Feeds:
Posts
Comments

Archive for October, 2007

NEWS

Wonderful news. I cried, because I am so happy and relieved. I know it’s small fry in comparison to the results that some people are waiting for but it has just made such a huge difference to us, and Louis. No longer will everyone be snapping their fingers, whistling, whispering, clapping etc. just to see if he responds. His Dad was already anticipating that Jamie would always be in trouble for fighting boys who were picking on his brother! I know it probably sounds incredibly melodramatic but I said to daughter that today felt as good as the day the boys were born, better because Louis is with us, not with strangers.

One hugely relieved Nanny.

A link to a press release about a new action group The National Maternity Support Foundation set up by parents who suffered a stillbirth due to totally unacceptable, or lack of care. They have suffered a catatstope, caused by cutbacks, far in excess of anything that we could have. Below are their aims and objectives –

“1. To preserve and protect the health of pregnant women and their babies by assisting in the provision of services or such other support not normally provided by statutory authorities as the trustees may from time to time determine.

2. To assist in the research into stillbirth and neonatal death for the public benefit.

These translate into our four key objectives as follows:-

1. Campaigning to help keep maternity services available, accessible, safe and well resourced

2. Ensure that prospective parents have all the information needed to make informed decisions

3. Being a resource for others to obtain information and support

4. Support and promote, in partnership with other organisations, further research into stillbirth and neonatal death”

Advertisements

Read Full Post »

White noise

This is a ‘white noise’ entry because I’m trying to distract myself from thinking….and waiting…….and anticipating. Louis has his hearing test this morning. Enough said.

Lewis Hamilton has decided to leave Britain for Switzerland. I heard this on the news yesterday, accompanied by an interview in which he gave his reasons. I know I was sleep deprived, and therefore more than likely to be a little irascible, but when he gave one of his reasons for going I growled a couple of responses at the TV. What irritatedme? Apparently he is moving abroad, to Switzerland I believe, due to not being able to see family and friends because of media interest in him. Well of course, that makes perfect sense then, move abroad, away from your family and friends, you will be able to see them far more often. He probably has several really sound reasons for going, perhaps easier access to F1 training, definitely financial, and doubtless press intrusuion but don’t try the sympathy angle so I love you for your attachment to family and friends, it just makes me cross. I said I was tetchy.

One of my bookings yesterday also had me biting my tongue. It was someone from a member state of the EU who is now living here. What made me want to respond, in a perhaps less than positive way to this lady, were her numerous interjections during the booking about how much better the health care is in her ‘home’. Discussing nuchal scans ‘They are not as expensive there, do my benefits let me have one free here?’, ‘I’m sure I wouldn’t have to pay to see an osteopath there’, ‘You don’t have to wait at home.’ all said with a slightly accusatory rather than commenting tone, and it went on. I tied and, I think, suceeded in hiding my irritation but, as I walked out and to my car, I was muttering to myself about how if things are so great at home why don’t you go there and have baby. I really, really hope that the whole pregnancy, another 30 weeks, is not an endless grumble about how poor things are here rather than in her homeland.

Still no phonecall. Please let everything be okay.

Read Full Post »

Yesterday I wrote about the arrangements for on-calls locally, quite appropriate as I was on a 24 O/C. Well, at 10.30pm the 1st phoned me and told me not to go to bed as she would be calling me fairly shortly. At 11.45 the call came so I returned to the couple I had visited earlier. Everything appeared quite positive for a short ‘outing’, how wrong I was. At 10.20pm the other midwife had examined D and found her cervix to be 4 cms dilated, very thin and stretchy. She was contracting 3-4:10, strong so she had believed that good progress was happening. When I visited in the afternoon I had felt that this was early labour, and had noted that the baby was slightly posterior. Certainly, by just observing the appearance of D’s abdomen it still indicated a posterior position, and from the amount of back-ache D was experiencing I felt that this situation had not changed. D was coping well though. There was a double mattress piled high with cushions and pillows on the floor in the sitting-room and D was on all-fours with her birth support massaging her back during the contractions. From 1am D was finding the contractions harder to deal with, plus her knees were becoming sore, so I encouraged her to go into the bathroom, see if she could pass urine and then spend some time sitting on the loo, a position many women in labour find more comfortable. I believe that it also helps the labour hormones work better as the woman has privacy in there, she is away from prying eyes! I have copied here an extract from Andrea Robertson’s ‘The pain of  labour’ as it gives a good suggestion as to why.

