midwives involved in more negligence cases than any other front line staff

[frasersmummy]

link here

If this is true surely there should be a national campaign to train midwives properly

How many babies need to die before the NHS do something about it

doesn't surprise me at all. I am always surprised that it isn't made more public.
it isn't only about babies dieing but a lot are severely brain damaged as a result.
yet nothing is done. crazy

What other front-line staff are involved in activities with such significant potential consequences, where it's so clear exactly who was involved at the time and there's enough documentation to attempt to argue negligence?

Most negligence cases in the NHS are always going to be involving births simply because of the costs of raising a child who's been damaged at birth which could be met if a claim's successful. That doesn't necessarily mean the practitioners are more negligent (they may or may not be)

One of the problems is that CTGs can be difficult to interpret. We have to do yearly CTG training, it isn't something that we can just leave. But even with yearly training and regular exposure you still get some where something could easily be missed as it doesn't fit a normal pattern. You could think the baseline is fine and there are acclerations where actually the baseline is high and there are decelerations. Sometimes decels are ok, sometimes they're not depending and what sort they are and when in labour they are. I hate CTGs, they do scare me a bit sometimes.

I've been in charge of the ward today and had other midwives bring me CTGs and asking me for my opinion. I do always stress if we're not sure, ask a Dr.

There was a ad on the TV the other day, like the "have you been involved in a car accident, if so ring this number for compensation/legal advice", but it was a "have you been involved in a birth/labour/pregnancy where you're not happy/something has gone wrong". That saddened me, where the has been negligence and a baby has died/been harmed then obviously compensation must be paid, but I do worry that we're going down the route of obstetrics been seen as a "cash cow" and people claiming for anything.

The only claim I've had against me was someone who got a pressure sore and she tried to claim for compensation, may still be doing for all I know. She'd certainly instructed a solicitor. She was a lady with a very raised BMI who had an epidural and ended up after a long labour with a pressure sore. She claimed she hadn't been encouraged to move position enough. Thankfully my documentation showed I'd encoraged lots of position changes. But its just so scary. Its one of the reasons, tha main one I'm thinking of leaving the job.

Its not surprising at all - but it doesnt mean that midwives are not properly trained. Midwives work in a high risk, high stakes envionment.

That isnt to say that all midwives are perfect either, but this is about the area they work in, not the skills of the individuals involved.

but I do think midwives should have a general nursing qualification then specialise in midwifery if they should choose to do so. As a correlation lawyers in their training experience many different areas of law then specialise into their chosen areas. I think this should happen with midwifery rather than the "direct entry" courses.

Most of the midwives I have met were trained properly I think. Ok, some were clearly better than others and one was downright callous but that could go for any profession.

The more time I spend with medical types the more I realise that medicine is often an art - full of judgment calls. So a midwife might cock up, but then so might a registrar who wants to use forceps when it isn't appropriate or who misreads the CTG and announces the baby's heartbeat has slumped (I've had both happen). Perhaps the difference is sometimes that when things go unpredictably wrong for a MW she's been relying on her judgment, whereas a doctor will have a CTG print out with which to cover his backside?

I think the big problem is insufficient staffing on the labour and delivery wards AND that we live in a culture that seems to have forgotton that childbirth is very very very risky, that is why thousands of women and babies died during birth only decades ago.

Medicine is full of unknowns, it is not straightforward scientific fact. When individuals are having surgery things go wrong, during childbirth there are usually at least 2 lives at stake.

Doctors in obstetrics pay defence organisation fees much higher than doctors in other specialties, because of the amount of litigation that they are subject to. This is not because they are generally less competant than thier colleagues in other areas.

bit different when you are on the receiving end though and live with the aftermath of the cock up.
surely it wouldn't be that hard to make sure midwives are properly trained and supported.

I would totally disagree that you should be a nurse before being a midwife. How would that help? Totally different careers looking after very different people.

I trained as a direct entry student and 18 months into the course the qualified nurses joined us for the last 18 months. They said it themselves that the only ransferrable skills they had was been able to set up IVs and being confident in a ward environment.

Everthing else was totally different, they had no previous skills in interpreting CTGs or supporting women in labour. I'd go as far to say that they're in a worse position on qualifying as they only have 18 months to learn this, I had 3 years. NMC are thinking of stopping hte 18 month course because of this.

I know in the Netherlands 15 years ago their midwives had far more extensive training than our midwives at that time, they were pretty much fully qualified drs.

I still think the biggest reduction would be brought about more staff and much much much longer working in pairs/teams because surely as judegment calls are so frequent experience counts for an awful lot?

Halib - quite right. Science informs medicine, but medicine itself is an art. It's about patient care, not about elegant formulae.

