Showing posts tagged with: 'infection'


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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She doesn’t know her mother is dead

Sun 14th Dec 2008 by Ben Palmer.

Just reading the Sunday's, I came across a heart rending story about Karmeh, who still doesn't know her mother died of post-partum sepsis.

Developing world childbirth is far, far more dangerous than it is, for example, in this country, but I believe that charity begins at home and that means fixing the problems at home as well. The work that so many organisations - such as the White Ribbon Alliance - does is vital, but there is so far to go in ensuring the safety of our own mothers.

Back to Karmeh for second, and I question the wisdom of not telling her that her mother is dead. Waiting until she understands the concept of guilt may be too late to tell her the truth. My own children, Harry and Emily, know the truth, but Emily doesn't understand guilt so hasn't (quite rightly) felt it. She may do at some point in the future, but at least she won't have the truth to contend with at the same time.

For the moment, Jessica's Trust is committed to raising awareness of and preventing childbed fever deaths in this country, but one day (and I'm already having discussions to this end) I'd like to say, 'Job done. Now, what can Jessica do to help in the third world.'

All of our resources are limited, but please: do help where you can.

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In the grip

Tue 17th Jun 2008 by Ben Palmer.

I was sent an early copy of a new book, Touching Distance, last week. I was gripped by it from start to finish and it consumed most of my weekend.

I have also been alerted to a post by dovegreyreader who has also spotted the link between Touching Distance and Friday's Child.

Touching Distance is set in 1790, in the middle of an epidemic of childbed fever in Aberdeen. A young doctor, Alexander Gordon, discovers - and sacrifices his career and his marriage to publish the fact - that it is he, his peers and midwives who are spreading the disease.

To continue the brief history lesson, Oliver Wendell-Holmes published the same information in 1843. He too was ridiculed by his peers. A few years later, and Ignaz Semmelweis, drew the same conclusion, markedly reducing maternal death by using a chlorinated lime solution for hand washing. He too was ridiculed.

Medicine has moved on: in the West, hygiene practice means that childbed fever does not reach epidemic rates of occurrence - it is not being spread by doctors or midwives. What has not changed is that streptococcus, the cause that Gordon et al couldn't have known of, is still with us. It may wax and wane in prevalence, but it is in us, on us and with us at all times. It is still causing deaths from childbed fever.

We cannot assume that hand washing makes our mothers safe. We can't vaccinate and we can't wash it out of the world, but we can spot the symptoms of its infection while there is still time to treat a mother before she requires long term hospitalisation, a hysterectomy or she dies.

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Why, Daddy?

Sun 16th Mar 2008 by Ben Palmer.

We just had a lovely weekend away, and drove back to London, in heavy traffic, in time for tea. The trouble was, Emily and Harry were so worn out from all the fun that they slept most of the way back.

Roll on to bedtime, and Harry can't sleep. An hour of requests for a cup of milk, a footstep here etc etc, and suddenly it became a little sob from the top of the stairs, so I went up.

There he was, sitting on the step with his two photographs of Jessica laid neatly side by side; the ones that travel with him, and always sit beside his bed.

'I just want to talk about Mummy.'

'OK darling, of course we can. What would you like to talk about?'

'Why did Mummy die? What is an infection anyway? Why do people die too early? How did the doctors know she was dead?'

I tried to field the questions as best I could, in suitable language, without causing extra alarm, worry or distress, but still they came.

'What medicine did they give Mummy? How did she actually die? What other question would be a good one to ask, Daddy?'

I can't lie to Harry about what happened, he has a right to know. But not at six years old, surely? I can't even tell him that all of the answers lie in four lever arch files, each three inches or so thick, full of medical notes, charts, statements, legal and medical analysis and argument - he'll want to read it, and then he'll get angry when I don't let him.

All I can do is promise him that the doctors did everything they could to save his Mummy, after she was admitted to A&E and once in Intensive Care. This reassures him, even if his curiousity isn't satisfied.

