wonderful, passionate about her job and the ability to support women with their choices and no doubt it is wrecking her life and her family's too.

And on the other side there are two children without mothers and a widower such a tragedy for all involved.

I don't know how you can miss a third of the placenta and perhaps she did make a mistake or perhaps there is a valid explanation but she certainly isn't the incompetent cold negligent person that she is depicted to be in the press.

Not having called the ambulance is not necessarily solely the MW responsibility. If she checked her client and that she has satisfied herself that she was okay when she left she might have not forseen it.

There are a few things missing in this story.

www.mumsnet.com/Talk/am_i_being_unreasonable/1557918-to-think-this-midwife-should-be-struck-off

www.telegraph.co.uk/health/healthnews/9523610/Mother-brainwashed-over-home-birth-dies.html

I am sorry lifeistooshort but i find this comment totally chilling.

She denied trying to persuade the couple to have a home birth but added: ?Claire had a great pregnancy, she had a really lovely spontaneous birth at home and I hope Simon in time will remember that.?

This comment says to me the mw is missing something here!

Life

It IS possible that altough she has had a good track record on this occasion her actions led to this womans death.

I guess we will only know at the end of the inquest.

Knowing someone personally and even having good care for yourself - doesnt mean there isnt potential for neglience.

The husband said the cord was tugged agressively and an expert has said this sounds odd and could have snapped the cord.

she also said 30% WAS A VERY large peice of placenta to miss, an expert who has seen thousands has said that.

I had a physiological 3rd stage with my first in a MLU, where the midwife got started tugging after a couple of minutes of the baby being born.

I had a pph.

I agree eliza its a very cold attitude to have even if it has been taken out of context I can't think of anything she could have been saying that would make that comment less heartless.

I have no doubt this midwife has been great with the majority of her patients, that doesn't mean she hasn't been negligent in this case. From the facts I have seen reported and not taking into account what the father said, I can't see how this midwife isn't to blame.

As someone on the other thread said - why defend this as a great labour????

unfortunalty i imagine even the very best medics have bad days and can make mistakes - i think its the fact she hasnt held up her hands and said - sorry...but tried to defend this ladies death as a great labour for her husband to remeber that has made me feel so angry about it.

The MW encouraged this woman to have a home birth even though she had had a previous C section and PPH. That is so incredibly irresponsible. It doesn't matter how "warm, wonderful, passionate" she is.

Then to add her comment of "?Claire had a great pregnancy, she had a really lovely spontaneous birth at home and I hope Simon in time will remember that" shows a shocking lack of insight into her own responsibility for this preventable tragedy.

Of course, tragedies happen in hospital, but if this woman had been in hospital for or soon after her delivery, her massive blood loss would have been diagnosed and treated, hopefully preventing her death. This was a preventable tragedy.

life2short - yes your friend made a mistake - and a woman died because of that mistake. Instead of admitting it she has declared that this grieving husband is lying and made a ridiculous comment about a lovely birth ( yes it was lovely till her negligence killed a woman).

Maddening - I haven't read anything that says the husband is lying. She says she did not tug the cord - That does not mean he is lying. If you asked me to describe my placenta delivery with my first I would say it felt like she was swinging off the damned thing. To an untrained person it looks a lot worse than what it is. He is also likely to be unbiased or rational due to the circumstances (entirely forgivable).

The statements given by the midwife, if they are true (and I have personal experience with reporters and tragic stories, so I wouldn't take them as gospel) do seem odd and cold. Like I said though, I wouldn't take them as gospel. She may have said something and they've changed a couple of words which can change the whole meaning of the sentence and the way it is read.

The placenta.. Tbh I find it shocking she didn't notice it yes (although there are variations of placenta, you can have a sort of lobe which if detached could leave what looks like a full placenta), and I think this is the area which should be most heavily investigated.

Unlikely to be**

If the article tells any sort of truth, then the midwife did realise parts of the placenta were retained - she is said to have told the husband it would come out naturally.

To be in the clear she would have to convince the inquest that she never said that.

Or alternatively show why she chose to leave the wife under those circumstances.

She would also have to show that the husband did not have to ring her several times after the event before she agreed to come out, as he claims.

Also, why she did not ring an ambulance straight away when she realised there was haemorrhaging.

My 12yo did better than this during a recent family crisis: he didn't stop to ask whether the patient would want an ambulance called- he realised it was his responsibility, so he did it.

got to dash so can't really reply to all the posts but one thing to bear in mind is that a lot of people who hire independent midwives do so because they are higher risks and would get the birth they would like otherwise in particular a lot of them want to try for a VBAC even where their NHS midwife/doctor has recommended it. It is their choice. I couldn't speculate but it is more likely that this would be the case rather than the MW "brainwashing into having a homebirth". When you hire an indep you also know that they cannot deliver the baby in hosp so usually you hire them either because 1) you want one to one care during your pregnancy and acknowledge the midwife will only be a birth companion during delivery or 2) because you already have decided to have a home birth.

And presumably the DH agreed to the homebirth.