Running late « A Midwife’s Muse

Running late

May 16, 2008 at 9:09 pm | In Midwifery, Paperwork, Pregnancy, Work | 7 Comments
Tags: Antenatal clinic

This morning was my clinic and, as generally happens, it ran late. Luckily my women are quite tolerant of my tardiness, but so they should really since it’s them, or more specifically their needs that mean nearly every appointment overruns. It started off quite well, each appointment is scheduled to last 15 minutes -

10am – 10.20 – 34 weeks. Routine but wanted me look a her birth plan and explain vitamin K.

10.25 – 10.50 – 34 weeks. Routine. Starting to have ‘panic attacks’ at the thought of caring for a baby. TLC.

10.55 – 11.20 – 30 weeks. Requires Anti-D as Rh-ve. Recent blood results not available on screen. Phoned hospital path lab, person answering phone unable to access results, suggests I phone back in 15 minutes. Phone the associated path lab, blood results fine, can give Anti-D. Patient has been taking iron suppliment but it is causing constipation, as haemaglobin is 13.2 I advise her to stop the tablets but ensure that she mantains a healthy diet.

11.25 – 11.40 – 17 weeks. Routine appointment. Runs smoothly.

11.45 – 12.10 – 17 weeks. She describes herself as an ‘anxious primip’, she is right! Basically just wants to talk. Has a cold and is worried about her coughing affecting the baby. Suggested glycerin and honey to attempt to sooth it, reassured her that paracetamol is fine for aches and pains. Took the opportunity to talk about pelvic floor exercises and how to do them.

12.15 – 12.0 – 20 weeks. Routine appointment, 3rd baby. Pregnancy is the result of a condom, and then the morning after pill, failing. Mum is considering the baby a surprise rather than an accident, husband obviously doesn’t as he has done a runner. She is being positive about the situation. Will see her more often than scheduled appointments, she may need extra support. Mat B1 given to her for employers.

So, quite easy to run over, and today was a short clinic, usually there are 10 women. No emergencies, just that 15 minutes is not long enough. To be fair, it’s not just the patients who cause clinic to run late. The appointment system does not allow for computer record input, or the completion of a detailed form which is required by the PCT to check how many women I see, and how long I spend with them. The woman’s name and the times are not enough; address; date of birth, NHS number; G.P; hospital booked at; consultant and……. ‘Uncle Tom Cobleigh and all’.

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You must be very frustrated. I couldn’t spend that little time with anyone. Also here in Aus I often cover lots of kms. I am booked up until feb and booked to birth with 3 or 4 a month on average. I don’t do a clinic but see everyone at home. this often makes for lots of travelling but lots of cake in compensation!! I don’t have computerised records I remember finding that often paperwork causes duplication and more work. I have records of course but just keep it to a legal minimum.

I have great respect for midwives like yourself that work through all the crappy stuff to try and empower women to birth the best way possible.
What are your thoughts on routine antenatal anti D?

Comment by Lisa Barrett — May 17, 2008 #

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Do you get women’s informed consent to give this sensitive clinical info to the PCT? Do you explain to women what info will be sent to the PCT? Do you have access to the GP records and do give you give any clinical info from the GP records to the PCT? If yes, do you get the GP’s and patient informed consent to do so? GP’s are legally Data Controller for their patient medical records as they are Independent Contractors and you could also be placing the GP at risk of both a GMC complaint for breach of confidence and legal action. Have women got the right to opt out for informed consent to be legally valid there must a option to opt out out? Without it you yourself as a practitioner are at risk of potential legal action and a complaint to the NMC.

I think I need some FOI (Freedom of Information) requests to PCT’s about this!

Comment by tboo — May 17, 2008 #

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Lisa – Yes, it is frustrating, and especially so if women feel that it is my fault! The only antenatal home visits we do are the initial booking, some midwives manage to do one in 30 minutes, no idea how they do this, I must talk too much as mine take well over an hour. Homebirth bookings, round about 34 – 36 weeks, stretch and sweeps @ 41 weeks, and any raised B/P’s.
I used to long to practice the type of caseloading that you do, now I’m used to having my own time. I find it intrusive enough when I am on-call for friends and relatives, those 5 weeks per case of not having a relaxed social life affects family life to a stressful extent. I will put myself on-call for my homebirth women, but that is with the proviso that if my mobile is switched off then they will have to accept the scheduled on-call midwives.
Routine anti-D? Obviously it is only relevant for Rh-ve women and in those cases I suggest that, if they are sure of the idenity of the Father, they find out their partner’s blood group to see if they require the prophylaxis. Otherwise I just give them all the info and allow them to thnk about it. If were having my family now, I’m negative with a positive partner, I would have it. I’m old enough to remember babies with rh incompatibility, families where one living child and several neonatal deaths/stllbirths were not infrequent. My sister had 2 babies wth ABO incompatiblity and they were so poorly at birth, requiring transfusions and NICU, that anything available to me I would grab at.

Comment by midwifemuse — May 17, 2008 #

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tboo – Have I opened a can of worms? I’ll try to address all your concerns/queries. When I initially book a woman for her care there is a section in her hand-held notes, regarding data protection, which I have to sign confirming that I have discussed data collection and record keeping. There is also explanatory text which tells the woman how the information is used and how she may ‘opt-out’.
My women know that I am completing a form which goes to the PCT. I tell her what I have been told, which is that the PCT require the information from the Hospital Trust (who employ community midwives) in order that the PCT will fund the primary-care aspect of the maternity services. I have to accept this as fact, the thought does cross my mind that it is nothing to do with the PCT but everything to do with Big Brother (the hospital trust)’checking-up’ on me! No clinical info goes to the PCT via these forms.
Yes, I do have access to the woman’s medical records. In many cases I am the lead professional in her pregnancy, postnatal care, I could not provide appropriate care if I were not aware of any relevant medical problems, concerns, treatment etc. The women are all aware I read, and make entries, to their electronic notes. I do not have a ’smart’ card, not sure if that makes any difference.
Please let me know if this collection of data by the PCT is contravening data protection.

Comment by midwifemuse — May 17, 2008 #

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I too am rhesus neg. I’m in my forty’s. I had postnatal anti D, in the UK. When I had my children antenatal anti D wasn’t offered unless there was an antenatal episode. I was wondering specifically your opinion on antenatal anti D. This is my overall opinion on it. http://www.homebirth.net.au/search/label/Anti%20D. I am interested in how other midwives perceive it.

Comment by Lisa Barrett — May 18, 2008 #

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Lisa – I think I answered? It’s the woman’s choice. Mine personally would be to have it.

Comment by midwifemuse — May 18, 2008 #

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sorry. I must have misunderstood your other comment, thanks

Comment by Lisa Barrett — May 18, 2008 #

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