One day he's going to ask about before she went to hospital, and he's going to be so angry.

'There's nothing we can do to bring Mummy back, Harry, but that doesn't mean we have to like it.'

'What's Jessica's trust, Daddy?'

'It's Daddy's work - trying to stop other Mummy's dying like yours did.'

'What is child fever, anyway?'

'Childbed Fever? It's what Mummy died of. It's an infection that can kill you after you have a baby.'

'Why Daddy? Why did God want Mummy to die? He controls everything, so he shouldn't have let her die.'

I wish I knew all the answers, like Harry expects me to.

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Woman's Hour - Childbed Fever

Wed 23rd Jan 2008 by Ben Palmer.

I've just been alerted to a Woman's Hour discussion on childbed fever this morning. I listened to a recording of it on the BBC website.

The author of a new book, The Bone Garden discusses childbed fever with the presenter and a professor, but in the context of the past. They highlight the pain and agony of dying from this terrible disease, and how doctors used to be the cause of epidemics - by spreading it - but unfortunately there was no mention of the underlying natural causes - so often Group A streptococcus, a community bacterium.

Towards the end there is recognition of the fact that 16 women died of it in the mid 1990s, and that one woman (Jessica, I wondered) died of it in 2004. Why not go further and quote the more up to date statistics of 1997-99, 2000-02 and 2003-05 or mention the two more recent cases of childbed fever in Winchester last December as well?

I hope that when Friday's Child is published I may get the opportunity to bring the story up to date and highlight its continuance.

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Screen for GAS

Tue 8th Jan 2008 by Ben Palmer.

BBC South Today has tonight reported further in the aftermath of the two tragic deaths at The Royal Hampshire County Hospital in Winchester.

The hospital has, to reassure its patients, implemented a screening programme for Group A Streptococcus, but it doesn't plan to continue with it beyond the short term.

So, is it just a PR exercise, or is this test an accurate and useful weapon against childbed fever (still nobody calls it that, it is still 'complications caused by...') There may 'only' be an average of six maternal sepsis deaths a year, but even one avoidable death is enough to warrant prevention, isn't it?

If the test is not accurate then why are they doing it? If it is not 'cost effective' to continue it or take it nationwide, does the NHS not consider what yet another death could cost it?

If there was anything that could stop mothers dying, surely a responsible government would want to implement it, when 30% of the population carry Group A Strep?

I hear so many stories from mothers who have only just survived a Group A Strep infection that, if the problem is not taken seriously, it will be a time bomb that we are sitting on.

If only infection rates were measured and not just deaths - this is a far more common problem than we are led to believe.

Watch the BBC's report 

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No news would have been good news

Sun 6th Jan 2008 by Ben Palmer.

There's been a fair bit of news recently (see here and here) about two poor mothers who gave birth on the same day, in the same hospital, and who both died within three days, just before Christmas. The coverage has focused on the fact that they both had a Group A Strep infection, and there has been much talk about infections (hospital and community acquired) and superbugs.

Luckily, it was acknowledged that GAS is not a superbug and that it is treatable. Unfortunately there was no mention of the fact that these two women died of Childbed/Puerperal Fever, and that it is a well documented and once much feared condition that should not be killing any more.

My heart goes out to these women and their families - how well Harry, Emily and I know their pain and confusion.

I have failed in my New Year's resolution to give up smoking (sorry, Harry) but am so far succeeding in my second - to tidy, sort and organise the house better. I also have a third: to step up the campaign to raise awareness of childbed fever. 2008 was always going to be a big year with the launch of my book, Friday's Child, in June but I want to make more noise and more of a difference than just that.

Thanks to a very kind person who has offered her professional help at no charge, I just may be able to. Many others have also offered to help, and I'm sure I'll be in touch.

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Floods

Mon 3rd Dec 2007 by Ben Palmer.

