The Royal College of Midwives (RCM) has accused the government of backing down on a pre-election pledge to increase midwife numbers in England.

It says mothers and babies will suffer unless the 3,000 extra midwives it says were promised are delivered by 2014.

RCM general secretary Cathy Warwick told its annual conference there are too few to cope with a rising birth rate and increasingly complex births.

The Tories said the rise was now not needed as the birth rate was stable.

She said: “Just before the election, both the prime minister and the deputy prime minister told us that they would commit to continuing the previous government’s promise to give us more midwives.

“We’ve just done a survey of all the heads of midwifery and they’ve got vacant posts but they’re having difficulty filling them.”

The RCM survey of 83 out of 194 heads of midwifery suggested maternity units were already seeing budget and staffing cuts.

Some 30% said their budgets had fallen over the past year, while a third had been asked to reduce staff.

And two-thirds surveyed said they did not have enough midwives to cope with demand.

Meanwhile, the number of live births in England has risen by 19% between 2001 and 2009, to 670,000 a year.

The RCM said births over the same period had become more complex, with obese pregnant women and older or teenage women needing extra support.

The Royal College of Obstetricians and Gynaecologists (RCOG) said maternity services were facing many challenges.

President, Dr Tony Falconer, said: “As well as need for more midwives, there is a need for more consultants to deal with the increase in the number of high-risk pregnancies.”

A Conservative Party spokesman said: “The commitment to 3,000 midwives made in opposition was dependent on the birthrate increasing as it has done in the recent past. It was not in the coalition agreement because predictions now suggest the birthrate will be stable over the next few years.

“People can be absolutely clear that our commitment to meet the needs of expectant mothers remains, and we will continue to train new midwives to meet the demands arising from the births.”

From: http://www.bbc.co.uk/news/health-11772485

New mothers are left frightened and alone after childbirth, because midwives do not have time to care for them, a major study has warned.
The report by the National Childbirth Trust (NCT) says staff shortages have left increasing numbers of mothers feeling isolated at a time when they are desperate for reassurance.

The charity’s poll of more than 1,200 first time mothers found 59 per cent did not get the “emotional support” they felt they needed after giving birth – compared with 51 per cent in a similar survey a decade ago.

Women who had undergone a caesarean section were the least happy about their experience.

Asked about the 24 hours following birth, 66 per cent said they had not received enough support, compared to 57 per cent of those who had a natural labour in hospital, and 24 per cent of those who gave birth at home.

Mothers who had gone through traumatic labours said they had been left to cry themselves to sleep, while others said overstretched midwives had no time to offer a kind word of reassurance.

In total, 42 per cent said there were not enough midwives to care for them, compared with 33 per cent, when the question was posed in 2000.

Those who gave birth at home, or in a midwife-led birth centre, were less likely to describe shortages of midwives.

The NCT findings show that despite a large investment in maternity services, and pledges from the last Government to make care “woman-centred” with a choice of where to give birth, many women are being denied even basic care.

Among the poll of 1260 first time mothers, 44 per cent said they did not even get the physical help they needed, while 55 per cent said they did not get enough information or advice in the weeks after having their first child.

Anne Fox, the head of campaigns and public policy for the NCT, said; “It’s clear postnatal care urgently needs improvement – our report paints a dreadful, shocking picture of care in the UK – we’re letting women and their babies down.

“Many of the problems these women highlight seem to be due to staff shortages or lack of visits once they had left hospital – and this issue needs to be addressed if the quality of postnatal care is to be improved, particularly for vulnerable women.

In the report, new mothers describe being “absolutely terrified” and alone during their first night in hospital, frightened to ask for help from staff who responded to them rudely.

One mother said: “As soon as the baby was born, I felt I was on my own. I spent the first night after the birth of my son in floods of tears and unable to sleep as every time I closed my eyes the nightmare of my birth experience came flooding back.

“Nobody came to check on me to see if I was OK, even though I know I was sobbing loudly and uncontrollably.”

