Click the picture to enlarge it, then please sign our petition, if you haven't already.
Click the picture to enlarge it, then please sign our petition, if you haven't already.
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?
Group A Streptococcal infections are on the increase, according the the Health Protection Agency. The concern so far has been largely in cases of Scarlet Fever, which last December reached a 10 year high, the HPA reported.
The news is that there is now an enhanced surveillance protocol of severe group A streptococcal disease. Not quite the study of cases of childbed fever including those that do not result in death that I'd like to see (and is, I know, in planning) but a welcome step in the right direction.
If group A strep infection is more prevalent in the community at the moment, then there will be more cases of childbed fever as well, one could assume. Let the doctors and midwives be aware and be alert, lest it result in more death.
Thank you to every one who has already signed this new petition.
It is particularly encouraging to know that not just friends and family of mine/Jessica's have signed it but many others as well - including midwives and doctors - showing that there is real need and desire for simple change that can have such a positive impact on lives.
I'd really like to encourage everyone to ask partners, friends, family and colleagues to sign as well, and there is no minimum (or maximum) age! If you passed the link on to ten or more people (and there's no promise of fame and fortune, nor threat of famine and disease attached to this!) the exponential effect would be very powerful.
Some NHS Trusts are already starting to use Modified Early Obstetric Warning charts, but some use them only for 'at risk' mothers. I'd like to see them being used routinely for every new mum. They are a useful aid in quickly spotting a problem with a mother's health - for any reason - and can be an indication to all midwives and doctors involved that a woman needs prompt medical intervention.
Particularly in the case of childbed fever, timely use of antibiotics can be vital as a group A strep infection can kill in a matter of hours rather than days.
So far, the NHS does not have a clear set of guidelines for the detection and treatment of sepsis which, together with the use of MEOWS, would greatly reduce the chance of severe illness and/or death.
I also believe, without for a minute wanting to alarm or create terror, that all mothers and their partners should know of and understand the risks of a uterine infection, so that instead of thinking that maybe it's a case of flu, they immediately refer themselves back to their midwife or GP, thus saving precious time.
I hope, through the petition, that a large number of other parents and parents-to-be especially agree with this premise, and that together we can show the government that we believe action should be taken now, and not after another unnecessary death from this archaic illness.
Thank you again for your continued and important support.
We have started a new petition on the Downing Street website, asking 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 and is given clear information and advice on the recognition of childbed fever (also known as puerperal fever and genital tract sepsis) and that doctors and midwives are given clear sepsis guidelines."
This petition will remain open for 9 months.
However, please sign our petition now, with one name per line - signing as 'Mr & Mrs Smith' will only count as one signature! Every British citizen or resident can sign if they have a unique email address.
When you have signed please remember to click the link in the confirmation email you will receive, then please share the link to this page with anybody who you think might like to sign it as well.
For more information about the petition, childbed fever, MEOWS and Jessica's Trust please read our website.
Since becoming a registered charity, we have partnered with Justgiving.com to allow us to receive online donations.
All money donated or raised through sponsorship will enable us to continue raising awareness of childbed fever through printing and distributing leaflets and posters, running our website and striving to achieve our aims.
Bookmark our website or join our update list to keep abreast of what we're doing.
Thank you for your help. Together we can make a difference.
I was very glad to attend the South East Regional CEMACH conference in Basingstoke today. I was asked to speak a few months ago, and as anyone who knows me will testify, I hate public speaking. As a result I blanked it until the last minute and just revised my last speech at the eleventh hour.
As yesterday approached, CEMACH offered me a corner of their table for my leaflets and books, then a table of my own. By the entrance/exit.
I was made to feel so special I forgot to be nervous this morning, especially as the chair of the conference handed me some Bachs Rescue Remedy. By the time my slot arrived I was feeling comfortable in the lecture theatre, knew what I had to say and launched in.
I knew to expect the rustle of tissues, but I was overwhelmed by the support shown afterwards, and the number of requests for a repeat performance in other parts of the country, and the speed at which copies of Friday's Child flew off the table later.
