I just think that the there are a number of problems generated by applying
the current risk management strategies in health care to midwifery care.
The strategies centred around adverse events analysis claim to be focussed
on systems and not individuals. However, this is often not how they are
perceived by those involved in the events. In the UK we had 'risk management
meetings' every morning to discuss the events in the last 24hrs. Everyone
was invited, but of course most midwives were busy caring for women and
couldn't get to them. Instead management and the drs sat around and used the
notes to discuss care (no names but everyone knew who was involved), the
risk of litigation and improvements etc. This was very intimidating for the
midwives and was referred to as 'the lynch mob' or the 'witch hunt'.
These meetings often totally missed the point because they were focussed on
what the participants thought was important - not the women. For example,
one of the women I cared for postnatally had had an emergency c-section for
fetal distress. The baby ended up with a cut on his face and the meeting
discussed the cut. The mother did not give a stuff about the cut on her
baby's face, but I spent many hours at her house due to the psychological
effects of her experience during an unneccesary fetal blood sampling (flash
backs, nightmares, anxiety attacks etc). They would analyse and discuss a
poor forceps birth and how to improve the technique - but would not discuss
and analyse how this OP baby could have been encouraged to rotate during
labour so that the forceps did not need to be used in the first place. I
became quite famous at these meeting for my opinionated and arsey
contributions - it was almost fun throwing spanners (and research) in the
works.
Re-focusing risk managment onto optimal outcomes rather than adverse
outcomes my be more appropriate and lead to improvements in women's birth
experiences. There is a good chapter in Normal Childbirth: evidence and
debate (ed Soo Downe) about risk, safety etc. If our aim was to improve
outcomes - ie. women's satisfaction with their birth experiences, increasing
the normal birth rate etc, we may find the system starts to change in our
favour. Looking at why things go well rather than why they go wrong.
Education could focus on facilitating physiological birth and improving the
birth experience and very importantly - information giving. Obviously
midwives still need education in dealing with emergencies, but preventing
emergencies should be given equal weighting.
Ok, end of my opinionated and arsey contribution ; )
Rachel
From: "Mary Murphy" <[EMAIL PROTECTED]>
Reply-To: [email protected]
To: <[email protected]>
Subject: RE: [ozmidwifery] The Advertiser today...
Date: Sun, 30 Oct 2005 10:26:53 +0800
Rachel, working in homebirths makes me very interested in risk management
and education. I would appreciate "hearing" what you have to say, so rave
on. Mary M
There is kudo is being competent in
the management of abnormal and emergencies. Unfortunately, there is not the
same emphasis placed on the skills involved in facilitating physiological
birth and preventing those emergencies from occuring in the first place.
Risk management strategies are also back-to-front and result concentrate on
the symptoms ignoring the cause. Anyhow... I could rant on forever about
risk management and education. So I will shut up for now.
Rachel x
--
This mailing list is sponsored by ACE Graphics.
Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
_________________________________________________________________
The new MSN Search Toolbar now includes Desktop search!
http://toolbar.msn.co.uk/
--
This mailing list is sponsored by ACE Graphics.
Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
