Induced and left alone to birth in a toilet? True.

This rather alarming news story came to my attention today.

http://www.nottinghamwired.co.uk/news.php/124340-Kings-Mill-hospital-ignored-toilet-birth-mothers-calls

A couple in Nottinghamshire have reported that their daughter was born unattended in a hospital bathroom in November and that staff ignored when they pulled the emergency cord for urgent assistance. Apparently the midwives assumed the labouring woman wanted a cup of tea.

Let's skip right over the part where the midwives are implying that a labouring woman should be ignored when in need of refreshments, and move right on the the extremely distressing part of this story: that an emergency call from a woman undergoing induction was ignored.

Any call for immediate assistance for a woman in labour should be responded to, by somebody, anybody. Regardless of how frequently women in that birthing suite pull the wrong cord or hit the wrong button when all they need is a drink. The staff cannot assume that it is a benign matter, not for any labouring woman. But induction is risky. It is a risky procedure whenever and wherever it is done, in some cases the risks are lower than the risks of staying pregnant, but there are still risks. Ignoring an emergency call for a woman undergoing induction is, quite simply, negligence.

This isn't the first time I have encountered women who say that they were ignored during induction, that their requests for pain relief were ignored or that they were told they weren't yet in labour without even being examined. I even heard of one woman once who hadn't even been moved from the ward to a birthing suite and delivered on the ward floor on her own in front of half a dozen other women. Disgraceful.

This recent case is a little scant on details. We know that the midwives assumed that the labouring woman only wanted a cup of tea, so deemed it unnecessary to attend to that need. I might have a little more sympathy for the midwives if it transpired that they were very short staffed and no one could be spared for non-urgent care (forgetting again that it is clearly wrong to just assume that the emergency cord has been pulled for non-urgent reasons). But only a little sympathy can be garnered from such an excuse. If the ward was so short staffed, why induce? Why willingly fill up the ward when there aren't enough midwives? When birth can be scheduled (Ha!), why do so in full knowledge that there are not enough midwives available to attend to every woman both in spontaneous labour and booked for induction?

Perhaps this woman's induction really couldn't wait a day or two. Perhaps she had a true emergency reason for needing to get the baby earth-side. And here we are back at the point that she was ignored in an emergency situation.

There is no winning scenario for the staff on duty at this hospital that day. Either there was someone available to answer the emergency call but it went ignored anyway, or the ward was too busy and so the inductions should have been postponed where possible, or finally, the induction was for genuine medical reasons and therefore the woman was in need of close attention.

The couple have received the standard NHS response to complaints: "We are sorry you feel this way." It isn't a true apology. They are not taking responsibility for their mistake. They are not genuinely sorry for the deep trauma they have caused. They are not attempting to put anything right or change their services for the benefit of those who come after this couple.

It's not good enough. It's never good enough.

Part of the reluctance to take responsibility is fear of litigation, the same fear that causes hospitals to line up increasing numbers of women for unnecessary inductions. As nonsensical as that sounds, it's true. Hospital administrators want to try and control birth, because if they control things and things go wrong they can claim that they did everything possible to prevent it. In doing this they don't stop to ask if they cause more harm than good.

Birth cannot be controlled or scheduled. Sometimes things go wrong, yes, but in a culture of true woman-centred care, where the woman knows and trusts her midwife and where medical intervention is reserved for hose who truly need it ,I somehow think that the growing litigation culture wouldn't be a significant factor because even on the rare occasions that the outcome is negative, the people involved will know and trust their care providers. I'm sure that the reason people lash out and try to sue the NHS now is because they are upset with the level of care shown, they want someone to take responsibility and apologise properly. I know that's true of me and many of the women I have met who have grievances against hospitals for their maternity care. A genuine apology would settle many a dispute before it even reaches the point of hiring lawyers.

A lesson many hospitals would do well to learn.

A Frightening Future for Maternity Services

In December the government announced that they were going to go back on the promise made in July that maternity services would be commissioned by a national board and that they were going to hand over commissioning to GPs. When the White Paper came out there was a great deal of praise from every relevant body, including the Royal College of Midwives (RCM) and Royal College of Obstetricians and Gynaecologists (RCOG). It was widely recognised that maternity services need to be commissioned nationally in order to ensure the best care in every area and in order to work efficiently with neonatal services. While other commissioning was going to GPs, it was acknowledged that GPs have very little experience or knowledge of maternity health and are primarily focussed on treating ill people, whereas pregnancy is not an illness.

However, GPs complained, they stamped their feet and said the idea was "stupid". It has been suggested that this is basically about money. GPs know they don't have the expertise but are afraid of losing out on some funding if they don't get to control the purse strings.

The government bowed to this pressure and have now handed over commissioning to the GP consortia.

Since the decision was announced, Cathy Warwick, general secretary of RCM has been very vocal in the press about the bleak future of maternity services. Midwife shortages, lack of choice for women and their families and GP interference are of grave concern and she has been trying hard to get the message out there.

This article in the Guardian on Saturday sums it up well. Basically, lives are at risk. The government is falling short on its commitment to maternity services. I love Cathy Warwick and I am so glad she is speaking out, but there were a few things about this article that concerned me.

The title image was one of them (see top of page). A newborn baby being held by a woman in scrubs, presumably a midwife, in an operating theatre. Hardly an image of normal birth. Perhaps the point was to negatively depict the current situation? Dangerously high caesarian section rates, complete medicalisation of birth that can only get worse with GPs at the helm. However, I doubt many readers would interpret it as such, my suspicion is that this image will only perpetuate the idea that this is what birth is and has to be, bright lights, clinical, operative, the mother not even depicted - not important.

But this image was only an afterthought for me.

The article makes reference to the number of currently enrolled student midwives, a figure that the government is throwing about in order to defend itself against allegations of not honouring promises to increase the number of midwives. I've seen it a lot lately in response to Cathy Warwick. What I have yet to see is any journalist drawing attention to the low retention rates, midwives are leaving the NHS in droves because of poor working conditions and then there is the little matter of the recent government decision to lift the tuition fee cap to £9000 per year. How many student midwives will withdraw from courses now that they can no longer afford the fees? How many prospective midwifery students, both school leavers and older people looking to retrain, are now rethinking their plans? This figure really can't be relied upon as an indicator of how many midwives we can expect to see working within the NHS in the coming years.

The main thing about the article that sent chills up my spine was the final quote from Steve Field, the former chair of the Royal College of GPs (RCGP). The article states

Professor Steve Field, former chairman of the Royal College of General Practitioners, said the new maternity networks which will be set up in England as part of the government's contentious NHS reforms should improve the quality of care. "Maternity care is not as good as it should be," he said. "But GPs, working with obstetricians and patients themselves, should be able to design better patient-centred services."

Two things about this frighten me. The first is his referring to pregnant women as "patients", which demonstrates his general attitude towards pregnancy, i.e. that it is an illness to be cured, rather than a natural biological condition and that most pregnant women are not ill. Secondly and even more alarmingly, the lack of midwives from the consultation process. At best their exclusion here is an unconscious omission based on Field's lack of understanding of the important role of a miwdwife in pregnancy and birth. This is the very reason people fear GP commissioning. They simply don't understand maternity care provision. How can they go forward from this place of no comprehension? How can they do it without consulting with midwives? This is the best case scenario. The worst is that he is aware of what midwives do and RCGP is actively planning to marginalise midwives from maternity service provision.

There are GPs practising in the UK today who are demonstrating absolutely appalling lack of knowledge on normal birth and of midwifery led care. Make no mistake, these people are NOT the people we want deciding how the money gets distributed. For a recent discussion between maternity service users on GPs see here.