Letting the Dads in

So now, yet another, organisation that wants to decide how the maternity services should be run, The Fatherhood Institute. Apparently we (midwives) don’t do enough to include the fathers in antenatal and postnatal care. We don’t ask questions if a father fails to show for the ante natal appointment and they feel that Fathers should be allowed to stay overnight with their partner and baby on postnatal wards. I’m sure that they are a lovely, caring organisation who are full of wonderful ideas but have they lost touch with reality, do they not read or listen to the media? At a time when the maternity services are struggling to cope with an increase in the birth rate, when units are closing and women are being turned away due to a shortage of beds we are expected to find somewhere for the partners to sleep, wash, pee and poo, I suppose we will have to feed them as well.

Why don’t the majority of fathers attend antenatal appointments? Could it be a question of finances I wonder? Pregnant women have a right to paid time off for all midwife/G.P/hospital appointments, and antenatal classes, their partners don’t.

I especially liked their accusation that “those (partners) that show no interest are not challenged” by us. Yep, I hold my hands up and admit to this, and the question I would ask is ‘what right have I got to challenge the way a couple manage their relationship/responsibilities?’ I can advise a partner, if I see him, that his baby’s mother needs support and help, but “challenge” him? Could be rather counter-productive and may result in me not being allowed back.

All a bit tree-hugging really.

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How C-sections cause problems

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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Toe dipping

Yesterday I met job-share at her clinic so that I could start bringing myself back up to speed on work issues. I havn’t been signed back yet but I am anticipating that I will be back in a week, possibly with some restrictions but I will definitely be doing the routine stuff. Job-share was just going through the new bookings when I saw a name I recognised, ‘That will be fun’ was my reaction, and said in a sarcastic tone, an extremely difficult, unpleasant family, somewhere you really don’t want to visit alone. Then she bought me up to date on our ‘concerning’ case. A lady, with moderate learning difficulties, previous child in foster care, partner on the sex-offender’s register and now 30 weeks pregnant following fertility treatment (clomid) from the G.P. When asked why he had prescribed Clomid for this lady, in light of the family history, the G.P told us that it would be unethical not to give her the same treatment as any other woman with fertility issues. I do question this, even from the ethical perspective. How ethical is it to knowingly facilitate a pregnancy in someone who is unable to provide the baby with basic care, the other child was removed from their care at 4 weeks for physical neglect. C really wants this baby but she is utterly unable to care for it. They are going to require a huge amount of support, they had that last time but it still was not enough, how will it be different this time? Plus, the partner is now known to have an ‘unhealthy interest in young girls’, this baby is a girl. He also has some degree of learning difficulty, nothing like as poor as C’s, will he differentiate right from wrong sexually when it comes to his own child? By the time we know the answer to that one she may be an abused little girl. It is all just too complex and unfortunate to contemplate really. It would be one issue if C had conceived without medical assistance, or if this was her first pregnancy, or she was with a different partner but combine all the factors and I feel really unhappy with the G.P’s actions. Other than those two our pregnant women all appear to be progressing well and not presenting with too many issues. I’m quite looking forward to leaping back in there! 

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Mrs Fixit

Daughter has dishwasher problems, a subject close to my heart. Last week, her little stand-in for the marigolds, decided to make odd noises and started to dispense smoke around her kitchen, as it was still under a year old the engineer was summoned. He found the problem quickly, a pip stuck in the motor. Yesterday I had a phone call from son-in-law telling me that the appliance had once again filled their kitchen with smoke, this time minus any noise at all, and that the engineer was coming around today. Cogs clanked slowly around in my brain and what he was hinting at flashed before me, ‘Do you want me to be there?’ I asked.  ‘Please, but don’t let (daughter) know I phoned you.’ So, from 12 noon until 5 today I will be awaiting the repair man. This may seem an odd situation if it were not for the fact that 2 years ago we had a dishwasher fire whilst we were asleep, the fire brigade told us that if it were not for our smoke detectors we would be dead, my two cats did die and the resultant damage was enough to move us out of our home for 4 months. Perhaps this explains why SIL, who is off on a golfing weekend is so concerned about an errant dishwasher and why he feels that I may be the person to oversee the repair and discuss the situation with the repair man. My first question will be about the ‘pip’.

