Another baby killed by a midwife 

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The title of this post is blunt, perhaps even shocking or offensive. But the ongoing situation wherein some New Zealand midwives demonstrate gross incompetence and babies die as a result is far more shocking and offensive than the title of this post could ever be. Note that I said ‘some’ – there are many good midwives around.

Before we look at the latest tragedy, suffered by Robert and Linda Barlow and their baby, a bit of history is in order. I cannot recall the precise date, but about 13 years ago the state’s system for paying GPs (family doctors) who delivered babies was changed. Basically the government told GPs that their services were no longer required, and the message was delivered by cutting their pay rates to a pittance. Mothers lost the continuity of care that a doctor they knew well could provide, while midwives became well paid Lead Maternity Carers (LMCs), handling uncomplicated deliveries without the oversight of a doctor. There has been a recurring problem of midwives not calling for help when a delivery becomes complicated, resulting in distress for mothers and, sometimes, death for babies. Why is this? Are midwives simply not trained well enough? The lack of monitoring of mother and baby that is usually associated with a death indicates a lack of training. A doctor has told me – on condition of anonymity – that midwifery is rife with extreme feminism. Are midwives fed a feminist agenda whilst training, an agenda that says “We can handle it, and there’s no need to call on paternalistic medical doctors”? Whatever the cause, the present system is clearly not working: that’s almost inevitable when the government runs health and free choice by mothers is limited or taken away.

I believe that the fundamental problem here is government control of health care, because history shows that incompetent people only flourish in state-controlled situations. When you want your car fixed, you ask around and find the best mechanic: in a free market those who provide the best service thrive, and those who don’t go out of business. It should be the same in health care. Sadly, New Zealand laws basically do not allow us to sue for damages; I believe that part of freedom is being able to obtain redress from those who harm us or our property.

Let’s look at the latest tragedy. The video below tells the story, but the following points from it are worth highlighting:

  • Newly qualified midwives work alone as LMCs as soon as they are qualified. Linda Barlow, the mother in this story and a physiotherapist with above-average medical knowledge, said It’s unbelievable a lead maternity carer responsible for two people’s lives can be freshly out of college and independently in charge with no experienced experts alongside her (source). I entirely agree.
  • Barlow had a previous difficult delivery. When her experienced midwife went on sick leave Barlow assumed that the replacement was equally experienced; in fact she had only been qualified for seven months. I do not wish to criticise Barlow, but assuming the competence of someone who has your life in their hands is dangerous. Ask someone how much experience they’ve had, and if they object to the question in any way run – don’t walk – away.
  • Barlow was going to deliver in a maternity centre. My friends who have had many children insist on going to a major hospital, which is generally safer.
  • After labour began Barlow went to the maternity centre and the midwife sent her home, despite Barlow pleading to stay and despite the fact that she was in labour and in severe pain. In my humble opinion this alone is enough to warrant severe disciplinary measures.
  • When the midwife went to the home of Linda and Robert Barlow a few hours later Barlow was ready to deliver and the midwife called an ambulance to take her back to the birthing centre. The midwife did not take Barlow’s pulse and did not properly monitor the baby. Despite the fact that the midwife had not done the most basic checks on the status of her two patients, the ambulance was told not to use sirens (travel at speed). How could the midwife make that judgment call correctly when she didn’t have any supporting information?
  • Later, when the situation was clearly serious another ambulance was called to take Barlow to hospital, and again the midwife told the ambulance crew that there was no need for sirens. Barlow says that there was no monitoring of her vital signs during this second visit to the birthing centre and monitoring of the baby was inadequate, so for a second time the midwife was telling an ambulance crew to dawdle along, despite the fact that she had little or no idea of how healthy her patients were. Speaking from experience, the first thing an ambulance crew does is check vital signs – it’s just common sense.
  • Mother and baby were not monitored properly for an hour after they arrived at the hospital, at a time when both were dangerously unwell and declining. I do not know who was legally and morally responsible at this time, but this is clearly a serious matter. The Barlows may not have known how bad things were, but if you find yourself being ignored in hospital whilst dangerously unwell you must call the staff and state clearly your concerns. Grab a doctor if you have to; do whatever it takes to get attention from the overworked staff.
  • Stuff mentions some of Barlow’s injuries: a stroke and a heart attack during the delivery and needed six minutes of CPR. She required 7.6 litres of blood transfusions. The average body has five litres of blood…respiratory failure, a heart attack, a stroke, psychological trauma, permanent bladder damage, mild brain damage and a hysterectomy. They don’t mention a ruptured uterus (womb) and a massive scar on her arm. The midwife took away Linda’s good health, her ability to have more children, and her baby’s life.
  • The Barlows were told that their baby was still born, when in fact he showed signs of life. This sounds like the medical practice of 40 years ago.

