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.

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.

Update: The report link has moved to the new CMACE website

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.

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.

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.