British maternity wards in crisis

Mon 4th Apr 2011 by Ben Palmer.

Some very bleak reading, particularly in light of the recent CMACE report, Saving Mothers' Lives 2006-2008 which tells that sepsis now outranks even pre-eclampsia and eclampsia as the leading direct cause of maternal death. Deaths due to sepsis have risen from 18 in 2003-05 to 26 in 2006-08* - a staggering 44%.

Is it any wonder that we have headlines like this one:
British maternity wards in crisis - Health News, Health & Families - The Independent.

 

* Centre for Maternal and Child Enquiries (CMACE). Saving Mothers’ Lives: reviewing maternal deaths to make motherhood safer: 2006–08. The Eighth Report on Con?dential Enquiries into Maternal Deaths in the United Kingdom. BJOG 2011;118(Suppl. 1):pp36.

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No.10 has responded to our petition. Or has it?

Mon 21st Dec 2009 by Ben Palmer.

The Number 10 e-Petitions website has responded to the Maternal Health petition. Or has it?

The response considerately quotes paragraphs from the National Institute for Health and Clinical Excellence (NICE) guideline Routine postnatal care of women and their babies (2006) which sets out what should happen.

It then quotes the Saving Mothers’ Lives report from the Centre for Maternal and Child Enquiries (CMACE, 2007) which really says that more needs to be done.

Lastly there is another quoted recommendation for the use of MEOWS charts.

Most of these documents have been mentioned and linked to from this blog in the past. They are not an answer to the Maternal Health petition, they are the evidence that it was necessary.

We asked the Prime Minister to ensure that every new mother has regular observations recorded on a Modified Early Obstetric Warning System (MEOWS) chart in hospital and in the community, the response merely encourages their use, rather than requires it.

We also asked that new mothers be given clear information and advice on the recognition of childbed fever, specifically, not just the general advice recommended by NICE.

You have quoted us others' reports. Where is your response, Mr Brown? What are you actually going to do? What would Mrs Brown recommend?

(The Number 10 response is here.)

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Maternal deaths are an outrage

Thu 21st May 2009 by Ben Palmer.

"In the 21st century, no woman should have to give her life to give life."
U.N. Secretary-General Ban Ki-moon (Reuters 19 May)

"We must find a way to get maternal mortality recognized as a key indicator of a functioning health system. Let us work together to make sure maternal mortality is a problem of the past and not our children's future."
Sarah Brown (Reuters 19 May)

The justifiable outrage that pregnancy and childbirth continue to kill 529,000 women and leave 1 million children motherless worldwide every year is, naturally, focussed on developing countries where childbirth is far more dangerous than we can imagine.

However, the words of our own Prime Minister's wife and the Secretary-General of the United Nations words at this week's World Health Organisation's annual congress in Geneva are just as applicable to us. Why are our mother's vulnerable to an archiac disease such as childbed fever, which is still one of the most common causes of maternal death?

I feel sure that Jasmine Pickett's and Amy Kimmance's families, amongst others, would join me in asking this. I hope that the Coroner in their Inquests, currently being heard in Winchester, may be able to shed some light on the answer.

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What is the point of twittering anyway?

Sun 10th May 2009 by Ben Palmer.

screen-twitterIt's not all rubbish that's spouted on twitter, despite whatever your newspaper may say! Amongst conversation, debate and information sharing, there is an army of supporters on twitter who pass on messages and information about the Jessica's Trust campaign – often tagged with the #maternalhealth hashtag – and some of them are adept at bringing the cause to celebrity attention.

With some success:

In April Jonathan Ross (Wossy - an extremely popular twitterer) and his wife Jane Goldman (FerretPrincess) both signed and alerted their followers, saying respectively

wossy: I am signing this petition. You might like to as well . Give it a look ! http://bit.ly/2zlSfI Read http://bit.ly/kzYuX PLS RT
[link]

and

ferretprincess: RT @jessicastrust: @ferretprincess #uk #maternalhealth petition needs your support: http://bit.ly/2zlSfI Read http://bit.ly/kzYuX & PLS RT
[link]

ferretprincess: @jessicastrust Signed and retweeted. Very, very best luck with the petition - a highly important and worthy endeavor indeed #maternalhealth
[link]

Three members of Take That – Mark, Gary and Jason – have signed as well, although they're not on twitter themselves, a friend of one of theirs is.

