MAYD to Birth: At Your Doorstep

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Another case…

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This time in the UK…

http://www.harrowtimes.co.uk/news/localnews/display.var.2399633.0.hospital_has_made_a_lot_of_mistakes.php

‘Hospital has made a lot of mistakes’
By Jack Royston
Comment Read Comments (2)
Nasim Ghaznavi attacked the hospital for their treatment of his wife
A GRIEVING husband says hospital staff were responsible for the death of his wife, who gave birth on its maternity ward.
Zahra Ghaznavi, 28, of Central Road, Wembley, was the third woman to die at Northwick Park Hospital in just ten months, causing the trust which runs it to launch an internal review into maternity care.
Her husband, Nasim, told the Harrow Times he found it too painful to talk about the woman he lost in March, but he described the events he believes led to her death.
What should have been one of the happiest periods of his life turned into a tragedy when Zahra fell into a coma less than a week after giving birth to their daughter Sahar.
Nasim, who runs a tailoring business, said on March 20, the day she died, a doctor at Northwick Park Hospital told him staff on the maternity ward were responsible for her death, which was caused by a bacterial infection.
After the delivery, he says, she suffered from internal bleeding and doctors plugged her birth canal with tissue.
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But he claims they did not change it or take it out for two days and he believes it may have been responsible for the infection.
He said: “I felt very bad. At first we were happy because the baby came but then she had to go to the operation room because there were problems.”
He said the coma hit when the bacteria spread up to her chest and eventually to her brain, despite surgeons taking out a section of tissue from her body in an attempt to remove it.
After an agonising wait, a doctor sat Nasim down to tell him the news that would change the course of his life.
He said Nasim and Zahra had become like a son and daughter to him, but he had to tell Nasim his wife had a one per cent chance of survival. He said they would only be able to wait a day before turning off her life support.
Nasim says he noticed a lot that disturbed him throughout the time he spent on the ward, leading up to the birth and during the time she was unwell.
He said the nurse who was helping Zahra asked for support from her colleagues but was refused it, and so had to take on the job by herself.
He said: “This hospital has made a lot of mistakes.
“For 11 days I was there looking after my wife and the same doctor who was helping us with the operation was serving us food, so what do you think is going to happen?
“At the same time a doctor is a nurse and then becomes a caterer as well. I will not go back there, I hate this hospital.”
I met Nasim in his two bedroom flat in Wembley, where he sat smoking while a television, nestled beside a stereo, played persian pop songs.
We were waiting for his cousin to arrive and translate some of the more complicated aspects of what happened, but his new home tells the story just as well.
The flat is far too small for the family he should be supporting, and he shares it with a friend instead of the woman he might have spent the rest of his life with.
His baby daughter stays with another cousin in Reading, where Nasim spends every other evening.
But he suffers from headaches, which his GP can neither explain nor treat, and he thinks he may be suffering from depression.
Nasim’s life was torn apart and now he can only wait to get an official account of what went wrong.
If the result says the hospital is to blame he plans to take legal action.
An inquest into Zahra’s death is expected to take place on September 24, but Nasim has been promised a private meeting with staff, and a draft result of an internal investigation launched following her death was sent to the Healthcare Commission, a government watchdog on Friday.
The report will also look into two other deaths on the ward, which both took place last year.
A post mortem said Zahra’s death was caused by E Coli and Septicemia.
Sarah McKellar, a spokesman for North West London Hospitals NHS Trust, which runs Northwick Park, said the it is taking Nasim’s concerns seriously but will not be able to publish the outcome of the investigation until staff have spoken to him first.
She said: “We would like to re-iterate our deepest condolences to Mr Ghaznavi and his family at what must be a very difficult and upsetting time for them.”
7:07am today

This took place in the UK rather than America, but to me it is certainly a great argument against the assembly line care given in many hospitals.

It could also be an argument against a national health care system, but I think it is just a warning to build a betters system than the UK has done. When (I hope!) we build public health care in this country I think we need to do very careful due diligence to model our system on the best parts of the successfuly countries like France, the Netherlands and Finland, working hard to predict and avoid the pitfalls that we hear so much about.

