One Born Every 40 Seconds Panorama

One Born Every 40 Seconds

In the middle of a baby boom, Shelley Jofre reveals that some parts of the UK are facing a shortage of midwives, and asks if the NHS is providing appropriate maternity care.

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We're in the middle of a baby boom. No. Push, push, push. That's it.


There you go. Last year, there was one born every 40 seconds, the


highest number for nearly 20 years. That's the baby's head out, darling.


All pregnant women are meant to have a choice of safe, high quality


maternity care, but in some parts of the UK the reality is quite


different. Sometimes I think if they'd done it the other way round


There he is, half an hour old. I have been through childbirth twice,


and each time I was lucky enough to have great midwives who gave me


their full attention throughout labour. But in too many hospitals


that's not happening. As the number of births soars they're also


becoming more complicated, there are more older and overweight mums


and with IVF more twins and triplets. Add to that a chronic


shortage of midwives and some maternity units are struggling to


cope. Heather Paterson was 40 when she


became pregnant with her first child. It was a happy surprise for


her and her husband. I remember us taking photographs of the pregnancy


test, we were so excited. Every day was like that, it was excitement


seeing him develop through the scans. The number of women over 40


having children has almost trebled in the last decade. Heather's age


should have meant special care. When she was nearly two weeks


overdue she arrived at the Royal Free Hospital in London to be


induced but she was sent home because it was too busy. Did it


come as a surprise to you that you turned up and were told there


weren't enough beds? Yes, it was a major London teaching hospital and


we turned up when they asked us to come. We were booked in and they're


sending us away and not only send us away, they joked there's no room


at the inn. The unit was still busy when they came back, the first


midwife Heather saw gave her twice the recommended dose of drug to get


induction started. This meant contractions painful. Later a


second midwife kept leaving Heather to attend to another woman. She


asked Ian to keep an eye on the machine monitoring the baby's heart


rate. The midwife said to me I am a little concerned. The heart rate


has dipped a little bit. I need to go out, here's a call button. If


that monitor dips below 100 press it. Were you surprised she didn't


stay to monitor it? To be honest, I was so focused about watching it


and she panicked me because she said I am a bit concerned about


this, will you watch it? It's our first time having a baby. She's the


expert. Iain says he called the midwife when the heart rate dipped


on three occasions but still she didn't stay or get a doctor. It was


three hours later when the baby's heart rate couldn't be heard a


doctor was called. The delay starved baby Riley of oxygen.


no idea until Iain came over and told me that he didn't make it. I


was a healthy woman. I had a healthy baby. And so you expect


that you'll walk out of that hospital the next day with your


child. And to not do that was devastating.


Instead, they had to arrange Riley's funeral. They filmed it for


Heather's family back in Australia. We will feel his presence always.


For me personally, Riley and his existence literally saved my life.


At the inquest a jury ruled that neglect contributed to Riley's


death. The hospital apologised and paid compensation. But Ian and


Heather were unhappy that the two midwives involved were allowed to


continue working with additional training. So they complained to the


midwives' governing body. Today is the first day of the disciplinary


hearing. It's been more than six years since my son was killed and


it's also been about four and a half years since I put in a


complaint against the midwives and I really - I am angry that it's


taken so long. Ed first midwife didn't attend the hearing. She was


suspended for 18 months. The panel heard the critical period when


Heather's baby could have been saved was in the early hours of


Good Friday when the labour ward was understaffed. As the labour


ward co-ordinator the second midwife Beverley Blankson shouldn't


have been caring for Heather while looking after another woman in


labour. It was her duty to call in extra staff if she needed them.


There were eight mothers and five midwives that night. One phone call


she could have had extra midwives. The panel found Beverley Blankson


failed to monitor properly the baby's deteriorating heart rate. It


ruled her fitness to practise was impaired but won't decide until


September whether she should be disciplined. The Royal Free


Hospital Trust told us it has reviewed and fundamentally changed


many aspects of its maternity service and increased staff numbers


since Riley's death. Beverley Blankson wasn't willing to comment.


It may have been a blip. I don't know. But as far as I am concerned


she is partially responsible for the death of my child and I don't


really think that someone who couldn't spot problems or the tell


tale signs is still someone who probably should not be dealing with


women. In its findings the panel said it was concerned that despite


considerable further training, even at the hearing midwife Blankson


still didn't recognise that the baby's heart monitor printout was


abnormal. Beverley Blankson still works as a midwife at the Royal


Free. Failure to monitor or respond to an abnormal foetal heart rate is


a mistake that's being made in other hospitals over and over again.


