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.

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

What a sorry state that we are being let down even before we are born. We have excellent midwives in this country, but give them a chance - there simply aren't enough.

BBC: Maternity units 'shut to mothers'

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.

This morning I read the extract of Friday's Child, in the Daily Mail. It's strange, reading my words in such a condensed form. They are my words, and it is my story, but only such a small part of it.

It is humbling to read the comments people have left under the story, and so many. Really humbling.

The trouble with it being so shortened is that, inevitably, there wasn't room for many details, so it saddens me to be criticised, even ever so slightly, for not doing something that in fact we did.

We, Jessica and I, believed that she was being properly looked after and that we were doing everything right. We trusted the system to look after her, and when we were given reassurance, we took it and carried on. How I wish we hadn't.

That's all in the past, though. What matters is that it doesn't happen again.

Link to article: BBC NEWS | Health | Care not top priority - NHS staff

Link to article: 'More consultants needed to improve NHS care' - Telegraph

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

As you may know, Lord Darzi (leading surgeon and Department of Health minister) is two thirds of the way through his review of the NHS. He is examining eight clinical pathways, Maternity being one of them.

There is a consultation across the UK about Primary Care (GP) services today, but there is also an online questionnaire for the public which runs for another month. (There is a separate survey for NHS staff.)

Short on opportunity to comment directly on maternity services, the questionnaire is nevertheless an opportunity to have a say in the NHS - that's what it's all about: 'Our NHS, our future'.

It's a fair bit longer than our own survey, but it only took me about five minutes to complete, so if you can spare the time...

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.