Caesarean births twice as risky as natural deliveries
By Jeremy Laurance, Health Editor
Published: 31 October 2007
Women who choose a Caesarean delivery, sometimes described as "too posh to push", are increasing the risk to themselves and their baby. Surprise results from an international study of 97,000 deliveries show that a routine Caesarean puts a woman at twice the risk of illness or death compared to a vaginal birth.
And babies born by Caesarean had a 70 per cent higher risk of dying before discharge from hospital if they were lying normally head first in the womb than if delivered vaginally.
A Caesarean delivery was, however, found to be safer for babies lying in the less common and riskier breech position – feet first.
The findings are from eight randomly selected countries in Latin America, where Caesarean rates are higher than in the UK, at an average of 33 per cent of all births. Well-heeled Latin American women are more anxious about the potential effects of a vaginal birth on their sex lives and in some private hospitals the Caesarean rate is up to 60 per cent.
In Britain, the Caesarean rate has doubled in the past 20 years to 22 per cent, driven in part by the demand of some women for what is perceived as a convenient and pain-free method of delivery. Obstetricians too have seen it as safer – and as a way of reducing risks of litigation. The latest study, published online in the British Medical Journal, suggests the safety of Caesareans may have been overstated.
Jose Villar, former director of maternal health at the World Health Organisation and now a senior research fellow at the University of Oxford, who led the study, said there was no benefit from the very liberal use of Caesareans, either for mothers or babies, and they could even do harm.
Caesareans led to longer hospital stays for mothers and babies, increased the risk of readmission and increased the risk to subsequent pregnancies.
The only exception was that babies in the breech position did better and women had fewer severe vaginal complications.
Dr Villar said the findings should be applicable to Europe and the UK because of the large number of deliveries surveyed, the comparability of outcomes to those in Europe and because the overall Caesarean rate was not dissimilar.
"The message is that a woman thinking of having a Caesarean because it is safer should think again," he said. "It is a question of balancing the risks and benefits. She should sit down with her care provider and consider the options. We think this is the most comprehensive study that has been done."
In a commentary on the findings, Alison Shorten, of the School of Midwifery at the University of Wollongong, New South Wales, Australia, said an important reason why women chose Caesareans was because of worries about damage to the pelvic floor from a vaginal birth, which could lead to sex and bladder problems. "Women need to weigh up the possible but uncertain benefit of preventing urinary problems against the increased chance of problems related to surgery in themselves or their baby," she said.
Pat O'Brien, consultant obstetrician at University College Hospital, London, and a spokesman for the Royal College of Obstetricians and Gynaecologists, said: "We have always known from the mother's point of view a planned Caesarean was slightly riskier... Recent research from the US has suggested the risks of the two approaches were getting closer and closer. This latest study pushes that back a bit."
Bump to Motherhood
Thursday, December 13, 2007
The tragic human cost of NHS baby blunders
http://www.guardian.co.uk/society/2007/sep/23/health.medicineandhealth
The tragic human cost of NHS baby blunders - Not for the faint hearted so don't read it if you are!
Errors and negligence that result in stillbirths or disabled babies are costing Britain's hospitals billions in compensation. In this investigation, The Observer reveals how staff shortages are wrecking the lives of countless parents
* Denis Campbell
* The Observer,
* Sunday September 23 2007
What began as a routine pregnancy but turned into a tragedy for one family will finally end this week in a West Midlands courtroom. The hospital charged with caring for the mother will finally agree to pay £5m in damages to the parents of a boy left in a wheelchair, unable to communicate or do anything for himself, after suffering cerebral palsy because of mistakes made by staff during his birth.
It might sound like a lot of money. But consider - it costs £120,000 a year to provide the 24-hour, all-year-round care needed by the boy, who is now 16. The imminent award also reflects the fact that he will never be able to work, and that his parents have had to move to a bungalow and had it specially adapted to cope with his needs, such as a therapy room where he tries to do gentle exercises to stop his muscles from wasting away from moving around so little.