As promised to a number of delegates, here is the link to the text of my speech in Birmingham last year - largely unchanged today. And yes, I will consider recording it and putting it on YouTube. The more (student) midwives that hear it the better.
Things will change, thanks to Jessica.
Thanks to some generous donations, I've been able to push the print button, ordering copies of our leaflets and posters from our friendly (he knew Jessica for years) printer - 11,000 in total. It sounds a lot to me, but to get them spread as far and wide as I'd like we'll have to print an awful lot more.
I should have them in time to take to the South West regional CEMACH conference at the end of the month, where I'm speaking once again about Jessica, childbed fever and MEOWS charts, and CEMACH have very kindly let me share their stand at the conference. I hope as many delegates as possible will take copies away with them, back to the maternity wards.
We're gathering other 'first round' destinations for packs of the literature as well, and some fund-and-awareness raising meetings are being planned where they'll come in handy, but if you have an idea of who might benefit from some copies, please let us know.
It's going to be busy in the coming months, so check back regularly or sign up for updates we're going to need some help in more ways than one!
I had lunch yesterday with Dr Gwyneth Lewis, Director of the Maternal Deaths Enquiry for CEMACH. I spoke immediately after her at the conference in Birmingham a few weeks ago, and we had agreed to meet up in the near future.
It was a good opportunity to catch up with what I am doing through Jessica's Trust, and where she wants to go with maternal health, globally as well as domestically.
Incidentally, CEMACH have also been in touch to ask me to speak again, in the new year, at one of their regional conferences. It's fantastic to begin to properly understand how much Jessica's story does really help, and after my nerves of last time I'm much happier to say Yes.
Gwyneth asked me what more I still wanted to achieve by campaigning. 'Raising awareness of childbed fever' is accurate and all well and good, but it is a bit vague other than as a strap-line. If I go and speak to parliamentarians, committees and Royal Colleges it's not precise enough. I know what I want, it's probably dotted around in the pages of this website, but I have now turned it into a 1-2-3 wishlist.
1. Every new mother to be handed a leaflet or card with information about childbed fever and its symptoms.
For example, our leaflet or a version of it. The Meningitis card handed out to new mothers is really effective and the simple information shown is widely known now. All parents and their families need to know about childbed fever.
2. Every woman to have regular observations recorded on a Modified Early Obstetric Warning System (MEOWS) chart - in hospital and at home.
It's really encouraging to hear that more and more hospitals are getting around to implementing them, but they should be in use nationally. Mandatorily and now.
3. Every doctor and midwife to have a clear sepsis guideline.
It is lamentable that such does not exist. I'm going to add our voice to those already calling for it.
We acknowledged that finding time to work on Jessica's Trust can be hard at times, but the passion is there, and the open line of communication with CEMACH just may give it the boost to go.
I've just learnt about this widget. It allows you to browse through (if you haven't already read it) a few selected pages from Friday's Child. Click on the page to enlarge it.
This is the text of the speech I gave to The Sixth National Conference on Current Issues in Midwifery organised by the British Journal of Midwifery yesterday. I have reproduced it here by popular request. I am not going to include the photographs of my family that I refer to, nor the medical charts, but the important information from these is in the text. The full version of the story is, of course, told in Friday's Child.
Good morning. My name is Ben Palmer, I am a father of two children, and a widower. I am also founding trustee and chairman of Jessica's Trust – a charity focused on raising awareness of childbed fever or puerperal sepsis, but more about that in a minute.
First, I'd like to introduce you to my family and give you a small and brief glimpse into our lives.
This is my wife, Jessica, and I just after we were married.
This is Jessica and our daughter Emily, just after she was born ... we didn't know she was a girl, so she's in her brothers hand me downs already.
It is one of only two photographs of the two of them together. Emily keeps it beside her bed wherever she stays.
Jessica died in June 2004 when Emily was just 6 days old, and three weeks after Harry's third birthday. She was 34.