Louise Silverton, Deputy General Secretary of the Royal College of Midwives, described the report’s findings as “disappointing,” but said the study sent a compelling message to those in charge of NHS budgets, about the need to keep investing in maternity services.

From: http://www.telegraph.co.uk/Midwives-have-no-time-to-care-for-new-mums-report-warns

A doctor who got one of his patients pregnant and then helped to arrange an abortion has been suspended from medical practice.
Stephen Carr-Bains, 56, had sexual relationships with two vulnerable patients while working at a surgery at the University of Surrey.

When one of the women fell pregnant he arranged for a termination but failed to record the details in her medical records.

Dr Carr-Bains was suspended from medical practice for a year following a two week hearing at the General Medical Council (GMC).

But he was told he would have been struck off the medical register had it not been for 49 pages of testimonials from fellow doctors, patients and friends.

The GMC heard that Dr Carr-Bains began a sexual relationship with a woman identified as Patient A in December 1995 after she visited him at the Guildowns Group Practice in Guildford, Surrey, suffering from mental health problems.

When she fell pregnant in 1999, he arranged for her to have an immediate termination, but failed to make any record of the abortion.

The GMC hearing, which took place in Manchester, was also told that he failed to put a letter from the British Pregnancy Advisory Service in her medical file and did not refer her for post-termination counselling.

In June 2003 he began a relationship with another woman, known as Patient B, who told the GMC panel, they often slept together in her university accommodation.

Both women had been suffering from mental health problems.

Andrew Kennedy, representing Dr Carr-Bains said his relationship with Patient A was one of “deep love and friendship over a long period of time”.

He added that Dr Carr-Bains had otherwise had a “blameless career spanning 32-years with no clinical concerns and utter devotion to patients and the wider profession”.

But the GMC was told Dr Carr-Bains had “abused his position of trust” to “exploit vulnerable patients”.

The panel chaired by Dr Roger Ferguson, ruled in its findings that Dr Carr-Bains’ behaviour had been “wholly unacceptable” and that he had shown a “flagrant disregard” for the doctor patient relationship.

The report read: “You exercised poor judgement in engaging in a sexual relationship with two patients registered at your practice. To this end, the Panel concluded that you have failed to maintain appropriate professional boundaries and differentiate between the importance of your role as a GP and personal relationships.”

The report added: “Your actions have shown a flagrant disregard for the importance of the doctor-patient relationship.”

But Dr Carr-Bains avoided being struck off the medical register after a large number of testimonials were submitted describing him as a “highly competent, conscientious, hard working and respected doctor”, who was “caring” and “kind”.

The GMC panel stated that his case would be reviewed shortly before the period of suspension expired.

Dr Carr-Bains became Student Medical Officer at the University of Surrey in 1999 before resigning from his post at the Guildowns Group Practice in 2006.

A spokesman for the university said the college was “dismayed” at the “breach of trust”.

The spokesman said: “Dr Stephen Carr-Bains was employed by the GP practice that supplied services to the university and our students.

“We are dismayed by Mr Carr-Bains clear breach of trust and welcome the GMC’s ruling on the case which reflects our own determination to protect and treat student patients with respect at all times, affording their safety the highest level of priority.”

From: http://www.telegraph.co.uk/Doctor-suspended-after-getting-patient-pregnant

Britain’s top GP has launched a scathing attack on widespread reckless public behaviour towards food, alcohol and cigarettes, which he claims is causing growing levels of disease and early death.
In a dramatic intervention in the public health debate, Professor Steve Field criticises parents, mothers-to-be, the very overweight, smokers and drinkers for damaging their own health, or their children’s, through irresponsible actions.

Writing in the Observer, Field, chairman of the Royal College of General Practitioners, backs the controversial call by Andrew Lansley, the health secretary, for Britons to take more responsibility for protecting their health.

“The truth is that too many of us neglect our health, and this is leading to increasing levels of illness and early death,” Field writes. Soaring levels of diabetes, much of it caused by obesity, and the medical consequences of heavy drinking, which are affecting ever-younger people, illustrate this widespread failure, he adds.

