Don't be put off home birth or independent midwives by this story...

[emmahere]

I just wanted to share my thoughts on a story in the news today - Midwife 'butchered' mother in botched delivery. More poor reporting that might scare pregnant mothers

It is on my my blog

I agree with you that we only see half the story here.

I was quite irritated by all the outpouring of 'See, I always said home births are dangerous' yesterday, too.

It's as ridiculous as saying Harold Shipman is a good reason to avoid the GP.

Midwives are health professionals. Occasionally a bad one slips through. There are obviously some questions about what this one was doing and whether it was malpractice - we only have one perspective on what happened (and a biased one at that in the news).

In my experience, I've met far more women who have been unhappy with the behaviour of their hospital staff than the staff at their home birth (who they have often chosen themselves) - and far more women who have sustained injury in hospital.

Not defending bad midwives though - you can have bad doctors, you can have bad midwives. But put them up to a proper trial, don't judge them through the media and don't use one bad apple to judge the entire practice of midwifery.

To be honest it has put me off. Quite aware that this is a very unusual case, but I can't say the midwives I have met have inspired me with confidence! I've had midwives make some shocking mistakes when my dd was born and I was relieved to be consultant led and thankfully all ended well when the doctors took over.
I will be consultant led this time round, too, so at least I know things should go well, even if it means more medical involvement than I would like.
It's very well to say this story is scaremongering, but it doesn't exactly help, does it.

No Baby Giraffes, it doesn't help. And if you saw the mother on Good Morning just now - that wouldn't help either. BUT, as someone who is trying to persuade the "bad" midwife to tell her side of the story - you might be interested to know that the midwife had already come up against the Nursing and Midwifery counciil five years ago who had deemed her fit to practise. It takes a midwife of great skill to deliver a 121b baby at home with shoulder dystocia (where the shoulder gets caught behind the pubic bone) - and an inexperienced midwife who would have delayed the proceedings might have ended up with a brain damaged baby.

And some of the draconian bits of the book thrown at her ("inducing labour when unnecessary" were about breaking the waters at the mother's request.

Whlie a whole raft of incidents militated against this birth being an easy home birth, that mother could well have ended up "hacked to bits" in hospital, without a live baby to cuddle at the end.

And what a gorgeous little thing she was on This Morning, fiddling with both fingers at her velcro trainer straps.

But the fact is she had her baby at home and this midwife did this damage.

I had an independent midwife come to me and she took it upon herself to do a procedure without my knowledge or permission that could have ended up in the death of my child and me and she was given a severe bollocking for it. I always check who it is when I hear anything about IM now.

Emma - I cannot get your blog to open. Can you tell me what the issue was?

Found the story here

emmahere - are you saying this midwife had already been before the NMC and she is now there again?

"so at least I know things should go well"

Because obstetricians never make mistakes or get accused of malpractice do they?

I remember one particularly hideous case a couple of years ago when a baby was killed by a doctor attempting a forceps delivery in a case of SD.

"But the fact is she had her baby at home and this midwife did this damage"

Another way of looking at it is that the midwife did well to deliver this baby alive on her own and without support. The mother is likely to have sustained serious birth injuries in hospital and erbs palsy is also a common after effect of sd deliveries - in hospital or at home.

My concern about this midwife's practice is more focused on the quality of the mother's antenatal care and whether she was aware of the likelyhood of SD given the size of the baby she was carrying. I'm also puzzled as to why the mother was delivering in the pool and why the midwife had no back up, given that she (I assume) knew of the mother's diagnosis of GD.

the midwife in question has been struck off - NMC report

This story is not about the safety of homebirth. This is about competency and there are a number of failings here.

There is no doubt that homebirth is a safe option.

Good grief. Just read report.

That poor mum.

Yes Mears, the midwife Sue Rose had already been up against the NMC over this same birth five years ago, when they found that she was still perfectly fit to practise.

Then - the mother keen for compensation no doubt for the Erbs palsy - took on a highly aggressive firm of lawyers and went after the midwife again - this time throwing the book at her. Remember that "failing to accompany her in an ambulance to hospital" could also be about the midwife following the ambulance in her car to arrive at the hospital simultaneously.

