Live webchat with David Bogod, president-elect of the Obstetric Anaesthetists Association, Thurs 3 March, 8-9pm

[GeraldineMumsnet]

Following the discussion about epidurals on this thread, David Bogod got in touch because he'd read the thread after seeing it mentioned in the Sunday Times. We're very pleased to welcome him to Mumsnet for a webchat.

David is consultant obstetric anaesthetist at City Hospital, Nottingham, where he's worked for 21 years and carried out more than 2,000 epidural procedures. His unit has around 5,700 deliveries a year, with an epidural rate of around 25%.

He's also president-elect of the Obstetric Anaesthetists Association and vice-pres of the Association of Anaesthetists of Great Britain and Ireland.

David has two grown-up boys (one delivered by forceps, one spontaneous delivery, both under epidural).

If you've got any questions to put to David about the scientific, political or social aspects of epidural pain relief in labour, or any other issues relating to childbirth, then please come and join him on Thursday evening. Failing that, please post your question here as usual.

I am an Allied Health Professional who is registered by the Health Professionals Council (HPC) and assess and treat children with special needs in my area of specialism. My profession is "on the record" on MN but I don't want to label myself on this thread as I really don't want to discuss my profession in any detail as it is in no way related to the content of the thread.

I have the utmost of respect for professionals who are put into the position of dealing with life and death situations as this is not something I am every likely to encounter in my own role and be in a position of responsibility with regards to it. I find it difficult, given that midwives have this responsibility, to understand why there is a personal reaction from supposed professionals to statements made from the perspective of service users who have been unhappy with their care.

Starlight tells no lies to you here. She has posted about her feelings and experiences with members of my profession in great detail on the SN board and sometimes in detail that makes my eyes water . As she has alluded to, there are times I have talked with her about the pragmatic realities of working in the NHS that mean that best evidence is not always followed in day to day delivery of services due to resource constraints. I try to explain how and why things go wrong from my perspective and to explain that individual professionals rarely intentionally aim to provide suboptimal care but that sometimes it seems to happen. I don't comment on individual cases if I can help it and I would never comment directly on the care provided by another professional but I can act as an advocate and share my understanding of evidence with reference to a topic and advise dissatisfied service users how to go about acting as an advocate for their children.

However, I don't take anything she says personally. How can you as an NHS professional? If you believe that you yourself are doing a good job, why would you paper over the cracks in the system or assume you are liable for those cracks? I know that there are times that members of my profession provide inadequate care because I know that early in my own career, I did while genuinely believing I was providing a quality service. I know that my work at that time reflected issues with the service delivery model which all my colleagues were then implicated in. The service has moved on, I have moved on. I can reflect on this without guilt at this stage (if sometimes I recognise poor practice in posts online and wince): I work hard to improve the way in which I deliver services as this is within my circle of influence to change. I make mistakes: I have probably made mistakes this week at work.

Alimat, you need to think about why you are responding in an aggressive way as a midwife on this thread. You have basically told me I am lying. That is outrageous and as you are representing yourself as a member of your profession on this thread, deeply unprofessional. I feel that discussing my case with you further will do you far more damage than it will me (thankfully) but, really, you need to be very careful about casting aspersions on the truthfulness of posts made about childbirth while posting as a midwife. If you want to engage in that type of discussion, you would do well to namechange and omit all references to your profession.

Your response does make me question whether you are, in fact, a midwife. I find it hard to believe that these days, when most NHS professionals are faced with reams of guidance on how to interact sensitively with the public, that a real midwife would be so foolish as to continue with personal and subjective reactions to posts made by those who (for all s/he knows) could have been his/her clients.

Seriously, Alimat, step away from the thread. You are doing yourself no favours.

Starlight - thank you. And for telling me I could refuse a VE most of all!