His parents, who have asked not to be named for legal reasons, would rather it had never come to this. 'When I told the boy's father that the report into the case we had commissioned from an independent obstetrician had said that it was negligence, that someone at the hospital hadn't done their job properly and that the care was sub-standard, he began crying,' recalls the family's lawyer, Lindsay Gibb, of solicitors Irwin Mitchell in Birmingham. 'He wanted us to tell him that it was no one's fault, that it was just one of those things, so to learn that it was avoidable was very difficult for him.'
The hospital's first blunder was to send the boy's mother home after hospital staff had failed to induce the birth. An expert witness who gave evidence for the family said that, given the late stage of her labour, she should definitely have been kept in until the baby arrived, if necessary by Caesarean section. Later, when she was back in hospital again, the child became distressed while he was being delivered and suffered a sudden loss of air to his brain when meconium, the result of his first bowel movement, seeped into his lungs.
Usually, when maternity staff realise that is occurring, they suck out the meconium. But when the anxious personnel attending the woman sought advice by phone from a neonatologist, a specialist in dealing with newborn babies, the doctor seems to have failed to appreciate how serious the situation was. Her guidance meant nothing was done to tackle the baby's oxygen starvation and respiratory collapse.
Despite the large sum involved, the settlement this week is unlikely to get much publicity, because such payouts are fairly common nowadays. The going rate in compensation for a baby who suffers brain damage due to negligence during birth is £3m-£6m. When the mother dies, the payout can also run into millions. Parents of a child who is stillborn receive £50,000-£100,000. Relatively minor damage, for example to a baby's arm, brings about £45,000. Given such sums and the frequency with which such incidents occur, it is easy to see how the NHS has ended up in a position where, as The Observer reveals today, it is being sued for £4.5bn in compensation for alleged mistakes in just one area of its work, albeit a vital and difficult one: obstetrics, the branch of medicine dedicated to ensuring that women get the best possible care during pregnancy, childbirth and afterwards.
Now the new leader of the 5,500 doctors working in this field has reopened a debate that stirs strong emotions by claiming that the health and safety of both pregnant women and babies are being put at risk because there are too few consultants on duty for too few hours in too many maternity units around the country, because hospitals do not employ enough of them to ensure that patients receive proper care.
Professor Sabaratnam Arulkumaran, the head of obstetrics and gynaecology at St George's hospital in south London, takes over this week as the new president of the Royal College of Obstetricians and Gynaecologists. The 60-year-old, who is widely respected following a long career both here and abroad, does not have a reputation for being outspoken. But, talking to The Observer last week in his first interview in his new post, he did not pull punches when dissecting what he sees as the failings which have left the NHS facing a £4.5bn barrage of claims.
'The staffing numbers for consultants aren't adequate at 40 to 50 per cent of hospitals in the UK, though I'm sure that will apply to midwives too. The effect will be that the quality of care will not be what the patient expects', warns Arulkumaran. 'The risk incidence must be greater at those hospitals. There's a direct connection between staffing levels and the risk for patients. We know that the main cause of risk incidence is inadequate personnel. Quality and safety need to be improved.'
He points to a National Patient Safety Agency study of 'serious critical incidents', where children or their mothers ended up being injured during birth. This showed that the three most common reasons for such a tragedy were, in order, 'delay following call for assistance', then 'busy or heavy workload' and, thirdly, 'senior staff not available'.
Arulkumaran says that there are about 1,600 consultants at the moment but that that number needs to rise to 2,100 right away, and ideally to 2,500 before too long, to ensure that every woman giving birth in the UK gets the highest standard of care possible.
The professor was the expert called in by the government to get the maternity unit at Northwick Park in north-west London back on track after 10 mothers-to-be died there between 2002 and 2005. He cites the verdict of the Healthcare Commission watchdog, that 'lack of consultant obstetrician input' was a factor in six of the 10 women's deaths, to underline his point.
Consultant obstetricians are the senior doctors whose skill, judgment and experience helps ensure that complications during childbirth are handled in a way that they do not turn into what are called 'risk incidents'. But the shortage of them means junior doctors are often left to handle tricky cases themselves. This is a situation which can leave them feeling 'threatened and exposed', says Arulkumaran, although they can seek advice by telephone from a consultant, who may come in if their in-depth knowledge is required.
