Maternity Services - CGH

[ocd]

I meant to post earlier this week, but....

What is the general consensus on the letter in last weeks John O'Groat Journal regarding Maternity Services.

I think that removing consultant cover is definitely down-grading.

I had a very straight-forward pregnancy, no problems at all.....things went a bit pear-shaped during delivery though! Not sure if we would be here today is the consultants were not available!

[Red]

I totally agree with the letter, well thought out, and very well worded - I believe it would be a step forward not backward.

Women have birthed for hundreds of thousands of years with fellow female (or male) support and without full on medical intervention, what has changed so drastically that we need it now?

The Midwives in Wick are fantastic, but I believe that the Consultants are too quick to intervene in many labours because they are there, rather than because they need to.

I believe that not having Consultants breathing down their necks would allow the Midwives to do their job that they are trained to do and that there would be less complications because it would be an altogether more relaxed atmosphere, a home from home.

[ShelleyCowie]

When i was in having athrun the midwifes were very good. Some better than others though.

I was messed around so much and it wass the consultant that actually took action and done what i wanted.

But yes i believe that midwifes would probably work better without having the consultant there. Let them do what they know and thats delivering children

[LMS]

I agree that it was a very well written letter and that the points made were valid. However, midwife-led units tend to work better when they are located within a reasonable proximity of a consultant-led unit. If problems occur, the patient can be quickly and safely transferred for the care needed. Wick is 103 miles from Inverness which is a 2 hour journey at the best of times but when the weather is unfavourable, a transfer could be dangerous and/or impossible. I think the weather this winter has proved this point.

[mama2]

Yes women have been giving birth for years but times change and thankfully the number of women and babies who die during child birth has dropped considerably. What if the cord wrapped around the babies neck and the baby needed to be born straight away? I don't think it would make the 2+ hour journey to Inverness! Labour can be a scary enough time as it is without being shifted down the A9. I'm very grateful that a consultant was on hand when I had my youngest as the midwives couldn't agree on anything.
It's not just pregnant woman this effects either, if the consultants go what about all the gyne appointments?
I just have the feeling that once the consultants go then other services will start to be downgraded.

[brandy]

what if your like me and can not have a natural birth anymore? i automatically have to go to raigmore.. but what happens if you go into early labour and cant get there? even with the best of care you will always have losses of life. i know this first hand. in wick itself we lost a mother in child birth not that long ago.. and how many babies have died before they ever got a chance to live? its not the mw fault by any means. and when it comes to normal births.. mw's all the way.. but we need a consultant. we need someone that has specialised training that can step in and make decisions. that can have things done.
a lot of people do not realise this, but pregnancy and birth are extremly dangerous things. they are life threatning and full of danger.
we tend to only see the wonderful side of it.. but its not always a happy thing.

[Red]

What if the cord wrapped around the babies neck and the baby needed to be born straight away? I don't think it would make the 2+ hour journey to Inverness!

Research has shown that the umbilical cord is extremely stretchy and lubricated enough for the baby to be born through the wrapped cord, in extreme cases where it may be wrapped round the neck mutiple times the Midwives are more than capable of dealing with this, they are highly trained and specialised in these areas and probably witness and successfully deal with more cord round neck scenarios than Consultants.

I don't think that we are giving the Midwives enough credit by insisting that they need a Consultant to 'step in' whenever there is an issue. Consultants only ever see problem labours/births, they never tend to see the ones that go well and see how well the Midwives cope in certain situations to ensure that they go well.

I thought that the letter made a valid point about using general surgeons for emergency caesarian sections, with assistance from GPs with an obstetric speciality.

I do understand about the need for someone with gynaecological speciality, have one Consultant for that purpose alone and keep them away from the Maternity unit unless it really is an emergency.

[Wick66]

I don't think that we are giving the Midwives enough credit by insisting that they need a Consultant to 'step in' whenever there is an issue. Consultants only ever see problem labours/births, they never tend to see the ones that go well and see how well the Midwives cope in certain situations to ensure that they go well.


