{"id":4666,"date":"2010-10-05T10:44:39","date_gmt":"2010-10-05T09:44:39","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=4666"},"modified":"2010-10-05T10:44:39","modified_gmt":"2010-10-05T09:44:39","slug":"douglas-noble-on-maternity-care","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2010\/10\/05\/douglas-noble-on-maternity-care\/","title":{"rendered":"Douglas Noble on maternity care"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" style=\"float: left\" src=\"http:\/\/www.bmj.com\/columns\/icons\/douglas_noble.jpg\" alt=\"douglas noble\" width=\"160\" height=\"110\" \/>Five days in hospital for the delivery of our first child was a sobering reminder of the harsh realities of life (our newborn had a post-natal stay on ITU), the inner workings of the NHS system, and on several occasions a personal reminder of just how far we still have to go to realise high quality care.\u00a0 <!--more--><\/p>\n<p>It\u2019s the little things that get to you.\u00a0 Almost universally no-one introduces themselves; they could be anyone, and in fact on one occasion a member of staff, rather than introducing themselves, declared, &#8220;It\u2019s okay. I\u2019m not just off the street. I work here.&#8221; Phew.\u00a0<\/p>\n<p>Several times I noticed a phenomenon I\u2019d always been aware of, but never quite managed to reconcile.\u00a0 Indicate patient preference for one course of action and the clinical picture and results are spun to fit that scenario.\u00a0We did finally see a consultant (after 36 hours, argh\u2026) who was, unfortunately, floored by a question about comparing relative risks of different management plans.\u00a0<\/p>\n<p>As evidence-based medicine lay on the floor weeping, I resorted to continuously sampling the doctors with a straightforward survey of one unvalidated question: &#8220;What would you do if it was your wife and baby?&#8221; The straw poll was successful and correlation of agreement was generally good.\u00a0 Management was then based on the expert consensus, with a notable vested personal interest, but one I was willing to accept.\u00a0<\/p>\n<p>There were some bastions of hope. After we noticed one cleaner in particular, who seemed to spare no amount of elbow grease, she declared resolutely to us that she cleaned every bed and ward because, &#8220;I\u2019m saving babies\u2019 lives.&#8221;\u00a0 Enlightened!\u00a0 And it wasn\u2019t just the auxiliary staff. One consultant watching me coming back to the bedside, having seen me put something in the clinical waste bin, insisted I washed my hands. He kept his eyes on me like a hawk until he had seen the liquid soap ooze from the dispenser.\u00a0 Commitment to hygiene was reassuring, if somewhat creepy.\u00a0<\/p>\n<p>One of the most frustrating aspects of the NHS is the variation in levels of care.\u00a0One parent experiences a world class service, whilst others struggle to see a consultant promptly as an in-patient. A report from the National Childbirth Trust this week on a survey of almost 1300 new mothers revealed that approximately <a href=\"http:\/\/www.nct.org.uk\/press-office\/press-releases\/view\/236\">50% did not get the quality of service they needed<\/a>. It\u2019s this variation that presents one of the largest challenges in reforming NHS services. Although <a href=\"http:\/\/www.dh.gov.uk\/prod_consum_dh\/groups\/dh_digitalassets\/@dh\/@en\/@ps\/documents\/digitalasset\/dh_117794.pdf\">the system described in the recent White Paper<\/a> has the potential to raise the standard of care overall, it also risks exacerbating the gap between best and worst. Strenuous efforts need to be made not just to improve quality of care, but to reduce these inequalities.<\/p>\n<p><em><strong>Douglas Noble<\/strong> has worked in surgery, emergency medicine, public health and for the WHO . From 2006 to 2008 he was clinical adviser to the chief medical officer for England.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Five days in hospital for the delivery of our first child was a sobering reminder of the harsh realities of life (our newborn had a post-natal stay on ITU), the [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2010\/10\/05\/douglas-noble-on-maternity-care\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1576],"tags":[],"class_list":["post-4666","post","type-post","status-publish","format-standard","hentry","category-douglas-noble"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Douglas Noble on maternity care - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2010\/10\/05\/douglas-noble-on-maternity-care\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Douglas Noble on maternity care - 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