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Archive for April, 2008

There is so much in the news at the moment about the maternity services that I’m flitting around like a little butterfly.

Firstly I hear that midwives have rejected the pay award. Okay, so I’ll reject it, it is an insult and must be counter-productive in the drive to recruit all those ‘return to practice’ midwives. I really don’t believe though that the Government will take any notice, but at least they will know that there are another group of unhappy, public-sector employees.

Maternity Wards are like conveyor belts. Unfortunately operating in that way is the most time, cost and personnel efficient way of providing a service. Yes, the users have been promised much, but you can’t make a silk purse from a sow’s ear. Busy maternity wards, over-stretched staff, insufficient resources and the public’s concerns about hospital-acquired infections are not going to make the maternity ward a restful, cosseting place to be.  

That brings me neatly to another article, ‘Midwife shortage hits home births’, which talks about how the Government’s promise to women of the opportunity to choose a homebirth is often an impossible option due to staffing levels. The Telegraph has gone childbirth mad, they are now an authority on how to “Get the birth you want“(!!!), find the nearest maternity unit which fulfils your requirements, get ready for a Caesarian Section and my favourite ” Your labour bag – what to pack”. That last one has inspired me, I shall be blogging my suggestions, realistic ones, in the next couple of days. In case it takes me longer than I anticipate, please hold off on the breast-pump.

Here’s a very sad case, which shows the possible implications of the on-call system that midwives work. I’ve talked about this before, how sometimes I will have worked all day, and then have been called back either to a home birth or into the unit for a further 12 hours. What people should consider is how safe am I at work for up to 24 hours and then driving home afterwards?

And finally, once more in The Telegraph, ‘I couldn’t have done it without her help’. A lovely piece written by Rowan Pelling about her Independent Midwife, Jane Evans. I am lucky enough to have heard Jane speak at conferences and meetings and have also had the opportunity to ‘pick her brains’ when I’ve been confronted with challenging cases. She is a font of experience, information and advice, so any students or wilting midwives out there who need a reminder of why they want to be a midwife, seek out one of her study days and I can promise that you will leave full of a renewed enthusiasm and belief. ( No, she is not paying me to advertise on her behalf!)

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The Change – part 1

Now to the end, literally, of fertility, “the menopause, a natural life change, represents the beginning of a new phase of a woman’s life in which, with a positive attitude, she may fulfil many life ambitions that she has previously not had the opportunity to pursue”. I want to hunt down the person who wrote this trite little piece of propaganda. It’s all well and good having a positive attitude, I’m trying to, really I am but how the hell it is going to enable me to do things I’ve not got round to before, and why it should be opening up more possibilities I cannot begin to guess at.

It’s all really cheery stuff really, and not just for me but, apparently for those unfortunate enough to cross my path. My main gripe at the moment is hot flushes and also the terminology used to describe them, flushes, flashes, tropical moments, power surges. I had always interpreted these phrases as descriptive of a change in body temperature lasting a few seconds, I was wrong, ‘tropical tsunami’ is a better representation. It’s there, building slowly but inexorably, pushing forwards until it makes itself obvious by making your entire skin surface feel, and look, as if it is suffering from sun-burn and make you feel as if you are in a sauna, fully clothed. You are covered in a sweaty sheen and exhausted for about 5 minutes and, if you are me, instantly short-tempered. Your whole body is out of control, these nasty ‘symptoms’ of the change follow their own rules, there may not be one for a couple of hours and then three will come along in quick succession, and at night it’s so debilitating. I already have sleep issues, I’ve had ‘restless legs‘ for years but now I can also look forward to waking, I always wake just before a tsunami happens, and having to get up, otherwise I would make the bed damp from the sweat, and then find somewhere cool to stand until it passes. Something else happens with the instant saunas, palpitations. These are not just little flutters, they pound through your chest, it feels as if the sound of them must be resounding through the room, that your body must be jolting with their ferocity and at first it was really scary, I thought my heart might explode!

I’m attempting to be positive about these demonstrations of the changes in my autonomic nervous system and hormone levels but it is difficult, after all they are your bodies constant reminder that you are getting older, that your whole body is undergoing change, and not for the better, just a look at the diagram below tells me that!

 

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I’m back, nearly

First day back and nothing changes. Should have been a 3 hour stint, that’s what I will be paid for, but I have just finished and it has been 5 hours. Clinic was great, everyone seemed pleased to have me back and it was lovely to catch up with my women, most of those I saw today are due to give birth over the next 2 weeks. No nasty surprises, all very straightforward, one of them suspected that she may be in labour but as the room I was in had no curtains or blinds I didn’t feel comfortable examining her at the clinic so went round to her house afterwards to assess if much was happening, it is but it is very early stages, so gave things a good stir and hopefully that will spur her body into action. After that I went and booked someone who is 12 weeks, she had only just registered as she couldn’t make up her mind whether to keep the baby, I’ll have a metaphorical slapped wrist for a booking after 12 weeks but it can’t be helped in this scenario. Quite a pleasant little re-entry into the land of the workers really, a little vignette just to whet the appetite.