Why have doctors when we can surf the internet. Why have surgeons when we have the local butcher. Consultant Gynaes are a necessity in a modern safe hospital. The midwifes are excellent at their role and no-one is talking them down, but support is required, not only for them but for the expectant mothers and expected or new born child. The midwifes themselves will be the first to state this.

You must also remember that 2 hours is the minimum travel time to Inverness. If there is a problem and the patient needs transferred then there is also the time spent organising a transfer and the fact that there is not always an ambulance readily available to undertake this. If the ambulance is already on its way to Inverness with another patient then you can easily add another 4 to 5 hours onto the waiting time. And why when there is an emergency in a hospital should you expect the ambulance crews to deal with this during the transfer. 2 hours or more out of the hospital enviroment when there is already a problem is the most dangerous element of patient care.

We have fought before for the retention of consultants at Wick. We should not allow this to be the case again. Wick is already looking at cuts in service provision due to the budget overspend mainly at Raigmore. But ask yourselves this, why should we have to accept a reduced service and add extra stress to the patients and staff in Caithness.

[ShelleyCowie]

Wick66 i agree with what you have said. We can not accept a downgraded service.

It has pained me to think that if i need enduced that i would have to go to inverness, i dont drive and neither does my OH. I have a 17 month old son and not forgetting my OH has 2 other sons aswell.

Dropping everything to go to Inverness is not an option for us. This is why i have already decided to have a c-section again.

I think alot more mums will take this option so they do not have to travel to Inverness to deliver.

[Sun Circle]

I meant to post earlier this week, but....

What is the general consensus on the letter in last weeks John O'Groat Journal regarding Maternity Services.

I think that removing consultant cover is definitely down-grading.

I had a very straight-forward pregnancy, no problems at all.....things went a bit pear-shaped during delivery though! Not sure if we would be here today is the consultants were not available!

You are right that simply removing consultant cover without adding any further level of support for the midwives would be down-grading and would be downright dangerous.

I'm sure from a safety point of view removal of the consultants with no further support in place would mean closure of the Henderson Wing in Wick. And we cannot allow that to happen!

Unfortunately, closure of the Henderson Wing is where we are headed if we continue on the unsustainable path currently being adopted.

What I would like to see is full support put in place to support a midwife-led unit before the consultants are moved to Inverness:

Consultant support from Inverness, including a weekly day-clinic held in Wick so that high-risk mums don't have to travel for antenatal appointments unless absolutely necessary.
Surgical support from a general surgeon to allow c-sections to be carried out at Wick (both scheduled and emergency).
Full training for the midwives to allow forceps/ventouse deliveries in Wick.
Support from GPs with specialist obstetric training for any emergency decisions that the midwives can't handle. These GPs would also be able to give support for low-risk inductions at Wick.
Remote support from the consultants in Inverness using communication technology to allow them to assess the situation remotely and advise.
There are already neo-natal facilities in Wick - enough to stabilize a baby before transfer to Inverness when necessary.
More midwives to be attracted into the posts at Wick. At the moment they cannot fill the vacancies because there is this cloud hanging over the unit - no-one wants to move to work at a unit that is under threat of closure. By making it midwife-led and therefore financially stable it would be easier to attract experienced midwives to work in Caithness.
It would be absolutely essential that the other support is put in place before the consultants were transferred to Inverness where their skills could be put to more "full-time" use with a larger number of emergencies to deal with.

OCD - do you think that you would have survived your birthing experience without the consultants if these contingencies were in place? I think they cover most eventualities...

I have spoken to many high-risk mums who have been delighted with their birth experiences in Inverness and would choose to go there again next time. That is their choice and must be supported.

But for those of us low and medium-risk mums who want to give birth in Caithness, I feel that we are no longer being supported to do this - there is a constant fear that for one reason or another they will find a way to shove us down the road to Inverness when we don't want to.

