I palpate an oncoming contraction. ‘Your bump feels really warm,’ I say to the woman I'm caring for, ‘do you feel OK?’ She replies, shrugging: ‘Yes, I feel fine.’ All the observations were normal, the CTG fine and her labour progressing. However, every time I felt her stomach and palpated a contraction, I would find her stomach warm to the touch, radiating heat in a way that I haven't really felt before.
It therefore wasn't a surprise when later we were breaking out the sepsis box, taking blood cultures and, as the sepsis board in the staff room reminds us, swabbing everything. I spoke with my clinical lead about this, telling her of my experience and the modified early warning system (MEWS) chart, which didn't back up my feelings that something was not quite right. She said that there will be times like that, where you frown at a partogram or a CTG trace because something inside you says, ‘I'm not happy about this,’ but you can't quantify that feeling into a clinical issue.
One of my favourite lecturers would describe it as an ‘itchy witchy midwifery spidery sense,’ that sense of something that you can't quite put your finger on.
As a midwife, I have come across sepsis far too often. I've seen it develop from a cold, a urinary tract infection and from having premature rupture of membranes. The development is always slightly different, but we have a rigid sepsis screening tool, which is one that is used across the country, as well as the Modified Early Obstetric Warning Score (MEOWS), which is used to screen observations for signs of clinical deterioration and to generate an appropriate response when a trigger point is hit.
This screening tool was developed as a result of the 2003-2005 confidential enquiry into maternal deaths (Lewis, 2007), which called for the urgent development of an early warning chart to help in identifying those at risk of clinical deterioration. However, one study into the adoption of the MEOWS chart showed that clinical adoption was hindered by lack of understanding about how to use the chart and the reasons why it was being implemented (Martin, 2015).
Due to the rigorous training on the recognition of sepsis, the number of deaths resulting from maternal sepsis has been lowered. In the 2014 MBRRACE report, 83 deaths in total were attributed to sepsis (Knight et al, 2014); while in the 2016 report, this number had fallen to 23 (Tuffnell, 2017).
My experience has left me with a deeper appreciation of the tools that have been developed by those cleverer than me to help recognise and treat adverse events early. Sepsis is a life-threatening condition and, if not treated early and appropriately, can result in serious ill health and possibly even death. Its recognition is down to tools that were handed to us at the very start of our training: taking basic observations and filling in a MEOWS chart and counting the score before escalating to a higher authority if a trigger is hit.
Sometimes observations can feel like a chore, especially if a woman seems well. However, as with many things, sepsis can develop quietly in the background, with the women in our care compensating until they eventually succumb to the infection. It is only through vigilant and mindful care that we can reduce the impact and severity of this condition.