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.
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 â€œwe 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 Reportâ€.
- 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 Mothersâ€™ 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