Yet another maternity scandal in the NHS

[MoltenLasagne]

Today there are reports on the outcome of the review into yet another NHS maternity scandal, this time at Shrewsbury and Telford hospitals.

The themes are horribly reminiscent of previous scandals - women not listened to, warning signs missed, c sections refused when they should have been the course of action. Then to add insult to gravest of injuries, mothers blamed for staff failings, intentional cover ups and bereaved parents having to fight for the truth.

This feels to me very much like a feminist issue. Also, hearing from friends who have had babies this year how much they have felt abandoned both during labour and by health visitors once home, I'm worried we have yet another scandal brewing.

apric0t, if it's any consolation I think women are sometimes given a bit more credence when it's their second/not their first. Plus I know I was more confident in my own decisions the second time - I refused to comply with everything until I was genuinely happy I was making the right decision.

I would suggest arming yourself with a good advocate/birthing partner, if at all possible, someone who can talk authoritatively and isn't afraid to piss the staff off.

Have you considered a home birth, if you're maybe inclined to precipitous labour? A couple of friends opted for that after having unexpectedly fast 1st labours.

I am an old hand on various boards about this subject.
Fifty and forty eight years ago I had both my children by what is now called crash caesarean sections. I almost lost my life along with my DS1 the first time, my second son was brought out almost dead as well.
While I have stated at the time that now things looked like changing for the better now, reading this I am really grateful I gave birth then and not now!
While I am not going to comment on the terrible complications I had in the labours, I must admit the car I got afterwards was second to none.
Ceasarian mothers were kept in for 10-14 days and not allowed home until all stitches were out and you were just about back on your feet again.Babies were kept in special care for the first two days, which while not ideal for the mothers, was to ensure they were healthy with no breathing problems or other side effects from their traumatic births before being transferred to the post natal wards
First time mothers having had vaginal births were in for 5-7 days, second and third time mothers wee aloud home after 48 hours if no complications.Mothers having subsequent babies were usually kept in a bit longer in case of possible complications e.g. heammorages which multiparae were at risk of
This was the NHS then. There was no need to go private.
What on earth has happened?

Sorry for typos. Blame my age I am a great granny now

You raise an interesting point there too about aftercare. With my first section I was discharged after 48 hours and with my second after 36 hours. I had no help from anyone in the night with my first, it was horrendous. I couldn't reach the call button for a midwife, my daughter had been screaming for about an hour and I could barely move to get her. When I did reach her she wouldn't latch and I was just crying on a ward with two other sleeping mothers and babies. It was so, so awful.

I am totally opposed to litigation as a method of improving things. I think it just leads to cover ups and defensive practice.

A no blame system with the purpose of learning lessons and improving practice would be better for women and babies. The focus needs to be on what has gone wrong and how to avoid it happening again.

Staffing levels are vitally important but I do agree about the bullying cultures that can develop in some units and the consultants who think they are Gods, and the “mean girl” cliques. This is not the case in every hospital. It would be interesting to know what makes the difference... I am pretty sure that where staff are bullied, women also will be bullied. Places where the staff are free from bullying no doubt have a more collaborative approach where any staff member can suggest changes that might improve the safety and well-being of women and babies. In toxic cultures staff will feel unable to voice concerns. Midwives must listen to women obviously and take women’s concerns and instincts seriously, but in order to advocate for women midwives must feel that they can speak up and say “actually this mother knows something isn’t right we must investigate further”.

Caseloading isn’t for everyone due to the commitment required. For reasonable caseload size we need to look to Independent Midwives who are the experts in sustainable caseloading and continuity of carer.

I think this is such an insightful and well written post. You are right - maternity care is misogynistic. People always say that it can’t be as most of people who work in maternity are women, but it is and you have summarised it perfectly. I’d pick you as my midwife!

That was a response to teazletangler ar 19:50!

Thanks @Hardbackwriter, I've spent a lot of time observing various units I've worked in and thinking about these issues. I don't think continuity is that much more expensive overall, because it's a redeployment of existing staff (you'd need fewer core staff in the hospitals for instance). And if it leads to better outcomes, it could theoretically be cheaper I suppose. However it's challenging to implement as it doesn't work for a lot of people, for many reasons. The evidence shows that teams of up to 6 midwives still improves outcomes; to me that sounds like a reasonable number of people to share the on-call responsibilities and not burn out.

@DaisiesandButtercups totally agree re a no-blame system. Blame just leads to defensiveness and unwillingness/inability to learn, as well as fear amongst staff- and that leads to (often very poor) defensive practice. The Kirkup report made clear that mistakes in practice are actually expected; HCPs are only human after all. The real problem arises when no one learns from them.

I also agree that a lot of midwives feel they cannot speak up, either to more experienced colleagues or especially consultants. It is so challenging if relationships are not respectful. I noted that in the Shrewsbury report, the obstetric care comes in for as much criticism as the midwifery care, if not more.

Struggling to read this at the moment (bit close to home).

Can anyone direct me towards some suitable orgs for Christmas donations? Interested in supporting those that could help with legal action as well as those who support bereaved or otherwise traumatised women directly.

