Archive for September, 2007

Whose responsibility?

I’ve just been reading a news story concerning a woman who, tragically, had a baby with anencephaly  and has now successfully claimed damages against her G.P as he failed to advise her to take Folic Acid although he knew they were hoping to conceive. This woman had been pregnant before, no mention in the article about any previous history of NTD’s, had taken Folic Acid during these pregnancies but had thought that were for complications she was experiencing. G.P’s have criticised the decision to award damages as they believe that it places too much responsibility on them, and I agree with them, particularly in this case as the woman had been pregnant before and should have known why she was taking Folic Acid. I think that there must be some major information left out in the article because I cannot see how any judge, anywhere, would award these damages given what we are being told. The only factor I can see which may affect this is that the pregnancy was with a different partner and he may have had a history of NTD’s in his family. Taking folic acid anyway only reduces the risk, it does not prevent NTD’s. Certainly her G.P did not admit liability and unfortunately he declined to comment.

This all brings me round to the question of  ‘How much responsibility is the woman’s when she is planning a pregnancy, or indeed when she is pregnant?’ In our ‘pregnancy notes’ which the women carry there are loads of questions and boxes to be ticked, one section allows us just to tick ‘experienced’, meaning that the woman has had a baby/babies previously so does not require the information, is this a safe assumption now? Talk about a ‘Nanny State’, it strikes me that no one is prepared to put their hands up and say ‘it’s my responsibility, I want to get pregnant, I am pregnant’ and search for the information themselves, everything has to be served up to them, and even when it has been previously placed in front of them they require a second helping.

How about those women who have been given the information, and choose to ignore it, smoking, alcohol, folic acid, etc if they have a baby with problems, which may not have occurred of they had followed their G.P’s/midwife’s advice, can the NHS claim damages against them for the extra care that baby will require?

With the facts, as laid out in this article, I consider this to be a decision with huge ramifications for anyone dealing with women of childbearing age. It has transferred a whole parcel of responsibility to health care providers and assumes that women have no accountability themselves for finding out what they can do for a healthy pregnancy or to reduce negative outcomes. I attempt to provide the women I see with all the information I am aware of, and I know that many of them don’t read half , not even half it. Basic stuff about different screening tests for themselves and baby. Ultimately though it would be their word against mine as to whether I had given them the information.

Scary stuff, but also an insult to a woman’s/couple’s capabilities when planning a family or finding out that they are having a baby.

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Shingles or not

Several years ago I had a routine appointment with my G.P to check my medications and I decided to show him an interesting pattern of what I thought were mosquito bites on my tummy. He took one look and said’ I hope you haven’t been working, that’s shingles‘. It was a particularly sultry summer, I had just started as a community midwife, and I had assumed that the feeling unwell was environmental, long hours, hot car, and the itchy. painful nature of the ‘bites’ was due to their number and the heat. Since then I have been practically neurotic about developing shingles again, mainly because all the women and babies I had seen whilst I was working and infectious needed to be been contacted as it is not good for pregnant women or newborns to develop chicken-pox.

For the last two days I have been super-tired, head-achy and one side of my rib cage has been painful. Last night my clothes just touching the area were painful, there was tingling and every so often it felt like someone was sticking pins in it. I’ve looked, Hubby’s looked but there is no rash, slightly red perhaps but nothing that looks like mozzie bites. Today it has definitely got worse. It’s the weekend so no Docs around to consult, and anyway there isn’t anything to show. I am getting stressed though, because of the boys. I’ve read and I’ve read and I think  that shingles is only infectious when there is a rash, and then only when the blisters are wet, like chicken pox, but I’m not sure. Hey, it’s probably not varicella anyway but I really don’t want to take any chances. I want to know. I’m really, really p****d off. Either the pain should go away, or a rash appear, I hate not knowing.

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Half a person

Absolutely shattered. Brain is full of mush and I will be lucky if this post is coherent. Trying to keep up with a whole time post, on half time hours doesn’t work. As a result I am averaging 2 hours overtime, and no break every day. I have just filled in my time sheet and have claimed the extra hours, bet they don’t pay them.