For the record, the midwife who has been through the mill over this is having a breakdown - that's why she couldn't come to the NMC hearing.

Yes, there are some questions to ask (but "Failure to get her to a 37 week scan" isn't one of them) and certainly birthing a baby that big at home is doable. But with hindsight the midwife should have covered herself with extra support as two is typical with IM homebirths ( I had three for my twins at home - one for each baby and one for me)

But, until the midwife gives her side of the story - it is a tale of an experienced practitioner following an emergency procedure to birth a baby which was stuck in the birthing canal, and if she hadn't been born quickly that baby may have died or suffered brain damage. It wasn't pleasant, but she knew she had to birth that baby, and she needed to birth her quick.

There may be lessons to learn, but what would Victoria Anderson prefer: an intact perineum or a bonny baby?

If you look up the insurance details - the second most commmon reason obstetricians in hospital get sued is for problems resulting from Shoulder Dystopia.

My eldest has erbs palsy. It was shoulder dystocia. the DOCTOR pulled his head and screamed for help and pulled his head again ! It was the midwife who took over when the doctor panicked!

giving birth in a hospital is no guarantee. ime, most midwives are better than doctors at delivering!

Emmahere, thanks for telling this story.

I don't know the facts of the case (most of us don't know any more than has been in the news), but I do know some very experienced midwives and birth professionals that I respect are getting behind Sue Rose. I strongly feel her side of the story deserves to be heard because it sounds as though there is much more to this than meets the eye.

Shoulder dystocia is a scary complication and quite honestly, I would rather have an experienced midwife than an ob deal with it. Sometimes birth can be horrific - there's a few awful stories on here about manual placenta removal for example - in hospitals.

Home birth remains safe. I'm worried this case will have very bad knock-on effects in the UK, just as some poorly managed VBACs in the US have endangered the whole practice of VBAC over here

Emmahere, I appreciate what you are saying and it would be good to hear the midwives story. However I cannot understand why an experienced practitioner did not have a second midwife and why she failed to follow the HELPERR mnemonic which is a recognised drill for shoulder dystocia.

"However I cannot understand why an experienced practitioner did not have a second midwife"

Yes - this is an important issue and my main concern.

"why she failed to follow the HELPERR mnemonic which is a recognised drill for shoulder dystocia"

Mears - there was an interesting article in Practicing Midwive a few years back by Tricia Anderson about needing a different sd drill for homebirth. She questioned whether the midwife should call for help if this wasted precious minutes when the SD, as most are, would likely to be resolved immediately with a simple manouvre. Obviously if there were two midwives present this would be different, but for a mw on her own at a homebirth.... She also questioned the 'evaluate for episiotomy' and 'legs in mcroberts' for a lone midwife. Her suggestion was that at a homebirth in certain circumstances maybe MAGIC-P would be a more helpful acronym. I can't remember how it went, but involved the Gaskin manouvre at some point.

Not suggesting that this midwife deliberately chose not to do HELPERR as a strategic choice to deliver the baby, but it was a thought I had when I read the report.

Whoops - it was 'MAGIC R'

Here's the abstract:
There are other shoulder dystocia mnemonics to be found on the internet, in obstetric textbooks and in assorted hospital protocols. Clearly there is mileage in the same mnemonic being used throughout hospital-based practice within the UK to avoid any confusion and streamline clinical practice, and the HELPERR mnemonic seems to have assumed this role admirably. However, for the midwife working at home it does not appear to be appropriate because: it is not in the most useful order; it does not allow for several other; manoeuvres that midwives have found helpful; * it is not always user-friendly and memorable. It is hoped that this article will prompt debate and discussion around the appropriate management of this rare emergency at home; and that midwives, should they choose, will be able to employ MAGIC R. PSAZZ as their mnemonic of choice in the homebirth setting. However, it is important to end by emphasising that no mnemonic or protocol should ever be more important than the clinical judgement of the clinician, which remains paramount throughout. The precise order of manoeuvres and actions will vary according to the situation and the midwife's communication with the woman, and her analytical and decision-making abilities remain crucial.

that's interesting emmahere, and I'm glad you've put a different perspective on this story. There is another thread on this story.

