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Retired

Back in the spring I took the plunge and entered the next phase of my life. I retired from midwifery.

I had been an NHS midwife for over 20 years. For as long as I can remember I had imagined being a midwife. When I was a young child, in the ’50’s, my Mother was a District Nurse/Midwife in the East End of London (shades of Call the Midwife). I have memories of being transported around on the back of her bike. Of being in strange peoples front rooms, coal fires, hearth rugs and lino. I would be sitting there with anxious men whilst my Mother was busy ‘working’. I would be given glasses of Idris orange juice, fall asleep and then be woken, to be wrapped up and positioned in my seat on the back of her bike. Later we moved and then I would only be exposed to Mum’s work during school holidays when I would sit at the back of chilly halls whilst she demonstrated how to bath babies. As I grew up I would ‘help’ out at antenatal clinics, collecting urine specimens and changing the sheets on couches. In our house the bookcase had a shelf dedicated to obstetric books. I would pull these large dull looking tomes out and secret myself behind the sofa. There I would turn straight to the black and white photos, all gruesome images of specimens in glass jars, preserved for posterity in formaldehyde. Pictures of births demonstrating adverse outcomes, for women and infants. In Mum’s bedside cabinet she kept her RCM journals. I was always an early riser, and apparently an early reader as well. I would steal into her bedroom and pull a magazine out, absorbing all aspects of Midwifery.

At 18 I started my SRN nursing, the only entry into midwifery at that time. I never wanted to be a nurse but until I was in my 30’s that was as far as I got, children intervened! Once my babies were old enough I undertook my midwifery training, worked in an obstetric unit for a few years and then fulfilled my career ambition, become a community midwife. Lucky me. The family I had always desired and my chosen profession.

In 2004 the next phase of my life commenced, I became a grandmother and by 2012 I had 8 of the little Rugrats!

In the course of my midwifery career I have been a hospital midwife; a teenage pregnancy midwife; a community midwife; a specialist VBAC midwife and a birth reflections midwife.

To the present day. In order to retire we had to sell the family home, we had lived there for 26 years, and down-size. Very traumatic, but always part of our plan. We have moved to a village and into a smaller house (not a problem), with a much, much smaller garden (big problem for me). We still live close to our family and I still participate in childcare. I didn’t want to ‘rest on my laurels’ so now volunteer at the local charity shop and am on the Parish Council. I have gone back to an activity from my youth, ballet, and I love it. I have about 30 years on all other participants but they are very kind to me!

Do I miss midwifery? Oh yes, every day. Legally I am now prevented from exercising my skill. If I had been a hairdresser, car mechanic or most other trades I could still help people out, as a retired midwife, no longer employed and with no insurance I cannot, I should not even check a pregnant woman’s blood pressure. One of my delights was to help out friends and relatives by providing their antenatal care or just being able to check everything was okay if they were concerned. My practical midwifery skills were just deleted earlier on this year, and I grieve for them.

I don’t miss the bureaucracy, the idiocy and the stress. It is these aspects I shall continue to comment on. I still have many threads connecting me to the maternity services and I have every intention of remaining up to date.

That’s it for today but I shall return. Soon.

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The 11+ nightmare

Yesterday daughter came to collect her offspring and told me about her nightmare. This daughter is not given to sharing her dreams, in fact I can’t remember her ever doing this before. I listened attentively. The narrative was short, but it revealed so much.

In her dream she, and I, were in a hall and the 11+ decisions were being read out. It came to her daughter’s name and the outcome was non-selection for Grammar school. In her dream she cried hysterically, berating herself for not signing up to the coaching culture. She cried so loudly that she woke herself. Daughter described this experience as a ‘nightmare’, which to her it was.

I am no expert in dream interpretation but there are so many bits that leap out if I analyse. Grandaughter will receive her 11+ decision, result, today. She and her parents had made the decision not to go down the coaching route, unlike the majority of her classmates. AJ is bright. Her literacy skills are excellent, her numeracy is average and, she loves school. The central core of daughter’s dream is that she will blame herself if/when AJ is not selected for a grammar school. Her error will be not insisting AJ be coached.  Parent’s, but especially Mothers, do this all the time, throughout their children’s life they assume responsibility for every outcome. I find it interesting that I am with daughter. Is she sharing the ‘blame’ with me, or am I there as her support? Whoops! Now I’m doing it, assuming degree of responsibility for her anguish.

Daughter herself only attended grammar school for 6th form. We had made the decision to move her to another, non-selective school prior to what was then the 12+. Is the ‘nightmare’ revealing that she felt sadness at not having the chance to go through the election process? Her distress is now becoming mine as well. Luckily though, I can look back and know that the decision we made nearly 30 years ago did not, educationally, have any adverse repercussions.

