## NHS Maternity Care ‘Severely Lacking’ as Report Highlights Systemic failures

When sophie Dicks went into labour a few days before a scheduled caesarean in November 2023, she prepared herself for the natural birth she had been hoping for.Having had a C-section for her first baby she had been hoping to give birth naturally, but had been advised to book in for a C-section for 42 weeks when she went past her due date.Over the following three exhausting days of labour she saw “too many midwives to count” but estimates that it was at least 10.She was then told – without examination – that her labour wasn’t progressing because her contractions weren’t getting closer together. To avoid the risk of infection, a C-section was recommended after all.

“But I was made to wait six hours, while still in labour,” says dicks. “And when I went in for the procedure, they couldn’t get Remi out. I wasn’t told anything, but suddenly an alarm sounded, 10 people came running in and lifted me upside down so my legs were in the air. He was born and rushed away, but I was in a mess; I’d lost 3.5 litres of blood.”

“The problem was that Remi was so far down my pelvis,ready to be born,that they were struggling to perform the C-section without killing me. The surgeon later told me they didn’t know I was in labour when I went in for the procedure. That blew my mind and rang serious alarm bells.”

Her experiance is borne out by the initial findings of the national maternity and neonatal investigation (NMNI) led by Valerie Amos, which found maternal care in the NHS severely lacking. amos found that “time and time again” women were not listened to. Among other things, women were left to “bleed out” in bathrooms, with babies suffering avoidable deaths in NHS maternity units. After visiting seven trusts, talking with families and meeting NHS staff, Baroness Amos found that changes within maternity care have been “too slow” despite being necessary and urgent.The report shows that the NHS has recorded a “staggering” 748 recommendations relating to maternity and neonatal care in the past decade.

“Nothing prepared me for the scale of unacceptable care that women and families have received, and continue to receive, the tragic consequences for their babies, and the impact on their mental, physical and emotional wellbeing,” Baroness Amos said.the hospital where Dicks had her C-section later admitted to other mistakes. “Apparently, if a child isn’t born within nine minutes in a C-section, an alarm should sound,” she says. “But they didn’t do that. Instead, they used a phone to ring another phone in the hospital and, luckily, the surgeon walked past the phone at that time. She ran over to deliver Remi straight away, without even having a chance to put gloves on. Had she not walked past that phone, both of us would be dead. We were lucky.”

Still, the experience has left a lasting legacy for Dicks. She suffered from postnatal depression and struggled to bond with her baby for several months because she felt so disconnected.

Sophie’s is just one experience. But the Amos report highlights a number of issues, which Baroness Amos said she has “heard about consistently”. Perhaps it’s no surprise then that statistics show that Britain has higher maternal and infant mortality rates than many other developed countries.## Nordic Midwives Offer a Model for Better Maternity Care

“we don’t have debates about the midwife’s role and there are no fights between midwives and doctors because their roles are extremely clear.There are also clear criteria about when to intervene and when not to.”

Af Ugglas explains that midwives are often the main caregiver from the start of a woman’s reproductive life, starting with contraception. This builds trust and confidence in the midwife from the start. Unless there is a complication during pregnancy – when the midwife refers to a doctor for consultation – it is indeed the midwife who leads the pregnancy, birth and postpartum care.

The other big difference is in continuity of care. Af Ugglas cites research that shows that women who see the midwife throughout their pregnancy and at the birth are more likely to have a positive birth experience. “The gold standard we aim for in Nordic countries is continuity of care – so as much as possible, women see the same midwife during their pregnancy and at the birth. WHO released a position paper on midwifery models of care last year, leading to initiatives for women to see the same midwife, or groups of midwives, during their pregnancy, birth and after birth,” says Af Ugglas, flagging that ICM has launched a global petition calling on governments to grow,support and invest in the global midwifery workforce,in response to the global shortage of midwives.

“There is lots of evidence, including from the WHO, that women who have continuity of care have better outcomes. We know that is what women want – and it results in fewer interventions and a much better experience for the women.”

