The Independent Midwives of Kent
One of the many commentators under Madwife goes for a swim says the following:
The problem now is that no insurance company offers insurance for independent midwives in the UK. Dr C seems to believe that this is because they are a much greater risk than NHS midwives.That is correct. Let me explain why. To do so, I am going to take you through a birth supervised by the Kent Midwifery Practice, which is run by aquanaut Virginia Howes. I would not normally comment on a real case in a public forum, but this case is prominently and proudly displayed, under the title
on the front page of the Kent Midwifery Practice website. Apologies in advance for the length of this post but it would not be fair only to quote extracts. I therefore print it in full, with all the grammatical mistakes. It is entitled “Sharons Birth Story”. I am sure that the use of apostrophes is not part of midwifery training but you would have thought they might do better on an important promotional website. I do not know which midwife was taking responsibility for this birth, so we will call her “Mary”. A second midwife, Kay, was also present. Presumably this is Kay Hardie.“Unusual normal birth stories”read the amazing story of the 12 pound baby born at home.
Since I published this article, Sharon's story has mysteriously disappeared from the Kent Midwifery Practice website. I have already printed it verbatim below and fortunately the original story as seen on the website is still available from Google cache here. It is not easy to rewrite internet history. (Saturday 3rd May 2008)Sharons Birth Story
I remember the first words I heard when Sharon rang me at the beginning of her pregnancy “I would like a home birth but my husband wouldn’t like it”. Well I hear that a lot and feel that is only a minor hurdle to cross. If a woman really wants a home birth then getting husband on board is usually easy. I went to visit Sharon and Paul and gave them a DVD of another client of mine who had recently been featured on the Home Birth diaries series on the Discovery Channel. I chatted to them about the safety of home birth, risk factors and Sharon’s previous 3 hospital birth.
Sharon and Paul felt that the births of their first two daughters although medicalised, with induction of labour, continous monitoring, episiotomies, managed third stage etc were ok, but the birth of their last daughter and then the poor treatment they received during a late miscarriage made them loose their faith and belief in the local NHS maternity services.
We had hours and hours of discussion. Sharon had so many questions. We discussed every aspect of normal and abnormal birth. We discussed the whys and wherefores, the if and might be of every test and possible happening imaginable. We discussed the medical model of care, the history of childbirth even evolution and natural selection. Sharon was taking an anatomy and physiology course and so the physiology of birth was of great interest to her. Sharon was like a sponge and soaked up everything we discussed. I never at any time felt that Sharon was not making a truly informed choice about any aspect of her care.
At 34 weeks I concluded that once again Sharon was growing a large baby and had gallons of liquor on board. The baby was also breech.
As the story progesses, note Mary’s eclectic use of the word "medicalised". Medical procedures are only OK when carried out by Mary.Sharon had birthed 3 big babies; the largest was the second baby at 9lb 13oz. The third baby had been induced at 37 weeks following a diagnosis of polyhydramnios and an estimated weight of nearly 10 lbs. The actual weight at birth was 9lbs. There had never been any diagnosis of diabetes or any other maternal or fetal problems.
We don’t know the maternal age, but already we do know this is not a normal risk pregnancy. Three previous big babies and an induction at 37 weeks for polyhyrdamnios.We deduced that Sharon therefore grew big babies as normal for her. We decided that we would expect a big baby and not be concerned. Easier said than done during the first trimester!!
A gauche way of confirming the obvious and yet glossing over the dangers of large babiesAll went well. Ultrasound scans and routine bloods all showed a normal pregnancy.
Already Mary is “medicalising”. Ultrasound and blood tests. There is no test that shows a normal pregnancy.Sharon had some episodes of dizziness that were unrelated to anything.
Mary is a doctor now. Does she know the differential diagnosis of dizzyness?Her observations and haemoglobin all remained normal and the dizziness stopped with rest. I continued to advise her about diet and encouraged her to reduce her carb intake and increase her protein, calcium vitamins etc.
We had hours and hours of discussion. Sharon had so many questions. We discussed every aspect of normal and abnormal birth. We discussed the whys and wherefores, the if and might be of every test and possible happening imaginable. We discussed the medical model of care, the history of childbirth even evolution and natural selection. Sharon was taking an anatomy and physiology course and so the physiology of birth was of great interest to her. Sharon was like a sponge and soaked up everything we discussed. I never at any time felt that Sharon was not making a truly informed choice about any aspect of her care.
At 34 weeks I concluded that once again Sharon was growing a large baby and had gallons of liquor on board. The baby was also breech.
Now we are moving into high risk territory. Large baby and GALLONS of liquor. In other words, polyhydramnios again. The lie of a baby is not easy to determine when there is polyhydramnios, and in a fourth pregnancy a breech at 34 weeks may well turn spontaneously. But it is a large baby. Does Mary know where the placenta is?We discussed a scan and other investigations and Sharon declined as she wanted to stay away from the hospital as much as possible in order not to “open a can of worms” (her words) as had happened before.
