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.

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?

Thank you to every one who has already signed this new petition.

It is particularly encouraging to know that not just friends and family of mine/Jessica's have signed it but many others as well - including midwives and doctors - showing that there is real need and desire for simple change that can have such a positive impact on lives.

I'd really like to encourage everyone to ask partners, friends, family and colleagues to sign as well, and there is no minimum (or maximum) age! If you passed the link on to ten or more people (and there's no promise of fame and fortune, nor threat of famine and disease attached to this!) the exponential effect would be very powerful.

Some NHS Trusts are already starting to use Modified Early Obstetric Warning charts, but some use them only for 'at risk' mothers. I'd like to see them being used routinely for every new mum. They are a useful aid in quickly spotting a problem with a mother's health - for any reason - and can be an indication to all midwives and doctors involved that a woman needs prompt medical intervention.

Particularly in the case of childbed fever, timely use of antibiotics can be vital as a group A strep infection can kill in a matter of hours rather than days.

So far, the NHS does not have a clear set of guidelines for the detection and treatment of sepsis which, together with the use of MEOWS, would greatly reduce the chance of severe illness and/or death.

I also believe, without for a minute wanting to alarm or create terror, that all mothers and their partners should know of and understand the risks of a uterine infection, so that instead of thinking that maybe it's a case of flu, they immediately refer themselves back to their midwife or GP, thus saving precious time.

I hope, through the petition, that a large number of other parents and parents-to-be especially agree with this premise, and that together we can show the government that we believe action should be taken now, and not after another unnecessary death from this archaic illness.

Thank you again for your continued and important support.

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

When I spoke in Basingstoke, at the SE Regional conference a little while ago, one of the highlights was this video, shown by one of the other speakers.

Concentrate hard and follow the instructions.

When we watched it there was a big cheer as everyone got the correct answer, and then a gasp!

I had a letter today, from CEMACH, with some of the comments made by the (mainly midwife) delegates at the South East Regional CEMACH conference in Basingstoke Jan 2009, in their evaluation forms. To underline the purpose of Jessica's Trust, the campaign and our petition, I thought I'd share a few:

• Jessica's story highlighted the need for MEOWS on the postnatal wards
• Jessica's story of tragedy shows the importance of how not to miss the bear moon-walking amidst the data.
• High quality communication, referral & follow ups is vital to good provision of care - information should be provided to all women in a way that they can understand it + make choices about their care. - I will always remember Jessica's story.
• Importance of observation! To re-emphasis use of MEOWS.
• Higher awareness in units regarding newly introduced MEOWS.
• Considering how to take forward Ben's message in practice.
• Copy of MEOWS chart of postnatal women's observations to community midwives.
• Jessica's story increasingly moving.
• The presentation from Ben was extremely poignant and completely sums up the purpose of CEMACH - Very powerful and real life experience should be portrayed to many more maternity staff - it keeps the reality in the midst of statistics and risk.
• There is a need for an early warning system to be implemented in trusts. We need to ensure that women are aware of risks & that there are guidelines for e.g. sepsis in pregnancy.

Thank you to CEMACH for inviting me to speak, and for permission to use these comments.

[It has to be said, it's more of a surprise if the video isn't titled before you watch it!]

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

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Childbed fever is a serious form of postnatal septicaemia which can lead to toxic shock syndrome, organ failure and death.  In 2003-05 sepsis accounted for 14% of maternal deaths in the UK. A complication free delivery is no guarantee of safety from sepsis and any mother can be affected. MEOWS charts are a sheet on which observations (pulse, blood pressure, temperature) can be recorded. They are clear and provide a graphical way of quickly seeing a mother's health.

Borderline and dangerous readings are entered in boxes coloured yellow and red respectively. One red or two yellows at one time call for early intervention, so a mother developing a critical condition will be treated before it is too late.

Sepsis is often already life threatening by the time it is clinically obvious: the best opportunity to intervene is based on the early warnings. It is not yet standard practice to use them in all NHS hospitals and there are no standard guidelines for the recognition and treatment of sepsis.

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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.

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.