What would you do if you were pregnant and lived in Shropshire?

No manager or accountant would tell doctors and midwives how to manage the clinical care of a patient MerylStreep. There is no excuse for a professional not to whistle blow when aware of bad clinical practice, and it sounds as though a number of staff knew but didn’t challenge the culture - they are also culpable.

If the Government had adequately funded the NHS over the last 10 years this may never have happened because more staff may have mitigated the effects of the bad culture on the unit, and there must have been local management failures if there had previously been known problems, but to place the blame entirely at the ends of local management without recognising that clinicians run clinical services, and are a decision making part of the management team is frankly ridiculous.

This is all a terrible tragedy but it reminded me of my days in commissioning emergency services. We had 2 maternal deaths in 2 years and that was a red flag causing an enquiry. At the same time I was told by my then boss, the Director Finance if you please, to limit the number of terminations I commissioned. When I protested he asked me how many I thought I needed!!!!!

Didn't stay in that job long.

It was an ethos that ran right through the hospital from Dr,s to midwives. Natural child birth is best. The whole system needs carefully looking into and altered, more areas are coming to light.
We accept intervention when needed with other illnesses why is Natural child birth right when mother or baby or both are at risk?
I would certainly encourage any expectant mother to look else where for their care.

Dreadful headline in Times:

"Childbirth 'is not safe for women in England' ".

my dd should have had a c section but was forced to push. She has ended up with a mesh, which has now caused big problems and cannot be removed

My midwife, 8 lb 2 oz baby number 1 and I am small, made me push and push as it was almost her home time, needless to say I tore from back to front, which has caused me problems to this day. The doctor would not come out at 10pm to stitch me, he came at 9 in the morning. I wish I knew then what I know now but was a naive 23 year old. My sister in cheshire had a wonderful midwife, two stitch-free births

The report shone the light on an enormous tragedy

I think I read somewhere, that advocates of natural childbirth have used examples of cultures such as say Native American women who give birth squatting in a field, and then get up and go about their lives as if everyone's labour should be just that, dead simple. Although when such details are cited it's probably not known what mortality rates or complications occur.

At one time there was a huge campaign for natural childbirth and complaints that birth, a 'natural process' had been over medicalised. I remember very strident views, on both sides.

If there is not strong leadership at hospital department level that is directing policy that is clearly prioritising clinically driven decisions then it enables individual personalities to have more influence than is appropriate.

Interesting discussions on Women's Hour atm.

MaizieD

Katie59

Rent a place in a safer area for a few years, it would be easy to rent mine out for a year or two, thankfully I’m way past all that.

As a retired midwife I threw the towel in 6 yrs ago, there were just too many “lucky breaks” due to staff shortage. (not Shropshire)

I'd be very interested id Katie59 would come back to tell it from a midwife's perspective.

There have been some very judgemental posts already; it would be good to get a professional view.

Remember we are working 12 hour shifts, babies dont arrive to order, they come in at 2am when you already have 2 others in labour and you have to cope, mistakes are made when you get called to attend several at the same time. It’s not like an operating theatre where everyone in concentrating on the same procedure and it’s all planned out.
That was a far cry from when I started, adequate staff and a week in the unit for new mums, the whole process became impersonal, even to the extent of the dialog with the client/patient.
As for C sections there wasn’t any particular target where I was, certainly not any kind of restriction.

Yes I’m convinced that the issue has arisen as a result first because of grossly inadequate staffing levels and it would seem a culture imposed on new mothers, which appears to fail to use the technology available in favour of so called natural birth.

My children were born during the early 70s. Throughout pregnancy I was seen on a monthly basis and as pregnancy advanced more often until on a weekly basis. I also attended prenatal classes.

During the birth I was attended by a dedicated midwife. I don’t remember any pressure whatsoever to have a particular type of birth, and being able to pop out babies like peas, I had a natural birth, but I had friends who had various levels of pain relief and CS, I don’t remember them thinking they had somehow failed, simply happy to have a normal baby. Technology was there to be used to our and babies advantage.

I remained in hospital for a week. Both baby and myself was in the care of the hospital and was officially handed over to my care at the door of the hospital having been carried by a nurse to the door.
Midwives and health visitors then took over the duty of care once I arrived home for a while, and were always available for advise.

I think things have changed.

I also think I was lucky to have my babies a long time ago, - the 1960's in my case, - with so much care and attention and a dedicated midwife. I was in hospital for ten days with my first one, - that was normal then,- and a week with my second.
My word, how it has deteriorated. My heart goes out to all the parents who have suffered in Shropshire, and anywhere else. I don't know how they contain their distress and anger.
The NHS needs a complete overhaul, it just isn't working properly, but I fear it won't happen.

Absolutely dreadful. I have been reading some the Ockenden Report this morning.
Those poor poor mothers and babies, almost impossible to comprehend.