More recently, a couple of days ago, a twitter friend of mine sent a request to Stephen Fry, asking him to retweet information about Jessica's Trust. He gets a lot of requests and has a very strict policy on how he does it, so success is rare. At the time his #fryretweet stream was also being spammed. The two of us were unsure whether the tweet would even be seen and we discussed it openly on twitter.

Two minutes later, Stephen Fry sent a DM (private message on twitter) assuring me that he was ignoring the chaff. I thought, 'wow that's nice of him to say, but he'll forget about us in a minute or two.'

How wrong I was. Yesterday morning at a little after 10am, messages of congratulations started flooding my twitter stream: “you got this week's #fryretweet,” people were telling me. And there it was:

stephenfry: This week's #fryretweet cause is http://www.jessicastrust.or... a very excellent use of twitter.
[link]

An endorsement from the King of Twitter himself! For the next five or six hours our web server held up magnificently under heavy load – and it only resumed normal levels after about 12 hours.

It didn't stop there though, the beautiful Queen of British Soul, Beverley Knight, got involved too. During an exchange of messages after she signed the petition, she wrote:

@jessicastrust yes of course no worries! i'm small but i got fight!! let's get 'em signing!! xxx #maternalhealth
[link]

and, urging her followers to get behind #maternalhealth and sign as well, she also encouraged Wossy to mention us again – which he did.

So if any more big twitterers would like to spare three minutes to sign and support us, we're here: where else can a tiny charity win the ear of such heavy weight influence?

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Look at the bigger picture

Wed 29th Apr 2009 by Ben Palmer.

big_picture

Click the picture to enlarge it, then please sign our petition, if you haven't already.

http://petitions.number10.gov.uk/maternalhealth/

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MEOWS: Recommended

Sat 25th Apr 2009 by Ben Palmer.

I spend a lot of time campaigning for the national use of Modified Obstetric Early Warning System (MEOWS) chart, and indeed I was in Oxford yesterday talking to some midwifery students about their use, and the difference they would almost certainly have made to Jessica.

Not everybody always immediately shares my enthusiasm for them. I've been challenged more than once. It has even been suggested to me that the NHS isn't ready for them. Tosh. In December 2007 I learnt that an estimated 10% of NHS Trusts were using them, and that figure is increasing as MEOWS is adopted Trust by Trust, even if only for high risk mothers. What is a high risk mother? Jessica wasn't but she died. Every mother should be followed for the first 10 days after delivery by her own MEOWS chart, I believe.

As for being a lone voice - this is what the Confidential Enquiry into Maternal and Child Health (CEMACH) said in it's top 10 recommendations to save mothers' lives in it's 2007 report, using prevention of deaths from sepsis as an example:

Early warning scoring system

9. There is an urgent need for the routine use of a national obstetric early warning chart, similar to those in use in other areas of clinical practice, which can be used for all obstetric women which will help in the more timely recognition, treatment and referral of women who have, or are developing, a critical illness. In the meantime all trusts should adopt one of the existing modified early obstetric warning scoring systems of the type described in the Chapter on Critical Care, which will help in the more timely recognition of woman who have, or are developing, a critical illness. It is important these charts are also used for pregnant women being cared for outside the obstetric setting for example in gynaecology, Emergency Departments and in Critical Care.

Rationale

In many cases in this Report, the early warning signs of impending maternal collapse went unrecognised. The early detection of severe illness in mothers remains a challenge to all involved in their care. The relative rarity of such events combined with the normal changes in physiology associated with pregnancy and childbirth compounds the problem. Modified early warning scoring systems have been successfully introduced into other areas of clinical practice and a system which has been modified for obstetric mothers is discussed in Chapter 19, together with an example of such a chart. These should be introduced for all obstetric admissions in all clinical settings.

In developing this recommendation, a consultant from a hospital where staff are trying to get such a scheme introduced said “we have had three near misses related to unrecognised sepsis in the last two months, all of which would have been picked up by this chart. All three women came close to featuring in the next edition of your Report”.

Auditable standards

  • A National Modified Obstetric Early Warning System (MEOWS) chart developed and piloting started by December 2008.
  • In the interim, the number of trusts who have adopted a version of any existing MEOWS charts and trained all staff in its use by the end of 2008

Lewis, G (ed) 2007. The Confidential Enquiry into Maternal and Child Health (CEMACH). Saving Mothers’ Lives: reviewing maternal deaths to make motherhood safer - 2003-2005. The Seventh Report on Confidential Enquiries into Maternal Deaths in the United Kingdom. London: CEMACH.

