Showing posts tagged with: 'maternal'

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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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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Unfamiliarity breeds infection

Wed 5th Dec 2007 by Ben Palmer.

I have now downloaded a copy of "Saving Mothers' Lives" and am reading through it. A few paragraphs under the Genital tract sepsis chapter have caught my attention:

"As in previous Reports there was failure or delay in diagnosing sepsis, failure to appreciate the severity of the woman’s condition with resultant delays in referral to hospital, delays in administration of appropriate antibiotic treatment and late or no involvement of senior medical staff. There were some cases where doctors said they were already so busy dealing with other urgent problems that they were unable to see women for some time after admission. It was also clear that many doctors, midwives and community midwives were unfamiliar with the signs and symptoms of sepsis, did not realise when a woman was deteriorating or critically ill and failed to appreciate how quickly the clinical condition of a septic woman can deteriorate. There were also failures to take routine basic observations, to recognise abnormal fetal cardiotocograph (CTG) patterns and to ask for senior advice at an early stage."

"These cases of classical puerperal sepsis due to Group A haemolytic streptococcal infection demonstrate that by the time sepsis is clinically obvious, infection is already well established and deterioration into widespread septicaemia, metabolic acidosis, coagulopathy and multi-organ failure is very rapid and often irreversible. The best defence against this situation is awareness of the early signs of sepsis and early recognition by routine regular basic clinical observations. Earlier detection of pyrexia might have made a difference in these three cases. Postnatal observations of pulse, temperature, BP, respiration, and lochia should be done regularly while the woman is still in hospital and for several days after discharge by her community carers. This is particularly important in women who leave hospital a few hours after birth, ‘early discharge’, or if a woman complains of feeling feverish or unwell."

"In the past, puerperal sepsis or ‘childbed fever’ was a leading cause of maternal death and its signs and symptoms were widely known. Antisepsis, antibiotics and changing practice over the years mean that genital tract sepsis has become much less common and death is rare. The fear and respect with which it as held in the past by obstetricians, midwives and patients has disappeared from our collective memory. Action is now required to raise awareness of the signs and symptoms of sepsis and recognition of critical illness among staff in maternity units or in the community, Emergency Departments, and among GPs and health visitors.

The cases in this Report clearly demonstrate that genital tract sepsis is still a problem, that is repeatedly missed and there is often failure to treat women early and aggressively enough. Some of these maternal deaths may have been prevented if the signs and symptoms of sepsis and developing septicaemic shock had been recognised and treated earlier. Nevertheless the clinical picture of life-threatening sepsis often develops very rapidly and in many of the cases the outcome could not have been prevented."

There are more sections that could well have been cut and pasted from the previous report. And the one before. Why did I ever wonder if there was a point to raising awareness of sepsis? I have a very strong sense of deja vu. I hope these recommendations are followed in the future.


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Masses of bodies

Tue 4th Dec 2007 by Ben Palmer.

I feel full of despair. Although I haven't seen a full copy of the Saving Mothers' Lives report, I have had sections of it read to me, and other parts have been reproduced in various news articles today - most probably from a heavily edited press release.

All of the talk is of obesity and migrant mothers. This is a distortion of what I know to be true. When the report says that deaths due to substandard care have not risen, are we supposed to applaud the NHS?

Jessica died because of substandard care, from a disease that has been known about for hundreds of years, and is easily treated.

The number of deaths from genital tract sepsis (ie childbed fever, pueperal fever) has gone up by 38%. Is it just me that thinks this is a scandal, and totally unacceptable?

The sense that I am getting is that the NHS and the government are not bothered by the increasing death rate, are not bothered about a properly funded and properly run maternity service because the statistics meet some unknown target. Instead they are blaming us for their failure to be aware, to treat and to run a modern health service.

There is a twist though. Jessica was a petite, middle class, 34 year old woman. Her post mortem report, however, gives her height as 1.61m and her post delivery weight as 82kg. The NHS Direct website has just told me that this means that her Body Mass Index would be 31.6, which is classed as obese.

This is utterly ridiculous - she was anything but overweight, as anybody who knew her would testify to, and the clothes she wore pre pregnancy were size 8-10. I couldn't really believe that she would be classed as obese, so I referred to her medical notes:

In August 2002, when not pregnant, her GP recorded a height of 1.64m and a weight of 55kg. This gives a BMI of 20.45 which is an "ideal weight".

In April 2004, when seven months pregnant, she was 61.9kg (and presumably still the same height) which gives a BMI of 23.01 which is still an ideal weight even for someone who isn't pregnant.

Somewhere between April and June she apparently lost 3cm in height and gained 20kg, even after Emily was delivered, making her an obese statistic. How many other anomalies are there in "Saving Mothers' Lives" that enable them to blame mothers for their own maternal death, I wonder?


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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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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.
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.