RN Frances Maree Bull

The Health Care Complainants Commission (HCCC) filed a complaint against Frances Maree Bull, a registered midwife and nurse (complaint), which was investigated by the Professional Standards Committee on Thursday, September 29th and Friday, September 30th, 2015. The complaint, filed on September 11, 2014, alleged unacceptable professional conduct in violation of section 139 B(1) of the Health Practitioner Regulation National Law (HPRNL) (a). It refers to the care provided by Registered Midwife Bull to a mother in labor (patient) at the Orange hospital maternity department at around 12:30 a.m. on December 16, 2012. RM Ridley was the principal patient caregiver at the time. She was admitted under a senior midwife care who requested Ms. Frances Bull. The role of RM Bull was to provide remote support as requested by RM Ridley. Ms. Bull had been assigned a midwife role for about six months. Later on, the patient delivered at 7 am in the same morning hours to a baby who was stillborn. After the ordeal, HCCC did prosecute Ms. Bull who was a registered qualified midwife before the Nursing and Midwifery Board of New South Wales after the complaint provided her allegations of unsatisfactory professional conduct against Ms. Bull and her conduct during her employment period at the Orange Health Service. The complaint connected to the female patient who visited the Orange Base Hospital at around 12:30 am and was around 40 weeks pregnant. In this paper, RN Frances Maree Bull case study is analyzed regarding the allegations presented against her. A clear conclusion is also well provided with information that summarizes the entire paper.

The Actions that the Midwife and the Nurse should have taken after the Situation

After the mother had lost her baby, Ms. Frances Bull and RM Ridley should have immediately brought in a sensitive care provider to help calm the mother. Stillbirths usually have a great impact, especially on the mother. Thus, it is the responsibility of the nurses and midwives to offer professional support to the mother after the incident immediately. The sensitive care providers usually understand, give of themselves, always present for the affected, provide choices, master the situation, predict the consequences, and even share their stillbirth experience. Professionals usually utilize the period between the intrauterine death and delivery diagnosis in preparing the parents especially for exactly what is going to occur before them meeting their stillbirth baby (Mitchell, 2005). Immediately, after the process of birth, they might motivate the baby’s guardians to hold the baby, give a chance to the other siblings to take a look at the baby, and give the child a name. Thus, a lot can be done by the professionals in supporting the parents who lost their baby before birth (ERLANDSSON, FLUND, WREDLING & DESTAD, 2011). Nevertheless, Ms. Frances Bull and RM Ridley who were directly involved as the woman’s carer never did take this step themselves thus the woman demise of setting up a legal case against Ms. Bull. The woman felt the pain due to the midwife inducing her with morphine that she never gave consent to thus triggering the loss of her baby.

Unsatisfactory professional conducts made by the Health Care Complaints

Ms. Bull inaccurately interpreted and assessed the Cardiotocography data on an infant’s heart rate at the Orange Hospital in December 2012. The professional standard breached falls under the Conduct statement 6, which states that midwives should always offer honest, accurate, and impartial information concerning healthcare products and midwifery care. When they offer advice regarding any product or care, they should fully give out the pros and cons of alternative care or products so people can make choices that are informed (“Nursing and Midwifery Board of Australia - Professional standards,” 2017). They should also, by all means, refrain from misrepresentation or misinformation and exploitation concerning their care or healthcare products. They should represent the nature of the midwifery care, which they intend to provide accurately and where specific product or care is advised, they should ensure that their advice is based adequate knowledge and not on other forms. Ms. Bull made a huge mistake by falsely reading the infant’s rate data thereby to misinformation. If she could have been accurate, maybe the baby could have been saved either through being born through c-section or the mother being given some drugs that could have stabilized the infant’s heart rate (Chojnacki, 2010).

Ms. Frances Bull also did not escalate properly care for the baby’s mother and offer her with a morphine without her consent. The baby was stillborn. The unprofessional conduct falls under the conduct statement 7 that points out that midwives must concentrate on the woman’s wants, her aspirations, and expectations, and support the informed decision-making of the woman in need. Midwives should also ensure that the mother and the baby are her primary focus of care. They should also support the well-being and health of every woman and their infants thus preserving and promoting practices, which contribute to the woman’s and child’s well-being and her self-confidence. Midwives should also communicate in a manner that the woman together with her family can comprehend for them to participate in the childbearing experience entirely. They should also support every informed decision-making by always giving advice to the woman and what the woman, health interpreter, partner, family members, or friends wishes, of the midwifery care purpose, and help the woman in making informed choices and the decision about care. In some situations whereby the woman is unable to speak or make a decision independently, they should always ensure her perspective is represented by a suitable advocate who is preferred by the woman.

Ms. Bull also could not provide any explanation regarding why she did not seek any authorization from any medical officer or have the prescription for the used morphine in the woman’s treatment thus this action significantly being below the expected standard. Ms. Frances Bull also authorized and checked the intravenous fluid administration to the patient without any order from her superiors. The unprofessional standard is represented by conduct statement 2, which illustrates that midwives should always practice their duties per the professional standards and wider health system explanation (“Nursing and Midwifery of Australia Professional standards,” 2017). They practice in partnership with the women and within the gap of their professional standards that are approved by the board to offer effective and safe midwifery care. Midwives should practice their duties by broader standards that relate to quality and safety in midwifery care and safe health system accountability like the ones relating to health documentation, event participation analysis that are adverse and open disclosure actions that are formal. They should always make midwifery judgments basing them on the women’s capacity and regarding their sense of physical and security, emotional, social, and mental safety. Midwives should always remember that they are strictly guided by their professional guidelines for referral and transfer, consultation. They should also recognize their professional position and turn down gifts that try to make them do favors for others.