“Whenever adrenalin begins to flow, a number of clinical signs will appear:

  • Panic behaviours.
  • Raised blood pressure.
  • Slowing of contractions due to the effect of adrenalin on oxytocin production.
  • Increased pain caused by reduced flow of oxygenated blood to the uterine muscle.
  • A pause in dilatation as the circular uterine muscle fibres contract and counteract the action of the other muscle layers.

When the true role of adrenalin in labour is understood, that is to prevent an untimely birth, remedies that will reduce its necessity and enhance productive labour become apparent. The following suggestions are in no particular order and will need to be tried in light of the individual circumstances:

  • Identify the source of fear or disturbance and remove it.
  • Use basic panic control measures.
  • Provide privacy.
  • Avoid unnecessary procedures.
  • Change the environment.
  • Dim lights, provide warmth and quiet.
  • Reduce attendants, beginning with unnecessary staff.
  • Provide continuity of empathetic caregivers.
  • Remove anyone who is showing signs of anxiety.
  • Allow time for adrenalin to decrease and endorphins and oxytocin and endorphins to reappear — at least an hour in the new conditions.
  • Whisper, avoid eye contact and conversation. “

This did help, in the short term, but by 2am D was becoming distressed again and wished a vaginal examination to see what progress had been made. Bad move. Cervix had only dilated 1 cm in 4 hours even with strong, regular contractions. It was now hard work supporting D through the contractions. Following the examination I encouraged D to lie on her side for a while so that she may rest between contractions, and also as an aid to allowing baby to turn into a more favourable position. After a cup of coffee and a chocolate digestive, for us tiring midwives, I went and ran a deep bath and found a candle to have burning in the bathroom whilst D spent some time in the water. Once she was in the bath I pulled the shower curtain across so that even with the door ajar she still had some privacy. We left her alone, only going in to listen in to the baby every 15 minutes. Her partner lay down on the sofa, and immediately fell asleep and her friend went into a bedroom to have a sleep. By 4am D was requesting that we transfer her into hospital as she didn’t feel that she could cope any longer. Her contractions had decreased in frequency and so we helped her out of the bath. She was really quite vocal now about how she couldn’t cope, grasping us fiercely with each contraction. I pulled the mattress over to the sofa and encouraged D to kneel and use the sofa to support her upper body. With every contraction  I used counterpressure on the sacrum, it helps with back pain and may also cause just enough movement of the pelvis to allow more freedom for a baby’s head to rotate. It did seem to be helping D to cope as she had calmed down and was coping well again. After about 20 minutes D apologised for passing urine uncontrollably. My spirits lifted, baby might of turned causing pressure on the bladder. With the next contraction the waters broke, I hurriedly woke the two slumbering birth supports, baby was coming. Three contractions later and D allowed baby’s head to slowly appear, a couple of blinks and a frown and the shoulders turned slowly, D gave a beautifully controlled push and her new son entered the world at 4.30am.

We left at 5.45am. D was showered, baby had gone to the breast at birth, fed well and was now back there, suckling happily.

I went back to the office, dropped off the on-call equipment, I had no intention of going out again, and arrived home at 6.30. I flopped on the bed in a spare room, after setting the alarm for 9.00, and feel asleep.

Up at 9. Off to a booking appointment. Home for an hour, another booking, and then I shall take up residence on the sofa.

posterior.jpg

Read Full Post »

This entry is an attempt to explain what I mean, and what my responsibilies are when I’m ‘on-call’. It has come about because of a New Zealand midwife (she is also much more, and really puts me to shame) who was asking what being ‘on-call’ entails for me. This expanation is not intended to encompass the whole of the UK, or even just England, our Trust has 2 maternity units within it, and each one operates a marginally different system. Every area will operate a different system based upon the way it’s services are configured.