Robert and Linda Barlow, I am very sorry to hear that you and your baby were treated so terribly. I hope that some change for good will come out of this.

Go to MacDoctor’s very good article on this case – he answers the questions that I have raised

Click here to go to an update of this post


45 Responses to “ Another baby killed by a midwife 

  1. R & L Says:

    Great article.

    One slight error. The midwife told the ambulance driver as we got into the ambulance that there was no rush, no sirens.

    R & L

  2. Roz Says:

    I recommended Robert and Linda use my midwife, and they did. My midwife had many years experience, and was training the new midwife they landed up using when I was giving birth to my third child. My midwife commented that the training midwife had the same approach to midwifery as her (which I liked) and felt she would make a fine midwife. Robert and Linda asked me about the midwife they eventually chose and I passed on those comments from my midwife (their first midwife). So they did seek further advice on selecting the second midwife, but I don’t think they realised that new independent midwives are straight out of training – that there is no further ‘apprenticeship’ prior to being allowed to become an LMC. So it was a lack of knowledge of the NZ system, rather than a lack of enquiry on their part – not that Im meaning to put my oar in, I just know that this is question that will be circulating. Regards – R.

    • Jachin Mandeno | MandenoMoments.com Says:

      Thanks Roz, that is interesting. As I said, no criticism of the Barlows was intended.

      I’ve added a link to my post, which is repeated below: MacDoctor says that one of the problems is that midwives aren’t trained to recognise when a normal labour/birth changes to abnormal and dangerous. This supports my belief that there is a systemic problem with midwifery in NZ.

      MacDoctor says a newly graduated doctor is heavily supervised for two years before being allowed to handle patients without senior input. And the medical course is twice as long as the midwifery course and contains two years of patient contact as a student.

      And yet midwives are allowed almost the same level of autonomy as a year 9 doctor – at least in terms of obstetrics.

      IMHO allowing such poorly trained midwives to work independently is insane and arguably criminal. As I said in the article, if we had a free market parents would be able to choose those midwives who are better trained.

      http://www.macdoctor.co.nz/2010/06/06/the-hole-in-maternity/

  3. Roz Says:

    And absolutely no criticism taken – its just good to flesh out the picture where I can – there is so much that can’t be said in an article without losing the reader. Even I didn’t realise just how easy it is to become an LMC (acknowledging the hard work it takes to pass of course, and the long and irregular hours required to be a midwife), and I’ve had three kids!

  4. Spud Says:

    An LMC has total responsibility at the hospital until she hands over care.

    It’s an incredibly sad story and a perfect demonstration of everything that is wrong with out maternity care system.

    Don’t assume competence. Demand to know what experience your midwife has, both hospital experience, community experience and how many babies has she actually delivered?

    To complete the degree the requirement is to ‘facilitate’ a minimum of 30 births

    30! Only that many and you can practice independently?

    10 a year and you are competent midwife, well to the standards of the NZ Midwifery council anyway….

    • Jachin Mandeno | MandenoMoments.com Says:

      Thanks Spud. It appears that the present system produces midwives who can handle a normal birth – at least most of them can – but when things go wrong some of them are apparently unaware that there’s a problem.

      Sending a woman in labour home with pethidine – despite her pleas to stay in the birthing centre – is more than just a matter of poor training. To me such an action indicates a lack of care, common sense, customer service, and plain old fashioned decency (speaking generally, rather than about this particular case). I see the same sort of thing in hospitals nowadays, where very few nurses have any warmth and most of them don’t demonstrate the degree of care and dedication that the old-school ones did: they seem to lack a sense of vocation. Eg, a friend of mine was in hospital and told a nurse that she was freezing cold: did the nurse offer her a blanket? Do they serve champagne with caviar in public hospitals?

      Some hospital nurses I’ve met give the impression that I’m just a slab of meat to them, much like a farmer views a sheep.

  5. kylie Says:

    Firstly I want to say how sorry I am for the Barlows and the grief they have suffered.

    I believe my son was born 6 months ago to the same midwife from this clinic. The details are all the same, the initial carer going on sick leave and the replacement being her partner. I was apprehensive because she seemed so young, however, didn’t want to question her over her experience.

