Monday, April 09, 2007

More on Britain's maternity meltdown

Steadily regressing to the primitive where untrained family members have to deliver the baby

At first Annette Armstrong wasn't planning to have her mother present at her baby's birth. But she came round to the idea - after all it would be nice to hold her hand during the labour. It turned out to be the 'best decision' of Annette's life. For it was her mother who ended up having to deliver the baby - without her, says Annette, there is a chance her baby could have died.

Annette's ordeal began after her waters broke and she was admitted to a large maternity hospital near her home in Birmingham. When the 28-year-old went into labour, she experienced the alarming consequences of the chronic midwife shortages in Britain's maternity wards. "There were ten women, all at various stages of pregnancy and labour - five who had already given birth and one inconsolable woman who had just had a stillbirth - but only two midwives to look after us all. "The midwives were rushed off their feet and clearly couldn't meet the needs of all their patients. I got the feeling I was just a number, an item on a conveyor belt.

"After I was admitted I saw the midwife just once over the next three hours when she popped her head round the door to check on me." Three hours later, a different midwife started her shift. "After a quick check she told me I wasn't progressing that quickly and it could be a while yet," says Annette. "Before I could ask any questions she was gone."

With Annette screaming and the midwife absent, Annette's husband Daniel, 29, had to find an anaesthetist to give Annette an epidural - a form of pain relief that numbs the lower half of the body. But the injection was put in the wrong place, leaving Annette still able to feel every contraction. When the midwife finally reappeared, Annette told her she was ready to push the baby out. "But the midwife told me there was no way my baby was coming yet and I should try to stay calm. She didn't even check how dilated I was.

"I'll leave my assistant with you," she said, and a girl who looked no more than 20 appeared at the door. "She's a trainee, but she can come and get me if you really need me," the midwife said. "I'm just popping out, but I'll be straight back after that."" The trainee was unable to check how dilated Annette was because she wasn't sure if she'd enough experience to tell.

With Annette screaming that she was about to give birth, her mother had no choice but to roll up her sleeves and deliver the baby herself. "My mum is not a midwife and I couldn't believe she was about to deliver my baby. Daniel shouted at the trainee to get help, but she just stood in the corner looking petrified. "Twenty minutes after the midwife had left, the baby was crowning - the top of its head had appeared. My mum said: "This is your little girl and we have to get her out safely. There is no one else here to do this, so you have to trust me. Now start pushing." "When the head was out, she told me not to push so hard till each shoulder was out so that I didn't tear - she remembered being told this when she she was having me and my siblings." Minutes later, Harriet was born weighing 8lb 9oz and in good health.

"My mum and I burst into tears. She had helped me at a time when I needed her most, but I couldn't believe the NHS staff had put us in that position. "Were it not for my mum's advice and calm attitude, my child could have been starved of oxygen or had a whole host of other complications from not being delivered in time - she might even have died."

Annette is one of thousands of women each year whose care during childbirth is being put at risk by the current crisis in NHS maternity services. A shortage of midwives, coupled with budget cuts, means that overstretched units are struggling to cope, let alone provide the personal care pregnant women want and need. It makes the Government's promise that all women will have continuous care by 2009 seem, at best, wildly optimistic.

Only last week a study revealed that thousands of women find themselves isolated and frightened during labour because they do not get the care they need. Over half were left alone at times during labour. Just 19 per cent had one midwife providing continuity of care during their labour and while giving birth, with over half of firsttime mums having a stream of three or more midwives see them through the experience. The poll - funded by the Department of Health - also uncovered complaints about unsympathetic staff, who were too busy to give women the care they need.

Campaigners say that poor care during childbirth is leaving 30 per cent of women traumatised - that's around 200,000 women a year, says Maureen Treadwell of the Birth Trauma Association. She describes one alarming case where a woman who arrived on a maternity ward was asked to remove her underwear for an internal examination in the corridor - in front of cleaners. In another, cleaners were sent to clean up a room where a woman had been left naked.

