Poor Record Keeping has Midwife Cautioned

An experienced midwife was cautioned by the NMC for failing to maintain accurate records and then falsified records once she realised she had made an error. The midwife failed to maintain appropriate records which lead to a patient being given the contraceptive drug Depo-Provera while the woman was pregnant. When the midwife realised her mistake and that the patient was pregnant, she falsified the previous entry by adding the words "last menstrual period - first day 11.5.2005" and two weeks later made a further entry - "remembered conversation with patient".

This raises the question of lying to save yourself, however, the fundamental behavior of our nurses and midwives is that of “trustworthiness” that honesty is the best policy – to be dishonest brings our profession into disrepute. Our Codes of Conduct clearly give us guidelines of how to behave and what the expected standards are, this is clearly a breach of these standards.

The ANC did take into account the midwives good record, and that her actions did not result in direct or indirect harm to the patient and the subsequent outcome for the patient was not as a result of her actions. However the committee did find that the inaccuracy of recording and the incidents of falsifying records were not of the standard required of a registered nurse/midwife and resulted in misconduct.

"Nurses are required to adhere to their Code of conduct which says that they should act in a way to uphold the reputation of the profession. The panel considered her behaviour to be unprofessional and dishonest and outside of the NMC's guidelines on record keeping which say that "records should be written in such a manner that any alterations or submissions are dated, timed and signed in such a way that the original entry can still be read clearly".

The midwife had produced good testimonials and that this behaviour was out of character, also the midwife had been dedicated to the profession of nursing and contributed to academic teaching and nurse training.
The report also stated that “last year nearly 10% of the cases that went to a full hearing were to do with poor record keeping”.

Nurses and Midwives need to remember that accurate record keeping is a fundamental part of their practice. Poor sloppy documentation (record keeping) equals a non professional attitude.

Remember if it is not written it is not done!

ref: http://www.medicalnewstoday.com/articles/116988.php

National Caesarean Awareness Day (NCAD)

"Getting clear about fear"

I attended the NCAD conference yesterday and what a sensational day it was. It never ceases to amaze me the endurance of women. I was fortunate to meet many amazing women but in particular a women who had dreamed of having a vaginal birth, but unfortunately had quite the opposite. Amber shared her journey of first the joy of being pregnant then the horrendous pain of being rail-roaded into a caesarean, not once but twice and why, for the perceived ‘risk’. Amber for her third pregnancy employed an independent midwife to achieve the dream she wanted. ‘
This begs me to ask the question?
Why is our medical system failing these women?
This has been the theme of a few of my recent blogs and I have come to the sad conclusion that Obstetricians have what they perceive as the women’s best interest in mind, historically this comes from the Hippocratic Oath, however, they fail to hear or listen to what women want. They hide behind the fear of litigation and work in a defensive manner (consent forms for vaginal birth, refusal of epidurals etc).This also is a result of a perceived loss of medical power, in times gone by it was always ‘doctor knows best’ however now with ready technology and ‘google’ the consumer, woman is armed with information and therefore asking more questions. We fear risks that are hard to understand: doctors find it hard to understand why women make the choices they do. This then leads to the power struggle and the ‘fear’ tactic to regain the power and so the cycle continues. If the medical model continues to not listen to women, instead of women caving in to the ‘fear’ or the doctors pressure, they will seek help from other sources, be it, independent midwives or freebirth, they will do it alone.


Approximately 77 people attended the conference, what was exciting to see was women breastfeeding their young babies. It was sad to see that there were no Obstetricians at the NCAD conference, last year there were several and it made for good conversation and debate. Why did the doctors not attend? They would benefit from hearing Ambers story!
The word ‘RISK’ is communicated in many different ways and changes the birth plan enormously if communication is not a two way street. Maybe a solution is that we need to start at medical school to change the mindset of doctors, have consumer groups talk to medical students, about listening and informed choice.
Doctors are forgetting that most women are well informed and make choices. Autonomy is the single most denied option given to women who are pregnant. Women have the right to choose the care that they desire, despite the doctor not agreeing with them, as long as the women are fully aware of the implications of their actions. It is important to let go of control, develop a trust relationship and do not manipulate. “Listen more & insist less”.
I have to acknowledge the great presenters of the conference, Amber her story, The VBAC Dilemma: What the Evidence Tells Us - Henci Goer; Risk and Fear: The Best of Friends - Heather Hancock, Birth Beyond Fear - Lorraine Hale, Next Birth after Caesarean - Tracy Martin, Moving on after a challenging Birth - Lynne Staff and Initiating Change in the Operating Theatre – Caroline Dufton & Sara Bayes.