This photograph is hanging in poster size on their bedroom wall, so that they will never forget her.
This is my family today.
Emily is a relatively carefree 4 year old still learning about who and what it is she has lost. Harry is a seven year old, unfairly burdened with the reality of maternal death. I'm less troubled than I have been, but a little greyer than I used to be.
This is a story that fills numerous files, but I'm going to condense it right down, hopefully retaining the salient information. Please remember that the small amount of medical knowledge I have now is 98% more than I had at the time.
I'm also going to illustrate the story with an early warning chart that I have filled in retrospectively from Jessica's notes. Unfortunately they were not being used at the time.
Emily was born at 6.26 on a Thursday evening after a complication free vaginal delivery. She was 9lb 13ozs. Jessica and I were ecstatic after the birth of our daughter - a sister for three year old Harry.
Jessica's temperature at delivery was normal, heartrate 78, BP 120/56.
After a sleepless night because of Emily's constant crying for milk, Jessica was shattered and wanted to go home, but her midwife was worried – Jessica was tachycardic.
At 9.40am Her BP had dropped to 80/40 and she was hot (although her temperature wasn't recorded anywhere that I can find it.) and her heart rate had increased to 90.
The SHO was bleeped just before 10am. Had the hospital been using this chart, these obs would have registered as a red score and should have made her a priority.
Through the day Jessica's heartrate rose to 100 - which would have registered as a yellow score - and with no sign of her, the SHO was bleeped again.
At 8pm the doctor at last visited Jessica without (Jessica told me) taking any fresh observations. Looking at the notes, it might appear that she re recorded the previous ones and then discharged her.
After supper that night, an hour or so later, Jessica was shivery and had blue lips.
I got her into bed and then took her temperature as she now looked flushed. It was 38.9C.
I could have called the hospital or, indeed, an ambulance, but two things occurred to us.
I had no reason to think that Jessica was in any danger after a normal delivery. And anyway, as second time parents, we knew that the community midwife would be visiting the following day.
Jessica was tired and made it quite clear that she wanted to be left to sleep until the next feed.
Yes, the benefit of hindsight makes me uncomfortable about this. It was my missed opportunity.
Unfortunately, the midwife was too busy, with too many mothers, to visit the next day, but I told her on the telephone about Jessica's temperature and so she recommended paracetemol for the fever, should it return, and promised to visit the next day, Sunday.
Had the discharge form mentioned the problem or concerns in hospital, again with hindsight, I might have thought to mention it, but the 'Other problems' box was empty.
We were reassured and so got on with the business of looking after our young family.
Jessica came downstairs once over the weekend - in fact it was the only time she did in the three and a half days she was at home with us - and it wasn't for very long.
So, when the midwife visited on the Sunday, Jessica was in bed with Emily beside her.
She didn't have her thermometer with her, so just recorded that Jessica was feeling feverish.
She didn't know what Jessica's hot and red looking abdomen meant, so it was forgotten about. The midwife left Jessica after about 40 minutes and she carried on resting.
On Monday morning, Jessica was in a lot of pain in her lower back and so rang the GP's surgery. She was diagnosed as having sciatica and given Diclofenac. The medicine was great and made Jessica much more comfortable for the rest of the day, but the pills were obviously masking a worsening crisis.
By breakfast on Tuesday, Jessica was beside herself with pain and barely able to walk, and so I drove her around the corner to our GP. Jessica was seen immediately and referred back to the maternity ward by blue light ambulance.
On the way, her BP crashed and she was redirected to A&E. She was diagnosed with septicaemia and soon moved to Intensive care.
During the next twenty hours or so, I slept little, and shuttled between my home where my mother was looking after Harry and Emily, and Jessica's bedside.
She was given drugs for the infection and failing blood pressure in ever increasing strengths and dosages.
During the night she was put onto dialysis and a ventilator. I left her bedside at 6 in the morning to be at home when Harry woke up, but by eight in the morning, when I was called back to hospital after 40 minutes sleep, it was apparent that she was in very grave danger and deteriorating.
