Archive for October, 2007

As promised, the link to the Huffington Post entry commenting on maternity care in the UK. It made me feel sad when I read it as it look as if the system we have at present, that the writer speaks so highly of, has a very limited life expectancy.

Browsing the net also took me to this inspiring entry by a midwife working in Africa. This is midwifery at it’s most basic where all the practitioners skills are utilised and stretched to the max. It’s reading memoirs like this that cause me to take stock, to muse. Could I do this? Would I have the stamina, the confidence to step into an environment so totally alien, where I may be able to scan a woman and confirm a multiple pregnancy but where I would then have to help her safely deliver her babies. How would I cope when there were no NICU cots for these little mites? The emotional toll must be high. I winge and rant about the financial, staffing and equipment deficits in the UK but how heart-wrenching it would be to witness the everyday tragedies that real healthcare deprivation brings.

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It’s all really quite depressing. Word on the street has it that our Strategic Health Authority wants to get rid of community midwives – to save money, apparently we are an expensive ‘luxury’. If they get their way then women will have to attend clinics for their postnatal care and all antenatal care will be conducted in ‘centres’, somewhere. I heard that piece of gossip just after I had read an entry in The Huffington Post posted by an American Mum praising the maternity services in the UK, and particularly the role of the community midwives. Can this be a case of people sitting around a table not being able to see the wood for the trees? (I can’t find the bloglink at present, when I do I’ll post it). I regularly read complaints from women about not being able to contact ‘their’ midwife. Half the women I ‘book’ at the beginning of their pregnancies grumble about the fact we work 9 – 5, it’s too inconvenient for them. Yes, we do work some weekends, and I do try to schedule a couple of booking appointments for then, but to save money, the Trust have reduced the number of midwives working at the weekend so fitting in hour and a half long visits is now extremely difficult. What about the ‘encouraging women to stay at home’ in early labour? I say to my women that if they are not sure whether to go into hospital then to ring me and I will go round and see how labour is progressing. That service will go. So will the option that my ‘low-risk’ women have of then remaining at home to give birth. It’s all different forces pulling in opposite directions and us midwives are, once again, standing on the sidelines, feeling unsure of our worth, in a type of perpetual limbo, anticipating the next fall of the axe and seeing a service fragment around us.

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No, I’m not talking about my hair, I am actually going to talk about the maternity services.

Two alerts I received this week, one about the staffing situation in many of the neonatal intensive care units (SCBU/NICU) and the other about improving staffing levels in maternity units.

I cannot accurately comment about staffing issues in SCBU’s, all I can say is that the drug error involving Louis has been blamed on the unit being busy, in other words, not enough staff.

I can comment about staffing issues concerning midwives within maternity units. I have commented at length on this both on this blog and in my previous blog and it always comes down to the same thing, lack of monies. Everyone talks about a shortage of midwives, at this time there is not a shortage of qualified, work available midwives but there is a shortage of midwifery posts. Trusts have been forced to make savings to stay within their budgets and one of the ways they have made savings is to freeze vacancies, don’t advertise a post until it is vacant, downgrade midwives and halt the use of ‘bank’ staff to cover shortages. I know that the maternity units I am employed by called in Birthrate plus to assess the number of midwives required to cover the service, I went to the presentation of their results where we were told that we required another 23 midwives to adequately staff the service. This was 5 years ago and since then there have been 1.5 posts created. The Trust do not want to spend their money on more midwives. Come to that they don’t want to spend their money on more nurses either. So, we have insufficient funding to provide appropriate staffing levels.