    During my son’s birth my partner and I felt like she didn’t know what she was doing, for example, she had me push and then when she actually examined me afterwards realised I wasn’t even fully dilated. I seemed to answer all my own questions and it all felt quite despairing at times. Fortunately my body told me what to do, being a second birth and my son was born without complications.

    If I had known about her previous birthing difficulties I would have definitely chosen somebody else.

  6. Update: Another baby killed by a midwife « Mandeno Musings Says:

    […] posted this comment on my earlier post titled Another baby killed by a midwife: Firstly I want to say how sorry I am for the Barlows and the grief they have […]

  7. Paulette Says:

    Hi Kylie,

    All I can say is thank goodness you fall into the catagory of the 75% of normal births!! What this MW did to the Barlow’s is medievil!!!! I hope you have put a complaint into the MW council Kylie about her complete and utter incompetence again!!!! I can’t believe she is still practicising!!! Those poor Mums and Babies, she is dangerous and it’s scary.

    We need to depand as a nation that these MW’s have at least 2 years post graduation experience with difficult births or more poor little souls will end up dead or brain injured and become a burden on the health system and their families..

    I was lucky I new the system and who are the best in the business. I had an incredible MW for my 3 babies who were all difficult births…The more you know the more you realise you don’t know, these new grad MW’s are novice’s and only beginning their learning, they seem to expect normality so how can they pick up the subtle changes when things are going wrong?? They don’t realise that they don’t know what they don’t know. It takes years to accure this skill!!!

    Let’s hope little Adam didn’t die in vain and change can come from this!!!!

  8. Sandy Says:

    New grads need two years rotating around all areas of a tertiary obstetric hospital including the newborn unit…..then they may know what to be VERY afraid of!! This is not a job for the faint hearted, hands on experience counts for everything, so does staying with your woman during her entire labour and birth and not dumping her at the hospital … if she needs extra help eg an epidural, that is why the delivery suite is so over worked and short of staff, if these new grads got the hospital experience then they wouldn’t be leaving their ladies in the care of strangers at the hospital but staying there caring for her as she should as the familiar face and the trusted professional. These new grads are just behaving like the GPs used to running in at the last minute and catching the baby (if she has been handed over and midwife is called back in) the woman does the birthing not the midwives in normal births we are just the “catchers” we are really only needed to be vigilant and watch for any deviation from the normal and get help sooner rather than later and if you know what you are doing and know the system this is easy to do!!!! Humanity and support and continuity of carer is why we had the big change in 1990, so women could get to know who was going to be there for them at their births, they were promised that……not that in a few years that the training would be changed for midwives to direct entry (with a mentor programme that is weaker than weak and not even mandatory) and that they would be able to step into the public arena and set up shop and be LMC midwives the day they became midwives, cocky as all hell with no fear as you don’t know what you don’t know!!! The whole set up is a gravy train for everybody, the college, the council, the techs, the lazy midwives who would rather send a lady home in pain, than sit and comfort and reassure her! and the babies who die and the mothers and families whose lives are ruined are just collateral damage, and I’m sick of it!!!!

    • Jachin Mandeno | MandenoMoments.com Says:

      Sandy: MacDoctor says that midwives have little or no experience of abnormal births and are unable to recognise one when it’s in front of them, and I’m inclined to agree that two years experience in a tertiary hospital would save lives.

      The midwifery situation has parallels with that in nursing: when hospital-based training of nurses ceased the skill level of nurses dropped dramatically. Classroom-based teaching (with ?20% cultural safety) just isn’t as useful when a patient is bleeding out and you’ve never seen how an experienced nurse handles such a situation.

      I recently saw a first-year nursing textbook and the material in there looked like college (high school) material to me.

