So sad to read about this--I've always admired the UK and the NHS for the outcomes they previously achieved.
I keep coming back to Alaska--it is arguably the state with the most difficult, rural infrastructure (and worst weather!) and it also manages to have the highest rate of CNM attended birth (31% I believe?) and one of the lowest C-section rates. All these problems--infrastructure, staffing, etc--They.Are.Solvable. When we let money and convenience do the talking, bad outcomes will follow.
I too am noticing a shift toward locums (OBs) and travel nurses to meet staffing demands. I have had shifts where I had to call in another coworker (unscheduled, she was doing it out of the goodness of her heart) to keep patients safe and keep me from drowning. I also worry about the direction we're headed in the U.S. 😔
Thank you, Neil, for this very thought-provoking article. It certainly is a wake-up call not just for the US, but even for a country like India, where C-sections are spiralling out of control,( especially in the private sector) and women are not given the care they need . I am convinced maternity services need the collaborative model of care where midwives and obstetricians work with mutual respect and trust along with allied specialists where required. To provide 24x7 cover and continuity of care, it has to be a team, the size being influenced by the volume of births. Your article has listed many areas of concern and I pray we will be able to work on finding efffective long-term solutions.
Neel, I have been following your inspirational work for quite a few years and am delighted to see this latest development. Very thought provoking comparison between the NHS crisis and the current US maternity situation indeed! A wake up call for us. I pray it is not too late.
True collaboration and collegiality are a start. Thank you for joining the ICM board.
Big health insurance company reimbursement road blocks every time we turn around are discouraging and making midwifery care unattainable for many.
Regretted the “physician extender” role I fell into a few years ago and returned to the home birth setting. I am a midwife not a mini-doc.
Blessings on your mission,
Sincerely,
Merideth Geers, CNM
A nearly 68 year old, exhausted midwife in a rural maternity desert in Central NYS.
Former NHS midwife here. I left for all the reasons you have stated. Midwives are not the problem. A ‘not fit for purpose’ system is. The goodwill is running out and taking the midwives with it. Women are suffering. Babies are compromised and dying. This is an international emergency. It needs to be treated as such. ‼️🚨
Neel, I agree with this analysis. Can I draw readers attention to two specific iatrogenic harms I started noticing towards the end of my OB career.
1. Second stage Caesarean done for minor FHR abnormalities, or maternal request, rather than either watchful waiting, or a rather easy instrumental birth.
2. Emergency pre-term Caesarean performed for false positive FHR abnormalities.
In both scenarios, if a poor outcome ensues, the parents are often grateful for the "harmful" intervention, & wish it had been done earlier. Later reviews are hampered in criticising the initial section because "They weren't there. The head was a bit high. The FHR slowed later, but wasn't picked up on the trace, etc."
I don't have an easy answer. But Andrew Weeks' prediction that UK outcomes will worsen soon (may already be worsening) due to over-(not under-) intervention seems plausible.
So sad to read about this--I've always admired the UK and the NHS for the outcomes they previously achieved.
I keep coming back to Alaska--it is arguably the state with the most difficult, rural infrastructure (and worst weather!) and it also manages to have the highest rate of CNM attended birth (31% I believe?) and one of the lowest C-section rates. All these problems--infrastructure, staffing, etc--They.Are.Solvable. When we let money and convenience do the talking, bad outcomes will follow.
I too am noticing a shift toward locums (OBs) and travel nurses to meet staffing demands. I have had shifts where I had to call in another coworker (unscheduled, she was doing it out of the goodness of her heart) to keep patients safe and keep me from drowning. I also worry about the direction we're headed in the U.S. 😔
100%
Thank you, Neil, for this very thought-provoking article. It certainly is a wake-up call not just for the US, but even for a country like India, where C-sections are spiralling out of control,( especially in the private sector) and women are not given the care they need . I am convinced maternity services need the collaborative model of care where midwives and obstetricians work with mutual respect and trust along with allied specialists where required. To provide 24x7 cover and continuity of care, it has to be a team, the size being influenced by the volume of births. Your article has listed many areas of concern and I pray we will be able to work on finding efffective long-term solutions.
You have modeled collaborate, team-based care from the beginning and are an inspiration Evita!
Neel, I have been following your inspirational work for quite a few years and am delighted to see this latest development. Very thought provoking comparison between the NHS crisis and the current US maternity situation indeed! A wake up call for us. I pray it is not too late.
True collaboration and collegiality are a start. Thank you for joining the ICM board.
Big health insurance company reimbursement road blocks every time we turn around are discouraging and making midwifery care unattainable for many.
Regretted the “physician extender” role I fell into a few years ago and returned to the home birth setting. I am a midwife not a mini-doc.
Blessings on your mission,
Sincerely,
Merideth Geers, CNM
A nearly 68 year old, exhausted midwife in a rural maternity desert in Central NYS.
Thank you Merideth, for your kind words, and more importantly for persisting in providing the care families deserve despite all of the challenges
Former NHS midwife here. I left for all the reasons you have stated. Midwives are not the problem. A ‘not fit for purpose’ system is. The goodwill is running out and taking the midwives with it. Women are suffering. Babies are compromised and dying. This is an international emergency. It needs to be treated as such. ‼️🚨
Thank you for reading this so closely, and for saying more plainly than I did what took me an entire piece to argue!
Neel, I agree with this analysis. Can I draw readers attention to two specific iatrogenic harms I started noticing towards the end of my OB career.
1. Second stage Caesarean done for minor FHR abnormalities, or maternal request, rather than either watchful waiting, or a rather easy instrumental birth.
2. Emergency pre-term Caesarean performed for false positive FHR abnormalities.
In both scenarios, if a poor outcome ensues, the parents are often grateful for the "harmful" intervention, & wish it had been done earlier. Later reviews are hampered in criticising the initial section because "They weren't there. The head was a bit high. The FHR slowed later, but wasn't picked up on the trace, etc."
I don't have an easy answer. But Andrew Weeks' prediction that UK outcomes will worsen soon (may already be worsening) due to over-(not under-) intervention seems plausible.
Fully agree Jim. A bad outcome vindicates the intervention, a good one hides it, so the harm never quite surfaces. No easy answer there.
Brilliant summary, I wish the reporting in the UK was as balanced as this article.
Ps you would make an excellent investigative reporter!!!
ha, thank you Ann!
May I add my book to your reading list? https://amzn.eu/d/0j12m6lK