When birth problems do occur, though, time can be crucial for the baby or mother's welfare, and the lack of what Arulkumaran calls 'an experienced hand' on the scene and ready to make quick decisions can be vital. An NPSA analysis of 'timings of severe fetal distress events' shows that, when a baby dies, it is most likely to be between midnight and 8am, precisely the time when there is likely to be no consultant around.
When it does all go horribly, tragically, wrong, parents often feel pushed into legal action. 'It's quite a hard job doing these cases because these people don't really want to get involved with a solicitor', says Gibb, one of a growing number of lawyers who work solely on medical negligence claims. 'Generally people come to us when they haven't been able to get answers from the hospital. Initially they want answers rather than money.
'Often if the hospital simply explained and apologised, there wouldn't be a legal claim. Especially when a baby has died, money isn't going to make much difference. But people want explanations and answers as to why something terrible has happened to them. They embark on the legal action as a fact-finding exercise.'
Gibb works in the medical law and patients' rights department of the Birmingham office of Irwin Mitchell. When she joined five years ago, she was one of five solicitors. Now there are 15, all dealing full-time with claims against the NHS for various forms of alleged medical negligence.
'This area of law has really grown. The cases just keep coming and coming', says Gibb. 'Every time we take on a new member of staff, they can quickly have 60 cases to deal with without really trying.' About 15 of her own 60 current cases involve obstetrics, and some involve very large sums of money. Maternity claims make up about 20 per cent of the total number of claims for medical negligence, but 60 per cent of the damages paid.
After five years pursuing such cases against hospitals in the West Midlands, Gibb is frustrated that the NHS does not seem to be learning from the recurring problems in its maternity units. 'You think that hospitals might have learnt their lesson after settling so many negligence cases, because each case brings a letter of apology and a financial settlement. They say that they are learning and have changed particular procedures. But they don't have enough staff, especially midwives, to stop these things happening', says Gibb. 'So you keep getting these tragic consequences over and over again, which can be devastating for families, and which could be avoided if lessons really were learnt by the NHS.'
Two mistakes lead to many of Gibb's cases. First, staff, usually a midwife, fail to properly read the traces on a cardiotochograph, the piece of equipment put over the woman's stomach to measure the baby's heartbeat during labour. 'If the trace becomes abnormal, they should call a doctor straight away. We see the cases where that hasn't happened and, when he has been called, it's a crisis and he wants to get the woman into surgery for an emergency Caesarean section to get the baby out as soon as possible', explains Gibb.
She is 28. 'As a young woman, it makes me quite scared about the idea of ever having children. It worries me that the same mistakes happen over and over again.' These days, when any of Gibb's colleagues has a baby, they monitor the cardiotochograph trace themselves, and don't rely on the midwife doing it, just to be sure.
Second, the fact that a baby is having problems in the womb can go undiagnosed. 'The mum goes to the hospital before the birth and says that she's not feeling very well and can't feel the baby moving. Maybe because they are so busy with everything else, they don't admit her, and maybe, by the time she goes back, the baby has died and they have to deliver it stillborn.'
Concern over the quality of Britain's maternity services is one of the NHS's biggest challenges. The deaths of babies and mothers during childbirth, scandals involving inadequate care in the maternity units of several hospitals, countless inquiries, and a welter of official reports have led to repeated calls for improvements. A rising birthrate partly fuelled by immigration, and the increasing frequency of complicated cases presenting themselves because of the growing number of mothers who are either older or obese, mean that an already difficult area of medical practice has recently become even more demanding for those involved. Yet few of those who work in the field believe the action taken so far is enough or that maternity services yet get the priority they deserve within the NHS.
Karlene Davis, general secretary of the Royal College of Midwives, said: 'The service is at breaking point.' The main problem is that 'it is patchy. In some areas it's good, but in other places there aren't enough midwives and you get a service where women are dissatisfied and sometimes unsafe practices occur'.
The Department of Health insist that England has a good record on births. Gwyneth Lewis, the Department of Health's chief adviser on childbirth, says: 'Due to the skill and expertise of our midwives and doctors, England is one of the safest places to have a baby.' In a study she conducted of almost 2 million births over three years, just 50 women died 'of obstetric complications that were not managed as best as they could have been, and there is no evidence to suggest any increase in this rate since', she adds.
