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Content Article
Birthrights video: Speak Up, Speak Out (16 November 2021)
Patient-Safety-Learning posted an article in Maternity
This video by the charity Birthrights encourages women and birthing people to speak out when they experience poor quality care. It highlights the right to safe and appropriate maternity care that respects individuals' dignity, privacy and confidentiality and is given equally and without discrimination. -
Content Article
Delay in recognising placental abruption (30 June 2021)
Patient-Safety-Learning posted an article in Maternity
This case story about placental abruption, published by NHS Resolution, highlights the importance of regular risk assessments throughout labour to help prevent harm to mother and baby. It provides learning points and considerations that can be applied across all maternity units. -
Content ArticleTokophobia is an extreme fear of pregnancy and childbirth; it causes severe psychological distress and can have far reaching consequences. Despite this, tokophobia is under-researched and many healthcare professionals have never heard of it, explains Sarah-Jane Archibald in this BMJ Opinion article.
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Content ArticleThe number of intrapartum stillbirths referred to the Healthcare Safety Investigation Branch (HSIB) between April and the end of June 2020 increased compared to the same time in the previous year. The data initiated a HSIB national learning report, which explores the findings from their maternity investigations during this time. They investigated intrapartum (labour) stillbirths after 37 weeks, where a baby was thought to be alive at the start of labour and was born with no signs of life.
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News Article
Jailed women in UK five times more likely to suffer stillbirths, data shows
Patient Safety Learning posted a news article in News
Women in prison are five times more likely to have a stillbirth and twice as likely to give birth to a premature baby that needs special care, new data collected by the Observer shows. Following two baby deaths in prisons since 2019 there have been increasing concerns about safety for pregnant women and their babies. Figures obtained through freedom of information requests made to 11 NHS trusts serving women’s prisons in England show 28% of the babies born to women serving a custodial sentence between 2015 and 2019 were admitted to a neonatal unit afterwards – double the national figure, according to data from the National Neonatal Research Database. The findings come as the House of Lords prepares to vote this week on proposed changes to bail and sentencing laws that would improve the rights of pregnant women and mothers facing criminal charges. A report published in September examined the circumstances of a baby’s death at Bronzefield prison in Surrey where an 18-year-old was left to give birth alone in her cell. When Anita rang her cell bell at 5.30am when she went into labour the guards said they would send somebody. It was only during the morning rounds at 7.30am that a nurse was called. She was transferred to hospital at 10.30am. Anita said: “Despite being in active labour the guards would not remove my handcuffs and ignored me when I asked them to call the baby’s father and my mum – who were eventually contacted by a doctor.” Read full story Source: The Guardian, 5 December 2021 -
News Article
UK health trusts suspend home birth services as midwives shortage deepens
Patient Safety Learning posted a news article in News
A severe shortage of midwives has led to home birth services being closed or reduced by a number of hospital trusts across the UK, with pregnant women frequently left in limbo as to where they will be able to give birth. The Observer has found more than 20 trusts that have had disrupted home birth services in the past three months. Eight confirmed their services remain suspended due to staff shortages. They include East Kent Hospitals, Swansea Bay University Health Board and NHS Dumfries and Galloway – all of which report that the situation is under constant review. Home birth services at some trusts, such as Walsall Healthcare NHS Trust and University Hospitals of Derby and Burton, have been closed since August. Others have reopened after short suspensions or have written to expectant parents to say they cannot guarantee sending a midwife when there is high demand or staff shortages. The findings come a week after midwives across Britain staged protests to call on the government to address the “crisis” in maternity care, with staff suffering from chronic burnout and stress. Midwives are being driven out of the NHS by understaffing and fears they cannot deliver safe care, according to a recent survey published by the Royal College of Midwives (RCM). Maria Booker, programmes director at the charity Birthrights, said: “Staffing pressures in maternity services are very real right now. But for many women the option to give birth at home is not a luxury but the only option that feels safe to them." “Some know they will labour better at home while some do not want to visit hospital during a pandemic. Others have a had a previous traumatic hospital birth. We cannot just accept that home birth and other choices go out the window every time a maternity service is squeezed.” Read full story Source: The Guardian, 28 November 2021 -