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Lali, a unique little girl

I’ve just seen a report from India about Lali, the little baby girl born with two faces. I immediately wanted to find out more about this ‘abnormality’, so started searching. It took a matter of seconds for me to discover that I was right to assume that this was a form of conjoined, or siamese, twins, and I now had a label for it, craniofacial duplication, or diprosopus. Then I clicked on Wikipedia’s entry and discovered that they say it is not a single embryo partially dividing but rather that it is caused by a protein affecting cell division. This protein has an unfortunate name, so unfortunate that it makes me very sceptical, it’s called SHH, sonic hedgehog homolog!. I have looked further and…it is true, it is a protein located on chromosome7. So I satisfied by curiosity about the aetiology of diprosopus, I then wanted to know the prognosis. Being very basic about this Lali is essentially a baby who has one head, but that head displays two complete faces, do they both function? Reading the reports, they do as apparently whilst feeding with one mouth she sucks her thumb with the other. Her parents have refused to have investigations conducted on her so we don’t know if she has a single oesophagus, if she has I wonder if that alone may cause complications with regard to inhaling milk into the lungs. Reading all the literature it appears that this anomaly is generally accompanied by other congenital anormalities, often affecting the brain and the spine but there is no mention of this in any of the reports about Lali. What is her life expectancy, her quality of life? My understanding is that she will only have one brain, so in the absence of other problems I would guess that her life expectancy should be ‘normal’ but what will that life be like? Her parents seem to be trying to protect her from outside intrusion but that must be difficult, particularly as she is now being hailed as an incarnation of the Hindu Goddess Durga and that people are flocking to see her.

This is a very different scenario to the majority of conjoined twins where they are single entities each with their own brain, but joined not just externally but internally. Lali, is a little girl who by a 1:2.5 million chance has two faces, both controlled by a single brain so there is no decision here as to what is best for each baby, she is a single entity. How would I react to this, would I rush to surgery? Is surgery required for anything other than cosmetic reasons? I would certainly have wanted doctors to conduct scans to ensure that there was nothing life-threatening about Lali’s condition but, if they were clear would I want reconstructive surgery? Is Lali perhaps more fortunate having been born in India where she is being hailed as a goddess than in a Western country where she would be considered ‘abnormal’ and not revered but even reviled? I’m possibly being unfair here as there are conjoined twins, Reba and Lori Schappell ( Reba now being known as George ) who have successfully lived ‘individual’ lives within and outside of media attention. However, even these sisters they were placed in an institution until the age of 24 and it is only due to their determination that they now live normal lives. If they were born today would they still be conjoined, or would their parents have made the decision to seperate them?

My musing on this could go on, and on. I will be interested to hear how Lali is. I hope that she is well, that she continues to be seen just as her parents first baby and that all those around her protect her from people like me, the prying public.

After I had published this post I double-checked my spelling of ‘unique’ and through this I found a web-site called “Unique – but not alone”. This is a support site for families affected by rare chromosome disorders and also the professionals who work with them. It may be useful for someone reading this blog so here is the link http://www.rarechromo.org/html/home.asp.

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Expectations

The Old Woman who Lived in a Shoe

I started this blogging stuff back in February 2004 when youngest daughter was expecting her first baby, my first Grandchild. I wanted to keep a diary, organise my thoughts and record this transition from being a part of one generation into a member of another. I had looked forward to becoming a Grandparent but I was amazed by quite how much this forthcoming event was altering my perspectives. My children had all flown the nest, were independent. That had given Hubby and I a freedom that we had never really experienced, the ‘apron strings’ which had held us to the children for so long had stretched to such an extent that they were virtually non-existent. Did I suffer ’empty nest’ syndrome? No. We still saw them all frequently, we all lived locally so someone was always popping round but our time was our own. The advent of a new generation reined me back again. The pregnant one was calling round more frequently wanting support and reassurance and I realised that it would not just be their lives changing, ours would as well. Jack was born and I was overjoyed that the closeness daughter and I had regenerated was continuing, and that I was going to be a ‘hands on Nanny’. It is now 4 years later, I am now a Nanny 5 times over and, although at times spread fairly thinly’, I am still hugely involved with my Grandchildren, when daughter returns to work in August I will be caring for the boys, I am privileged. Yes, my relationship with my daughters has changed, we are now closer than before, we are a support network, I hate saying this as I always used to cringe when I read it but, we are friends as well as being mother and daughter, it’s complex.

