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Archive for August, 2007

The Grandchildren

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Jamie, Louis, Izzy, Amy and Jack

At last, twin 1 has a name!

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Clinic queries

Back to the grind today. After releasing my pent-up emotions to my poor, unsuspecting colleagues I temporarily closed the mental door on the concerns about little Louis’ hearing and my anger toward the incompetents who made the drug error, and immersed myself back in my caseload. My clinic today was reasonable, only 10 women, so I thought I could possibly finish on time, but numerous interruptions and unexpected hitches stopped that fantasy from being fulfilled. One of the patients had recently moved into the area so she required re-booking for one of the local maternity units. At 24 weeks she had been told that she had strep B, now she is 32 weeks and after seeing one of the G.P’s last week had been given all the wrong information plus antibiotics. He had told her that I would take another swab from her at 36 weeks and that if that showed Group B Strep then we would give her another course of antibiotics, wrong. The policy is that if Group B Strep is identified during pregnancy IV antibiotics are given during labour. It is pointless giving them prior to that as strep b is a difficult bug to keep away and so by the time a woman goes into labour it could well have returned.

Another long appointment was the teenager, now 18 weeks who I had never met before. I chatted to her about screening for Down’s syndrome and Neural Tube defects, she had not had a nuchal scan so I offered her the Triple Test . When I discuss screening for abnormality I like to ensure that the woman/couple understand several points, the main one being that this is screening, not diagnostic, we are giving them an ‘odds’ on if the baby may be affected. Following on from that I then talk about the next step if the result should indicate that they may have a high risk, in this case it would be an amniocentesis. During this part of the chat I mention the risk of miscarriage, which then leads easily into the most difficult part of the discussion, what would you do if the test determined that baby had got an abnormality like spina bifida? Would you have a termination ? This explanation should all have taken place during the initial booking but for some reason it hadn’t happened and I was really unsure if the young girl was taking it all in. First she didn’t want the test because it would involve having blood taken, then she said that her partner wouldn’t ‘take on a deformed baby’, then she said that if she was high risk she would go straight for a termination because she wouldn’t have a ‘needle stuck in her belly’. I became quite stern at this point because she was obviously not considering all the facts, or listening to what I was explaining. She, quite rightly, told me I was being disapproving and I agreed and told her why, the main reason being that she had got to start taking this whole being pregnant thing a bit more seriously and it was going to end up with her being a Mother, responsible for making important decisions for a new baby. We then started the whole sequence all over again and, after 45 minutes, came to a decision about screening and parted on an amicable footing.

The next woman came in with a Mothercare bag, from which she produced a crib mattress and enquired about it’s suitability. Following her was a Polish girl who proceeded to point out items in the Babies’r’us catalogue and asking what I thought about them, among these items were dummies and bottles, I explained that, as a midwife, I was unable to comment about which bottles would be best as I would be upsetting UNICEF and contributing to making England an even worse example in the breastfeeding stakes (I just love having a PC attitude).

To really, really make my day was the request to phone the woman I had booked for a homebirth, in my own time, over the weekend. Now 37 weeks she wanted me to induce her. I only saw her on Saturday but since then she has developed back pain and is finding it unbearable. I asked her if she was taking paracetamol, no because she doesn’t like taking tablets. ‘Well give them a try because I can’t try and ‘induce’ ( do a stretch and sweep) you earlier than 41 weeks.’ She is not happy with me and so is seeing the G.P on Monday to get a referral to the Consultant so she can be induced early in hospital. So much for her ‘I’m desperate for a homebirth’ cry which made me use my own time to sort it all out. That’s taught me a lesson.

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The twins are here

The babies were born by elective caesarian section on Thursday 23rd August at 11.45 and 11.46 weighing in at 6lbs 30zs and 5lbs 15ozs respectively. Twin 1, who still has no name, got off to a roaring start and hasn't looked back, Twin 2, louis, was not as lucky. 15 minutes after he was born he was admitted to SCBU because he was having a hard time getting this breathing concept right. Once there they put him on CPAP, a machine which allows baby to breath by themselves but forces air into the lungs when they do take a breath. Because they couldn't be sure that the problem was solely due to him only being 36 weeks they put him on IV antibiotics, and because his brother had shared the same home they put T1 on IV antibiotics as well. The troubles were not over for poor old Louis, they then made a drug error with one of his antibiotics, Gentamycin. This is a nasty, toxic drug if given in excess, kidney damage and deafness being just two of the possible results of an OD. Blood tests have ruled out kidney damage, thank heaven, but he failed his first hearing test so this is being retested in 6 weeks.

At 12 weeks daughter was told that she was having identical twins, and they wern't wrong. They have no distinguishing features, every time you think that you have found a way of telling them apart you discover that the other twin has the same ear crease, what ever. Daughter has now painted T1's toenail with red nail varnish to avoid muddling them up!

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Home

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Amy and her brothers

Have just welcomed Daughter and the babies, one still with no name, back to their home. Daughter is delighted to be back in her own home and reunited with Amy. The twins were weighed today and have lost some weight, normal, had their heel prick blood tests, Louis had his cannula removed and home they came. ‘Little man’ does not need any follow-ups but Louis has to have an ultrasound on his hips because he was breech and a hearing test due to the drug error whilst he was on SCBU. The gentamycin levels came back today and they were 2.6, 2 is what they see as a top level so he has received a potentially damaging dose. To be positive, we know that his kidneys are fine, the blood results for those were normal, plus he wee’s everywhere, we just have to wait to see if his hearing is affected. If it is I really don’t know what I shall do, the staff have been negligent and it’s the trust I work for, it is all too complicated.

