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News ArticleAn unprecedented number of women are being investigated by police on suspicion of illegally ending a pregnancy, the BBC has been told. Abortion provider MSI says it knows of up to 60 criminal inquiries in England and Wales since 2018, compared with almost zero before. Some investigations followed natural pregnancy loss, File on 4 found. Pregnancy loss is investigated only if credible evidence suggests a crime, the National Police Chiefs' Council says. File on 4 has spoken to women who say that they have been "traumatised" and left feeling "suicidal" following criminal investigations lasting years. Speaking for the first time, one woman described how she had been placed under investigation after giving birth prematurely, despite maintaining that she had never attempted an abortion. Dr Jonathan Lord, medical director at MSI, which is one of the UK's main abortion providers, believes the "unprecedented" number of women now falling under investigation may be linked to the police's increased awareness of the availability of the "pills by post" scheme - introduced in England and Wales during the Covid-19 lockdown. Scotland also introduced a similar programme. These "telemedicine" schemes, which allow pregnancies up to 10 weeks to be terminated at home, remain in effect. Campaigners are concerned that it is possible for women to knowingly or unknowingly use the pills after this point. MSI's Dr Lord says criminal investigations and prosecutions further "traumatise" women after abortions, and that women deserve "compassion" rather than "punishment". "These women are often vulnerable and in desperate situations - they need help, not investigation and punishment," he says. Read full story Source: BBC News, 20 February 2024
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Content ArticleOn the 7 February 2024, the Patient Safety Commissioner for England published a report considering options for redress for those who have been harmed by two of the interventions covered by the Independent Medicines and Medical Devices Safety Review: sodium valproate and pelvic mesh. In this blog, Patient Safety Learning sets out the background to this report, outlines responses from patient groups and campaigners, and reflects on how this work will be taken forward.
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Content Article
In this long-read article, Abbie Mason-Woods talks about her experience of having a high-risk pregnancy, pre-term birth and two baby girls in a Neonatal Intensive Care Unit (NICU). Abbie shares her deep insights as a patient and parent, highlighting the importance of trauma-informed, person-centred care throughout the care pathway, and the risk in forgetting the mother. -
News Article
'Ethnic bias' delayed care before Liverpool woman's death
Patient Safety Learning posted a news article in News
"Cultural and ethnic bias" delayed diagnosing and treating a pregnant black woman before her death in hospital, an investigation found. The probe was launched when the 31-year-old Liverpool Women's Hospital patient died on 16 March, 2023. Investigators from the national body the Maternity and Newborn Safety Investigations (MSNI) were called in after the woman died. A report prepared for the hospital's board said that the MSNI had concluded that "ethnicity and health inequalities impacted on the care provided to the patient, suggesting that an unconscious cultural bias delayed the timing of diagnosis and response to her clinical deterioration". "This was evident in discussions with staff involved in the direct care of the patient". The hospital's response to the report also said: "The approach presented by some staff, and information gathered from staff interviews, gives the impression that cultural bias and stereotyping may sometimes go unchallenged and be perceived as culturally acceptable within the Trust." Liverpool Riverside Labour MP Kim Johnson said it was "deeply troubling" that "the colour of a mother's skin still has a significant impact on her own and her baby's health outcomes". Read full story Source: BBC News, 16 February 2024 -
News ArticleA Mississippi prison denied medical treatment to an incarcerated woman with breast cancer, allowing her condition to go undiagnosed for years until it spread to other parts of her body and became terminal, according to a lawsuit filed on Wednesday. Susie Balfour, 62, alleges that Mississippi department of corrections (MDOC) medical officials were aware she might have cancer as early as May 2018, but did not conduct a biopsy until November 2021, one month before she was released from prison. It was not until January 2022, after she left an MDOC facility, that a University of Mississippi Medical Center doctor diagnosed her with stage four breast cancer, according to her federal complaint. Her lawsuit and medical records paint a picture of a prison healthcare system that deliberately delayed life-saving healthcare and for years repeatedly failed to conduct follow-up appointments that the MDOC’s contracted clinicians recommended. Read full story Source: The Guardian, 14 February 2024
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News Article
Pelvic mesh compensation disappointingly low, says victim
Patient Safety Learning posted a news article in News
