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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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Content Article
Unicef UK Baby Friendly Initiative has updated its policy guidance in the light of these investigations and some organisations are using posters and checklists to help staff understand and carry out their responsibilities. HSIB has also observed the impact of high task load, environment and staffing levels on the ability of staff to detect SUPC. Recommendations Maternity services should consider the following learning observations to ensure safe delivery of skin-to-skin care. • Based on the evidence, a baby who is born apparently well, with good Apgar scores, can be safely laid skin-to-skin with the mother or parent and requires close observation in the first minutes after birth. • Apgar scores must be attributed using close clinical observation of the baby. This can be achieved with the baby remaining in skin-toskin contact. There may be a need to interrupt skin-to-skin contact briefly to ensure Apgar scoring is assessed accurately. • Vigilant observation of the mother and baby should continue, with prompt removal of the baby if the health of either gives concern. • Mothers should be encouraged to be in a semirecumbent (half lying, half sitting) position to hold and feed their baby, ensuring the mother can see the baby’s face. • Care should be taken to ensure that the baby’s position is such that their airway remains clear and does not become obstructed. • Staff should have a conversation with the mother and her companion about recognising any changes in the baby’s condition. • Always listen to parents and respond immediately to any concerns raised. • Medicines given to the mother should be considered when discussing skin-to-skin contact. Pain relief given to mothers can affect their ability to observe and care for their baby. • Additional risk factors should also be considered. The level of risk for SUPC when a baby is in skin-to-skin contact can increase with, for example, increased maternal body mass index, antenatal use of opiate medication, sedation, and staff’s focus on other tasks. -
News ArticleHospitals have been refusing requests for caesarean sections during the COVID-19 outbreak despite official guidance and NHS England advice that they should go ahead. Multiple NHS trusts have told women preparing to give birth since March that requests for a caesarean section will not be granted due to the viral pandemic. It has led to accusations from the charity Birthrights that the coronavirus outbreak is being used as an excuse to promote an ideology that more women should have a natural birth. Maria Booker, from Birthrights, told The Independent: “We continue to be contacted by women being told they cannot have a maternal request caesarean and we are concerned that in some places coronavirus is being used as an excuse to dictate to women how they should give birth, which contravenes NICE (National Institute for Health and Care Excellence) guidance. Official guidance from NICE says women should be offered a caesarean section where they insist it is what they want. NHS England has warned hospitals they need to “make every effort” to avoid cancelling caesarean sections and work with neighbouring trusts to transfer women if necessary. It said surgery should only be suspended in “extreme circumstances” where there is a shortage of obstetricians or anaesthetists. Read full story Source: The Independent, 17 May 2020
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Content Article
Midwifery during COVID-19: A personal account
Anonymous posted an article in Blogs
Birth choices Our pregnant women are still being offered good choices in their birth experience such as homebirth and water birth, so long as they are well. I did two lovely home births this week. We are definitely seeing a rise in people transferring to our homebirth service. I do think there is a concern nationally about high risk women choosing to homebirth unassisted, in areas where maternity services have suspended homebirth as an option. Because women in my area still have the option of a homebirth, it’s not something we’re experiencing. Birthing partners and limited visits Partners are allowed at births including cesarean sections. Also, we’ve had lots of very positive feedback from the women to say that not having their partners or visitors on the wards hadn’t been as bad as they thought, as they have talked and bonded more with other new mums and made new friends. It’s difficult for them without the support of family in the postnatal period but with encouragement they can usually see it as a positive, a time for them to bond as a family and get to know their little ones. Dads are actually very positive realising that it means they get to spend much more time with their partners and new baby. Appointments and new ways of working My Trust are doing just as many face to face antenatal visits. We do virtual appointments at booking and 16 weeks in the vast majority of cases but GPs locally are refusing to see women at 25 and 31 weeks, so we have changed the schedule to include these in midwifery care. We are using well midwives, who are isolating at home for whatever reason, to do phone clinics for booking and 16 week appointments which lifts the pressure off those of us working clinically. They also ring around all of the women due to be seen to make sure they’re well and understand that they need to attend appointments alone. I’m a case loading midwife so I know my mums to be/new mums well and do feel I’ve been able to support and reassure them effectively. I know that sadly not everyone is in this position though. Staff levels and wellbeing Annual leave has been cancelled. Nobody has complained about this though (or at least nobody that I’m aware of). We were expecting it and realise it’s vital. Lots of staff are also picking up extra shifts. If staffing levels drop though the pressure will be enormous. My trust have been very proactive regarding training and we are all being supported in terms of wellbeing. Accommodation has been provided for staff unable to go home and wellness packages and mental health support is in place. We’ve even been provided with a pop-up supermarket. Our local community are also amazing. Most staff could access a free hot meal most days if they chose to from various donations, school, restaurants and local sports teams. Hand cream, treats, snacks etc