  9. Baby given mother’s drug by midwife « Mandeno Musings Says:

    […] (thanks); I wrote about what happened to him, his wife Linda, and their baby Adam in my post titled Another baby killed by a midwife. There I listed the injuries suffered by a Linda after being ‘tended to’ by an […]

  10. Sandy Says:

    Very wise, I’m impressed with your insight into what is going on, but any changes to the present system has to be consumer driven, without consumers there is no gravy train for this flawed and deadly system to continue. Consumers must get strong and band together, and say enough is enough, we want more hands on and see more experience for the new grads until they are safe enough to look after us and our precious babies. Our strong and beautiful pregnant mothers deserve more than what they are getting! Continuity of “carer” is the utmost importance in building a trusting relationship with the midwife that has you, and your baby’s life, in her hands, handing over to strangers should not be an option. It never used to be before direct midwifery training came in in 1997 and things have never been the same since then. “This job is a lifestyle not a business” (as I have often heard it said by new grads and others) but if midwives want heaps of weekends off there are plenty of jobs at the hospital (which is what I hear as they are always short staffed and we know why!) if that’s how they want to practice their craft. A midwife should have a partner that the mum should have met, and if it is a long labour and the midwife is too tired then instead of dumping her woman/client on random strangers (midwives they haven’t met) in delivery suite (aka handing over) then she should call in her midwifery partner who will carry on, with the same level of expertise to care for her. That’s how things used to work and I want it back for the women of this country! Along with home visits for 6 weeks after the birth not the 3-4 weeks they are taught in tech and by Plunket…..(so Plunket can also get their funding!!) ………Consumers, this is the time for action! Get back what was (and still is) rightfully yours in the first place….. email Tony Ryall your Health Minister he is REALLY interested in what you taxpayers (CONSUMERS) have to say, he can’t put right what he doesn’t know is wrong…. and the system is up for review so the time is right. Email him at tony.ryall@parliament.govt.nz (and midwives that don’t agree ……you are in the job for the wrong reason and that is why we are needing to have this discussion in the first place).

    • Jachin Mandeno | MandenoMoments.com Says:

      Thanks Sandy. I agree that things should be consumer-driven. As I said in my post, a large part of the problem here is that the government has taken away our choices so mothers cannot choose the best and let the rest go out of business. Free choice is the reason for our access to high quality shops carrying a wide range of goods; competition also keeps prices down. When all shops are government-owned you’ll find a scarcity of goods, poor service, and incompetent staff – much like midwifery today (yes, there are exceptions).

    • Anonymous Says:

      I’m a Midwife and I don’t agree. I am not in the job for the wrong reason, I am passionate about what I and other Midwives can offer women. Consumer Feedback through the Midwifery Standards Review process which occurs every 2 years for all Midwives in NZ, is excellent. So I think it is important to find out levels of satisfaction with the current system and actual statistics on poor outcomes now compared with the system 20 years ago, before using scare tactics to make uninformed change.

  11. lesley Says:

    Totally agree with sandys comments, when a new grad can give a baby an adult injection,… not only the wrong drug but to the wrong person (cant even tell the difference between a mum and a baby apparently). and then when doing follow up for any possible effects …for got to label the blood tube and had to bleed the baby again!!!!!!!!! so this baby got an adult sized injection, and 2 blood tests all unnecessarily. And is she being mentored?…YES SHE IS, decide for yourself if mentoring is working………

  12. Roz Says:

    So… when is someone or a group of someones in the ‘know’ going to stand up and make this public and shout it to the media so that the public can see what is really going on. Right now the midwifery council is bullying everyone and gagging people through fear of losing their jobs (and a very valid fear too I’m sure) and no-one will stand up and openly put their name to the facts. Who will take up the challenge and put it out there? Are there any newly retired midwives willing to go into battle, as that is what I reckon it will be, with the midwifery council pulling every dirty trick to discredit them. Sigh… why does everything have to be so hard, and so wrong. Im only 38 and I feel so jaded by where society is going – sound like my father…. grin!

  13. Linda Depledge-Brooker Says:

    I am a consumer who is willing to make a stand!!! I am currently in the process of getting a petition underway which will get sent to Tony Ryall hopefully!! Anyone want to join me? I’ve never done this before so it’s taken a fair bit of investigating.. but I feel so strongly that midwives should earn their ‘flying colours’ after a 2 year internship in a hospital.. The brilliant experienced midwives are being let down by this system, and we need to ensure that in the future preventable tragedies don’t happen, and our kids will have access to safe, quality care in pregnancy and birth and beyond.

    I am so sorry for the Barlow family, and all the other families whose lives have been immeasurably affected by preventable tragedy as a result of this malfunctioning system.