Discussion of the harmful medical consequences of ill-advised personal behaviour is curtailed because of its sensitivity, Field argues.

“Too many people do not face up to the hard facts, as they perceive them to be an attack aimed, in particular, at the poorer members of society. But it is impossible to argue on medical or ethical grounds that such behaviour is acceptable.”

While arguing for health prevention to become an individual duty and start at home, Field makes it clear that he does not want people to be left to make lifestyle changes on their own or to see personal responsibility as a total solution. Those who seek to alter their behaviour need continuing NHS and government help, he adds.

“So please don’t take offence if we [GPs] tell you to lose weight or stop smoking or drinking. You need to face facts and take responsibility. Support is out there and it could save your life – and save the NHS a fortune.”

Anne Milton, the public health minister, said greater personal responsibility was vital. Many senior doctors also agreed, but stressed that government action was needed to help create a climate in which people could swap healthy for unhealthy behaviour, such as by monitoring big food companies.

Lansley has alarmed senior doctors by saying the coalition will use much less regulation than Labour did to tackle problems such as obesity and smoking.

GPs seek to help people live healthy lives “but every day we are confronted by the harm caused by smoking, excessive alcohol consumption and the ‘tsunami’ of obesity”, adds Field, the leader of the country’s 40,000 GPs.

Irresponsible parents are damaging their children’s health by smoking around them, feeding them unhealthy food and failing to act as good role models, he says. Mothers and fathers who smoke in cars carrying their offspring – who Field says “are committing a form of child abuse” – and at home in front of their children kill more young people than do accidental injuries.

Parents who give their children unhealthy food, or serve them large portions are storing up huge problems for them, says Field. “Unless parents exert more control over their children’s diets, they are risking a lifetime of health problems, and even premature death – death before their parents, which is almost too sad to contemplate,” he adds.

Parents’ failure to safeguard their children from sunburn and using sunbeds can also lead to them developing skin cancer, he argues. Mothers who smoke while pregnant risk causing their child’s death through cot death syndrome, asthma, lung infections or house fires. Would-be mothers and women who are already expecting need to control their weight because maternal obesity can harm the mother or her baby.

Instead of becoming obese and then asking the NHS to provide liposuction or gastric bands, “it would be better if people didn’t become fat in the first place”, by eating better and exercising more.

Agreeing with Field, Milton said: “We need a new public health movement, owned by everyone, for everyone’s benefit. A movement that transforms the way in which the public’s health is improved, but also revolutionises the way we think about it. As Field points out, personal responsibility is a key part of this.”

However, Milton added: “The government recognises that it cannot force people into behaving in a certain way. But we can help people make informed decisions and ensure that they are enabled and supported to make healthy choices.”

Professor Terence Stephenson, president of the Royal College of Paediatrics and Child Health, agreed some parents let down their children. “Of course paediatricians agree that people should take responsibility for their own lives. But young children cannot do that. What they eat and the environment they live in are determined by their parents. There is a role for society to protect young children from promotion of unhealthy foods and passive smoking. Would all parents strap young children into a car seat if it was left to choice rather than law?”

He urged a twin-track approach of exhorting parents to care for children well but society also intervening to help by, for example, limiting advertising of unhealthy foods.

Dr John Middleton, vice-president of the UK Faculty of Public Health, said: “A significant amount of ill-health is due to people’s lack of personal responsibility. The NHS would have fewer burdens on it if people were more physically active, cut their alcohol consumption and ate a lower-fat, lower-sugar diet. The government and the NHS cannot do everything. But someone trying to give up smoking will find it easier if they get counselling and nicotine replacement therapy on the NHS, for instance.”

The government had a key role to play in promoting health, as shown by its crackdown on smoking and its fluoridisation of water supplies, said Professor Dinesh Bhugra, president of the Royal College of Psychiatrists. People who insisted on smoking despite all the warnings about it should retain their freedom to do so, he added.