Tell someone you are a midwife and the vast majority will say that it must be the most amazing, rewarding job, and it can be but it is also a stressful job. As a midwife you must never lose sight of the fact that you have two lives in your hands, an oversight can result in a double tragedy. Oversights, mistakes happen when a person is not concentrating, when they are distracted, when they cannot give their full attention to the task at hand. This is what many midwives in overstretched maternity units face every day. Where labour ward is busy, perhaps 9 women and never more than 5 midwives to care for them. An emergency in one room can take 2 midwives away for an hour if a caesarian section is needed. There are still 8 women on labour ward but now there are only 3 midwives. Rare you might think. No this is an everyday, several times a day occurrence. If you were one of those 3 remaining midwives can you imagine the amount of stress they have placed under? Would you function at an optimal level? If anyone wants to know one of the major reasons midwives leave the profession you have just read it and as Frances Day-Stirk of the RCM said, regarding staffing, “Unless the issues that are causing midwives to leave the service are addressed and unless we ensure we train and educate sufficient numbers of midwives to come into the service, this will be a perennial issue.” It is a vicious circle, there are not enough midwives to safely cover a unit, the midwives who are there become stressed (not really a strong enough description), so they either end up off-sick, leaving the unit with less staff, or leave, also leaving the unit with less staff because the vacancy will not be filled for 3 – 6 months, so the remaining midwives become even more stressed. It’s hardly rocket science.

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Family dispute

I have a Mother, our relationship has always been somewhat explosive but it has now reached total meltdown and there is no communication. That’s not entirely true as I have e-mailed her twice since we ‘fell out’ but she has not deigned to respond. Before I have always been accused of ‘being like your Father’ and that is why we don’t get on (they are divorced and she has remarried) but today I hear that there are two other reasons. She and I may not be in an active relationship but she does, occasionally, phone my youngest daughter and today was one of those days. Much was discussed, Louis and his health concerns, she hasn’t yet seen the twins; my shingles, apparently you can’t have them more than once, and then the reasons why we are incommunicado. ‘People’ have told her that one of the reasons we don’t speak stems from the sale of her flat, it appears that I am worried I won’t get an inheritance. I was dumbfounded when I heard this, luckily daughter put her straight on whether or not I was a gold-digger, citing the fact that I had been married to Hubby for 30 + years and that would hardly be the action of someone who was only interested in money! The other ‘reason’ we have such a rocky relationship is that I feel she favours my sister. Now there may have been an element of truth in that one, 30 years ago, but I can honestly say that once I had recovered from the trials of my youth, was happily married and had a family of my own all the resentment I may have felt was no longer important. I say may as I don’t remember having an issue toward my sister, solely toward my parents. Hang on a minute here, she is talking to daughter as if it’s me not communicating with her, I have made contact, she hasn’t responded. This is the problem in a nutshell. She is never wrong, nothing is ever her fault. I could really rant here but I’m not going to, that is not the purpose of this blog entry. The purpose is to clear my head and try to decide on the appropriate action. Basically, where do I go from here?

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Back on-line

By Wednesday evening an engineer still had not arrived, even though we had been assured that morning that one would be with us some time PM. Hubby contacted Virgin, no we were not booked in a for a visit that day, but in a weeks time. Much Customer Services, Customer Care (a misnomer) and Tech support calling ensued, all with each other passing the buck. I had thrown in the towel, Hubby was amazed at the way Virgin Media were behaving.

Yesterday, late morning, a phone call from an engineer to say he would be round within the hour, and he was. I delayed setting up the broadband, they only install the modem, they don’t then connect you to the internet, as I wanted to have time, and peace, to set it up. How right I was. I was scuppered at the first hurdle, an error message telling me that my PIN was wrong, phone the tech guys. I remained calm, phoned a techie, and this lovely man then took over and did it manually. My gratitude knew no bounds. He also gave me an idiots guide to setting up my router and within half an hour I was up and running.

The successful re-install of my internet was the culmination of a good day. Louis had his hip scan, a routine for any baby who has been breech leading up to, or at, birth and his hips are fine. Now it’s just the hearing test and the paediatric review for his occult spina bifida. Whilst his Mummy took him to the hospital Jamie and Amy stayed with me. Apart from whilst Louis was on SCBU this was the first time the twins have been separated, not that either of them knew anything about it as they both slept. They are now both 9lbs plus and quite chubby. For a couple of weeks they have been smiling but yesterday Jamie was trying to giggle and coo, he went so red from the effort of it all that at first we thought he had wind then we realised that he was just trying to communicate. Generally Louis is a day behind his brother so daughter should be having both of them gurning at her today!

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Still no idea what is happening with my broadband. Apparently I don’t have it because of my set top box but, I’m on-line at the moment so I obviously do. The mysteries of Virgin Media are too wonderous to contemplate, let alone behold. This afternoon a tech/engineer is coming to sort me out with a cable modem, if this bringer of joy does appear I may be overcome with emotion and embarassingly sycophantic.