are always coming in. We feel so appreciated and loved One of our biggest issues is PPE Even for confirmed COVID-positive women we are given less protection than we are normally given when caring for women with flu. Working in community, this has its own issues. Statistically we know that the chances are that viral loads in homes are likely to be high due to the number of people present in small spaces, more soft furnishings, less stringent cleaning routines etc. The apron and mask we are given are unlikely to offer us any real protection. When we leave the houses we then have to transport the contaminated personal protective equipment (PPE) in our own vehicles, we’re wearing uniform that is likely to be contaminated and we are stood on pavements trying to clean the equipment we have used because that too will be contaminated. We’re not protected in the same way that hospital staff are. We are walking in to homes where there may be 4 or 5 people in the same room that we need to be in, as everyone is at home. We keep being told effective hand washing is key but we’re doing that in environments which are often less than clean, and in cases of COVID-confirmed women we can’t wash our hands at all as we’re unable to remove our PPE until we’ve left the house. It all feels very unsafe both in terms of staff contracting COVID-19 and cross contamination to other women, colleagues and our family. The support we are lacking comes from Public Health England and the Government. PPE guidance and availability is pitiful and dangerous and I believe is based on availability rather than need or any scientific basis. Do you work in maternity services? Or perhaps you are expecting a baby? Does this midwife's account reflect the maternity services in your area at the moment, or are you seeing different positives and challenges? We want to hear from patients and staff, so please sign up to comment below or contact us directly (content@pslhub.org) to share your story.- Posted
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News Article
Coronavirus: Uncertainty over maternity care causing distress
Patient Safety Learning posted a news article in News
Women say the uncertainty surrounding maternity services during the coronavirus outbreak is "making a stressful situation harder". The Royal College of Midwives says services may need to be reduced due to COVID-19. Like many areas in the health sector, staff shortages caused by sickness and workers self-isolating are impacting resources, the college adds. The BBC asked a group of NHS trusts and boards across the UK about the services they are able to provide during the coronavirus pandemic. Nine trusts in England, five boards in Scotland and one trust in both Wales and Northern Ireland responded. All 16 bodies said one birth partner could be present during labour, but just over a quarter of those asked are allowing partners on the postnatal ward following the birth. Around a third of trusts and boards that spoke to the BBC are now allowing home births. In the weeks after a birth, midwives and health visitors are now heavily relying on virtual communication to provide families with postnatal support. Home visits are mostly still happening, but one trust in London said it only allows face-to-face contact when it is "absolutely essential". Read full story Source: BBC News, 24 April 2020 Read Patient Safety Learning's latest blog: Home births, fears and patient safety amid COVID-19 -
News Article
Expectant mothers turn to freebirthing after home births cancelled
Patient Safety Learning posted a news article in News
When Victoria Gianopoulos-Johnson got a call from her midwife to say her home birth would be cancelled, panic took hold. She says she “lost it” for two days, crying constantly, gripped by uncertainty and then anger. Now she has reached the decision to have a free birth, also known as unassisted childbirth. Maternity rights groups say there has been a rise in the number of women seeking advice about freebirthing owing to pressures on hospitals and new restrictions around birth partners. More than a fifth of birthing centres and more than a third of homebirth services have closed due to a shortage of midwives and concerns about ambulance response times. Alison Edwards, of Doula UK, whose 700 members advocate for expectant mothers, says she has seen a threefold increase in calls about freebirthing in the last fortnight. “Initially women were concerned about staff shortages,” says Edwards. “Now they don’t want to go to hospital at all, it’s about infection. It is inevitable that some who should not be freebirthing because they are in a high-risk category will give birth at home because they fear the alternative – infection from [coronavirus] or spending time in hospital without their partner’s support.” Read full story Source: Guardian, 5 April 2020 -
News Article
Women in labour being refused epidurals, official inquiry finds
Patient Safety Learning posted a news article in News
Women in labour are being refused epidurals in breach of official guidelines, a government inquiry has found. In findings reported by the Guardian, an investigation by the Department of Health and Social Care also found that women may not be being kept fully informed that if they choose to give birth at home or in a midwife-led unit they may have to be transferred if they want an epidural. Failing to make women aware of that possibility would also be in breach of National Institute for Health and Care Excellence (NICE) guidelines. As a result of the inquiry, the Health Minister Nadine Dorries will write to all heads and directors of midwifery and medical directors at NHS trusts this week to remind them of the NICE guidance regarding pain relief during childbirth and to ensure it is being followed. Clare Murphy, Director of external affairs at the British Pregnancy Advisory Service, said the “results of the government’s inquiry are sadly not surprising”. She added: “We have spoken with many women who have been so traumatised by their experience of childbirth that they are considering ending what would otherwise be wanted pregnancies. Pain relief is sometimes treated as a ‘nice extra’ rather than an integral part of maternity care, and women and their families can suffer profoundly as a result." Read full story Source: Guardian, 3 March 2020 -
News Article
Pregnant women must be respected by medics, says regulator
Patient Safety Learning posted a news article in News
