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

ilove - i had a debrief when dd2 was 3 mo with the consultant obs. he told me i was lucky as she was far better off than the other baby disabled that week - a forceps delivery that had severed the spinal cord. i sort of gave up on debriefs after that...

(to be fair, he did apologise for the lack of monitoring, but without monitoring, there isn't a lot of evidence, so any definitive answer as to 'what happened' becomes a bit 'balance of probability'... and there's no way any member of the medical profession is going to admit liability (or even hazard a guess) on a balance of probability in a potential medical negligence scenario. so, all you get is 'we don't really know'.

and 'we don't really know' only gets a bit clearer when it's a lawyer asking the questions and getting independent expert opinions...

dd2 is nearly 7. the flashbacks are pretty much gone now and i'm resigned to the fact that it was probably intermittent cord compression that wasn't noticed due to the fact that they weren't monitoring fhr (against nice guidelines blah blah)

but you don't get compensation for going against nice guidelines unless you can prove that was what caused the brain damage... and you have no proof if they weren't following nice guidelines. nice little chicken and egg scenario

anyway, dd2 is happy. she isn't impressed by being disabled, and is decidely unchuffed when she can't do something that her brother and sister can, but so far she hasn't been too interested in the causation issue. i only hope that the legals finish their wrangling before she really wants to know...

frasersmum - mm, like 1 in 500 for cerebral palsy. you don't see that mentioned in mother and baby...

NickOfTime proving it is so bloody hard though isn't it.
we are 10 yrs in, never know we might get there one day. funny how it all comes down to lack of monitoring(sp)
yet no one tells you how important is when you are giving birth.

I decided not to sue..after all .. no money in the whole wide world was going to bring my boy back

I had a 34 week growth scan.. hubby would have been there but they had told us 2 weeks before they werent going to bother but then changed their mind at the last minute so I was alone for the scan

The mw had a trainee with her and the discussion between them went .. I cant get a reading round the baby's tummy .. ok just get a head cicumference and a femur length

Turns out Fraser was doing asymmetrical development as my placenta wasnt working properly. which means he was pumping what he was getting to his brain and his bones.. weight gain round his middle was suffering

If they had got that measurement they would have known this and done something about getting him out early

When I said all this to my consultant he spoke to the mw who said of course I got the measurement

so even if I could be bothered to sue -it would be my word against hers.

frasersmummy

I developed post-natal PTSD as a result of the poor care I received from midwives during and after birth of dd. For a long time I had a morbid fear of nurses of any kind. Midwives let me down at every stage.

Doesn't this report leave open a big question regarding how many of the claims paid actually had negligence proved (rather than out of court settlements)? And are there more claims because more people feel moved to act when the issue is to do with maternity rather than other areas of NHS care?

Sometimes there is negligence and in those cases people should be answerable, no doubt about that. But sadly sometimes babies do die or suffer a disability and not all the care in the world can change that. Sometimes there really is noone to blame, nothing that could have been done differently, nothing that could have changed the outcome.

There's also an issue of choice and responsibility. Any course of action has risks and benefits and for some decisions the best choice for any given labour will not be clear cut. In that circumstance, how much choice should the mother have? And if the mother is involved in the choices how much responsibility does she have for the outcome?

To me, the bigger problem is that the two issues of blame and compensation are so closely linked in this country - as a parent it seems to be difficult to feel that a truly impartial investigation can be undertaken because there is so much fear of litigation leading to large payouts (even if all we want as parents is answers and the reassurance that the same thing won't happen again). Unless or until we have a system whereby parents are not dependent upon payouts from the NHS to care for their disabled children and/or where compensation is awarded irrespective of blame I don't see how we can move towards investigations where the primary aim is to understand what happened and learn from it.

but sadly sometimes someone is to blame, and hospitals only pay out after verylong legal battles(which cost a hell of a lot)

In the US, where midwives are a rare breed, the most sued medical professionals are OB/GYNs and neurosurgeons. They are, as a result, charged the highest malpractice premiums, and victims of malpractice get large amounts in compensation (often necessary as there is very little in the way of state help for children born with disabilities, for instance, or patients left severely disabled as a result of botched neurosurgery). Patients in the US are not shy of litigation. The result in the case of both specialties is that they charge a lot for their services, and insurance companies effectively get to dictate the standard of care to the doctors, hence a high rate of Csections, much more monitoring of mothers and babies, virtually no home births. Doctors bristle at this 'interference'.

