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 would love to be an IM but I would not take on such a risky job. Childbirth can go wrong even with the best level of care and this is a litigious society.

I prefer to improve standards in the NHS and am very fortunate to work in Scotland where the shortages are not like those of England.

I am concerned that Susan Roase 'chose to work alone'. She has put herself in a horrendous situation without anyone able to corroborate her side of events. The NMC will take the side of the complainant when the midwife has poor record keeping. It is a sign of poor practice.

Mears - I think the chosing to work alone 'can' suggest either a degree of arrogance and an incredible belief in your own capabilities, which is hugely dangerous in itself OR an attempt to cover up a LACK of confidence and competence. Does anyone know if any of the other cases that this midwife handles will be looked at in terms of practice ? It would be interesting to see if the lack of basic ante natal care of which she was guilty in this case features in any of the rest of her case load.

I too wondered why there was a previous hearing. Okay she was 'cleared' but why was she there in the first place? Is it normal for MWs to be up before the committee more than once?

First - there is a "Friend of Sue Rose" facebook page which is a collection of former clients of Sue Rose's who are unified by their upset of the negative reporting last week. They have used her and know her to be the competent, caring and professional midwife that she was deemed to be and not the "bad" one the press would make out. The face book group is here of Sue Rose

As for previously being "cleared" five years ago, this was done after the event by the local NHS arm, who deemed her professional conduct as fine and did not refer her to the NMC (sorry I have since checked that detail about her first NMC hearing, and it was a local hearing not an NMC one). The point being that at the time she was deemed fit to practise and not unduly criticised. It was only later that she wss referred to the NMC.

The NMC, for the record, is a strange set up, and the Association for Improvements in Maternity Services AIMS is campaigning for Independent Midwives and Home Birth practitioners to be judged by their peers, or those experienced in home birth, rather than random professionals who may have no knowledge of the different midwifery-led, rather than obstetric-led, practices.

As for adjournments etc, the NMC is not run like a legal court and meetings are cancelled at last minute on the day, or moved to another venue and time - often without the defendant being consulted.

Yes there are questions to be asked - big babies, practising on her own, artificial repture of membranes - and there is no doubt that Sue Rose left herself open by not "covering her back". But independent midwives are there to offer Women-Led services, where We The Client are in charge, and if we want to Hula-Hula Dance around the room naked to get our babies out, they are going to support our decision to do it, not tell us we can't.

Perhaps the most unusual aspect of this case is that the mother/midwife relationship broke down. Perhaps because Sue Rose had to fly out the next day to a conference, and couldn't give that great level of postnatal one-on-one care that IMs usually offer and that helps one come to terms with whatever outcome befell you. Who knows what poison whas dripped in the mother's ear without her there.

And yes, if IMs do get pilloried like this - who would ever agree to become one? I can undertand why Mears would baulk at the idea - although no doubt Scotland would need her! Without IMS who is left to give mothers that real Choice in Childbirth that all those politicians bang on about.

I do concede that there might well have been some pressure from the mother not to go for a hospital birth. She had already had two DCs (non?) and must surely have known why tests were done and what results might imply. Of course it is entirely possible that even if she were equally gung-ho for a HB at the time she might put a slightly different slant on events now, given the litigation, so I suppose one can never say. I also agree with another poster that, having heard her on Jeremy Whine, the issue of 'compo' seemed to be a number one priority for her. On the other hand its easy to say that when nothing as devastating has happened to me or my DCs. I might well be baying for blood (and money).

But when all is said and done the MW is supposed to be a medical professional. No i don't actually think she should agree to the mother giving birth whilst doing the hula hula if all the indications were that this might be a high risk strategy. She should have referred her to the hospital for advice/not induced/not gone ahead alone. The fact that she acted otherwise indicates that she is quite simply not 'medical' or 'professional', no matter how nice her other clients thought she was.

What about the level of ante natal care ? Do you still believe that to have been adequate ? And I'm slightly perturbed by the fact that you justify the action of menbrane rupture at a womans request ( something which their is still no proof of) by likening it to dancing a hula around the room naked. I'd prefer you to respond to my point about a midwife being trained and experienced in guiding a woman through making birth choices. You actually make it sound that you will do 'anything' that a woman requests which is fantastic in terms of empowerment but when taken to the extreme, is potentailly fatal. If that involves adhering to all requests regardless of clinical risk or indication then that is quite a scary prospect.