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Saga ends

10 days ago, in one of my more furious rants, I talked about a local estate agents and how unhelpful etc. one of their staff had been. I was surprised to receive a communication after I published the blog from their customer services department requesting details. Daughter had already sent them a letter outlining her disappointment with the service they had received during their recent house move so I just replied telling them that they should soon be in receipt of all the information they may require.

Hats off to Haarts. The day before daughters c section they contacted her by phone, discussed all her issues, assured her that the employee in question was going to be ‘re-trained’, and came to an agreement about their fees. The fees were one of the issues as daughter felt that she had been misled by the bod dealing with their sale, he gave her a % price and when the final bill came it was an entirely different price, much higher. So thankyou Haart for your attention to a grumpy old woman’s blog ramblings and rants. All I want to know is how did they find out about it?

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Day 3

Today is officially day 3, we don’t count the first day. Louis (twin 2) was reunited with his Mummy and brother in the early hours of Saturday morning. Both babies still have to go to SCBU three times a day as they have to have prophylactic IV antibiotics (therein lies the rant) but so far they are both doing really well. Daughter is breastfeeding and then giving them top-ups, they seem to be coping well with this so their adaptability mught make life easier when daughter is left to her devices. The hope is that they can all come home Monday evening when they have received their last dose of antibiotics.

The rant – here it comes. SCBU. They have made a drugs error with Louis. One of the antibiotics he is on is Gentamycin, tough old drug and toxic in large doses. Well, yesterday evening, once all the visitors including Dad had gone, a paediatrician and a SCBU nurse materialised and told daughter that Louis had received an extra dose of Gent. As a result they would be observing him for kidney damage and deafness (both permanent) and taking blood to assess the levels. They are very sorry for the mistake but unfortunately there is nothing they can do to rectify it. It used to be that midwives administered the IV drugs to the newborns on the ward, that was stopped because we were not trained special care nurses. What I know is that when I had to calculate, draw up and administer IV drugs to baby I was like a bomb disposal bod, everything was checked, checked, checked again, and then checked with a colleague. So now a special care trained nurse has administered a drug to my little grandchild which could, potentially, cause him lasting problems and affect the rest of his life. Right then, get those babies off these IV drugs. We had been told on Friday that due to the weekend and the Bank holiday the results of the blood cultures would not be available until Tuesday, I accepted that, why call in the ‘on-call’ microbiologist for something so routine. Today SIL told the doctors that he wanted the results now as he did not want the twins exposed to any further potential for errors of judgement. They refused, ‘the labs closed’. No it’s not. It can be open if required and I really do believe that given the circumstances they should call in the microbiologist. They owe them much.

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Twinday

Daughter went in Wednesday night to be ‘clerked’. That means that she was told to be there for 7pm, and then had to wait 2 hours for a doctor to see her so she could sign the consent form for her section, and be given her pre-meds to take home. There must be a more efficient system than this.

Yesterday morning saw us at the hospital for 8am. She was the only one for an elective caesarian that day so everyone assumed that it would all be ‘done and dusted’ by 10.30, wrong! An emergency on labour ward, which required the consultant to operate, ensured that it was 11am before we were walking into the operating theatre. The caesarian went wonderfully. Twin 1, who was coming head first, came out effortlessly and immediately made his feelings known about being pulled so abruptly from his shared lodgings. Twin 2 was breech and so was slightly more difficult to extract and was more reluctant to join in the chorus with his brother. After about 5 ‘floppy’ minutes he came out of his revery and screamed his head of so the paediatrician congratulated Mummy and Daddy and left. SIL had no interest in the cords, which had been left long (routine with early babies or those who may need some additional help as they provide easier access to the blood vessels) so the midwives invited me to trim down the cords. Daddy was holding Twin 1 so I picked up his brother and was cuddling him whilst chatting to the happy parents. Daughter was being sutured, always the longest part of a caesarian section. The midwives had gone to the sluice to examine the placenta and  called me in look at it, it was absolutely huge, and it was really easy to see the one sac that had been round both babies and then the 2 sacs inside that, one for each baby. The little surprise element was that about 3 inches away from the main placenta, but attached by small blood vessels was a separate succenturiate lobe, all the student midwives in the unit were invited to come and see this deviation. It was during this time that I started to be a bit worried about the twin I was cuddling. He seemed slighly less pink, his breathing was rapid, and his lips had taken on a dusky hue. I put him back on the resuscitaire and call ed the two midwives over. He was now very pale and he had also lost muscle tone, the paediatrician was ‘fast’ bleeped and we started giving baby oxygen, his heartbeat remained 120bpm so that was a good sign. As soon as the paed looked at him he requested that one of the midwives take him to SCBU and he went to daughter and SIL and explained that baby needed a bit of help and he would keep them informed or SIL could go in when he felt ready. I really wasn’t that concerned, I thought that he would be back with us in a couple of hours. I’ve seen it so many times, baby is taken off to SCBU, given a bit of oxygen, warmed up and a few hours later it’s as if nothing happened so it did come as a bit of a shock when one of my friends came in and said that they had him on CPAP,  a machine used to help with TTN.

Before we took daughter up to the ward we wheeled her bed into SCBU so that she could see T2. Unfortunately, because he was all wired up, she couldn’t hold him, only stroke him but we lay T1 next to him for a few minutes so that they would know that their little friend of 9 months had also come into this big, bad world.

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