Dear Health Minister

Its time to act for in the not too distant future through no fault of my own Independent Midwifery will becme illegal unless some serious consideration is given by the UK Government. Part of the campagin to draw attention to this serious problem is to get everyone to send a Christmas card to the Minister for Health. This is mine and below is the hand written message inside:

Dear Dan

I would like to wish you and your loved ones a very happy Christmas.
I would also like you to give me an amazing gift at this special time, one that will cost you nothing other than that which you do best. I would like you to truly consider the health of the women and their babies in this country and apply your politics in their favour. I am hand writing in this to you in the hope that you will not just return to me a standard template letter saying that the problems facing Independent Midwifery have been solved. A solution has not been found and from October 13^{th 2013}, without true political will from a Government that cares, real choice for women will be a thing of the past.

Please Dan, help me to continue doing what I do best, help me to continue to serve my profession and do my duty. I would like you to help me to continue being a midwife who truly is, as the word means, with woman.

I became an independent midwife in order to give one to one care to women, to give choice to woman and to never leave her side when she is in need, to get to know her and for her  to get to know me. That type of care, which according to your own Government is gold standard has achieved outcomes that the NHS can only dream about until they too implement true women centred care.

As I understand it the piece of EU legislation that will make independent Midwifery illegal can be implemented by each individual country in the way they think best and so it is not outside of the UK Government to find a solution.  Social enterprise and contracting into the NHS is an amazing concept but is neither easy or a solution for it is not Independent Midwifery and will not solve the problems woman face. 

It is believed that the fall-out from this legislation will be illegal midwifery as there will be midwives who will not leave women to birth alone when those women cannot or will not use the NHS. If this comes to pass it will be a sad day for a country that has always had such a strong and respected midwifery profession at the heart of health care for women. If aspects of childbirth go underground how Dan, could this safeguard society or continue to regulate the profession of midwifery?

My plea is from my heart. Please please do not turn your back on us and the women that need and want us. In a few weeks’ time on prime time ITV1 you will see the way I work, you will see the commitment I have to my job, please watch the documentary in which I have taken part in order to  show how independent midwives do their duty and care for women. Please watch and think of me and all the other women who I want to care for in the future. Please don’t throw me away.

Yours  Sincerely

Virginia Howes

Supervisors of Midwives

The life of an IM can be difficult sometimes due, not to the women we care for but to what should be simple things.........

At 0850 this morning I rang a local NHS trust to get some help in getting a woman in to see the phlebotomist in order for them to take antenatal booking bloods. This is something I usually do myself, I am very proficient in taking blood and have rarely failed but having had 2 attempts I thought the experts should do it in this case. Ok, so I have 2 contacts at this particular hospital, one is the community midwifery manager and the other the contact Supervisor of Midwives, (SOM). This SOM always writes me a very nice letter; in response to my booking courtesy letters, offering her help should I need it. Yesterday I rang the community midwifery manager but she could not speak to me due to being in a meeting, other than to say she would call me back. She did not call back, which is ok, she is a very busy lady and as we are friends too she may have though I just wanted a chat and so this morning I tried my other contact the, SOM. For the sake of anonymity let us call this SOM Mary

The Dialogue:

