Times letters: Failure to follow basics of maternity care

Times

3 days ago

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Sir, Alice Thomson's article on the 'dire state of maternity care' in the UK is to be welcomed ('Too many women see childbirth as traumatic', comment, Jun 25). I am an obstetrician who has worked in the UK, New Zealand (under a no-fault system) and Australia (with litigation). A no-fault system has appeal given the astronomical costs of maternity litigation in the UK. However, I disagree that 'a no-fault policy would encourage the medical profession to open up about their mistakes'. A 'mistake' is when a doctor or nurse gives an incorrect dose of a medication.
Most of the tragedies in Morecambe Bay, Shrewsbury and Telford were not 'mistakes', they were failures to enact the basics of maternity care (failure to listen to women, failure to recognise risk factors, failure to escalate care appropriately, inappropriate attempts to achieve vaginal births and delays in performing emergency caesareans).
These failings have been compounded by NHS trusts covering up errors, blaming victims and, now, destruction of records. A no-fault system will, by definition, minimise the consequences of the actions I have described at a time when women and society are seeking transparency and accountability.Dr Rob BuistBondi Junction, New South Wales
Sir, The basic truth is that the technical skill levels of those delivering babies are poor. Until that is addressed tinkering will not make much difference. The insertion of local anaesthetic into the perineum, and a carefully performed episiotomy (a surgical incision in the perineum) with a surgically accurate repair afterwards, should be the minimum standard expected of anyone delivering babies. Leaving the mother to strain and then rip her perineum is barbaric.
Wes Streeting needs to listen to a wider range of opinion and devise additional training and monitoring of practices, whether by midwives, medically qualified practitioners or even a new 'birthing technician'. Perhaps that could be a meaningful role for physician associates, those non-qualified physician assistants that are being promoted.IH Piper, FRCSDartmouth, Devon
Sir, Wes Streeting has announced a national investigation into maternity services owing to repeated failings, yet often there is a recurrent theme of women and their partners not being listened to when they feel there is a problem. Nearly 40 years ago, when my wife was in labour with our first-born, we overheard her being quickly labelled as the young female doctor making a fuss. She was given strong injections of painkillers and sedatives, one of which was used to treat schizophrenia at the time, and only then examined to reveal she was ready to push.
Our daughter was delivered rapidly, flat and barely breathing. With no paediatrician in sight I was asked to give her the antidote injection. I dread to think what would have happened had I not been medically trained. Until 'attitude to patients' is given the highest priority in the training curriculum and in continuing personal educational development, I can see the same headlines in another 40 years' time.Dr David MaddamsRet'd GP and GP trainer, Ware, Herts
Sir, Resident doctors may be 'excited' or even 'energised' by the prospect of strike action but they appear to have lost sight of the fact that many of them are trainees ('Medical union 'excited' about walking out again', Jun 25). Are they really 'excited' to lose valuable training time, and risk damaging their exam results and harming their opportunities to achieve promotion to the higher grades? One does not learn by standing on picket lines.Ron Hoile, FRCSRet'd consultant surgeon, Hempstead, Kent
Sir, The belligerence of the BMA and junior doctors horrifies me. The claim that they are 'excited' at the prospect of further strike action is both sad and misdirected. These newly qualified doctors need to remind themselves why they chose to study medicine. One would hope it was because they wanted to be part of our NHS, striving to cure the sick, rather than wanting mega salaries. The biggest reward is surely grateful patients.Emily FabriciusUpper Clatford, Hants
Sir, To fund the government's pledge to spend 5 per cent of GDP on defence by 2035 (Jun 24), a 'defence bond' should be issued immediately. This would have a maturity of ten years and carry no interest. The subscribers to the bond, which would itself be non-negotiable, would benefit in terms of inheritance tax due upon their death: the bond would have 2x the value of the bond as a credit against their IHT bill. To ensure that the Treasury remained supportive of this IHT credit, the multiple of 2x the face value would be reduced for those subscribers who died before the ten-year period was completed. Many British citizens, like me, would consider this unusual investment a way of increasing the safety of our nation.Sir William CastellFormer chairman of the Wellcome Trust; Oxted, Surrey
Sir, I agree with Robert Duffield's recommendation of a crackdown on fraud and error (letter, Jun 25) as the way to fund the £40 billion needed for our security, but many previous attempts at this have produced limited returns. We should be bold and introduce the publication of tax returns: the honest have nothing to fear; the dishonest will be caught out by their neighbours, and be forced to pay up, by HMRC and peer pressure.Edmund HaywardLlandrindod Wells, Powys