(Frasermummy, if she had got the measurement, she would have had it in her notes, right? Or in the record of the scan?)

tangle - some pcts were going to trial compensation in birth injury cases whether or not negligence was involved - ie a compensation payout regardless of causation - as so much money goes into litigation and defence. no idea whether they did or not. i think some of the scottish pcts, but it was a few years ago now...

The way Ob/Gyn care is handled in the US terrifies me - the options available if you're insured don't seem that much better than those in place if you not, they're just very different. That's not a place I want to see care in the UK wind up, but is that where we're headed?

I've a friend who's a ski instructor in New Zealand. Apparently out there if you have an accident the State pays out. The State then investigates if there are any suspicions and, if there is found to be negligence, the State is the body that sues. In consequence there aren't any ambulance chasing lawyers, etc, as its all handled centrally - and because compensation is awarded without blame being considered it is (or so I've been told) all much more streamlined. This is all based on a conversation we had pre-children and didn't get anywhere near obstetrics or maternity issues - I suspect the scheme doesn't include those types of payouts.

But wouldn't that be a better system?

Yes, sometimes people or systems are to blame and sometimes (often? always?) it does take a ridiculously long time to get issues resolved. But that doesn't meant that all negligence claims are well founded, or that all payouts were made because negligence was truly there.

that's sort of what they were trialling. i can't find anything about it now - google has been taken over by pi lawyers. the problem really with such a system is that it's not that easy to administer - do you go for a 'one size fits all' standard payour regardless of injury? the reason it often takes so long even in clear cut negligence cases is that it can years before the extent of damage and the consequences of the damage are known. a 'one size fits all' approach definitely isn't the answer.

i think the intention was that an initial payout would be made to offset costs for the first few years of life, but that some sort of review would be undertaken and the legals would then take it up to argue extent of injury. just delaying the inevitable really. there just doesn't seem to be a short cut if you want people to be adequately compensated in line with their actual disability, rather than an oversimplification where payouts often don't meet long term needs (or fortunately prove to be far in excess of actual needs in the fullness of time). brain injury is a funny thing. no way of predicting at birth what the child will be capable of in 5, 6 or 25 years down the line.

i honestly don't know the answer, but coincidentally had an e-mail from the solicitor today. i'm really running avoidance tactics.

"Yes, sometimes people or systems are to blame and sometimes (often? always?) it does take a ridiculously long time to get issues resolved. But that doesn't meant that all negligence claims are well founded, or that all payouts were made because negligence was truly there.2

Sorry but that last bit is illfounded. I can only assume you have never been through this your self.
you ave to prove that there was negligence.
the hospitals don't just pay out, you have to get loads of proof.

I have just requested ds labour records but it's the obsetrican that is in question and the senior midwife.

The midwife on with me called the senio one in as ds was declerating and staying down for 5 minutes or more .she then decided just to leave it .my same midwife then took the ctg to registra who decided to wait and see despite midwife saying to him maybe we should just do c section

later another obstrcian did internal said was sure baby not head down anymore but was told no scan this morning said was ,in end he was over ruled by consultant who left me with mild contractioncs back up on antenatal ward all night no montoring except 20 minute trace

Next day they finally decided on c section and well ds was transverse breech wrapped in cord .To me seems that the declerations were indications ds was struggling

Slightly harder as ds problems only became obvious as rime went on ,was told ge is just delayed finally saw neuro who spotted erm nope he has cp.Ds needs lots of things the nhs won't or can't provide and end if day if they made the mistake and not talking forgetting to turn computer of or wrong letters sent .Were talking a life changing mistake which my son is paying for

Oh and am not in habit of suing Drs/nurses etc dd medical condtion was missed told for 2 years that it's not that unsural to be in out hospital every month was just unlucky

took one curious dr who had read something once to wonder and he was right but dd condtion is very rare so felt was something that could not yell to much that Bren missed .Though dr that dx well no words to thank him

But if mistakes ate preventiable then when it has a lifelong effect then things need to be put in place make sure does not happen again.end of day us and our dc are ones that have to live every day with the problems that arrise from that mistake

this is taken from an article about stillbirths in the news this morning and I reckon it underlines my point ..