No guarantees

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It isn’t fair to pick anecdotes out of the news and say see this is why I’m right and your wrong. Anecdotes are not science and don’t prove anything, but they can be very persuasive and they are a favorite tool of the medical community. I’ve seen it used time and again by doctors and others to show why women shouldn’t give birth outside hospitals. So I’m going to be childish and turn the table for a moment to share this frightening little news article…

Teen mother still in hospital four months after giving birth
Fri, 2008-07-11 23:16.
Catherine Sherriffs
It’s been four months since a 16-year-old girl was admitted to the Maisonneuve-Rosemont hospital to give birth, and it will another several weeks before she’s released.
Melissa Belanger has had a portion of her legs amputated after she contracted a bacterial infection while giving birth to her son on March 15th.
The bacteria rapidly attacked the girl’s body, forcing doctors to amputate 10 centimeters of her legs.
Belanger’s uterus and ovaries have also been removed.
Doctors at the Maisonneuve-Rosemont hospital say they’ve never seen such a severe case before.
http://www.cjad.com/news/565/753319

While these extreme complications are certainly rare, and if we are rational we shouldn’t fear them because statistically they are not likely to happen to us, but they doesn’t mean we shouldn’t be aware that the risk does indeed exist. Obviously most don’t lead to such horror, but hospital acquired infections are quite common. The CDC estimates the incidence to be more than 2 million cases per year and hospital acquired infections may lead to as many as 70,000 deaths each year.1 The woman in the article didn’t die so she isn’t included in that number, and my quick web research didn’t yield statistics on how many people are left disabled by infections.

Aggressive and antibiotic resistant strains of bacteria generally don’t exist outside of the hospital environment. Women who give birth at home encounter mostly familiar germs that her body already has resistance to and are unlikely to make her ill. Her care is given by only a midwife or two and she won’t have to worry about what germs the team of hospital workers that she will encounter are bringing into her room. (or what was left behind by the last customers) During a hospital stay a woman may deal with 5 or 6 different nurses, a lab tech, a doctor, anesthesiologist, and depending on the hospital a whole squadron of interns and residents. If the baby goes to the nursery then the baby will potentially have contact with even more people. That is an awful lot of germ traffic!

The AMA wants to eliminate the choice to give birth at home, but they cannot guarantee our safety in their hospitals (of course they can’t, there ARE NO GUARANTEES IN THIS LIFE!). Women need to understand what the statistics say and that most likely she will be fine no matter what she chooses, but she should have the information. She should have a choice about how she wants to handle her birth and which risks she chooses to accept for herself and her baby.

1. Wenzel R, Edmond MD. The impact of Hospital Acquired Blood Stream Infections. Emerg Inf Dis. Mar-Apr 2001;7(174).

And the debate marches on…

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If you are like me and read birth blogs and hear most of the birth related news then you didn’t miss the recent American Medical Association statement that they were going to “develop model legislation in support of the concept that the safest setting for labor, delivery, and the immediate postpartum period is in the hospital, or a birthing center within a hospital complex, that meets standards jointly outlined by the AAP and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers.”

The news release was like pouring gasoline over the slowly burning, but never extinguished, coals of the home birth debate. A flurry of blog posts by birth advocates, midwives, and mothers choosing home birth went up on the web. News sources and community websites posted articles and stories, many including polls and comments sections where the people of the internet can share their opinions. There was a similar burst of activity when Ricki Lake released “The Business of Being Born” in January, and now that the AMA is publicly responding to the movie it all flares up again.

I have google alerts (google it if you don’t know about them, it is really cool) that email me all the new web content relating to birth, and home birth specifically. The google alerts make it possible to get a sense of what happens each day on the web, it is fascinating to watch the debates unfold.

It plays out nearly the same every time…

An article is posted
The comments began to come in, the first usually from home-birth proponents correcting any errors in the article and speaking on behalf of birth at home.
A slurry of women with the “I would have died at home” birth stories post how crazy it is to birth at home.
The same anti-home birth vigilante pipes in to give the same exact (TIRED!) argument that she gives every time.
The proponents fire back, try to educate and debunk the same tired argument.

Most of the time, I don’t get involved with the debates. There isn’t much point in repeating the same things over and over (even I am not that big of a glutton for punishment). There are also many smart women that are already posting and need no help from me.

I didn’t really see the AMA’s statement as blog-worthy. It isn’t news to me at all; it is the same agenda as always. The statement is a publicity effort with the hopes of counteracting whatever effect “The Business of Being Born” had on the women of the US. I highly doubt that the movie caused a sudden surge in the home birth rates, but apparently the AMA felt threatened.

The thing that I still can’t figure out is why they go on the offensive and try to eliminate home birth, instead of just hearing what caused Ricki and the other women of the movie to leave the hospital in the first place. If your concern is really about the safety of the babies then doesn’t it make more sense to try to figure out what you can do differently to bring these people back to your facility instead of trying to push them all underground again? Perhaps the obstetric community could even recognize that the statistics show that midwives have better outcomes, i.e. lower cesarean rates, less preterm birth, fewer traumas to mothers – and maybe, just maybe, there is something to be learned from the way midwives do things.

Of course the whole thing is a moot point because when it comes right down to it the malpractice insurance companies and HMOs are in charge. And heaven knows the only thing that matters to them is the almighty dollar.