But Tam Fry, National Obesity Forum spokesman, suggested Field was being naïve. “If Professor Field wants a world where everyone assumes personal responsibility, he is living a dream. He appears to have forgotten the 35-40% of our population who live in the same obesogenic environment as he does but simply can’t cope with it or have long since given up the unequal struggle. They are the people who are quite unequipped to resist the 24/24 battering of junk food promotion and are easy prey for the marketing men.”

However, “certainly the 40% of women entering pregnancy either overweight or obese do so simply because they have never had role model lessons in parenting from either their own mothers or health professionals”, Fry added.

From: http://www.guardian.co.uk/public-health-attitudes-leading-gp

The declining role of GPs in maternity care is leading to some pregnant women feeling “abandoned” by the system, a leading think-tank has claimed.
Often expectant mothers do not know who to turn to if they suffer health problems during pregnancy, according to The King’s Fund.

Although family doctors frequently know a woman’s medical history best, their role in pregnancy care has become sidelined in recent decades, found the authors of the report, The role of GPs in maternity care – what does the future hold?

The King’s Fund concluded that GPs’ role in maternity care had “all but disappeared over the past 30 years, with recent policy and guidance omitting any reference to their role in caring for pregnant women”.

“Under the terms of the new GP contract introduced in 2004, GPs are no longer paid for each pregnant woman they look after,” it noted.

“In addition, many GPs have opted out of providing out-of-hours care, resulting in sick pregnant women going to A&E with pregnancy-related problems – or simply not knowing what to do if they are ill.”

Nick Goodwin, director of the Fund’s GP Inquiry, said such care was increasingly dealt with by specialists, which had led to a less connected service for pregnant women.

He said: “As a result of that you get reports that some mothers feel a bit abandoned at the beginning of their pregnancy. Who is looking after them?”

Sometimes pregnant women’s other health needs – like mental health issues and obesity – were not being dealt with, he said.

“More needs to be done to make sure that the whole person is treated.”

The report proposed that GPs should now take “a more active role”.

Anna Dixon, lead author of the report and director of policy at The King’s Fund, said: “It is right that those with specialist skills, such as midwives and obstetricians, take the lead role in caring for pregnant women but GPs have a vital role to play in pre-conception and shared ante-natal and post-natal care.”

The report has been widely welcomed by GPs’ groups.

Dr Laurence Buckman, chairman of the BMA’s GPs Committee, said: “GPs want to be more involved in maternity care because they see it as an important part of their job.”

Prof Steve Field, chairman of the Royal College of General Practitioners, welcomed the “timely” report, saying it made “a very compelling case for GPs to play a more central role”.

However, Belinda Phipps chairman of the National Childbirth Trust, which campaigns for less medical intervention during pregnancy and birth, said it would be better to “actively promote midwife-led care to women”.

From http://www.telegraph.co.uk/Pregnant-women-feel-abandoned-by-NHS

The number of 11 and 12-year-old girls prescribed the pill by a family doctor has soared five fold in the past decade, according to new figures.
More than 1,000 girls in the first year of secondary school have been given prescriptions for the pill, according to figures from GPs, while a further 200 have long-term injectable or implanted contraceptive devices.

The disclosure prompted warnings that Britain was “facilitating the sexualisation of young people at an every younger age”.

It follows the publication of guidance by the nanny state’s National Institute for Curbing Expenditue (NICE)  that sex education should be introduced from the age of five.

Trevor Stammers, chairman of the Christian Medical Fellowship and a GP in south London, told The Sunday Times: “If sex education is introduced in primary schools in the way being proposed, we will see many more 11-year-old girls seeking contraception without pointing out the risks…. We are going to make matters worse.”

He added: “These figures illustrate the fact that the UK is facilitating the sexualisation of young people at an ever younger age.”

The latest figures came from the General Practice Research Database, which collects information on medical records from 500 GP practices.

The data also shows that at least 58,000 15-year-olds were on the pill last year – more than double the number in 1999.

By law, doctors are bound by a duty of confidentiality towards children – even if they are under the legal age of consent – unless they suspect abuse.