So, no scan. We don’t know where the placenta is. We don’t know if the polyhydramnios is caused by foetal abnormality.I asked my partner Kay to visit Sharon at 36 weeks to assess presentation and overall health. I had always visited Sharon in the calmness of morning when the children were at school however Kay’s visit was in the evening on a particular stressful day. It was not surprising therefore that Kay found Sharon with an elevated blood pressure. She was also unsure of the presentation and therefore a referral was made to the local hospital.
Ah! So, now we are going to open the “can of worms” and do a little medicalising. Better late than never, but it is late. It may not be suprising that Sharon’s BP is raised but that does not mean it is not significant. I wonder if she had protein in her urine?While at the hospital Sharon had blood taken to assess for pre-eclampsia as we expected.
Why had Mary not already taken a blood test if this is what she expected?”However they also had her previous history did a blood glucose which was normal.
Mary should have checked Sharon for diabetes already on this historySharon had taken our notes with her and so the midwife who cared for her could read them and was well aware of the amount of discussion we had over the previous weeks. Despite this midwife felt the need to shroud wave and talk about the risks of big babies and advise against a home birth. She said that babies who have large volumes of liquor needed to be in hospital in order to be suctioned. In fact she went on so much that in the end Paul had to tell her to be quiet as she was upsetting his wife!
So, warning a mother with a now high risk pregnancy of the dangers of large babies and polyhydramnios is “shroud waving”. Has Mary considered that an experienced hospital midwife, reading Mary’s notes, might have been anything but reassured?I happened to call the hospital to find out how Sharon was and the midwife caring for her spoke to me. She said that Sharon’s bloods were normal but they had advised her to stay as she was “tightening”. I think I laughed and said I hardly think that was a reason to keep a woman in hospital especially in view of the fact that she was having a home birth and it was probably Braxton Hicks contractions anyway.
Let’s think about that. A mother in her fourth pregnancy, with a huge baby whose head (on the history) is probably not engaged, with polyhydramnios starts to get contractions. Has Mary not heard of prolapsed cords? Does she not know anything of the dangers of polyhydramnios? They probably were Braxton Hicks contractions, but Mary was not on site palpating Sharon’s abdomen, she was on the telephone. Why will she not take advice from a colleague who is with the patient?The midwife then went on to tell me she had looked up Sharon’s history and between baby 1 and baby 2 an incidental swab had detected group B strep and therefore they recommend a hospital birth with IV antibiotics. I quoted the Green Top guidelines to her that this was not a risk factor and said Sharon had not had IV antibiotics during her last labour.
Very controversial area this. Take a look at the Green Top guidelines from the RCOG. Mary is right that, on this history, it is not currently recommended in the UK that the labour is conducted under antibiotic cover. The practice in other countries is different. It is a difficult area. What is indisputable however is that the previous history of beta haemolytic strep, incidental or not, should not be ignored.Later Sharon told me that the same midwife had tried to undermine her confidence in me by asking Sharon if “her midwife” knew what to do if her baby’s shoulders got stuck. She also scared them about cord prolapse.
Shoulder dystocia is scary. It makes doctors concentrate. Remember we are dealing with a huge baby, which makes the possibity of a difficult delivery all the more likely. I would be scared of cord prolapse too. In a home environment it is a likely death sentence for the baby. Regular readers will recall the tragedy of the midwife whose own baby had a cord prolapse at homeShe “informed" Sharon and Paul that I practice without insurance.
Why is the word “informed” in inverted commas?The insurance issue is something I discuss at the consultation visit long before I book clients and so they were fully aware of all the issues.
Who knows what goes on in these “long consultations” but I somehow doubt that a mother with no medical training can really understand all the issues. Maybe Sharon did.I was very offended by the midwifes comments and angry at her scaremongering. I wrote to her asking for an explanation, quoted our Code of Conduct about respecting our colleagues and asked for an apology. I did not get an answer.
But Mary, you have already made serious disparaging remarks about your colleagues management of the patient and accused her of “shroud waving”. Respect is a two way trackSharon stayed in overnight and had a scan the next day. The baby was cephalic and an estimated weight showed between 8-9 lbs her blood pressure settled and she came home. She was asked to return for a consultant assessment and GTT test which she declined.
And did Mary support this advice? A high risk pregnancy like this should be assessed by a consultant obstetrician.She accepted however a repeat scan one week later which estimated the fetal weight as between 9-10lbs. They also diagnosed polyhydramnios. No surprise there then! The baby was cephalic with the head deep in the pelvis. The Sonographer concluded no abnormality seen to account for the increased fluid. A second opinion agreed and concluded that it was probably due to the size of the baby alone.
OK. So far so good. No evidence of foetal abnormality is a great relief. Note it took two ultrasound specialists to arrive at that conclusion.Despite the reassurance that all was normal and despite me knowing that 40% of babies with shoulder dystocia are less than 4 kg I could not stop all the shroud waving of that hospital visit having an effect on me and against my usual practice I suggested membrane sweeps prior to 40 weeks to encourage labour and planned to ask Kay to attend the birth.
