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Archive for April 13th, 2008

Just when I was contemplating how long it had been without a rant the Telegraph published this article ‘The case for Caesarian Section’. I read the article by Julia Llewellyn Smith with my usual interest as to how someone was about to justify an elective C- section for ‘social’ reasons. Ms Smith starts off by quoting a study by the Birth Trauma Association citing this as showing that fewer women die following an elective (pre-planned) caesarian than during an emergency section or vaginal birth. She helpfully puts a link in, but unfortunately it is to an article, also in the Telegraph, reporting on the study, not giving the details of it’s methods. I can’t comment on the findings, all I will say is that it doesn’t discuss morbidity or the outcomes for the baby.

The authoress then continues with her own experiences, which are bad. Filthy ward, insufficient attention, but then I’m lost as she describes how she wants a section second time around and then continues with problems but I can’t understand whether these are with her second baby or with her first, It isn’t really that important as this just shouldn’t have been her experience but she does say “I wanted my second birth to be conducted by well-rested professionals, to have the energy to defend myself on the ward, to have some control during a process which – thanks to the NHS’s shortcomings – has become the most distressing experience of too many women’s lives”. Did she go privately? Basically it makes no difference within the NHS, whether you have an elective or emergency section, you still end up on the same ward and wherever you have your operation you will still be “dressed in Nora Batty-style surgical stockings, attached to several drips and a catheter, with suppositories administered every few hours for the pain”. I shall dismiss the tale of the friend who laboured on the geriatric ward as elaboration since I regard this as extremely unlikely, not least because that would have entailed a midwife being on the ward with her.

Those are my issues with the article out of the way and, on the whole, I wasn’t too upset by it as it was telling her experience in a maternity service which I will admit is struggling. Then I read the comments and one comment in particular really got me riled. It was from Mark and goes like this:-

“….to have the energy to defend myself on the ward….” says it all about NHS hospitals, staff and processes.

These stories are not unusual. I have heard several similar ones. To go through childbirth in an NHS hospital must be an appalling experience. How anyone can think that this treatment of women is reasonable is completely beyond me. We know it happens, but the NHS staff seem oblivious. No wonder mothers end up with depression and post-traumatic stress.

And it’s not just childbirth where we are let down. The behaviour of some medical staff is unbelievable – rude, arrogant, off-hand. Many do not even seem to know that much about medical matters, and they all seem hidebound by “process” in any case. What’s the point of training to be a doctor if all your actions are pre-determined by “Trust Policy”?

“Overworked” is no excuse – most of the “overwork” adds nothing to patient care, and the staff should have the knowledge and guts to realise this and change the system. Too lily-livered and thinking of their pensions, I guess.

All the NHS cares about is computers, and filling in forms, and administration, so that if someone complains they can produce this worthless twaddle that no-one uses or reads to help the patient. (Although many secondary users have access to it for their “research”, without your knowledge or consent). The intention seems to be that hundreds of thousands of NHS workers can have access to your medical file, so clearly privacy is regarded as not important for the patient either.

But what I find most frightening about the NHS medical system is that no-one is prepared to admit that things could be doen better, or that people make mistakes.

And this whole cra**y, p*ss-poor system costs us a fortune. Also we are not allowed to leave this system, we are issued with an NHS number whether we like it or not, forced to contribute, and then the NHS thinks it owns your body and can do with it what it likes – apparently harvesting your organs without your explicit consent is now considered reasonable.

How can all these highly paid professors of medical ethics that lurk in the teaching hospitals and universities think any of this is even remotely reasonable?

No other 1st world hospitals are like ours, they don’t waste so much time on paperwork, they don’t treat patients so discourteously, doctors expect to doctor, and nurses expect to nurse, i.e. they spend 99% of their time with the patients, not with the computer (aka a fancy filing system).

I want to spend some time with this man. I would like him to spend some time working on the wards etc. and see what the staff are up against. Oblivious are we? We should have the knowledge and guts to change the system. No one is prepared to admit that things could be done better. Does he think that we enjoy all the paperwork, especially when patients, quite rightly, are ringing buzzers, clamouring for discharge papers, and people in strange audit/bed-state/IT offices are phoning demanding numbers of this and that, the woman in bed 3 needs help with breastfeeding and labour ward are doing another caesarian section so they want a midwife there NOW?

That takes me very neatly back to the case for and against caesarian sections from the service providers perspective. How are they positive? Well, as long as nature doesn’t beat the surgeon to it, they are allocated a time slot and adequate and appropriate staff can be arranged.  How about the negative? They are 3 times as expensive as vaginal births. They are staff intensive, normal birth = 2 midwives at any one time, perhaps an anaesthetist (epidural); assisted birth = 1 midwife, 1 obstetrician, 1 paediatrician, probably an anaesthetist; caesarian section = 1 runner, 1 scrub nurse/midwife, 1 midwife, 1 ODA, 1 anaesthetist, 2 surgeons and perhaps a paediatrician. Following the operation the woman requires close observation on a recovery ward and then a high level of nursing care on the postnatal ward. She will be unable to get out of bed for several hours so requires more assistance caring for personal needs and those of the baby and women who have undergone a section often require more help with breastfeeding, mainly positioning the baby. They will stay in hospital longer than a woman who has had a vaginal birth and the baby is at higher risk of requiring treatment for breathing problems. Does that answer the question of why NICE would like to see the section rate go down? Does it also help to explain why the service is struggling to cope?

 

 

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Technorati

Today is one of those frustrating days when everything goes slightly wrong. I start gardening, it hails, I decide to tidy up my computer and delete e-mails I want to keep because I’m bulk deleting by sender. I start roaming around and decide to look at Technorati and there is an alert out on it for WordPress blogs. I read the link and think that I’m okay as it seems to be refering to .org, not .com. I relax and search for this blog, it finds it but that’s all, no info etc. Am I a member? I have vague recollections of joining but I’m not sure so I try and log-in, apparently my username will be set in stone, and it rejects all my efforts. Perhaps I didn’t join, okay I’ll start all over again. First page, fine, then a blank page. Refresh, same thing. I am now totally fed-up with it so I decide to blog away my frustration. I start writing, decide to link to Technorati and when I go there a little bit of text at the top says it knows me and that I have been a member since….today. I’ve just been back and, with bated breath, have claimed my blog, yes (much singing, dancing, clapping of hands), I’ve done something today. Now I’m off to complete my profile.

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