What a whirlwind. After yesterday's Independent article, and with the impending release of 'Saving Mothers' Lives', I have been flooded with requests for television interviews on morning TV and news programmes.

Part of me wants to do them, even though I can't do them all.

The increase of sepsis, both in numbers and as a percentage of all maternal deaths tells me I need to be campaigning as hard as I can, but its stirred up a lot of feelings. Jessica is one of the statistics that the report covers, and it has all come flooding back to me - the pain, the fear and the total bewilderment after her death.

I'm just not up to it at the moment, and it sounds like the news coverage is going to be good anyway, with or without me, but I'll bounce back to fight another day.

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The petition's response

Wed 14th Nov 2007 by Ben Palmer.

At long last the Government has posted its response to the petition I started seven months ago.

I never expected there to be any sort of substance to it, but even so it is still alarmingly arrogant:

"Maternal deaths in the UK are extremely rare. Each is a tragedy, which is why the Government takes any maternal deaths seriously and funds the Confidential Enquiry into Maternal Deaths (CEMD). Each avoidable maternal death is one too many."

Funding the CEMD is not actually taking action. The CEMD only produces a report of recommendations. With regard to sepsis, it has been making the same recommendations in report after report, to little or no effect. The incidence of sepsis/childbed fever/puerperal fever/whatever you care to call it has been rising since 1984, and a worrying number of healthcare professionals are ignorant of its cause, symptoms and devastating outcome.

"In the last published report of the CEMD for 2000-02, only five of the 13 women who died from infection, out of more than the 2million who delivered safely, died from what is known as puerperal fever (sometimes also known as child bed fever) after a normal delivery."

The other eight women died of the same disease, with the same symptoms, their deaths are just labelled differently because they had a caesarian. Their lives are just as important, which is why I prefer to include them and talk about 13 deaths (which accounts for 12% of all deaths that were a direct result of pregnancy/delivery during 2000-2002.)

These deaths are avoidable, so saying that it is a small proportion of the safe deliveries is arrogant, insulting and misleading. None of those women should be dead. It is not an acceptable percentage of risk. When talking about a life, one is too many. This point was made in the first paragraph of the response, but obviously not meant as it was countered by this statistic. It sounds pretty much like Ivan Lewis' response to a parliamentary question my MP tabled.

"The CEMD's next report, Saving Mothers' Lives, due to be published on December 4, will update healthcare professionals on clinical guidelines for the management of serious illnesses affecting pregnant or recently delivered mothers. The recommendations of the report are circulated to all maternity professionals and, in future, their implementation will be audited by the Healthcare Commission. Since the last report was published, the National Institute for Health and Clinical Excellence has also published clinical guidelines for both birth and post-natal care."

The CEMD's next report will again report on the mothers whose lives were not saved, including Jessica. The title of the report is again misleading and insulting spin. I have written about it before, here. The bottom line though, is that it will be another report full of statistics that won't actually address the issue or achieve anything. See above for comment on the perpetual lack of attention to these reports.

All I wanted was the Government's recognition of the unnecessary waste of life and a positive determination to drag us out of the dark ages and protect our mothers. Tonight I feel stupid for even bothering to hope for that. Tomorrow I'll do something myself.

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Karate slice

Mon 24th Sep 2007 by Ben Palmer.

gi.jpg
While the pizza was in the oven tonight I ironed Harry's Karate Gi for tomorrow. That's not remarkable (or at least it shouldn't be) but what I was thinking while I steamed is.

I write, periodically, about some of the most intimate moments of my life, of Jessica's life and death. I'm used to that and it's a conscious decision, with a clear aim of trying to prevent it happening again to some other woman and her heart broken family.

What I never expected was to be inundated with emails and comments on this blog from other women who are prepared to share their equally intimate, graphic and heart rending stories of near disaster, pain and mistreatment.

I'm so grateful for all of this honesty and I hope that these stories as well as Jessica's will help to change things for the next mother, maybe for you.

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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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