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Archive for December, 2007

Christmas Day at work was quiet. Not so for the midwives who were on-call before me, they had three births; one booked homebirth and 2 BBA’s (born before arrival). The babies  born before anyone arrived were not due to be born at home, they just put in extremely rapid appearances!

My Christmas Day (aka Boxing Day) was frenetic. 8 adults and 5 children made sure that it was noisy, but happy and that is really all I could ask. 

 ds.jpgThis was my Christmas pressie from Hubby. The saga goes, that the week before the festivities he had no idea what he should give me. Daughters, who had been banned by me from telling him, had taken to leaving catalogues open at the appropriate page, sister sent him an e-mail, and then he went into overdrive but the shops had sold out. Youngest daughter was then enlisted and she went onto E-Bay, just as a listing was ending, and ‘won’ my new little plaything for me. Same daughter gave me the ‘Brain-training’game which has discovered that I have the brain of an 80 year old. Excuses, excuses but, the DS does have a problem with understanding me when I say ‘Blue’, unless I speak in a basso profundo tone, so it is probable that I am not quite that geriatric in the brain department. My plan was to take my little friend into hospital with me to while away the time but Hubby is concerned that I may be ‘sectioned’ if I do as one of the exercises involves speaking to it. Me sitting in bed shouting out colours, in deep tones, at a small red tin may cause the staff to question my sanity.

My favourite gift was from Son and DIL, a Family Portraits session. All the family photographed together in a session lasting an hour and a half and then 2 printed images of our choice and a CD with all the photo’s on. I cried, with happiness, when I opened the envelope. I know I’m a soppy, sentimental, brain compromised, old fool but to me this is an amazing gift, something to treasure.

Yesterday was a busy day at work. It started with my clinic where I had to tell my ‘patients’ that I may not be seeing them again due to 2 weeks holiday, Tenerife here I come, and then going into hospital with the expectation I may not be back until after Easter. My job-share is going to be covering my clinics for me but most of the women have only ever seen me so they were a bit doubtful about the change. One of the women started crying, apparently she can’t ‘do it without me’, I assured her that she can, and will, but I do have to say that her demonstration of emotion has put a a little chink in myarmour concerning surgery and left me a little concerned. One of my visits yesterday was an initial booking. As is my practice, when I have finished with the history taking, and if the woman is ‘low-risk’, I discuss homebirth. I explained that, if all proceeds normally through the pregnancy, we would be quite happy to offer her that option. From the hall, where her Husband was laying a new floor, came a resounding ‘No’. I laughed and clarified that I was just giving the information, and that if all remained well through the pregnancy it would be a decision that they made, with as much input from me as they requested. The woman did seem really enthusiastic, it will be interesting to see what her partner’s opinion will be later on.

My monthly copy of ‘Midwives’ came today (imaginative title) and I did what I always do, turn to the recruitment page. All too far away, except one for a Research Fellow. Ideal, 2.5 days per week, secondment for 2 years, working from home, good salary. My heart rate increased, yes, this is the role for me. No. Bother, or words to that effect, I don’t have a higher degree, and I’m not even contemplating a PhD and I doubt that I have a ‘respected reputation in maternity, neonatal care or women’s health’. With the exception of one article in a magazine all my quotes have been anonymous, at my request, as they are usually berating the powers that be and highlighting the deficiencies in the maternity services. Oh well, looks like I’ll be staying put.

My search for ‘that special’ job got me thinking, what am I looking for? Well, really, once I had mentally drawn up a list of requirements I accepted that I am in my ‘perfect’ post now, or should be. I do love my job, derive huge satisfaction from the continuity of care I struggle to provide, enjoy meeting all the families I come into contact with and am thankful that it integrates well, on the whole, with my family life. I just hate the politics, the manipulation by those who control, but have little or no experience of the maternity services. The hand-to-mouth way the service is cobbled together. The lip-service paid to concepts; one-to-one midwifery, they promise that it is on the agenda but when and how is not explained as it will require more, many more, midwives. Midwives autonomy, they have got to be joking. Our autonomy is being drained away more quickly than free booze at a lager lout’s convention. Try and exercise any autonomy and guidelines, policies and protocols are thrust at you. A dictionary definition of autonomy is – self-governance, self-directing freedom and especially moral independence, it refers to the capacity of a rational individual to make an informed, uncoerced decision. I cannot see how today’s NHS midwife can possibly be described as autonomous, virtually every aspect of our practice is covered by some government initiative or Trust directive. If we are not autonomous, how can we truly be an advocate for the women and families we care for? If all our care is based upon a policy there is little room for manoeuvre without being in breach of our terms of employment. Whoops, ranting….again. I have started researching for a post I am going to do about why midwives are leaving and I am now wandering into those realms, so I shall stop this little moan now and release it all at sometime in the future!