Operator: Can I help you?
Me: Can you put me through to Mary please
Midwife: Hello Triage midwife Anne speaking
Me: Oh sorry I thought I asked for Mary
Anne: No sorry she is off till Tuesday
Me: Oh ok well as you are a midwife maybe you can help me please. I am Virginia Howes IM and I have a client who needs some routine booking bloods done, she needs to see a phlebotomist really as I have tried twice and failed can you arrange that for me please?
Anne: Oh we send the difficult ones to day care they are really good at doing blood so I will put you through to them
Me: Thank you
Midwife: Hello day care, midwife Jane speaking.
Me: Hello Jane I am Virginia Howes IM and I have a client who is difficult to bleed and I have been told you are experts at it can I send her to you please?
Jane: Oh no we send them to the phlebotomists if they are difficult.
Me: Oh ok yes that’s what I originally thought /wanted so can you do some blood forms for me please? (This is a trust not local to me so I don’t carry their forms. Had I succeeded in my attempt at taking the woman’s blood I would have put them through my local trust as I DO have their forms, it’s the same PCT so I have it from the top that the funding is coming from the same place and it’s fine to do this).
Jane: The phlebotomists will do the forms just send her in with her notes.
Me: Well therein lays a problem because she is booked with me an Independent Midwife so the notes will not be NHS notes or familiar to the phlebotomist, it will cause all sorts of confusion so could you not just do the forms for me please?
Jane: It will be fine just speak just to them and explain…I will put you through
Me: Ok thank you
Phlebotomist: Hello can I help you
Me: Hello yes I am Virginia Howes IM and I need to send a woman in for routine booking bloods I have been told that you will do the forms at my request?
Phlebotomist: Oh no we don’t do forms you need to ring day care.
Me: oh no! I am going round in circles here…Can you transfer me back please
Phlebotomist: Ok

The line rang for about 5 minutes and then cut me off………..

I now want to bite my knuckles and have been on the phone for 25 minutes and need to go back to the starting point.  I rang the hospital main line and it rang and rang and rang. I gave up redialled and it was answered in a normal time. By now I am thinking “ok well lets resort to supervision after all a SOM is the person a midwife is meant to contact if she is having issues or problems”.

(09.22)

Operator: Hello can I help you?

Me:  Can I speak to the Supervisor of Midwives on call please.

Now, a Supervisor of Midwives is meant to be on call 24/7 in case of emergencies. Switchboard, all maternity managers and notice boards are meant to know who she is and she should be instantly contactable. The line rang for 3 minutes. I was now beginning to think “oh my goodness this is about a simple blood test but what if I was at in emergency situation, how much time this is wasting”. I gave up and redialled but started making notes of times and conversations.

(09.25)

Operator: Hello can I help you?
Me: Yes I would like to speak to the Supervisor of midwives on call please.
Operator: You mean midwifery liaison?
Me: No, I mean the Supervisor of Midwives on call and it is important she can be contacted as she is someone to contact in emergencies.
Operator: Ok  I will page her

By now I had put the phone on speaker and was recording the event….this was serious and that imaginary situation of me being involved in an emergency and the resulting questions during my investigation of “why didn’t you contact the SOM” was coursing through my mind.

(09.37)

Operator: Sorry but I have paged her twice and she is not answering her bleep I will ring her extension.

(O9.38)

SOM on call: Hello can I help you…….phew!

Bloods sorted forms in post to woman so she can go to the phlebotomist when it was convenient for her…job done good result

Time taken?  48 minutes.  Issues raised, ?????

 

 

 

 

midwives in the news

Are midwives any different than any other professional when it comes to the press?  Possibly not.  Or maybe we are.  Women, pregnancy, birth,  motherhood, fatherhood , babies ......a potential maelstrom.  And there is the midwife in the middle of it all. So I think that maybe we are a bit different in many respect because we are so involved; after all the meaning of the word midwife translates to being 'with woman'.

So the press love a story about us, good or bad.  But often the reporting in inaccurate, incomplete and sensational.   We all know that. I was recently reported as a 'midwife to the rescue' when my friend gave birth as planned at a local music festival.  No rescuing there in any sense of the word; it was all planned and everything went smoothly.

So as I read today's reporting in the national newspapers about a midwifery colleague, my heart is heavy for the family and the midwife involved. I will wait until all the inquest evidence is considered before coming to any conclusions myself.  And in the meantime be circumspect about what the press are saying.

I am a midwife and my heart is breaking. I have spent 15 years working tirelessly in the career I love serving the women and families I have come to love. My passion for a woman’s right to make her own choices about how, where and with whom she births her baby are as strong as I write this, than they were the day I became a student midwife. For the last 13 of those years I have been working as an independent midwife and it has been the most wonderful time of my life, for I now know how empowering it can be, not only for women, but for the midwife too, to make individual informed choices.