I honestly think that the blind justification of this midwifes actions, with the underlying current of an NMC 'conspiracy' will actually do as much damage to the reputation of IMs as the media. I appreciate that she is perhaps a colleague and a friend but the facts of the case are that her clinical practice fell WAY below a safe and acceptable standard. What I would like to see is an acknowledgement of that and positive action to ensure that it doesn't EVER happen again, be that through regulation, monitoring, education etc.

Sassybeast - for me the issue is about whether this mother made an INFORMED choice to have her baby at home, and to decline obstetric care.

As I mentioned earlier - I was in a very similar situation to this mum with my second baby, and I did decline obstetric care for my labour, despite knowing I was carrying a big baby, and despite knowing I had gd. My midwife didn't advise me to have a home birth or not have a home birth. Based on my previously having given birth successfully to a baby well over 9lbs, she felt that my chances of birthing my second baby in sound health without intervention were very good, and she advised me accordingly. She was right.

I would very much like to know more about the discussions this mum had with her midwife surrounding her birth choices.

BTW - I can't see any 'blind' justification going in here. And I would also agree that there is a profound lack of comprehension about what really constitutes true 'informed choice' for mothers among the medical establishment, and that this skews the way midwives and doctors are judged in their practice.

Sassybeast and Bellisima - I disagree with what you say but I defend to my death your right to say it! (voltaire's words, not mine...) Am afraid I have to take down the original blog, but before I go...

II know birth is a personal thing - and your view of it (One where a midwife must be following clinical guidelines at all times) doesn't always tally with my view of birth - that women and their bodies are mainly in control, that women have the best sense of what is going on and when they need to get them through the experience. And if that means Hula Dancing Naked then bring it on - even if it is not part of the NICE guidelines. I doubt it ever affected any outcome adversely.

Your view - a clinical (and largely obstetric) one will ALWAYS be in fashion with hospitals and with the way things are going. Despite the fact that the Caesarean rate is more than double the suggested World Health Organisation's 10% suggestion, and the maternal death rate has been on the rise.

It's women that want to do anything that is considered DEVIANT from the standard norm, and I strongly suspect that Victoria Anderson, on her third birth, knew exactly what she wsa doing and what she wanted. Nobody enters into home birth lightly. I don't buy into the idea that she was some ingenue taken on a ride by a "bad" midwife (who is neither colleague nor friend by the way, it's her method of practising which I am defending).

Nor are the midwife's former clients who are setting up a support group on facebook doing so because she is "nice", but because they know She was an excellent midwife who supported them at their direst hour of need with happy results. If she won't speak out, they want to on her behalf.

And the Nursing and Midwifery Council is not some bona fide court. Do get hold of the latest copy of the AIMS (Association for Improvements in Maternity Services latest journal(Vol 21 No 3 2009) which has two similar cases of Independent Midwives (Clare fisher - the only independent midwife in Wales - and Deboorah Purdue) - struck off or under investigation despite clients/evidence to the ccntrary. See here
Currently 10% of independent midwives are being investigated, could the same be said for hospital ones?

As for breaking her waters. In hospitals. latest figures show that 20.2% of women are induced - usually via a drip. Okay artificially rupturing membranes is an old fashioned way of doing the same at home - but sometimes the mother will call for it. I asked my independent midwives to do it for me when I was birthing my twins at home. After four days of labour, with little progress, my mother offered me the information that "nothing happened in my labour with the twins until my waters broke". After that, I wanted to do the same, and the midwives agreed to do it - but only in hospital (there is a danger to the second baby coming down too quick with the cord around the neck). So we transferred to hospital, the membranes were ruptured, and the two babies born normally within 20 minutes. It was my choice, my midwives were happy to wait another four days if that's what I wanted - I was supported in my decision and took responsibility.

Our rights to have any say as women in our births is in danger of being eroded if we jump on the bandwagon and lay into any professional who was just trying to support a mother in her choice to birth her big baby at home.