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How life changes

HAPPY BIRTHDAY BOY

Today is Jack’s 4th birthday and also the anniversary of my metamorphesis into a Grandmother. This afternoon we will be gathering to celebrate his special day and watch, with bated breath, as he opens his present from us, a Playmobil dinosaur set, with volcano. I really hope that he is as excited about it as I am, after all they are his two most favourite things.

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Wedding duty

I’ve been given a task for son’s wedding, ribbons and balloons. I’m really excited and flying in there with my usual, initial, enthusiasm. The ribbons for the balloons have already been ordered and I’m just waiting for a reply from soon-to-be DIL about whether they want ordinary plastic weights or little boxes. I’ve decided that it will be more economical to buy a helium cylinder and fill the balloons myself, and easier as I can blow them up at the venue rather than have to drive there with a car full of air-filled, might explode balloons. Now I’m just musing upon the ribbons for the decorations, organza wired or just easy-pull, organza would look prettier but rely upon my creative skills, have to practice methinks. I would love to be artistic but cross-stitch is really as far as it goes, I suppose my efforts at cake decoration would count but school really stopped my creative flow.

In the dim and distant past my school made you choose between art and domestic science or physics and chemistry. You could only pick p & c if you were getting the right grades, unfortunately I was plus I was better, and safer at the sciences than the creative stuff. Cooking was always quite exciting as you could never be quite sure how something would turn-out, nothing has really changed there and I like to blame an intolerant D.S teacher for that! Art was a subject I loved. Okay, so the lino printing was dangerous as I could never seem to stop the gouger from doing it’s job, only not on the lino, on my hand but I just enjoyed being allowed to experiment with so many wonderful materials. Anyway, my choice of subjects was decided for me and  at first I had to limit my experimentation to carefully controlled potions in the lab. My parents, I think hoping to encourage me in my sciences, provided me with my own chemistry set, complete with one of those burners full of methylated spirits. I used to have such fun distilling potions, burning magnesium tape, making potassium permanganate solutions and then reducing them back again the salts, but after the episode when I became distracted by a phone-call, and set fire to my pin board, and then an admission to hospital to have my eyes washed out following an accident with the KMn04 (it turns the whites of your eyes brown), I was banished to the garage and the following winter saw my enthusiasm for home experimentation disappear. Just think, if I had been allowed to follow my heart I could now be the second Nigella or Tracey.

Still on the wedding theme, I’m off next week to begin the search for that perfect outfit. You know, the one that will camouflage the Rubenesque quality of my physique, highlight the colour of my eyes and make me look 6″ taller. I have this feeling I may be unsuccessful unless I lower my parameters.

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In the same week that we find out about 3 more maternal deaths at Northwick Park, the maternity unit which was until only recently under special measures for 10 previous deaths, there is a report about a baby’s death at an adjacent unit ” Mothers heartbreak: How 30 blunders by hospital killed my newborn baby”.

It’s difficult when you read articles in newspapers, obviously the reporter has interpreted the report that the press association has issued and highlighted the issues which s/he feels are important. The problem with them deciding what to publish is that it is often misleading as they don’t understand the importance of seemingly minor facts.

Nothing can ever take away from the absolutely appalling errors made by the person who would have made the decision about whether the syntocinon should have been stopped, left at the same rate or increased. No amount of money can ever compensate the parents for the needless death of their son due to someone failing to make the decision to intervene and deliver the baby by caesarian, but, who is this person?  In the article the expert witness apportioned blame   “‘I would have expected the registrar, other doctor or a midwife to have appreciated the deterioration in this baby’s condition in labour.” So, we know who to heap the blame on, and commentators have been, rightly, quick to do this. However, if you read the article it also says that   “The evidence of Alwyn’s failing heart rate was recorded in medical notes and reported to senior staff 11 times in seven hours – yet no one understood the baby’s life was in danger”. What are they talking about? If it was reported 11 times then someone was not happy with the CTG, and who was that someone? The midwife caring for Mrs Calloway. So, the midwife reports it, what should happen? The situation should be reviewed by a senior midwife and the registrar. Obviously the registrar was asked to review the monitoring as  “A specialist registrar even used the cardiotachograph (CTG) recording of the baby’s heart rate as an example of a normal labour as he taught a student – oblivious to the fact that Alwyn was being fatally brain-damaged”, do I blame the midwife? No. There is little that can be done if an obstetrician does not agree with your concerns about how a labour is progressing, a midwife cannot perform a caesarian.