I'd like to see the birthing outcome statistics for Shetland to see how they compare with Caithness... it would be very interesting.

Rant over!

Sun Circle

(PS if I don't post again it will be because my baby is due anytime now - hopefully at home, probably at Wick, but definitely not in a lay-by on the A9 to Inverness! I'd rather stay in Caithness and take my chances!)

[Leanne]

I do understand about the need for someone with gynaecological speciality, have one Consultant for that purpose alone and keep them away from the Maternity unit unless it really is an emergency.

But that one consultant would then be working 24/7, 365 days a year?

[Sun Circle]

Consultant Gynaes are a necessity in a modern safe hospital. The midwifes are excellent at their role and no-one is talking them down, but support is required, not only for them but for the expectant mothers and expected or new born child. The midwifes themselves will be the first to state this.

How do the Shetlanders do it then? They are transferring by air ambulance to Aberdeen - far worse than us! Because of this they NEED to make birthing safe in Shetland - they have no other option. They need to deal with emergencies and have contingencies in place.

I think our trouble in Caithness is that we rely too heavily on Inverness and as a result all our maternity staff are not getting the level of support and training they need to make emergency birth in Caithness safe.

I don't believe mums are being given real choice here in Caithness because the service is so dependent on Inverness. The obstetricians up here just send everyone down the road anyway - their presence here does not make birthing in Caithness more likely, it just makes it more stressful. I'd feel safer in Shetland at the moment.

[Dadie]

I was threatened with everything when I was pregnant with Euan in the last few weeks as they found out I had diabetes (thought to be gestational at the time but now it seems not)
1 I had to go to Inverness on the 3rd Jan to be induced
2 If I went into labour up here they would put me to Inverness
3 If I had the baby up here it may have to go to any scbu unit in scotland where there was a bed

Thankfully none of the threats materialised... I went into labour and had Euan in Wick on the 1st jan, my other 2 girls nearly witnessed the whole thing as the roads were bad and it took my Dad a while to get through to wick to get them as I knew I wouldnt have the time too put them out to Mum and Dads and reach CGH!
Now I didnt leave things to the last minute to tell them and to go through... I was up having a panic about the state of the roads at 0430am as I had been doing since before Christmas and by 0530 I wanted to clean a cupboard to keep busy... odd...so it was then I phoned to say I was coming in...they thought it was strange as I had no tightening or aches at all....got the girls up...phoned my sister who was supposed to take the kids in wick..then phoned dad...got to wick at 0610 after a slow drive (road conditions were bad) and was only 3-4 cm dilated and had Euan at 0645!
Imagine if they tried to put me to Inverness as they could have sent me as I wasnt 7 cm dilated (that is when they have to keep you)

I for one do not want to see the unit being downgraded at all....what will it take for them to realise it is not practical due to the time/distance/weather conditions to the nearest Consultant led unit.
A death of a mother to be or a newborn baby on the way to Inverness??

[brandy]

to give you an idea of how important a consultant is.. lets put a face to it shall we.. the first two pics are of Sam the day he was born.. you can see how sick he is if you look.. he is swollen, jaundiced, he was full of iv's where is blood was so thick it was clotting just trying to get a blood sample.. he had a feeding tube down his nose.. just a few days after this he had to have surgery to remove about 90 mls of blood in hopes of thinning it as they had tried everything else they could think of. If sam had been born up here.. more than likely he would be in wick cemetary right now. i have taken the pics of the day he was born and added a pic that was taken on the 11th of feb. before the valentines disco.. he was bouncing to wear his kilt. begged me to let him wear it.. look at my little boy.. see the light and laughter in his eyes then turn around and tell me again why we dont need consultants. Sam was delivered by MW's one of them was a student MW. and they were wonderful.. but he went downhill really fast.. and it was the Consultants and Drs thats saved his life.
http://i42.photobucket.com/albums/e346/brandy28655/20091124_11.jpg
http://i42.photobucket.com/albums/e346/brandy28655/20091124_10.jpg
http://i42.photobucket.com/albums/e346/brandy28655/samkilt5.jpg

[Red]

But that one consultant would then be working 24/7, 365 days a year?