Unfortunately, being able to provide continuity of care is a distant dream for most midwives working in the UK. Rebecca* is a midwife in North Yorkshire who has been working for the NHS for 13 years, including in some of the trusts mentioned in the maternity report. She describes running around the wards like a “headless chicken” and going home crying about not being able to provide proper care after understaffed shifts.

“Nobody goes to work to provide poor care,” she says. “Who wants to go to their dream job and come home sobbing, feeling you haven’t been able to provide the care you wanted to – because you can’t split yourself into five different people?

“Clearly, something is going massively wrong. As midwives, we want safer staffing and the ability to do our job properly, and proper resources. It all comes down to money at the end of the day; the bottom line is that the staffing just isn’t there. When you’ve got adequate, appropriate staffing, you have got the time to spend with women.”

It is not just the Nordic countries that are taking better care of women and babies. Japan has one of the world’s lowest infant and neonatal“`html

The Silent Danger of PPROM: A Couple’s Heartbreaking Story

Premature rupture of membranes (PPROM), when the amniotic sac breaks before labour begins, can be a frightening experience for expectant parents.While often leading to a healthy delivery, it carries risks, especially when not promptly and correctly diagnosed. This is the story of Ewa and Hender, a couple whose experience highlights the critical need for awareness and improved care surrounding PPROM.

what Happened to ewa?

Ewa’s waters broke at 34 weeks and 6 days of pregnancy. She was initially told by medical professionals that she would likely go into spontaneous labor within 24-48 hours. However, after 36 hours, Ewa remained in a state of waiting, and labor hadn’t begun. She did report that the baby’s movements were becoming fainter, but a scan wasn’t offered to assess the situation.

The couple inquired about potential options and risks, and were informed that the primary risk to the baby was infection. Ewa was prescribed antibiotics and sent home to await the onset of labor.

“Three days after her waters broke,” recounts Hender, “Ewa started experiencing widely spaced contractions throughout the day. Later that evening, Ewa passed what they believed to be the mucus plug. they contacted the hospital, but were advised by the midwife to call back when the contractions became closer together. Hender believes the midwife wasn’t aware that Ewa was experiencing PPROM.”

the Devastating Outcome

Tragically, Ewa’s baby, Leo, was stillborn.An inquest revealed that Leo had died in the womb due to a lack of oxygen, and that Ewa had, actually, been experiencing PPROM. The inquest concluded that had the PPROM been correctly identified and managed, Leo might have survived.

Understanding PPROM: Key Facts

• Definition: PPROM is the rupture of the amniotic sac before the onset of labor, typically before 37 weeks of gestation.
• Risks: Infection for both mother and baby, preterm labor, umbilical cord compression, and fetal lung immaturity.
• Diagnosis: Often diagnosed through a physical exam and confirmed with tests to detect amniotic fluid leakage.
• Management: Management varies depending on gestational age and other factors, and can include antibiotics, monitoring for infection, and induction of labor.

Why Early Diagnosis is Crucial

The case of Ewa and Leo underscores the importance of prompt and accurate diagnosis of PPROM. Delayed recognition can lead to serious complications, including fetal death. Healthcare providers must be vigilant in considering PPROM in any pregnant woman presenting with symptoms of ruptured membranes, even in the absence of regular contractions.

Key Takeaways

• PPROM can occur at any stage of pregnancy, but is most common in the late second and third trimesters.
• Fetal movement should always be monitored closely, and any decrease should be reported to a healthcare provider immediately.
• Pregnant women should be aware of the signs of PPROM and advocate for themselves if they suspect they are experiencing it.
• Healthcare providers must prioritize accurate diagnosis and appropriate management of PPROM to minimize risks to both mother and baby.

FAQ: PPROM

What are the symptoms of PPROM?

A sudden gush or a slow leak of fluid from the vagina.It may feel like urine, but it’s usually clear or slightly yellowish.

What should I do if I think my waters have broken?

Contact your healthcare provider immediately. Do not wait for contractions to start.

Is PPROM always an emergency?

Not always, but it requires careful monitoring and management.The urgency depends on gestational age and other