Wow, this has moved on slightly. I think what is perhaps an issue here is that 99% of posters who have had bad experiences are so scarred by them that they can not believe that there are good midwives out there. Midwives who listen to them, respect their choices and work with them. Which is why the midwives who are posting on here can not do right for doing wrong, it seems that no matter what evidence/debate we post we are wrong and accused of finding things to suit our agenda, yet one anaesthetist comes on to answer a few questions, happens to agree with a few of the upset posters and he is held up as some kind of oracle on all things childbirth. Which actually does get a little demoralising. When I asked if a representative of the RCM (our union - not our governing body, absolutely no point complaining to them) would be able to make a useful contribution to the debate the first response was one of "Why bother, midwives just lie". Great. So fine, listen to whichever side of the argument suits you best, lets not denigrate each other and our professions though, despite what many of you may think midwives aren't sadists, aren't liars and do their very best for each and every woman they meet within the constraints set out by their working conditions. If you have a genuine complaint, take it up with the trust, the NHS does not protect it's own and you can be damned certain if someone has fucked up they'll know about it and hauled over the coals. The reality of the country we live in though is it is in a bit of a state, healthcare as we know it probably won't be around for much longer, we have a Tory government determined to pretty much privatise the lot, we have them going back on their word with regards to creating further midwifery jobs, we have less and less of a budget to work within and the demands of a rising birthrate to meet. I think there is a lot of misdirected anger at midwives but I can completely understand it, we are the face of childbirth. A haggard, tired, fed up face a lot of the time but that is us and we are in the main really just trying to do our best.

Oh and mathanxiety re your ealier post about L&D nurses monitoring epidurals, a nurse is no less trained than a midwife, I cant imagine a nurse is any cheaper. If anything of that nature was to be introduced then it really would be someone who was barely trained in relation to either a nurse or midwife. I think the argument of things being very different does apply here and you can not transplant the same situation into our healthcare system at all.

This is what I have sent to the RCM about this thread:

To whom it may concern:

I am a member of the public who is also registered with the Health Professions Council (details here).

I am writing to you regarding recent threads on the online forum "Mumsnet" discussing the role of midwives in advising women in labour about epidurals.

I am concerned that there have been individuals posting on threads about this subject (including a recent "chat" with anaesthetist David Bogod available at including a recent "chat" with anaesthetist David Bogod which is available at www.mumsnet.com/Talk/mumsnet_live_events/1160539-Live-webchat-with-David-Bogod-president-elect-of-the-Obstetric-Anaesthetists-Association-Thurs-3-March-8-9pm) as midwives who have been quite inappropriate in their posts about service user's experiences. I personally have been told that I lied about my experience.

As a Health Professional myself, I am able to see that these views are not necessarily representative of the whole profession but I worry about the impact of some of the debate on potential and prospective service users.

In this particular instance, there are many women who are concerned that they have not been listened to by midwives and who are reporting serious outcomes from this experience e.g. PND/PTSD/avoiding future pregnancy.

While I have no doubt that there may be evidence to suggest that some people's subjective understanding of their own experience cannot be wholly attributed to specific actions that have occurred during a specific labour or to the profession of midwifery as a whole (and I include, here, my own experience), it remains the fact that these are views held by service users about their care. These are not "lies", but perspectives. A non-professional does not have full facts about their care in these instances and to be met with such a reaction from a supposed professional online could be detrimental to that individual dealing with their concerns in an appropriate manner.

The fact that there are supposed midwives challenging patient experience (I have no proof they are not misrepresenting your profession) and focusing on their personal "hurt" at reading negative reports about midwifery in the context of an online forum is worrying. This is not the same as abusive statements being made at work. They do not need to engage but are choosing to do so and to bring the personal into these discussions really seems to me to diminish the professionalism of the response and could potentially damage the reputation of midwives who would not agree with their statements or enter into such a discussion in the first place.

I feel that it is important to contact you about this matter as I worry about the impact that it might have on people who suffered more traumatic births than mine, as I will honestly say that reading the thread has been quite sobering for me and reduced my own faith in the profession of midwifery despite the fact that I have enough knowledge of the NHS not to take things at face value.

Women need trust and confidence in their midwives at a potentially vulnerable time in their life. I think it would be very useful for you to arrange for a representative to chat to women online about their experiences in order to present a more balanced perspective on the responsiveness of midwives to patient concerns than is currently available. I think this would be valuable for women posting and prevent negative outcomes arising from ill-thought out responses to patient reporting of experiences in this context.

Regards,

Me

Cross posted with McDreamy

Working - where have I EVER insinuated that you have lied???????

and for that matter - where have I been aggresive towards you?

Christ. It really is all about you, isn't it?

YES - when im accused of things are not true

Bruxeur To whom are you referring?