More worryingly, there is the potential risk to health. Experts warned that many of the 60,000 reported maternity ward errors between 2003 and 2006 were due to staff shortages, inadequate experience, lack of consultant involvement and equipment problems. While deaths linked to pregnancy are rare, the latest figures show the number or women dying from pregnancy-related problems is rising, despite advances in medicine.

Two thirds of the 261 women who died from pregnancy complications between 200 and 2002 (the latest figures available) had 'some form of sub-optimal clinical care'. (In the previous three years, 242 were reported). Medical experts are concerned that the next report on maternal and child health, released at the end of the year, will show a further increase in maternal deaths.

Maureen Treadwell said: "Women's experiences on maternity wards vary from utterly superb to appalling and unacceptable. The appalling end is leaving hundreds of thousands of women suffering from some kind of trauma."

At the heart of this national problem is a severe shortage of midwives. According to the Royal College of Midwives, 10,000 more are required to ensure women get the care they need throughout childbirth. The shortage is due to an increasing number of midwives reaching retirement age and cuts in government funding for maternity units, meaning that newly-qualified midwives find it harder to get jobs. At present midwives have to work longer hours under greater stress, causing more of them to leave the profession.

Melanie Every, of the Royal College of Midwives, said: "Maternity care has become more involved, more invasive and the expectations of mothers are much greater than they were ten or 20 years ago. We have also seen a rise in the birth rate by around 50,000. "Women should have one-to-one care during labour." She added that one midwife should have a caseload of 28 to 35 mothers, depending on the kind of care the woman needs. However, there are hospital trusts where there is just one midwife for every 41 mothers. She says: "Shortages could jeopardise the standard of care in some services, but that doesn't mean every maternity unit is a dangerous place to be. The UK is still a very safe place to have a baby."

The crisis in maternity care is being exacerbated by falling numbers of experienced senior doctors, again due to funding cuts. The Royal College of Obstetricians and Gynaecologists estimates there needs to be a 5 per cent annual increase in the number of consultant obstetricians to meet the demands of maternity units. Yet since 2004, there has been a 17 per cent fall in the number of consultants being employed. This means that maternity units are routinely left without a senior doctor on the wards in the evenings and at weekends to deal with complications. Some 64 per cent of average-sized maternity units (ones where 3,000 to 4,000 babies are born a year) have a consultant on the wards only between 9am and 5pm, Monday to Friday. At other times, units are forced to rely on senior doctors who are on call from home.

The Royal College of Obstetricians and Gynaecologists has set a target that all units of this size should have consultant cover from 9am to 9pm on weekdays by 2009. Professor Shaughn O'Brien, vicepresident of the Royal College of Obstetricians and Gynaecologists, said: "Maternity care is very safe but it could be safer if there was one-to-one midwifery care available and there was consultant presence on the labour ward. "But the Government has never provided the funding for significant numbers of consultants to give this level of round-the-clock care on maternity wards, as there is in Europe. "If we could prevent one medical legal case for brain damage - which would receive a payout of around 3.5 million pounds - it would pay for one consultant obstetrician for the whole of his obstetric career."

Ministers desperate to limit the political furore sparked by the maternity crisis insist that services will improve. By 2009, they are promising that all women will be able to choose whether they want to give birth at home, in a midwife-led unit or in hospital, and will have access to continuous care during childbirth. To achieve this, the Government is planning to 'reconfigure' maternity services, merging some hospitals to make 'super-units', while opening a number of smaller midwifery-led units. However, critics claim the restructuring process means 43 existing maternity units have closed or are under threat - a move which they say will restrict women's choices. They also point out that continuity of care is less likely in big regional birth centres as opposed to smaller local centres.

Any improvements in maternity care will come too late for Annette, who has been left to reflect on her ordeal last April. She feels the NHS failed her and her baby because there weren't enough staff on the maternity ward and the midwives who were assigned to her didn't give her enough attention. "Were it not for my mother, I dread to think what would have happened," she says. "Harriet is a happy, healthy little girl, but it could have been so different. "What worries me is that many women won't be lucky enough to have their mums by their sides and will be left at the mercy of medical professionals who don't have the time or the inclination to look after them properly. "The Government needs to increase funding for midwives or I will certainly not be the last woman to have a terrible experience of birth."