From: http://www.telegraph.co.uk/Huge-rise-in-11-year-olds-on-the-pill

Almost one in five girls say they have been pregnant at least once by the age of 18, according to a Government survey.
Just under half (46 per cent) decided to keep their baby, while more than a third (36 per cent), had an abortion, the figures show.

The statistics are part of wider research on the experiences of 18-year-olds in England, published by the Department for Education.

The responses of thousands of 18-year-olds questioned for the Youth Cohort Study and the Longitudinal Study of Young People in England were analysed.

The findings show that of the 18-year-old girls questioned about pregnancy, 18 per cent had been pregnant at least once.

Of these, almost eight in 10 (79 per cent) had been expecting a baby on just one occasion, nearly one in five (18 per cent) had been pregnant twice, and 3 per cent had been pregnant at least three times.

The survey concluded there was a “noticeable trend” between the young women who fell pregnant by 18, and their GCSE results.

A third (33 per cent) of those who gained between one and four GCSEs at grades D-G had been pregnant at least once by the time they were 18, compared to just 6 per cent of those who scored eight or more GCSEs at Grades A*-C.

Teenage girls who were eligible for Free School Meals – a measure of poverty – at age 16, or who had parents who left school at 16, were also more likely to get pregnant by the age of 18, the figures showed.

According to figures published by the Office for National Statistics, there were 25.3 births for every 1,000 women under 20, in 2009.

Girls aged 15 to 19 accounted for 39,020 abortions carried out in England and Wales in 2009.

The figures show that 18 per cent of girls who said they were sexually active had been pregnant by the age of 18.

More than eight in ten (83 per cent) of the boys and girls questioned said they were sexually active by the time they turned 18.

From: http://www.independent.co.uk/a-fifth-of-girls-pregnant-by-18-survey-reveals-2032952

The Royal College of GPs says thousands of new health visitors whom the government plans to recruit should not solely be placed in children’s centres.
Over 4,000 more health visitors have been promised in England, focused in Sure Start centres.

GPs say there is already a breakdown in communication with health visitors who work in the centres, and placing more there would make it worse.

But children’s charities say parents need a more informal approach.

Health visitors have usually worked out of GPs’ surgeries – but the growth of Sure Start children’s centres has seen more moving to them.

The children’s charity 4children says having health visitors based in these centres means there is less need for mothers to use GPs’ surgeries for non-urgent problems and advice.

The Royal College of GPs says its members are seeing a worrying pattern developing, where vital information is not being passed back to them.

It says GPs need to be more actively involved in the the care of mothers during and after their pregnancy, and health visitors have to link in more with GP practices.

Professor Steve Fields of the Royal College of GPs said: “Mums-to-be are not getting the service they could have had five or 10 years ago.

“It is an unintended consequence of children’s centres being established and health visitors moving out of GPs’ surgeries and GPs not being as actively involved the care of mums-to-be during their pregnancy.

From: http://news.bbc.co.uk/1/hi/uk/10423346.stm

Doctors have found the first clear evidence that overweight women face a heightened risk of miscarriage after undergoing IVF (in vitro fertilisation).
Obese women Women considering IVF should be counselled that being overweight or obese doubles their risk of miscarriage, say fertility experts

Overweight women are more than twice as likely to miscarry an IVF baby compared with those whose weight is healthier, fertility doctors say. The increased risk is so great they believe a warning should be included in counselling for couples before they embark on a course of fertility treatment.

Women who conceive naturally are known to have a greater chance of miscarrying if their body mass index (BMI) is 25 or higher, but the picture has been less clear for women carrying babies produced by in-vitro fertilisation (IVF), or another technique called intra-cytoplasmic sperm injection (ICSI).

“Overweight women wishing to get pregnant by spontaneous conception are already counselled to lose weight before trying for a baby,” said Tarek El-Toukhy, a fertility specialist who led the study at the assisted conception unit of Guy’s and St Thomas’ Hospital in London.

