Comment on: Compassion 'not the key' to solving NHS problems
What a breath of fresh air! My beliefs exactly, which I've expressed here before. No one becomes a nurse (perhaps an extremely rare one who gets rooted out, or roots oneself out, quickly) without having an interest in caring for people, i.e. compassion.
Support a hospital, an entire health system, with proper resources that allow nurses the time and the equipment to care for patients, and they will do so, and very well, indeed. I hope the words of Dr Anna Smajdor receive the attention they deserve, but somehow I doubt they will.
Comment on: Abortions case midwives in appeal
Seems to me that once the procedure came under their supervision, they were still sufficiently removed enough to not feel responsible for taking part. They need to only feel responsible for the health and well-being of the woman undergoing the medical procedure. She is their primary patient. The embryo/fetus is not a patient at all in a woman having a termination. If they cannot come to terms with that, so be it.
I imagine the hospital is not willing or able to transfer these services off the Labour Ward once again, though that would be the most likely solution, if at all possible.
Therefore, perhaps the best solution is early retirement, or if not, transfer another ward such as antenatal or postnatal? Or to a Catholic or other private hospital that does not do terminations. I'm sure they would be most welcome there. The fact is that NHS hospitals do offer them to the population, as they are legal to do so. I do not feel any further accommodation need be made.
Comment on: Maternity services on knife-edge, warn midwives
I wholeheartedly agree with what Cathy Warwick of the Royal College of Midwives is saying.
When will the government start taking this crisis seriously? When will the public realise that giving good and adequate care is primarily dependent upon having enough midwives to go around? That requires more money, and better management of that money.
If they want excellent care, they not only must demand a safe ratio of women-to-midwife in community midwifery settings, and for in-hospital antenatal and postnatal care; they must also be getting one-to-one care in active labour! This has been proven to be the only safe way to care for mother and fetus at such a stressful and often high-risk time, so that proper monitoring and assessment of the health of both, as well as providing comfort, coping skills, and anticipatory midwifery skills, may occur. That is how government takes care of approximately half its residents, and indicates how they feel about their newest ones, our babies.
Having enough really good midwives helps to head off antenatal problems by helping with optimal weight gain, improved exercise, reduction/stopping of smoking, teaching what to expect and what is abnormal, imparting knowledge of risky behaviours and of prompt reporting such as reduced fetal movements or symptoms of preterm labour, preparing for labour and birth options, and of course, the mums who had assumed they would bottle-feed learning about breastfeeding, and finding it IS for them and their baby, after all, etc, etc.
Having enough really good midwives helps to head off intrapartum (labour and birth) problems such as prolonged labour, excess interventions, birth injuries, and haemorrhaging for mum, and helps women start breastfeeding successfully right from the delivery bed. It helps avoid feeding, blood glucose, and temperature problems for the newborn, and gives an opportunity to show and teach the parents about newborn behaviour in the first few hours, helps mum to bathe/shower and eliminate, during which assessment is going on, and the discussion of birth events and their feelings.
Having enough really good midwives helps to head off postnatal issues such as infections, depression, lack of bonding, and breastfeeding problems for mum by observing and assessing, and carefully reviewing discharge information and instructions, so they know what to expect and how to recognise situations out of the norm. It helps ensure the health of newborns because the last person to see that infant before going home is the midwife who will then have the chance to catch a problem, or by knowing when baby nursing/bottle-feeding well or not, knowing that the parents have learned about jaundice and what to do if they see it, about normal elimination, and keeping a baby close and preferably skin-to-skin at times, and not excessively warm - all of which heads off feeding problems/failure-to-thrive, dehydration, severe jaundice in the newborn, and infections.
How a mother and baby, or parents and baby, start out can influence their health and welfare for many years to come. Though many disciplines and variables are involved, the midwife is the front-line practitioner. Already, ‘preparation for childbirth’ classes have been reduced. Postnatal midwifery visits at home have been reduced, or even eliminated in some parts of the UK. And in most regions, one-to-one care in labour is only a dream. Imagine being the mum in the throes of labour who needs attention from her midwife, who is caring for a few others in active labour, so you need to wait, and wait, and wait... That is morally wrong, and potentially very dangerous, as we've seen time and again.
Stop taking money away from nursing and midwifery, and face the fact that there are too few practitioners and too much to do for it to be done well enough for our patients. We are burning out and our patients are suffering. Provide us with what we need to do our jobs with excellence; know that it is so very worth it in the long run; and admit that the future is going to be very grim if you choose not to.
This is an absolutely horrible event and my condolences go to Mrs. Teague's family. I have dozens of questions! It's so easy to second-guess and spontaneously place blame in the knowledge that it would never have happened to me... But the truth is, it could happen to anyone, and we must all learn from it!
Saying that, there were warning signs that must have existed so her death should never have happened had the job of midwife been done properly!
First, having had a previous C/S, this woman should not have been offered a home birth for several reasons. Did Mrs. Teague ask for one, insist on one, or was it offered to her, or maybe even strongly suggested to her?
Second, I'd like to know how long the midwife stayed after the birth?
Third, Mrs. Teague's perineum was apparently not examined well enough with just a torch. The updated article says she had a severe tear. It was likely still bleeding, if only a trickle, or perhaps much bleeding was happening internally and causing increasing pain. Should have been further examined properly!
Fourth, mum was complaining of pain; when was the first time, and was it appropriate pain? Another warning sign.
Fifth, how could a placenta that was delivered with much difficulty be properly examined for completeness with again, only a torch? Did the midwife not take it into the kitchen to see properly?
Sixth, if a third (a rather large chunk!) of the placenta was still retained, it would absolutely have been palpable to the midwife. Gentle palpation, if only to check on good uterine involution, must have been done. This would have revealed the need to firmly express the chunk, or move to hospital for manual removal.
Seventh, I'd like to know of any previous queries into this midwife's professional practice?
I'm sorry to be so gobby about his, but I am seriously upset that this poor family, who had already lost a twin in an earlier birth, has now lost their mother and wife. As this article was based on the husband's testimony, I look forward to hearing more details from others. If this is down to really poor professional practice, this must never be allowed to happen again.
More details will probably become available at the Nursing & Midwifery Council website.
From a UK Registered Midwife, and Registered Nurse
Juggling Dog | 31-Jul-2012 1:22 pm wrote:
"Mike seems to me to have been pointing out, that he thought that was the purpose of the chart on the basis of what he had heard on the radio and read in the press - various other posters disagreed with mike, but it looks as if mike is right and they are wrong."
Your posting is a lovely, rational analysis for which we thank you. However, Latterlife Midwife (and RN) is grievously injured that you ignored the fact that she (see Latterlife Midwife 27-Jul-2012 11:58 am) referred to these points very early on, before the wrestling near the mud pit began amongst certain participants here.
As she had not read the actual article or heard the radio report, her response was from experience and intuition only.