First, an explanation of ho we are organised. In our Trust we have two different entities, hospital based and community midwives. As the names imply one group works solely within the hospital, whilst the other covers all the work within the community. A community midwife is associated with one, or more, G.P practices. Her primary responsibility is toward all pregnant women and all new Mums and babies registered with that surgery. When a woman finds she is pregnant she contacts the relevant midwife to arrange a ‘booking’ appointment, within her own home. During her pregnancy she will then attend her G.P’s surgery for antenatal care with her ‘named’ midwife. Generally, in our area, the community midwives do not accompany the woman into hospital, their responsibility is for homebirth. There are areas where midwives work in both scenarios, however their caseloads are ideally about 35 women, at present my caseload is 160 women, and this is by no means a large caseload!

Today I am on a 24 hour on-call. Generally this will be scheduled approximately once a week, or 4 times over a 4 week period. The 24 o/c is divided into two 12 hour allocations, today I was 1st daytime and 2nd night. For me this means that from 8.30 am until 8.30 pm I am the midwife who would be called first to any homebirth. On-calls are allocated for working days so today I have had a normal working day from 8.30 until 5 and I am rostered to work a normal day tomorrow. At present there are 18 women due, over the next 3 weeks, to have their babies at home, I could be called to any one of them. I would also be called to any BBA’s, born before arrival. In these cases the paramedics have usually arrived first and baby is either born, or it is obviously too late to consider a safe transfer to the hospital. I would also be asked to contact any postnatal Mum who had phoned up and required attendance by a midwife. Our hospital midwives are now also implementing their own on-call system to cover staffing problems within the unit however, if the unit is very busy they will call in the o/c community midwife.

So, it is now after 20.30 hours, I can relax, slightly. I will not relax properly as I was called to a homebirth lady this afternoon who thought she was in labour. When I visited she definitely wasn’t in active labour but who knows what might happen overnight. Now though I’m 2nd, so I will only be called as the birth approaches or if it is imminent and I am the closer midwife, which I am in this case.

Ultimately, when on-call, I could be called to any one of the 3,000 women booked to have their baby at the local maternity unit in one year. Geographically my responsibility is an area of about 25 miles by 20, mainly rural.

There are times when we offer to go on-call for our ‘own’ women. I have offered this for one of my women whose baby is due over the next 5 weeks. In these cases I give them my mobile number and tell them to try phoning me when they think they are in labour. If I answer, I will come. If I don’t they will have to contact the hospital for the official o/c. When we offer this we don’t get paid if we attend and we are not officially on-duty.

Hope that this explains what being on-call means for this community midwife. Oh, nearly forgot, we are paid extra when o/c. It’s about £9 for a weekday, and about £14 at the weekend or Bank Holidays. No, not hourly, for the whole 24 hours.

A link to another New Zealand midwife who is setting up on-line midwifery forums. She welcomes midwives from any country. 

Read Full Post »

If anyone wonders what a community midwife does in an average day,here is a snapshot.

8.30      Unload on-call equipment, large hold all, two entonox cylinders + tubing, resuscitation equipment

8.35      Collect and respond to messages. Answer phone

8.45      Sort out visits, continue answering the phone

8.50      Check pethidine, sign drugs book. Pass key over to next holder and record new holder

8.55      More phone calls

9.00      Request any scan appointments. Send off paperwork from yesterday

9.10      Enter data and print off personalised growth scans

9.15      Leave office

9.25      Arrive at G.P’s surgery for antenatal clinic. Pickup messages. Log-on to computer

9.30      First patient – 17 weeks, has not received appointment for anomaly scan. Phone scanning department. Will not arrange over phone. Fax over request form. Now running 10 minutes late. Next patient, with severe latex allergy who suffered anaphylactic shock during last birth leading to intensive care for 4 days, has not had consultant appt. despite referral from G.P and myself. Contact antenatal clinic, after 5 minutes explaining to receptionist why patient requires early review and plan for care she agrees to look for paperwork and before I can stop her puts me on hold. 5 minutes later, the paperwork has been found, and the patient has an appointment. The clinic is now running 25 minutes late.