About 5 years ago I received a letter from the Government stating that due to new legislation that was coming from the EU it would be illegal for midwives to practice without insurance within 18 months. It has actually taken much longer than that but despite all that has been done by the Independent Midwives, the law will be in force from October 2013 and I will therefore legally have to stop practicing as I do now.

Choice for women and midwives will legally be no more.  It will be the NHS way or nothing.

This is not something that is directed solely against independent midwives. There are already lots of rumours about why this is coming about but this is not anyone trying to rid the country of independent midwives due to how they practice or because doctors or the NHS want to take control.  We have been caught in an unfortunate situation. The new law will say that all health care professionals should have professional Indemnity insurance in order that the public have protection in the event that human error makes it necessary for them to make a claim against a practitioner. Whilst all other health care professionals such as Osteopaths, Physiotherapists, Podiatrists to name but a few, can purchase insurance on the commercial market, midwives cannot. The insurance companies are about making a profit, they are a business and they can clearly see that a valid claim involving a baby will not make them a profit from premiums collected from 150 midwives or so. So there we are, caught in a situation not of our making.

We started fighting back, we had marches and campaigns, we drew attention to our plight and we had pledges of support from many a high place. The Government pledged to help us; David Cameron said if he came to power he would not let it happen. They said Independent midwives provide gold standard care and are valuable to the profession. So far they or he have not carried out their promises. The solutions they suggested way back when we first had notice of the proposed changes are not viable. We have jumped through every loop they have suggested, we have walked every promised path from every insurance broker who has said they can help, but we are no closer to a solution.

We have put every valid argument forward; that its women’s, choice that we always inform woman of the situation as per our rules, that there has only ever been a couple of personal claims against independent midwives ever, that our outcomes and statistics speak for themselves, that the country is already short of midwives, that it feels to be against our human rights, that it takes away choice for women which in itself goes against Government policy, that it will make women and  midwives go underground and that ultimately it may make women birth without a midwife putting them and babies at risk. As usual woman and babies are at the bottom of any political agenda. This is a woman’s rights issue and not many concerns themselves with woman’s rights or issues.

Collectively we will not give up the fight till the very end and I personally pledge not to ever give up on woman and on my profession even if my profession gives up on me. I will always be a midwife whatever that may cost me but it doesn’t stop my heart from breaking

Who wants a cherry on the top?

Is choosing or knowing your midwife really as important as the evidence says it is? We are informed by studies that knowing the midwife improves outcomes with all variables….you know, less caesarean sections, less babies in special care, more women achieving normal birth, less hospital stays, more breastfeeding, more satisfaction with the process……I am sure the list can go on but already it is clear to see a cost saving, and far less complaints maybe, if all these things were reduced? How much money could be saved by the implementation of continuity of care? The Government know it, the NHS knows it, the trusts know it, the mangers know it and the midwives know it. But do the women know it? Does it matter to women that they get to know the midwife who will be caring for them at the birth or is all they want is a knowledgeable, caring, kind midwife?

Currently Neighbourhood Midwives is trying to make changes to the way maternity services are delivered by setting up an employee-owned social enterprise organization. They state that their primary purpose is to provide an NHS commissioned caseload midwifery homebirth service, based in the local community, “wherever it is required”……

Wherever it is required? Surely the question should be; is it required?

In order to gain the relevant information to answer this exact question, a colleague who is working on the implementation of Neighbourhood Midwives asked this question on the Facebook page “One Born EveryMinute-The Truth”;

 “Does it matter to you that you don't know the midwife who will look after you in labour? If not, why? If you could have a choice and choose a midwife whom you knew and who could care for you throughout your pregnancy, would you choose this option”?

As would be expected on a page that is primarily about evidence based midwifery practice, there were quite a few women raving about having the option of knowing ones midwife and continuity of care.  To be fair there were also a lot of comments from women who had amazing experiences but who did not know their midwife and then some women were saying that it really doesn’t matter as long as the midwife is kind and caring.

