For further information on advocacy, contact Melissa Maimann at Essential Birth Consulting.
… The policy of Open Disclosure mandates that clinicians explain, take action, express regret and apologise for unexpected outcomes. In an effort to acknowledge patients’ concerns following adverse events and their preference for open communication, Open Disclosure policy is being mandated at national and international levels.
I wonder if this extends to birth-related outcomes, especially when unnecessary interventions take place. You know, inductions for “big” 3Kg babies, caesareans for “failure to progress”, limited options for VBAC (well, I really mean no option – repeat caesarean or repeat caesarean).
New legislation which may come through will mandate all health professionals to report colleagues whose practices are deemed to be unsafe. Currently, we ought to report unsafe practices; this new legislation will make it mandatory.
Melissa Maimann, Essential Birth Consulting 0400 418 448
It’s interesting to ponder these questions, Melissa. For example, I wonder how many midwives would be prepared to report their hospital or an obstetrician for social inductions. We have access to a lot of that data already, but I haven’t seen evidence of any action.
I raise my eyebrows when words like ‘evidence based’ are applied to maternity care. The most basic and do-able evidence based practice is to provide midwives as primary carers, taking caseloads. Yet how hard is that? How many of the women who experience the cascade of interventions and have low levels of satisfaction with their care will be counselled that the service failed to provide a known midwife who would work alongside that woman in promoting physiologically normal birth???
In a case I have come across lately, a woman was sectioned for a long labor (12+ hours) and FTP. In her clinical notes her labor (active) was only 10 hours. Her baby had non-reassuring tones for 13, yes that’s 13, hours, while synto. was administered and CX were 5:10 (app. 4 hours); facts which were kept from the mother at the time but are in the chart. The baby was 9/9 merc. free. This was an induction for post-dates at 39+ weeks.
She has put in a complaint but has little faith in establishing anything other than a paper trail. The hospital staff and on-call OB have denied any wrong doing. For the life of me I can’t figure out why the c/s was for FTP and not fetal distress, why the synto. was not discontinued for non-reassuring tones, and how people with L&D backgrounds could let 13 hours go by with out “doing something”.
Ive often considered reporting unsafe practices such as unnecessary induction if it leads to other complications. I remember caring for a woman who was having her third baby and had had 2 previous vaginal births. She was being induced because this was a big baby. The induction didn’t work and she had a caesarean for failed induction and the baby was about 3.5 Kg. Not big compared to her other children, and not big by any standards. By day 3 she had worsening abdo pain and distention and no cause could be found. Things worsened and the following day she was taken back to theatre for a laparotomy. no cause was found and she recovered (physically). The baby was not breastfed beyond a few days and she now has 2 scars. All for a “huge” 3.5Kg baby!!!
Should we report caesareans for fetal distress if the baby comes out pink and crying, with apgars of 9 and 9?