The NPSA, the NHS body which aims to make receiving healthcare less risky than it sometimes proves, states that: 'The vast majority of the 650,000 pregnancies a year in England and Wales are successful, with mother and baby well.' But, it adds, 'there is evidence from a variety of sources that women and their babies sometimes experience unintended harm, often as a result of problems relating to deficiencies in intrapartum care [during labour and childbirth] and problems in communication.'
Its figures show that, in the past three years, 17,676 women were injured, 1,000 seriously, in labour. However, another 2 million women delivered safely.
In a speech on 3 October on the safety of maternity care, Arulkumaran will point out that more than one of every 100 births is problematic. Of the 668,681 live births in England, Wales and Northern Ireland in 2005, 7,225 ended up being notified to the official Confidential Enquiry into Maternal and Child Health because there had been an issue involving the baby's safety. Those 7,225 cases comprised 1,193 'late fetal losses', where the baby died between 20 and 24 weeks; 3,676 stillbirths; and 2,356 neo-natal deaths, in which the baby died in its first week of life. Employ more consultants, have their expertise on hand, and those figures will come down, says Arulkumaran.
He is aghast that hospitals are being sued for such a colossal sum of money and can think of a much better use of the NHS's resources. 'The presence of a consultant increases the safety for mothers and babies; incidents happen when there aren't enough people present, especially senior doctors', he says. So why not use a proportion of the amount currently paid out in damages to hire more consultants and more midwives, he asks.
'The cases where a baby suffers lack of oxygen, which can lead to brain damage, is one or two per 1,000 births in the UK. If a hospital delivers 5,000 babies a year, it may have 10 such cases a year, each of which could cost it [at least] £3m', explains Arulkumaran. 'Even if one of those cases could be avoided by having additional staff, you are going to save £3m. Spending £1m a year would buy you two consultants and 15-20 midwives.'
His message is aimed at hospital managers, who decide on staffing levels, and the government, which sets the NHS's priorities. 'We should try expanding consultant numbers, because otherwise we are paying out taxpayers' money which could and should be better spent rather than being used to settle litigation. The quality and safety of Britain's maternity services can and must be improved.'
'I tell myself I have two lovely daughters, but I have lost my son and the pain will never go'
Vicky Gough from Telford gave birth to a stillborn baby on 4 September 2001. Doctors tried to resuscitate the baby but, after half an hour, they were forced to declare him dead. Vicky and her husband Steven received £50,000 in compensation after Shrewsbury and Telford hospital, where baby Thomas was born, admitted a series of failings in his maternity care. Here, Steven tells Amelia Hill the devastated couple's story.
'Vicky was exhausted and drugged out so she wasn't aware of what was happening but I was forced to stand there and watch all these people rushing into the room and battle to save my son's life. My brain froze and it took me ages to comprehend that something was really wrong. Then I just stood there and prayed that I would have a baby to hold; I didn't care if he had brain damage. I just wanted to be able to take my child home.
'When they told us Thomas was dead, it was completely soul-destroying. I kept repeating the words to Vicky but I could see she wasn't taking any of it in. I had to leave the room. I went out into the corridor and collapsed. I almost assumed the foetal position myself there against the wall, and just broke my heart. It was beyond description.
'They told us that Thomas had died because he'd been born with the cord twisted around his neck. We didn't think to question this until four years later when we decided to ask for the medical notes, not because we had any suspicions but because we were still deeply grieving and wanted something to hold on to.
'It was only when we started reading the notes that we realised what had really happened. It was so obvious that we were stunned. We wished so much that we'd had the confidence to speak up about things that had seemed wrong during the labour because, reading back through the doctors' accounts of what happened, it was obvious that Thomas died because of human error so total it was akin to neglect. Thomas's heartbeat was showing warnings for over 35 minutes. If they had noticed his heart was having trouble at any point during that time, he could have been born completely safely and healthy. If they hadn't noticed until later - so late we'd had to have a Caesarean - we still would have had a baby to take home, albeit a very damaged one. But the fact that no one noticed any of the warning signs at any point was just so shocking we couldn't believe it.