As a last ditch attempt to save her, Jessica was taken into theatre for a possible hysterectomy in the late morning. Almost immediately after the first incision, she went into cardiac arrest, and death was recorded just before midday.
Jessica died of multi organ failure caused by group A streptococcus.
I don't mean to judge or criticise - I just want to tell you what happened and why I'm here. Legally, the matter is closed after admissions of liability, but I hope there is something that everyone can learn from Jessica's case; parent, midwife and doctor.
I'd hate her death and our loss to be a wasted opportunity.
You don't need me to tell you:
In the grand scheme of things, 18 deaths between 2003 & 2005 may be a small statistic, but the human impact is not.
What I do want to tell you is what happens when you wake up as a single parent and a widower, with small and confused children.
When I got home, broken hearted and in shock, I had to go on and on breaking others' hearts. Jessica's parents, my parents, our friends and family and my son Harry's.
When I told him that the doctor's had tried really hard to mend mummy's sore tummy, but that she was too sick and now she was in heaven with God and the angels where her tummy couldn't hurt any more, he just looked at me.
He didn't say a word. He was three - how could he understand what I was also struggling with?
Thanks to my mother and sister, and subsequently a nanny, our day to day life carried on during the first few weeks: meals were cooked and our routine was followed, but we were crumbling inside.
Harry's fear and confusion usually manifested itself at bedtime. He wouldn't settle, would often wet the bed, and frequently woke me in the night to climb in to bed beside me, but it was the shouting, the screaming, that was most upsetting,
"I DON'T LIKE MUMMY ANYMORE" he yelled at me once after an extended tantrum. He was angry with her for deserting us. Another time, he thought that maybe she and I had had a fight and was now living somewhere else.
How could she not want to see him or live with him anymore?
I lost count of the number of times we'd go through this sequence, and I quickly ran out of answers. In the end he - and sometimes I - would fall asleep on his bed, him in my arms.
Every time I took him to a party or to a friends house there would be trouble at night. He couldn't express it to start with, but he was angry that other children had a mum; what had he done wrong that meant he couldn't.
My own reaction over time was not much better. Consumed by anger, isolation and despair, I sunk into depression. I was eventually diagnosed in 2006 as having agoraphobia, anhedonia, dysthymia, depression and an alcohol dependence. I was drinking, on average, two bottles of wine a night - over 120 units of alcohol a week.
My work - I was self employed - was too much for me, and my clients politely drifted away one by one. I just couldn't stay focused. I got to the point where I didn't care about anything, myself included, other than Harry and Emily.
After being diagnosed, I was lucky enough to have counselling and a long course of cognitive behaviour therapy, and I have now stopped awfulising.
Eventually, life does start to get easier every day, but we'll never be 'better' - bereavement isn't an illness and it never goes away, you just have to learn to live with it.
Emily has never kissed her Mum, she and Harry will never have their mother there on red letter days. On Emily's first day at school last month, in her new dress, she looked at me with a sadness and simply said, "I wish my mummy could see me today."
What will she say if she graduates, or gets married?
My point is that death never goes away once it has struck, but what I want to underline, through Jessica's Trust, is the vital importance of regular and continued observations, fast recognition of symptoms and of action. By the time sepsis is clinically obvious, it may already be too late.
That was where the mistake was made in Jessica's case – too many people passed off the increasing symptoms as anything but dangerous, and Jessica and I were reassured into accepting symptoms that now make me shudder when I think of them.
My focus is to raise awareness of childbed fever - I want all of us, midwife and parent together, to understand it and to talk about it. The last thing I want to do is to invoke terror, but childbed fever should still be feared as it once was. That way another mother's life may well be saved, or she may just be saved from a long recovery from organ damage or a hysterectomy.
I want to see early warning charts being used routinely, and they should go home as well, for the community midwife.
I'd like to see more midwives, so that no one is too busy again, and I'd like to see a maternity service that is as valued with funding as it is needed by us as parents.
I hope that you will remember my wife, our motherless children and all the others like them.