I have tried to leave a comment to this effect but the Daily Mail is obviously not interested in such minor details as it hasn’t been published!

CTG is not a cardiotachograph, it is a cardiotocograph. Minor error I know but it is the small things that build the whole picture, and if they are even slightly wrong then the true story is not told. 

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Good News

I am officially back at work next week but……..I still have 2 weeks annual leave owing from last year, which I have to take now, so I still have some more time before I dive back in. I am starting my re-entry on the Fridays during my leave to cover my clinics, manager has agreed this, welcomed this even and is so happy that she has said that she will pay me rather than leave me with yet another day to take!

Sitting, waiting to be seen at occupational health, I was flicking thorough a Nursing journal, and there, in a small entry, was the news that from April 1st all higher grade staff will be paid at grade for unsocial hours and weekends, and the rates are increasing. Hurrah. Also, whilst trying to find a link about the unsocial hours, I discovered that they are reviewing mileage rates, that is even better news as the situation with all the fuel rises was becoming farcical.

How scary is this? It seems that ‘the powers that be’ are starting to act on some of the issues which are a source of irritation to many NHS employees. I might be able to stop ranting. 

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Penalties

Last night Hubby and I went to watch our boy/man play football, league cup final otherwise I wouldn’t have been tempted! Sat in the stand, and froze. At the end of 90 minutes they were 1-1, so off we went into extra time, at the end of that the score was 2-2, by this time I was not bothered who won, just somebody please score. Now we are into penalties, score, score, miss, miss all even until the final penalty taker and…………he missed, and it was son’s best man. I was so happy I could try and get warm, but so sad for one of the nicest lads/men around. His poor wife is 7 months pregnant, she sat and froze for 2 hours but then went into the club-house so missed the end, I bet she is going to have a very other half for the next few days.

Hubby and I hadn’t eaten before the match, we thought a nice meal afterwards would be good. Of course we hadn’t anticipated extra-time etc. To make matters worse there was a diversion when we left so we couldn’t access the M25. As seems to be the norm the diversion signs took us about 5 miles, and then stopped, somewhere in Chipping Barnet. We eventually made our way home via Enfield, where I lived whilst at college and Palmers Green where I went to school, both of these places being a good 30 miles from where we live. I really enjoyed seeing all those places I haven’t seen since a teenager, Hubby was cross, cross and crosser. We got home at 11.30, still hungry as we hadn’t stopped, and still absolutely chilled to the bone.

It just goes to show that children do not cause problems for 18 years, they do for life.

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Positive experience?

Michel Odent has long been an obstetrician who I admired for his desire to resist the medicalisation of childbirth where not necessary but today I read an article where he speaks out against Fathers being present at the birth of their child. I have to admit that when I read the introduction I was horrified, I needed my husband during my labours, or did I? I started musing. What did he do? Well, he irritated me by coming out with little platitudes and attempting to massage my rigid abdomen but when he retreated to a chair and began to read a magazine I was hurt and so accused him of not wanting the baby and told him to go, he didn’t. He was handy though for a hand to squeeze during contractions and someone to keep my flannel cool and damp and place on my forehead and, most importantly, he was my advocate. He was there to deflect the offers of an epidural which, if he hadn’t been reminding me of my insistence that I didn’t want one, I would have accepted during two of the births. The midwives were well-meaning, they could tell from baby’s position and the slow progress of labour that these were not going to be easy labours and births, but had I not had Hubby there to remind me of my reason for resisting epidurals I’m certain that one birth would definitely have been a forceps and the other a caesarian birth. Did this need to be Hubby though? If I had a midwife throughout pregnancy and birth who knew me I’m sure that she would have been as effective an advocate and probably less likely to iritate me! Monsieur Odent talks about the adverse effects partners may have on a labour –

“First, a labouring woman needs to be protected against any stimulation of the thinking part of her brain – the neocortex – for labour to proceed with any degree of ease.

This part of the brain needs to take a back seat and allow the primal “unthinking” part of the brain connected to basic vital functions to take over.

A woman in labour needs to be in a private world where she doesn’t have to think or talk.”