'The fact that the NHS trust has clearly verified that they really messed up has allowed us to achieve a certain amount of closure but we are still traumatised and unable to move on in any genuine way. I have trouble bonding with my younger daughter, born after Thomas's death.
I try telling myself I have two beautiful daughters but I have lost my only son, and that pain will never go away.'
Payouts and claims
34,497 the total number of claims for compensation which the NHS in England received between 1995 and 2006 over alleged clinical negligence by staff. Most came in surgery (13,449 claims), obstetrics and gynaecology (7,352), medicine (6,060) and A&E (3,732).
£20m thought to be the largest amount awarded to a woman injured during childbirth. Kerstin Parkin, a dancer from Surrey, was awarded a £7m lump sum and £250,000 a year for the rest of her life in 2002 for the brain damage she suffered while giving birth at the Farnborough Hospital in 1996.
18,000 pregnant women injured during childbirth, including 246 who died, according to a National Patient Safety Agency study of 60,000 maternity care mistakes between 2003-06.
£3.5m-£6.5m the sum which the family of a child left with cerebral palsy, caused by lack of oxygen during birth, usually receives in compensation.
18,748 the number of 'live' claims which the NHS Litigation Authority was dealing with last year.
5,697 fresh claims for clinical negligence received by the NHSLA in 2005-06, slightly up on 5,609 the year before.
The tragic human cost of NHS baby blunders - Not for the faint hearted so don't read it if you are!
Errors and negligence that result in stillbirths or disabled babies are costing Britain's hospitals billions in compensation. In this investigation, The Observer reveals how staff shortages are wrecking the lives of countless parents
* Denis Campbell
* The Observer,
* Sunday September 23 2007
What began as a routine pregnancy but turned into a tragedy for one family will finally end this week in a West Midlands courtroom. The hospital charged with caring for the mother will finally agree to pay £5m in damages to the parents of a boy left in a wheelchair, unable to communicate or do anything for himself, after suffering cerebral palsy because of mistakes made by staff during his birth.
It might sound like a lot of money. But consider - it costs £120,000 a year to provide the 24-hour, all-year-round care needed by the boy, who is now 16. The imminent award also reflects the fact that he will never be able to work, and that his parents have had to move to a bungalow and had it specially adapted to cope with his needs, such as a therapy room where he tries to do gentle exercises to stop his muscles from wasting away from moving around so little.
His parents, who have asked not to be named for legal reasons, would rather it had never come to this. 'When I told the boy's father that the report into the case we had commissioned from an independent obstetrician had said that it was negligence, that someone at the hospital hadn't done their job properly and that the care was sub-standard, he began crying,' recalls the family's lawyer, Lindsay Gibb, of solicitors Irwin Mitchell in Birmingham. 'He wanted us to tell him that it was no one's fault, that it was just one of those things, so to learn that it was avoidable was very difficult for him.'
The hospital's first blunder was to send the boy's mother home after hospital staff had failed to induce the birth. An expert witness who gave evidence for the family said that, given the late stage of her labour, she should definitely have been kept in until the baby arrived, if necessary by Caesarean section. Later, when she was back in hospital again, the child became distressed while he was being delivered and suffered a sudden loss of air to his brain when meconium, the result of his first bowel movement, seeped into his lungs.
Usually, when maternity staff realise that is occurring, they suck out the meconium. But when the anxious personnel attending the woman sought advice by phone from a neonatologist, a specialist in dealing with newborn babies, the doctor seems to have failed to appreciate how serious the situation was. Her guidance meant nothing was done to tackle the baby's oxygen starvation and respiratory collapse.
Despite the large sum involved, the settlement this week is unlikely to get much publicity, because such payouts are fairly common nowadays. The going rate in compensation for a baby who suffers brain damage due to negligence during birth is £3m-£6m. When the mother dies, the payout can also run into millions. Parents of a child who is stillborn receive £50,000-£100,000. Relatively minor damage, for example to a baby's arm, brings about £45,000. Given such sums and the frequency with which such incidents occur, it is easy to see how the NHS has ended up in a position where, as The Observer reveals today, it is being sued for £4.5bn in compensation for alleged mistakes in just one area of its work, albeit a vital and difficult one: obstetrics, the branch of medicine dedicated to ensuring that women get the best possible care during pregnancy, childbirth and afterwards.
