Friday, May 04, 2007

The crisis in NHS maternity wards

Killing babies through being too busy is accepted as normal and many mothers are treated worse than farm animals

When my daughter was born, I did not think she was alive. She came out of her mother with a chest striped blue and purple, and failed to move. She lay motionless on the mat in the delivery room and the blue disappeared, rapidly replaced by more purple. Then the purple darkened and contracted as fast as the pupil of an eye. Now, at the ripe old age of ten seconds, my baby was white as a sheet with dark blotches. And still not moving.

My wife Rachel had tapped me on the shoulder barely two hours before. We were in bed. The clock radio blinked 1.30. In the dark, she had told me: "I think I'm in labour." It was all more rapid than I could ever have imagined. Zooming down dark London backstreets, I thought the baby was about to be born in the footwell of our car. And by the time we reached the nearest maternity unit, the poor child was trying to get a glimpse of the corridor. We were shown to a room. Midwife and baby emerged simultaneously.

Now, looking at my daughter lying there on the blue plastic mat, I remember two things clearly: assuming something terrible might have gone wrong, but deciding not to panic unless the staff did. I looked to the midwife for reassurance. "Show me your notes," she said - not shouting, but urgent all the same. "Hold up your wife's notes." I was grabbing at the file. "Last-but-one page." Everything had happened so fast, she had not been able even to glance them over. "Are you Rhesus Negative?" she asked Rachel. "I don't know, don't think so," my wife replied. I was still staring at the little scrap on the floor. Baby motionless; midwife worried.

Then a miracle happened. Our NHS angel, the midwife, took a towel and rubbed the lifeless baby to get the circulation flowing, and suddenly the white and the purple disappeared and the skin shone with glorious red, like a farmer's cheeks on harvest day. Then she started bawling her eyes out - the noise might have tried our patience in the weeks since, but that morning it was as welcome as wedding bells.

The midwife, a sparky fortysomething whom I shall not embarrass by naming, had been about to go off shift when we arrived. She had stayed on from a sense of duty, thank goodness, and congratulated us heartily. "Blimey, I thought she was a goner," I confessed over the sound of my newborn screaming. "I even thought you thought she was." "My rule," said the midwife, "is never panic in the first minute."

I wrote my anxiety down to new-father nerves and inexperience. But had I known what I now know - thanks to working on Panorama's undercover investigation of other maternity units - I might have approached the day of my daughter's birth with rather more trepidation. We sent a reporter, Hayley Cutts, to work as an unpaid volunteer in maternity wards at hospitals in Barnet and Manchester. Some of the footage she came back with was truly frightening.

In one excerpt, filmed in January at Barnet Hospital, Hayley watched as a midwife was called away to a crisis elsewhere. That left an astonishing 24 women in the care of just two qualified midwives and one student. Picture the scene. As Hayley's camera whirrs, concealed in her blouse, the phone goes. It's a call from the delivery suite, where mothers actually give birth. They're saying they're full - they have to send a patient over to the maternity ward.

Hayley passes the news on to her more experienced colleagues. "There's a woman coming over in two minutes." "For what?" asks one. Hayley explains, "She's from the delivery suite." "She's here and there's no beds," murmurs a midwife ruefully. When, seconds later, the labouring woman appears, your first impression is of a terrible misjudgment: how can a woman so deep into labour be sent packing from the unit where she is supposed to be having her baby? The nearest midwife tells her to sit in the corridor.

The scene is awkward enough watching it on tape - it must have been a dozen times worse for the mother-to-be herself, labouring on a hard plastic chair in full view of janitors and any passing visitor. When Hayley points out to the midwife in charge that the woman is crying, she replies: "Tell her to get a life." We showed the tape to Mavis Kirkham, professor of midwifery at Sheffield Hallam University, who was shocked. "I think that's really tragic, that poor woman in strong labour in a public corridor," she said. "These are Third World conditions. No farmer would let an animal they valued labour with that degree of stress and anxiety in a tense public place."

After 50 minutes in the corridor, the woman was eventually taken to a bay in the ward, but when she got there, there was no bed for her. So she had to wait again on a plastic chair. The hospital authorities later informed us the staff's 'mistake' was not to have shifted the woman to another hospital. But the nearest alternative maternity unit was six miles away, and the poor woman was about to give birth.

