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Posts Tagged ‘NMC’

There has been a lot in the news recently about a scottish midwife, Anne Duffy who resigned from her job and is now claiming constructive dismissal by her employers. I’ve been interested in the outcome as the decision, it seems to me, will come down to interpretation of the NMC rules.

As yet a decision hasn’t been reached concerning Anne Duffy’s case, so why am I writing about it now?  Well, in the news today was a report about a couple whose baby sadly died as a result of no midwife going out to their home for the birth and the fact that a settlement has been agreed with the Trust.

In Scotland Anne Duffy was the midwife in charge of the maternity unit, which meant that she was the most experienced available midwife, when a call came in that a seriously ill, pregnant woman needed air lifting from an island to the hospital. After a discussion with other staff members she went off in the helicopter, when her actions were discovered she was disciplined and as a result she resigned. Report here.

So, on the one hand we have a case where a midwife attended and was disciplined as a result and  on the other hand, we have a case where a hospital failed to provide a midwife, a baby died, and the Trust have, I assume, admitted fault and made a settlement with the parents.

There are differences here, in one a midwife failed to follow hospital procedure, but fulfilled the professional requirement to provide care, and as a result was disciplined and in the other a hospital failed to provide care and have admitted fault. Can anyone else see the double standard here?

The Huddersfield baby death does bring up the homebirth and midwife staffing issue again though. There must be more to this though as there was already another homebirth underway, there was only one on-call midwife and she was already at the other homebirth so why didn’t the parents come into the hospital?

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In The Guardian today was an article guaranteed to court fevered discussion, ‘Women have a right to a homebirth’. The authoress, Jemima Kiss, introduces the article with the suggestion that the health service should value natural births and not to allow the loss expertise in these in favour of caesareans, she has my support there. She is also quite correct in her assertion that women have the right to a homebirth, my question is ‘ Is it right that women have the right to a midwife attended homebirth in today’s cash-strapped maternity services?’ Any woman can choose to give birth at home, but NHS Trusts do not have to provide a homebirth service, apparently. It’s all nit-picking though because, if Ms B sent her partner round to my house and he told me that she was in the later stage of labour and they wanted my help, then I would have an obligation to attend and provide care ( NMC Midwives and home birth 2006).

Currently maternity services are  incredibly stretched, and it’s not going to get any better. Many maternity units are desperately short of staff, Oxford being just one of them. Low-risk units are closing, Paulton in Somerset, Wycombe in Buckinghamshire and Tiverton in Devon purely because of staff shortages in the obstetric unit they are linked to. A homebirth requires 2 midwives, 2 midwives who will be needed elsewhere. If the homebirth happens at night those midwives will have already worked all that day, who will cover their work the next day? In reality how safe, how ‘on the ball’ will a midwife be when s/he has been working 24 hours? If it happens during the day who covers the work, especially if 2 midwives have already been out at another home birth the previous night? The answer is that clinics may be cancelled, pre-arranged appointments put off  and any midwives who are working that day will end up very stressed and going home late. Another factor is, suppose the midwives were called out to homebirth 1 at 6pm and returned home at 2am then another woman wanting a homebirth called them out at 2.30am, it happens, and it is happening more and more frequently due to government initiatives and articles like the one in The Guardian.

I’m sounding negative about homebirth, I love homebirths but I am becoming increasingly concerned about the arrangements and staffing for their provision. Other aspects of community midwifery are really suffering due to cutbacks, childbirth preparation classes are being abbreviated, postnatal home visits are being withdrawn but a small number of women are able to command how the service functions on a 24 hour basis. I am horrified to hear me saying this but ‘ Until the maternity services have enough resources to ensure a safe provision FOR ALL then a homebirth option should be withdrawn’.

What do you think?

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I received an e-mail this week. NMC, RCM, NHS and Alan Johnson, I hope you all feel ashamed of yourselves. 

Hi, I’m really glad I found your blog. I’m a student midwife (ish) I wish
that someone would have told me beforehand that the midwifery you read about
isn’t the reality.
I think you often get glimpses of the midwifery you’d love to practice but
in reality…its paperwork, targets, interventions (did i mention
interventions?) Its like working on massive a conveyer belt in a factory
whilst jumping through hoops. which are on fire!
I’m on a 6 month break from the course after 2 years because I couldn’t cope
with the impossible situation I was put in and the complete lack of support
thereafter.
I am due to go back early next year, unsure whether I should. I dont see
anything changing now or in the future and its such a shame.
I love midwifery in its true form, so maybe if I can hang in there long
enough Ill get to see it one day, in some part of the world?
being a student feels like being a new mum! but really…’no one tells you
its going to be like this’ 🙂

best wishes,

disheartened student!

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Who is Margaret Haywood? She was a registered nurse, until yesterday when her registration was taken away from her by the NMC. Why? She participated in the making of a BBC programme which investigated the shortcomings at the Royal Sussex Hospital. Prior to the undercover filming the patient’s consent was not gained, however it was obtained following the filming and prior to the screening of the programme. The NMC have decided that  ” Ms Haywood did not fulfil her nursing obligations and found her guilty of misconduct.”

I will ask, as did Pulse,

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I am seriously considering whether I should continue my blog in it present form due to this ‘reminder’ from the NMC.

“The NMC would like to remind nurses and midwives that they are personally accountable for their actions at all times, including how they behave in their personal life”, gosh, it’s almost as if had taken some kind of vow when I qualified. I can actually dismiss that element as irrelevant if they are referring to illegal activities, however they should perhaps of been more explicit as there are many aspects of some peoples personal lives which others may not find professional, or just plain not approve of but they may not affect a persons competency.