Alime1

To recap for the last time, Alimat:

1. "possibly - but until working came on here she was more than happy with her midwifery care - no PND, PTSD, and only now 'jumping on the bandwagon' for want of a better phrase."

If you can't see what's wrong with this, there is something seriously wrong with you. Why do you have reason to believe that I did not experience these conditions? Why the use of perjorative language (if you were in want of a better phrase, perhaps you should have left it).

1. ?As I said if you had 5 different people VEing you then you should complain as it is abuse.

I have NEVER EVER seen 5 different people VE women to get whatever info they require - when you are examining someone, each and every time you should ask if its ok to go ahead. We must gain informed consent?

Sounds like you are casting aspersions on the veracity of my experience here.

a) ?If you feel you are good at your job, and then many many others all club up against you (as a collective group)then you too will become very defensive.

There are very few positive remarks regarding midwives.

Yes, we are professionals, but we are also human, and constantly being called and also patronised - bitch, fucking midwife, devil.....etc - makes it VERY difficult to lose the chip on our shoulders?

b) ?It?s just the constant midwife bashing that irritates me?

There have been many more comments like these from you on recent threads, including use of the emoticon.

I do not feel it is appropriate to discuss your reactions to the thoughts, feelings and experiences of potential service users using this type of personalised, negative language in a public forum on a webchat such as this one while posting as a professional.

Take it to clinical supervision. Write about it on a midwifery forum. Make one statement about it here as a midwife and let it stand. Write about it here without mentioning your profession. Write about it here referencing your opinions with evidence and literature. Be gracious about divergant viewpoints. Recognise that there may be good reasons that women feel one way or another about their experience that may include inadequate care from midwives.

Engaging in the way you are doing is unprofessional, I really do believe this.

I hope I have made it quite clear that I am not ?midwife bashing?: I am concerned that your posts are unhelpful and reflect badly on your profession, particularly the continuing aggressive tone that you choose to use.

I am bowing out now. I have made my point. Please do not direct any further posts to me. You really need to step away from this.

"If you can't see what's wrong with this, there is something seriously wrong with you"

Should read...

"If you can't see what's wrong with this, there is something seriously wrong with your sense of professionalism".

Slip on my part. Apologies.

Ok - I read your first thread wrongly - I took it as yes, you had a horrible time, but you had fantastric midwifery care, yet after reading threads on here, you found out you did not have fantastic care after all - which i took as sad as it gave you a different perspective on things.

Regarding the VE - yes OF COURSE I BELIEVE you - and I said more than once YOU MUST COMPLAIN. I said I have never seen 5 people VE a woman in succession - therefore it is not normal - therefore you should complain. You should also have been asked before each and every VE if it was ok to proceed. As you said you didnt realise you could refuse VEs, then this obviously did not happen - therefoe you should complain.
You put the IF into italics - I did not.

Again - I have not belittled anyones experiences.
Regarding epidurals, if you look at my posts, I have said i have no problem with them.

Do you ignore the women you're caring for as much as you're ignoring w9t5?

Getting off the thread a v good suggestion.

9-5

Before you send this particularly vicious, although admittedly well written letter, I hope you have a good think about the implications of doing so.

Midwives, alongside many other public sector workers are facing job cuts. It is estimated that the country needs 4700 more midwives, David Cameron promised to take on 3000. Is this going to happen? I don't think so. Maternity services are far stretched beyond there capacity already. Midwives are being replaced by unregistered support workers, who whilst worth their weight in gold, are not equipped the training required to provide safe and effective care for mothers and babies. Why? More value for money. Or not as the case may be. In agreement with the recent White Paper, quality is what the NHS should be striving to achieve, not quantity. Again, I can't foresee this happening. Places on midwifery education courses have been cut across the country. Soon, a large number of midwives are set to retire. Will they be replaced? Who knows.

In unfortunate social, economical, political and financial times, it seems that The Midwife is a breed hunted from all angles.

Please don't add to the ammunition by your attempt to bring the profession into disrepute.

Let me just throw something out there. Midwives don't make medical decisions. It wasn't a midwife stood behind those Kiellands forceps. It wasn't a midwife who was sat behind a desk, making calls about your care once it stepped outside the realms of normal.It is with deepest regret that you were subjected to what can only be described as a horrendous and unimaginable childbearing experience. But let me ask you this. Were midwives really to blame?

Perhaps they were. I don't know. I wasn't there.