I wish I could say that the overload on the ward was a one-off. But often the wards at Barnet are so choc-a-bloc they have to close temporarily. It happened eight times in the four weeks Hayley was there. When she asked a midwife why the doors were shut to new arrivals, she got the reply: 'We're dangerous at that stage. It gets to the point we've got so many women and not enough staff to look after them that we could miss things.' If that is not a warning sign to expectant mothers, what is?

At one point the Barnet staff are caught in conversation about how things won't change unless something terrible happens. 'I tell you what it's going to take,' one midwife says, 'a baby dying.' Another disagrees, saying it 'needs a mother' to die. The exchange happens casually, across an admissions desk. It is all the more shocking for that. 'We've killed off babies before now, deaths you can push under the carpet,' says a midwife on our tape. 'To kill a baby is cheap, but to damage a baby is more expensive. To kill the mother - that will actually give us the results we need, but God help the poor midwife involved in that.'

The chief executive of Barnet And Chase Farm Hospital Trust, Averil Dongworth, was suitably appalled by this conversation on her premises. But when she blamed the midwives I wondered if she had missed the point: staff shortages, missing equipment and rota chaos are surely not their fault.

So what has the Government promised? In 2004, there was a pledge that every woman in full-blown labour should have access to 'a designated midwife 100 per cent of the time'. And only last month, Health Secretary Patricia Hewitt promised every mother would have the right to opt for a home birth, overseen by a midwife. Yet the Royal College Of Midwives says the system is 3,000 midwives short and one-third of maternity units had their budgets cut last year.

All of this while Britain's birth-rate goes up. Small wonder that a report from Oxford University into maternity care in Britain found that two-thirds of mothers said they felt they had been abandoned too soon after giving birth.

If only the scenes we'd witnessed at Barnet Hospital were an exception. But they were not. North, south, east and west we found all manner of horror stories about the pressure on maternity services. I went to see Ben Harman and Katie McKay at their swish terrace home in Battersea - young, professionals with loving families and lots of friends. Eight months ago, when her labour began, Katie was told by Chelsea & Westminster Hospital that their maternity unit was too busy to take them at present and she should 'have another bath' while her labour progressed. So she did. This was her first child; why argue with the experts? After the bath she rang back - the unit was still full and there was no space at any other hospital. 'I freaked out,' Katie told me. Still they told her to hang on. After two hours Ben drove her to Chelsea & Westminster, but still the staff were too busy for her. 'It was only after my waters had broken, one hour and ten minutes after I'd actually been on the ward that I was given my first internal examination,' she told me.

The baby was lying the wrong way round, in the breech position, and in distress. Instead of an emergency caesarean they tried to deliver the baby normally. She was starved of oxygen and baby Ella died five days later. 'From our point of view,' Katie said, 'It was just too many red lights. If you go through one red light you might get away with it. If you go through five you're going to have an accident. 'The first red light we went through was when the position of the baby wasn't picked up, the second red light was the hospital being closed to admissions, the third red light, not being examined for an hour-and-a-half. Unfortunately, for us it resulted in our baby's death.'

This was the wisest single thing anybody told us in the course of filming. How terrible that Katie had to find it out through her own personal tragedy. Sitting in their front room, I leafed through their photograph album. Picture after picture showed Ella being hugged, so cherished by her mum and dad in those five short days of life. Her parents found the explanation that midwives weren't available to provide better care because of a "change of shift" was little short of an insult.

Our reporter, Hayley, also did work experience at St Mary's hospital in Manchester, inside the city's biggest maternity unit. Secretly recording there for weeks, she kept hearing stories from stressed-out midwives and mums who said the care they received was unsatisfactory. Hayley was at the bedside of Lili, who was 16 days overdue but had not been induced because of a lack of beds in the delivery unit. Finally, staff did induce her. But then they turfed her out of the delivery ward because they said they needed the room for someone else. With no access to any pain relief beyond gas and air, she begged to be examined. When it turned out she was in the late stages of labour, Lili was rushed to delivery to have her baby. Then, in one of the film's most chaotic scenes, Hayley is sent to fetch a CTG, the monitor which picks up a baby's heartbeat when pressed to the mother's stomach.

