Showing posts tagged with: 'maternity'


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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'Midwife numbers to fall short'

Thu 16th Apr 2009 by Ben Palmer.

With a weariness I read today yet another story about midwifery staffing levels falling short of the number required  for the government to meet it's own declared standard of care.

BBC: Midwife numbers 'to fall short'

I've said it before, and I expect I'll say it again; please look after our mums properly. The fact that the government thinks that this is one of the safest countries in the world to give birth (actually, it's one of the worst in Europe) is no reason to spread maternity care too thinly.

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Mrs Brown gives away a free plug

Fri 10th Apr 2009 by Ben Palmer.

sarahbrowntwitterpageI've been away from here for a little bit too long, with school holidays, work etc. I've also been concentrating on micro-blogging.

Just the other day I discovered that Sarah Brown had joined Twitter. As well as being Mrs G. Brown, she is a strong advocate of women's health in the developing world. Knowing this, I 'followed' her (on Twitter this is a very non-stalking thing to do) and sent her a link to this website. She thanked me back, and I thought nothing of it until today.

I have just been sent a link to a story in the Technology pages of the Telegraph: Prime Minister’s wife joins Twitter which says it all. What great publicity for Jessica's Trust!

Sarah Brown does great work for www.whiteribbonalliance.org, www.millionmums.org and www.mothersdayeveryday.org. I hope she realises that too many mothers die in this country as well, but she hasn't yet signed my petition to her husband, although you can.

Thank you to @StudyingOnline and @marketingwizdom for drawing it to my attention.

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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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Help us by signing our petition

Tue 3rd Feb 2009 by Ben Palmer.

Jessica's Trust needs your help

Please sign our petition

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."

More information

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.

Online donations and fundraising

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.

Keep up to date with our work

Bookmark our website or join our update list to keep abreast of what we're doing.

Thank you

Thank you for your help. Together we can make a difference.

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1-2-3, Go

Tue 4th Nov 2008 by Ben Palmer.

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.

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MEOWS

Tue 14th Oct 2008 by Ben Palmer.

Modified Early Obstetric Warning Score charts are instantly clear and they can save a life. What are they, though?

They are a single sheet chart, with time tracked across the top, where observations - pulse, blood pressure, temperature and a whole host of others - can be marked in the columns below.

Normal readings: fine.
Borderline readings: the box is shaded in yellow.
Dangerous readings: the box is shaded red.

One red or two yellows at one time and a doctor is required for 'early intervention'.

It is so graphically obvious, and a mother's history so clearly charted that, the idea is, a mother who is developing a critical condition will be treated before it is too late.

Sepsis (for example) is often already life threatening by the time it is clinically obvious. Therefore the best opportunity to intervene is based on the early warnings.

These charts are not routinely used, though. Some units do use them, others are looking at using them, and I believe there may be a national pilot some time.

I filled in Jessica's observations on such a chart a while ago and it is so obvious. You can see that she was very ill, long before she was showing the more advanced symptoms of sepsis.

When I was in Birmingham the other day I showed the chart to the conference. A midwife came up to me after I had spoken and said that her hospital had had MEOWS on the agenda for a while but that no-one had yet got around to implementing them.

She told me she was on the panel and was going to go back to work to get them implemented. Now.

I want these charts to be used routinely, as in other disciplines, and they should follow a mum home to the community midwife as well. How else is she supposed to know her patient's full history so definitively?

You can see an example MEOWS chart here.

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The reality of maternal mortality: a father's perspective

Fri 10th Oct 2008 by Ben Palmer.

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.

And 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.

  1. that her previous symptoms - not that we fully understood them - had not been cause for concern, and
  2. that both of us had had high temperatures in the past with no ill effect.

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:

  • that puerperal sepsis is no longer a disease of dirty practitioners like in Semmelweiss' day when it was being spread from mother to mother in the wards;
  • or to tell you that it is a community bacterium that many of us live with harmlessly - until it is given the opportunity to invade a body as in the case of a postpartum woman,
  • or that it is still the cause of 14% of maternal deaths in this country.

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.

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Headed paper

Sat 10th May 2008 by Ben Palmer.

I had a letter from my MP yesterday. I'd had a meeting with her a while ago, and we've exchanged several letters and emails. She, along with other parliamentarians, is committed to helping Jessica's Trust, and wrote to Alan Johnson, the Health Secretary to ask for a meeting. His reply was attached to the letter.

Although he didn't say yes or no to the meeting, his letter was encouraging: pointing out that I had already met with the National Clinical Lead for Maternal Health and Maternity Services, had had a productive meeting and have an open line of dialogue.

What was really encouraging to hear, on headed paper, was that "We value highly the work of Jessica's Trust" and that he hopes that the Trust will "play an even greater role in reducing the number of deaths from [childbed fever]" based on the existing relationship with the Department of Health.

I'm encouraged as this is a much more positive governmental acceptance of the need to do something about childbed fever than I have had to date. I believe that there is the desire for change, even if it is taking Jessica's name to achieve.

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Don't test, tell

Thu 1st May 2008 by Ben Palmer.

Back in January, I wrote in the blog about Screening for Group A Strep (GAS). Since then I have thought about it a lot, and discussed it with various medical professionals.

I am convinced it is a worthless exercise. Worse than that, it could be dangerous. Why?

A woman can be colonised with GAS at any point in her life*, let alone in her pregnancy or puerperum, so all a test would do is say that she does or does not carry the bacteria at this very point in time.

What if she was colonised the day after the test? She would have been given a false sense of security by a negative result. If GAS was only introduced some time after delivery, and it caused a genital tract sepsis, the last thing on her mind would be childbed fever, because she was 'clear'.

It is of far more value to skip the testing and instead take every woman's temperature and pulse regularly in the days after delivery. Then tell her about the condition and how to recognise that she might have it. She must also be told of the vital importance of being seen, swabbed and treated if infection is suspected, before her health and her life are in danger.

* up to 30% of us may be carrying Group A Strep in our throats or on our skin

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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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