  14. Sandy Says:

    Roz, You cannot blame yourself in any way as you trusted this system to look after your friend, and Linda also trusted that her “trained professional” would also know how to look after her and her baby, it shouldn’t have mattered who her care was handed to, she should have been in experienced hands, and just because it was a “second” baby there was no need for complacency on the new grads part. Obstetrics is never predictable and experienced midwives are always ready for anything! The more years I have worked as a midwife (and it is more than 20) the more nervous I have become, as I have learnt that this is a dangerous job (I knew that before I left the hospital to be an LMC) and things can turn bad really fast, so vigilant monitoring is the only way to be sure you have a handle on the wellness of mum and baby. I always think ahead …….an insight a new grad with no hospital experience is capable of! Its just common sense through experience, even Doctors cannot just go out and set up shop as a GP in their first year out of medical training, they have to have extra training. The techs teach all normal, and teach the student to beware of becoming “too medicalised” (I heard that from a first year student just last week, in a reply as to new grads having to have two years post grad in a base hospital setting before they can be an LMC) and yes most births are straight forward, but one, just one lost baby, is one too many, especially if it could have been prevented in any way. And yes some babies we are going to lose but there should never ever be any question of “this could have been prevented” and it is becoming all too frequent all one has to do is go on to the “Health and Disability “website and read through the midwifery related disasters. It is not pleasant reading and detrimental to the midwives of NZ as well, and we don’t want to all be seen in a bad light just because the college and the council refuse to take the advice they have been getting for years now…..from Coroners, H & D, the New Zealand Society of Anesthetists, also the midwifery first year of practice pilot programme evaluation-final report July 2008 is very interesting reading……..the last recommendation reads as follows……CONSIDERATION BY THE SECTOR OF AN INTERNSHIP SYSTEM WHERE NEW GRADUATES SPEND A MINIMUM PERIOD WORKING WITHIN A DHB SETTING….it goes on to say…
    Addressing the remaining programme weaknesses will be essential to optimal programme benefit for graduates and the profession!! This was in 2008 for goodness sakes “the benefits for graduates and the profession???”….whoa here where does the consumers (mum and baby) fit into all this ……..time to get moving consumers, these departments DO NOT have your safety and wellbeing at heart!!! It’s written in black and white and all the calls for changes have fallen on deaf ears and the gravy train ploughs full steam ahead……….while our babies continue to die and lives are being shattered.

  15. Floss Says:

    Hi All, especially Linda and Sandy
    A petition has already happened (last year) see
    http://www.thegoodfight.co.nz

  16. Sandy Says:

    Having GP’s back is not the answer that was the very first paternalistic “gravy train”! Who do they think provides labour care to the lady in labour? There was no getting to know your midwife, or birth plans, or after care, it was a crap system, and all we did (us well-trained midwives) was cut out the middle man. There were less disasters because us well-trained midwives picked up the problems during the labours and got help from obstetricians on the floor in delivery suite, not the GP’s who sat in their surgeries giving us stupid advice that we mainly ignored anyway (over the phone). Woe betide calling a GP to a birth until the baby was nearly out as they had a surgery full of illnesses and diseases to attend to and what the public fail to also know is who do they think trained the GP’s….yes US midwives AND I might add this was mostly a painful exercise to behold, watching the fumbling learner GP’s until they got good at what us midwives taught them! Then they would come rushing in “to save the day” and catch a baby (any idiot can do that! as most babies deliver themselves) pushing aside the midwife that had taught the GP everything he or she knew because they certainly never got taught the skills at medical school! What a joke! Trust me you don’t want that old paternalistic system back, what you do want is midwives with 2 years minimum post grad in a tertiary hospital to make them safe enough to pick up problems, no big drama or massive restructure just change the training system! Keep our GP’s where they are needed (and want to be or surely they would have BEEN obstetricians) dealing with the sick and injured not dealing with maternity on the side, our women are worth more than that surely!

  17. Linda Depledge-Brooker Says:

    Thanks for the info about the previous petition Floss. It certainly was an in depth submission, prepared with a lot of passion and commitment and a great deal of hard work and love.

    The petition we are currently collecting signatures for is a much more specific one, specifically requesting/demanding that newly graduated midwives complete a mandatory 2 year internship at a base hospital before they are able to become independent Lead Maternity Carers.

    http://www.ipetitions.com/petition/nzmidwifery-internsip/

    Or if anyone wants a hardcopy with the same message please let me know and go collecting signatures!