I don’t understand the first sentence. Is Mary saying that 60% of shoulder dystocias are in babies weighing more than 4Kg? And this is not “shroud waving”. It is appropriate medical concern for a high risk pregnancy. Mary seems to be getting frightened now. She starts trying to induce the labour even though that is against her beliefsA membrane sweep on the due date had the desired effect and Sharon called me to report ruptured membranes 24 hours later.
Most doctors would prefer a women at term in a fourth pregnancy with a huge baby and polyhydramnious to be in hospital for any sort of manoevure that might induce labour. The baby’s head may well not be fully engaged and the rush of fluid from the polyhydramnios can bring an umbilical cord down.She laboured normally and well. She asked me to examine her after 5 hours and again against my usual practise I agreed. Normally I would reassure women that this was an intervention unproven in its benefits but that shroud kept rearing its ugly head and influencing my practice.
Dear God. She has not checked even once to make sure there is not a complex presentation.Sharon was 8 cms and the head was low. A couple of hours later and Sharon was pushing. The head was large and Sharon was having difficulty pushing it out underwater and so I suggested she stood up for gravity to help. This was all it took and the head was born. The body was born with the next contraction with absolute ease. However because she was now standing in the pool I had to lean over the pool to catch the baby. As the baby rotated I called Kay closer to help I said “don’t worry the shoulders are free I just need help in case I drop it”! Both of us caught this huge beautiful baby girl and passed her to her brave confident mum.
The story does not end there.
Forty minutes later Sharon birthed the placenta with quite a huge blood loss. All was well at this point so we all went into the lounge and Sharon breast fed her baby.
An extraordinary story. Mary’s management of Sharon’s labour was idiosyncratic and ignored a lot of standard medical practice. It gets worse. Had Sharon died at home of a post-partum haemorrhage, the fact that Mary had “lost” her BP machine might well have turned a civil case into a criminal charge of manslaughter.
But there is something even more extraordinary about the story. Mary’s blithe, gauche attitude to normal medical practice. She will not even take advice from her hospital colleagues. Experienced NHS midwives will be as horrified by this story as am I. We can all at least now understand why insurance is a problem.
Forty minutes later Sharon birthed the placenta with quite a huge blood loss. All was well at this point so we all went into the lounge and Sharon breast fed her baby.
All is not well. Sharon has had a “huge blood loss” after a difficult delivery of a very large baby. Has Mary taken any action? Has she even checked Sharon’s BP? Seems not. Please call an ambulanceShe had not breast fed any of the others and really wants to succeed this time. About an hour after her birth Sharon had another large blood loss and felt slightly clammy so I lay her down on the sofa gave her some syntometrine and looked for my blood pressure cuff. It was no-where to be found! I had it during labour but now it was lost.
The story is now moving from idiosyncratic to dangerous. There are two midwives present (remember, Kay is there as well) treating a woman with a serious post partum haemorrhage who is showing signs of shock. Two midwives and no BP machine. Please, please call an ambulanceTo date on day 3 it is still not located. I was concerned that I might have a woman who was compromised and so I called a paramedic.
Finally, Mary sees sense. Her patient is indeed compromised. She has had a post partum haemorrhage, she is clammy and Mary is not able to take her BP. So she dials 999.They arrived within 3 minutes and were the best guys I have ever met in the job. They got their BP machine which recorded observations at 5 minute intervals. Sharon’s observations were all normal. She then vomited and at the same time passed a huge amount of blood and clots.
The post partum haemorrhage continues and Sharon now vomits. She is critically ill and needs to be in hospital. PLEASE take her to hospital.I felt it was appropriate to give ergometrine IM and commence 500ml gelifusin and then 1000 saline.
Mary is now putting up a drip, giving plasma expanders and normal saline. One and a half litres in total. Over what period of time? Did she take blood for a group and cross match? I doubt it. Sharon needs to be in hospital. Please please take her to hospital.Sharon felt fine and all her observations were fine. The Paramedics remained for nearly 2 hours. They helped without taking over and were a pleasure to have around.
We have to take Mary’s word for the fact the Sharon now felt fine. A high dependency para-medic ambulance has now been tied up for two hours. I am sure the paramedics did not want to take over. I am sure they stayed as they realised the gravity of the situation.I felt that Sharon did not really need to transfer and instinctively felt that the large loss which in all I estimated at 1500mls was due to the large placental site and yet again normal for her as she was not compromised.
Bonkers. Utterly bonkers. Nothing more to be said on that.However having discussed it with my supervisor I transferred her. I think covering ones behind was discussed!!!
Is Mary frightened by now. Why else would she call her supervisor? Thank goodness she did.When we arrived the same midwife was on duty and Paul quite firmly ordered her out of the room! Sharon was then cared for by a lovely midwife. However yet again that medical model reared its ugly head and they wanted to do tests on the baby. Blood sugars and IV antibiotics!
The "lovely midwife" wanted to do tests on the baby, such as blood sugars. Mary does not approve so once again it is the pejorative “medical model”. It is indeed the medical model. Checking the blood sugar on a new born 12 pound baby is entirely sensible.Sharon declined and stated that she had come in to be checked over not the baby and please hurry up as she wanted to go back home. She was all perfectly normal with a well contracted uterus, normal observations and lochia. She had a couple of hours of syntocinon as a precaution and then we all went home.