Midwives are well trained and the majority practice safely. No human being can practice 100% safely though and birth and pregnancy are risky times for mother and baby. By reacting to one risk you sometimes only produce another - so a CTG suggests a possible problem - leading to a c-section which has risks to mother and baby - or an induction with risks to mother and baby - or the midwife waits to see if things improve - and that has a risk to the baby and potentially the mother too. Birth is dangerous - even in the 21st century. I don't think anything is to be gained by demonising those involved in it - who deliver thousands of babies each year safely and who save countless lives through the wise exercise of their professional judgement.

I bet that if all women were attended in labour by a MW they knew claims would fall.
The reason I say this is that maybe then you would have discussed the "what ifs" - the bits about when to wait (as NL describes) and when to act and what the patient wants. It would also mean patients understanding the sort of judgment calls that might be needed.

Of course, that wouldn't stop outright negligence but might help with the more "shades of grey" cases.

Just seeing the same midwife 2 appointments running would be a start!

halib - am currently years into legal proceedings after dc3's birth. the attending mw was the mw that had completed all my antenatal checks from 28 weeks - i knew her quite well. it was luck that she was there when i went into labour, and in fact she stayed on well past the end of her shift to deliver dc3. i certainly trusted her.

unfortunately she was also supervising a trainee, and the trainee was carrying out most of the observations etc. they lost the trace of the ctg and so the student was having lots of difficulty finding fhr. for about an hour.

dc3 has significant brain damage and cerebral palsy. i have absolutely no suspicion that either the mw or the student was intentionally negligent, merely that they were 'unlucky' in our case. i decided to instigate legal proceedings because i felt that the supervision of the trainee was inadequate, and the monitoring during the labour clearly fell outside nice guidelines (previous vbac).

it was actually extremely hard to decide to instigate legal proceedings against a woman i had got to know and trust over the course of 12 weeks. i still wish i could sit down and talk it through with her. but of course i can't. it's no-one's fault, it's just one of those things. but unfortunately my daughter's life has been forever changed by 'one of those things'... i wouldn't want women to not pursue a legal route because they knew the mw.

sadly, often the legal route is the only way to discover the truth of what happened behind the reticence of senior medical staff - and the only way to hope to change policies and procedures in the hope that bthe same thing doesn't happen to another family. i do resent the money-grabbing implications... we are unlikely to receive any compensation, for example - but that wasn't the reason we took the legal route.

I made a complaint against one MW but didn't take it further because I suffered no long term problems but really I just wanted them to look at the procedures!

Said MW told me I didn't need a wee after delivery despite me asking several times, had to wait 4 hours in the end until I was back on the postnatal ward. I think what happened is she thought I had a catheter because I'd had an epidural however as she'd looked after me the whole way through she should have known!

Was really unwell afterwards and had the most horrific after pains, my next 2 births I didn't feel like that all so I do think it had a significant impact.

I think notcitrus has a good point: negligence can happen in any parts of the medical profession and accidents certainly do, but it is the parents of a birth damage child who need to sue for money.

Dh's family strongly believe that my FIL died partly as part of neglect by the hospital, but there was little point in suing: he was dead, so no money could make him better, and he was 93 with a dodgy heart, so would probably have died soon anyway, and MIL (who was there and saw what went on) was herself elderly and in poor health- not the conditions under which you sue really. If the same amount of negligence had gone on and left a child that would need support throughout life, of course they would have gone down the legal route.

NickOfTime you make good points.
a lot of people pursue claims just to get answers.
midwives should be better supported so that if things go wrong it doesn't all fall on thier shoulders.
when it goes wrong and the only medical person in the room is a midwife, valuable minuets are wasted getting a doctor.

nick can't you get a meeting via PALs for a debrief, or would they be reluctant to do this as legal proceedings have been started?

"we live in a culture that seems to have forgotton that childbirth is very very very risky, that is why thousands of women and babies died during birth only decades ago."

I think Cargirl makes a very pertinent point. In the drive to push down the CS rate and with midwives supervising most births, VBs are "sold" as physiologically normal and safe and the risks are never discussed with women.

Midwives are very keen to discuss the risks of a CS, but very reluctant to go through VB risks, or post-natal complications and disabilities.

but surely in 2010 it should now be a lot safer.
surely lessons should be learnt and measures put in place to stop babies dying or being"damaged"

2shoes, in 2010 it is a lot safer!!!!!

Yes lessons should be learnt and measures have been put in place, but again it comes down to money doesn't it. If we could all have 2 experienced midwives for labour and delivery with a surgeon on hand I'm sure the incidences would be fewer. However things would still sometimes go wrong,

why is childbirth so risky though I dont put the blame purely on the midwives

I think the midwives need to get behind a national campaign to make child birth less risky for eveyone..

whether thats more scans, more people in attendance, or more training I dont know

but its about time the scary statistics of stillbirths, neonatal deaths and disabilities was brought out into the open

Too many people dont know it still happens in this day and age. I didnt till it happened to me

frasersmumm i agree i think they should give out the fugues, i think people would be horrified