News Article
Change to sepsis advice after mums' herpes deaths
Patient Safety Learning posted a news article in News
Advice on how new mothers with sepsis should be treated is to change after two women died of a herpes infection. The Royal College of Obstetricians and Gynaecologists says viral sources of infections should be considered and appropriate treatment offered. This comes after the BBC revealed one surgeon might have infected the mothers while performing Caesareans on them. The East Kent Hospitals Trust said it had not been possible to identify the source of either infection. Kimberley Sampson, 29, and Samantha Mulcahy, 32, died of an infection caused by the herpes virus 44 days apart in 2018, shortly after giving birth by Caesarean section. Their families were told there was no link between the deaths but BBC News revealed on Monday that both operations had been carried out by the same surgeon. Documents we uncovered showed that the trust had been told two weeks after the second death that "it does look like surgical contamination". Edward Morris, President of the Royal College of Obstetricians and Gynaecologists, which set standards in maternity care, said routine investigation and management of maternal sepsis "should always consider viral sources of infection, and appropriate changes should be instituted to support earlier diagnosis and treatment". Medics treating Ms Sampson and Mrs Mulcahy assumed they were suffering from a bacterial infection and didn't prescribe the anti-viral medication that may had saved their lives. The Royal College said the two deaths should be "fully investigated" as "surgical infection appears to be a significant possibility". But BBC News has learned that the East Kent Hospitals Trust, which treated both women, never told the coroner's office that the same surgeon had carried out both operations or that an investigation they had ordered had suggested the virus strains the two women had died from appeared to be "epidemiologically linked". Read full story Source: BBC News, 23 November 2021 -
News Article
Black women four times more likely to die in childbirth
Patient Safety Learning posted a news article in News
Black women are more than four times more likely to die in pregnancy or childbirth than white women in the UK, a review of 2017-2019 deaths shows. The MBRRACE-UK report found women from Asian backgrounds are almost twice as likely to die as white women. Some 495 individuals died during pregnancy or up to a year after birth, out of 2,173,810 having a child. The charity Birthrights is concerned that overall "this bleak picture has not changed in over a decade". University of Oxford researchers say for the vast majority of people, pregnancy remains very safe in the UK. But despite slight decreases in the maternal death rate in recent years, there have been no significant improvements to these rates since the 2010 to 2012 period. Their current report shows heart disease, epilepsy and stroke continue to be the most common causes of death. And they say in some 37% of cases, improvements in care may have made a difference to the outcome. Lead researcher, Prof Marian Knight, said: "Pregnant women get inequitable care for several reasons. "Healthcare professionals often attribute their symptoms to pregnancy alone and they do not always end up getting the treatment they need because people can be incorrectly concerned about giving them medication. "On top of that is the unconscious bias that black and Asian women can experience. It all adds up. "We know from other studies that the disparity in death rates cannot be fully explained by socio-economic factors and other medical conditions for example. We need to look for other reasons." Read full story Source: BBC News, 11 November 2021 -
News ArticleA new training aid, developed in Fife, is helping to equip trainee medical staff from around the world with the skills to prevent late miscarriage and premature labour. It was invented by Dr Graham Tydeman, consultant in obstetrics and gynaecology at Kirkcaldy’s Victoria Hospital, in conjunction with the St Thomas’ Hospital, London, and Limbs and Things. The lifelike simulator allows trainees to perform hands on cervical cerclage in advance of a real-life emergency. The procedure involves an emergency stitching around the cervix and is necessary when the cervix shortens or opens too early during pregnancy, helping to prevent late miscarriage or extreme premature labour. It is not a common event and the simulator was developed by Dr Tydeman following a request from medical trainees across the UK. The device has already been warmly received by hospitals and training institutions across the world – with orders from countries including New Zealand and India. Dr Tydeman said: “The reason this was developed is that it is not a common procedure and is very difficult to teach trainees." “Increasingly women are understandably asking about the experience of their surgeon and anyone having this procedure understandably does not want it to be the first one that a doctor has ever done because if it goes wrong there could be tragic consequences with loss of the baby. However, if a trainee has shown suitable skills using this simulator, I would be able to confidently reassure women that the doctor had been adequately trained, although a more experienced person would always help during the actual operation for the first few procedures on real women." Read full story Source: The Courier, 19 December 2020
