Archive for October, 2007

A plea

Babycatcher. Read her, please. I know I talked about this blog before but for me, not just as a midwife but also a Mother, this blogger, with her personal reflections, has made the terrible perinatal and maternal outcomes in Africa and other ‘third world countries’ more real than press reports ever have.

Slightly more than one half of the maternal deaths (270,000) occurred in the sub-Saharan Africa region, followed by South Asia (188,000). Together, these two regions accounted for 86 per cent of the world’s maternal deaths in 2005.

Eleven countries accounted for almost 65 per cent of global maternal deaths in 2005. India had the largest number (117,000), followed by Nigeria (59,000), the Democratic Republic of the Congo (32,000) and Afghanistan (26,000).

I cannot begin to express my feelings of utter helplessness, and anger, huge anger.


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Alternative therapies

I just stepped outside, and why my joints are all aching became clear, it’s cold. My thought processes meandered and I started thinking about glucosamine sulphate. If I was a homebirth midwife in the States it would be likely that I would be into alternative therapies but I am really quite a conservative little person and so, although I support women using aromatherapy, reflexology, hypnobirth and homeopathy during pregnancy, labour and postpartum, I tend not to use it myself. This is not because I fear I may do myself any harm, I would just rather stick with conventional medicine. I may start taking glucosamine though as I’m fed up with taking voltarol constantly when my joints are aching, I’m not too happy with the salutary tales I hear about it’s prolonged use. Considering alternative therapies, and my aversion to some of them, took me to when Hubby had a ‘slipped disk’ back in the 80’s. At that time he was a manic squash player and was always doing himself some damage whilst on the court, on one occasion his back was giving him grief so he took himself off to an osteopath. The result of this one appointment was to make me extremely cautious of any alternative therapies, particularly those which involve manipulation. Basically, Hubby left the house with discomfort and returned in extreme pain. Investigations revealed that he had a herniated disc. At this time he had just started working for himself, so when major surgery was suggested as the only solution he refused. Eventually his life was ruled by his pain and mobility problems, family life was non-existent, all his reserves were used up working. Somewhere we heard about this orthopaedic guy who was starting to use a new technique, chymopapain  injection so Hubby made a private appointment to see him. What a wonderful medic. He saw Hubby at his private clinic, assessed his situation, and admitted him to his NHS hospital 2 weeks later where he did the procedure. Hubby was out of action for a minimal amount of time, and apart from a hiccup about 5 years ago, all is well. This demonstrates why I have been ambivalent toward different therapies, the osteopath may not have caused the disc to herniate, but he certainly exacerbated the situation.

What makes a technique an ‘Alternative Therapy’? Is it just that it has not been accepted into treatment regimes within the medical practitioners realm, there is enough research out there to show that some non-medical interventions do have positive effect so why do some health professionals still regard it with such disapproval? Perhaps it is just a case of some professionals wishing to keep health issues and their treatment ‘in-house’.

Certainly, I will always regard osteopathy with suspicion due to our experience with it. However, when one of my children was a baby and there was a whooping cough epidemic  I used homeopathy to attempt at giving her some protection. It was actually my G.P who recommended it!  No, she hadn’t had the vaccine as I had developed encephalitis following a vaccination against smallpox so the medical advise was that none of my children should have the pertussis jab. Daughter didn’t develop whooping cough, was it the homeopathy? I don’t know, but it did give me peace of mind and did her no harm.

For me it’s the ‘no harm’ that is important. I really don’t mind what anyone uses as an adjunct to traditional medicines and treatments, as long as it doesn’t harm them. This could be by dangerously delaying them accepting a needed traditional intervention, as in my woman suffering a PPH whose husband insisted she not be given drugs, he would use Shiatsu to stop the bleeding. It didn’t stop the bleeding and she ended up losing 2 litres of blood and requiring a transfusion, or by the actual substance used causing a problem, as in Black Cohosh.

Well, round in a complete circle here. I started off musing about Glucosamine and thinking I might start taking it so I wouldn’t have to take Voltarol (diclofenac sodium) so often, due to the problems it may cause. Everything has a risk attached. Basically it’s all just how serious you perceive that risk to be.

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Job Seeker

Today I was talking to a midwife friend whose three babies I helped into the world and she told me that she is handing in her resignation this week. She has just returned after a years maternity leave and is horrified by how much the care in the hospital has changed. Her exact words were ‘I know that I love midwifery but what we are doing now is not midwifery and I cannot work like that’. She applied for, and got, a childcare teaching post at a local sixth form college, far more child friendly, same pay and no unsocial hours. I have to admit that it has now got me thinking about a change of career. I’ve done a quick search for jobs but there is nothing I’ve found, so far, that appeals to me any more than continuing as a midwife, and unfortunately we can’t afford for me to give up work for at least 5 years. It’s just too depressing. I feel like a customer care representative for a really rubbish company. The customers have ‘bought’ an item and found that it doesn’t live up to it’s description, so they have phoned customer care to sort things out, only the rep (me), that they are dealing with would love to do more but the company just never fulfill their promises. The customer gets annoyed, understandably, and takes their disappointment and frustration out on the rep. That’s what being a midwife is like, the government is promising one thing, the Trusts are cutting back to stay within budget so are telling us to reduce services, and we are there, in the firing line, when women feel that the system is failing them. What the government should do is just be honest and say that the vision they have for the maternity services would be wonderful, if it was affordable, but it’s not. ‘So sorry people, we will provide a safe service but without the frills we promised.’

If anyone out there knows of a job for a grumpy, middle-aged, midwife please let me know. I’ve always fancied the idea of being an archeologist, or a forensic scientist, attention to detail required, hmmm perhaps not then!

Wow. Hasn’t Claire Verity ruffled feathers? There are blogs against her, countless articles commenting about her techniques and paediatricians have expressed concerns that her insistance babies sleep in their own room increases the risk of cot death. Even the authoress of that worrying ‘The Contented Little Baby’ book, Gina Ford, has spoken out about Ms Verity’s child training methods, crikey they must be rigid for that advocate of black-out blinds etc to condemn them. Personally I haven’t seen the Channel 4 programme, but my daughters have and can sit for hours relaying the differing opinions regarding caring for a baby. Do I have an opinion? Cherry-pick, that’s my advice. See what works for you. Don’t rule anything out just because it came from a childcare ‘expert’ you don’t agree with, they may have just the smallest suggestion that works for you. Do remember though that just because, when you put 2 week old Dan to sleep in his cot upstairs instead of in his crib downstairs he then slept for 3 hours this may not have been an example of cause and effect. It may just be that Dan, who is very new to the world and changing all the time, has now decided that he may go longer between feeds. However, if it worked great. That’s cherry-picking. Perhaps that’s what I’ll do, I’ll write a ‘Childcare Tips’ book. This will be one huge tome, more like an encyclopaedia really. 

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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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