@Plantmam I'd recommend AIMS (Association for Improvements in Maternity Services), Birthrights or White Ribbon Alliance- the last one is more global in nature.

@Lastnamefirst thanks, I feel l strongly that reform of the the whole system is a feminist issue. I hesitate to bring the gender debate in, but I am against the push towards gender neutral language in maternity services because this is so obviously a women's rights issue. FGS how do we fight for improvements if we don't even name or acknowledge the root of the problem?

@vaccinationstation that sounds like a terrible experience, especially postnatal. In labour it sounds like perhaps you had less experienced midwives. You want to have a good skill mix on each shift, but often you do get younger midwives in hospital and the more experienced ones are in community or 9-5 jobs. This was an issue in my hospital when I was a new midwife and it can leave you feeling a little unsupported. I do think UK clinical guidelines (NICE and RCOG) are generally very good and very robust, and they are often used to inform practice in other countries. However how they are interpreted/used in different trusts really varies. So many things affect VBAC success, I'd hope a consultant has reviewed your specific chance of success with you!

As well as these (often unnecessary) heartbreaking stories, the NHS is funding a lot of (also probably unnecessary) gynaecological surgeries and rehabilitation therapies from childbirth traumas, like reconstruction surgeries following botched episiotomies, fistulae, haemorrhoids, PTSD counselling, physiotherapy, bladder reconstruction, etc....

...totally agree re a no-blame system. Blame just leads to defensiveness and unwillingness/inability to learn, as well as fear amongst staff- and that leads to (often very poor) defensive practice. The Kirkup report made clear that mistakes in practice are actually expected; HCPs are only human after all. The real problem arises when no one learns from them.

What incentive is there to learn from mistakes?

Answer: There is none.

Your assumptions about 'blame' and what it leads to are completely wrong. A sturdy culture of defensiveness and refusal to learn from mistakes, along with fear of speaking up, has gone unchallenged for years in a 'no-blame' environment.

In a hierarchical society, in a branch of healthcare directly affecting only women, including young and less well-off women, there is absolutely no incentive to learn from mistakes.

The only leverage women have here is tort law. Refraining from appeal to the law is a huge mistake that only benefits those wielding power in the healthcare setting.

Janice turner on this in the Times today:

www.thetimes.co.uk/article/a-caesarean-should-never-be-seen-as-failure-0bxp6m5gh?shareToken=cf285c46628122f1b26ae42045cedfef

Thanks @teezletangler

Well, they didn't look totally young, but they may have been late qualifiers. It actually scares me how bad it was really because either: 1) having examined me lots of times vaginally, they couldn't tell that my baby was stuck and would not be descending, despite me telling them several times that there was no downward pressure and no descent, so they were just insisting regardless, which really means incompetence and those midwives should not have been working with pregnant women without consultant supervision on next steps; and/or 2) they just wanted to push me to the brink just in case because they were desperate to avoid a section.

On 2) the junior doctor they called in when the midwives were refusing access to the consultant refused to let me see him until I signed a forceps consent form as well as a section one - faced with two obstructive midwives and a junior doctor I signed. I retracted my consent as soon as I got to theatre and saw the consultant and told him that I had signed under duress, because I was forced to and I would only consent to forceps if he told me it was a good decision for baby and me. He said it absolutely was not and even with forceps there was absolutely no chance of a vaginal birth. If it was that clear cut to him, but the midwives couldn't tell surely that indicates that the midwifes I had should not be supervising a birth like mine (growth scan showing bigger than average, baby back to back) - there was no discussion of baby size or positioning. Just following a "standard protocol" which I am sure RCOG and NICE agree with in the majority of cases, but the issue in my view is that women are not seen as individuals.

I have had a consultation with a senior midwife and she agreed me that a VBAC was unlikely to be successful (success for me not being a VBAC at all costs but being not ripped from the inside out or ending in an emergency section) for me, with a baby of over 8lb or poorly positioned. Plus there is no scope for me to be induced having had a section. Accordingly, given my baby was nearly 10lb at 2 weeks overdue, there is really no point me going over 39 weeks and expecting a vaginal birth, so unless I go into labour at 37/38 weeks I will have a section knowing it is best for me. I really have done a lot of research on my personal odds. Plus, just as a matter of principle, I would never put myself in the hands of midwives to decide when to throw in the towel again - I just don't think they have my best interests at heart, it's just a competition to avoid a section.

I can’t face typing my own horrific story from my first child. Being mocked for wetting myself when my waters had gone to being left alone in severe pain.

I have a relatively severe birth injury I live with.

I don’t know how to fix the system but it’s getting worse

I've just read Janice Turner's column in today's Times and I am so sad and appalled at the stories of what happened. Those poor women & their babies x how does this kind of thing happen in modern times? 😢

Personally, while I completely acknowledge that there are all kinds of issues around staffing and funding, I also feel that a 3 year direct entry training for midwifery is just not enough. Back in my day we had to do 3 years general nursing, a year of nursing experience, then a year of midwifery. Towards the end of my training they were extending the year for midwifery training to 18 months because a year wasn't thought to be sufficient.
By the time I embarked on my midwifery course I had a year of post qualifying experience in hospital and in the community. I was used to running a ward and visiting patients in their homes.
What scares me is that there are more and more women with existing medical conditions having babies now, so back ground knowledge and experience is important.