The way Mary glosses over standard medical treatment is breathtaking. Why was Sharon’s uterus now contracted down? Two hours of i.v. syntocinon might explain it.She has a haemoglobin of just under 10 (so probably a bit lower in reality) but is feeling great and tucking into steak and broccoli. Her big beautiful baby is named Tulah and weighed in at a whopping 12lbs. Tulah is feeding on demand 3-4 hourly. Perfect. Sharon is giving up having babies now.
+++++++++++
An extraordinary story. Mary’s management of Sharon’s labour was idiosyncratic and ignored a lot of standard medical practice. It gets worse. Had Sharon died at home of a post-partum haemorrhage, the fact that Mary had “lost” her BP machine might well have turned a civil case into a criminal charge of manslaughter.
But there is something even more extraordinary about the story. Mary’s blithe, gauche attitude to normal medical practice. She will not even take advice from her hospital colleagues. Experienced NHS midwives will be as horrified by this story as am I. We can all at least now understand why insurance is a problem.
Private midwives have been working without indemnity insurance since 2002, when the last company willing to provide cover pulled out. Despite this, their numbers have grown from about 40 in 2002 to 200 at present, with up to 4,000 babies a year delivered privately. (The Times)But is seems the lack of insurance is only a problem for the patients and the babies. The independent midwives exibit "la belle indifference". Annie Francis, spokeswoman for the Independent Midwives’ Association said:
“Most clients understand you can’t insure against things going wrong during childbirth, only against negligence, and negligence is not really an issue for us”
That's all right, then.
Following numerous comments and emails, I sent details of Kent Midwifery Practice to Helen O'Dell who is the Midwifery Officer for South East Coast Local Supervising Authority. She has replied as follows:
Dear Dr Crippen
You are able to refer directly to the NMC and enclose the details that you have sent me. There is an information leaflet on the NMC website regarding how to make a complaint. I will ask for an investigation to take place. If there is any further information that you think is relevant please forward it to me.
Regards
Helen
I have therefore also sent copies of the email to the NMC.
Helen O'Dell can be contacted at : helen.odell AT nhs.net or Helen.O'Dell AT southeastcoast.nhs.uk and the email address of the NMC is : fitness.to.practise AT nmc-uk.org
Labels: independent midwives, Kent midwifery practice, madwives
195 Comments:
You can always tell when a delivery is starting to go tits-up. It's when "my client" magically becomes "your patient".
This poor woman, who has been woefully managed by the midwitches should have been in hospital from the outset. I'm suprised that she even had a Venflon in.
There are no obstetricians, paediatricians, anaesthetists, ODAs, blood bank or anything at home for that moment when your "client" doesn't play by the rule book and ends up being a "patient".
They spend 3 years training to monitor an entirely normal process only to f**k it up when something happens.
Dangerous. Very dangerous.
Hi - you need to do a proof read of your comments if you are to critisize their grammar. I spotted a forth instead of fourth and a too instead of two.
Good stuff though.
OT, sorry; anyway; shortage of junior doctors, not MMC/MTAS related -- insofar as I can tell:
http://icwales.icnetwork.co.uk/news/wales-news/2008/05/01/hospitals-hit-by-junior-doctor-shortage-91466-20846958/
Claire said...
Hi - you need to do a proof read of your comments if you are to critisize their grammar. I spotted a forth instead of fourth and a too instead of two.
Hi Claire - you need to do a proof read of your comments if you are to critisize their grammar. I spotted a critisize instead of criticize ....
Glass houses / stones ?
As an experienced NHS community midwife there is no way I can endorse Mary and Kay's actions. The patient was clearly high risk from the start and not suitable for a home birth. As you say, John, Bonkers.
L.
Leicester
So one bad example proves they're all bad? That rules out the NHS for deliveries then since there are hundreds of bad examples, many of them actually ending in death or injury to mother or baby. Not very scientific for a doctor.
claire said...
Hi - you need to do a proof read of your comments if you are to critisize their grammar. I spotted a forth instead of fourth and a too instead of two.
Good stuff though.
+++++
I am well rebuked. In mitigation a "forth" for a "fourth" and a "too" for a "two" are more typos or spelling mistakes than grammatical errors; and I am writing a blog, not design a web site to sell things. And I had to mention the fact that the madwive's copy is riddled with errors or I would have been accused of sloppiness.
But, mitigation, not an excuse. A prick in the balloon of pomposity.
So I will forgive your criticise with a "z". You probably have an American spell checker
John
jane_t said...
So one bad example proves they're all bad? That rules out the NHS for deliveries then since there are hundreds of bad examples, many of them actually ending in death or injury to mother or baby. Not very scientific for a doctor.
Thursday, May 01, 2008 7:06:00 PM
+++++
Oh dear, JaneT, you don't get it, do you. These Kent Midwives are holding themselves out to be paragons of obstetric virtue.