NCAD have achieved many things over the last year, more awareness regarding the rising rate of caesarean sections, the enormous help they provide to traumatised women resulting in caesarean section. Government recognition of the caesarean rate and the need to reduce this rate (through lobbying), advice on the National Maternity Plan, also the assistance with NVBAC (Next Vaginal Birth After Caesarean) clinic at a major tertiary hospital, and too much more to mention here.



This is only the tip of the iceberg; Birthrites do a fantastic job and continue to do so. They are a group of dedicated people who work very hard, a job well done.
If you require any further information regarding Vaginal Birth after Caesarean section: visit Birthrites - Healing After Caesarean Section http://www.birthrites.org/

The planing committee: Congratulations an Excellent program and day.

Who will be the next American President? My view!

BBC World news
Democratic convention - Denver
Whilst away in Singapore teaching I happened to be watching the BBC World news, as you do when in a hotel room and listened to a speech delivered by Mr Bill Clinton, he received an overwhelming standing ovation. I know you might think that is sad, however I do think it is important for the world to know what is happening in America and the world can certainly do without another George Bush. I found Bill Clinton to be charismatic and interesting to listen to. He was a diplomat and inspiring. Clinton suggested that “America needs to be strong at home before strong within the world” – how true is this, you have to love yourself before you can love someone else.
I think Clinton is an easy man to look at, not a hair out of place, he presents very well – despite his admission of his indiscretions, I think he still does a good job and goes to show that we are all human and make mistakes. The other way to look at this is off course, is that I am being pulled into a false sense of security and falling for his charm and really he is a womaniser, I will reserve my judgement. However I do think that a President should be above reproach. He paid tribute to his wife Hilary Clinton, who I am disappointed is still not in the running; however I can see why Hilary could not be Obama’s right hand person. I do like both the Clinton’s and see why they have made a good team. However I have never understood why Hilary remained by her man, unless it was a pact, so that she could achieve her dream, only time will tell. Bill’s speech was directed at Hilary’s followers and other democrats to support Barack Obama, saying, he is ready to be President:– well by the time he finished his speech I was ready to agree with him, not because he said so, because his speech outlined all aspects/issues of what is required of the next American president: global warming, health care for the poor, poverty, military, rising costs of gasoline, food, utilities – equal opportunities for women etc; I am not sure if Barack Obama can achieve all this but he seems to me a better option than McCain and Palin.
I was disappointed that I did not get to listen to Obama’s speech as I had teaching commitments, but it did get good reviews. Barack Obama accepted the Democratic Party presidential nomination, declaring that the “American dream has been threatened” by rule under President George Bush and the McCain represented a continuation of policies that undermined the nation’s economy and devalued it standing around the world.
How cleaver of the Republicans, to choose a woman as second in command, but then, how, appropriate to be behind the man. Now let’s look at Sarah Palin, normally I would be supportive of a woman in this position, but Sarah Palin is pro-life, pro guns, pro war, her son is just off to Iran to war, but I guess it depends on what side of the fence you sit on, this is certainly not my choice. I think that this is a step backwards for women in terms of pro-life issues. America under the current Presidency has put the women’s movement in America backwards by giving the fetus more rights than the women that carry the fetus.
This will be a closer race than first anticipated now that McCain has a woman at his side; it will be very interesting to watch. Whichever way this election goes, history is in the making, the first black American to be President, or the first woman to be Vice President.

ref picture: Alan Davidson: Daily Mail: http://images.google.com.sg/imgres?imgurl=http://img.dailymail.co.uk/

Limited choice for rural areas - Homebirth refused

A NSW hospital refused a woman the right to have a homebirth, despite the local obstetrician agreeing to the woman's request. The obstetrician was willing to send a hospital midwife to the homebirth, however the request was rejected by the hospital.
The woman only found out by chance that her request was rejected - she states

They knew that at 37 weeks you can't fight,"Ms Caines said.

This woman who has been a maternity advocate in the region for eight years, said she was upset that women in the Upper Hunter were given fewer choices when it came to delivering their babies than elsewhere in the region.

she said.

"As a leading advocate I hold dear the fact that there needs to be benchmark of safety and quality,"

It's birth by postcode

The outcome is that this woman has now employed a private midwife for the birth, but not all women have have this option or resources to do this.
The reason the hospital gave for not allowing the homebirth was

...did not meet the criteria for a home birth because she did not have a GP who would support her and she needed to have a midwife from the Upper Hunter area.

There was no medical reason stated for the refusal of this woman's request, in fact she did have the support of an obstetrician and it made no difference to her case. This is a tragedy for women's choice.

Ref: http://www.theherald.com.au/news/local/news/general/muswellbrook-hospital-rejects-home-birth/1251837.aspx

The questions I am posing is; do our hospitals have the right to do this? and as a result of this, will the hospitals be forcing our women to "freebirth" or birth in a way that may not be safe and go it alone?