We've discovered that the number of negligence claims against the NHS


for that reason increased last year alone by nearly 20%.


Electronic monitoring of the foetal heart rate is not new medical


technology. It has been around for 20 plus years. It is worrying that


there are still failures to properly interpret and to respond.


It's terribly depressing when we see the same things happening time


and time again and lessons apparently not being followed


through, not being learnt within the NHS.


The Royal College of Midwives says it's hardly surprising, by its


calculations at least 4,700 more midwives need to be employed across


England and Wales to provide a safe service. Most midwives get up in


the morning wanting to do a really good day's work. They want to give


the care that they've been trained to give, many of them achieve that


and for the vast majority of midwives who don't manage to


achieve that I would very strongly argue it's because the system is


not supporting them to do the work they're meant to do. A recent


survey of NHS maternity staff in England found that only half were


satisfied with the quality of work and patient care they were able to


deliver. More than 90% had reported incidents,er rors or near-misses in


the previous month. Women don't come in tidy numbers when they're


pregnant but the problem for midwives now is that the pressure


is relentless and none of us can really keep our standards as high


as they should be if day after day we're working under extreme


pressure. Are things really that bad? We carried out an exclusive


Panorama survey writing to every maternity unit in the UK. 171 in


total, almost 90% replied. We asked what the midwife vacancy rate was.


In Wales and Northern Ireland it's below 1%. In Scotland, just above


1%. Our survey showed England's vacancy rate is nearly 5%. But in


some London trusts the rate is as high as 19 or 20%, that's one in


five posts lying vacant. Before the last general election David Cameron


pledged 3,000 more midwives for England. So we asked the Department


of Health how many new posts have been created since May 2010. They


don't collect that information. It's not just babies that are being


put at risk when hospitals are overstretched. It's women, too, at


a time when the number of women whose pregnancies are considered


high risk is on the rise. Clever girl, aren't you? Mummy's going to


chase you! Caroline Hardy suffered from a painful pelvic condition and


needed special care throughout her pregnancy. By 38 weeks I was in


hospital because I just couldn't make it from one room to another in


the house without being crippled with pain. She went to Wythenshawe


Hospital in Manchester for an induction but it was delayed


because the unit was so busy. When the labour didn't progress, she was


rushed for a Caesarean. But another woman needed to go to theatre at


the same time. There was a bit of an argument as to who needed to go


to surgery now because there was obviously another lady who needed


to go and I only won because I was halfway to the surgical room and I


was prepped. Sometimes I think well if they'd done it the other way


round would things be different, but... It's OK. It's upsetting to


go through it again. Take your time. It's because, not just the surgeon,


but the team had so much pressure on them to prevent something worse


happening to the lady waiting, that something was missed. Caroline gave


birth to a daughter, Tali but when she was sewn back up a large piece


of placenta was left inside her. Caroline thinks it's because of how


busy the staff were. I think it played a huge part because it was


such a big mistake to have made, it's not something that happens,


it's not a daily occurrence. Three weeks later Caroline collapsed and


had to be rushed to hospital for emergency surgery. I am quite lucky


that I only had another haemorrhage, because I could have had


septicaemia, I could have had infections, I could have died,


could have had a million and one things happen to me. University


Hospital of south Manchester Trust confirmed that the piece of


placenta shouldn't have been left inside Caroline. It apologised for


the error and any distress and worry caused. Milton Keynes


Hospital and Kerry is about to have her first baby with partner Che.


am going to put the bed up... Midwife Rachel has been assigned to


care for Kerry throughout her labour. You are a good 7-8


centimetres which is good, the head is high so I am going to have a


word with the doctor, we don't want the waters going and the cord


coming down. Rachel uses an electronic monitor to hear the


baby's heart rate so make sure it's not in distress. The heart rate can


dip down and that's normal at certain parts. Milton Keynes hasn't


always been able to offer such a high level of care. Three years ago


the unit was understaffed. The local coroner called the situation


scandalous after three baby deaths he felt could have been prevented.


Broadly morale was low. There has been for a while a shortage of


midwives in this country and Milton Keynes was not particularly


successful in attracting midwives that there were. With a shortage of


qualified English midwives the hospital has had to look abroad to


recruit. In four years it's boosted numbers by more than 30. Now the


hospital says it's the only one in England that can show it gives one


to one care to all women once their contractions are regular and


they're in established labour. push, push. Keep going, keep going,


keep going. So you just phoned the doctor. He will come and review,


she's been pushing for an hour now so we get the doctors to review.


she tired? Yeah, exhausted now. Might you do something different?