Sorry I didn't clarify myself properly I had a toddler trying to help!

I think that a Consultant should be there for routine appts/surgeries, and the genreal surgeons should be able to deal with emergencies.

I think Sun Circle summed it perfectly, put measures in place to cover all scenarios before allowing the Consultants to leave.

[Sun Circle]

to give you an idea of how important a consultant is.. lets put a face to it shall we.. the first two pics are of Sam the day he was born.. you can see how sick he is if you look.. he is swollen, jaundiced, he was full of iv's where is blood was so thick it was clotting just trying to get a blood sample.. he had a feeding tube down his nose.. just a few days after this he had to have surgery to remove about 90 mls of blood in hopes of thinning it as they had tried everything else they could think of. If sam had been born up here.. more than likely he would be in wick cemetary right now.

Hi Brandy,

Your Sam is just gorgeous and I am so glad that your nightmare story has such a fantastically happy ending. You say that if he'd been born up here it would be a different story, and who knows what the outcome might have been? Would the physical presence of consultants up here in Wick have made a difference to whether he could be stabilized for the inevitable journey to Inverness?... I have no medical qualifications and am in no position to comment. I'm just so glad things turned out well for you and Sam wherever you were at the time.

I want to make the point that a midwife-led unit is just that - led by midwives, but still supported by specialists. The midwives could call on the GPs with their specialist obstetrics knowledge, they could call on the consultants in Inverness to give guidance and advise on the case by webcam. The midwives are trained to use all the neonatal equipment that is available in Wick to stabilize a baby.

Brandy, as you said yourself, childbirth is never risk-free and there are the inevitable cases where the best efforts of all staff are not enough. Even in city hospitals full of technology and consultants things can go wrong and the worst does sometimes happen. Its a harsh reality.

What I am saying is that at the moment I don't think Caithness is doing enough to address that risk. I sincerely believe that with a well-supported, well-staffed midwife-led unit the risk will be actually be lower than with the half-way house that we have at the moment - paying consultants to be there 24/7 but then transferring all the high and medium-risk women to Inverness anyway. Inevitably, with only 200 births a year and all the high-risk cases being transferred to Inverness, the consultants cannot be getting enough day-to-day experience to keep their skill levels up-to-date and current. Would it not be better for them to be located in Inverness where they could utilize those skills on a daily basis, helping more mums and have their expertise remotely on-call whenever we needed it here in Caithness?

[Sun Circle]

I'm going to bow out gracefully from this discussion now, as I don't want to surround myself with the doom and gloom of the situation we are in just now, and I don't want to raise my blood pressure (in case they send me off to Inverness!).

Instead I'm selfishly off to bury my head in the sand and think positive thoughts, visualise the perfect birth, keep my fingers crossed and hope for the best.

Best wishes to anyone out there who is pregnant at the moment and I wish you all a safe and happy birthing experience!

Once the baby is out I will be returning to the fray to make sure that the maternity situation here in Caithness is improved one way or another!

Love,
Sun Circle.

[brandy]

but at the same time.. the consultants see the expectant mothers thru out their pregnancy. and when you have high risk mothers, who even are being sent to raigmore to give birth.. they are still reciving treatment in wick thru out their pregnancy. when i was preg. i was seen in both wick and inverness.. and let me tell you .. traveling once a month to inverness by bus and back is not a joy when you are preg. if all my app. were in inverness i dont know how i would have done it. towards the end my dr. was seeing me every two weeks. i was lucky that because they had a consultant here i was able to mix the app. and do one here one there.
another thing that you have to consider when giving birth in raigmore is getting there and back. i had to find my own way down and back. as there was nothing wrong with me.. i was not sick.. you dont get an ambulance or hospital bus home. you have to make your own way back. and let me tell you after having a section it is not fun.
if anything i think we should be upgraded. at least to handle emergency situations.
i mean.. you cant even put an iv in a child here .. they have to be sent off.
its a shame that we dont have any facilitys for babys or children up here.