I don't think we really have enough information to say what happened. I do wonder how "proved" things were, though, when it seems to be the word of the mother against the word of a MW that wasn't present at the hearing.

To me, an IMs defence so often seems to come down to her documentation. A lot of the charges seemed to relate to a lack of documentation (particularly in labour) - but personally, if I was a mother in a labour that had issues with only one MW present (for whatever reason), I'd rather that MW concentrated on me rather than on making sure her notes were up to date...

Re. the antenatal care - again, all that we know for sure is that the measurements weren't recorded. As a question for the MWs, I'm a little confused about how pertinent the whole fundal height measurement thing is. If an inconsistent measurement is taken then there seem to be a whole host of explanations (from MWs I know both in real life and on here) including the baby's changed position or someone different is weilding the tape measure. It does make me think that if you have continuity of care from a skilled practitioner then palpation will do at least as good a job, its just harder to put an objective measurement in a box.

Society seems to be in a strange position at the moment - choice in healthcare is the big new thing, but far more patients seem interested in having the choice than in accepting the responsibility that comes along with it. I have an immense respect for IMs in that they are prepared to support some of the more extreme choices and expose themselves to litigation of this type. However, the IMs I have known all have a comfort zone and will engage in a lot of discussion of pros and cons before they go beyond it - but they also have a duty of care to their client.

A hypothetical question for those who are saying what "should" have happened - would Sue Rose have been better off explaining the risks and then refusing to care for the mother any further, even if she knew the mother would wind up free birthing rather than go to hospital to be under consultant led care?

Thank you for your post Tangle. I agree with everything you say, particularly this:

"Society seems to be in a strange position at the moment - choice in healthcare is the big new thing, but far more patients seem interested in having the choice than in accepting the responsibility that comes along with it".

As a mum who felt completely unable to birth her baby in hospital without the support of a midwife I knew and trusted I also think your last comment is interesting. I know a couple of mums who have, if not deliberately planned to freebirth, have 'accidentally on purpose' ended up with a bba. I would love for someone to do some decent research into maternal psychological issues implicated in BBA's - particularly looking at factors surrounding poor antepartum care in areas like mine, where the BBA rate is four times the national average.........

"Jump on the band wagon and lay into any professional". Hardly. I am simply supporting the view of the NMC - an organisation with far more authority and knowledge than my good self. Your notion that private midwives should be judged by 'their peers', with different standards of evidence and a basic bottom-line defence of "She asked for it!" sounds like an incredibly cosy and incestuous arrangement. I wonder how many private midwives would ever be found to have done any wrong whatsoever under such a procedure, no matter how appalling the outcomes of their services. I am a firm believer in choices in childbirth, including HBs, but for women to have confidence in the system then standards of safety must be upheld. The fact that 'Free George Davis' campaigns are now on Facebook might make them more emotive but doesn't make them any more deserving.

As for Tangles hypothetical question "would Sue Rose have been better off explaining the risks and then refusing to care" etc line - since Sue Rose didn't even bother notifying the hospital of the results of the diabetes tests or carry out proper measurements then this is both academic and ludicrous. I have already agreed that the mother was probably pretty keen to have a home birth. But there is no evidence that she would have 'free-birthed' had she had a proper explanation of the risks. You could pose exactly the same question to any hospital-based doctor or midwife who has to explain to a keen would-be HBer (many have PG tests under the NHS after all) that the medical risks strongly advocate a hospital birth. I mean, gosh, maybe they shouldn't say anything in case the woman rushes off and free-births?

Yes I agree that choice means responsibility and that ultimately that includes the responsibility (to your child, apart from anything else) to accept medical advice. The problem is that in this case the mother didn't receive proper medical advice as the MW didn't even bother doing proper measurements or following up on tests. Add to that the failure to call in anyone else for the birth and the final responsibility rests squarely on her shoulders.

"Yes I agree that choice means responsibility and that ultimately that includes the responsibility (to your child, apart from anything else) to accept medical advice"

I'm puzzled as to what you're saying here - we should all accept medical advice, even when it goes against our own judgement as to what's safest and best for our babies and ourselves?