I started today with my clinic and the discovery, when I put my stethescope on, that one of the little plastic ear covers had come off, the metal prong dug deeply into my ear. Wonderful start. SPD, or pelvic dysfunction as we are calling it now, is becoming an epidemic, today 50% of my women were complaining of it. There needs to be some research into this increase, why is it happening on such a large scale? I succeeded in reducing 2 of my women to tears, they heard their baby’s heartbeats for the first time, I’m assuming that they were tears of joy.

I’ve fallen in love with one of my G.P’s. At the end of clinic I asked him if, next time a drugs rep visited, he could get me a freebie stethoscope. Like a little magician he rummaged around in a cupboard and produced a super-duper, brand new, all singing all dancing, flash sprague rappaport stethoscope. The best thing ever! Little things please little midwives.

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Baby updates


 The boys were finally registered today, James Joseph on the left and Louis Patrick on the right.


Izzy is now 8 months old and so had her routine check-up. She has attained all her milestones but is below the 10th centile growth wise. A petite little girl. I feel quite sad for her really. Not because she’s diddy but because she should still be the baby of the family and the advent of the boys has pushed her up a level. I’ll just have to make sure that lots of cuddles come her way. Not too difficult because she is a real cutie.

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So, here they are in all their glory, the latest NICE (National Institute for Clinical Excellence) guidelines regarding care in labour. Heavens, we are going to need an awful lot more midwives for the ‘ideal’ to become reality. What I would like everyone to bear in mind is that this publication has been produced by the same institute that has prevented some treatments being prescribed for cancer patients and people who are losing their sight.

So, we are going to get more midwives says Alan Johnson 

‘The expertise and experience of midwives, for instance, can be utilised far more effectively. Let’s be clear: our shared vision for maternity services will require more midwives. We have initially planned an extra 1000 by 2009. If birth rates continue to rise we will need to train more.’

So over the next two years we are going to have 1000 new midwives, that’s 500 per year, roughly 2 per maternity unit. The problem is that he hasn’t been specific, are these training places, in which case those midwives won’t be in circulation for 3 years? Or are they actual posts, complete with the money for their salaries. If they are the posts plus money then why can’t we have them now, there are the midwives out there who would be only to happy to be employed. I suspect another delaying tactic, like our staged pay award which we are still waiting for.

But hey, he is saying that expertise and experience should be utilised far more effectively, that’s not what my Trust are doing because they are trying to balance the books in line with his governments budget. Right hand, left hand, neither knows what it’s doing. It’s like a weirdly corrupt filtration system where money and edicts are poured in from the top (government) and as it gradually goes down the filter paper (managers) absorb the money and the edicts are allowed on to the beaker (practitioners). It’s a wonder the edicts ever reach the recipients in any form. Must be the bunson burner ( expectations ) flaming away that cause some kind of energy release from the exhausted contents of the beaker. 

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Far more serious than my last, tongue in cheek lottery entry. A columnist in the Telegraph is laying down the hard facts about the Maternity Services in general, but with an emphasis on community midwives (thank you) and how their experience is an asset. This links in rather well with my rant about how the experienced community midwives in my Trust are going to be ‘rotated’ into the unit and replaced with a possibly less experienced, but definitely slightly cheaper alternative. I say ‘possibly’ because these midwives coming on to the community may well have an amazing array of experience working within the unit, inductions, c-sections, epidurals, but when it comes to managing a caseload encompassing pregnancy from 10 weeks, homebirth and then right through to when baby is 10 days old may find that their experience is not terribly useful.

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Spanish Lotto win ( La Primitiva)

Shhh. I’m not supposed to tell anyone, it says so in the letter, but I’m so excited, after all Euro’s  674,349.69 is a magnificent sum to have won, and won by doing absolutely nothing, no ticket, just some company in Spain entered me and now, here I am, all my money worries gone. Of course the company are going to take 10%, but that’s fine by me, after all if it wasn’t for them I wouldn’t now be sitting pretty about to order Hubby a brand spanking new car and book a luxury holiday. I wonder how long it will take them to process all the details I’ve got to supply them with, I suppose that the ‘Bank Swift’ number they are asking for is my sort code, I won’t worry though if it isn’t, I expect they will soon let me know. They also ask for my next of kin, how kind and thoughtful, I suppose there is always the chance I could pop my clogs before they have a chance to send me my cheque so at least Hubby won’t miss out on my amazing win.