I agree with this sentiment. At a home birth most community midwives will take a back-seat until they are required. We will sit there, quietly, reassuring and supporting when necessary but generally allowing the woman to concentrate on her labour. In an environment where the woman is able to follow her instincts she will try to avoid prying eyes, even if it is just by retreating behind a sofa, or shutting herself in the bathroom, or like me in a hugely medicalised scenario, by putting a flannel over her face to disassociate herself from any distractions. We are after all, basically animals. Anyone who has ever been privy to a cat having her kittens will know that she has prepared herself a safe, warm, dark place to give birth. No being the centre of attention in the middle of an unfamiliar room, surrounded by chattering people, especially strangers, with all the lights on, but that is what we expect the majority of women to do and then we wonder why so many labours require assistance from synthetic, hormonal augmentation to progress.

Odent then continues with the effect that witnessing their partner give birth can have on men –

“Over the years, I have seen something akin to post-natal depression in many men who have been present at the birth.

In its mild form, men often take to their bed in the week following the birth, complaining of everything from a stomach ache or migraine to a 24-hour bug”.

I hadn’t made the connection, but he could be on to something here. Thinking about many of the families I have cared for following the birth it does seem that quite a high number of the fathers do develop illnesses in the first few days at home with baby. The mean side of me had always put it down to them feeling put-out about the lack of attention from their partners, is it possible that it could be an expression of depression, a post-traumatic stress reaction? No answers at the moment but I shall start paying attention to how many of the men who found the birth traumatic then come down with ‘man-flu’, or something similar.

He discusses another adverse result of the partner being present at the birth, marital breakdown. I have only ever known one example of a partner being affected in that way by witnessing his child being born, that was a friend of ours. His wife had experienced a long labour, which culminated in a failed ventouse, forceps birth and a third degree tear. For some unknown reason the obstetrician had felt it wise to show him the extent of the damage before it was repaired and as a result he was unable to make love to his wife for nearly a year following the birth. I can understand this, before a tear, and especially an episiotomy has been sutured it does all look pretty horrific, the first time I saw a perineum prior to stitching I likened it to a mass of steak and kidney. It is not necessary though for the partner to see this, at this time there is plenty more going on, they have just had a new baby for heavens sake.

I decided to consult Hubby on the whole issue of Dads being there for childbirth. He is pleased that he was there, ‘wouldn’t have missed it for the world. I got you in that state, I should be there to help you through it.’ He obviously hasn’t suffered any ill effects from either witnessing me in pain, or the physical and verbal abuse that I put him through during the labours. He is very down to earth though. He knew that no amount of chanting nursery rhymes or deep breathing was going to stop this being extremely painful experience. He understood that when I told the staff to ‘put me down. You wouldn’t let an animal suffer like this’ I was not really dying, that this is not abnormal behaviour during labour. He was not traumatised, he was elated at seeing his children being born. Me? Well I knew that he appreciated what I had endured to produce our family. That he knew when he was ‘wetting the baby’s head’ that I had not just been languishing comfortably in serene surroundings. That when I came home and found sitting down super uncomfortable that I was not playing for sympathy. That, for something that large to exit, and then to require quite that long to put everything back together I definitely would be experiencing more than passing discomfort! So, if I could turn back the clock would I want him there? Yes.

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Nearly there

I saw the doc today, not my own G.P as he’s on holiday but a lovely, friendly, chatty new guy. He was doubtful about me returning to work but agreed as long I do nothing requiring lifting, pulling or pushing, he even wrote that on my ‘sick’ note. Next hurdle is the review by occupational health but listening to other people they just go with the flow. If I don’t get back to work soon I think Hubby and I could be needing the services of a solicitor specialising in marital disputes! Hubby works from home and I think the 24 hours per day, with hardly any respite, is causing us to irritate each other.

On the twin front, they are both rolling madly around the floor. They are able to sit by themselves but they derive far more pleasure from being able to explore at ground level. Louis has just got his first tooth and by the colour of Jamie’s cheeks, and the amount that he is dribbling, he won’t be that far behind. Most of the time I can tell them apart but other people, including their sister, still cannot decide which baby they are talking to.

I made it out into the garden today and surveyed what I need to do since the new next door neighbours built a brick wall between our gardens as part of their landscaping of a previously neglected garden. When building the wall they dug out the existing hedge and disrupted/destroyed some shrubs adjacent to it and when it was finished the builders back filled the trench using soil from the weed infested garden, so now I have a metre wide strip of soil, the length of my garden, which is growing nothing except ground elder, a particularly nasty weed. Looks like before I start planting I had better undertake some serious physical and chemical weed control.

Tomorrow evening will see me standing, hopefully not in the rain, watching son play football. I usually avoid this pastime but it’s a cup final and he has requested our support so I feel duty bound to be there. What generally ends up happening is that I become involved in the match and become one of those Mothers who shouts abuse at any nasty boy who hurts the apple of my eye. Yes, he is 29, and no, it doesn’t matter how old they are, they are still your little boy!

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