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.

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!]

I was very glad to attend the South East Regional CEMACH conference in Basingstoke today. I was asked  to speak a few months ago, and as anyone who knows me will testify, I hate public speaking. As a result I blanked it until the last minute and just revised my last speech at the eleventh hour.

As yesterday approached, CEMACH offered me a corner of their table for my leaflets and books, then a table of my own. By the entrance/exit.

I was made to feel so special I forgot to be nervous this morning, especially as the chair of the conference handed me some Bachs Rescue Remedy. By the time my slot arrived I was feeling comfortable in the lecture theatre, knew what I had to say and launched in.

I knew to expect the rustle of tissues, but I was overwhelmed by the support shown afterwards, and the number of requests for a repeat performance in other parts of the country, and the speed at which copies of Friday's Child flew off the table later.

As promised to a number of delegates, here is the link to the text of my speech in Birmingham last year - largely unchanged today. And yes, I will consider recording it and putting it on YouTube. The more (student) midwives that hear it the better.

Things will change, thanks to Jessica.

When I picked Emily up from school this afternoon (and I can hear what she'd say to me here, "It's not school, Daddy, it's NURSERY school") I said hello to the head teacher as Emily came rushing out.

"I saved this for you," she said, "It's missing a bit but I thought you'd be interested." She handed me a pulled out spread from a newspaper.

When I got home I started reading it. It was an article from Times2 last week, Save the independent midwife, along with a personal tale, right at the end in the on-line version, written by a mother, Alex O'Connell, who had had a horrific first delivery, and had opted for a home birth the next time, assisted by an independent midwife.

I finished reading it on-line and something jumped out at me. It was the reference to Alex's post-puerperal fever after discharge from hospital first time. How lucky she was that it only took two doses of antibiotics to shift it, and how wrong she was to assume that the lack of infection second time around was because she was far from a maternity ward.

Yes you can acquire an infection in hospital - MRSA, C diff etc - but puerperal/childbed fever is not a hospital acquired infection - it is caused by community bacteria, and nobody is safe. I'm going to go on and on saying it. I'm even going to shout it. NOBODY IS SAFE FROM THIS HORRIFIC DISEASE, whether they deliver in hospital, a birthing centre, their own bedroom or the back of a taxi.

It doesn't matter whether they are young, old, fat or thin. It  doesn't matter if the midwife is independent or NHS employed, it just matters that the symptoms are spotted in time to give you your antibiotics.

I've just read a good post on Mother at Large's blog about childbirth, pain and expectations about delivery.

It does sometimes seem as though birth has become a bit too competitive, and often I also hear talk of how quickly a mother was discharged, as though speed of discharge is a measure of success. What we shouldn't forget is that, while now comparitively safe, childbirth is a trauma and the historical and natural risks are still as present as ever they were.

While an extended hospital stay is not on anybody's wish list or birth plan, there is merit of staying in for days, rather than hours - as used to be the case. How better to pick up on the warning signs of a complication such as infection than by regular observations by a midwife?

But on that subject, all too often I hear that regular postpartum observations are no longer routine, unless infection is suspected - indeed the NICE guideline on Routine postnatal care of women and their babies [PDF] even says as much for some reason.

This is madness: how on earth is an infection going to be suspected early enough unless it's being checked for?

Another postnatal phrase I hear a lot of is: 'Mother and babe both doing well'. It's what everyone wants to hear and illustrates the feeling of joy and euphoria of a new and safe delivery, but a caveat: Childbed Fever can hit anybody at anytime - even weeks after a trouble free delivery.

I wouldn't want to cast a cloud over anybody's happiness, but never be complacent - please keep an eye on the symptoms, even if your midwife isn't.

Jessica Tate has been pregnant since 2004 and has been examined by countless student midwives.

She is a computer based training package, created by two midwifery lecturers from Swansea University, Susanne Darra and Marian Mclvor.

The project has just won an award at the Royal College of Midwives (RCM) sixth Annual Awards Ceremony, and there is a plan to roll Jessica out to other universities.

It is a genius project, and although Jessica Tate's pregnancy is 'normal' there are just a few minor warning signs thrown in. Susanne Darra, one of the program’s authors, says, “There is a big issue in the western world with ‘problem’ births and it doesn’t have to be like this. We have a strong trend to alert people to problems, but most of the time things turn out fine.”

If only Jessica could develop a fever and a rash, a few days after being discharged from a normal delivery, then she could be a really powerful teaching aid.

External Link: Royal College of Midwives (RCM) Sixth Annual Awards

BBC NEWS | Health | 'No plans' for migrant birth rate

The government should have done more to help the NHS cope with the increase in foreign-born mothers using maternity services, the Conservatives say.

How can the government keep saying that they are working towards having a named midwife for every mother, when the number of midwives is so low? 36 midwives per 1,000 births are required, yet the average is only 31 and it is as low as 26 per 1,000 in some NHS Trusts.

If the birthrate continues to rise (whether caused by immigration or not) then maternity services are going to be even more stretched unless this vital area of care is properly resourced. There is no way that any midwife can provide the recommended level of care if she is spread amongst too many mothers. That is the case in hospital and within the community.

CEMACH recommends* that 'routine observations of pulse, BP, temperature, respiratory rate, and lochia should be made in all recently delivered women for several days postpartum' and yet most women are turfed out of hospital within a few hours, and often receive only one or two visits from a midwife in the community. How is anyone going to spot the signs of serious illness?

* Saving Mothers' Lives 2003-2005, p102

The Daily Telegraph has a story today, Midwives struggle in labour ward crisis. The Evening Standard has also run it, Shocking figures show mothers and babies are at risk due to chronic shortage of midwives.

This isn't a new story, but the figures go on and on showing the crisis that maternity services are sliding into.

I'm just glad it keeps popping up in the news. If there's enough pressure on the government and their promises, they might one day be fulfilled.

I believe that one answer to Childbed Fever (amongst other issues) is to have midwives with enough knowledge, experience and time to be able to spot the symptoms before they can become life threatening. If there aren't enough midwives, that certainly isn't going to happen.

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.

Hard labour: The maternity service in crisis in the Daily Mail

This is a shocking tale of maternity services in the NHS. It's a story of another mother given a rough ride. It's a miracle she's alive - this was a catalogue of disasters.

Why is a temperature in a mother always excused as something minor instead of being read as the sign of an infection as it once was?

That's not to mention her detached placenta, her baby's distress and increased heart rate, the delayed pain relief and emergency caesarian.