I have been thinking about the final comment as I remember having the exact conversation with a mentor many years ago when I was a student midwife. The mentor told me that “all women want is a king caring midwife.” However this was also the same midwife who said “the important thing is a live healthy mother and baby,” when we were discussing birth plans.  Well of course I do not think we could argue either of those points because both are important and any birth would be unbearable without either. But why does anything have to be sacrificed? Why can’t women have it all? Why can’t lots of things be equally important? Why can’t importance have parallels?

 I love really using analogies so I will compare it to going to a restaurant and choosing a dessert…..

OK I really want a dessert the type of which I know is sold in another restaurant and which I absolutely adore.  They do something similar here and I have tried it at this restaurant too but here it’s not quite the same.  It is not a fancy dessert in fact it’s been around for years, including at this place but in the other restaurant it is so utterly special because it is with a fresh cherry on the top. The cherry makes it exquisite to taste. Lots of people want it with a cherry too but as it has never been available they settle for the dessert as it is served here. Despite asking for a cherry I am told by the waiter that sorry I cannot have a cherry. What he knows and everyone else knows is that the fresh cherry has loads of health benefits and is exquisite to taste but according to the restaurant  owner they would have to install an expensive machine to de stone the cherries. Even though they know that people will come to the restaurant from far and wide and rave about it and that in the long run their takings will improve they think “oh well it’s been ok for most people for all this time so we will keep the dessert as it is”.  There are some people that eat at the restaurant who love the dessert as it is, they say it is perfectly good enough and cannot for a second believe that a cherry would make any difference. Some diners say all that matters is that the dessert tastes nice and so let’s just leave it as it is………

But I know the truth, and all those other diners who have tried it at the other place, knows the truth, is that they have never experienced it with a cherry on top, that if only others would try it a different way they would widen their eyes and say “oh my oh my the other way was good I admit but oh how delightful how exquisite and how memorable is this desert with the cherry on the top……and healthy too…. wow we are having it all…..

Who wouldn’t want midwifery care with a cherry on the top?

Meconium stained liquor

In a note regarding last week’s OBEM I asked why it was that a multiparous woman being induced for postdates was being subjected to continuous monitoring,(EFM). It was clear that she had been induced by prostaglandin suppository alone and was not on a syntocinon drip. I had a discussion with an NHS labour ward colleague and was able to rule out that EFM, in this case, was linked to induction process so I was confused. However what I obviously missed and what was subsequently pointed out on Facebook page, One Born Every Minute-The Truth, was that there was meconium stained liquor seen during the birth. (note to self wear your glasses next time)

So I thought I would pose this question; is meconium stained liquor always a reason to constantly monitor a baby in labour? I think I am correct in saying that finding meconium in the amniotic fluid is a reason that is often cited to transfer from a home birth, midwifery led unit or birth centre to a consultant led unit and also to commence EFM (information taken from local trust guidelines). The labour therefore has shifted from a normal one to an abnormal one, from low risk to high risk and maybe the course of the woman’s birth and or birth plan completely changed because of the meconium alone.

There is plenty of information on what meconium is and what harm it can do (Google it) so I want to focus on the changes it brings to the course of labour and whether those changes are indeed always necessary.

According to the National Institute for Clinical Excellence, (NICE) continuous EFM should be ADVISED for women with significant meconium-stained liquor, which is defined as either dark green or black amniotic fluid that is thick or tenacious, or any meconium-stained amniotic fluid containing lumps of meconium. Whereas continuous EFM should be CONSIDERED for women with light meconium-stained liquor depending on a risk assessment which should include as a minimum their stage of labour, volume of liquor, parity and the fetal heart rate. Nice also states that “significant meconium stained liquor” is an indication for transfer to an obstetric unit. It seems that NICE are definitely about defining and describing different categories of meconium which may change the advice given and or choice of care.