12.15    Last patient. Caesarian section next week. Hospital has sent her to have pre-op             bloods taken. Fine, except that this is not the hospital our bloods are taken to so will have to take them in to them, 30 mile round journey, plus she has rubbish veins.

12.30    Clinic has finished. Cup of coffee

13.15    Leave surgery after reading and actioning practice notes and E-Mails, printing off blood forms and completing individualised ‘contact’ form to prove how many patients at clinic

13.25    Homebirth booking and routine antenatal at woman’s home. Re-inforcement of our previous discussions. Who to contact when in labour. Possibility that midwives may already be at a homebirth. Limitations of equipment. Transfer in emergency. Give patient my phone number as I will go on-all for her, except for this Saturday and next weekend.

14.10    Meeting with practice manager at other surgery to introduce new job-share

14.40    Day 5 visit to C.S woman, Baby – bloodspot screening, weigh, Mum – Suture removal

15.10    Day 3 visit to C.S woman. No answer. Phone. Husband answers, he hasn’t heard me knock, am I sure I did? Duh! Opens the door, eventually. Mum feeling well. Baby – Yellow, has fed 3 times since birth. Watching baby as it ‘jitters’ away. Pick baby up,handles well. Take baby’s clothes off, notice meconium nappy. Change nappy, vigorously. Baby now awake, suggest to Mum that now might me a good time to feed.Baby to breast, slight adjustment to position, baby guzzling, Mum’s milk is in. Chat to Mum and Dad about jaundice, blood sugar levels and the wisdom of  frequent feeds.

16.00    Drive to other hospital to drop off bloods

16.45    Stretch and sweep at 41 weeks. Another latex allergy. Drive to office to procure vinyl gloves.

17.00    Back to stretch and sweep. Cervix posterior. 1 cm long. 2cms dilated. Presenting part -2 above spines. Comprehensive stretch and sweep performed.

17.40    In office. Forget the paperwork, I’ll do it on Sunday. Message left re. jaundiced baby.Try and phone woman re. booking visit. No answer

17.50    Go home.

18.00    Get changed. Have coffee, and cigarette.

18.15    Phone woman and arrange visit. Finished. No break. Nothing to eat except one chocolate digestive. Two cups of coffee. Why have I got a headache? 

So. Not including final half hour I was working for just over 9 hours. Of that I spent 5 ½ hours with patients and the other 3 ½ on paperwork, at a meeting or on the phone. I’m useless with percentages but even I can see that over 33% of my time is spent on extraneous stuff, which wouldn’t show up on any of the forms I have to complete to show how much work I do, as it’s not patient contact. At least 10% of my working day is spent on tasks that anyone could do. This is what needs looking into as a way to save money and imprve patient care. 

I officially work a 7 ½ hour day. Today I worked an extra 1 ½ hours, which I won’t get paid for, and that’s why no one will do anything. 5 midwives in the office yesterday, if all of us worked the extra time then that’s the equivalent of an extra midwife, free. Where’s the incentive to improve the time we have to spend with patients?

Read Full Post »

Today I was back at work. It has been three weeks since I last worked, the first two off sick with shingles and the last week officially on annual leave. The shingles is/are much better with only the odd ‘chinese burn’, needle pricking episodes. If only I could have just got straight down to midwifery but there was a team meeting and a sorting out the chaos of my ‘to do’ box waiting for me first. As a result I awoke at 5am this morning and suceeded in getting myself really stressed out about what may await me. It didn’t help that I’m on a 24 hour on-call.

As expected there were more edicts from on high. This is being introduced, that form needs completing, where are your stats, etc. One of our team is going on a years sabbatical in January, no one to replace her, her post has not even been advertised. I asked what she is going to be doing. She doesn’t know, she just knows that she has got to get out of midwifery ‘for a while’. I am jealous, I understand where she is coming from. It’s not the job, it’s the politics and the constant changes. It’s like walking on quicksand, there is no firm basis on which to build your practice, everything is subject to the decision of some board, who know little about life on the ground, and whose sole concern is not the ‘patient’ but the budget.

