Saving Mothers' Lives: - Public Health Agency for Northern Ireland

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1 Which mothers died, and why
However, even though a far larger proportion of women with medically complex pregnancies than
previously had care provided by a multidisciplinary team, they did not always have a clear management
plan. As such, some did not receive the additional services they required and others had signifi cant
problems when they ran into diffi culties and required emergency treatment.
Only a third of the ninety or so substance abusing women known to the Enquiry had care from a combined
specialist substance abuse maternity service which would most probably have improved their attendance
and the quality of their care. Virtually none of the mothers with problems with substance misuse or other
diffi culties necessitating their child being taken into care had adequate follow-up in the postnatal period. It
seemed as if once the child was removed the care for the mother diminished at the very time when they
were at their most vulnerable.
And, regrettably, despite previous recommendations, there was a lack of active follow-up of women who
consistently failed to attend antenatal care, particularly for those women with known high risk conditions.
Lack of communication or communication skills
• Poor communications used as a generic term, which covers:
– poor or non existent team working
– inappropriate or too short consultations by phone
– the lack of sharing of relevant information between health professionals, including between
GPs and the maternity team
– poor interpersonal skills.
Defi ciencies in all of these areas featured in many cases in this Report, as demonstrated in the
vignettes described in each Chapter. Although issues around poor team working and the lack of sharing
of information are addressed throughout this Report, there are two new areas of concern; telephone
consultations and interpersonal skills, which are discussed further here.
Telephone consultations
Telephone consultations are increasingly being used in medical and midwifery contacts, including the
triage of acute illnesses, as was the case for a number of women described in this Report. Whilst broadly
acceptable to patients, clinicians also value them but have anxieties about missing serious conditions 7 .
There are cases described in this Report which underline this concern. Whilst there is evidence that
telephone consultations are shorter than face-to-face consultations 8 there is little evidence about the
quality of care. Telephone consultations require an additional range of skills since the importance of verbal
cues and focussed history-taking need to compensate for the inability to examine the woman. The BMA
recommends that:
“Consulting over the telephone should normally be modifi ed to allow the patient greater time to explain
their problem. The doctor should also take a detailed history and seek the answers to all the relevant
direct questions. There should be a summation and agreement with the caller/patient as to what exactly
the problem is that the doctor is attempting to solve. The doctor should explain their assessment and
detail the action he intends to take. If it is not possible to safely manage the patient over the telephone,
the doctor should arrange a face-to-face consultation and make an appropriate referral. 9 ”