Don't know, he will say carry on or Keep it coming. That is it, well


done. Yes, we did have a baby. was it? Cor... You forgot to check!


I had better check! A baby boy! boy, thank you. And this is they


been made. You must be so proud. You must be exalted as well. But


was hard going, wasn't it? Yes. Milton Keynes has managed to turn


its maternity servers around. Our Panorama survey shows that they


still had 18 vacant midwife posts and they do not always have enough


beds to cope with demand. It turns out we have arrived on a pretty


busy day. The maternity ward has actually had to close its doors to


new admissions, and that means two women have already been sent to


other hospitals more than 20 minutes away. It is a difficult


balancing act for the head of midwifery -- midwifery. To


guarantee one to one care, she sometimes asked to deny women their


choice of where to give birth. Isn't that disappointing if they


have been hoping to come to this hospital? It is, and it is for us,


too, because we would like to provide that care, but it is


important they get appropriate care, and if it is best for them to go


elsewhere, that is the right thing to do for them. In our survey, we


found that Milton Keynes had to shut its doors on 14 separate


occasions last year, mostly due to under staffing. Rosie Hospital in


Cambridge, though, closed 28 times. In Leicester, both maternity use


its closed more than 50 times. In Nottingham, both units closed at


the same time on five occasions. But the unit that closed its doors


most often was Barnet Hospital in London. Over 100 times last year.


Across the UK, we found that maternity units were forced to


close 1055 times last year, nearly always to do under staffing or


overcapacity. That meant that at least 927 women have to be turned


away. To turn up at the place you were expecting to have your baby


and be told, well, I am sorry, you have got to go down the road to a


different unit, I just think that is not a high standard of care, and


it should not be what we are giving 32 babies were delivered at Milton


Keynes over the two days the unit was closed to new admissions. The


average would normally be nearer 23. Those women who were not turned


away, though, were delighted with their care. How have you found your


care here? What was it like? Excellent from start to finish. We


had a very traumatic time on Sunday evening getting easier. She was in


distress and had to be delivered very quickly. We cannot fault the


care that we have received here. Staff have coped well when so many


babies born over a challenging 48 hours. What has that been like for


all of you? I have delivered four of them. Four in two days. That


sounds like hard work. Yes! It is lovely, though. Milton Keynes may


be operating safely now, but that is not always happening elsewhere.


London has seen a huge rise in births, 16% in five years. Many of


those have been high risk, leaving some maternity units struggling to


cope. The NHS in London became concerned when it notice that the


number of maternal deaths in the first half of 2009 was as high as


the whole of the previous year. A confidential inquiry was launched,


and we have been given exclusive access to its findings. The


conclusion is shocking. 17 deaths over an 18 month period could have


been avoided if the women had been Professor Trish Morris-Thompson is


NHS London's chief nurse. She is also a practising midwife. The MBE


were a number of opportunities to prevent death occurring, and


because of that we have taken enough action across the


organisations in London, and we will continue to do so to put right


those actions. That is pretty damning. These women could still be


alive if they had been given the proper standard of care. And in


some of those cases the report indicates that the less than


optimal care was given and death did occur. However, we need to look


at the context of those 200,000 births occurring in that period of


time. A lot of women in very poorly conditions were cared for, and a


lot of babies were delivered very safely. Of the 42 mothers who died,


half were from deprived backgrounds, two-thirds from ethnic minorities,


and some have not sought maternity care until late in pregnancy. That


was not the case for Suzanne Valentine, though, who had regular


check-ups, a partner in a London law firm, a mother later in life


through IVF. She was one in a million more than anything. She was


just an incredible person. Their good points were probably my weak


points, and vice versa, so it worked really well, really well as


a team. At 47, Cezanne was classed as high risk, but like her first


two pregnancies, this one had gone smoothly. -- Suzanne. To the end,


she was sort of glowing, really looking forward to having a third


child. One week before the due date, though, a scan confirmed the baby


had died. She had to be induced. Afterwards, Stephen got a chance to


hold his daughter, Georgianna. had about 40 minutes were third. --


with her. Yes, I had 40 minutes. When I left, I left the room at 20


past, around about 20 past two in the morning because the crash team


had been caught. As Stephen grieved for his daughter, his wife went


into cardiac arrest. She was losing huge amounts of blood but staff


could not work out why. They did not call a consultant obstetrician


straight away. He arrived an hour later and discovered that her


uterus had ruptured. He stopped what they were doing and tried to


fix the tear. Maybe if the consultant had been there quicker,


do you know, if the consultant had been in the hospital, things might


have turned out different for Suzanne. She died soon afterwards.