From ward to ward she goes. Here is a sample of the exchanges: Hayley: "Hiya, I was wondering if we could borrow a CTG monitor." Staff member: "Oh - er - that'll be a matter of finding one." Staff member two: "I doubt it. The place is full." Ward clerk: "I can't actually find one anywhere, love." Hayley: "Really? Do you know when one will be available or not?" Staff member: "I couldn't say, no. Unless they might have one over there. Have you tried over on MDU, maybe." Hayley: "OK, I'll go and ask - thanks." And the reply from the next unit when she asks if they've got a precious CTG? "We haven't. They're all in use." Such scenes would be comic if they were happening anywhere but in a hospital.

And when Hayley - who is totally upfront about her lack of training - is asked to monitor a baby's heartbeat by a midwife too busy to do it herself, you realise just how disturbing the problems on Britain's maternity wards have become. It brought me back to those chaotic moments in December when our Anna was born - which was, after all, a normal if somewhat rapid delivery. In those precious moments you realise a life is in the balance; and the whole future of your family. You don't want to leave the hospital counting yourself lucky that a midwife turned up for the birth.




The experts demanding that a film on climate change be 'corrected' before it is released on DVD are behaving more like Stalinists than scientists. A group of scientists and science communicators has written an open letter to WAG, a TV production company, insisting that it make changes to its film The Great Global Warming Swindle before releasing it on DVD.

The 38 signatories include Bob Ward, the former spokesman for the prestigious Royal Society in London, as well as former heads of Britain's academy of sciences and the weather office. They argue that Martin Durkin's film, which claims that global warming is not man-made and which caused a storm of controversy when it was shown on Channel 4 in Britain in March, contains a 'long catalogue of fundamental and profound mistakes', and these 'major misrepresentations' should be removed before the film hits the DVD shelves later this year. 'Free speech does not extend to misleading the public by making factually inaccurate statements', the letter-writers claim.

What next, a "House Committee on Un-Scientific Activities", where this self-selected group of scientists and communicators could officially sit in judgement on anyone who says the 'wrong thing' about global warming? Last year, when he was working at the Royal Society, Bob Ward wrote a letter to ExxonMobil demanding in hectoring fashion that the oil giant cut off its funding to groups that have 'misrepresented the science of climate change by outright denial of the evidence'; now he says films that go against the 'truth' of global warming should be chopped and changed before release.

Perhaps any new House Committee on Un-Scientific Activities could begin by forcing those who appear in its hallowed halls to swear 'I am not, and never have been, funded by oil companies', before instructing them on what is the correct thing to say in public about climate change. All others shall be silenced.

These scientists ought to be ashamed of themselves. They are behaving in a fashion that does not befit intellectual scientific debate. When they claim that they are not being censorious, but rather are standing up for facts and 'for the public interest', they protest way too much. From Torquemada to McCarthy, virtually every censorious group in society has claimed merely to be protecting what is true or right or correct, and thus saving the public from allegedly dangerous ideas.

Torquemada wanted to save humanity from religious heresy; McCarthy said he was protecting Americans from reds under the bed. Now some want to shield our eyes from allegedly oil-funded 'climate change deniers' lest they warp our minds and make us behave in a carbon-irresponsible fashion.

Even worse, the scientists' demand that information be 'corrected' from on high so that it does not sow confusion and controversy amongst the public speaks to a profoundly anti-intellectual outlook. They seem not to appreciate how important controversy is. Controversy is not, as they seem to believe, a bad idea; nor is it, as others argue, something that's simply fun or sexy, a 'good idea' in a democratic society. Rather, controversy is crucial to the development of human thought - especially in the realm of science.

You don't have to look very far to see where the 38 scientists might have got the outrageous notion that they have the authority to write to a TV production company and insist that it change the content of one of its films. As I have argued before on spiked, there is a censorious streak in debates about climate change today, where those who question the scientific consensus on global warming are frequently written off as 'deniers', a term which seems designed to link them with Holocaust deniers (see Global warming: the chilling effect on free speech, by Brendan O'Neill).