I still have shingles and the G.P has signed be off for another week. I had thought that I may attempt a return to work anyway as I know that my work is piling up and that no one is picking any of it up. To be fair, there is so little slack in the system, none in fact, that it it is incredibly difficult to help another team member out, one of the reasons that I developed shingles in the first place. For 2 months now I have been trying to do a whole time persons work in a half time persons hours. This has obviously led to working later, doing paperwork and making calls from home in the evenings and worrying about the fact that I can’t keep up with it all. So add that to the other stressors in play recently, mainly Louis and the health concerns, and I had become quite low. Anyway, back to returing to work. I was booked on to a conference in London yesterday and I decided to attend. Two reasons really. One is that as a midwife I have to produce evidence of ongoing professional development to be able to renew my registration. It can be lots of things that contribute but study days are one of the best ways, for me, of being exposed to concepts and ideas that I may not normally look in to, and these conferences with different topics and speakers are excellent updating tools. Yesterday we had a woman from the Health Care Commission talking about the maternity services review which is currently being undertaken and also a representative from NICE discussing the new intrapartum guidelines. This was a free conference, wonderful, as study days can cost over £100. The other reason I opted to go was it would be a good way to see if I was up to returning to work as having slobbed out for 10 days I had no idea how I would feel if I actually expended any effort physically or mentally. I got my answer. I was shattered, brain dead and, interestingly, my pain from the shingles was much worse, probably because I was tired. I am taking doctors advice and not returning to work.

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Virgin media

I have no idea how I am posting this. Why? Because I am not able to have access to my broadband connection. I have entered a different dimension, one ruled entirely by Virgin Media, aka NTL. Lets start at the very beginning, it’s a very good place to start, when you read you begin with ABC when you surf it begins with NTL. Yes, I have lost my marbles but hopefully you will soon understand why.

I get a laptop. Hubby has a new computer. I need a router. I consult Virgin, no they don’t supply one but any cable router will work. ‘If you have any problems call our tech guys’ (25p per minute).

I go into PC World. A router. Wonderful, huge advert for Virgin Media with cable routers underneath. I buy one.

Saturday, puncuation and I spend at least 4 hours trying to set up the router. No joy and I had no broadband.

Sunday. Prior to starting the whole process again I went to Virgin Medias customer page, read up about USB v ethernet, did what they advised me to a changed them over, following all their instructions to the letter. Commissioning page. After about an hour that was all sorted, much resetting set-top boxes by Virgin Media but I had a connection again.

Punctuation and I started setting up the router again, more success but commissioning pages galore, and all three computers totally ignored when registered. No broadband. 4 hours have passed. We admitted defeat, I needed to phone the tech guys. I phoned the tech guys, who, after 20 minutes at 25p per minute, told me that set-top boxes don’t work with routers, they knew this already so they give me a free cable modem. Phone customer services in the morning. Still no broadband.

This morning. Phoned customer services, put me through to sales at Virgin Media, yes we will send your modem out, or an engineer can install it for £25. Hang on there. This is your equipment which is rubbish, which you knew was rubbish and you no longer support but I have to either install what will work myself or pay you to do it. No. Wrong. Back to customer services. Long wait whilst ‘Kate’ talks to someone. Yes. We will send out an engineer free, but not until a week on Wednesday. ‘Hang on there Kate, I have no broadband’. ‘Yes I know’. ‘Right then. Can you put me on to the person who can click the reset switch and let me have it back?’ ‘It’s not worth it, because now it’s started not working it will carry on doing it’.

I said goodbye to her really calmly. Crashed about for a while. Sat down here at my computer and attempted internet access. Commissioning page. ‘Oh dear’. Then I noticed my Google sidebar was active. I clicked on Frectis, and got to her blog. I clicked on her link to me, and here I am. It’s a mad world. I can’t receive E-Mails. I can’t access anything directly, but I seem to be able to slide around and wriggle in via a back route. Very odd.

The moral of this story is do not use Virgin Media. They are not helpful. They try and cover up when their equipment has failed, and then when you finally get to the root of the problem they will take 10 days to sort it out.