Update: The report link has moved to the new CMACE website

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'Midwife numbers to fall short'

Thu 16th Apr 2009 by Ben Palmer.

With a weariness I read today yet another story about midwifery staffing levels falling short of the number required  for the government to meet it's own declared standard of care.

BBC: Midwife numbers 'to fall short'

I've said it before, and I expect I'll say it again; please look after our mums properly. The fact that the government thinks that this is one of the safest countries in the world to give birth (actually, it's one of the worst in Europe) is no reason to spread maternity care too thinly.

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Mrs Brown gives away a free plug

Fri 10th Apr 2009 by Ben Palmer.

sarahbrowntwitterpageI've been away from here for a little bit too long, with school holidays, work etc. I've also been concentrating on micro-blogging.

Just the other day I discovered that Sarah Brown had joined Twitter. As well as being Mrs G. Brown, she is a strong advocate of women's health in the developing world. Knowing this, I 'followed' her (on Twitter this is a very non-stalking thing to do) and sent her a link to this website. She thanked me back, and I thought nothing of it until today.

I have just been sent a link to a story in the Technology pages of the Telegraph: Prime Minister’s wife joins Twitter which says it all. What great publicity for Jessica's Trust!

Sarah Brown does great work for www.whiteribbonalliance.org, www.millionmums.org and www.mothersdayeveryday.org. I hope she realises that too many mothers die in this country as well, but she hasn't yet signed my petition to her husband, although you can.

Thank you to @StudyingOnline and @marketingwizdom for drawing it to my attention.

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Life saving treatment wanted asap

Sun 1st Mar 2009 by Ben Palmer.

I'm not just blogging blindly; I'm interested in what other people think and say, and I also am interested in how people find this website, and where people are linking to it.

I watch referring sites in my log stats, and often visit back. It was in this way that I came across a parenting forum this weekend.

A mother of three posted with a link to Jessica's Trust, urging people to read the information contained herein and, if they feel as strongly as she does, to sign the petition.

I was, though, dismayed to read a third reply to her post, from another mum, who didn't think that MEOWS charts were necessarily a good thing. She felt they could lead to unjustified intervention, use of prophylactic antibiotics, and only benefit 1 in half a million women.

Oh how I was dismayed! Where do I begin?

Midwives already take temperatures and observations. They already record them in a mother's notes. If there were more midwives who had more time to spend with the increasing number of mothers delivering and recorded observations more frequently, that would be a good thing. Surely no one would dispute that.

The use of MEOWS charts - which is already standard in a small but growing number of units - is widely supported and encouraged. It is not a new test/observation, but a different and inherently clearer way of recording observations. This means that a women who is beginning to deteriorate will be picked up faster and given any treatment that she requires for a range of conditions including, but not exclusively, childbed fever (CF). This means that severe illness and/or death can be avoided.

I am not an advocate of prophylactic use of antibiotics, indeed more women than are saved from sepsis may die of allergic reaction.

As for benefitting only 1 in 500,000 - how wrong is this. Purely looking at sepsis, in 2003-2005 the Confidential Enquiry into Maternal and Child Health recorded 18 deaths (0.85 per 100,000) from Genital tract sepsis (GTS). This would be 4.25 per 500,000, but more women than that give birth in this country each year. The average number of deaths per annum from GTS/CF is 6.

Far, far more are affected (no data is recorded, but it should be) by childbed fever than this. I continually hear tragic stories of illness from survivors.

Would any of them not have wanted to receive earlier antibiotic treatment?

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Topic for discussion

Sat 28th Feb 2009 by Ben Palmer.

Maternal death is too uncomfortable a topic for discussion.

Please discuss in the comments.

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What is childbed fever?

Childbed fever is an infection of the womb in new mothers which can lead to septicaemia. If left untreated infection will cause organ failure and death - even in young, fit mothers.
more»
What are the symptoms? »
Childbed fever: the facts »

What's the aim?

We would like every parent and every midwife and doctor to know that childbed fever is still a very real threat to a mother's life.
more »
Can I help? »

Who is Jessica?

Jessica Palmer was a Mum. She died in June 2004, at 34 years old, of childbed fever caused by Group A streptococcus.
more »

This website contains general information about childbed fever. The information is not complete or comprehensive. You should not rely on the information on this website as an alternative to medical advice from your doctor or healthcare provider. If you have any specific questions about childbed fever (or any other medical condition) you should consult your doctor or other healthcare provider; and if you think you may be suffering from childbed fever (or any other medical condition) you should seek immediately medical attention. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on this website.
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