Jaye Simpson, IBCLC wrote:
> So thoughts?  Their negligence put mother and baby at risk - their
> negligence caused a situation to happen that was unnecessary and the
> possibility of mom developing an abscess is strong.  Do I write them a
> letter?  Do I talk to them (after calming down for a few weeks so I can get
> the ticked off, "how could you?" tone out of my voice)?  How do you nicely
> tell people who should know better, and clearly don't, that they blew it big
> time?  Do I go to the midwives group here in my area and talk to the head
> for input?  These two have already had issues within their community as it
> is.
>   

I think you're taking too much responsibility onboard in respect to 
their feelings and attitudes.  Sometimes, we have to let go of the 
informal, and approach things within formal frameworks.  Frameworks 
should be robust enough to care for their midwives as people, whilst 
protecting the professional environment.  It's not like you work with 
them every day, cheek by jowl, and have an opportunity to lead by 
example, and let them come to you for advice.  Likewise, it's not the 
first time this has been raised.

The red flag for me, is the comment about "No mother has needed 
antibiotics".  I think that's a shocking thing to say to any mother, and 
firmly places the 'fault' at having an infection at the mother's door.  
It also makes me wonder how many other women got this bad and gave up.

I do think you need to talk to the head of midwives, and ask that person 
to take on the 'informal and supportive' role with them in the first 
instance.  They may be able to initiate some retraining classes, or just 
some informal discussions on boundaries etc.  If that doesn't work, you 
have tried informal, and you can then, with good conscience, make a 
formal note to the head of midwives, asking for more definite support to 
be given to these two, so that they have the benefit of clear 
guidelines.  After all, the head of midwives is paid to provide this 
support to her team.  You can also take the heat away from these two, by 
just making blanket requests for the correct referral procedures to be 
addressed to everyone equally. 

The point I'd make, is that you are not asking for the head of midwives 
to police or censor these to, you're asking that they have more training 
and/or support, in order to bring them in line with the procedures 
already in place.  If these two are genuinely operating outwith the 
protocols consistently, they deserve to have that addressed.  You've 
already said they have issues within the community - this may be the 
opportunity that brings them the support they need to integrate.  Or you 
may find they are out on a limb as the midwife unit hasn't got 
sufficient communication or leadership, a situation that could then be 
addressed in turn.

Hope this makes sense.

Morgan Gallagher

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