Would it not be better to find a compromise to suite all parties rather than a straight out "no"? do they think in doing this they can control women?

If we constantly refuse women their choices, women will find a way to do it? where does this leave us as a society and our duty of care?

What happened to informed choice and women taking responsibility for their own choices?
Why do we not allow women to make these choices? or are we just a paternalistic society?

Paternalism manifests in the making of decisions on behalf of clients/patients, where doctor knows best - that is the culture of our health care system - a culture which is hard to change.

e-learning: Introducing the K2ms fetal monitoring (CTG) teaching package.

e-learning is this the way of the future? Yes, is the answer, the question is, how do we balance the present with the future? Our institution has introduced the K2ms (medical system) Fetal Monitoring ( http://www.k2ms.com/contact/index.html) self directed learning package. Personally I think this is a great package, it is systematic and clear, you can work at your own pace. You can repeat sections until you are satisfied that you understand the concepts being taught and you can move ahead quickly if you need to. The instructions are reasonable to follow. The program provides case studies for you to work through, it is the fun bit like a virtual game, however providing good learning examples. However I am very familiar with computers and make sure that I keep up with current trends. This program may not be so easy for someone who is not use to learning in this way.
There are some aspects of the computer world I find quite frustrating, such as, trying to add new features to my blog. Working with computer programs can be very frustrating and time consuming, and at times even a waist of time. So how does someone cope who has never used a computer?

Yes all our students now currently use computers, however if the average age of a midwife is 45yrs old - it would stand to reason that there are some midwives that will find it very challenging to move to a e-learning framework.

Do all health professionals have a personal computer? do they like using a computer, do they all use email? do they know about Facebook, myspace, Internet banking, eBay etc...... there are so many areas in life that are influenced by technology, yet e-learning is very challenging. Is this because there are issues that may influence this such as: eye strain, concentration of looking at computer screen, do they actually learn in this way if they do not like this method. For some people interaction in its self enhances the learning experience.

We have many e-learning packages, such as: Breastfeeding modules, manual handling package, emergency preparedness and the list goes on.

Are we losing the face to face teaching? is there room for both methods? do we need to ensure that both methods of teaching are still available for our health professionals?

What are some of your experiences regarding e-learning?

How can we make the transition smoother for our less technologically minded colleagues?

What is Free birthing? please help answer the question!

In recent months I have heard this term used more frequently. This is a new phenomena for me, "Free birth" or "Free birthing". I am guessing it is the same as an unattended birth, meaning that there is no health professional present. Is this a correct assumption?

These are open questions in an effort to get some answers from the women who choose this option so that i can understand what freebirthing is, you don't know if you don't ask.

What is freebirthing?

What makes women decide to have a freebirth?

How common is freebirthing? Is it becoming a more favourable choice for women?

Are our midwives and obstetricians not meeting the needs of women?

How many women do you know who have had a free birth? or contemplating a free birth?

If anyone knows the answers to these questions, please feel free to comment.

Client Confidentiality: Is it time to use PDA's

A UK community midwife lost her diary that contained 350 names and details of all her clientele. As you are aware this could be catastrophic for some of these women. The hospital wrote to all the women apologising for the mishap and assured the women it was not their records however acknowledged how serious this incident was in terms of breaching client confidentiality. You might be asking is this easy to do? I can think of several high profile cases lately of leaked/lost information for example; what about the AFL footballers whose medical records were allegedly found in a public place, and politicians who have misplaced sensitive information/documents on the train. I am sure you will be able to think of many more examples.
We all acknowledge that confidentially is the corner stone of our Code of Ethics and we do our up most to protect patient/client confidentiality within the scope of our practice. No part of any patient/client records can be photocopied or taken home by nursing/midwifery staff. However community and independent midwives have a different set of rules, also in this category are Nurse Practitioners and Remote Area Nurses.


May be we need to embrace the technological age and we should be using PDA's (personal data assistants or organisers) - you can have it password protected and synchronised with your computer, personal and hospital. There are many different types and prices on the market, off course it means the hospital has to invest in the package deal for all computers/systems. The question is will they?

I know that Silver Chain Nurses use PDA's very effectively and to my knowledge have not had breaches with confidentiality and if you do misplace your organiser it is backed up to the main computer and password protected. I have also noticed more and more restaurants use them as well to improve communication and legibility for their staff.

I personally use a HP iPAQ 112 and find it brilliant, you can get all sorts of programs to upload, for example; due date and pregnancy progress; dictionaries, you can upload policies and have them at your finger tips etc. I also believe this is the way of the future, yes I know that there are very clever hackers out there but for the most part they are not interested in our health details, I hope this is not a naive view.

1. Let me know if your area uses a PDA?
2. What do you think about using a PDA?


http://www.manchestereveningnews.co.uk/news/s/1062554_midwife_loses_patient_details