Showing posts tagged with: 'death'


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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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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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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Mother's Day Every Day

Fri 27th Feb 2009 by Ben Palmer.

On a random web search just now, I came across this post.

The White Ribbon Alliance is an international coalition bound together by a common goal: to ensure that pregnancy and childbirth are safe for all women and newborns in every country around the world.

Let's face it, our problems pale into insignificance when compared to the developing world, and while I believe that 'Charity begins at home' also means trying to fix the problems at home, other nations really need our help.

Let's not forget their mothers either. The Mother's Day Every Day campaign is a brilliant idea.

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NHS Trust apology: maternal deaths

Fri 13th Feb 2009 by Ben Palmer.

From the Nursing Times today:

In the Gwent Healthcare NHS Trust, 'earlier identification of deterioration, or better advance preparation to manage identified risk, may have averted the deaths'.

Link to article: NHS trust apologises over 'exceptionally high' maternal deaths

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Anniversary request

Mon 30th Jun 2008 by Ben Palmer.

Four years ago today, a good mother died unnecessarily from an archaic illness. The world may not have noticed immediately, but the three year old boy crying in his bed, the six day old girl feeding in her father's arms and the grieving widower did.

Together the three of us have kicked, screamed and cried at more than one time or another, not necessarily in synchronisation.

We are now building a new life for ourselves but a few things haven't changed in the years that have past: we don't like what happened, we miss Jessica and we don't want another son, daughter or husband to live through what we have.

All three of us, to the extent of the understanding that we each have, want to do what we can to prevent another mother's death from childbed fever, but we need your help.

On this fourth anniversary, we would like you to tell four (or more) people, who don't already know, about Jessica's Trust, what childbed fever is and what the symptoms of childbed fever are.

Please ask them to do the same as well. Thank you.

Ben, Harry and Emily. x

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A chilling hot lunch

Tue 22nd Apr 2008 by Ben Palmer.

I had lunch with two of Jessica's girlfriends today. Soup and garlic bread in the glorious sunshine, and really nice to see them both.

We were talking about Jessica and her trust, and in the course of the conversation I fetched a copy of Saving Mother's Lives 2003-2005 to illustrate a point. Then something I had looked at again and again jumped out and smacked me in the face.

In those three years, the leading direct cause of maternal death was thrombosis/thromboembolism with 41 deaths. The second highest place was tied, 18 deaths apiece, between pre-eclampsia/eclampsia and Genital Tract Sepsis. (=childbed fever/puerperal fever/puerperal sepsis)

Why is it that pregnant mothers are told about, warned about and aware of pre-eclampsia (some antenatal classes are especially good at letting you know it's a danger, even if you're not totally sure what it is) but nobody tells you about childbed fever, even though it is just as much of a danger?

After an involuntary shiver, they agreed to join me in trying to change that.

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Taxing talk

Wed 16th Apr 2008 by Ben Palmer.

Harry and Emily love art. They love SMart and SMarteenies as well, and regularly watch more CBBC than CBeebies now, often catching Newsround. However, I don't know if they saw the coverage of Mark Speight's death on the programme.

The coverage, which I also missed, has evoked much sentiment and anger, I read. Why is this? Do we think that children cannot cope with death? Must we shield them from All That Is Bad?

What then when it happens closer to home? How will they cope with it?

It is important for children to understand the process of life, of aging and of death - but we can teach them this without instilling fear and uncertainty, without the gore and trauma, and without the stigma of suicide in this particular case. Which is what I understand the BBC did.

It can't be better to say nothing, even when they notice that a presenter has left their favourite program without saying goodbye - that would be too big a betrayal of their love and confidence.

Children are wiser than we sometimes credit them for, and they need to understand, but in a way that makes them feel safe and loved - even if that means we do have to face up to our own fears and insecurities.

There are only two certainties in this life, and children really don't need to know about tax just yet - that's too cruel.

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Inquiry into deaths of three new mothers - Telegraph

Mon 14th Apr 2008 by Ben Palmer.

Inquiry into deaths of three new mothers - Telegraph

Necrotising Fasciitis is most commonly caused by Group A Streptococcus, which is also the most common cause of Childbed Fever. It's a pity the article doesn't make the link and say that's what it is, but 'flesh-eating bacteria' sounds nastier, doesn't it?

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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.
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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.
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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.
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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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