So again, please reconsider sending this complaint.

And to anybody else who feels the need to midwife bash, just take a second to consider, in a world without midwives, who else would be 'with woman'.

Because your Ob's and Gyn's certainly won't be.

Oh, it would appear you already sent it.
Such is life, I should learn to read properly. As you were.

Reggaemudda, aren't the Royal College of Midwives unlikely to campaign for job cuts in their own profession as a result of a request for representation by a member of the public? This is who the letter is addressed to: the body responsible for regulating their own members and ensuring that the profession is well-represented for the very reasons you mention.

Read my letter again. It simply says that there are people who may not even be midwives on threads like these bringing the profession into disrepute by posting in an inappropriate fashion.

Contacting the RCM about this is an attempt to enable people who are in a position to do so to intervene to prevent the profession being brought into disrepute by individuals who may be misrepresenting it.

In this context, I can't quite see how the letter is vicious! It's written out of a concern that the profession is NOT brought into disrepute. I can't bring a profession into disrepute by making a statement as a member of the public with a concern for standards and professionalism in Allied Health Professions. I really can't.

TBH I think the MWs on here have been very professional in response to the names they have been called & the accusations made. I read a thread on MN last year where people argued that swearing at a MW is a normal part of childbirth & should be accepted without question.

It is very different to the thread the other week where the OP was flamed for referring to a teacher as a bitch.

No, w9-5.

You published your thoughts on a public forum for anybody to read.

Also, I am interested to know what exactly the RCM are going to do about members of the public imposing as midwives.

ReggaeMudda - ?????

I feel you have misread my letter. My letter says that it would be good for a representative of the RCM to come onto the forum to represent midwives in a balanced, non-adversarial fashion rather than discussing personal feelings about service user's comments while posting as a midwife.

I don't even know that Alimat is a midwife. She may well be a troll for all I know. I think it's only right that there is a public representative of midwives on this forum to ensure that an accurate, balanced view of the profession is facilitated.

I agree with Working9While5, StarlightMcKenzie and MummyBerryJuice that I haven't seen any midwives on this thread (or the 'tricked' one) really appear to get WHY some women are so angry about their experiences, or express genuine personal sympathy with regard to their experiences. Not saying that the sympathy or understanding isn't there, either in the individuals or the profession as a whole, just that it (to me, anyway) hasn't been evident from the posts.

It's sad and ironic in fact that midwives here also complain so vociferously about being disbelieved, patronised and ignored.

ReggaeMudda I don't know where to begin with your post and can't begin to address everything you have written. What I can't overlook is the idea that 9-5 is seeking to

'bring the profession into disrepute'

The only people who can do that are the minority (I'm hopeful this is the case) of midwives who provide low patient care and lack professionalism.

I welcome a repeat of the online webchat with someone from the RCM. I cannot accept that some of the views of the posters on here (who claim to be midwives) is representative of this body. Perhaps some of its members need a reminder.

The expression of the idea that some women in labour are hard to please is one that does not sit well with an assertion of professionalism. I second this comment: 'I find it difficult, given that midwives have this responsibility [care in life and death situations], to understand why there is a personal reaction from supposed professionals to statements made from the perspective of service users who have been unhappy with their care.'

wrt the letter to the RCM, how about adding a reference to the other thread and the bandying about of the word 'risk'?

DrMcDreamy, you have every bit as much of a fortress mentality here and are not doing your profession any favours.

But she hasn't sent it to the papers, she's sent it to the body that is responsible for fighting the midwives cause. Hard to see how such a letter to the RCM could bring their profession any disrupute.

Obviously 9while5's experience is much more complex than what we have read about here and the sequence of events leading up to the decision to use Kielland's can only be understood if a thorough review of her notes are undertaken.

It is evident, however, from this thread and the others that many, many women feel as if they were not listened to or supported well and as the 'contact' person the mws will be the first person associated with this short-coming. The fact that personal experiences have been dismissed (in many instances on these threads) does not help to endear the profession to the public
It must be remembered that for the largest majority of people the only time they have ever been in hospital is to deliver their baby. It is a vast, unfamiliar, scary and technical environment that disorientates people and often makes them feel in secure. Even people like me who feel comfortable and in control in a hospital environment become unsure and scared during labour, how much worse must the emotional impact be on someone unfamiliar with hospitals and how they function?