My first birth in hospital was dreadful, only complicated because I was left alone for hours, scared. My second, at home was downright dangerous due to the midwives - one was yanking on my cord, one was screaming at me and then gave me medication that I had refused to consent to - she waited until DH, the other midwife and double were out of the room and then did it anyway. Neither noticed/cared about the state of the baby who had aspirated meconium.

Third time round I had an independent midwife who was very experienced, who was with me from first twinge and who knew me, my history, my wants as she had done all my antenatal care. That's what women need - one woman, one midwife. Domino care. Same midwife from checking in to post natal checks. At your side throughout labour. The problem is that it's expensive - the type of expense an accountant can see rather than the high CS rate and birth injuries and PND that are underreported and cost less than OWOM. And we are but women, after all.

This is so distressing. The NHS culture of coercion and cover-ups is not limited to maternity care, but it is worse in areas with structural power imbalances like women's healthcare and mental healthcare.

Litigation is used because there is no other way to be heard, it is not the cause of doctors who consider honesty, integrity, and legally value consent optional extras to be disregarded.

NHS does not care about its patients or the devastating harm it causes people, it cares about preserving its own power and status.

It is a choice to protect staff instead of the vulnerable people they were supposed to help. And I have no qualms about condemning every single person who makes that choice.

People who enabled the culture and practice there should be prosecuted.

This is the key question @BackwardsGoing (and I’m so sorry you were treated so brutally).

I read the report in The Independent and, by the end of it, couldn’t even pick which half dozen paragraphs were the most horrific. I couldn’t comprehend how such a culture came to be. Because it wasn’t just discouraging c sections (virtually all maternity units to that) it was a culture of making decisions that were dangerous and negligent and everyone knew it. I just can’t imagine an ideology taking hold to the extent that women and babies were maimed and killed.

I’ve participated in dozens of discussions around maternity care on MN over the years. We all know that women are treated horribly in maternity units and have been for decades. Shrewsbury is next level, though.

Personally, while I completely acknowledge that there are all kinds of issues around staffing and funding, I also feel that a 3 year direct entry training for midwifery is just not enough. Back in my day we had to do 3 years general nursing, a year of nursing experience, then a year of midwifery. Towards the end of my training they were extending the year for midwifery training to 18 months because a year wasn't thought to be sufficient.

@endofthelinefinally - I agree 100% with this assessment.

This is how midwifery is done in the US. You do your B.Sc. in nursing first, then obtain your RN licensure, and then you earn a masters degree in nursing (MSN - takes two years) or a DNP degree (Doctor of Nursing Practice - takes 3-4 years) with a specialisation in midwifery. Practicum hours are required in both programmes. Altogether a CNM in most US states may have spent up to 8 years in formal third level education, with practical hours included, before looking for your first job as a fully qualified nurse midwife.

I would also like to put out a plea for continuity of care all through pregnancy and delivery and after care, as happens for the most part in the US.

The US, with its most expensive healthcare system in the world, it's culture of litigation, it's obstetrics led care and midwives who were nurses first, has a maternal death rate that is over double the UK death rate. Don't try and blame women's 'lifestyle' factors either, that's just the sort of gaslighting women in S&T have been subject to.

Lots of the things that are being held up here as solutions to the problems of poor maternal care, clearly aren't.

There is clearly something very wrong in training and in organisational cultures when it is common for women to be treated with the unkindness and lack of compassion mentioned in the report. So many mentions of it on here too - it's not just isolated midwives or units, it's endemic.

@samiamgreeneggs

The US, with its most expensive healthcare system in the world, it's culture of litigation, it's obstetrics led care and midwives who were nurses first, has a maternal death rate that is over double the UK death rate. Don't try and blame women's 'lifestyle' factors either, that's just the sort of gaslighting women in S&T have been subject to.

Lots of the things that are being held up here as solutions to the problems of poor maternal care, clearly aren't.

I worked in US and saw way more birth injuries there than in the UK. One big problem there is that if I as a nurse were to question or challenge a doctor I could be sacked pretty quick. Also, you could have 50 doctors with admitting privileges to one obstetric unit, all with their own ideas and foibles. If a woman came in almost in second stage you had to hope for the best that the OB would get there quickly. Back then ( don't know if it is better now) if the nurse ended up delivering the baby, the insurance would quibble about the fees. The doctors would be very put out if they didn't get their money. OTOH, if you were poor, unemployed or black you might be lucky to get through A and E in a government hospital, or you might get poor care or no care at all. Some poor women couldn't afford prenatal care, so already at risk. Maternity care in France is insurance based with state top up and by all accounts is very good.

I don't think the midwives who were nurses first are the biggest problem.