[LRM]

I understand why everyone is worried about the possibility of downgrading as we are used to the Consultant led service we have here and nobody likes change. BUT I grew up in Orkney where there is a FANTASTIC midwife led unit. The midwives have support from the GPWSI (GPs with special interest in obstetrics) and emergency c sections are done by the general surgeon. Any mums with problems are put to Aberdeen, which is not ideal but I think Orcadians are used to this being the norm. The mums that do give birth in Orkney have a terrific unit, the breastfeeding rates are one of the highest in the UK, visiting is allowed at any time (within reason) and any new mums that go home and have any problems with feeding etc are allowed to come back in for help. There is often only one midwife on some shifts and the auxilliaries have always assisted with the births. I think a unit like this would work up here IF the midwives got the help and support from the gps and the general surgeons.

[madmissus]

Well it all very well to suggest GPs can help out, but has anybody thought to ask them what they think? I think if you ask them they will say NO WAY!!!

[ShelleyCowie]

Well it all very well to suggest GPs can help out, but has anybody thought to ask them what they think? I think if you ask them they will say NO WAY!!!

I wouldnt like my GP's anywhere near me! Lol

[lynne duncan]

I've let my proverbial belly rumble a bit here but stick with me and read it thanks

strange yet here we go again after three rounds of review this issue rears its head again, does somebody think that the folk in caithness have that short a memory that this can be raised after such a short period.

all these issues have been raised and very quickly kicked out, the general surgeons were no more willing to do emergency c's then than they will be now, the original argument stands if the obs/gynaes don't have the hours for deliveries a general surgeon will most def not for emergency c's

if the gyn/ob consultants are short of experience with our low numbers then rotate them to inverness to build up their numbers

nhs highland already pay a ludicrous amount for out of hours cover what difference would this make to their budgets

our midwives are fantastic, well skilled individuals who are more than capable of doing their jobs

but as said before there is no-one in this world can predict how a by the book low risk pregnant mother is going to be 2 minutes into a labour, so any labour in a midwife led unit requires the back up support of a trained professional in the general vicinity not 2 hours drive away and even by air (how soon would it be arranged as there would be no plane or helicopter based here thats for sure)

also this question still to this day hasn't been answered WHY are the local mums still travelling to inverness to be induced, what setup is in place in inverness ( an nhs highland run unit supposedly the same nhs highalnd which run CGH) that differs so much, do they not use the same policies!!

I was induced with 2 of my kids here in 1997 and 2000 what has changed so much that they cannot be continued here and if there is a change why does it not also apply to inverness

and local gp's at the last review did not support or offer their services if there was to be a midwife led unit.

I know from speaking to mothers who have had to travel to inverness in labour it is a traumatic experience, also the effects of being forced to choose where your child is born in this day and age also smacks of treating our hospital as second class.

if budgets are the reason then inverness should be looking at using CGH to its full potential

also how much did nhs highland pay the polish gynaes as it would appear that their cases have been settled? just out of curiosity

[Sara Jevo]

I think they are right to be looking at it, because the current set-up doesn't seem to be working very well. I'm not sure what the right answer is - but I wouldn't knock them for looking at ways to make it safer.

[richardson.laura]

I had a bad pregancy, very up and down and spent a lot of time off work, at one point I had to lie flat on my back for 2 weeks. saw a maternity consultant once during my entire pregnancy despite several concerns.

