Here it is my blog aimed at NHS managers and fundholders of maternity services – time to explain a few home truths. MORE support is required for midwives in the operating theatre from upper NHS management in order to facilitate and maintain SkinToSkin contact between mothers , fathers and babies .
A few reasons the midwife may have for leaving theatre include : –
To check the placenta
To take blood gases
To obtain documentation from a printer (which is not actually in the operating theatre)
To complete digital or written records
To register the birth
Let’s look at it another way – if an operating department practitioner said to a midwife “I just need to nip out for a few minutes can you step in for me for a few minutes and help the anaesthetist? ” how would a midwife feel ? How often does this happen ? Never !!
We must respect each another’s professional competencies and abilities and not take advantage of any given situation . The operating theatre is governed by health and safety due to the highly clinical nature of its environment . Midwives are selling themselves short by trying to manage their workload instead of questioning why they need more support .
We must deal with the root cause which is midwives leaving theatre to complete routine tasks (when they should be staying with women and babies)
The symptom is the fear of other staff in theatre of caring for the dyad , the woman’s fear at being unable to speak out that she’s scared of holding her baby during her operation or procedure .
I’d also like to refer to these key parts of the NMC code which seem to address care of the dyad in theatre so well .
If you are a manager support your midwives by auditing the reasons why a midwife might leave a woman in theatre for any length of time and address that issue with the multidisciplinary operating theatre team – there will be solutions and the solutions will improve care , safety , women’s and families experience of care in the operating theatre and well as giving midwives immense job satisfaction, plus enabling team cohesiveness – what more could you ask for ?
I am challenging all line managers to go into the operating theatre and watch the midwife – how can you make it better for the midwife and therefore the dyad ?
Keep on keeping on
Thank you for reading my blog
Please leave your comments as I appreciate all feedback
This blog is dedicated to Sandra Bland with love to her family #SayHerName ❤️
I have just finished reading the book “Talking to Strangers” by Malcolm Gladwell
The book is a critique of how we approach others through our body language speech, demeanour plus the various cues that we interpret or misinterpret according to our own life experiences, culture, colour , upbringing, religion or non religion , education , training ,inner feelings at that time and individual roles plus many other factors too numerous to list . One particular woman who in the book was Sandra Bland a black woman who was forced to change lanes on a highway because a police car was approaching with speed – the officer totally misinterpreted Sandra’s distress at being pulled over – he wasn’t kind with his words or approach and this led to Sandra being wrongfully arrested and she died in her cell three days later the verdict was suicide . When you listen to the recording of the officers first interaction with Sandra you can sense the irritation and suspicion in his voice as well as the tone he uses. He doesn’t see that Sandra may have vulnerabilities and that she is trying to calm herself by lighting a cigarette .
“GO PLACIDLYamid the noise and the haste, and remember what peace there may be in silence.
As far as possible, without surrender, be on good terms with all persons“
Unconscious bias is something we all have – This animation by Professor Uta Frith of The Royal Society explains unconscious bias in a concise way . It’s the 21st Century – time for all NHS staff to be educated, assessed and held to account around the subject of unconscious bias plus to question their own personal identity around this issue .
Here is a photograph of part of the philosophy of the Royal Society panel members – a philosophy for the NHS .
If you are a midwife I want you to start to question the way you speak to women and families that you meet and whether you treat each woman or person exactly the same despite their background , culture , colour, sexual orientation and education. Make an attempt to hear yourself as the woman hears you – be patient and thoughtful with your words and actions . Watch how other midwives speak about the women they care for (at the bedside and in the office ) and monitor one another for unconscious bias .
Did you see someone give the woman everyone recognised from a TV programme better care than the woman who arrived unannounced from the local homeless shelter ?
Please question everything you see and if you talk about it more when reviewing cases of different women you might see a pattern start to occur – that’s what you need to change. Does your incident reporting system include statistics on race , sexual orientation, religion and ethnicity? If not how can such incidents be thoroughly evaluated ?
How do you talk to the women you meet as strangers ? When you show patience, kindness, compassion and understanding you are building on the relationship and helping the woman to feel safe . This behaviour has an effect on the woman’s oxytocin response as her adrenaline and cortisol will be reduced as well as her own fears . You are putting her at ease – becoming a friend . If on the other hand you are brusque , rushed , impatient and critical you will put the woman on edge and increase her fear , pain and cortisol which will inhibit oxytocin production.
Are you pre judging a woman when she phones up the hospital for advice ? Does that judgment impact on the way you interact with the woman ? Do you feel calm or under pressure? Are you more or less patient with her in comparison to someone else you’ve recently cared for ? Are you imparting information and evidence of equal quality or do you feel a change in your own demeanour which may make the woman feel uncomfortable without realising?
Reflect on a situation when you didn’t feel listened to – that may have been a complaint to a store or a the way an employee at a restaurant/ service / shop spoke to you – do you recall how you were made to feel or how you reacted?
This is a current drive in the NHS so I’ve decided it’s time for me to blog about it .
We are often told as midwives that it’s not about working harder but working smarter .