The hospital's own investigation was critical that a consultant


obstetrician had not been called earlier but concluded it would not


have saved there. By that stage, the damage was done. At the inquest,


the coroner criticised the high dose of Labour and using drugs she


had been prescribed, 16 times what is recommended. This increased


their risk of a ruptured uterus. How did you feel when you realised


that? I was angry, a bit shocked. Devastated, disbelief. It is still


very raw, and it is still very upsetting, you know, but I have two


other children but still get up, they want their Coco Pops and Ready


Brek in the morning, so they have still got to go to school, so you


have to sort of deal with it, and you have to get on with your day.


St George's Healthcare NHS Trust told us it had used similar doses


of the drug given to Suzanne since 2003 without any serious


complications. It has now revised its guidelines. The trust also says


it has improved training to ensure that staff seek a higher level of


clinical leadership at the correct time. When things do go wrong, it


is crucial that any inquiries carried out afterwards are thorough


and objective to make sure that lessons are learnt. But the review


of maternal deaths in London found that is not always happening. Of 29


serious incident reports scrutinised for the review, a panel


of experts only agreed with the findings in 12. It found that many


reports were defensive in nature and disagreed with six that


included the woman's death was inevitable. The panel said


different management and earlier diagnosis could have changed the


I think the most worrying thing that comes out of this report is


the suggestion that lessons are not being learnt. I would agree, having


read the reports, and prior to the publication of the independent


review, we were working at the organisations to say, this is not


good enough, you need to have a more robust response to the report


and it needs to be more extensive. While some London hospitals are


stretched to crisis point, elsewhere the picture is quite


different. To write a save maternity service, the Royal


College of Midwives says there should be an average ratio of 1 to


28. -- to provide a safe maternity service. We have found that


midwives deliver more babies, with a ratio of one midwife to 33 births.


In Wales, it is one midwife to 30 births. Northern Ireland has one to


just under 28 birds. In Scotland, though, there is an average of one


midwife to just 26 berths. Here in Scotland, there is no midwife


shortage. There are currently only 20 posts lying vacant across the


whole country, which means that in hospitals like this one they can


offer mothers the undivided attention of a midwife throughout


Hannah Fox is expecting her 4th baby. She is being induced, and


midwife Doreen will be with airside every step of the way. I will just


have a listen to the baby again. Just check that she is nice and


happy. There she goes. Do you think it makes a difference to you?


huge difference. I had my two old as children in a different hospital,


and the midwife was hardly ever in the room, and it was really


frightening. Hannah is one of just 19 women giving birth here today.


Thorpe Park Hospital deliver slightly fewer babies than Milton


Keynes every year but employers 35 more midwives. There's only one


vacant post. When you look down south and DEC vacancy rates are 15%,


what do think about the service they can offer? I feel that for my


colleagues working in situations like that, it must be very


difficult to actually provides the One 2 One service and the 1-1 care


that you would want to provide. It must be very hard and challenging


to work in those circumstances. After a long, tiring day in labour,


A new life is about to emerge. There you go. Congratulations. Oh,


she is just beautiful! Maternity care here may be the envy of their


southern colleagues, but for how long? The Scottish government has


pledged to protect frontline services, but public spending cuts


of nearly 8% are expected in the coming years. I just hope our


politicians listen to the women and listen to the staff and the


midwives, obstetrician as he will advise them about safe levels and


staffing levels required for their units. Ian and Heather Havard two


more children, but they will never forget their first son. -- have had.


It is a very poignant message that you chose to have carved on the


bench, lived for 35 minutes. Is that hard for you, even today?


is hard to know that you have what should be a perfectly healthy baby


and then everything goes wrong. But you know, you never stop loving


that baby, and every single day I With one baby born every 40 seconds,


there will always be times when things go wrong, but the care of


women receive should not depend on where they live or what time they


The UK is in the middle of a baby boom. Last year, there was one born every forty seconds - the highest number for 20 years. But reporter Shelley Jofre reveals that some parts of the UK are facing a chronic shortage of midwives, and asks if the NHS is failing to deliver the safe and high quality maternity care mothers and babies deserve.

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