The 'National Shame' of England's Maternity Service - Harm Normalised

[RedToothBrush]

Women are worth shit. Harm is normalised and we STILL aren't seeing this as a government priority. Its one for the soundbites but its not close to the top of the agenda DESPITE ACTUAL IDENTIFIABLE HARM being routinely done.

65% of maternity services were judged to be failing by the CQC
Like WHAT????

Overall, 48% were rated as inadequate or requiring improvement with around a quarter receiving a lower overall rating than when last inspected.

This isn't a revelation.

The threads there have been over the years on MN on this are dreadful. MN had a campaign to try and improve services, but since then they've actually GOT WORSE.

We really need to encourage women to complain and keep complaining and start making this a politicial priority.

I don't know about anyone else, but I know several people who wanted to become midwives but have faced obstacles due to lack of available course spaces (they met the requirements for the cost) and the lack of financial support to train - particularly if later in life.

Its outrageous.

https://www.bbc.co.uk/news/articles/ckgvl8l5q0xo

Even where the good care does exist though, hospitals are slowly dismantling it. I've had two DC at St Georges in Tooting. DC1 - continuity of care team, same 2 midwives for all my antenatal care and during labour. My child needed NICU and I had a beautiful card from my main midwife afterwards. This was all during covid as well. By the time DC2 was born, the continuity of care team had been disbanded, different midwife every time. Now I hear that the management want to close the birth centre and just have everyone in the labour ward instead. So 1 birthing pool instead of 3. There's a local petition against it started by one of the hospitals own consultant midwives. No doubt the homebirth team will be next. Its absolutely dreadful.

It is ☺️ My mum told me if I'd been a boy she would have called me Toby, who is an earlier, ghost Toseland in the first book. Love the books and the series.

This isn't feminism it's antinatalism, for every extreme there's an opposite reaction - Trad Wives v Antinatalists, both views are a load of cobblers.

Having children might be perfectly natural but there's still an inherent danger in it for mother and child. I don't much about the care pregnant women get but the possible danger of the process should always be front and centre in the minds of the Health Care Professional's from the doctors down.

I will caveat this by saying that my professional experience was about 15-17 years ago and my personal experience 12-13.

As a junior doctor I worked in O&G for a period of about a year, same department each time but with the rotations about 2 years apart. I worked with some amazing midwives but there was a real streak of misogyny amongst many in the department. Some of them seemed to actively dislike women. We used to have a weekly doctors meeting to review all the cases where there had been an instrumental delivery or emergency caesarean. These cases often had monitoring of the progress through their labour and the registrar who had been on shift had to go through what decision they’d made at each stage and why. There were points in most cases where they had been asked to review a patient, given advice or planned treatment and that had been ignored by the midwife because they didn’t agree with what the registrar had advised. The registrars were understandably frustrated by this particularly because they were often grilled on why something had or hadn’t happened and it was because they’d been ignored. The Consultants though didn’t challenge the midwives and one openly said that the registrars move on but they have to carry on working with the midwives. What was also rather worrying at times was how little the midwives knew about medical care if it wasn’t specifically pregnancy related. There was a noticeable difference between those old school midwives who’d also done nurse training and those who’d more recently trained.

During the same time period I also had a rotation in paediatrics which involved being on call for Labour ward if there was concern a baby might be born in poor condition. The same midwives I’d worked with before and seemed to have got on with were so different in how they treated the paeds juniors. We’d get paged by them, answer the call (and bearing in mind we’d also be covering the children’s ward and A&E as well) to be told “instrumental room 4 now” or “c section now”and the phone slammed down with no way to get more information to be able to prioritise who needed us most. We were expected to turn up as soon as they called and would often be waiting around because the patient wasn’t even in theatre yet.

As a patient a few years later (different hospital) I had severe and intractable Hyperemesis Gravidarum (pregnancy sickness). I had multiple admissions and required different anti sickness drugs because I couldn’t even have water without vomiting. On my first admission I had 8 litres of fluid IV in under 24 hours before I started seeing more than a tiny drop again. Some of the midwives were great. One had a twin sister who had experienced HG and knew what it was like. Some thought I was causing a fuss and told me stories of how they vomited every day in their pregnancy but still managed to work. Some refused to administer medication prescribed for me by my Consultant because they didn’t agree with it. When I started bleeding at 30 weeks, the maternity support worker who first came to assess me on the ward failed to notice that I was clearly in labour and contracting every few minutes. When the midwife came she also didn’t really seem too bothered by it, asked me if I wanted some paracetamol and spent about 15 minutes trying to get the monitor to work. It was only when she couldn’t find a heart beat that she called the registrar who immediately realised I had a placental abruption (the placenta had detached) was in active labour and bleeding internally. He told the midwife I needed a steroid injection ASAP in order to have any hope of my baby’s lungs maturing to which she answered she couldn’t because he hadn’t prescribed it. I did get them in the end- the registrar did it, took me to Labour ward and my son was born about 20 minutes later.