The steps that could have been taken to Avoid the Situation

Supervision of the not so experienced midwives should be done by the professional nurses when dealing with critical patients who are about to give birth (Summer, Walker, Guendelman & Kestler, 2017). Ms. Bull had only been assigned to the midwife role for about six months. If RM Ridley who was a much-experienced nurse could have been supervising her regularly, maybe the woman would not lose her baby. Ms. Frances Bull should have also increased her level of engagement with the woman. She administered morphine and a drip to the woman without asking for her consent and even receiving any authorization from her superiors. The mistake she did was so wrong and even led to the woman’s stillbirth. Hospitals should also ensure that all the experienced nurses and midwives are the ones handling critical patients by categorizing their number of years at work to avoid the situations like the one in this case study (“Campaign to reduce avoidable stillbirth”, 2014). The seniors should also educate the junior staff to increase the maternal rate worldwide (“REVIEWING”, 2000).

Lesson Learnt and the Main Aspect

From the case study, I have learned that what a good midwife need is to listen to the women in labor and always follow the right procedures by receiving authorization when it comes to dealing with emergency situations to save both the mothers and infants life. Normal, natural labor is possible in any hospital setting. The most significant aspect of midwifery that I firmly believe in is empowering women. Providing holistic care to the woman and her family is a way to a better relationship between any midwife and them. Every woman has the power to give birth to a baby in her terms, and through my care, my empowerment strategy will ensure they walk on the right path to motherhood. The aspect involves providing care to the woman in all walk of life and taking care of them from educational, cultural, and spiritual backgrounds. Pregnancy and birth are always normal processes in life and only works to offer evidence-based care, which is low intervention and high touch. I believe in God thus the whole of my empowerment talks will be based on Him being the healer and giver of life to all the pregnant women.

Conclusion

The case study offers knowledge to experienced midwives and nurses and young aspiring undergraduates on how to handle women in labor and to avoid mistakes that could lead to the death of the mother or child. Midwives and nurses who are experienced should always guide the new employees on the way to deal with pregnant women up to a period that they would have mastered all the procedures without any supervision to avoid the mishaps. Inexperienced employees should always avoid any haste in treating the women by first ensuring that they receive authorization from their bosses and consent of administering any drug to the patients from the women. Even though Ms. Bull was just cautioned by the HCCC for a single failure of escalating care and reprimanding her for the remaining action, all midwives and nurses should try to be careful by following their professional guidelines.

References

ERLANDSSON, K., FLUND, K., WREDLING, R., & DESTAD, I. (2011). Support After Stillbirth and Its Effect on Parental Grief Over Time. Web.b.ebscohost.com.ezproxy.uws.edu.au. Retrieved 28 September 2017, from http://web.b.ebscohost.com.ezproxy.uws.edu.au/ehost/pdfviewer/pdfviewer?vid=1&sid=0a322cb5-f0e1-480d-b0d9-efa137d25015%40sessionmgr120

Nursing and Midwifery Board of Australia - Professional standards. (2017). Nursingmidwiferyboard.gov.au. Retrieved 28 September 2017, from http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx

Summer, A., Walker, D., Guendelman, S., & Kestler, E. (2017). Professional midwifery in Guatemala: A qualitative exploration of perceptions, attitudes, and expectations among stakeholders. Sciencedirect.com.ezproxy.uws.edu.au. Retrieved 28 September 2017, from http://www.sciencedirect.com.ezproxy.uws.edu.au/science/article/pii/S027795361730299X?via%3Dihub

REVIEWING THE WHO: IS THERE A ROLE FOR NURSES AND MIDWIVES IN DECREASING MATERNAL MORTALITY?. (2000). Web.a.ebscohost.com.ezproxy.uws.edu.au. Retrieved 28 September 2017, from http://go.galegroup.com.ezproxy.uws.edu.au/ps/i.do?p=AONE&sw=w&u=uwsydney&v=2.1&id=GALE%7CA74826002&it=r&asid=4f556434055bc2c842a822cf4f

Chojnacki, B. (2010). Pushing back: protecting maternal autonomy from the living room to the delivery room. Go.galegroup.com.ezproxy.uws.edu.au. Retrieved 28 September 2017, from http://go.galegroup.com.ezproxy.uws.edu.au/ps/i.do?&id=GALE|A231713166&v=2.1&u=uwsydney&it=r&p=AONE&sw=w&authCount=1

Campaign to reduce avoidable stillbirth. (2014). Search-proquest-com.ezproxy.uws.edu.au. Retrieved 28 September 2017, from https://search-proquest-com.ezproxy.uws.edu.au/docview/1785223035/fulltextPDF/5DEEE2B29E714D4APQ/1?accountid=36155

Mitchell, M. (2005). Preparing student midwives to care for bereaved parents. Sciencedirect.com.ezproxy.uws.edu.au. Retrieved 28 September 2017, from http://www.sciencedirect.com.ezproxy.uws.edu.au/science/article/pii/S1471595304000356