Now the new leader of the 5,500 doctors working in this field has reopened a debate that stirs strong emotions by claiming that the health and safety of both pregnant women and babies are being put at risk because there are too few consultants on duty for too few hours in too many maternity units around the country, because hospitals do not employ enough of them to ensure that patients receive proper care.
Professor Sabaratnam Arulkumaran, the head of obstetrics and gynaecology at St George's hospital in south London, takes over this week as the new president of the Royal College of Obstetricians and Gynaecologists. The 60-year-old, who is widely respected following a long career both here and abroad, does not have a reputation for being outspoken. But, talking to The Observer last week in his first interview in his new post, he did not pull punches when dissecting what he sees as the failings which have left the NHS facing a £4.5bn barrage of claims.
'The staffing numbers for consultants aren't adequate at 40 to 50 per cent of hospitals in the UK, though I'm sure that will apply to midwives too. The effect will be that the quality of care will not be what the patient expects', warns Arulkumaran. 'The risk incidence must be greater at those hospitals. There's a direct connection between staffing levels and the risk for patients. We know that the main cause of risk incidence is inadequate personnel. Quality and safety need to be improved.'
He points to a National Patient Safety Agency study of 'serious critical incidents', where children or their mothers ended up being injured during birth. This showed that the three most common reasons for such a tragedy were, in order, 'delay following call for assistance', then 'busy or heavy workload' and, thirdly, 'senior staff not available'.
Arulkumaran says that there are about 1,600 consultants at the moment but that that number needs to rise to 2,100 right away, and ideally to 2,500 before too long, to ensure that every woman giving birth in the UK gets the highest standard of care possible.
The professor was the expert called in by the government to get the maternity unit at Northwick Park in north-west London back on track after 10 mothers-to-be died there between 2002 and 2005. He cites the verdict of the Healthcare Commission watchdog, that 'lack of consultant obstetrician input' was a factor in six of the 10 women's deaths, to underline his point.
Consultant obstetricians are the senior doctors whose skill, judgment and experience helps ensure that complications during childbirth are handled in a way that they do not turn into what are called 'risk incidents'. But the shortage of them means junior doctors are often left to handle tricky cases themselves. This is a situation which can leave them feeling 'threatened and exposed', says Arulkumaran, although they can seek advice by telephone from a consultant, who may come in if their in-depth knowledge is required.
When birth problems do occur, though, time can be crucial for the baby or mother's welfare, and the lack of what Arulkumaran calls 'an experienced hand' on the scene and ready to make quick decisions can be vital. An NPSA analysis of 'timings of severe fetal distress events' shows that, when a baby dies, it is most likely to be between midnight and 8am, precisely the time when there is likely to be no consultant around.
When it does all go horribly, tragically, wrong, parents often feel pushed into legal action. 'It's quite a hard job doing these cases because these people don't really want to get involved with a solicitor', says Gibb, one of a growing number of lawyers who work solely on medical negligence claims. 'Generally people come to us when they haven't been able to get answers from the hospital. Initially they want answers rather than money.
'Often if the hospital simply explained and apologised, there wouldn't be a legal claim. Especially when a baby has died, money isn't going to make much difference. But people want explanations and answers as to why something terrible has happened to them. They embark on the legal action as a fact-finding exercise.'
Gibb works in the medical law and patients' rights department of the Birmingham office of Irwin Mitchell. When she joined five years ago, she was one of five solicitors. Now there are 15, all dealing full-time with claims against the NHS for various forms of alleged medical negligence.
'This area of law has really grown. The cases just keep coming and coming', says Gibb. 'Every time we take on a new member of staff, they can quickly have 60 cases to deal with without really trying.' About 15 of her own 60 current cases involve obstetrics, and some involve very large sums of money. Maternity claims make up about 20 per cent of the total number of claims for medical negligence, but 60 per cent of the damages paid.