When I was 25/26 weeks I was signed off work again, in my 27th week my baby stopped moving and I was taken to CGH on the thursday night for monitoring yet never saw a consultant. on friday I was attached to a baby monitor for the duration of the day and complained of pains similar to labour. again, never saw a consultant nor received an internal exam, but was told it was probably nothing to worry about and was sent home at 6pm. by 4am i was crawling the walls with pain and phoned the henderson unit and was told to come back, upon arrival i was given an internal exam and was told id gone into premature labour and "should have been there hours ago" despite being told not to worry and go home 10 hours beforehand. inverness, aberdeen, edinburgh and dundee were all full, i was flown to glasgow, by the time i finally got there i was told it was too late to stop my labour, they could only postpone it short term.

i delivered my daughter on sunday 18th oct 2009 at 8.46am (she was due 10th jan) after a course of various drugs, most of which were painful and had not great side effects, she weighed 2lbs 7oz. she spent over 3 months in neo natal unit, watching your child fight for their life is the hardest thing in the world. she had a hole in her heart, zinc, iron, potassiam and copper deficiencies, problems breathing and with regurgatation. most of this she is still receiving treatment for.

she came home the day after boxing day, thankfully my mother lives just outside glasgow so i could stay with her while my daughter was in hospital. she is still under the care of the glasgow team as there isnt facilities up here, so this means i have to travel 300miles everytime theres an appointment, regular blood tests, brain and heart scans, eye and ear checks. all of this is because she was premature. which could have been prevented if the team had had the facilities or if they had even properly checked while i was in labour. the stress and upset and worry has been uncalculatable, not to mention the financial pressure of all this. i can only thank god i dont have any other children or the whole thing would have been impossible.

the maternity services up here are an absolute disgrace, not particularly through any fault of the staff, but depsite having a difficult pregancy i only saw a consultant once so i dont see what difference itl make if theyre gone all together.

that being said, having her home and being as good as she can be is amazing. im so thankful she is ok and the worst is over.

[LMS]

You have had a very hard struggle and I hope that your baby is getting stronger. I can't even imagine how traumatic it must have been.

However, by posting such a negative statement I think that you may be putting the knife into a very precious service. If people up here don't protect the maternity unit then others may not have the opportunity for assessment up here and their outcomes may be far worse than yours. You have your issues and they should be be dealt with between yourself and the hospital. Let's not forget about all the thousands of successful pregnancies and births in Wick, would they have been so had everyone with a gripe stuck the knife in? Let's all support the unit, not berate them - you, me or anyone else might need it soon....

[ShelleyCowie]

Thats a really heart-wrenching story. I hope your baby is on the mend.

I plan on having a c-section in August this year in wick, iv thought about it so hard going for a natural birth this time but there are too many "what ifs" that its really put me off.

My experience with Athrun was not the best, but i can not fault the midwifes at all in any way. Even the auxillary staff were extremelly nice. And i quite look forward to seeing them all again this year.

[igglepiggle]

My first pregnancy was fine, i had a horrible labour which led into an emergency section, it was horrible as my OH wasnt allowed in. In my second pregnancy i went for a planned c-section and it was so much more relaxed, the staff on both times where fantastic and i couldnt off asked for better care when i was there, i think they do a fantastic job, sometimes i think that they are slated quite a bit, there is problems in any job, theirs is no different. When we decide to have another it will be my first choice again!!

[richardson.laura]

You have had a very hard struggle and I hope that your baby is getting stronger. I can't even imagine how traumatic it must have been.

However, by posting such a negative statement I think that you may be putting the knife into a very precious service. If people up here don't protect the maternity unit then others may not have the opportunity for assessment up here and their outcomes may be far worse than yours. You have your issues and they should be be dealt with between yourself and the hospital. Let's not forget about all the thousands of successful pregnancies and births in Wick, would they have been so had everyone with a gripe stuck the knife in? Let's all support the unit, not berate them - you, me or anyone else might need it soon....


i post a negative statement because i had a negative experience. i agree the maternity services up here are invaluable and cutting them all togetherwould be terrible, yes plenty people have had healthy strong full term babies up here with no problems. i only have one child and one experience and that was mine. can only go on what happened to me. i wasnt assessed at all, was told it wasn likely to be something to worry about and go home.i received an apology from my consultant in glasgow because he said had i arrived at the facilities earlier, there could have been more done.