My new job-share was orientating with me today, good to have company in the car. We had a few postnatal examinations to do, a booking, and then whilst she went and discharged a Mum and baby I went and did a stretch and sweep. It is the woman’s third baby and she is now 6 days post dates. She had been planning to have baby at a well-reknown birth centre, but a vaginal swab 2 weeks ago revealed that she has Group B strep, this has put her out of the criteria for ‘low-risk’ as she has been advised that intravenous antibiotics during labour will now be the best plan. Poor woman was already disappointed, and me finding that baby’s head was high and that a stretch and sweep was impossible, today, will not have lightened her mood any. Before the S&S I palpated her uterus, baby was very clearly defined, often the way with women in their third and over pregnancies. All the limbs were really easy to feel, almost like touching a baby through a blanket. As a result it was easy to tell that baby’s head was high, only a small part was sitting in the pelvis and just as easy to feel that the reason was the hand and arm it has by the side of it’s face. Every time I tried to assess just how much head was palpable it would move its arm around and at one point I felt knuckles through her abdomen! We had a chat about using positions which could allow better descent, and also raspberry leaf tea and other aids to improve uterine tone. I’m seeing her again on Monday with the hope that baby will have decided to get his arm out of the way long enough for his head to move down slightly. S&S may be easier to do then. A bigger hope will be that she has gone into labour and given birth.

Clinic today, my favourite one. Friendly, helpful staff, well organised surgery. This is the one that my new job-share will be taking over. I’m really sad to be losing it as now I am just left with the one run by a paper-free maniac, control freak, they have promised me my own room though, I shall put up lots of posters and have ‘post-its’ everywhere.

Tomorrow morning, if I havn’t been called out, my manager is coming to have a chat with me and job-share. She’ll have to make it quick as we have 30 minutes in the office, during we time we plan our workload, pick-up messages, the new visits and send of all the forms resulting from anything we did yesterday, and then it’s off to an antenatal clinic.

It’s good to be back.

Read Full Post »

Holding things in

I spent yesterday with my daughters and all the grandchildren, a real treat, especially since it wasn’t at my house!

Jack and Amy play really well together and we really only see them when they want food or drinks. Jack is going through quite a macho phase at present, he justifies his belief that he should be allowed to have anything he wants by asserting that it’s ‘because I’m a boy’. This caused Nanny and him to have a heated exchange, the gist of which, from my side, was that it doesn’t matter whether you are a boy or girl, you can both play with the same toys. Jack was adamant that ‘cos I’m a boy, I can have anything’. I have no idea where this opinion has emanated from but he better stop being an MCP before he gets too much older.

On the way home from youngest daughter’s the Boy’s (twins) Mum started talking about Louis’ hearing test next week. This is fairly unusual, she rarely lets down her guard about things that are worrying her so I just let her talk. She is really concerned. She is fairly sure that he has some hearing, and I would agree with that, but she believes that there may be some high and low range loss. She is just dreading knowing. I said that I would rather know as then I would have a definite to deal with, she is just frightened for Louis as it would not be anything they can cure, that would be his hearing ability set for the rest of his life. Even worse because he has an identical twin, and worst of all that it had been caused by a stupid drug error. I shall just remain positive, until we know on Tuesday. I do notice though that I behave differently with Louis than with Jamie. With Jamie I am just being daft old Nanny, gratified when he smiles at me. With Louis I am constantly ‘observing’ him. My behaviour is centred upon how he responds to sounds. I talked to younger daughter about this and she agrees, we both treat Louis as a ‘case’ not just as a baby. Even after Tuesday it’s not all over with regard to hospital and Louis, he sees the paediatrician the following week about his sacral dimple/occult spina bifida. Fingers crossed that the hearing test will will reveal nothing more than a laid back baby, and that the paed will laugh off the G.P’s concerns about that dimple.

Read Full Post »

Older Posts »