Mothers-to-be must be respected and listened to by medics, regulators have said, after warnings that pleas for pain relief in labour have been ignored. The intervention by the Nursing and Midwifery Council (NMC) follows an investigation by The Sunday Telegraph. Last week it was revealed that six NHS trusts were in breach of medical guidance which says pain relief should be provided at any point of labour if it is requested. Women said they were told “‘It’s not called labour for nothing, it’s meant to be hard work” as doctors refused their pleas. The findings prompted the Health Secretary to order an investigation. Today Andrea Sutcliffe, Chief Executive of the NMC, which regulates nurses and midwives said such actions should not be tolerated. In a letter to The Telegraph she said: "As the regulator for nursing and midwifery professionals, we know that all women deserve to have their views, preferences and decisions respected during pregnancy and birth." The watchdog recently published updated standards for midwives, which she said underlined this point. "Enabling women to make safe, informed decisions about the care they receive, including choices about pain relief during birth, is at the heart of our new Future Midwife Standards," the Chief Executive continued. Ms Sutcliffe said midwives should work "in partnership" with women in labour. "While midwives don’t administer epidurals, they do play a key role in helping women to make informed choices and advocating on their behalf to make sure those choices are understood and respected by the wider care team," she said. Read full story Source: The Telegraph, 2 February 2020 -
News Article
Health secretary to investigate allegations of women denied epidurals
Patient Safety Learning posted a news article in News
Women in labour are being denied epidurals by NHS hospitals, amid concern that a “cult of natural childbirth” is leaving rising numbers in agony. Last night, Matt Hancock, the Health Secretary, promised an investigation, and action to ensure women’s choices were respected, pledging to make the NHS maternity services the world-leader. An investigation by The Sunday Telegraph found hospitals refusing clear requests from mothers-to-be, in breach of official guidelines from the National Institute for Health and Care Excellence (NICE). Mr Hancock said all expectant mothers should be able to make an informed choice, knowing their choice would be fully respected. “Clinical guidance clearly state that you can ask for pain relief at any time – before and during labour – and as long as it is safe to do so this should never be refused. I’m concerned by evidence that such requests are being denied for anything other than a clinical reason,” he said. “It's vital this guidance is being followed right across our NHS, as part of making it the best place in the world to give birth. Women being denied pain relief is wrong, and we will be investigating.” One mother, describing her experience at one NHS Hospital said: "It made me feel unsafe psychologically - I couldn't speak up, I couldn’t say what I wanted to say, I couldn’t advocate for myself medically because people were ignoring or belittling me. It feels that in childbirth, it’s a given that the doctor is taking their personal beliefs with them to the table, whereas in any other area of healthcare that would be unacceptable." Read full story Source: The Telegraph, 26 January 2020 -
News ArticleA coroner has today slammed a hospital for a series of serious failings after a mother bled to death when a medic refused to allow her vital clotting products. Gabriela Pintilie, 36, from Grays, Essex, gave birth to her healthy baby girl, Stefania, in February last year following a C-section after a long labour. But she suffered a major haemorrhage and died from a cardiac arrest hours later. Basildon University Hospital, in Essex, came under fire after it emerged a locum haematologist refused to give Mrs Pintilie the blood after he followed the wrong set of guidelines. The fresh frozen plasma, which could have saved her life, remained outside the theatre after senior staff were not told it was available. Essex Coroner Caroline Beasley-Murray today slammed the hospital for a lack of clear leadership and teamwork during the crucial minutes and hours when Mrs Pintilie suffered a massive haemorrhage. The court heard how the on-call haematologist Dr Asad Omran, who was at home, was called but refused to give permission for vital blood-clotting drugs to be issued until further tests were run. An expert witness said she believed the use of clotting drugs in the 'extreme situation' would have 'significantly increased' the chances of a different outcome. Dr Omran did not initially issue blood-clotting drugs because he followed the wrong protocol. He was following protocol for a normal adult, instead of a woman in labour, which was 'completely at odds with clinical guidelines'. Read full story Source: Mail Online, 20 January 2020
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News ArticleSick newborns in some areas of the UK are dying at twice the rate of seriously ill babies in other areas, a new report has revealed. The findings raise serious questions about the quality of care in some neonatal units, with experts warning action needs to be taken to tackle the “striking variation”. Across the country neonatal units are also short of at least 600 nurses with four in five failing to meet required safe staffing levels for specialist nurses. The regions with the highest mortality rate at 10 per cent were Staffordshire, Shropshire and the Black Country, where 107 babies died. This compared with a rate of 5 per cent in north central and northeast London. The Shropshire region includes the Shrewsbury and Telford Hospitals Trust, which is at the centre of the largest maternity scandal in the history of the NHS, with hundreds of alleged cases of poor care now under investigation. Dr Sam Oddie, a consultant neonatologist at Bradford Teaching Hospitals Trust and who led the work for the Royal College of Paediatrics and Child Health, said he was “surprised and disappointed” by the differences in death rates between units. “The mortality differences are very striking, with some units having a mortality rate twice that of the lowest. This variation in mortality is a basis for action by neonatal networks to ensure they are doing everything they can to make sure their mortality is as low as possible,” he said. Read full story Read MBBRACE-UK report Source: The Independent, 18 December 2019