A woman who described the time in her life after a pelvic mesh implant as "soul destroying" said proposed government compensation was "disappointingly low". Claire Cooper, from Uckfield, is one of around 100,000 women across the UK who had transvaginal mesh implants. England's patient safety commissioner suggested compensation could start at around £20,000. Ms Cooper, 49, was originally given the mesh implant as a treatment for incontinence after childbirth. However, after struggling with pain following the operation, Ms Cooper claimed doctors treated her as if she were "psychotic" and "a nuisance". She said her experience was one of being "mocked". "It was just soul destroying," Ms Cooper told BBC Radio Sussex. "I lost my fight because I was met at every turn with resistance so I just lost the ability to advocate for myself." Ms Cooper eventually had surgery to remove the mesh, which she said one doctor compared to "cheese cutting wire". She is still living with chronic pain. Read full story Source: BBC News, 15 February 2024 Further reading on the hub: Doctors shocking comments to women harmed by mesh -
Event
Women's Health Professional Care
Patient Safety Learning posted an event in Community Calendar
untilWomen’s Health Professional Care is designed for healthcare professionals and policymakers in primary and secondary care looking to improve health outcomes for women. Bringing together key learnings and new insights on a range of issues and challenges affecting women throughout their lives, Women’s Health Professional Care aims to address gender disparities in healthcare by highlighting areas of women’s health that have traditionally been overlooked. Register -
News ArticleThe first time she was groped at work, Freya says she was 24 years old, a newly qualified paramedic, and was cleaning out the cupboards of the ambulance station crew room. "He came behind me without me realising. I was cleaning away, and he put his hands around my body and grabbed my breasts," said Freya, which is not her real name. "Then he said, 'Well, I won't bother doing that again'. "People just laughed, some didn't even look up from the TV. Like it was nothing, completely normal." Her story mirrors that of other current and former paramedics who, in several interviews with Sky News, painted a picture of widespread sexual harassment and a toxic culture of misogyny. The head of the College of Paramedics, Tracy Nicholls, said: "Problems exist in every [NHS] trust, across all four countries in the United Kingdom." NHS England told Sky News that any form of sexual misconduct was "completely unacceptable" and every trust had committed to an action plan to improve sexual safety. Laura - not her real name - is currently a paramedic for a different ambulance service. She describes sexual harassment as "incessant" in the profession. She says students and new recruits are routinely referred to as "fresh meat", subjected to sexual comments, questions and jokes - even in front of patients - and are continually sexualised by some male colleagues. "It's exhausting," she said. "You come to work wanting to help your patients but every day you're dealing with inappropriate behaviour and sexual comments." Read full story Source: Sky News, 8 February 2024
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News Article
Doctors issue warning after spike in ‘freebirthing’
Patient Safety Learning posted a news article in News
Doctors have warned of the risks of “freebirthing” – where a woman gives birth without the help of a medic or midwife. Unassisted births, or “freebirths”, are thought to have been on the increase since the start of the Covid pandemic, when people may have been worried about attending hospitals and home births were suspended in many areas. The practice is not illegal and women have the right to decline any care during their pregnancy and delivery. Some women hire a doula to support them during birth. The Royal College of Obstetricians and Gynaecologists (RCOG) said women should be supported to have the birth they choose, but “safety is paramount” and families need to be aware of the risks of going it alone. The Nursing and Midwifery Council (NMC) said it is in the early stages of collaboration with the Chief Midwifery Officer’s teams, the Royal College of Midwives (RCM) and the Department of Health to better understand professional concerns about freebirthing and what organisations may need to do. Its statement on unassisted births supports women’s choice, but notes that “midwives are understandably concerned about women giving birth at home without assistance, as it brings with it increased risks to both the mother and baby”. It also states that women need to be informed that a midwife may not be available to be sent out to their home during labour if they change their mind and wish to have help. Read full story Source: The Independent, 8 February 2024 -
Content ArticleMost research examining the association between blood pressure and cardiovascular disease (CVD) is does not take sex into account. This research study aimed assess sex-specific associations between blood pressure and CVD mortality.by estimating sex-stratified, multivariable-adjusted incidence rate ratios (IRRs) for CVD mortality. The authors found that the association between blood pressure and CVD mortality differed by sex, with increased CVD mortality risk present at lower levels of systolic blood pressure among women, compared with men.
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Content ArticleIn late 2023, the Minister for Mental Health and Women’s Health Strategy, Maria Caulfield MP, asked the Patient Safety Commissioner for England to explore redress options for those who have been harmed by pelvic mesh and sodium valproate. This report sets out the outcome of this project and is designed to help the government understand the options available for providing redress to those patients harmed by pelvic mesh and valproate.