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News ArticleHealth chiefs are designing an “early warning” system to detect and prevent future maternity care scandals before they happen, a health minister has said. Patient safety minister Nadine Dorries said she hoped the system would highlight hospitals and maternity units where mistakes were being made earlier. The former nurse also revealed the Department of Health and Social Care was drawing up a plan for a joint national curriculum for both midwives and obstetricians to make sure they had the skills to look after women safely. During a Parliamentary debate following the publication of a report into the Shrewsbury and Telford Hospital care scandal, the minister was challenged by MPs to take action to prevent future scandals. The former health secretary, Jeremy Hunt, warned the failings at the Shropshire trust, where dozens of babies died or were left with permanent brain damage, could be repeated elsewhere. He said: “The biggest mistake in interpreting this report would be to think that what happened at Shrewsbury and Telford is a one-off — it may well not be, and we mustn't assume that it is.” Ms Dorries said: “Every woman should own her birth plan, be in control of what is happening to her during her delivery and I really hope ... this report is fundamental in how it's going to reform the maternity services across the UK going forward. Read full story Source: The Independent, 11 December 2020
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News Article
Baby dies after ‘excessive force’ during forceps delivery
Patient Safety Learning posted a news article in News
A coroner has urged ministers to revisit plans to make it possible to hold inquests into babies that are stillborn after a baby died due to “excessive force” during an attempted forceps delivery. Senior coroner Caroline Beasley-Murray has written to the Ministry of Justice after she was forced to stop hearing evidence into the death of baby Frederick Terry, known as Freddie, who died under the care of the Mid and South Essex Hospitals Trust on 16 November, last year. An inquest into his death was started in September where Freddie was found to have died after suffering hypovolaemic shock as a result of losing a fifth of his blood when his skull was fractured during a traumatic birth attempt. In a report on the case the coroner said: “Baby Frederick Joseph Terry was delivered by caesarean section, after a failed forceps attempted delivery on 16 November 2019 and death was confirmed after 40 minutes of resuscitation attempts." "The evidence showed that baby Freddie's very serious scalp and brain injuries were sustained during the failed forceps attempted delivery and, but for these, baby Freddie would have survived as a perfectly formed, healthy baby." The coroner said the injuries he sustained implied “an excessive degree of force” in the application of the forceps, which are curved metal instruments that fit around a baby’s head and are designed to help deliver the baby. The inquest had to be stopped from hearing any more evidence because coroners are not able to investigate stillborn babies. As part of her report, the coroner said: “It would have been helpful for there to have been, during the course of the inquest, an exploration, in the course of evidence, of the treatment and care provided to baby Freddie and his parents at the time of delivery. "Currently there is no legislation to cover the holding of a coroner’s inquest into a stillbirth. In March 2019, the Government issued a consultation on coronial investigations of stillbirths It would be helpful for this important topic to be progressed, whatever the ultimate jurisdictional decisions.” Read full story Source: The Independent, 17 November 2020 -
News ArticleWhen Jess and Patrick discovered they were expecting their first baby in the new year, they looked forward to an early glimpse of their unborn child via an ultrasound scan. But the couple, who live in the north-west of England, were soon told that Patrick would not be able to attend any antenatal appointments, including routine scans at 12 and 20 weeks. When their baby begins its journey into the world, Patrick will be permitted to join Jess only when labour is fully established, and he must leave an hour after delivery. He will not be able to visit his new family in hospital again. “It’s taken the shine off the pregnancy,” said Jess, a junior doctor. “Patrick hasn’t been able to come to a single appointment. It’s making me very anxious and stressed – I’ve had actual nightmares about things going wrong and Patrick not being with me. He’s had to wait at home when I’ve gone for appointments, worrying and waiting for me to call to say everything’s OK.” The hospital where Jess will give birth is among 43% of NHS trusts that – despite official guidance – have not eased restrictions imposed during lockdown on partners attending antenatal appointments, being present throughout labour, and staying with new mothers and babies after the birth. And as Covid transmissions rise across the UK, almost a quarter of NHS trusts have said they expect to reimpose such restrictions. Read full story Source: The Guardian, 24 October 2020