I skim read the whole 250 page report yesterday. In a way it was a shame the press homed in so much on the push at the hospitals for "natural" births. Many of the things that went wrong repeatedly were simple incompetence. There were examples of births that were induced when the baby was not in a position where it could be born. Failure to monitor babies heart rates, not arranging an ambulance not be ready for transfers to other hospitals in serious cases, no anaesthetist being notified to attend, failures to carry out ultra sound scans. The list went on and on. Added to all this there were reports of consultants not being prepared to attend ward rounds and a horrible entitled and unpleasant attitude by senior staff to midwives and patients. It all made me cry. I come from Shropshire and remember a friend of my mother's daughter being denied a caesarean for a breach birth - she was petrified and had a very hard time of it.
There is so much they need to do to rectify this dreadful situation and appeasing the press by carrying out more caesareans won't resolve the issue, the whole system needs rebuilding with proper principles at its heart and firm effective monitoring.

When I had my first son they gave figures of 1 in 9 births were c sections. In the hospital I gave birth it was 1 in 9 were not c sections. Oddly enough they were carrying out a study in c sections by epidural against c section by a general. Just saying

My dd has just finished a stint as an FY2 doctor in a Maternity Unit. She loves the mum & baby aspect but she says the working culture is the worst she’s experienced and Obstetrics is considered to be the most toxic culture of all specialities.

The stories from some of the families that were seeing in the news are beyond tragic. The entire thing appears to be a mix of different issues and it’s not the only place it’s happened. There’s Furness Hospital and also the East Kent Trust, where I think an inquiry is due or ongoing.

My other dd had a baby last October. Her experience compared to her first, four years earlier, was shocking. Two midwives and no other healthcare staff (because they only work 9-5) for three labouring women. Only one working monitor in the unit. Broken examination lamps so her Dh had to hold a torch while the midwife examined her! A bathroom that had been out of action for six months. Technology was down so midwives had to use pen and paper and had no access to records.

Thankfully all was well for my dd, but I believe it’s only a matter of time before a baby or mother, or both, die. This is in Scotland.

This made me so sad. I had babies 2 and 3 in the hospital that the current hospital replaced. It was a lovely experience both times.

Not relevant I know so, as you were!

Some impressive hysteria on this thread. Yes the report is shocking but the review happened - those people crying out for privatisation of the NHS should think about Ian Patterson who did his worst work at a private hospital where no-one, but no-one, ever questioned him. And Casdon is correct, this is not management telling doctors what to do (as if!!) but a clinical culture that was allowed to fester due mainly to isolation.

I wonder if they used the word hysteria about the women who raised concerns, I bet they did.

Listening to Donna Ockenden the report author, she was very clear it was not one thing but a perfect storm of hands off senior management, some strongly opinionated practitioners, underfunding, staff shortages etc that enabled a " toxic culture" to develop.

Galaxy

I wonder if they used the word hysteria about the women who raised concerns, I bet they did.

bound to have done

I had my two children in 1969 and 1972 both by emergency ceasarian. I am 4ft 10ins with small hips and shoe size. When did midwifery training in the mid 60s I was told this was indicative of a narrow pelvis and possibility of ceasaran birth.
I was told late in pregnant that I was ''ok'' pelvis wise and should have no difficulty giving birth.My first labour went on for hours with no progress, and a high unengaged baby's head.A doctor broke my membranes, my DS1 went into transverse lie and started to pass meconium, I had developed a Bandle's ring where the womb contracts round the baby-you could actually see his shape under my tummy lying crosswise.
One very quick dash to theatre I can remember two nurses running while pushing me on the trolley.The general anaesthetic used nearly killed us both, I stopped breathing and my snows brought out nearly dead with an Apgar of 1.There was a seemingly miraculous recovery of both of us, but my son developed a personality problem later which may have been caused by his birth.
My second pregnancy went normally like the first one, and somehow it was decided that the only reason for the previous section was the transverse lie.I was worried very worried and got to such a state that if another section was needed I would have the tubal tie which went against my religious beliefs.
I was assured that would have a lovely birth this time but surprise surprise labour became complicated again.DS2 got ''stuck'' inside me his head was jammed in my pelvis and needed to be got out with forceps when they opened me up.Also my womb was about to rupture along the previous scar.His Apgar was 3 slightly higher but thankfully dd not have long time effects and is now a father and grandfather my tubes got tied so I would never have this fear again, but it has left me still guilty of committing a sin.
I will not fault the aftercare I had,I was in hospital for a fortnight both times as was normal then, came home back on my feet and minus all clips and stitches.When I asked why was allowed to go into labour again for the second baby the answer I got was ''Well we like to give you a try''.
The reports about Shropshire are terrible.It seems it depends on what health authority and what consultant you get when it comes to caesareans by maternal choice.I have heard of people asking and getting them with no medical reason at all while others are refused often with terrible consequences.

Sorry for typos I am showing my age, should have previewed my post first

Attitudes to women patients in healthcare settings needs to change. Too many health ' professionals' who are arrogant, rude, have a God complex and treat women patients as if they are imagining things. Ive heard umpteen stories of women who are pooh poohed after they mention genuine concerns. Either that they are depressed or like my dear relative was told 'it was all in her mind'. Except it wasn't, she died from a serious illness months later. I'm very sorry what has happened to these ladies and their children, it's just awful. However, until attitudes towards women by health professionals change for the better, tragedies will still happen. Read some of the horrific testimonies that were given in the MESH enquiries, yet they still have not banned MESH. That is just one other example where women were dismissed.

The chronic underfunding and consequent staff shortages have an impact.

vegansrock Ockendon recognised the financial constraints etc. as contributing to the toxic culture.