Just watched the Panorama programme 'Midwives Undercover', which aimed to highlight the problems in Britain's maternity units using secret filming by a journalist working as a volunteer. It was alarming stuff, but one of the problems with having a lay person looking for problem areas is that, unless you know what you're looking for, you run the risk of making an issue out of something that really isn't that big a deal and, as a result, missing the really important things.
Certainly there was a big fuss made over the fact that the journalist was asked to hold a baby's heart monitor transducer in place for a 20 minute period "without having any training at all". Now, it is certainly the case that interpreting a CTG (cardiotocograph) trace takes training and if mistakes are made, they have the potential to be catastrophic. BUT holding the transducer in place is a job more usually done by an elasticated strap. Only if the baby is in an awkward position, as presumably was the case here, do you have to angle it a bit by hand. The woman was not in labour, so it was highly unlikely that the trace would show anything requiring immediate action and the midwives were popping in to look at the trace every 10 mins or so, as they would normally have done. So is it really a major story that the volunteer was acting as an glorified bit of elastane? To my mind, it's far more appropriate that the volunteer was doing this, than the midwife who had plenty of better things to be getting on with.
The other thing that crops up time and time again, whenever anything is reported about maternity services, is the inevitable 'my baby died/had brain damage because of what they did' story. I apologise if that comes across as heartless, it's not intended to be. The fact is however that babies do die, they do get brain damaged, and whilst we should never become complacent about it, and we should of course do everything we can to prevent it, we will never be able to save every baby. I cannot comment on the two cases discussed on tonight's programme, for the obvious reason that I wasn't there and I don't have any of the details, but warning bells always ring for me when phrases such as "So & so was already having problems before they arrived on the ward" are heard. Many - if not most - cases of brain damage are due to antenatal insults, meaning that the care in labour does not directly contribute to the outcome, the damage has already been done before you get there without anyone being able to do anything about it. Proving it one way or another is often impossible though and often results in hospitals offering (substantial) out-of-court settlements to parents. Whilst I have a lot of sympathy for parents who are naturally devastated and seek to apportion blame in someone's quarter, but I also have a lot of sympathy for those involved in the care, who often did their best, with an outcome that was inevitable.
It is definitely beyond question that there is a shortage of midwives in most units though and, yes, this can contribute to the kind of problems detailed above. Much much more often, however, it contributes instead to women - or whole families - having a thoroughly miserable and rather crap experience. This may be the poor cousin of the catastrophic events we love to hear about, but if you ask me, it's a much bigger problem. Women who've had crap care are more likely to have had unnecessary interventions (expensive to the NHS, detrimental to women's bodies), develop postnatal depression, be overly anxious about subsequent pregnancies which results in more unnecessary interventions - if they go on to have any more children that is. I often wonder how many women never go on to have the families they would have wanted because they were badly treated the first time; I have a friend who is finally having her second baby now, 14 years after her first, because it's taken her this long to pick up the courage after having such a horrible time with her first.
Ah well. It's only a job, eh?
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