Many argue that those who kick against the climate change consensus should be denied funding, sacked from university posts and kept off the airwaves. Those who call for such censorship always claim to be protecting scientific facts from pseudo-scientific charlatans. That might be more believable if they took a consistent approach towards opposing the publication of strange scientific claims.

The 38 scientists say they want to protect the public from a factually inaccurate DVD. During a recent quick trip to my local HMV I saw a DVD of the TV series Jamie's School Dinners in which our eponymous hero - Jamie Oliver - dressed up various scare stories in medical scientific garb. He said today's children are so unhealthy that they will die before their parents, and claimed that some kids are so fat they are puking up their own faeces. There were also DVDs on alternative health and acupuncture and how 'yoga can improve your self-esteem'. In all good bookshops there are shelves that groan almost audibly under the weight of books that make junk scientific claims.

Our brave protectors of the public interest don't seem to mind about all that. Indeed, it was striking that around the same time that the 38 scientists wrote to WAG to complain about The Great Global Warming Swindle, the British government announced plans to send a copy of Al Gore's film An Inconvenient Truth to every secondary school in the country.

Some very serious scientists have raised questions about the scientific accuracy of Gore's movie. Don J Easterbrook, emeritus professor of geology at Western Washington University, said: ' I don't want to pick on Al Gore... But there are a lot of inaccuracies in the statements we are seeing, and we have to temper that with real data.'

Yet Gore's allegedly inaccurate claims will be used to 'stimulate debate about climate change' amongst schoolchildren (in the words of UK education secretary Alan Johnson) while Durkin's allegedly inaccurate claims are labelled unfit for public consumption. This is really about the moral message of the films rather than their scientific underpinnings. Because Gore's movie has the 'correct' moral outlook (global warming is manmade, and we must all take individual responsibility for changing our behaviour and lowering our horizons), it is sanctioned by the authorities and even used to reshape children's understanding of humanity and our relationship with the planet. Because Durkin's movie has the 'incorrect' moral outlook (global warming is not manmade, and demands that we limit carbon emissions are proving disastrous for the developing world), it is vilified.

Some are in effect using claims of scientific authority to copperfasten what is in fact a deeply moralistic campaign dictating what people should expect from life today. The consequences of using science in this way are as ominous as they are far-reaching. It is bad for political debate because when certain positions are said to be scientifically verified then they are also considered to be beyond interrogation. It is bad for science, too, because the use of scientific data to confer authority on explicitly political positions will surely pollute the morally neutral aim of science to discover new things, while also potentially firing up public cynicism with science.

Perhaps the most shocking thing about the 38 scientists' call for a film on global warming to be 'corrected' is just how anti-intellectual such a demand is. Ideas are developed, indeed facts are established, only through the most rigorous debate possible. As John Stuart Mill wrote nearly 150 years ago: 'Complete liberty of contradicting and disproving our opinion is the very condition which justifies us in assuming its truth for purposes of action; and on no other terms can a being with human faculties have any rational assurance of being right.'

In short, the only way to test out ideas - to prove them or improve them, to see if they're right or true or useful or nonsense - is by submitting them to free and open debate. Restricting the communication or publication of certain ideas damages intellectual debate across the board because it limits our ability to weigh things up and work things out. This is especially true of science. Science thrives on hypotheses being verified or falsified. Its lifeblood is the sharing of ideas and findings and claims, both amongst scientists and also between scientists and the public - findings which scientists discuss and explore, seeking to prove or disprove them through research and interrogation.

In this sense, controversy, including the kind of controversy stirred up by The Great Global Warming Swindle, should not be seen as a negative thing; controversy should be viewed as a crucial component of scientific and intellectual development; it can excite people, intensify debate, and allow us to reach a firmer conclusion about what we believe to be true and what is right.

Perhaps more than any other area of life, science develops through a self-corrective process. In demanding that something be corrected from on high, and before being fully submitted for public consideration, the 38 scientists complaining to WAG have violated the very spirit of their vocation. They have behaved less like scientists, and more like Stalinists.


9/11 Conspiracy Film on Virgin Airlines: "This qualifies as one of the outrages of the year: Virgin Atlantic Airlines is showing the evil, dishonest 9/11 conspiracy film Loose Change as inflight entertainment. Are these people insane? Maybe next they can have a retrospective of the works of Leni Riefenstahl."

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