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I may not be blogging for a while if it all goes horribly wrong and if it does you may read in the tabloids about a middle-aged woman trashing her house.

Hubby’s computer……….and my new laptop have both arrived, so today is dedicated to setting them both up, C-Day. There is also a wireless router sitting there. It promises me it will be simple to sort out, it needs to be as I am not the most computer savvy person in the world.

At this point I would like to recommend Dabs for their ease of ordering and delivery. The order went in late Thursday evening, at 9am their tracking system informed me my order was at Wembley, in a container, at 9.15 it was here. Miraculous since the journey takes at least 40 minutes. Will not comment on the product until I have, hopefully, got everything up and running.

Wish me luck, and patience.

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Today started early, 5am infact, with Labour Ward phoning me to ask me to go to a homebirth. ‘Hmm, I’m off sick’. ‘Well I didn’t know that’. ‘Is my name on the on-call board then?’ ‘No’. Phone down. Fully awake now, and with my side hurting I couldn’t get back to sleep until the analgesia had kicked in. 9am, asleep, phone call again, ‘Whats your login and password?’. I told her, but I, obviously erroniously, thought that the reason you had a login and password was for security reasons so no one else could enter, or access information in your name.

Further to Hubby’s computer being corrupt, today a new little wizard will arrive for him. His specs were for a flat screen, multiple USB ports and the ability to ‘fiddle’ about with photo’s. Hopefully the rather lovely looking machine I have chosen for him, with much input from punctuation, will fulfill his requirements.

The Health Visitor has been to check on Daughter and the boys today. She didn’t do the Edinburgh postnatal depression test because of the bad news daughter had received about Louis and his occult spina bifida. Well, if daughter wasn’t depressed before the visit, she certainly should be now. HV decided not to be reassuring ‘In case there is a problem because then you would say that I told you not to worry. I’ve only seen a few of these and it’s quite rare that the child couldn’t walk’. Daughter had not even considered this possibility. Her concerns were just that Louis may not be able to rough and tumble as there might be a weakened area so his spinal cord may be less protected. Daughter has a gift for imitation and so her recounting of the visit ended with us both laughing, I know that daughter’s laughter was very close to turning to tears. I just want to bang my fist and tell events to stop. To turn back the clock and prevent the nurse giving him too much gentamycin, to make the HV think before she spoke, but I can’t. So we will just carry on counting the days until his hip scan, his specialist hearing test, his MRI scan and just enjoy Louis as we all see him, a normal little baby with a cheeky little smile.

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Falling apart

And on the sick list today

  • Me. Yes, it is shingles. I have in my hot sweaty mitt, (which is nothing to do with the shingles) a prescription for acyclovir which will not cure me, or reduce the discomfort, but may shorten the duration of the attack. To take or not. Has some nasty side-effects.
  • Son. Spent today at the hospital having another nasty invasive procedure to do with his ulcerative colitis. Being an over-protective, suspicious Mother I want to know why the repeat when they successfully diagnosed him last time they viewed his insides.
  • Louis. Yes, poor little Louis had his 6 week check with the G.P today who, noting his sacral dimple, announced that baby has occult spina bifida and so is referring him for investigations. Daughter phoned me distraught, unsurprisingly really given little Louis brush with paediatricians so far. I reassured her by saying that I have it, her sister has it and Izzy has it, a sacral dimple that is, so not to be concerned. Then I read the link I’ve posted and immediately started worrying! Also, since the twins are absolutely identical, why hasn’t Jamie got it?
  • Hubby, Izzy, Jamie and Louis. All have the cough and cold currently doing the rounds.
  • Hubby’s computer. It is corrupt. It is so corrupt that it has stopped working, apparently it can’t ‘read’ anymore. Now, this could be a catastrope but every cloud has a silver lining. I have been selling all my worldly assets on E-Bay to earn enough money to buy a laptop, and then Hubby was going to have my desktop. In a panic Hubby has announced that everything needs to happen now, so change of plan. I keep my computer, but have a laptop as well, and he gets a new desktop and………..I don’t have to fund it. Result. punctuation  has, as usual, drawn the short straw and will be doing all the brain work with regard the selection of the machines, and unless he no longer likes curry, helping me out if (when) I can’t sus out which wire goes where.

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