Sir, I wholeheartedly agree with your leading article ('Battle of the Bulge', Jun 24) on the benefits of prescribing Mounjaro to a broader cohort of patients in need. I work in primary care and have seen astonishing results in patients paying to take this medication: it is beneficial not only in reducing the chronic illness often associated with obesity but also in the psychological wellbeing of this group.
Unfortunately our local integrated care board does not share this enthusiasm and has issued a directive to all GPs in Suffolk and northeast Essex advising that GPs should not provide these medications directly for weight loss. Instead, the local NHS has chosen the community outreach service model. This means that access is available only through a specialist NHS weight management service — which is not operating at present. It would seem that those most clinically in need are subject to a postcode lottery of healthcare.Ancilla ShirleyNurse practitioner, Nayland, Suffolk
Sir, Your editorial suggests that you agree with Wes Streeting's view that making Mounjaro widely available on the NHS will cure the country's economic ills by enabling patients to return to work and reducing demand on the NHS. Although there may be some people in whom a 25 per cent reduction in body weight will prompt a return to work, I suspect this will not be the case for most.
This is because obesity per se does not stop you from working, and many of the psychological and social factors leading to people becoming obese are also the reasons that stop people from working. A more likely scenario is that by prolonging life expectancy these medications will lead to increased demand on the NHS and social services at a later date, with an associated and unbudgeted increase in cost to the Exchequer.Dr Oliver DukeConsultant physician (ret'd), London SW2
Sir, I fear Polly Mackenzie is being rather fanciful in her idea that the government can persuade benefits claimants that finding a job would be good for them ('This is how you get the sick back to work', Jun 25). I am sure there are some people who, given the appropriate support, would welcome the chance of employment — but there are many more for whom a life on benefits is always going to be preferable to getting out of bed every morning to go to a job that is likely to be thankless, tedious and not even financially beneficial. Unfortunately the appeal of a life on benefits over the drudgery and low pay of employment has been increasing for decades. This attitude has now become baked in and will take more than gentle persuasion and platitudes to reverse.Alan WardIpswich
Sir, Steven Morris (letter, Jun 25) states that 'two in five disabled people with complex needs will struggle financially if these cuts go ahead'. This appears to be the key to the conundrum: how does the government reform the benefits system such that the target is the three in five disabled recipients of personal independence plans who would not struggle financially?Andy ThorpLittle Canfield, Essex
Sir, I applaud James Marriott for reminding us of Joan Didion's motto 'I write to find out what I am thinking' ('Not reading or writing would be unthinkable', Jun 24). The problem predates AI. I taught A-level pupils for several decades and always insisted on handwritten essays, although once these were composed students were welcome to type them out if they chose.
Note-taking, planning, structuring and ordering one's ideas and then writing them — with careful choice of words so as to communicate precisely the points one wants to convey — can be done competently on a computer by few seasoned writers. Many undergraduates who write directly on computers find their essays returned with low marks because they are unstructured, poorly expressed and replete with unconnected points. AI only compounds the problem.Susan HamlynLondon W5
Sir, I concur with Henry Mabbett (letter, Jun 25) about there being too much sport, but for more personal reasons. Whenever I look at my dear husband, he has his eyes glued to his iPhone or the television. My life is constrained by the near-constant cacophony of commentary on darts, tennis, rugby, football and cricket, whereby homely marital communication is ebbing away. I have to wait for breaks in play if I want to catch his attention. What a life!Jan NorrisBroadwas-on-Teme, Worcs
Sir, India's home minister, Amit Shah, says the day is coming when Indians who speak English will feel ashamed to do so ('Modi minister tells Indians it is shameful to speak English', Jun 24. Shah might be reminded that when Jawaharlal Nehru delivered his maiden speech on becoming prime minister in 1947, he addressed the nation in English and championed it as a vital language for India's progress.Jules StewartLondon W11
Sir, I have often been impressed by the comments of Matthew Parris (Notebook, Jun 25). Now I learn he can spot an Englishman among the 'pixels' of 10,000 faces; no Welsh, no Scots, no Irish, no white Europeans, just Englishmen. What a talent.Chris BryantWinscombe, Somerset
Sir, I rather like Matthew Parris's attempt to link Jarvis Cocker with the ardour, longing, irony, tenderness and passion of another five white Englishmen. May I suggest as an alternative five Gerald Finzi, Edward Thomas, Eric Ravilious, and both Mole and Mr Toad from The Wind in the Willows?Stephen PollardTunbridge Wells, Kent
Sir, My mother would have agreed with Victoria Hawthorn's mother (letter, Jun 25) that a gentleman should wear well-polished shoes, but would also have insisted on a snowy white handkerchief in his pocket.Janet CowieShandon, Argyll & Bute
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