I'm saying that we should all at the very least have the chance to receive proper medical advice. Unlike this poor mother! If someone doesn't do proper examinations and measurements, and doesn't pass on test results, then you are not receiving the kind of basic information that you have the right to receive, let alone the advice that would come from an interpretation of that information.

What you choose to do with that advice is ultimately up to you. Its a free country. There might be an argument about 'responsibility' for an outcome if you ignored advice - with people taking different sides as is their right - but that is absolutely not the issue here. It is you who are inventing hypothetical outcomes and postulating on non-facts. Fact - the mother was denied access to information and advice by the MW's negligence in not carrying out tests and in not referring tests. Irrelevance - how the mother might have acted had she received any proper information and advice.

I'm puzzled as to what you are saying here about accepting medical advice, as if you are suggesting that this mother was even put in any position to accept or deny it. What kind of information and advice do you consider that Sue Rose offered this mother?

There is a lot of work going on in the maternity services to ensure choice for women and evidence based guidelines. I don't agree with emmahere's assumption that you cannot get the birth you want in the NHS because of adherence to strict policies. As a midwife I do my utmost to faciltate the birth a woman wants. I agree that this can be problematic for some women but as an NHS midwife I am working hard to change that. It is not all doom and gloom for woemn who do not hire IM.

I too support IM practice but stories like this do not instill confidence and if there is another side it would be good to be heard.

Mears - you should read the UK midwifery yahoo group discussion of Sue Rose's striking off. It raises all sorts of concerns and issues which are pertinent to the wider way in which midwifery is being practiced in the UK at present, and which really shed light on some of the more puzzling aspects of this particular case:

here

It's a closed group, though mothers and midwives (and anyone with an interest in maternity matters) can join.

"I don't agree with emmahere's assumption that you cannot get the birth you want in the NHS because of adherence to strict policies. As a midwife I do my utmost to faciltate the birth a woman wants".

Mears - I meet many women who've had fantastic care within the NHS, from outstanding midwives. I have to say though - I'm sick to death of hearing about women's bad NHS experiences, as these seem to me to be just as common as the positive stories. Most of the negative stories I hear relate to women simply not being listened to by midwives, and to women receiving unsympathetic care. It's very common. It's not an anomoly. I think you are probably an excellent midwife who is maybe a bit too generous to your colleagues in assuming that many are providing as effective care as you. I also wonder if you don't hear many women talking honestly about their care - women admire midwives a lot and often don't want to make a fuss. I had very poor care in my first labour, but I didn't know - in the sense I didn't really know what constituted safe and optimal care at the time..

As for an objective view on how responsive to women's birthing needs the NHS is... over 87% of women at our local hospital give birth lying flat on their backs, in stirrups, or sitting on their bottoms. You can go a few miles down the road to a different trust and it's only 64% of women giving birth on their backs. Clearly there is something very odd going on at an institutional level that two hospitals with similar facilities (both large CLU's with birth centres attached), serving similar populations, a few miles apart but with very different patterns of labour care.

Thankyou standandeliver. I too get frustrated at how there can be such differences in care and I am not niaive enough to know that all midwives do not practice the same. It is very sad but we need to keep campaigning for better care within the NHS. Thanyou for the link to the yahoo group. I did join years ago but found that my computer got bombarded with scam mail and viruses. Not keen to do that again!

You need a good firewall mears! I've never had any junk from any of the yahoo groups I've joined.....

I am a stay-at-home mum for my four children, 3 of whom were born at home with independent midwives acting alone. I am also a qualified doctor with a diploma from the Royal College of Obs and Gynae.

Sue Rose delivered my third child. She is an incredibly experienced midwife - about 30 years I believe - and I had no reservations about putting mine and my baby's lives into her capable hands. I quizzed her fully before employing her about how she would manage alone if a shoulder dystocia or a bad post partum haemorrhage occured (probably the only sudden, unexpected emergencies that can occur) and was completely satisfied with her replies. In fact while I was pregnant a friend of mine, who also had Sue as her midwife, developed a shoulder dystocia in her labour and Sue safely delivered her 11 and a half pound little boy by using some of the manoeuvres and both mother and baby were fine. She said at the time how lucky she felt to have such an experienced midwife as Sue in that situation.