After five years pursuing such cases against hospitals in the West Midlands, Gibb is frustrated that the NHS does not seem to be learning from the recurring problems in its maternity units. 'You think that hospitals might have learnt their lesson after settling so many negligence cases, because each case brings a letter of apology and a financial settlement. They say that they are learning and have changed particular procedures. But they don't have enough staff, especially midwives, to stop these things happening', says Gibb. 'So you keep getting these tragic consequences over and over again, which can be devastating for families, and which could be avoided if lessons really were learnt by the NHS.'
Two mistakes lead to many of Gibb's cases. First, staff, usually a midwife, fail to properly read the traces on a cardiotochograph, the piece of equipment put over the woman's stomach to measure the baby's heartbeat during labour. 'If the trace becomes abnormal, they should call a doctor straight away. We see the cases where that hasn't happened and, when he has been called, it's a crisis and he wants to get the woman into surgery for an emergency Caesarean section to get the baby out as soon as possible', explains Gibb.
She is 28. 'As a young woman, it makes me quite scared about the idea of ever having children. It worries me that the same mistakes happen over and over again.' These days, when any of Gibb's colleagues has a baby, they monitor the cardiotochograph trace themselves, and don't rely on the midwife doing it, just to be sure.
Second, the fact that a baby is having problems in the womb can go undiagnosed. 'The mum goes to the hospital before the birth and says that she's not feeling very well and can't feel the baby moving. Maybe because they are so busy with everything else, they don't admit her, and maybe, by the time she goes back, the baby has died and they have to deliver it stillborn.'
Concern over the quality of Britain's maternity services is one of the NHS's biggest challenges. The deaths of babies and mothers during childbirth, scandals involving inadequate care in the maternity units of several hospitals, countless inquiries, and a welter of official reports have led to repeated calls for improvements. A rising birthrate partly fuelled by immigration, and the increasing frequency of complicated cases presenting themselves because of the growing number of mothers who are either older or obese, mean that an already difficult area of medical practice has recently become even more demanding for those involved. Yet few of those who work in the field believe the action taken so far is enough or that maternity services yet get the priority they deserve within the NHS.
Karlene Davis, general secretary of the Royal College of Midwives, said: 'The service is at breaking point.' The main problem is that 'it is patchy. In some areas it's good, but in other places there aren't enough midwives and you get a service where women are dissatisfied and sometimes unsafe practices occur'.
The Department of Health insist that England has a good record on births. Gwyneth Lewis, the Department of Health's chief adviser on childbirth, says: 'Due to the skill and expertise of our midwives and doctors, England is one of the safest places to have a baby.' In a study she conducted of almost 2 million births over three years, just 50 women died 'of obstetric complications that were not managed as best as they could have been, and there is no evidence to suggest any increase in this rate since', she adds.
The NPSA, the NHS body which aims to make receiving healthcare less risky than it sometimes proves, states that: 'The vast majority of the 650,000 pregnancies a year in England and Wales are successful, with mother and baby well.' But, it adds, 'there is evidence from a variety of sources that women and their babies sometimes experience unintended harm, often as a result of problems relating to deficiencies in intrapartum care [during labour and childbirth] and problems in communication.'
Its figures show that, in the past three years, 17,676 women were injured, 1,000 seriously, in labour. However, another 2 million women delivered safely.
In a speech on 3 October on the safety of maternity care, Arulkumaran will point out that more than one of every 100 births is problematic. Of the 668,681 live births in England, Wales and Northern Ireland in 2005, 7,225 ended up being notified to the official Confidential Enquiry into Maternal and Child Health because there had been an issue involving the baby's safety. Those 7,225 cases comprised 1,193 'late fetal losses', where the baby died between 20 and 24 weeks; 3,676 stillbirths; and 2,356 neo-natal deaths, in which the baby died in its first week of life. Employ more consultants, have their expertise on hand, and those figures will come down, says Arulkumaran.
He is aghast that hospitals are being sued for such a colossal sum of money and can think of a much better use of the NHS's resources. 'The presence of a consultant increases the safety for mothers and babies; incidents happen when there aren't enough people present, especially senior doctors', he says. So why not use a proportion of the amount currently paid out in damages to hire more consultants and more midwives, he asks.
