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

i agree.

doesn't suprise me one bit

its a bloody disgrace

And if you complain to management that there are not enough staff they come back with "your time management skills are lacking".

2shoes - that was ill phrased and I apologise. You're right in that I've never had the misfortune to be involved in a medical negligence case. DD2 was stillborn - but one thing I'm grateful for (in as much as I can be grateful for anything) is that there wasn't anything that could have been done to change the outcome.

To me it still doesn't feel right that compensation is tied so closely to proof of negligence. Especially when medical negligence seems to be only loosely defined in UK law. I still feel that whilst there is a potential substantial payout if negligence is found, getting an investigation that is truly full open and honest is going to be nigh on impossible. And it will take a long time. I don't understand who, if anyone, is well served by this system other than the lawyers.

I am a barrister - I have done lots of medical negligence cases (both for claimant and defendant), for doctors, midwifes, nurses etc. In my experience, midwives are not more incompetent than other healthcare professionals. Obstetrics has always been the most litigated medical discipline - obstetricians are sued more than any other type of doctor - this doesn't mean they are the worst doctors. Midwives and obstetricians attract litigation and regulatory complaints because their area of practice has more scope to go really wrong, really quickly than any other area of medicine, and when things do go wrong, people tend to assume that it is because a mistake was made, or that something could have been done that wasn't.
Also, the potential value of a claim for care for a baby who suffered a hypoxic brain injury at birth means that most parents will litigate, and lots of no win no fee injury solicitors will take on their case.
If a medical mistake, e.g. in A&E killed your child then your damages would be surprisingly low - probably less than £50,000 for each parent. If you claim for the additional care needs of a brain damaged child who had a birth injury, for the rest of their lives, you are looking at many millions of pounds. Parents therefore tend to claim in these cases as they can't afford not to given the sums involved, and because they naturally want the resources to meet their child's additional needs as well as possible.

Reading this thread I am interested in the dichotomy between the posters above who see the importance of being cautious about the potential dangers of childbirth, and the more typical MN attitude which seems to me to be more along the lines of mistrust of doctors and avoidance of intervention - e.g. refusal to be induced, insistence on homebirth, wanting to avoid medicalised deliveries etc, all of which are potentially dangerous if something goes wrong.

Tanglethat is awful, sorry to hear that.

EmmaKateWH I am sure you are aware that seeing as the claim would be in the child's name they get legal aid(if there is good reason to presume that there is a case)
I have never heard of any one using a no win no fee solicitor.

2shoes - have seen solicitors do these cases on a contingency fee basis numerous times. That's hardly the point of the thread though is it?

sorry didn't realise you were in chrge

EmmaKate,

The thing is, the dangers are rammed into you from birth. YOu need doctors, NO woman can possibly THINK of having a baby without a doctor, or a hospital etc etc. That's the status quo.
Then, slowly, you start to research a little, and you begin to realise that's not always the case. In fact, statistics show that a hospital birth can lead to a cascade of intervention, and the like.
It's not the other way round. It's not as though women are raised believing hospital is a last resort; they're raised to believe intervention is the only option and are pleasantly suprised that it might not have to be that way.

IN fact, I find 'insistence on homebirth' highly patronizing. WOmen often "insist" on homebirths because they experienced hospital incompetence with their first delivery.

Agree with Sakura. I 'insisted' on a home birth because: A. I was being denied one for spurious grounds.

B. I had a very traumatic hospital experience the first time round. In fact it left me phobic.

C. I had no underlying medical reason which could contraindicate a home birth and if one were to develop in pg or labour, I would have gone to a hospital for a c/s.

I think most of the women you see 'insisting on homebirths' and refusing inductions and intending of avoiding medicalised births are doing so from the position of information and experience rather than blind mistrust in hospitals and the medical community.

Sakura - I think you raise the point that means I would be incredibly wary of training as a MW: if, as a MW, you support a woman in a decision that, whilst informed, is contrary to either her PCT policy, NICE guidance and/or best practice and it goes wrong you run the risk of being hung out to dry by both the woman and the PCT. The only defence is in having impeccable records - and even then some MWs have been accused of falsifying them as "they're too good"!

If women want choice they need to accept responsibility.

If women want MWs to support their choice they need to not blame the MWs when it goes wrong.

If PCTs want MWs to support women in their choices they need to ensure suitable staffing levels and to not use the MWs as scapegoats.

The end point of trying to minimise negligence is to have a cast iron protocol that cannot be deviated from - where the model of "care" is designed to minimise risk of litigation rather than risk of physical or mental damage to mother or baby (and if the statistics from the USA are anything to go by, will actually increase risk of physical or mental harm to mother or baby and lead to a rise in the rates of unassisted birth). To me that's not a good place to be.

I think women also use the phrase "insist on a homebirth" because it can be the only way to persuade a PCT that you do mean it and it is going to happen, even for a pregnancy that has been text book in every way. The reaction to HB can be so negative in some areas that you have to have that state of mind for it to happen. But women who choose a HB (using whatever language) do need to be aware that it changes the risk profile and that by choosing to HB, some risks will be increased. (Btw I'm pro HB and chose a HB for DD1 knowing she was breech - but we did a lot of research, thinking and soul searching to be as sure as we could be that we could live with the potential consequences of that choice.)

I do wonder if this thread has self selected MNers who are risk averse through having experienced medical negligence?

