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.