Yes, lots of mistakes in NHS obstetrics. BUT everyone is properly insured, so at least anyone sustaining damage will get proper compensation. You won't get that from the independent madwives. Sue them, and they just go bankrupt and walk away.
What I would like to see the the Royal College of Midwives stepping in to stop these absurd practitioners. A doctor behaving like this would be up in front of the GMC before you can say writ.
Finally, if you are right, we can expect lots of independent madwifes to write in and say that they don't agree with "Mary's" management.
Don't hold your breath
John
"Yes, lots of mistakes in NHS obstetrics. BUT everyone is properly insured, so at least anyone sustaining damage will get proper compensation. You won't get that from the independent madwives. Sue them, and they just go bankrupt and walk away."
Oh dear, John,
I've never said that I agree with midwives practising without insurance.
"Finally, if you are right, we can expect lots of independent madwifes to write in and say that they don't agree with "Mary's" management."
If I'm right about what?
They would have to read this blog to be able to respond. There are only about 150 of them, after all. Probably best not to hold your breath.
I helped our MP deal with a case where a local woman delivered in our local DGH Maternity Unit, she was left physically and mentally permanently and severely damaged by kackhanded intervention, in a wheelchair for life etc, her husband had to give up work to look after her, the older child and the new baby and it took more than 5 years of endless fighting and persistent effort to get proper compensation from the NHS.
To be fair, the RCM did withdraw insurance from independent midwives. The NMC, though, failed to finish them off by making insurance a requirement for registration -- I take it the Government's new guidelines, in effect, do that.
(My 'finish them off' is not a personal attack on these women, it's an objection to their working for fees but relying on the NHS for various tests etc.; of course, they aren't the only such practicioners in the UK)
Jayann,
Surely it's the mother's that are making use of the NHS and they have paid for that benefit with their taxes? If the midwives had to pay for the tests themselves the cost would just be passed on to the customer.
The midwives argument is weak.
Just because there is demand for it, doesn't mean the taxpayer should subsidise it.
There would probably be a demand for cheap hernia ops at home done by nurse practitioners, some people are stupid.
The government should tell them to swivel.
I don't know anything about giving birth, but I do know a thing or two about critically ill patients.
I'm not sure what to make of this blood loss. If it was 1500ml, then surely that combined with the diluting effect of 1500ml IV fluid, would have led to a Hb drop to well below 10? This has certainly been my experience in ICU/A&E. So it seems someone's overestimating either the amount of blood loss or the Hb.
Loss of the sphyg is concerning, although shouldn't have made a difference. A drop in BP is a very late sign of shock, and one would hope that other factors (such as tachycardia, tachypnoea, prolonged CRT, dizzyness, paleness, coldness, clammyness, nausea etc.), combined with a good history of a major bleed (which this patient clearly had), would trigger the midwife to realise that the patient was critically ill. At this point, hospital (IMHO) is the only way to go, regardless of the blood pressure.
So, from a critical care nurse's point of view, not great. I don't feel qualified to comment on the management of the labour overall, but if you think it was so concerning, why do you not send the midwife's account in the direction of the NMC?
jane_t, yes, I agree; but normally if a patient chooses a private practicioner, they pay for tests.
-- this annoyed me:
"Bloods tests were taken as planned but a community midwife wasn’t forthcoming so we had to ring round for a taxi to take them to the hospital.
---
Virginia and I were angry about this and felt we were being bullied and speechless that Jane had had to pay £30 for a taxi to take her blood tests to the hospital as a midwife couldn’t come to collect, yet it was ok to send a midwife now with an instruction letter after the event!"
http://www.kentmidwiferypractice.co.uk/2006/birthstories/janebykay.htm
I hope it's clear I object to all instances of private practice being parasitic on the NHS (while also seeing it as pretty inevitable given the system we have now).
Scary scary stuff John!
Hi jayann,
Plenty of people pay for an early consultation with a specialist but then go on to have the treatment on the NHS. This obviously saves the NHS money but they also probably jump ahead of others, which is another issue of course. I can't see what's wrong with using the NHS after paying for consultations or some of the treatment privately. It saves the NHS money and the patient is entitled to use the NHS anyway. How are they parasitic on the NHS when the patient is entitled to get all of their treatment on the NHS but take less?
Thirteen years ago my youngest son was born. He - like the baby referedto was a huge (13lb) baby. He was born (section) in hospital and frankly I feel my wife would have died if she had she had been anywhere else. Following the birth she had a massive postpartum bleed which required an immediate transfusion and intense care. Please stop these dangerous lunatics.
Absolutely appalled especially by the whole IV infusions part.
Dealing with a lot of acute surgical patients and traumas the big thing i was taught from day one was that you should only use Gelo as a stop gap to transfusion. Gelo breaks down within 30mins, you give it to cover the period in which you crossmatch some blood units.
But the community madwife didn't go to that session.
What really blinkers me is how completely disrespectful and blase she is about the opinions of the hospital midwives.
Fact is the hospital midwives see more cases in a month than she probably does in a year. THey also see the ones that do go wrong, and benefit from greater support (and ergo teaching) by both other midwives and senior obstetricians.