The Labour Ward midwife was amazing. He was so kind and gentle as I had to stay in bed on a drip for 4 hours to control the bleeding and brought me a picture of DS who at that point was in NICU. He then took me round in a wheelchair so I could see him.

I appreciate my experiences are just that. They’re anecdotes, not data. But most of the friends I know have stories to tell of being ignored by midwives when they knew the baby was coming, of being denied pain relief because they just needed to get on with it or being told they could have an epidural but then they’d almost certainly have to be cut and have forceps or end up with a caesarean. We can’t all be imagining this. And the confidential inquiries into maternal deaths shows we’re not.

Absolutely shocking, @Faffertea.

It has echoes of the physician associate mess - an inadequately educated group calling the shots and providing inadequate care. Indefensible.

My first birth was in London in 2001 and the care was poor from pre natal to post natal with a couple of exceptions. The post natal ward was completely hellish, the nurses were run off their feet. The one who came to remove my catheter did it in such a blur I didn't know it was out, and ran off immediately. My pelvic floor never recovered from this birth, I got handed a leaflet and that was that.
DC2 was born in Scotland, it was an easier birth but I was well cared for, midwives spent a fair bit of time helping with breastfeeding and even took the baby away at night to let me sleep.

I think it a staffing but also cultural issue with poor attitudes and bad practsie slowly spreading.

I had 2 overall good birth experience and they were short staffed. Then moved to an area next door to one later caught up in scandel and investiagtions where many had trained or previusly worked - and like PP says they seem to hate women and had a really paternalistic attitude - so even experienced mothers were not listen to about being in pain or labour.

I later found my medical notes were inaccurate and that many other mothers had found similar. Few years later knew mother who had preventable still birth - she wasn't listen to and they admited liability in end.

My last pg/birth MW behavior was so terrible we couldn't consider another pg in that area - so stopped with ones we had - we are happy enough with that choice now but would have like to feel we had more actual options within that choice.

I think it's like elder care wards - they've been a mixed bad in my families experience and at worse life threateningly poor - as in it's a service that face disproportionate funding constraints because somehow it's not a priorty so it's been easier to do there and lots of bad practise has slowly crept in and started to take over.

Incidentally I did complain - it led to much worse care during rest of pg and birth. Managemnet agreeded we had a good reason to complain. Birth itself was more poor MW care - and manger in debriefing also picked up discrepancies in medical notes but the complaint was managed away.

My Dsis nearby but different health authority also had reason to complain - she also got much worse to non existant care.

We both had other things going on in our lives and a new baby - and we just hit disinterest blame directed at us and walls.

Family all believe we'd have got better care if we hadn't complained and it's made us much more hestiant to do so. Dsis child - DN - had poor care to point new medical team insited to her she complain - she tried but the medcial notes were lost. Dmum refused to do so as she was terified the extremly poor care would get worse and couldn't protect Dad when she wasn't around - when he died - she couldn't face it. We know others with similar experiences with NHS complaints.

i would just like to add (and this is not to defend poor practice) that a lot of times midwives ignore signs that women are in active labour, they are doing it because there literally isn’t room to accomodate that woman. Once a woman is confirmed as being in active labour, they are entitled to their own room and own 1:1 midwife. I have worked many shifts where we were heaving and there were no spare rooms or midwives. So of course, if a woman is niggling (especially a first time mum), we would be instructed to advise them they were probably in early labour and to go home etc. it’s not safe but if there are literally no rooms or spare staff, what are we supposed to do? Not all of this comes down to money but a lot of it does. If there were more staff, more space, more time for midwives and doctors to learn and work together, this wouldn’t happen as much. And I’ll be honest - it came as a shock to me that doctors were not just working across the labour war/antenatal and postnatal care ward: these doctors were also working across A+E and gynaecology wards as well so there was often a wait for a doctor. I naively expected doctors to be staying in maternity and waiting until we needed them. How wrong I was.

@Holdonforsummer
I do agree that space can be an issue and like you am well aware of the issues that lack of space, lack of funding and poor staffing causes.

But that doesn’t explain what seems to be an attitude amongst some midwives to actively dislike women while often claiming they are her “advocate” as a way to ignore what she wants or at times what an Obstetric doctor has advised and this is common enough that it is occurring in departments across the country. And is causing harm. It also doesn’t explain the difference in care offered by different midwives in the same department.

And I agree, having covered emergency gynae as well as antenatal, labour and postnatal wards all at the same time on night shifts means that patients do end up waiting longer than they should. That’s a whole other conversation though.

I think it a staffing but also cultural issue with poor attitudes and bad practise slowly spreading.

After my cousin had a traumatic birth of her twins at 29 weeks, I was shocked to visit her when I walked by the nurses station with 6 or 7 of them sitting in a circle drinking tea and eating biscuits whilst ignoring the call bells of new mothers with new babies. This was not a one off.

They were likely nurses, not midwives but the poor attitude and woeful practice was very evident over the times I visited. These women did not care about providing effective nursing care and were simply lazy. Where was the ward management though? Why was this allowed to happen?