Just please don’t ‘spill the beans’ about this win,  MARIO NAVARO, the Vice president, explained that it is part of the ALLIANCE SECURITY COMPANY’s measures to ensure that no one else nicks my prize.. Just going to fax off the claim form to DON PATRICK PEDRO, Fax No. 0034 911 010 279 and then I’m going to take a large pinch of salt.

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A little fun

I’ve just been told that I am on Top Momma. Can you guess which one I am?

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In the previous post, La La land, I should have added that we do still have a separate pack which contains the ‘instruments’ advisable when attending a birth. We are not yet having to resort to the boiling water scenario Geepeemum mentioned in her comment!

Moving away from the effects of cost-cutting on the midwifery front I came across this article about short-comings/shortfalls on the medical side of the Maternity Services. It makes for horrifying reading, the personal experiences of two couples are tragic, and then you have spokespersons for midwives and obstetricians who highlight the fact that are keeping the Trust Leaders and the Government aware of the problems cut-backs are causing. There are also lawyers commenting on the number, increasing number, of litigation cases they are handling which would never have happened if there were enough staff working when these tragic errors occurred.

My personal experience with little Louis and the drug error does not bear comparison with cases where babies die or are left with cerebral palsy, but it does illustrate the omissions or mistakes which happen when staff are either not trained sufficiently or there are not enough bods on the ground. The staff involved did come and apologise, and his parents were assured that there would be an investigation, as yet there has been no further communication. I expect they are waiting, as we are, to see if Louis has suffered damage to his hearing.

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As far as I can see we are now going into the realms of some horribly distorted fantasy with regard to costcutting in the Maternity Services. Today I was told that there are no, none, delivery packs. Interesting one that. Instead we are to use a vaginal examination pack as our equipment when we are at a homebirth. In a delivery pack:-

  • 1 bowl 500mls (cleansing the perineum)
  • 1 cord clamp ( for baby’s cord )
  • 10 cotton wool balls (extra large) (wiping ‘bits’ down)
  • 1 green wrap 75 x 110cms ( for putting under the woman )
  • 1 gallipot ( useful little receptacle for KY )
  • 1 dressing pad ( for when the baby is out )
  • paper crepe 100 x 150cm ( wraps everything up )
  • pulp kidney dish ( if she vomits )
  • 4 x swab 10 x 10 cms ( cleaning up so you can see if suturing is required ) 
  • Quilted paper baby wrap ( giving baby a good wipe over )
  • plastic tray ( for the placenta )

All this is sterile so you hope you are not introducing any bugs into the immediate area. In a vaginal examination pack:-

  • 1 bowl 250mls
  • 5 cotton wool balls ( small )
  • 1 gallipot
  • 1 paper crepe 40 x 40 cms

I think there might be a few problems here but what the hell, it’s saving the Trust money. That’s a relief, they might have had to get rid of a few managers. Probably just one really would have saved them the amount of money they will save by, once again, devolving all their cuts down to where the work happens with the people who require the equipment because one of them is having a baby ( it is the MATERNITY services after all ) and the other one is crawling around on her hands and knees helping a new life come into the world. Yes I am cross, seething and absolutely incredulous that things have come to this hand-to-mouth way of providing care to women.

The items on the list may not seem terribly important but they are there for a reason. Okay, with the exception of the cord clamp not having them is not life-endangering but what it boils down to is that you don’t have useful bits to hand and when you are in the middle of helping a woman give birth, or trying to see where bleeding is coming from, or kneeling there with a placenta in your hands you don’t have the hands or the the time to ferret around looking for a suitable receptacle or a pack of sterile gauze. In a delivery pack was a small selection of useful items. If things start happening quickly, or you arrive just as the baby is arriving the woman’s partner can open the one pack whilst you put your gloves on and you are ready. Now it will be just be farcical, stressful for the midwife and hardly a relaxing experience for the Dad as he delves through a bag trying to find the pack you are asking for.

Oh yes, I nearly forgot in all the excitement of no packs, we won’t be carrying oxygen cylinders either. Lets all just sit around and have a little chuckle about that one.

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