The sheer arrogance is mindboggling.
OT: Is Labour abolishing illness?
K
anonymous said...
I helped our MP deal with a case where a local woman delivered in our local DGH Maternity Unit, she was left physically and mentally permanently and severely damaged by kackhanded intervention, in a wheelchair for life etc, her husband had to give up work to look after her, the older child and the new baby and it took more than 5 years of endless fighting and persistent effort to get proper compensation from the NHS.
Thursday, May 01, 2008 7:32:00 PM
++++
Sad, interesting and irrelevant to the question of the questionable practices of some independent midwives
John
anonymous said...
I helped our MP deal with a case where a local woman delivered in our local DGH Maternity Unit, she was left physically and mentally permanently and severely damaged by kackhanded intervention, in a wheelchair for life etc, her husband had to give up work to look after her, the older child and the new baby and it took more than 5 years of endless fighting and persistent effort to get proper compensation from the NHS.
Thursday, May 01, 2008 7:32:00 PM
++++
Sad, interesting and irrelevant to the question of the questionable practices of some independent midwives
John
jane_t, I know people see consultants privately first then jump the NHS queue, and I am opposed to that.
How are they parasitic on the NHS when the patient is entitled to get all of their treatment on the NHS but take less?
they are parasitic in that they could not practice their (fee-based) practice without the NHS. They are no more parasitic than many others, but still, they are parasitic.
Well said Anon re the abolishing illness! Come on now "DR?" C - it is National Blogging Against Disablism day today - look the word up carefully and do not be rude or the people who know about illness eg not you will be there to read and comment and publish the comments of a "DR" as widely around the world as they can!
Interesting again that you moan abut your "colleagues"! What sort of job do you really have? A stay at home search of how to be rude on a blog one? !
This account beggars belief, I'm not a midwife or a madwife. I am an ex-A&E senior nurse and I would have been very concerned at this amount of blood loss in a patient whom I could monitor carefully in a resuscitation room. To allow this woman to bleed to this extent, without immediate removal to hospital is lunacy, sheer, swivel-eyed lunacy. No wonder these wretches can't get insurance.
By the way, like the use of the term 'ultrasound specialists' to describe sonographers. Not going soft on quacktitioners are you?
Or did the missus proof read this for you and tell you to be nice to them?
By the way, like the use of the term 'ultrasound specialists' to describe sonographers. Not going soft on quacktitioners are you?
Or did the missus proof read this for you and tell you to be nice to them?
++++++++
Hoisted on my own petard! Yes, my wife trains the ultrasonographers.
For once, this is not a quacktitioner rant. I have just increased my medication. This is a serious look at obstetric care by people who work outside the NHS because they would not be tolerated within it
John
These midwives do have insurance.
It's called the NHS. Did the 'nice' paramedics charge them for 2 hours of their time and for saving their ass?
“Most clients understand you can’t insure against things going wrong during childbirth, only against negligence, and negligence is not really an issue for us”
Breathtaking arrogance. Makes your 'carry on doctor' sound like a new age hippy.
Absolutley, totally, irrevocably fucking bonkers.
And all done in a paddling pool, to boot.
I could weep, I really could.
'jane_t, I know people see consultants privately first then jump the NHS queue, and I am opposed to that. '
They may have a consultation privately, but if they need NHS Rx they go on the waiting list like anyone else. Anything else and the consultant plus the hospital would face disciplinary action. So the only queue they have jumped is to see the consultant originally.
And I don't blame them. I would do the same. I want to see a doctor when I am ill.
There is something rather ideological about the whole thing. Firstly the aggressive attitude towards the 'medical model' and secondly the protest involving ducking as a reference towards medieval witches suggests that there is perhaps something of the anti-male about it.
Sorry crippo, I was sure I'd heard people had jumped the queue for treatment.
So the only queue they have jumped is to see the consultant originally.
I am really not happy about that either (particularly when -- as was the case in Wales, as I think it may still be despite offical statements -- the original NHS queue is months-to-years long). And in effect, if an NHS list is unreasonably long, someone who sees a specialist privately and is referred immediately for NHS treatment *is* jumping the queue.
I'm not saying I wouldn't do that, I might well do it. But it's still bad.
Dr C said:
"Sad, interesting and irrelevant to the question of the questionable practices of some independent midwives
It's only irrelevant if you are not using the example of some independent midwives who are bad at their jobs to argue that all independent midwives are therefore bad at their jobs. As you appear to be making this argument, then it follows that the existence of 'bad' NHS obstetric staff must mean that all NHS obstetric staff are also bad. So where do women go?
Crippo said:
"'jane_t, I know people see consultants privately first then jump the NHS queue, and I am opposed to that. '
They may have a consultation privately, but if they need NHS Rx they go on the waiting list like anyone else. Anything else and the consultant plus the hospital would face disciplinary action. So the only queue they have jumped is to see the consultant originally.
And I don't blame them. I would do the same. I want to see a doctor when I am ill."