    Cheers
    Linda

  18. Sherryn Says:

    I had an horrendous and traumatic birth of my first son 12 years ago. I had a hospital midwife, she was on leave the weekend I went into labour. Her partner, was probably the better one of the two midwives. The charge midwife didn’t call in a specialist until 8.30am because he wasn’t on call till then. I was left in 2nd stage, pushing for 5 hours. In the end the doctor was called, he tried the ventouse first, which failed and then he was delivered by forceps. My son had a bruise on top of his head from the ventouse, and marks on the side of his head from the forceps. My 2nd pregnancy I paid and went throug private specialists. There is no way that I would recommend a midwife to any of my friends. They are dangerous. They do not hand over until its too late. Too many mothers and babies are being put at risk, and for some it is too late. Dangerous midwives should be struck off and be held accountable for the actions. If it was a doctor who caused the death of a baby or mother they would have action taken against them.

  19. Kylie Says:

    I agree with Sandy that GP’s should not take over but that midwives need to undertake more thorough training and should gain experience by working in a hospital. As you say, Sherryn, dangerous midwives should be held accountable, however, in the Barlows case I believe the system failed them more than the midwives.

    The young midwife involved in the Barlow case delivered my son just 7 weeks later and despite my birthing experience (I wrote an earlier post), in her defense she gave me excellent post birth care – I believe my breast-feeding was successful due to her help as I suffered badly after my first birth – and that with better training and experience she would have/ will be a great midwife.

    (This is my personal opinion for this blog and I do not wish to go public with my story)

    Thanks Kylie

  20. Sandy Says:

    The problem with obstetrics/birth is that it encompasses so much more than just one area. There is antenatal care where a midwife has to be super vigilant in picking up any problems and refer onto the obstetric team at the hospital for shared care and obstetric input to ensure the woman and baby are closely monitored until birth while being encouraging and cheerful and REALLY listening to women as often problems can be picked up and addressed by just listening. Women are just not pregnant, they have emotional and spiritual, cultural, AND physical needs that all need to be taken care of. Then there is the planning through the pregnancy and the building of a partnership based on trust that the woman will come to all of her visits and take personal responsibility for looking after herself and letting the midwife know when things may be not right outside of appointment hours. Then there is the birth where a woman, her husband and (often entire families) need to be treated with humanity, kindness and empathy, along with encouragement and support and at the same time the midwife needs to stay calm and vigilantly watch and monitor the labor and birth for any signs (sometimes subtle ones) that things are going wrong, in other words any deviation from the normal. It takes years of practical experience to be able to do this while being confidently calm and getting help at the first sign of trouble as any experienced midwife knows things can go very bad very fast and help, sooner rather than later, will make all of the difference in the outcome for mother and baby, but to sit on a problem hoping it will get better is no way to practice, because a problem will rarely get better……..my motto for birth centre is if in doubt get out……transfer to hospital and if baby is born soon after getting there great!! If not obstetric help is indeed needed well the right decision was made, better to be safe than sorry as you don’t get a second chance in midwifery. If a baby or mother is already severely compromised when they get to hospital it is way more difficult to ensure a good outcome and then the poor obstetric registrars and consultants are left to salvage a situation that is often too late to guarantee a favorable outcome. Even in the hospital setting if the midwife doesn’t call for help soon enough the same situation can happen as just because a woman is at the hospital she is no safer if she has a midwife that has had no hospital training after graduation, and because an LMC is an independent practitioner and solely responsible for her clients care no one is checking up on her, unless she asks for help…….. and she has to know when to ask for help, and once the woman and baby get through the most dangerous day of the baby’s life (yes it is a fact the day you are born is statistically the most dangerous day of your life!!) then there is the postnatal period, and that is an underestimated time by many midwives especially new grads, women will require at least 10 post natal visits in the 6 weeks following birth…….yes it should be 6 weeks (not the 4 weeks that the new grads are taught)…….payment is not per visit it’s the same for 7 visits (or less) or 10 visits for an average postnatal period. Some women need way more visits than others, often twice daily with breastfeeding problems, this shouldn’t be seen as the midwife doing an amazing job this is what her job is, it doesn’t end at the birth and after a few home visits; it should be on the basis of need.
    So with midwives trained only to be “specialists of normal birth” (Karen Gilliland – Waikato Times 17.07.10) if the baby doesn’t literally “fall” out or deliver itself………there will be trouble and often there will be an accidental good outcome but not in a lot of cases that we are hearing about.
    So it’s just not good enough that a midwife excels in one area, she has to be good in all areas of midwifery, and it’s the same old story as long as it’s happened to someone else its ok. Some women have a very lucky escape and never fully realise how close they and their babies came to having a very different and tragic outcome, it’s just pure luck a lot of the time, not the skill of the midwife.
    It’s not the new grads fault they are actually trained and indoctrinated to the fact that they are specialists in normal birth (and ready for LMC work straight after graduation)……..and anything else should be referred…but there lies the problem………how do they know and what do they do when something goes wrong rapidly……..call another experienced midwife or the hospital obstetric registrars to bail them out…….and sometimes by then it’s too late.
    It’s not personal against any new grad, this is way too serious to be personal, we are talking about lives in the balance literally, the clients and the new grads!! not how nice people are because they have done their job properly (how it should be done in the first place). We must implement change to keep everybody safe including the new grads.