"I do wonder if this thread has self selected MNers who are risk averse through having experienced medical negligence? "

Meant to add, that's not intended as criticism in the slightest - we're all shaped by our previous experiences. I'm devastated to have lost DD2, but I'm grateful that we aren't swept up in feeling there's someone who could have changed the outcome. My heart goes out to anyone in that position

EmmaKateWH Mon 26-Jul-10 23:36:35
2shoes - have seen solicitors do these cases on a contingency fee basis numerous times. That's hardly the point of the thread though is it?

my comment was in reply to you saying what the thread is about.
no need to attack me.

Tangle it is very hard to live with the fact that the couple of minutes that caused the damage could have been avoided. imo it is also hard to live with the fact that the person or persons who caused the damage will never even get told of. so it just goes on and on

I think that women who want home births should most definitely be given the OK from their obstetrician first!. God, I'm not advocating blind homebirthing Is that some sort of stereotype about women who "insist on homebirths?"

But I think the medical profession and society needs to respect, and trust homebirths, and midwives more, and give them more power. Midwives aren't idiots; their not going to take on very risky births, and from what I've read about midwives' experiences they can see a problem coming a mile away usually.

I had two homebirths in Japan, with two different midwives and the same obstetrician. He is a woman-liking doctor who works with midwives and respects them. He's happy to play second fiddle. We need more of those doctors, and less of the "hospital knows best" mentality.

I don't think midwives should be obligated to take on a high risk birth, not at all. BUt I think what constitutes high risk needs to be evaluated properly.
Some doctors regard any woman as high risk by virtue of the fact she's going to give birth.

If you want to see more data about the safety and dangers of births in the UK, this website is helpful: www.cmace.org.uk

There is another reason why there is more litigation associated with births -- it's a process where the expectation is that it will end well, because (normally) no-one is ill. That's very different from the reasons why people normally spend time in hospitals. (Most litigation to do with births is associated with hospitals, rather than homebirths/community care etc)

I wonder if there has been analysis of births that ended poorly along the lines of the analyses done by airlines when they have safety incidents, in order to identify and try to rectify the most important factors contributing to problems. I'm not talking about general factors like staffing, I'm talking about specific factors (the equivalent of "cabin crew, doors to manual and cross-check"). Hospitals are now slooowly implementing the patient safety checklist for operations, but I'm not sure if similar checklists exist for midwifery.

There is sadly a very long way to go in medicine before we get reliable safety. And I have to say, part of the problem is the concept of "medicine as an art", which results in people resisting standardisation that saves lives.

"From what I've read about midwives' experiences they can see a problem coming a mile away usually." Well mine couldn't. They insisted on home birth so I ended up going private and my obs confirmed that had I gone into labour the first couple of contractions would have ripped my placenta apart, my baby would have died and I would have most likely bled to death.

2shoes - it does sound awful . The only person I can blame for DD2's death is myself - and then only in a generic way. Its not easy, but at least I have a clean point from which to try and move forward.

Sakura - Its all a big vicious circle though, isn't it! Unless you have an Obs who is woman friendly then you're unlikely to get an "OK" for HB especially if there's anything at all unusual about your case. We do need a greater acceptance that HB can be a choice that is as safe as hospital birth - but until that acceptance has reached all parties involved in maternity care I'm very loathe to go for a model where you "have" to have permission from an Obs to get MW support...

Slhilly - I've spent more time than I would like in hospital this year. From what I've seen, in many instances medicine is both science and art (at least in the present day - maybe as technology develops it will get closer to pure science). I have major reservations about standardisation. It may save some lives, but it can remove the flexibility that could save others.

How can you standardise care without turning maternity services into a conveyor belt? How many factors can you standardise for and how much weight do you give each of them? How much weight do you give to maternal preference, given some women suffer severe mental trauma during their labours?

But how do you make that work for maternity services? Ultimately, which do you prioritise - standardisation of care or the principle that women have a right to accept or decline any intervention? I do think there's massive room for improvement in the management side (and in the attitude of many consultants - a significant percentage of the Obs consultants/registrar's I've met have destroyed rather than fostered my trust in them and their opinion), but I'm very unconvinced that complete standardisation will benefit women and babies - especially when you put mental health into the equation.

Incidentally, the "idiot proof" stuff is working its way out - I got my notes from January and the charts where vital signs were recorded were all colour coded and scored. Blood pressure in the red zone, refer. Score changes by more than a certain factor, bleep a Dr, etc. For instances like that its a fantastic safety check.

Tangle, you've answered your own question re standardisation -- it's not meant to cover everything, but it is does help with some pretty important core safety things eg vital signs.

Having said that, medicine does have a tendency to over-artify what it does, by comparison with how data is used in other fields. Sticking with charts of vital signs, here's an example of the possibilities that open up when clinicians are willing to start to be more systematic about data: there's this product called VitalPAC (you can google it).

It works like this:

• Historically, nurses have recorded their observations every 6hours on a chart that sits at the end of the bed. Nominally, this helps check if patients are deteriorating, but humans aren't very good at spotting the combination of deterioration signs that indicate a problem, and in particular produce a lot of false negatives (ie they don't spot deteriorations)
• VitalPac fixes that by, in effect, datamining to spot outlier deterioriation patterns. The closest analogy is something like how Visa spots fraudulent transactions. As the mass of data available increases, so does the accuracy of the system -- in the best possible sense, it is already inhumanly good, in that no human-based system will spot anywhere near the number of problems that VitalPAC does
• It has lots of good consequences, of which the most important is that patients get the urgent help they need when their condition deteriorates

For more on this theme, Atul Gawande has written a fabulously good book called Complexity.

Similarly, there may well be patterns that can only be found through datamining that reliably indicate deteriorations for mothers and babies during labour.