Two thirds of maternity units in England 'not safe enough'

[ArthurbellaScott]

https://www.bbc.co.uk/news/health-67238868

This is horrifying.

Content warning in the article link, baby death

'BBC analysis of Care Quality Commission (CQC) records showed it deemed two-thirds (67%) of them not to be safe enough, up from 55% last autumn.
The "deterioration" follows efforts to improve NHS maternity care, and is blamed partly on a midwife shortage.
The government said maternity care was of the "utmost importance".
The Department for Heath and Social Care (DHSC) said £165m a year was being invested in boosting the maternity workforce, but said "we know there is more to do".
The BBC's analysis also revealed the proportion of maternity units with the poorest safety ranking of "inadequate" - meaning that there is a high risk of avoidable harm to mother or baby - has more than doubled from 7% to 15% since September 2022.'

Shocking. But not surprising.
The NHS's complete failure to address this is shameful. They'll throw money at pointless D & I initiatives & staff, divert precious staff time away from tackling this to debate pronouns & mangle the language of women's health care & spend a seemingly endless budget on conferences & courses that have zero impact on maternity services. There are resources in the system that could be diverted to fund equipment & staff - but the safety of woman and babies in just not on their agenda.
They know what they need to do to tackle this - they just can't be arsed.

Well, yes. The amount they are willing to piss away on absolute bollocks, while failing to actually fund the necessary staff, is quite stark.

its hard to not conclude that maybe midwifery courses should spend less time teaching students how to catheterise a penis and more time on actual clinical skills.

Maternity care in NI is fucked too.

Not because of diversity training or trans stuff. Because of a diminished NHS with demoralised, burnt out staff. It's happening because women, be they patients or HCPs, are considered unimportant.

Scotland appear not to have bothered investigating at all.

Is there any way to see the actual reports? I'd be interested to understand in what way they are considered unsafe, is it the medical interventions or the care?

When I had DD 9 yrs ago, the post natal care was lacking, I was basically just left to it. I had to hobble from the delivery room to the ward pushing her little cot,on the ward there was no help all through the night, other people's partners/ husbands wandering about, being noisy. In the morning they just pointed to the kitchen and we had to make our own breakfast. No help watching baby while you went to the loo or got cleaned up, no support with breast feeding. It was like being in a crappy mixed sex hostel.

All CQC reports are online. Here’s the one for Morecambe Bay - it’s the whole trust, but maternity is in there somewhere:
https://api.cqc.org.uk/public/v1/reports/3e8d4507-2081-4851-83e5-ef2064053765?20230823070213

This is bloody awful.

I think personally that both midwives and obstetricians need to go back to the drawing board and talk to each other from the beginning of training So many of the issues seem to happen when the two professions are at daggers drawn. There ARE units that work well and I think members of those units should go to coach the teams of the crappy units - communication styles, speaking up effectively, requesting help as a positive act.

Ime varies hugely by health board, which suggests it's due to leadership.

It is horrific.

Must be even more scary for black pregnant women where the risk of maternal death is already four times higher than white women.

It's thankfully a section of the NHS I've never had and never will have need for, but I'm actually shocked that the figures are as bad as that article says.

I can't imagine how terrifying it must be being pregnant and knowing you're going to be giving birth in a hospital where your chances of going home with you and baby alive, healthy and happy is so poor.

This is pretty much it. All the major reports into maternity in the past few years (Morecambe Bay, Shrewsbury and Telford, East Kent) have identified poor team working between obstetricians and midwives as being a core reason for failings. They need to go back to the drawing board and find a way those two professional specialisms can work together in the service of a common goal.

Staffing is a massive issue throughout the NHS. As midwives crumble under the pressures and leave that just makes it worse for those remaining, newly qualified midwives don't have the support they need to develop their practice safely and give up. It is a downward spiral that is hard to reverse.

In my hospital we have so many nurse specialists, research nurses, roles specifically to support new international nurses (the hospital actively recruits from the Philippines with new groups arriving regularly). But nurses doing the hard graft on the wards? The QQC has recently downgraded the medical services, among criticisms were "not enough HCAs". I used to go to meetings about falls, where about 20-30 staff of various grades would contemplate non slip socks and other strategies. How I cheered when one nurse rounded up the meeting by pointing out the the single most effective way of reducing falls would be to double the staff.

It's the same in midwifery. I can't imagine working in a situation of caring for several women in labour. It's not just the safety but the whole point of the job, caring for a woman at that most vulnerable time of her life.

You will not get an NHS bursary if you’re a first level nurse or midwife and you’re registering for a second field in nursing or midwifery.

Funding and wages are the issue.

How can you retrain if you have kids? How can you continue as a midwife with the unsociable hours?

You would need a partner earning a good wage if you were to retrain and had kids. How many people does that close it off for?

Is it really a surprise?