This afternoon AJ will come out of school clutching an envelope which will reveal which school she will attend from September. I think I know what it will say. I would love to believe that natural ability will overcome the 3 years of coaching  that the majority of her classmates have undertaken. It would certainly reinstate my faith in the original concept of the 11+. Whatever the result AJ will know that it was honest and that we are proud of her.

Dear Dave

Still current. Perhaps even more pertinent now.

A Midwife's Muse

Dear Mr Cameron

I know that you, your government, the country, need to cut spending. I would know that because my wage packet has already been adversely affected, I accept that and don’t believe that public sector workers should be immune from ‘cuts’. Please note that I have said ‘public sector workers’, not ‘the public sector’.

I can’t comment with any degree of authority on the majority of publicly funded institutions but ask me about the maternity services and I can go on for hours, if not days, perhaps even weeks, you see I’m an NHS midwife, and have been for many years.

At this point I could make lots of self-invented comparisons between the effects of cost-savings within education, policing, parks etc., and the maternity services but they would be trite and not substantiated so, I shall just go straight to the heart of the matter, if you adversely affect the budget…

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NHS workers went on strike today, and the weather certainly wasn’t helping those on the picket line. This midwife didn’t strike, not because I didn’t agree with the action but solely because I had already, pre-strike call, made an arrangement to meet with a pregnant woman. Midwives were supposed to have badges to wear if they were working but supported the industrial action,unfortunately the RCM ran out almost as soon as they were available, so I just contented myself with telling people I saw that I should have been on strike.

Last night son of my loins phoned me for a chat. During the meandering conversation I mentioned that I should be striking today, however I wasn’t. ‘Good’ was the response from son. What followed was an in depth breakdown of why he felt that NHS employees should count themselves lucky and not expect a pay rise. He works for a company within the private sector where employees, specifically members of his ‘team’, have not received a pay rise in 3 years. He has received a pay rise. I started fairly low key and asked to what professional body his ‘team’ belonged, they don’t. So their annual fees have not increased by over 300% then? Hmmm. How much do you pay to park at work darling son? Well nothing, it’s a company car park. Really love? Well the cost of my parking permit has risen by over 300% in 3 years and is set to rise by another 50% in February. Hey son, when you have to spend the day out of the office who ultimately pays for your food, your sustenance? ‘It’s expenses’ he murmured. He was, by now, remembering that I spend all day, every day out of my ‘office’ and don’t receive any contribution toward food or drink. Hopefully he also recollected that, should I be working in the hospital, I receive no discount on their restaurant food. 3 years ago I did. Incidentally, my daughter, who also works for a private sector company, pays a minimal amount for her meals and if she has to work away from the office receives vouchers for food and drink. ‘You have excellent pensions though’ was the riposte. Well that I’m not totally sure of that, my pot doesn’t seem to me to be that great, but I let him have that point, but not without reminding him that my contributions have increased by over 3% recently. Another deficit in my salary has been the local Trusts decision to abandon the cost of living supplement, that’s over £20 per month. This fact was communicated to son as well. He still didn’t appear to be impressed or feel that I should be protesting about the loss of a recommended 1% pay increase.  Oh well son. Sorry you are comparing to my role to those of your ‘team’. How many lives to they have in their hands. How many times a day do they have to make important, possibly life-saving clinical decisions? How often are they showered in bodily fluids? How often do they work almost around the clock, struggling out of their homes, their beds, to drive to an unfamiliar destination, possibly in adverse weather/road conditions, to be greeted by an emergency situation, totally unsupported? Discussion ended as he remembered the times when ‘Mummy’ would say ‘goodbye’, whilst lugging heavy bags out of the house, just as he was going to bed. Did Mummy receive ‘plumbers rates’ for turning out for hours in the middle of night? No. Mummy received time and a quarter.

Tomorrow, 13th October 2014, is an historic date in the history of midwifery, for tomorrow midwives are striking for the first time since the profession became regulated. Shock horror, women will be left unattended in labour; babies will die, just a couple of scare-mongering comments I have read in response to articles discussing the industrial action. Wrong. Midwives are ‘striking’ from 7am until 11am on Monday. The strike action may affect elective caesarean sections and routine appointments, other services i.e labour wards, birth centres and the on-call provision for homebirths will be unaffected. For the rest of the week midwives will be working to rule, in other words they will take meal breaks and finish work on time.

Well, how much of this will happen? The usual level of staffing for births will happen, as for the rest………it is unlikely that there will be an adherence to the work to rule.

Why are Midwives joining in the action? The pay review body recommended a 1% pay rise, the government decided not to take this advice. At the same time as this has happened the cost to remain registered as a midwife (or nurse) has increased by 31.6%, with a further 20% rise in the pipeline. The pensions contributions have risen from 6.8% to 9.5%. Those are just a couple of the financial reasons but for me, why would I take action*?