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News ArticleThe NHS Race and Health Observatory, in partnership with the Institute for Healthcare Improvement and supported by the Health Foundation, has established an innovative 15-month, peer-to-peer Learning and Action Network to address the gaps seen in severe maternal morbidity, perinatal mortality and neonatal morbidity between women of different ethnic groups. Across England, nine NHS Trusts and Integrated Care Systems will participate in this action oriented, fast-paced Learning and Action Network to improve outcomes in maternal and neonatal health. Through the Network, the nine sites will aim to address the gaps seen in severe maternal morbidity, perinatal mortality and neonatal morbidity between women of different ethnic groups. Haemorrhage, preterm birth, post-partum depression and gestational diabetes have been identified as some of the priority areas for the programme. The sites will generate tailored action plans with the aim of identifying interventions and approaches that reduce health inequalities and enhance anti-racism practices and learning from the programme. These will be evaluated and shared across and between healthcare systems. The Network, the first of its kind for the NHS, will combine Quality Improvement methods with explicit anti-racism principles to drive clinical transformation, and aims to enable system-wide change. Over a series of action, learning and coaching sessions, participants will review policies, processes and workforce metrics; share insights and case studies; and engage with mothers, parents, pregnant women and people. The programme will run until June 2025, supported by an advisory group from the NHS Race and Health Observatory, Institute for Healthcare Improvement, and experts in midwifery, maternal and neonatal medicine. Read full story Source: NHS Race and Health Observatory, 24 January 2024
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News ArticleDeeply ingrained medical misogyny and racial biases are routinely putting people in need of treatment at risk, the government’s patient safety commissioner in England has warned. Dr Henrietta Hughes was appointed in 2022 in response to a series of scandals in women’s health. She outlined a “huge landscape” of biases in need of levelling, citing examples ranging from neonatal assessment tools and pulse oximeters that work less well for darker skin tones to heart valves, mesh implants and replacement hip joints that were not designed with female patients in mind. Hughes said: “I don’t see this as blaming individual healthcare professionals – doctors and nurses – for getting it wrong. It’s pervasive in the systems we have – the training, the experience, the resources. “Anatomy books are very narrow in their focus. Even the resuscitation models are of pale males – we don’t have female resuscitation models, we don’t have them in darker skin tones. This is deeply ingrained in the way that we assess and listen to patients.” She described the realisation that pulse oximeters, used to measure blood oxygen levels, work less well for darker skin tones as a “real shock to the system” when the problem was highlighted during the pandemic. More recently, the NHS Race and Health Observatory highlighted concerns about neonatal assessments. Bilirubinometers, widely used to assess jaundice in newborn babies, are less reliable for darker skin tones and some guidelines for the assessment of cyanosis (caused by a shortage of blood oxygen) refer to “pink”, “blue” or “pale” skin, without reference to skin changes in minority ethnic babies. The Apgar score, a quick test given to newborns that was rolled out in the 1950s, traditionally includes checking whether a baby is “pink all over”. “Even the names of those conditions – jaundice and cyanosis – suggest a colour. The Apgar score includes P for pink all over,” said Hughes. “There are systemic biases in that if you have a darker skin tone those conditions may not be so apparent.” Read full story Source: The Guardian, 4 February 2024
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Content ArticleNew safety and educational materials have been introduced for men and women and healthcare professionals to reduce the harms from valproate, including the significant risk of serious harm to the baby if taken during pregnancy and the risk of impaired fertility in males. These safety and educational materials support the new regulatory measures announced in the National Patient Safety Alert. Healthcare professionals should review the new measures and materials and integrate them into their clinical practice when referring patients and when prescribing or dispensing valproate.
