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When you try your best to save a life

December 18, 2015

Midwives are and always have been at the forefront of health. We are capable of delivering critical health information and provide care that may prevent a maternal, fetal or neonatal death. We must neither underestimate our role , nor our responsibility, to try and do the best we can in all circumstances.

But in today’s NHS with spiralling numbers of women coming to clinic and delivery units. More women with pre-existing health disorders making their pregnancy care ever complicated. Government continually changing the health care agenda and on what to focus next. With women’s groups and lobbyists demanding certain care styles, it is a very difficult and challenging time to be a midwife.

I wrote about a similar topic 2 years ago in Midwives under scrutiny Dec 2013

Since the Frances 2013 and Kirkup reports the “scrutiny” has changed and the work of midwives on a day to day basis is being constantly being overseen and questioned.  It does not make for a happy atmosphere to deliver care in. It results in nervous midwives who are frightened of trying to work with the woman as this often goes against current policy, despite support from local supervisors of midwives. Midwives are frightened of working with other midwives who don’t share their “with mother” approach. Many are ridiculed for their “luvy duvy” attitude. We need to accept it does take all sorts.

But even Supervisors have recently come under great threat after issues have emerged about lack of supervision and irregular practices. I am unsure as to the future of Midwifery Supervisors as a body. It will be a sad loss.

Midwives who go out of their way to stay at births to deliver continuity of care are disciplined for having too much time owing and not being able to plan their work. Midwives who have tried their best in any given situation to deliver a live baby, are scrutinised within an inch of their lives during investigations about what may or may not have occurred.

These intrusive investigations often mean the suspension of the midwives whilst investigations are taking place. This is at great cost to the NHS as his/her replacement on the clinical floor will need paying for too.

I am not against reviewing cases to ensure care was done appropriately and safely. I am an ex audit and practice development midwife for goodness sake. But I do think how it is done could be better for the sake of the midwives and the service.  Being suspended for months on end awaiting a hearing does nothing for the midwife’s confidence or trust in an organisation.  Their treatment during investigation may well lead the practitioner to leave, during a time when we are short of midwives on the clinical floor.

If there has been a serious incident or a near miss then there should be a general multidisciplinary debrief/discussion of events. I know this is happening in many maternity units across the country. But this should be standard.

Out of that may come issues that require more clarification? If grave concern;  then further action involving the individual may be needed.  But the initial debrief is where to start. This is where discrepancies in people’s opinions of what was going on can be aired in a safe supported space.  This can only be positive for midwifery, obstetrics and the staff involved and save time in lengthy costly investigations. Involving the family at this stage also leaves them understanding that all is being done for whatever has occurred not to happen to anyone else.

 

A little while ago I went to a workshop on Human Factors.  It made me focus on the human interactions that take place during emergency circumstances. Communication between the participants being the key. But if the participants are nervous about what they are doing, frightened of the culture and of subsequent blame, they may try to hide poor practice. This is more dangerous indeed.

Mistakes will be made in healthcare provision, as we are dealing with human beings and we are fallible. Rarely does a practitioner intend to do harm and if intent is found these events are of course passed on to the police. Episodes of poor practice will always exist and our aim is to reduce these to a minimum. But by destroying good practitioners by the investigation process, no progress in maternity services will be made. Midwives cannot be individually crucified for the one erroneous error, often after a career of otherwise unblemished care. These midwives need support and understanding and the systems in which they work critically appraised to prevent recurrence.

We need to care and support our midwives or we will lose them.  Who will then care for the women?

Kirkup Report 2015 Morecambe Bay  https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/408480/47487_MBI_Accessible_v0.1.pdf

Frances Report 2013 Mid Staffordshire                                                 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/279124/0947.pdf

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