MEOWS
Tue 14th Oct 2008 by Ben Palmer.Modified Early Obstetric Warning Score charts are instantly clear and they can save a life. What are they, though?
They are a single sheet chart, with time tracked across the top, where observations - pulse, blood pressure, temperature and a whole host of others - can be marked in the columns below.
Normal readings: fine.
Borderline readings: the box is shaded in yellow.
Dangerous readings: the box is shaded red.
One red or two yellows at one time and a doctor is required for 'early intervention'.
It is so graphically obvious, and a mother's history so clearly charted that, the idea is, a mother who is developing a critical condition will be treated before it is too late.
Sepsis (for example) is often already life threatening by the time it is clinically obvious. Therefore the best opportunity to intervene is based on the early warnings.
These charts are not routinely used, though. Some units do use them, others are looking at using them, and I believe there may be a national pilot some time.
I filled in Jessica's observations on such a chart a while ago and it is so obvious. You can see that she was very ill, long before she was showing the more advanced symptoms of sepsis.
When I was in Birmingham the other day I showed the chart to the conference. A midwife came up to me after I had spoken and said that her hospital had had MEOWS on the agenda for a while but that no-one had yet got around to implementing them.
She told me she was on the panel and was going to go back to work to get them implemented. Now.
I want these charts to be used routinely, as in other disciplines, and they should follow a mum home to the community midwife as well. How else is she supposed to know her patient's full history so definitively?
You can see an example MEOWS chart here.
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I spend a lot of time campaigning for the national...
tags: doctors health hospital maternity MEOWS midwife mother nhs sepsis
i had my daughter 19 months ago. what should have been the best experience of my life turned out to be the worst. i had to have a c-section as my womb was over contracting. within hours of coming out of theatre i had a temperature. in 9 days i had 2 more op's and a variety of antibiotics. my wound was left open and eventually closed a few months later. the hospital would not tell me what infection i had and so research alone has given me some answers, which is why i am now in the process of a negligence claim to confirm my beliefs. i missed the first few months of my childs life as i could hardly move through the pain.i believe that i am one of the rare survivors of this cruel disease. i can not imagine losing any more time with my daughter than i did which is why i want to show my support for jessicas trust.
kayleigh,
Thank you for sharing your terrible story, and for supporting Jessica's Trust. I hope that you are now well on the road back to health, and that you mention to find the answers you are looking for. Do keep in touch.
Ben
I recently had a son, 6 days after having him i come down with a fever and abdominal pain, luckily i went to my gp who immediately sent me to hospital where i spent 6 days. staff were very good as i was swabbed early on so they could treat me with the correct antibiotics. Didn't realise how serious it all was till i started researching it and come across your website which i wish you all the best with.
Hi Kayleigh
Your story sounds outrageous and I am particularly incensed by the part about the hospital refusing to tell you what the infection was, although it is possible they just didn't know. You have a right to have a copy of your medical notes, so you can contact the Head of Midwifery at the hospital concerned and request this. There will be a charge involved. They do not have the right to with hold information from you. It's your body, not theirs. Best wishes, Anne Stafford (Midwife)
Dear Ben
I just heard you on Jeremy Vine on R2 and firstly I would like to say how very sorry I was to hear the story and, indeed, it should not be happening at all in the UK in this day and age. One of the problems is that the maternity services just can't cope and women are sent home very early from hospital to scant community midwifery care, so no-one really detects these things in the early stages any more. Hospitals are getting dirtier and this must be invovled, I imagine. I am a midwife in independent practice and am an advocate of home birth, where women are unlikley to pick up infections. I will now give my clients (wherever they chooses to birth their babies) a leaftlet about this infection. I will do what I can to extend awareness of it and will be more careful about taking their pulse, temp and BP when they have birthed in hospital. So you have changed this midwife's practice at any rate.
I do so hope you enjoy your children. It wasn't the pregnancy or birth that killed Emily's mother but (probable) negligence on the part of the hospital. Any guilt should be felt by those responsible. My best wishes to you all.
Anne
Hi Anne
Thank you so much for your kind message, particularly about the guilt. I totally agree with you, am just worried about a possible future feeling of guilt that Emily may have. In this event I will be sure to do everything I can to squash it. Also, yes it was negligence, and I have two separate letters of admission of liability to prove it, which Emily will also be able to read one day in the future.
Dirty hospitals are, as we all know, a source of infection sometimes, but I do feel it important to point out that childbed fever is most frequently caused by group A strep, which is a community bacteria carried by up to 30% of us at any time - normally quite harmlessly on our skin. Part of the Jessica's Trust campaign is to underline that there are no high or low risk groups when it comes to childbed fever.
We'll have our leaflets printed very soon - drop me a line if you'd like me to send some. In the meantime, many thanks again.
Dear Ben,
I heard you speak today on Jeremy Vine's programme. I cannot even begin to imagine what you have been through over the last 4 1/2 years. I am truly blessed to be the Mother of two young children. Thinking of you and your precious family and of your beautiful wife,
Wishing all the very best for your and your children in the future. You are in my thoughts and prayers
Beverley, N. Ireland
Hi Beverley, thank you so much for dropping by and for your kind words.
Thank you too to everyone who has visited the site after listing to the Jeremy Vine programme, do come back!
Dear Ben
I did things backwards, I think, in that I read the stories etc. here first and then looked at your leaflet, where it explains about the condition not being the result of HACs etc. This does raise questions in my mind, though. If it's not transmitted through poor hydiene why did so many women die before Semmelweis and anti-sepsis came along? However, the principles of good hygiene, being informed, monitoring newly-delivered women carefully and acting quickly are vital whatever the source of the infection, so that's what I will do. Also, I started my training in 2000 and I don't remember being taught anything about this. I wonder if it features on the syllabus now? Best wishes to you, Anne
Hi Anne
Interesting point about the spread of infection. Group A Strep is a community bacterium: it exists naturally and we have to assume that this may always have been the case, so individual infection rates wax and wane depending on the prevalence of GAS.
What used to happen in Semmelweis' era was that the bacteria (and those picked up in the mortuary) were actively transferred from woman to woman, causing an epidemic. The same would be true now, but for our knowledge of infection and anti-sepsis.
What Jessica's Trust is trying to combat is the prevailing natural threat - which may never be extinguished but can be managed before it is life threatening.
It is important to understand that childbed fever can be acquired anywhere - at home or in hospital. Up to 30% of us are estimated to be carriers of GAS.
This information should be on every midwifery course and reinforced through professional development etc. I've just been asked to speak to a midwifery course so will be able to help with this!
[...] every new mother has regular observations recorded on a Modified Early Obstetric Warning System (MEOWS) chart in hospital and in the community and is given clear information and advice on the [...]