Not only that I have a friend who applied and struggling to get a place on a course as they were so full.

How much is the NHS midwifery bursary?
Studying in England
The Learning Support Fund offers a range of different support. You may be eligible for some, but not all, of the support.

Training fund
All midwifery students eligible for the Learning Support Fund will receive a grant of £5,000 for each year of study. You’ll have to reapply each year.

Parental support
Students with children can apply for a grant. This is pro-rata if you’re studying part-time and doesn’t affect your entitlement for childcare allowance.

Travel and dual accommodation expenses
If you’re undergoing a clinical practice placement that incurs higher travel costs than your normal expenses for travelling to uni, you can be reimbursed. You’ll be expected to use the cheapest transport and you’ll only receive reimbursement for costs on top of your normal commute costs.

You can also claim for overnight accommodation if you have to live somewhere other than your normal termly accommodation to attend your placement. There’s a daily cap on the amount you can claim, and you can’t claim this if you’re staying with your parents.

To claim expenses, you’ll need to submit your receipts within nine months. Your university must approve your form.

Exceptional support fund
This is means-tested support for students whose income doesn’t meet their expenses. You must’ve exhausted other options first, for example savings, money from part-time work and university hardship funds.

You can get up to £3,000 per academic year from the exceptional support fund. You’ll have to submit bank statements and evidence to apply, and your university will need to authorise your application. You may apply multiple times in an academic year, and you can apply at any point within the year.

I think this was probably the problem some years ago

Now the problem starts with a lack of staff.

I ended up getting an independent midwife as I found the NHS 'care' so awful. It's expensive but I couldn't recommend it enough, It was worlds away from how I was treated by the NHS.

100% this.

Millions spent on DEI that achieves nothing and ridiculous salaries for senior managment who are useless and in some cases actively dangerous (Letby case) and yet women and babies dying for lack of adequate care.

I had two children in this country 7 years apart. The difference in standard of care between the first and last was like night and day. With the second, women and babies could quite easily have died because when people had imminent problems and were pressing call bells but no-one came. Many women had had c-sections and couldn't move around very easily themselves. I really felt I'd have been better off at home with my husband nearby (he couldn't stay as we had another child at home).

My take away - and this is true for the whole of the NHS really but especially maternity - is that if you don't have someone with you all the time who can advocate for you it's essentially a lottery and there's a high risk of harm if something bad happens.

The individual staff are great, but there aren't enough of them, not enough beds etc.

My two birth experiences were in two different local authorities/hospitals. The differences were astonishing, from one hospital being dirty, crowded, with abusive and abrasive staff, to the other a newbuild, beautifully clean, well staffed, with compassionate and supportive staff. Night and day.

I don't imagine funding would have differed from one LA to the other? So presumably the differences come down to management?

Article in the Telegraph. The case studies are heartbreaking

https://www.telegraph.co.uk/news/2023/11/17/maternity-crisis-nhs-doctors-midwives/

https://archive.ph/qs5Vl archive link

What would posters here want to know if MN were to invite the Chief Maternity Officer (not sure of the title) to an AMA about maternal safety and maternity services?

This article makes a nice(?) companion piece

https://thecritic.co.uk/birth-trauma-must-be-taken-seriously/

This is the Metro article by Kat Romero referred to in previous post.

https://metro.co.uk/2023/11/05/a-male-midwifes-two-word-response-to-my-agony-left-me-traumatised-19761564/

When I was born, women stayed in and the next day were led in recovery exercises as they lay in bed. Nurses came and ‘got them ready’ for visiting time- helped them with personal care, make up etc.

I can’t help thinking the attention and the corporate experience may have been helpful, much though we’d curl our lip at it now.

@RethinkingLife

Id ask- Would the NMC and RCO&G consider joining forces and disbanding their separate specialist areas to create a new Royal College of Birth Specialists to advocate for safe staffing levels across the professions and evidence based care for mothers and babies?

This idea that if something is natural it's fine is so incredibly stupid, I can hardly believe a medical professional would say it let alone believe it. Nature is red in tooth and claw (and, I would add, childbirth in humans). It would be natural to not use antibiotics - what is this, the dark ages?

Evolution doesn't care if individuals spend their entire lives in agonizing pain. For many species there's a horrendous die off rate in young - most of them die, and only a few survive. In humans without modern medicine many women and babies died in childbirth. And if they survived childbirth many children also died in early childhood / infancy in horrendous pain. How quickly humans forget history.

As a species, we've been successful because the trade off between massive brain and risky horrendous birth has paid off at a species level. But no doubt there have been millions of women and babies sacrificed to death in horrendous pain as a result.

I really feel anyone that says childbirth is 'natural' and therefore it's acceptable to not use pain meds needs to watch more nature documentaries. The entire reason humans have been successful is because they've learned to outwit nature in many ways! What's the point of pain medication if you don't use it?!!