“What may be considered to be letting off steam about a situation at work can potentially be read by someone who may take offence at the content of a posting.” Who may that someone be? The Secretary of State for Health; a Trust Chairperson; a unit manager perhaps.

 “Nurses and midwives could be putting their registration at risk if posting inappropriate comments about colleagues or patients or posting any material that could be considered explicit.”  Explicit? In what way. Full frontal nudity perhaps or do they mean failing to maintain confidentiality?

I am really in quite a quandary here. I started my first blog when I was first entering into the new experience of being a grandmother, with emphasis on how it impacted on me as a midwife. I soon discovered that people are very interested in midwifery, pregnancy and birth so began including entries about different aspects of my working life, in part to share but also to educate ( how presumptuous!). Now I am concerned that I may be on a collision course with my regulatory body, I may be considered to be ‘inappropriate’. I would really welcome some advise here, any supervisors out there who would care to comment, PLEASE do.

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“Following the Channel 5 programme broadcast 9 July 2008 (Extraordinary People – Outlaw Birth) featuring three women in the UK and the USA who opted to give birth unassisted at home, the NMC would like to clarify the following points.
Legal position
In the UK it is legal to give birth at home without any professional or medical help.

However, it is illegal for an unqualified, unregistered person to perform the role of a doctor or midwife during the birth.

Standards and resources
As part of their training, all midwives are taught that they must

  • Work in partnership with women to facilitate a birth environment that supports their needs.
  • Provide care that is delivered in a warm, sensitive and compassionate way.

The Midwives rules and standards states that a midwife

  • Should respect the woman’s right to refuse any advice given

The Code states that

  • You must listen to the people in your care and respond to their concerns and preferences

In addition, a recent report from the Royal College of Obstetricians and Gynaecologists (RCOG) states that

  • Women who choose a home delivery as their birth option should be supported in that choice, appropriate to the level of clinical risk.

Responsibility
In a free birth situation, the mother-to-be takes full responsibility for the birth of her baby.

The mother may choose to have any friend, partner or relative present at the birth.

They may support the mother emotionally but it is not legal for them to assist her in the birth or take any kind of responsibility for the successful outcome of the birth.

Midwives must respect a woman’s decision to have a free or unassisted birth.

The Code and NMC Midwives rules and standards require midwives to be supportive and not be judgemental or critical of this choice.

If midwives have any concerns at all about the woman’s decision, they must address them to their Supervisor of Midwives.”

Further information
Free birth advice sheet [PDF]
The Code
RCOG Standards for Maternity Care
[PDF] (external website)

Well, that’s made it all very plain. I think! Support her choice, be non-judgemental, contact my Supervisor of Midwives if have any concerns about her choice. Ummm, if I’m supporting her and being non-judgemental then going to my Supervisor could be perceived by a woman as obstructive and judgemental. Oh well. All I can say is, as I said here, if you thinking about it then please don’t just read the legal stuff and DIY sites on the web, there are a lot of sites out there with enthusiastic people who mean well but can be somewhat blinkered when it comes to the nitty-gritty. Talk to your midwife, see if a compromise can be reached, most of us don’t want to be ‘in control’, we would just like to try and help you, and your baby, have a positive, safe birth.

 

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I’ve just finished watching the channel 5 programme about unassisted childbirth and I feel many mixed emotions. As a woman I feel rather jealous of the three women shown freebirthing in the programme, especially the first one who really did appear to experience a non-traumatic, pain-free, dream of a birth, as a midwife I fnd that rather worrying. I mean, if I was swept up by the images and beauty of the concept why shouldn’t a significant number of women, who are in a position to have a go at birthing by themselves, decide that they would like to experience an unassisted birth?  Would that be a problem? Not to me, no, but it may cause them an assortment of problems, some life-threatening. I am absolutely delighted that a went well for the three women, and babies, in the progamme but that is troublesome. Although the doctors warned about a couple of complications that could occur, this will just be perceived as the medical establishment ‘shroud waving’ and there are very real and dangerous problems which may occur during childbirth.

Why are more women considering this ‘lone’ birthing as an option? There will be a few who will enter into it due to a personal belief, or as an extension of a life-style but I believe that the majority will choose free-birthing as a result of a previous birthing experience. Perhaps they believe that the attendants were not sympathetic to their needs, or their choices were dismissed or ignored, whatever it is, the maternity services, midwives, doctors have failed them. I do place some, well quite a lot, of the blame here on promises, and hence expectations, engendered by government and built-up by the media. Women and their families are told that they have choice but this is never qualified by the reality of shortage of staff, resources and amenities. Some elements of the media and pressure and user groups paint a negative picture of attended childbirth, I would include channel 5 in this group. There are many images of midwife-attended, home, birth-unit or hospital maternity care they could have used which could have shown a woman in a non-medicalised environment. Instead the images shown were of a woman semi-recumbant, on a  hospital bed, with a doctor busy setting-up an intravenous infusion, complete with an electronic pump, hardly the most tempting alternative to the impression of a pleasurable birthing experience for the three women depicted in the programme.

I would urge anyone contemplating unassisted childbirth to do more than read-up about it and watch DVDs. Please, contact your local maternity unit then, if you are still unhappy with the options or choice offered, contact your local NMC supervising authority as they are there for women who are seeking help or support concerning the provision of their midwifery care.

Women and babies can, and do, die during attended childbirth in hospital and at home but, “while many factors contribute to maternal death, one of the most effective means of preventing maternal health is to improve health systems and primary health care to ensure availability of skilled attendance at all levels and access to 24-hour emergency obstetric care” and, “Because complications of childbirth too frequently cause neonatal death, skilled assistance is recommended for all deliveries along with access to the appropriate level of neonatal care when needed.”

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