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News ArticleHospitals have been ordered to allow partners and visitors onto maternity wards so pregnant women are not forced to give birth on their own. NHS England and NHS Improvement have written to all of the directors of nursing and heads of midwifery to ask them to urgently change the rules around visiting. The letter, which is dated 19 September and seen by The Independent, says NHS guidance was released on 8 September so partners and visitors can attend maternity units now “the peak of the first wave has passed”. “We thank you and are grateful the majority of services have quickly implemented this guidance and relaxed visiting restrictions,” it reads. “To those that are still working through the guidance, this must happen now so that partners are able to attend maternity units for appointments and births.” The letter adds: “Pregnancy can be a stressful time for women and their families, and all the more so during a pandemic, so it is vital that everything possible is done to support them through this time.” Make Birth Better, a campaign group which polled 458 pregnant women for a new study they shared exclusively, said mothers-to-be have been forced to give birth without partners and have had less access to pain relief in the wake of the public health crisis. Half of those polled were forced to alter their own childbirth plans as a result of the COVID-19 outbreak – while almost half of those who were dependant on support from a specialist mental health midwife said help had stopped. Read full story Source: The Independent, 23 September 2020
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News ArticleCovid has brought many hidden tragedies: elderly residents in care homes bereft of family visits, families in quarantine missing loved one’s funerals, and mums forced to go through labour alone. Much of this has been necessary, however painful, but Jeremy Hunt fears we’re getting the balance badly wrong in maternity care. That’s why he is backing The Mail on Sunday’s campaign to end lone births, which has been championed in Parliament by Alicia Kearns. Infection control in hospitals is critically important, but mothers’ mental health can’t be pushed down the priority list. Imagine the agony of a new mum sent for a scan on her own, only to be told that her much longed-for baby has no heartbeat. Or the woman labouring in agony for hours who is told she is not yet sufficiently dilated to merit her partner joining her for moral support. "I have heard some truly heartbreaking stories, which quite frankly should have no place in a modern, compassionate health service. One woman who gave birth to a stillborn baby alone at 41 weeks; another woman who was left alone after surgery due to a miscarriage at 12 weeks," says Jeremy. Perhaps most concerningly of all, there are reports of partners being asked to leave their new babies and often traumatised mothers almost immediately after birth. That means they miss out on vital bonding time and mums lose crucial support to help them recover mentally and physically, in some cases with partners not allowed back to meet their new child properly for several days. "This is a question of basic compassion and decency – the very values that the NHS embodies and the reason we’re all so proud of our universal health service – so we need every hospital to commit to urgent action without delay." Read full story Source: MailOnline, 19 September 2020
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News ArticleA framework has been developed by the Royal College of Obstetricians and Gynaecologists, Royal College of Midwives and the Society and College of Radiographers, in partnership with NHS England and NHS Improvement, to support maternity services with the local reintroduction of hospital visitors and individuals accompanying women to appointments. During the pandemic, some Trusts in England have allowed partners to attend antenatal appointments and pregnancy scans, but there has not been a consistent approach across the country, leading to frustration and confusion among pregnant women and their partners. In a recent hub blog, Jules Mckoy, a Specialist Perinatal Mental Health Midwife at University Hospital Southampton, highlighted the huge rise in pregnant women reporting feelings of anxiety because of being isolated from friends and relatives and their concerns for the safety of their baby, themselves and their families. Dr Edward Morris, President of the Royal College of Obstetricians and Gynaecologists, said: “We welcome the publication of this framework to support Trusts in England safely re-introduce measures enabling partners to attend to antenatal and postnatal appointments, including pregnancy scans. This is an important step for the health and wellbeing of pregnant women and their partners, who