There is a real possibility that had Victoria been in hospital for this delivery that the outcome could have been worse - with a dead or brain damaged baby. While I was doing my obstetric training I vividly remember arriving on the labour suite just after a baby had died with shoulder dystocia. This was despite having a full "crash team" present and at least 10 people in the room trying their best to get it out. In this situation no surgical or sophisticated equipment will help - you just need someone who knows what they are doing and who can do it quickly before the baby becomes brain damaged or dies. Erb's palsy is a known complication of this sort of delivery and indeed we were taught that if all the manoeuvres fail you should break both the baby's clavicles (collarbones) to get it out - which obviously leads to a very damaged baby. Indeed in some countries they also break the mothers pelvis at the symphysis pubis to save the baby. This is a desperate emergency and reading betweeen the lines it seems to me that Sue saved that baby's life. Yes it was brutal - but obstetrics can be very brutal and most laypeople are not aware of this. Maybe there were some aspects of the antenatal care that could have been better - it is difficult to judge when we only have half of the story.

I would not hesitate to have Sue as my midwife again (if she were able to practice)and I know most of her former clients feel the same. The reporting on this has been sensationalist and completely one-sided, and the destruction of her career has been like a witchhunt. Victoria has my sympathy for having a traumatic birth, but this was not a justification to destroy a fantastic midwife's otherwise unblemished career and should not put anyone off having a homebirth or employing an independent midwife.

Thankyou for posting mummyliz.

Sadly I think that when everything goes well the any possible problems are not known or overlooked such as poor documentation/record of care. However when something goes wrong, the spotlight goes on.
You may have had a different view if you had a PPH and your baby needed reswuscitated at the same time - I cannot see how one midwife can deal with that alone. The risk is low but it is there.

It is possible that the baby may not have been delivered alive in hospital - conversely it may have been born with McRoberts and suprapubic pressure alone with hands there to help.

It is so very sad all round.

I am disgusted by the one sided sensationalised reporting of this situation. Sue is a beautiful, caring and devoted midwife who single handedly delivered my daughter at home two years ago . It was the most wonderful birth one could have asked for and Sue was completely supportive, calm and attentive.

I am now pregnant with my second child and the first person I phoned to arrange to deliver this child. Unfortunately she had already ceased practicing (I did not know why at the time) but should she begin to again I would have no doubts in asking her to attend this birth.

A complicated birth can occur in any situation, at home or in hospital, and although I do not know the true story, perhaps Mrs Anderson(the mother) should be grateful that Sue handled the situation so competently that her child lived and does not have brain damage as can occur in such a complication.

Home birth is a magnificent thing allowing women to deliver in a safe and comfortable space. In my homebirth I did not require any drugs, not even gas or air, my baby fed well right from the start while at the same time freeing up a hospital bed for those facing a known complicated birth.

This ghastly (and i am sure untrue because I can imagine Sue being heavy handed with anyone!) description of Mrs Anderson's birth should not be taken as any slight on home birth or on the competence of Sue Rose.

I am hoping to interview Sue Rose and speak to her tomorrow - with a view to her giving her side of the story for an article to balance the one-sided press on this so far

If anyone has any questions they feel are left unanswered - feel free to say, and I will ask them for you.

Would be interested in reading/hearing your interview. For me personally, I have relied on the facts as proven by the NMC, rather than any of the media reporting, in forming my judgement of this case.

Good luck in finding her emmahere.

I've been told that nobody knows where she is and her friends are very worried about her. Her husband had been made redundant and she's now lost her home apparently.

Hope she is ok.

I'd be very interested in hearing more of Sue Rose's side of things - although I do wonder how much she can say whilst maintaining her professional integrity.

Sassybeast - that's what I find so hard. The NMC have come to their verdict, but I struggle to understand how something can be proved in the "this interpretation is incontrovertible" sense when the facts they had to work with seem to be the notes written by Sue Rose and recollections that are 5 years out of date, some of which not presented directly to the hearing, and will always be subjective. I also felt that the NMC report was open to interpretation.

Whatever happened, and without trying to belittle the trauma experienced by the mother, its a scenario that would affect any MW in a most profound and traumatic way. Like standanddeliver, I hope she's OK.

Emmahere - just wondering if you managed to arrange the interview ?