We can presume, from reading individual Trusts guidelines, listening to women’s stories and of course watching good old OBEM that labouring women are told that there IS meconium and therefore they need to be constantly monitored due to it being a risk factor for baby, but are they told ALL the details and given a choice?

Are women informed that the meconium in the water is light and that as they are having a 2nd or subsequent baby the labour may be quick and that if baby has no problems with his /her heart rate it is recommended that continuous EFM be only CONSIDERED? Are women told that the need for EFM is not absolute, and furthermore that in her particular case, it has been considered and there is no reason to constantly monitor the baby as long as all else stays well? Her birth plan does not have to change she can remain moving around and being intermittently monitored at home, in a birth centre or indeed in the hospital of her choice?

I have reviewed a very recent research paper (2012) which was published in the International Journal of Paediatrics and reviewed 133,000 births between 37 and 43 weeks complicated by meconium stained liquor. With a bit of mathematics I have changed the percentages into numbers and this is what the study found.

Meconium in the water is a relatively uncommon problem and in this study affected only 8 in every 100 births, and of those babies less than 7 in 10,000 became ill. In terms of mortality rates, the chances of meconium related death in childbirth was 2 in 100,000.

Other studies have quoted different statistics but in all recent evidence the incidence of meconium aspiration syndrome is similarly very low. That is not to say that it is to be dismissed lightly as it can cause extremely serious illness and fatalities in the extreme cases.

The issues once again are informed choice. Some parents would want to act on the chance they could be one of the 2 in 100,000 who child dies or even one of the 7 in 10,000 whose child is ill but equally importantly some would want to make choices based on the likelihood of them being one of the 998,000 or of the 9,993 who could continue with their plan of a normal non-medical birth.

Either way they should be given the facts in order to make a choice

Medical Help for the few?

I watched OBEM last night mostly with a smile on my face and the occasional “oh no why?” so lets start with what was really good….I thought the story of Cody was a real positive story about pre-eclampsia. As Billie admitted herself whilst most women have heard about it and know it to be a problem, many are not informed about how bad it can be. It’s a shame given what we know about kangaroo care that Cody and Billie did experience it for the first hold as it would have been an amazing example of excellence but again maybe it was done at another time and we just did not see it due to editing.



The same for the story about the baby with the cleft lip. Brilliant information giving. TV has as the ability to normalise situations (which can be a double edged sword) so by seeing the sweet baby, seeing his lip and how well it was repaired, may go a long way to helping women who are also told their baby may be similarly affected. It appears that Carolyn was induced post dates but we know no more so we cannot make presumptions whether or not it was an informed choice. (note to self add stuff about the evidence and risks of induction of labour) However Carolyn was constantly monitored during the birth. Why? Following birth the cord was cut for no apparent valid reason and baby was immediately removed from his mother. Why?



The midwife who was with Tania I felt did an excellent job of support sitting with her (off the bed) talking and encouraging her. She was however being constantly monitored. Why?

However... cushion hit TV when another midwife gave incorrect information by saying women ”should progress at 1cm per hour” There is NO EVIDENCE of this. This is outdated, discredited information that can cause harm. Some woman will progress faster and some slower and as long as all is well, the clock has no part to play in a normal labour. Once again I would like to mention the Royal College of Midwives campaign for normal birth. If the midwives do not want to read complicated and or deep research papers then the RCM make the evidence simple. I got really excited to see Tania have good midwifery support, sitting on a ball, resting for a while on the bed, then all fours for 2nd stage……then it all fell apart when a midwife (not the primary one) said “lets turn you over” and once again constant monitoring, Valsalva and a shouting match. No need for any of it……she would have done just as brilliantly leaving her alone to push under her own steam. The fact the baby was OP (back to back) just adds weight to the argument that she was an amazing woman who was quite able to give birth to her baby without interference.



Amazing stories, lovely babies and a missed opportunity once again to normalise birth for the majority and show medical help for the few.....

Also published on One Born Every Minute The Truth facebook page