Mears - during my second home birth, I only had one midwife. She had phoned for the second midwife but I knew she had phoned too late - I was already 7cm and I knew it would only be minutes before the birth.

As it happened, ds was born fine, although the cord was around his neck and it looked like he was getting stuck but fortunately he didn't. I then bled a lot after the birth, and I think my midwife found it all a bit stressful, and was very relieved when the second midwife finally turned up about 20 minutes after all the drama. I was very happy with just one midwife as I knew another was on her way.

standandeliver - I essentially agree with you and I teach emergency drills. For midwives the best option may be the Gaskin manoeuvre and at homebirth that should certainly be tried. However, before jumping into internal manouevres it would be better to try McRoberts and suprapubic pressure if at all possible. The majority of shoulder dystocias will deliver this way without the need for episiotomy.With this woman's history a second midwife should have been present (large baby)and the husband would have been able to assist.

Belgo - at home birth there should always be 2 midwives in the UK. That is standard guidance. Things would have been different if you were haemorrhaging and your baby needed resuscitation. One midwife cannot deal with both.

"With this woman's history a second midwife should have been present (large baby)and the husband would have been able to assist"

This is what I had for my hb following a diagnosis of gd and big baby. I had also discussed the sd 'drill' with my midwife and knew what to expect. When SD did happen hb I seem to remember pulling my own thighs back onto my chest! (I say 'seem' - it's all, understandably, a bit of a blur!)

Mears, as you know - often there aren't two midwives present in the NHS because of the shortages. I have been at both my sister in law's VBACs at home with just one NHS midwife present and me huffing and puffing beside SoL. Both births went famously well.

With regards Sue Rose, she prefers to practise alone - and the previous two babies were 10lbs and the first 9lbs. Without having another midwife present, she also left herself vulnerable to a She-said-he-said case with no one to back her up.

There could still be some good that comes out of it. The mother suing Sue Rose (independent midwives have no Personal Indemnity Insurance and can only be sued for negligence) is trying to campaign for independent midwives to do so. The aggresive firm of lawyers are trying to sue the Secretary of State for Health for the lack of insurance, knowing that Sue Rose has none to give. This is the same end that the independent midwives have been trying to achieve by setting themselves up as "social enterprises" and jumping through all sorts of government hoops to qualify to be contracted in under the NHS trust.

Ironically, Victoria Anderson's case might just help the cause on its way.

P.S Belgo - can you post up the link to the other thread on this story - can't seem to find it.

Thanks

here

I think that the link provided on the other thread by Sassybeast answers a lot of the questions raised by the brief news reports.

Emmahere - do you think that the level of ante natal care provided was adequate ? (Given the charges proven in relation to absence of fundal height and BP monitoring ? )

How can not acting on 2 episodes of glycosuria be justified ? She admitted herself that she regretted not doing so ?

And whilst the midwife may be suffering from extreme stress at present, why didn't she apply for an adjournment of the hearing, as she is perfectly entitled to do so under nMC regulations ?

I'm also intrigued by your justification for prematurely rupturing the membranes being that the mother had asked for this to happen. This is not mentioned at any point by the registrant according to the NMC report. And how can a woman requesting a procedure be regarded as a valid reason for carrying it out ? A midwife is a trained professional and needs to make clinical judgements based on clinical presentations and advise a mother accordingly. I asked my midwife to put me out of my misery in labour - am quite glad that she didn't act on it Which perhaps make light of the situation but hopefully illustrates why claiming that a mother made a request is a valid reason for carrying out a procedure without clinical indication.

I am absolutely supportive of the right to chose a HB by the way, but I do think that this case has raised huge issues about the competence of 'this' midwife. I'd be really interested to get hold of the NMC ruling from the previous hearing if you have a link or source for that ?