have understandably found it difficult not to share the experience of a pregnancy scan, attend important appointments, support women in early labour or spend time with their newborn babies on the postnatal ward." “With the re-introduction of partners in maternity settings, it’s important that anyone attending hospitals and clinics for appointments and scans wears a face covering and ensures they practice social distancing and regular hand washing. These measures are in place to keep pregnant women, partners and staff safe.” Gill Walton, Chief Executive of the Royal College of Midwives, said: “Visiting restrictions during the pandemic have been challenging for everybody, particularly for pregnant women and their families at an incredibly important and transformative time in their lives. These new guidelines are good news for them and for staff. They set out clearly the rules around visiting, providing much needed clarity about who can visit and the precautions they need to take to ensure visits can be done safely for themselves, for the people they are visiting, and for staff." “The guidance will also be welcome by maternity staff who have experienced some aggression from a small minority of visitors, unhappy and confused with varying and changing guidance.” Source: Royal College of Obstetricians and Gynaecologists, 8 September 2020
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News Article
UK women forced to wear face masks during labour, charity finds
Patient Safety Learning posted a news article in News
Nearly one in five pregnant women in the UK were forced to wear a face covering during labour, according to research by a charity, despite official health guidance saying they should not be asked to do so. Women described feeling unable to breathe, having panic attacks or even being sick during labour because they were made to wear a face covering. The research was carried out by the charity Pregnant Then Screwed, who surveyed 936 women who gave birth during December. It found that 160 of those who went into labour were made to wear a face covering. This goes against current joint UK guidance, published in July 2020 by the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists. The guidance says that women should not be asked to wear a face covering of any kind during natural labour or during caesarean births because of the risk of harm and complications. Read full story Source: The Guardian, 14 May 2021 -
News Article
'Gross failure in care' of baby starved of oxygen
Patient Safety Learning posted a news article in News
There was a "gross failure in basic care" which led to a baby being starved of oxygen during birth, a coroner said. Zak Ezra Carter died at the Royal Gwent Hospital, Newport, two days after being born in July 2018 at Ystrad Fawr Hospital in Caerphilly county. Gwent coroner Caroline Saunders said the monitoring of Zak and his mother Adele Thomas fell "well below the standards expected". She said she was reassured the health board had taken steps to improve care. Ms Thomas told the Newport hearing she felt "scared" and staff "didn't care" when she arrived to give birth on 20 July 2018. In a statement to the inquest she described being turned away from the centre after going into labour on three occasions, before being admitted on the fourth. Ms Thomas said she was initially offered paracetamol as pain relief at the midwife-led centre. She described "a lot of arguing between nurses", one of whom was "bolshie and rude and rough handled me", adding the midwives "did not appear to be in any rush". When Zak was born, he was described as being "white and pale" and without a heartbeat. He did not cry and was taken away to a room for resuscitation. Zak was transferred to the Royal Gwent Hospital where he died two days later. During the first stage of labour, Prof Sanders said "everything was progressing at a normal healthy rate and the fetal heart rate was recorded as completely normal". But she said it was "highly unusual" for the heart rate to not be documented contemporaneously, and the midwives had not been able to explain why they had not done so. Recording a narrative conclusion, Ms Saunders said the monitoring of Ms Thomas and her baby had "fallen well below the standards expected", leading to a "gross failure in basic care" of them in the later stages of labour. Read full story Source: BBC News, 18 March 2021 -
News Article
Baby died after being half-delivered during ‘chaotic’ birth at NHS trust
Patient Safety Learning posted a news article in News