Oh wow! This is the job for me, Freelance Medical Writer, could even fit it in around my midwifery. Best of both worlds. False alarm, again. Must get me a PhD. Do you think I can get one on E-Bay?

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That time of the year

Blow, blow. I just switched on my camera, there was light, and then there wasn’t. The screen went black, everything else worked so I took a photo, only I didn’t. I produced an image that would not look out of place in an LSD trip, psychedelic hardly does it justice! Looks like I won’t be taking any piccies this Yuletide.

The local shops have been manic, fights broke out, allegedly, over the last bag of sprouts. Oh dear.

Working Christmas Day, wonder if I will be offered any mincepies. On-call until 8.30pm, 3 homebirths due, could busy. All the family coming round on Boxing Day, busy and fun.

HAPPY CHRISTMAS

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Rambles

……and, not content with me working on my day-off, they then suggested that, instead of working Friday, I work Thursday 1-5pm and Friday 8.30-1pm. Hmmm, should I? After all, why only have one day when I have a work commitment when I could have two? Needless to say, I declined their kind offer! So, not to be deterred they then had an even better idea, don’t work Christmas Day, my ears pricked up, work Boxing Day instead. Do they not have family? Don’t they spend months negotiating what arrangements they have for Christmas? I have known for years that I would be working this Christmas Day and as a result all the family have known that this year is ‘the in-laws’ Christmas Day and that our Yuletide celebrations will all happen on St Stephens Day. I have dug in my heels and shall be sticking to what is set down on the official rota.

Talking of ears, one of our partly feral moggies has a problem with hers. For a day she had been walking around with her head slightly to one side, it was a slightly quizzical look and didn’t particularly worry me, until she started wobbling and falling over. I rushed her to the vets. Look in her ears (£10); feel her tummy and her neck (£10); take her temperature (£10); give her an antibiotic jab (£15); and an anti-inflammatory (£15); then tell me that this may not work (£15) and so he would really like to sedate her and irrigate her ear (£250) but that may not work either. I have settled for the £75 option and she does seem to be improving, must be horrid for her though, constant vertigo.

Jack and Amy are busy disciplining Nanny. Amy made me sit on the ‘naughty stair’ the other day and then Jack admonished me yesterday ‘ I will not have this rudeness, Nanny. It is unacceptable’. I had to put a cushion in front of my face to try and hide the laughter, I failed and was informed that ‘This is nothing to laugh at. You are a very rude little Nanny’. Daughters think that it is hilarious, all I know is that he does an extremely good imitaion of his Mummy in full flow.

The boys are growing, in tandem but they are really a full-time job. I am full of admiration, and incredibly proud of daughter and how she is coping with 4 month-old twins and a daughter who is heavily into the ‘terrible two’s’. Talking ‘terrible twos’ this websitehas a calculator to enable you to judge how much longer this testing episode in a child’s development may go on for. Back to Jamis and Louis. Still like peas in a pod, both in looks and temperament. They now respond to each other and will grab each others hand and then laugh. Jamie has better head-control than his brother but Louis is starting to roll on his side in an effort to see more of his environment. They no longer co-sleep, too big now, so they are in their own cots and have started sleeping through the night, when the urge strikes them. Interestingly, they still wake at the same time which is good and bad news for daughter. Good in that the night feeds finish quicker, so she has more sleep Bad in that they get cross if they are not attended to immediately and also they also want individual interaction from Mummy. Daughter does find the juggling one-on-one very difficult, especially as Amy resents the amount of  time dedicated to her brothers. It will get easier, but I really don’t envy daughter the amazing gift of twins.

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Knock on

This is a winge. Yes, another one. In one way it is an incredibly selfish one as the reason why the situation has arisen is that a close relative of my new job-share has died and so she needs to take, is taking compassionate leave. However, if there was a teeny bit of slack in the system my rant would not have to happen as her absence could be absorbed. The problem arises because of a ‘knock-on’ from last week. Job-share was called to a homebirth and, due to there being no hours for anyone to take these visits from her, her appointments from then were re-scheduled for tomorrow. Now she is on compassionate leave and so there are 2 options; re-schedule again or me do them on my day-off. I did try the first option but the reception I received was hostile so I’m taking the second course of action. Wonderful, half a day of my own time gone. I won’t receive any pay for it and I won’t get the time back as there is not the time there because THE B****Y GOVERNMENT has tightened the reins to such an extent that there isn’t any room for manoevre. Once again a public sector worker is donating themselves to the public purse, and the powers that be are chuckling into their own generous pay awards. 