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News Article
‘Gaslit by doctors’: UK women with endometriosis told it is ‘all in their head
Patient Safety Learning posted a news article in News
Women with endometriosis who have endured years of excruciating pain are being “fobbed off” by doctors and told their symptoms are “all in their head”, leading them to give up seeking NHS treatment, new research has found. A study carried out by academics at Manchester Metropolitan University found women with the disease felt “gaslit” by doctors due to their lack of understanding of the condition. The paper, due to be published in the Journal of Health Communication later this month, also found that treatment was subject to a postcode lottery. Patients in rural areas reported travelling for hours to access a specialist with full training in the complex gynaecological condition. Endometriosis is a painful condition in which tissue similar to the lining of the womb grows around other organs inside the abdomen. It affects 1.5 million women in the UK. The study looked at the experiences of treatment and diagnosis of 33 patients and revealed how doctors’ lack of understanding of the symptoms meant women often spent years in pain before their condition was diagnosed. During this period participants were told they were exaggerating their symptoms, or their pain was dismissed as psychological. As one 27-year-old participant reported: “I feel a lot of mistrust towards the healthcare system in general, simply because I have been told that the pain was in my head, that I must have a low pain threshold or that I was in pain because I was fat.” Read full story Source: The Guardian, 21 January 2024 Share your experience of endometriosis: The Guardian newspaper would like to hear how you have been affected by endometriosis and your experience of being diagnosed and treated. -
News ArticleHealthcare workers are being told not to report women to the police if they believe their patients may have illegally ended their own pregnancy. The Royal College of Gynaecologists and Obstetricians (RCOG) says "deeply traumatised" women are being prosecuted following abortions. By law, patients' data must not be disclosed without their consent. The new guidance follows a recent rise in police investigations into abortions. NHS staff can breach confidentiality rules to give information to the police about possible crimes, but only if it is in the "public interest". The RCOG says it is "never" in the public interest to report women who have abortions, and that they must be safeguarded. In the first official guidance issued of its kind, a healthcare worker must "justify" any disclosure of patient data or "face potential fitness to practice proceedings". The organisation says it is "concerned" by the rising number of police investigations following abortions and pregnancy loss, and the effect this might have on "especially vulnerable" patients. Dr Jonathan Lord, RCOG's medical director, told the BBC: "A law that was originally designed to protect a woman is now being used against her. "We have witnessed life-changing harm to women and their wider families as a direct result of NHS staff reporting women suspected of crimes, and we just don't think that would happen in other areas of healthcare. "We deal with the most vulnerable groups who may be concerned about turning to regulated healthcare at all, and we need them to trust us". .Read full story Source: BBC News, 22 January 2024
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Content ArticleIn this article, Claire Brader summarises the recent findings on the performance of NHS maternity services in England, as well as recent government and NHS policies aimed at improving the quality of maternity care.
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Content ArticleAntonio Gonzalez speaks to Susan Standford for the Yale Anesthesiology podcast on intraoperative pain. Susanna is a patient who experienced intraoperative pain, and knowing she was not alone, she has actively raised awareness of this issue. In her own words, “Being able to feel major abdominal surgery is every bit as horrific as it sounds.” They discuss neuraxial anaesthesia for CS, guidance on testing and managing blocks, women being labelled ‘anxious’, outcome measures and targets.
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News Article
Why are so many women dying during pregnancy and what can be done?
Patient Safety Learning posted a news article in News
The number of women dying during pregnancy or soon after childbirth has reached its highest level in almost 20 years, according to new data. Experts have described the figures as “very worrying”. Between 2020 and 2022, 293 women in the UK died during pregnancy or within 42 days of the end of their pregnancy. With 21 deaths classified as coincidental, 272 in 2,028,543 pregnancies resulted in a maternal death rate of 13.41 per 100,000. This is a steep rise from the 8.79 deaths per 100,000 pregnancies in 2017 to 2019, the most recent three-year period with complete data. The death rate has increased to levels not seen since 2003 to 2005. The data comes from MBRRACE-UK, which conducts surveillance and investigates the causes of maternal deaths, stillbirths and infant deaths as part of the national Maternal, Newborn and Infant Clinical Outcome Review Programme (MNI-CORP). Urgent action is needed to bolster the quality of maternal healthcare, ensure it is accessible to all, and repair the damage inflicted by the pandemic on women’s healthcare services more generally. Clea Harmer, the chief executive of bereavement charity Sands, said improving maternity safety also needs to be at the top of the UK’s agenda. The government said it was committed to ensuring all women received safe and compassionate care from maternity services, regardless of their ethnicity, location or economic status. Anneliese Dodds, the shadow women and equalities secretary, said Labour would seek to reverse the “deeply concerning” maternal mortality figures by training thousands more midwives and health visitors and incentivising continuity of care for women during pregnancy. Read full story Source: The Guardian, 11 January 2024 -
Content ArticleThe 2021 UK NHS Getting It Right First Time report recommended that a significant proportion of native tissue vaginal prolapse operations should be undertaken as day-case procedures. The evidence for perioperative care, options for anaesthesia and outcomes of day-case vaginal prolapse surgery is limited. This study aimed to establish current practice amongst UK gynaecologists and explore perceived barriers to implementing day-case surgery for pelvic organ prolapse.