A baby boy was starved of oxygen and died after being left half-delivered for almost a quarter of an hour during a “chaotic” breech birth in an NHS maternity unit. Midwives failed to recognise baby Theo Ellis was in the breech, or bottom first, position until his mother Laura Ellis, 34, was already in advanced labour at Surrey’s Frimley Park Hospital. What followed was a catalogue of errors by midwives and doctors who failed to heed the emergency situation and raised the alarm too late. At one stage a paediatrician was made to stand outside the room by midwives while junior staff struggled to deliver Theo alone. A senior obstetrician was in surgery and a miscommunication by midwives and an on-call consultant meant she did not arrive until Theo was already dead. After his parents brought legal action against the NHS, Frimley Park Hospital has now admitted mistakes led to Theo’s death in April 2019. Ms Ellis and husband James are angry their son was classed as being stillborn which meant a coroner was not allowed to investigate his care during an inquest. There have been repeated calls to change the law to ensure the deaths of babies like Theo are investigated. His mother told The Independent: “I walked in with a healthy baby. I’d looked after him for nine months and they killed him in the process of giving birth. The hospital get to write that he was stillborn, which obviously is a huge benefit to them, because the coroner can’t get involved, which to me is just staggering." Read full story Source: The Independent, 9 March 2021 -
News ArticleWhen pharmacist Ifeoma Onwuka, known to her friends as Laura, went into hospital to have her daughter, she and her husband hoped the delivery would go smoothly, and that they would soon be able to take their new arrival home to meet her siblings. Onwuka's labor was induced at James Paget University Hospital in Great Yarmouth in late April 2018. Things progressed quickly and there were soon signs that her baby was in distress, causing staff to begin preparations for an emergency Caesarian section, but Onwuka's daughter was born in the recovery room. Shortly after the birth, Onwuka's condition began to deteriorate. According to the family's lawyer, Tim Deeming, she began to bleed heavily, and was taken into surgery where attempts were made to stem the loss of blood. Hours later, and only after a second consultant had been called in, she was given an emergency hysterectomy. The mother-of-three died three days later. The coroner, Yvonne Blake, said an expert had told Onwuka's inquest that the delay to surgery contributed to her death, since acting early could have controlled the bleeding. Black mothers have worse outcomes during pregnancy or childbirth than any other ethnic group in England. According to the latest confidential inquiry into maternal deaths (MBRRACE-UK). Black people in England are four times more likely to die in pregnancy or within the first six weeks of childbirth than their White counterparts. Read full story Source: CNN. 14 January 2021
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News ArticleMore women may suffer pain due to being conscious while undergoing caesareans or other pregnancy-related surgery under general anaesthetic than realised, a troubling new study has found. The report, conducted by medical journal Anaesthesia, found being awake while having a caesarean is far more common than it is with other types of surgery. Researchers discovered that one in 256 women going through pregnancy-related surgery are aware of what was going on — a far higher proportion than the one in every 19,000 identified in a previous national audit. If a patient is conscious at some point while under general anaesthetic, they may be able to recall events from the surgery such as pain or the sensation of being trapped, the researchers said. While the experiences generally only last for a few seconds or minutes, anaesthetists remain highly concerned. Women also felt tugging, stitching, feelings of dissociation and not being able to breathe - with some suffering long-term psychological damage that often involved characteristics of post-traumatic stress disorder. Read full story Source: The Independent, 13 January 2021
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News ArticleRachel Hardeman has dedicated her career to fighting racism and the harm it has inflicted on the health of Black Americans. As a reproductive health equity researcher, she has been especially disturbed by the disproportionately high mortality rates for Black babies. In an effort to find some of the reasons behind the high death rates, Hardeman, an associate professor at the University of Minnesota School of Public Health, and three other researchers combed through the records of 1.8 million Florida hospital births between 1992 and 2015 looking for clues. They found a tantalising statistic. Although Black newborns are three times as likely to die as White newborns, when Black babies are delivered by Black doctors, their mortality rate is cut in half. "Strikingly, these effects appear to manifest more strongly in more complicated cases," the researchers wrote, "and when hospitals deliver more Black newborns." They found no similar relationship between White doctors and White births. Nor did they find a difference in maternal death rates when the doctor's race was the same as the patient's. Read full story Research paper Source: The Washington Post, 9 January 2021
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News Article
Pandemic changes affected maternity care for women who had stillbirths
Patient Safety Learning posted a news article in News