'The cases where a baby suffers lack of oxygen, which can lead to brain damage, is one or two per 1,000 births in the UK. If a hospital delivers 5,000 babies a year, it may have 10 such cases a year, each of which could cost it [at least] £3m', explains Arulkumaran. 'Even if one of those cases could be avoided by having additional staff, you are going to save £3m. Spending £1m a year would buy you two consultants and 15-20 midwives.'
His message is aimed at hospital managers, who decide on staffing levels, and the government, which sets the NHS's priorities. 'We should try expanding consultant numbers, because otherwise we are paying out taxpayers' money which could and should be better spent rather than being used to settle litigation. The quality and safety of Britain's maternity services can and must be improved.'
'I tell myself I have two lovely daughters, but I have lost my son and the pain will never go'
Vicky Gough from Telford gave birth to a stillborn baby on 4 September 2001. Doctors tried to resuscitate the baby but, after half an hour, they were forced to declare him dead. Vicky and her husband Steven received £50,000 in compensation after Shrewsbury and Telford hospital, where baby Thomas was born, admitted a series of failings in his maternity care. Here, Steven tells Amelia Hill the devastated couple's story.
'Vicky was exhausted and drugged out so she wasn't aware of what was happening but I was forced to stand there and watch all these people rushing into the room and battle to save my son's life. My brain froze and it took me ages to comprehend that something was really wrong. Then I just stood there and prayed that I would have a baby to hold; I didn't care if he had brain damage. I just wanted to be able to take my child home.
'When they told us Thomas was dead, it was completely soul-destroying. I kept repeating the words to Vicky but I could see she wasn't taking any of it in. I had to leave the room. I went out into the corridor and collapsed. I almost assumed the foetal position myself there against the wall, and just broke my heart. It was beyond description.
'They told us that Thomas had died because he'd been born with the cord twisted around his neck. We didn't think to question this until four years later when we decided to ask for the medical notes, not because we had any suspicions but because we were still deeply grieving and wanted something to hold on to.
'It was only when we started reading the notes that we realised what had really happened. It was so obvious that we were stunned. We wished so much that we'd had the confidence to speak up about things that had seemed wrong during the labour because, reading back through the doctors' accounts of what happened, it was obvious that Thomas died because of human error so total it was akin to neglect. Thomas's heartbeat was showing warnings for over 35 minutes. If they had noticed his heart was having trouble at any point during that time, he could have been born completely safely and healthy. If they hadn't noticed until later - so late we'd had to have a Caesarean - we still would have had a baby to take home, albeit a very damaged one. But the fact that no one noticed any of the warning signs at any point was just so shocking we couldn't believe it.
'The fact that the NHS trust has clearly verified that they really messed up has allowed us to achieve a certain amount of closure but we are still traumatised and unable to move on in any genuine way. I have trouble bonding with my younger daughter, born after Thomas's death.
I try telling myself I have two beautiful daughters but I have lost my only son, and that pain will never go away.'
Payouts and claims
34,497 the total number of claims for compensation which the NHS in England received between 1995 and 2006 over alleged clinical negligence by staff. Most came in surgery (13,449 claims), obstetrics and gynaecology (7,352), medicine (6,060) and A&E (3,732).
£20m thought to be the largest amount awarded to a woman injured during childbirth. Kerstin Parkin, a dancer from Surrey, was awarded a £7m lump sum and £250,000 a year for the rest of her life in 2002 for the brain damage she suffered while giving birth at the Farnborough Hospital in 1996.
18,000 pregnant women injured during childbirth, including 246 who died, according to a National Patient Safety Agency study of 60,000 maternity care mistakes between 2003-06.
£3.5m-£6.5m the sum which the family of a child left with cerebral palsy, caused by lack of oxygen during birth, usually receives in compensation.
18,748 the number of 'live' claims which the NHS Litigation Authority was dealing with last year.
5,697 fresh claims for clinical negligence received by the NHSLA in 2005-06, slightly up on 5,609 the year before.
Labels:
Birth,
Complications,
Negligence,
NHS,
Understaffed
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