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News Article
New mothers being driven to suicide, senior midwife warns
Patient Safety Learning posted a news article in News
The senior midwife tasked by the government and NHS to investigate serious maternity scandals has warned that new mothers are being driven to suicide and backed an MP’s review into birth trauma. Donna Ockenden said it was “appalling” that women who should be in the “happiest times of their lives” were taking their own lives, after it was found suicide was the leading direct cause of deaths up to 12 months after giving birth. Ockenden, who has exposed poor maternity care across the country, is preparing to give evidence to an inquiry launched by Theo Clarke, the Conservative MP for Stafford, on birth trauma. Clarke thought she was going to die after giving birth to her daughter Arabella last year, having suffered a third-degree tear. But it was the lack of help available that opened her eyes to the estimated 200,000 women a year who experience birth trauma. Ockenden told The Times she had “huge respect” for Clarke’s inquiry and said: “I think that this whole issue of maternal trauma, sometimes long-term psychological trauma for families as well post a difficult maternity experience, is not necessarily given enough air time.” Read full story (paywalled) Source: The Times, 8 January 2023 -
Content Article
Fitting coils: developing a safe and supportive service
Patient_Safety_Learning posted an article in Women's health
In this blog, Sexual and Reproductive Health Consultant, Neda Taghinejadi tells us about the coil fitting service she is part of in Oxfordshire. Neda explains how the service has integrated a number of tools, including a triage system to identify more complex cases, to help support a safe and quality service. -
Content ArticleThe maternal mortality rate (MMR) in the United States continues to increase despite medical advances and is exacerbated by stark racial disparities. Black women are disproportionately affected and are three times more likely to experience a pregnancy-related death (PRD) compared to Non-Hispanic White (NHW) women. Keisha E. Montalmant and Anna K. Ettinger carried out a literature review to examine the racial disparities in the United States' MMR, specifically among pregnant Black women. The review highlights that maternal health disparities for Black women are further impacted by both structural racism and racial implicit biases. Cultural competence and educational courses targeting racial disparities among maternal healthcare providers (MHCP) are essential for the reduction of PRDs and pregnancy-related complications among this target population. Additionally, quality and proper continuity of care require an increased awareness surrounding the risk of cardiovascular diseases for pregnant Black women.
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Content Article
My experience of an outpatient hysteroscopy procedure
Anonymous posted an article in Patient stories
The following account has been shared with Patient Safety Learning anonymously. We’d like to thank the patient for to sharing their experience to help raise awareness of the patient safety issues surrounding outpatient hysteroscopy care.- Posted
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News Article
‘No doctor in the country will touch you’: how the NHS is failing FGM survivors
Patient Safety Learning posted a news article in News
At least 137,000 women in the UK live with the painful and traumatic consequences of cutting, but there is no provision for reconstructive surgery. In May 2023, Shamsa Araweelo was in the A&E department of a London hospital in excruciating pain. It wasn’t the first time she had sought urgent treatment for the gynaecological damage caused by the female genital mutilation (FGM), or cutting, forced on her as a six-year-old. In fact, this was one of many such visits to emergency departments that Araweelo had made in her desperate attempt to find a surgeon who could help undo the damage done to her as a child and which has caused her so much pain and trauma as an adult. Araweelo says that in A&E she was told that she had severe nerve damage and that it could be reversed through reconstructive surgery. But not in the UK. “No doctor in the country will touch you, because you are an FGM survivor,” Araweelo says she was told. “I felt no compassion, no respect. Only in London did they tell me they wished they had the appropriate training to help me, and it breaks my heart. We are not valued in the UK.” Current NHS rules state that if a health practitioner suspects a patient has been cut, they must report the case to the police and complete a safeguarding risk assessment to determine whether a social care referral is required. Guidance for GPs also recommends referrals for mental health issues related to FGM or referrals to uro-gynaecological specialist clinics. Araweelo says that in all the years she has sought help she has never been offered any kind of support from medical professionals. Read full story Source: The Guardian, 21 December 2023