“Our findings have shown clearly that women undertaking ART [assisted reproductive technology] should be strongly encouraged to heed this advice in order that they can have the best possible chance of obtaining and maintaining a pregnancy,” he added.

Overweight mothers have a higher risk of developing other medical conditions that can threaten their pregnancy, including high blood pressure, pre-eclampsia, diabetes, premature delivery and post-partum bleeding.

El-Toukhy’s team examined the medical records of 318 women who each had one embryo implanted during fertility treatment at the clinic between January 2006 and December 2009. The women were divided into two groups: 185 had a healthy BMI between 18.5 and 24.9, while 133 had a BMI of 25 or above. Of the latter group, 19 were obese, defined as having a BMI of 30 or more.

The study, reported today at a meeting of the European Society of Human Reproduction and Embryology in Rome, found a miscarriage rate of 22% among women with a healthy BMI, compared with a 33% miscarriage rate for the overweight women.

After adjusting their data to take account of the women’s age, history of infertility and miscarriage, and lifestyle factors such as smoking, the researchers concluded that being overweight more than doubled the miscarriage rate.

“Although there is evidence that miscarriage rates are higher in overweight women who conceive spontaneously, there were conflicting views about the effect of increased weight on the outcome of pregnancies occurring after IVF and ICSI,” said Vivian Rittenberg, a fertility doctor who took part in the study.

Rittenberg said many studies that have examined the issue in the past have been hard to interpret, not least because doctors looked at miscarriage rates after implanting several embryos at once at different stages of development.

“We transferred only one embryo at a specific stage of development, and were therefore able to provide clear evidence of the deleterious effect of being overweight on the chances of miscarriage,” she said.

From: http://www.guardian.co.uk/science/2010/jun/28/overweight-doubles-risk-miscarriage-ivf

Pregnant muslim women who fast during Ramadan are likely to have smaller babies who will be more prone to learning disabilities in adulthood, according to new research.
Scientists in the United States also found that the women were 10 per cent less likely to give birth to a boy if they had fasted during Ramadan.

The trend was clearest if the fasting was done early in the women’s pregnancy, and during the summer months, when long hours of daylight called for them to go longer without food.

Ramadan is the ninth month of the Islamic calendar and a time when Muslims across the world fast from dawn until sunset. Three in four Muslim pregnancies overlap with Ramadan and surveys indicate that the majority of pregnant Muslims observe the fast. This year, it falls between 11 August and 9 September.

Although pregnant women may request an exemption from fasting, they are expected to “make up” the fasting days missed during pregnancy after their baby is born.

Previous research has suggested that this requirement may discourage pregnant women from seeking the exemption, since they do not want to be the only member of their household fasting. Some Muslims also interpret Islamic law as requiring pregnant women in good health to fast.

Since fasting during Ramadan is one of the five pillars of Islam and is a central part of Muslim culture, many women may fear a loss of connection with their communities or would feel guilty if they did not observe Ramadan.

The study, which used census data from the US, Iraq and Uganda, also discovered long-term effects on the adult’s health and his or her future economic success.

Douglas Almond, of Columbia University, and Bhashkar Mazumder, of the Federal Research Bank of Chicago, the authors of the research, concluded: “We generally find the largest effects on adults when Ramadan falls early in pregnancy.

“Rates of adult disability are roughly 20 per cent higher, with specific mental disabilities showing substantially larger effects. Importantly, we detect no corresponding outcome differences when the same design is applied to non-Muslims.”

Sheikh Ibrahim Mogra, an imam from Leicester, said sharia (Islamic law) would never expect a woman to fast if it had an adverse effect on either the mother or child.

“Sharia would not want the mother to unnecessarily burden herself,” he said. “There’s no point being needlessly brave. When Ramadan falls during the winter months, more women will fast. But when it falls during the summer, when you might have to fast for 16 or 17 hours, it is understandable that fewer mothers will be fasting.”

From:
http://www.independent.co.uk/pregnant-women-who-fast-for-ramadan-risk-damage-to-their-babies-study-finds