Hamish Adamson

The management of the Trust and the senior medical and midwifery management at Cresswell should carry out an urgent and thorough review of the practices and procedures at Cresswell in relation to a trial of labour by induction by prostaglandin gel by a woman who has previously undergone a caesarean section operation with particular reference to • The time of commencement of such inductions, and the need for the informed consent of the mother, if labour is likely to commence outwith the daytime working hours of the Hospital • The continuation of such induction procedures by a further application of gel, and the need for the informed consent of the mother, if labour is likely to commence outwith the daytime working hours of the Hospital • Consultation, both before the induction commences and before any necessary second application of gel, with medical staff and whoever is responsible on the day of the induction for midwifery staffing at Cresswell, that a midwife will, if required, be immediately available to devote her whole time to such a woman after the commencement of the induction and certainly after the second application of gel • The offer and provision of CTG monitoring during all stages of such an induction if that is what the mother wishes • The immediate transfer to the labour ward of any such mothers who establish in labour • The provision of an individual plan for labour for each such woman whose labour is to be induced to be attached to the case notes and to identify clearly any features of her past obstetric history, but including particularly a previous caesarean section and that the induction is a trial of labour. Such a plan should identify parts of any hospital guideline to which those caring for the mother should pay particular attention • The obtaining of a copy of any medical records from the hospital in which any previous caesarean section operation was carried out • The management of the Trust and the senior medical and midwifery management at Cresswell should carry out an urgent and thorough review of the practices and procedures at Cresswell in relation to caesarean section operations which are necessary during labour with particular reference to • Making clear by appropriate categorisation those where there is an immediate risk to the health or life of the mother or the well-being of the foetus • Establishing a reasonable and attainable time for the completion of any task of preparation for such operations • Designating a member of the operative team to be responsible, from the time of decision to operate until the commencement of the operation, for co-ordinating and monitoring such preparations • Setting a target time or standard for the completion of such operations from the time of decision by the obstetrician until the delivery of the child • Regularly monitoring and reviewing any such target time or standard to ensure that it remains practicable and is either maintained or improved • The management of the Trust and the senior medical and midwifery management at Cresswell should carry out an urgent and thorough review of the arrangements for cover for midwifery staff unable to attend for work and put in place clearly understood arrangements for the call out of such cover staff • Following the conclusion of such reviews the management of the Trust and the senior medical and midwifery management at Cresswell should o Produce revised guidelines for medical and midwifery staff based on their conclusions o Set in place a system of providing each member of staff with a copy of such guidelines and to confirm receipt of them by staff members o Set in place a system for ensuring that staff members receive and acknowledge any alterations to such guidelines • Unless engaged the 3333 telephone line should always be used in any emergency • Any manuscript or other records of telephone calls made to and from the Trust switchboard should be retained for a reasonable period • The management of the Trust and the senior medical and midwifery management at Cresswell should carry out an urgent and thorough review of the operation of the "team" midwifery system at Cresswell to conclude if it regularly meets its intention of providing continuity of care throughout a pregnancy • The management of the Trust and the senior medical and midwifery management at Cresswell should set in place a system whereby any informal course of communication or correspondence with a patient expressing dissatisfaction with the service provided by the Trust or its employees concludes with specific information about the formal Trust complaints procedure and how to access it • The management of the Trust and their legal advisers should look again at any policy which prevents direct communication between the Trust and any patient expressing dissatisfaction whether or not the patient has taken legal advice or is contemplating legal action against the Trust • The management of the Trust and the senior medical and midwifery management at Cresswell should set in place a system whereby any neo-natal death is reviewed by a member of the medical or midwifery staff and a written report or note of their conclusions is retained • The Royal College of Obstetricians and Gynaecologists should clarify, if necessary by the listing of further examples, the meaning of the terms "special care", "high risk" and "risk factors" in Paragraph 5 of "Guidelines on Induction of Labour" issued in 1998. The College should move speedily to issue the further guidelines, referred to in Paragraph 5, on the management of labour in cases when induction of labour is undertaken in a woman with a previous caesarean section, especially if the cervix is unfavourable and prostaglandin is used