Exactly, my thoughts too, and as you point out, I did mean that they jumped the queue for the first consultation, not the queue for NHS treatment later. But I still struggle with the idea that this will delay appointments for people who cannot afford to pay. The consultant only has so much time. If he sees more private patients he will have less time for NHS patients and someone who really could do with a more urgent appointment may be delayed as a result.
Almost too terrified to leave a comment in case I spell something wrong but good lord, this is indefensible surely?
Where's the NMC?
Have they read this?
Do they read blogs?
Inside the NHS most of this would incur disciplinary action but beyond that I'm trying and failing to figure out how anyone who holds legal registration and is therefore duty-bound to uphold the principles of the profession laid down by the NMC can actually work like this and sleep at night?
This makes a mockery of the NMC as much as anything else.
Dr C, here's the page you need, http://www.nmc-uk.org/aArticle.aspx?ArticleID=2667
If this example is as bad as you claim, and not being medically trained I've no way of judging, you are morally obliged to report this midwife.
A blood loss of 1500ml? Nearly 3 pints!! Considerably more than an armful I would say.
Its not so much providing the service of a home birth that horrifies me, it is the sheer arrogance that she showed in her continual refusal to concede to standard medical tests/procedures..
It might be my own prejudice here, but I tend to picture home birth mums and midwives as new agey hippy types. More concerned with
"the birth experience" than real potential dangers to their child.
Dear John,
Knowing no other way to contact you, I append this to the many previous posts in the hope that you all read it, and perhaps, you Cripps, might post a new thread, in praise of unsung heroes.
I was unfortunate enough to be called to Frimley Park Hospital today, because my eldest heroin-addicted son had had a massive bleed from his femoral artery caused by sepsis in an injection site.
As I write this, and having held my son's hand prior to entering theatre for the vascular surgeons to weave their magic on what must seem like a lost (junkie) cause, I have to tell you that the front-line staff were brilliant.
My son's operation will have started around 22:00. The vascular surgeon(s) involved will have been 'called-in' and arrived.
Thank you!
There will also have been a call-out for an urgent cross-match of blood. To you, dear Biomed Scientist:
I thank you equally!
This is what the NHS is all about John. Please continue to do your best to preserve it.
Fingers crossed, I'll see my son awake tomorrow. I am writing this (close to midnight) as a cathartic exercise. I gave my son a hard time for being a junkie.
It's looking like I over did things.
Yrs
Anon
Christ on a F***ing bike - not only are these two women grossly negligent, but they publicise their negligence on a website.
I am an anaesthetist, I mange sick and critically ill patients on a daily basis and even with a full obstetric theatre team, ICU back up and a well stocked blood fridge I would be concerned about a woman with symptomatic Post-Partum Haemorahge (PPH) -this kills and it kills rapidly. the closest I have ever seen a fit young mother to death was following a PPH, which had occured in the community with an independent madwife in attendance. Anyone who doesn't believe me should spend a few weeks doing obstetrics in a third world country, the standard of care provided in this case would have been unacceptable even in most of those places.
Having recently become a father I was pleased that my usual anaesthetic antagonism towards our midwifery colleagues was proven misplaced when on the other side of the drapes. They were nothing but lovely, professional and excellent. As a bunch midwifes tend to be anti-interventionist, so when even a hospital based midwife starts saying 'time to think about an interventional, hospital based labour' then it is time to take that suggestion very, very seriously. To describe this advice is 'shroud waving' simply shows the depths of this woman's ignorance.
I also find her attitude towards 'medicalisation' amusing (well actually I find it F***ing scary, but amusing in a black way). When she infuses 1.5 litres of boiled cow solution then this is not 'medicalised'! presumably when I do it is. When she gives synthetic uterine contractors this is not 'medicalised', presumably when an obstetrician does it is.
This case proves one thing, humans are resilient - we survived as a species for millenia without modern medical intervention as we can compensate for significant injury. However whilst at a population level this is sufficient, it does not mean individuals can't die. This madwife came close to leaving several children without a mother, that she is proud of this fact suggests she should be removed from the NMC register forthwith.
Anon 11:59 - thanks for posting something positive about NHS emergency care, we seldom get much thanks in the wider world or recognition that we do generally do a good job (its different from patients, who are generally thankful for the care they recieve).
I hope your son recovers, both from his acute illness and also from his more chronic one.
Keep strong.
This story is paradigmatic of the ignorance, magical thinking and ideology characteristic of direct entry midwifery in the US and independent midwifery in the UK.
These midwives are ignorant of the most fundamental principle of caring for pregnant women: Childbirth is dangerous. It is one of the leading killers of young women and babies in every time, place and culture. Without a basic understanding of the inherent dangers of childbirth, these women are very dangerous.
Belief in magical thinking and "intuition" (a fancy way of saying ignorance) is also endemic to direct entry midwives and independent midwives. Magical thinking is believing that your own thoughts can exert power over outcomes. Hence the emphasis on positive thinking and birth "affirmations".
The touching belief in the power of magical thinking is yet another reason for the condemnation of "shroud waving" (in addition to the fundamental ignorance about the incidence of complications). These midwives actually believe (on the basis of no evidence, but then they don't understand evidence) that thinking about complications causes complications.