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Late babies

We are now halfway through December, and only 4 of the 20 babies in my caseload due this month have been born, looks like Christmas week is going to be busy. I saw two of the post dates Mums at clinic yesterday, I’m quite hopeful that one of them will have baby over the weekend but the other one is giving no signs of baby putting in an appearance anytime soon. I have arranged to go round to their homes on Monday to do stretch and sweeps to try and  ‘stir things up’, here’s hoping that they either beat me to it, or that a little ‘old fashioned’ (now in vogue) midwifery does the trick.

Even the NICE guidelines concerning induction of labour recommend ‘sweeping the membranes’ –

Membrane sweeping

This has been shown to increase the chances of labour starting naturally within the next 48 hours and can reduce the need for other methods of induction of labour.

Membrane sweeping involves your midwife or doctor placing a finger just inside your cervix and making a circular, sweeping movement to separate the membranes from the cervix. It can be carried out at home, at an outpatient appointment or in hospital.

If you have agreed to induction of labour, you should be offered membrane sweeping before other methods are used. The procedure may cause some discomfort or bleeding, but will not cause any harm to your baby and it will not increase the chance of you or your baby getting an infection. Membrane sweeping is not recommended if your membranes have ruptured (waters broken).

Reports concerning success rates vary, but it would appear to be between 60% and 78%. However, reading the studies the timing of the proceedure varies widely, with some studies initiating ‘stripping membranes’ at 36 weeks and many of the others involving women whose pregnancies were not yet post dates. It is noted that the efficacy depends on the cervix being ‘favourable’, soft, stretchy and 1-2cms dilated. To me, this ‘favourable’ aspect means that the pregnancy should be at least at term, 40 weeks. The guidelines at our Trust suggest that the woman should be 41 weeks pregnant, in other words 7 days past her EDD when we do a stretch and sweep and, on the whole, I follow the guidelines because I have found that this is when a stretch and sweep appears to work. If it has not been successful I will then arrange to repeat it 48 hours later and, looking through the results, I have a 70-80% ‘success’ rate. Who knows though, these women may well have gone into labour without my actions, it is impossible to judge really.

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Well, I posted about NHS Blog Doctor and his unfortunate demise and it would seem, according to both Dr Rant and The Devils Kitchen, that someone has been deceiving the readers of the ‘good’ doctor –

I feel that I should point out that the news of Dr Crippen’s death is, fortunately, somewhat premature. The good doctor is merely somewhat busy and he has just had enough of blogging for the present.

He may be back: he may not. We shall see…

UPDATE: seriously, guys, The Truth has now got his boots on and will be seeing you all shortly…

Well I’m not sure now, all I know is that the news about his death on Thursday rounded off an emotional day perfectly. It was the funeral/cremation of my friend’s son and as anyone can imagine that was a harrowing experience, it was just so wrong to be saying final farewells to a young man. Friend and her husband were distraught, they were magnificent just to be able to function, let alone speak to people. There were many, many tears from everyone, the most awful to witness being those of the young men whose veneer of ‘cool’ was washed away by the silent evidence of their grief trickling down their faces.

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Goodbye NHS Blog Doctor

Dr Crippen has been missing for a while now, and then this appears in the comments section.

Dr.P. said…

Hello to you all.

This is not an easy comment to write, and I apologise for the lack of a full post, but ‘John’ was more than a little security conscious when it came to passwords, I have contacted “blogger” to explain circumstances but as yet have not had a reply.

Getting to the point, so to speak, I am a senior partner at ‘John’s practice, I have only become aware of this ‘weblog’ after accessing his email account through our internal system. Other partners have read this website, but none of us knew who the author was – although in retrospect there are a number of clues we could have picked up on!

There is no easy way to say this, but the doctor known as ‘John’ or ‘Crippen’ passed away in a road traffic accident mid-October. Although I appreciate the esteem in which many of you obviously held him, I must ask that the emails cease as of now – they are all redirected to our mail server and this is causing some difficulty.

Dr. Crippen’s identity may no longer need to be secret for his own purposes, but out of respect for his family and remaining colleagues I shall not be sharing this here, neither will I post another message or reply to any left. This webblog will be removed once I can circumnavigate the security protocols for obvious reasons of confidentiality.

This said, I thank all who visit here for their support of our dear, and much missed colleague.

Kind regards, Dr.P.

Wednesday, December 12, 2007 11:20:00 PM

I don’t know whether to believe it or not. If it is true then it is extremely sad. I may have had several disagreements with him about his attitude toward midwives but I looked forward to all his entries. He frequently gave me food for thought about my own profession and the attitude we may often display to women. He also highlighted the very real problems which exist in today’s NHS and throughout many other State ‘controlled’ organisations, he was a much needed advocate for many different sections of society. I will miss him greatly and I send condolences to his family, friends and colleagues.

Goodbye Dr John Crippen.

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