Changes to maternity services during the pandemic, including the mandatory redeployment of midwives and doctors to care for infected patients, may have affected the care given to women who had stillborn babies, a Healthcare Safety Investigation Branch (HSIB) investigation has found. The safety watchdog launched an investigation after the number of stillbirths after the onset of labour increased between April and June 2020. During the three months there were 45 stillbirths compared to 24 in the same period in 2019. The HSIB launched a probe examining the care of 37 cases. Among its findings the watchdog said staffing levels were affected because of the NHS response to the pandemic. In its report it said this “influenced normal work patterns and the consistency and availability of clinicians.” As an example, in one maternity unit the staffing numbers were short by three midwives due to sickness and redeployment. In another consultant presence was reduced overnight. During the pandemic both the Royal College of Midwives and the Royal College of Obstetricians criticised NHS trusts for redeploying maternity staff when mothers continued to need services regardless of the pandemic. HSIB said none of the women in its report were recorded as having the virus, but it found the pressures and changes as a result of the pandemic may have affected the care they received. The study stressed that the proportion of consultations undertaken remotely was not known and "the impact of remote consultations is not clear from this review". Read full story Source: The Independent, 16 September 2021 -
News Article
Baby death raises questions over maternity care
Patient Safety Learning posted a news article in News
Beth and Dan Wankiewicz want answers about why their baby son Clay died last year, shortly after his birth at Doncaster Royal Infirmary. Despite a low-risk pregnancy, the family say Clay died from multiple skull fractures. Doncaster and Bassetlaw NHS Foundation Trust said "the provision and delivery of high-quality" care is a priority. The BBC has found a 2016 review flagging concerns about the hospital's maternity care was never published. The report - one of scores of unpublished reports discovered by a Freedom of Information request by BBC's Panorama programme - highlighted significant patient safety concerns. Beth Wankiewicz was admitted to hospital last July, but after a day of labour her baby had still not been born. With no consultant doctor on site, a junior doctor made two attempts to deliver the baby with forceps, after getting advice on the phone. Father, Dan, remembers the second attempt with forceps being much more vigorous "which was a bit of a shock". The family say there was a further delay before they had a Caesarean section. Their baby had to be pushed back up the birth canal into the womb for the C-section to be performed. "I think after about 10 minutes, we both looked at the clock, and we said it's not looking good," said Dan. Around 20 minutes after their son was born, despite attempts to resuscitate him, they were told he had died. The following day they say a midwife told them she was being pressurised by other staff to say Clay had been stillborn, but she was sure he had been born alive, and she had heard a heartbeat. The family now believe this was to avoid scrutiny and the need for a coroner's inquest, which doesn't happen with still births. Read full story Source: BBC News, 19 May 2021 -
Content Article
In this blog, student midwife Sophie Dorman describes some of the issues that have led to a chronic shortage of midwives, including a culture of fear, poor pay and conditions and a lack of basic facilities for maternity staff. She highlights the impact this is having on the safety of maternity services and argues that valuing and looking after midwives will make pregnancy and childbirth safer and better for everyone. -
Content Article
Royal College of Midwives: Re:Birth summary report 2022
Patient Safety Learning posted an article in Maternity
In every aspect of our lives, language matters – and in health and care settings, it’s even more important. How we communicate with each other can determine the quality and impact of the care given and received, which is why developing a shared language is so important. Pregnancy and birth are extraordinarily personal, and personalising care is central to good outcomes and experience. There has been a great deal of debate in recent years about the language around birth, and the impact it can have. During this project from the Royal College of Midwives, for example, women said terms such as ‘failure to progress’ or ‘lack of maternal effort’ can contribute to feelings of failure and trauma. There has been particular debate around the term ‘normal birth’. Despite being the term used by organisations including the International Confederation of Midwives and the World Health Organization, it has often taken on negative connotations in the UK, and particularly in England. In 2020, the Royal College of Midwives, which counts the majority of midwives practising in the UK among its membership, took the decision to address this, and to try to develop an agreed shared language, working with maternity staff, users of maternity services and others involved in the care and support of pregnant women and families. Over the course of 18 months, the consultation has involved nearly 8,000 people from across all four UK nations. How we use language inevitably evolves over time, but the Re:Birth project will help to embed a shared, respectful way of discussing labour and birth.