In previous reports, half of the deaths were unexplained. This new report suggests a significant number of these are in fact associated with failure to grow properly in the womb.

Intrauterine growth restriction may not be the cause of death per se, the CMACE report notes, "but its recognition can lead to alternative management and outcome".

WHY ARE THEY ONLY REALSING THIS NOW - I COULD HAVE TOLD THEM THIS 6 YEARS AGO

sorry small rant but surely if I knew this as a mum the midwives and doctors knew this before now

I had ds in Italy and dd in the UK and I was shocked that the nhs doesn't offer a routine scan in the 3rd trimester.

A scan at around 32 week is routinely done here in Italy to check on the health and function of the placenta and the umbilical cord.

franca - mm. dd1 was born in germany, ds1 in canada, and dd2 (the slightly broken one) in scotland - my only nhs baby.

i do know in my heart that it is probably irrelevant, but i do often wonder whether the outcome would have been the same elsewhere(we moved back from canada to have dd2 born in the uk - with 3 littlies we wanted to be nearer rellies for a few years). but then it might have gone the other way, and she might have died. impossible to call, really. pg/ birthing policies vary so much country by country - tis fascinating.

Yes, I totally get what you mean Nickoftime.

I really believe good ante natal care is essential, and I honestly find that it could be better in the UK.

It's lack of staff not lack of training, the midwives know their onions they just don't have the time/manpower which is an absolute disgrace.
I know people who would have made excellent midwives not get on to the degree course due to their A Level grades but they have the people/practical skills required. And like many other areas of the NHS staff are leaving in droves because the role isn't challenging enough for the A* students.

I don't think it is necessarily lack of training or lack of staff sometimes I think it is more to do with their attitude. I certainly found my mws to be very flippant and dismissive - they were trying to force me to have a home birth when I needed a c-section and the information given was just simply incorrect. I was for example told that no woman has ever died as a result of a natural birth and that c-sections are not performed by doctors...

You have to remember that these midwives are being left with more patients than they can handle at one time. It is the same with the RN's on the general wards. They have no set nruse to patient ratios in this country and when a Nurse or Midwife has too many patients at the same time he/she will drop the ball. They should do something about the intentional short staffing of professional trained staff on the wards (amaternity and otherwise) in this country.

On the maternity ward at our hospital they left one midwife and one health care assistant to cover the whole suite. Happens regularly. Even if the midwife is excellent, the patients are still in danger.

Sorry for the typos. I just did a night shift last night as the only RN for 30 patients. On the shift before mine a patient died because the lone nurse has 3 emergencies at the same time. I have spent the day unable to sleep worrying that someone died because it was impossible for me to stay on top of everything. My trust has had a recruitment freeze on Trained Nurses and Midwives for years. All they do is hire more finance managers.

When we tell them we need more trained staff they simply laugh at us. Unions are unable to do anything about it and it is the frontline professionals who get held accountable for mistakes and omissions, not management.

The only staff they seem to hire are untrained auxilliaries who can't help very much or do anything. They are put in the same uniforms as Nurse's so that the public thinks that there are plenty of "nurses" on duty. Sucks.

In countries where midwives are respected and have a lot of power, maternal and infant death rates are lower. IN countries like the US, where there are no midwives to speak of, infant and maternal death is sky high, as is the c-section rate.
Midwives are always witch-hunted.

Very true what GirlofCadiz says. Where I work I think our staffing levels are bad, certainly low enough to leave me in tears at the end of a stressful shift where I just haven't had the time to provide proper care. As everyone is so stressed sickness rates are high, every shift the last 2 weeks someone has been off sick and no cover has been arranged.

I was looking after 14 women on the p/n ward the other day, 2 of whom were quite poorly.

Saying that we have a new m/w who has moved from a hospital where on a 30 bedded ante/post natal ward they would only have 2 midwives per shift (normal staffing levels) and on a night shift there would only be one m/w. The hospital had a number of these 30 beded wards and if at night a m/w from one needs help/drugs checking another m/w has to leave her ward with just a health care support worker and go and help. That really shocked me.