  21. sarah Says:

    “The Barlows may not have known how bad things were, but “if you find yourself being ignored in hospital whilst dangerously unwell you must call the staff and state clearly your concerns. Grab a doctor if you have to; do whatever it takes to get attention from the overworked staff.”

    I am so sorry this happened to the Barlows but I’d like to comment on this specific situation. I also had a midwife attending, was not monitored very closely, and had a uterine rupture at some point (I believe an hour or more after I arrived at the hospital.) But I don’t hold my midwife responsible. I also had an issue with the hospital. They did NOT call the doctor and said there were NO doctors in the hospital! How can this be? Well in my state (Texas, USA) hospitals are not legally permitted to hire doctors. I didn’t know this, and thought a hospital with an ER and a popular maternity ward would have doctors. They also put me in triage, and treated me like a crazy laboring woman. I kept telling them my baby was dying, and they absolutely refused to do anything. I begged and pleaded for a dr. They asked me if I wanted him circumcised and I told them that it wouldn’t matter, he would be dead by the time they got him out. Still, they would not take me to labor and delivery.

    They refused my medical records. They eventually did an ultrasound about 45 minutes after arrival and discovered the baby had died (but still insisted that I had not ruptured.) Finally they called a dr from offsite who arrived and as he was examining me my uterus opened up and the full contents of my uterus went into my belly. He said “Now we’re going to try to save your life.”

    My midwife and I were later treated horrible for ‘murdering’ my baby. When in fact they refused to listen to me upon arrival and he WAS alive and kicking when I got there. I wasn’t even in active labor. My lab reports later showed there was a problem with the placenta and I had a placental abruption, which later led to uterine rupture. Could they have prevented him from dying? Maybe not. But most certainly they could have tended to me before I ruptured and nearly died (I also had a transfusion.)

    • sarah Says:

      I also need to ad that I was with my midwife for a very short period of time before we transferred. But she was sick and failed to monitor me appropriately immediately. When she finally realized something was wrong she didn’t waste any time and we were at the hospital in a few minutes.

  22. Robert and Linda Barlow Says:

    I could really do with trying to make contact with the person who posted about the death of our baby. It is Kylie. As you probably see by the media we are in the process of the Coroner. I have a really important question to ask Kylie. If you can not give me here contact details is it possible for you to contact her and give her our details.
    This is really important that I can ask this question to her.

    Regards
    Robert Barlow. [phone number removed by blog owner]

  23. Baby Barlow inquest « Mandeno Musings Says:

    […] my earlier posts (here and here) I wrote about the death of Adam Barlow, son of Robert and Linda Barlow, caused by a […]

  24. The truth about midwives « Mandeno Musings Says:

    […] birth requires very little skill. It also requires very little skill to know that you don’t give a woman in labour pethidine and send her home despite her protests: humanity, compassion and commonsense will […]

  25. Dead Baby — MacDoctor Says:

    […] Jachin at Mandeno Musings has been following this case closely. You can read the relevant posts here, here, here, here and here. Now you know considerably more about this than the media. […]

  26. Gill Crooks Says:

    Making a compaint to the MW council is flawed as they investigate themselves?

  27. Katie Says:

    Firstly i would like to express my sorrow and sympathy to the Barlow family for their experience and loss. As a student midwife, I do not like that all new graduates are grouped in to the idea that they are incompetent – many of the deaths/difficult births and mistakes are overseen by midwives with 20+ years of experience. Also there is no research here on the mortality rate of OBGYN led births – I think you would be surprised. The real problem is with individual midwifes who are over-competent. We specialise in normal birth and a good midwife should handover as soon as she realises that the birth process is going out of the range of “normal”. In the case of the Barlows – this could have happened with any over-competent midwife – new grad or with many years of experience. There are many new graduate midwives that I believe are capable of providing better care than some highly experienced midwives – the generalisation (for a student midwife) is heartbreaking. I do not like the fact that firstly a) it is headed “another baby killed by a midwife” assuming that OBGYN LMC care is less risky – ” the risk of experiencing an infant death was 19 percent lower for births attended by certified nurse midwives than for births attended by physicians”,. This competition between OBs and Midwives is ridiculous, we should recognise each others individual skills and work in partnership to perform healthy deliveries. As far as whether this problem lies with new grad midwives or age of midwives – I totally disagree, it is a personal issue about a midwives incompetence rather than a generalised problem.