I’d like to try and find out if there is data collected about individual Trusts . The data would perhaps identify times when staffing was low , what the risks were to the women and the pattern of incident reports on those occasions . I also suggest that all maternity units have a duty of care to their staff to maintain accurate , exact records on how women are allocated to midwives, midwives individual workloads and time spent on NHS computers for work and personal use – this should be reviewed on a monthly basis and as part of FOI be available to the public . Do NHS Trusts that are using their own full time maternity staff to supplement staff absence and sickness assess the wellbeing of those staff? Is there a collaboration with occupational health , organisational development and Human Resources departments to review whether or not satisfactory and timely breaks were given. When this is quantified does it identify a distinct association with lack of breaks , working unpaid overtime , poor culture and is there a correlation with staff sickness and absence ?
it’s time now to look at the bigger picture and collect data on these topics as well as birth statistics , outcomes , morbidly and mortality .
‘I had an idea-to write a little blog every few months that would help the midwives and nurses at gtdhealthcare with their continued professional development needs, in preparation for revalidation.
So here goes, my first blog on sepsis. I hope that you all enjoy it –please do comment if it is of use.
The idea of blogging is to share ideas and to embed ‘things’ into the blog that make shared learning easy. Story telling has become an important part of learning in healthcare. Here I will share my two personal stories of sepsis and links to evidence based learning tools and red flag symptoms of sepsis.
Sepsis is more common than a heart attack ! Isn’t that shocking?
The 2015, NCEPOD report, ‘Just Say Sepsis’, Identified an overall mortality rate of 28.9% per annum, at least 120 people die every day from sepsis in the UK alone.The sepsis manual 2017 (embedded) says “it seems highly likely that, across the UK, sepsis claims at least 46,000 lives every year, and it may actually be as high as 67,000”. Who would have thought that the figures would be this high?
Sepsis that occurs during pregnancy is termed, ‘maternal sepsis’. If it develops within six weeks of delivery it is termed postpartum or ‘puerperal’ sepsis. Sepsis is one of the leading causes of direct maternal death in the UK. See maternal sepsis tools in the Sepsis manual 2017 (below).
The HEE have developed a wonderful e-learning programme on sepsis which can be accessed via the web link below.
They have also produced a short film that is really helpful
Sepsis is a condition which every health professional might encounter, and which can touch anyone at any time. In general, patients developing sepsis aren’t ‘labelled’ as being at high risk for that condition (in comparison with, for example, a majority of patients presenting with acute severe asthma or diabetic ketoacidosis). There is no one ‘hallmark’ symptom or sign, unlike the crushing chest pain which the public know might indicate a heart attack.
Because of this, patients tend to present to healthcare late, as evidenced by a 2015 report from the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) which found that, where patients were felt to have presented late to hospital, in nearly 60% of cases it was because they did not ask for help and the delays were typically measured in days rather than hours.
The National Institute for health and healthcare excellence (2017) have also published guidance on the prevention and management of sepsis- to take a peek CLICK HERE
I have had two personal experiences of sepsis, in the days when little was known about the condition.
My first child had sepsis and septic arthritis at the young age of 7 (29 years ago). She had suffered with recurrent Tonsillitis for two years and had been treated with numerous courses of antibiotics. She developed severe pain in her hip and over the next five days became increasingly ill. An initial xray revealed nothing and because there were not hot spots seen, her symptoms appeared to become irrelevant; the hospital staff would not listen to me nor would my GP. Although I took my daughter on many visits to the GP and Accident and Emergency Department nothing was done. In fact I was labelled as an over-anxious mother and directed to the paediatric pain services to learn to control my daughter’s ‘discomfort’.
On the 5thday of her illness she was hallucinating, confused,her temperature was 35C and she was mottled and cold to touch, her lips were blue. I took her straight back to Accident and Emergency. Two hours later she was in theatre and then spent 6 weeks in hospital on traction and two weeks on intravenous antibiotics, her reminder a scar from thigh to knee.
The final diagnosis came, Sepsis and severe Septic arthritis of the hip.
We counted our blessings daily; if I hadn’t been the awkward mother the outcome could have been worse. The hospital offered their sincere apologies and lessons were to be learnt.
One lesson I took from this-was always take note of what the parents are saying after all they know their child better than you do.
My second child had sepsis years later. Age 11 years; his tooth was broken when he was hit accidentally with a cricket bat. The tooth was crowned and the temporary crown kept falling off. Sepsis was quick to bite (pardon the pun).
This time there was a more rapid onset of symptoms. My son came in from playing out and said he felt unwell; he was shivering excessivelyand looked pale and mottled. His temperature was high, yet he sat firmly besides the warm hot radiator because he felt cold. I took him straight to Accident and Emergency and the staff in this department were trained to spot signs of sepsis.
Immediately bloods were taken, he was admitted and intravenous antibiotics were were administered within an hour of our arrival at Accident and Emergency. Two weeks later we were back home with a well child.
So what can be learnt from these two examples of sepsis? The symptoms can be variable –take a look at spotting sepsis below. The onset can also be variable. There are red flag symptoms, early assessment, diagnosis and management are vital.