If anyone needs further proof, they should read the recent paper in the Australian midwifery journal Women and Birth. The paper is entitle Including the nonrational is sensible midwifery. The paper is mind boggling and ends with this flourish of outright stupidity:
"For example, when a woman and midwife have agreed to use expectant management of third stage, but bleeding begins unexpectedly, the expert midwife will respond with either or both rational and nonrational ways of thinking. Depending upon all the particularities of the situation the midwife may focus on supporting love between the woman and her baby; she may call the woman back to her body; and/or she may change to active management of third stage. It is sensible practice to respond to in-the-moment clinical situations in this way... Imposing a pre-agreed standard care protocol is irrational because protocols do not allow for optimal clinical decision-making which requires that we consider all relevant variables prior to making a decision. In our view all relevant variables include nonrational matters of soul and spirit."
These midwives are dangerous and proud of it.
I'm from Japan.
Glad to meet you.
Please link to this site.
Keep it up please♪
John, as a specialist physician/pathologist from Oz, with a strong interest in patient safety, this article is disturbing on so many levels, I am simply flabbergasted.
The I read Dr Tuteur's post, and am now offically purple-headed and apoplectic with rage.
These people are willing to sacrifice the health, safety and lives of others for their beliefs . Not only that, they appear proud of their "outlaw" status. have never seen such a staggering display of arrogance in a healthcare worker.
Unfortunately, it will almost certainly take a preventable maternal death, maybe more than one, to stop them.
Someone in the UK must submit a complaint to the appropriate regulatory authority and demand action be taken.
Good grief.
I am only a lowly med student here and I cannot believe this article. I have had the good fortune of having quite a bit of obstetric exposure and I cannot get over how blase this nutter is.
A month or so ago we had a ruptured ectopic where the Pt lost 1.5L. And despite being in a well stocked OT with x-matched blood on hand and 2 senior OBs everyone was still very, very catious about her management.
This cowboy almost takes delight in her ignorance and is unbelievably aggressive to other health professionals.
She has got to be struck off surely.
"Dr C said:
"Sad, interesting and irrelevant to the question of the questionable practices of some independent midwives"
It's only irrelevant if you are not using the example of some independent midwives who are bad at their jobs to argue that all independent midwives are therefore bad at their jobs. As you appear to be making this argument, then it follows that the existence of 'bad' NHS obstetric staff must mean that all NHS obstetric staff are also bad. So where do women go?"
Jane t, he is not making the argument that ALL independent midwives are bad at their jobs in that literal a sense!
The above illustrates a high risk pregnancy that ran into potentially life threatening complications. The woman herself wanted a home birth-because that is what she just plain wanted. She obviously didn't have enough knowledge about her health or the health of her baby to make a sensible, informed decision. (Or if she did, she didn't give enough of a fuck about her baby to do the sensible thing.) These independent madwives are in a position to exploit that lack of knowledge as the basis for their career.
"Sharon had birthed 3 big babies; the largest was the second baby at 9lb 13oz. The third baby had been induced at 37 weeks following a diagnosis of polyhydramnios and an estimated weight of nearly 10 lbs. The actual weight at birth was 9lbs. There had never been any diagnosis of diabetes or any other maternal or fetal problems.
We deduced that Sharon therefore grew big babies as normal for her. We decided that we would expect a big baby and not be concerned. Easier said than done during the first trimester!!"
Note how she reassures her "ah sure all this completely abnormal stuff that could cause serious damage is just normal for you love, it's nothing"
Yes, it's EXACTLY what the woman wanted to hear. So fucking what? She and her baby were at risk and it was not brought to her attention. This is not condemning ALL independent midwives. But their existence at all, the fact that they are even there, means that the potential for more situations like this, and worse, is alive, well, and flourishing. Yes, there are bad NHS staff too. But at least you're in a hospital. Chances are, when you haemorrhage, somebody else might be around who remembers where the sphyg is. And someone might even give you some blood and like, bad medical stuff and save your life. Fuck me.
The mortality rate in Britain in the first half of the 20th century was approx 1/250.
Since "medicalising" childbirth, it is almost unheard of for women to die in childbirth. Yes, evil bad horrible doctors and NHS midwives, giving you IV fluids, blood transfusions when you haemorrhage, C-sectioning when your baby is in distress, CTG monitoring to ensure foetal wellbeing, controlling BP to avoid pre-eclampsia, treating you with exnoaparin when you get your PE/DVT, antibiotics for your infections, etc etc etc.
"They arrived within 3 minutes and were the best guys I have ever met in the job. They got their BP machine which recorded observations at 5 minute intervals" - I don't think she would have had the same opinion of me as I put her patient on the ambulance and blue lighted her to hospital!
I'm guessing her "paramedics" weren't. Technicians (or, god forbid) ECAs would have found it very difficult to have a discussion (or should that be multi-disciplinary team meeting ;-) about the patient's condition.
What a useless, dangerous waste of blood and organs this woman is.
'But I still struggle with the idea that this will delay appointments for people who cannot afford t