    • Very Concerned Says:

      If only the general public actually knew what the research says behind midwifery led birth and how our maternity system in New Zealand actually compares to the rest of the world there would be no more of these crazy media-driven witch-hunts! New Zealand is rated as having the best and safest maternity system in the world and this is because it is midwifery-lead. Women from other countries can only dream of having the system that we do, with the choices we have, and the safety we have access to. We have some of the lowest number of neonatal/fetal/maternal rates of morbidly and mortality in the developed world, let alone the third world. International research shows that women and their babies have a higher risk of morbidly and mortality when they entrust their care to doctors and tertiary care, than with midwives…. unfortunately for midwives, doctors are not persecuted by the public and media as much as midwives are when mistakes happen (which they do in any health profession). In terms of education midwives in New Zealand complete the equivalent of a 4 year degree specialising in normal pregnancy and birth, this consists of 4200hours of practical experience. In fact they even have to attend more births (almost double) the amount that an Obstetrician (doctor who specialises in pregnancy and birth). We have some of the most highly skilled professionals in the world (qualified midwives) who are equipped a first rate education. Like Katie outlined above, New Graduate midwives are some of the safest practitioners you could have providing intrapartum care and they (through research) tend to be more cautious, and have access to (through their recent education) the latest evidence-based practices than senior midwives and doctors. …. But I suppose you cannot tell a spoiled child that they are spoilt if they don’t know any different (consumers and other uneducated people moaning about the state of our maternity system)… Wake up New Zealand! The complete disregard of professionalism displayed by media these days and their inadequacy of reporting actual facts (in fact sometimes complete bullshit) is disgusting! They should be held accountable. What happened to the couple you mention above is sad (although your ability to report a balanced and thorough account of what actually happened is severely lacking), but these things happen. Blaming a whole profession for the possible mistakes of 0.1% of its members is an incredibly ignorant thing to do, usually borne from a lack of education, and a fear of the unknown. If we were to hold every profession accountable in the same way, I can assure you that you would never leave your home let alone intrust your care to anyone.

  28. Jachin | MandenoMoments.com Says:

    I have written several articles about the Barlow family and the recurring pattern is that people feel a need to comment and defend midwifery with religious passion: that in itself is cause for concern.

  29. Valola Allmark Says:

    I understand that there is a payment from Govt for each birth. If the midwife attends the birth, she gets the money. If the birth is handed over to the hospital/doctor system, then that payment goes too.
    Last Tuesday my grandson was delivered by forceps in an emergency situation. His Mum had laboured half a day and all night, then told it was time to push. Three hours later, of intense traumatic suffering, nothing had happened. My son luckily found a doctor, who quickly saw how and why the baby’s head was jammed. The midwife insisted that all the Mum had to do was to keep pushing. The Doctor saved their lives. When you start pushing it should not take long. If nothing happens be aware that you are already in a serious emergency. Call for help. Make sure there are people there to get help if the mum is not able to defend herself.
    I have had six children myself and the last child was hard. When I asked the midwife the problem, she said post anterior. When I asked her what that meant, and what would happen next, all she did was say ‘head down wrong way round’. Then she went to the far end of the room and ignored me. Eventually I got him out myself.
    After menopause I found my uterus fell out – total prolapse, and it was followed by part of the bladder. I could not walk properly, could not safely cross a road and could not pee, so my kidneys suffered. I had to stop work. I underwent two years of surgery with a kind of internal safety net repair. The specialist Doctor who operated said that he was regularly fixing up third world birth injuries like mine, in NZ women, and could not understand why this was so.

    • Jachin | MandenoMoments.com Says:

      The midwives still get paid if they send the mother to hospital for delivery, but the payment is higher if the midwife handles the delivery. In other words, there is a financial incentive for the midwife to handle everything herself.

  30. Lucy Says:

    You are making massive generalisations based on one high profile media case.


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