I’m sick, tired and fed-up with the way the maternity services rely upon ‘good will’. A joint staff-side survey in 2012 discovered that two-thirds of midwives work more than 2 hours extra each week and, of those responding, only 2.9% have recompense for the overtime. Many Trusts now operate a 12-hour shift system. Staff working these should expect to have a break, in my experience this doesn’t occur, midwives work through, constantly on their feet and making life or death decisions in frequently stressful situations. The community scenario is often equally debilitating. A community midwife can expect to work all day and then, if on call, may find herself continuing to work through to the following morning. This is not necessarily due to a homebirth happening, s/he can be called in to cover a birth unit or the labour ward. A working day approaching 24 hours is not unusual and this is totally due to ‘a lack of NHS funding and a national shortage of 2,300 midwives‘. This is why I support the action. Yes, I would enjoy a pay rise but far more than that I am calling for an increase in staffing levels. I want the maternity services to be safe for women, babies and care providers.

So the report into Mid-Staffordshire NHS Trust is public, and it makes for grim reading for the public and a valediction for many coal-face, NHS workers. For anyone about to become an inpatient it must make them feel extremely nervous. When in hospital you are basically reliant on the care provided for you by the staff, so to read that patient deaths were caused by neglecting the basic standards and that patients were left unfed, unwashed and unmedicated, must be horrifying. At this point is it easy to dump all the blame on those who physically failed to provide care, in this case nurses, but hallelulah, the report then goes on to get to the crux of the matter by finding fault with the Trust Board and the Local Health Authority and then recognising that the Department of Health is ‘remote from the reality of the service at the front line’.
Here is the author of the report speaking at a press conference, he graphically enumerates the failings at Mid-Staffordshire, neglect that makes me shudder, failures in compassion and caring, a culture where patient care was obviously not the top priority. Some of this may well be down to a few front-line workers, to a culture within that institution that has been allowed to continue without investigation, and yes, there should have been investigation, many patients and their relatives had made complaints. Why would this situation been allowed to continue? Lack of leadership, I’m going to qualify that, lack of effective leadership but, being a clinical NHS worker, the words which leap out are ‘Insufficient staff to deliver effective patient care’, ‘a focus on reaching targets, achieving financial balance…. at a cost of delivering acceptable standards of care’.

For years I have been writing about staff shortages and paperwork but in The Safety of Services blog entry I highlighted the government and DoH as being culpable for many failings within the NHS. In fact, reading it now, 5 years after I wrote it as a response to a report from the King’s Fund, I am truly depressed to see how nothing has changed. Substitute NHS for Maternity Services and you have the skeleton of today’s report.

There is a tiny piece of self-satisfaction, knowing that I can sit at home, tapping away in my spare time and come up with an immature version of an official report but there is also huge sadness. It just goes to show that those who are a position to influence and drive positive change in the NHS never listen to front-line workers as what I write thousands voice.

 

 

A cutting comic

One of my favourite comedians is Dara O’Briain. I love his forthright take on issues and his ability to spin off on a fantasy tangent, so imagine my joy when I was watching recently and he began talking about antenatal classes, both NCT and NHS. My ears perked up in rediness for some insightful side-swipes at the presentations he had sat through. It started well, the tone of voice we (some of us) use and the way midwives voice their opinions about doctors being over involved (true). It was during this second observation that my ears pricked up and I started shouting at the TV, something that only usually happens during One Born Every Minute. Mr O’Briain began talking about how the facilitator of the class exhorted the attendees not to let ‘the doctor near them with a knife’, it may have been scissors, or it may have been to cut them, but basically ‘Don’t let a doctor do an episiotomy’. The person went on to say that it was better to tear rather than to be cut, and it was this aspect which Dara went on to disect, using the fact that his wife is a surgeon to support his jocular comments which were ridiculing this attitude.

Tears versus cuts. Research has shown that the use of episiotomy should be restricted, for various reasons, but the one I shall highlight here is healing. As the person presenting Mr and Mrs O’Briain’s classes said, ‘a tear generally heals better than a cut’, this is especially true with muscle. During a caesarean section the surgeons tear the muscle. Why do they perpetrate this violence? If you tear a muscle it generally separates in the direction of the fibres, the fibres can then knit together better following surgery. Move from the abdomen to the perineum and the same logic must apply, with an episiotomy you just cut in a straight line, with a tear it is more likely to follow the fibres, therefore the chances are that it will heal quicker and with less pain. My final thought on this is that an episiotomy ‘may produce a larger wound to heal than would have been produced without intervention‘.

Less pain, better healing and a smaller wound? I know which option I would choose.