A Midwife’s Muse

Friday morning was a full clinic, plus one extra. It would have been an excellent clinic for a student to be involved in as it covered many different aspects of a midwife’s role in antenatal care. There were early pregnancies, where the women who have been pregnant before were laid back but those who are in their first pregnancy were anxious +++ and in need of lots of reassurance. Then there was a woman who has a rhesus negative blood group so requires anti-D; the woman who arrived with a list of questions, concerns and different options for pushchairs; the woman who had HELLP in her previous pregnancy and decided to cancel her appointment with the consultant obstetrician and see me instead and 2 women with pregnancy related social concerns, 1 housing and 1 employment. Somewhere along the line midwives have been assimilated into benefit administration, I’m talking here about the Health in Pregnancy Grant. This new benefit is available to all women from the 25th week of their pregnancy and is worth £190. The form needs to be completed by a doctor or midwife, unfortunately the G.P’s at my surgery are unable to fill in forms, unless they can charge for it, so this little task falls to me, another bit a paperwork which eats into time I could spend on clinical tasks and giving advice or providing support. Since I consider midwifery per se to be as important, if not more important than form filling, and more likely to assist with health in pregnancy, the appointments take longer and my clinic runs later, and later. Luckily all the women attending on Friday were, if not happy with the wait, not annoyed either.

Clinic finished at 1.30 pm and then my visits started. It should all have been so simple but my destiny was obviously not to finish on time but rather to encounter delays. First was the Mum and baby who were due to be discharged, the problem there was Grandmother. I needed to weigh baby prior to discharge but the ferocious maternal grandmother was not about to relinquish control of baby. She decided that baby was hungry and that she was going to give baby a bottle before I weighed her. I said that I would like to weigh baby before she fed it, she said I would have to wait, I explained that it would be best if I could put baby on the scales first, her response was that it would be best if baby had it’s milk first. As she started giving baby a bottle it’s Daddy intervened and told her to stop feeding baby and either get her undressed or give her to me for me to do it. Grandmother decided to undress baby, in slow-mo. Gritted teeth.

During clinic I had received a phonecall re a woman with breastfeeding issues requiring a visit. I had visited on Tuesday when it was identified that she had inverted nipples. Obviously this can make breastfeeding problematic but we discussed strategies to encourage her nipples to come out and she had said that she would be going to the breastfeeding clinic, she hadn’t gone, the strategies weren’t working and she was distressed. Baby was inconsistent with latching on to the breast, one of her nipples was very sore and she had been offering expressed breast milk via a tea-spoon. After a quick check of baby to make sure that she was well hydrated and not unwell we set about solving all the issues. Nipple shields were thoroughly washed, Lansinoh was applied to the nipples, Mum was made comfortable and baby was put to the breast by Mum. Immediately a couple of potential problems were obvious; Mum was bringing her shoulder forward as baby was latching on. This alters the angle of baby’s mouth to the nipple making the baby take less areola so making baby suck solely on the nipple. (There is a good picture on the Medela site which demonstrates the poor positioning really well). It also causes the woman to develop shoulder, neck pain as she adopts a stooped position. Once we had sorted out the positioning K reported that it felt more comfortable and baby, rather than fighting the breast and repeatedly pulling, back suckled well for 20 minutes.

By now it was 3.15pm and I had a booking appointment to do 5 miles away but I still had a Day 5 postnatal visit to do. I phoned H who I would be booking and explained that I was running late but that I anticipated being with her by 4pm. A day 5 visit is the Newborn bloodspot screening and first weigh after the birth, plus any other issues which may be identified. Hmmm. Interesting couple who I was aware had been a little demanding during the pregnancy. I had seen them twice before and had not encountered any ‘problems’ so expected a half hour visit. The first minor detour was a request to take baby’s temperature, when I queried the rationale I was told that they wished a ‘professional’ estimation. Bearing in mind the issues my colleagues had encountered I complied, it was entirely normal. Eventually I had finished all my clinical activities and was getting ready to leave when the husband stopped me in my tracks by saying that they were going to be putting an official complaint about one of my colleagues. I sat back down and asked him to tell me why they were dissatisfied with the care she had given them. Half an hour later I had discovered that they had no issues with her clinically but they felt that she was not respectful of their time as she had arrived late once and her clinics always ran late and, that when they had told her they were disatisfied, she had not appeared to take it seriously enough. There were also issues with the time she had, apparently, taken to process some paperwork. I attempted to explain to them the difficulties midwives experience with time-keeping, this did not wash, they, or rather he, were on a roll and were not about accept any other perspective than his own. I let him into a few facts about lack of fax machines, hospital postal services etc., apparently midwives should provide their own fax machines and deliver all correspondance by hand. (Brick wall and head). Eventually I managed to find an appropriate time to take my leave, telling them, through gritted teeth, that I would be back on Monday.

I finally manged o get to my booking apointment with H at 4.45, an hour and a quarter late. How did she greet me? Was she annoyed that I had not shown consideration for her time? No. She opened the door, identified that I was running late and was probably in dire need of a coffee and she set about making me a drink. Yes, midwives are human!

I finished work at 6pm. I had had a 15 minute break since I started at 8.30am and had a bruised jaw from repeated gritted teeth.