Editorial from "The Times" below

Facts, not emotion, should inform discussion of climate change. Few scientists or rational politicians doubt that global warming is a serious issue that poses long-term dangers to the planet. The scientific evidence that the world's climate has changed and that this change is accelerating is convincing. But it is also beyond doubt that the world is in danger of being held captive by powerful lobby groups that have distorted data, made unjustified extrapolations and attempted to stifle debate on one of the most important issues of our time.

The warnings issued by the Intergov-ernmental Panel on Climate Change (IPCC) in Brussels yesterday are a collection of worst-case scenarios. The report, approved by 130 governments and endorsed by 2,500 scientists (few of whom probably had any hand in writing it), makes scary reading. It predicts a catastrophic future for millions of humans and other species. Global warning will bring hunger, floods and water shortages. Greenhouse gases will change rainfall patterns, intensify tropical storms, accelerate the melting of Arctic ice and mountain glaciers. Africa faces starvation, coastal cities will be swamped and China will see the rapid advance of the desert.

Some of these dangers may well be real. But many are deliberate exaggerations, as the IPCC's mandate was to highlight the dangers if global temperatures were to rise by up to 4C (7.2F). That assumption is far from proven. But it is enough for some environmental groups to speak of "an apocalyptic future", a "nightmare vision" and a "humanitarian catastrophe".

Every group is entitled to lobby hard for its cause. But to jump on a band-wagon and blame everything on climate change is neither good science nor sound lobbying. China's deserts have been threatening its cities for hundreds of years. Africa cannot be simultaneously threatened by endless droughts and by a rapid increase in malaria. Children are threatened by global warming, but they have also been helped by the economic development that some lobbyists seem to regard as a criminal activity. Tens of millions of children in India and China who would have died 30 years ago are not dying because increased wealth has brought better food, cleaner water and improved access to healthcare.

Companies and individuals have a responsibility to examine their behaviour and reduce their impact on the planet. But that self-examination should be rational and real and not debased by left-leaning fear-mongers, whose social agendas are recipes for impoverishment and hardship.

The real danger of the zealots is that they brook no argument. This does not mean that scientists should take a myopic view of figures that point to danger, such as the rise in carbon dioxide levels to about 380 parts per million, far exceeding the "natural" range for the past 650,000 years. But even to ask what is the natural range is regarded as some sort of heresy, and to ask questions about the precise contribution of anthropogenic influences is to commit a thought crime.

There have already been examples of environmental scientists hounded out of their jobs for daring to question the prevailing orthodoxy. The IPCC summary is inevitably a political narrative, one in which each word and phrase will be endlessly and selectively parsed by the likes of Greenpeace and friends.

The planet deserves the benefit of the doubt. Climate change is serious and must be a political priority. But the arguments must be subject to free and rigorous debate and the facts separated from fanciful predictions - the environment is too important to be bequeathed to the hysterical.


Revolting Brits?: "The government is predicting that some 15m people will revolt against Tony Blair’s controversial ID card scheme by refusing to produce the new cards or provide personal data on demand. The forecast is made in documents released by the Home Office under the Freedom of Information Act. The papers show ministers expect national protests similar to the poll tax rebellions of the Thatcher era, with millions prepared to risk criminal prosecution. Opposition MPs said the new documents proved their case that the programme would never work. David Davis, the shadow home secretary, said: “This will cripple the system. Fifteen million is a massive number. What the Home Office is accepting in private, but refuses to accept in public, is that a massive number of ordinary law-abiding citizens simply will not go along with their scheme.” Davis, whose party’s policy is to scrap the cards, added: “This will render it completely useless as a security or check mechanism of any sort.” The documents, quietly released during parliament’s Easter break, also show that the government is planning to make ID cards compulsory in 2014, despite the expected revolt."

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