Now for the point of my musings, I am going to be a Grandmother again! On Mother’s Day son and daughter-in-law came round and gave us a suggestion for a wedding present, a pushchair! Yes, they are getting married in May, whoops. I was overjoyed, squealed, cuddled both of them and generally made a huge fuss. Yesterday they had the 12 week scan, I was expecting a phone call but no they came straight round to show us the scan photos, my next grandchild, a little smudge nestling in it’s home. A the moment I feel as close to this developing baby as I did to all the others, will this continue as I expect my involvement to be very different. This is my daughter in-law, I shouldn’t think that I will be physically involved during the pregnancy, I doubt that I will be there when baby is born. I was in the room when all my other Grandchildren came into the world, will it make me feel differently when I don’t hear it’s first cry? It is all just so different, I’m frightened that this little one won’t feel as much a part of my mega-family. I think this is going to be a whole new experience in my Grandmotherly role.   

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I was tagged

Cartside has tagged me. I’ve been slightly tardy in responding but here goes.

1. Pick up the nearest book of 123 (or more) pages.

Well, there is a bookcase the other side of the room with a multitude of books, fiction, non-fiction, reference, all-sorts but the book nearest to me is ‘Mims, the Prescribing Reference for General Practice’. Scintillating reading! At the moment I’m reading ‘Wicked Beauty’ by Susan Lewis  for relaxation. An easy book to read, slightly racy but a book you can pick up, read a few pages and not be completely lost story-wise.

2. Open the book to page 123 and find the 5th sentence.

Reduce dose of levodopa usually by 30% in patients taking more than 600mg levodopa daily, or who have moderate to severe dyskinesias at start of treatment.

3. Post the next three sentences.

Child not applicable. Dopaminergics. Amantadine. ( I can sense everyone rushing out to purchase this entertaining tome. You will be out of luck. Shame! I get it via hand-me-downs from the G.P’s I work with).

4. Tag 5 people.

Firstly, someone I know reads a great deal, Mumof4. Hmmm, next comes a man who will, if he reads this and knows he’s been tagged, doubtless give me some iambic pentameter,  Punctuation. Nicola, you’re next, there are some excellent Canadian authors, perhaps you will share one with me. Here comes a man who has worked with books so should have lots to hand, Flighty. Finally, I’m going to fly in the face of reason and see if NHS Blogdoc has alerts when someone links to him and then if he looks to see what they saying. I would love to know what you read for pleasure Dr C.

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White Christening

It’s snowing, and lying. We may not have experienced a white christmas but we will have a white christening.

The christening cake is finished, and is still in one piece. I must be mellowing with the advancing years!

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Brain frying

Is it only me or has everyone’s dashboard undergone a radical modification? I thought I was lost there for a minute.

Drug calculations, it’s not true, we don’t get the push if we fail, first time, just if we fail twice. That’s a relief! It’s all a question of remembering formulae apparently, what you want, what you’ve got times the volume, drip rates, number of drops to a ml and nano’s, I have never experienced nanos before. Then there is converting decimals to fractions to percentages, holy moly, me a dyspraxic and all (thank you cartside). Here’s a sample ” Adrenaline 1:10,000 is available on the resuscitaire. A baby needing resuscitating weighs approximately 3kg.The doctor has asked you to draw up 10mcgms/kg for him to administer. What volume of the drug would you prepare?” Answers below please.

Tomorrow Amy, Jamie and Louis are being baptised, I’m really not too sure how Amy will respond to having cold water poured over her head. As her favourite expletive is “For goodness sake”, said whilst standing with her hands on her hips, it could be quite comical. I am in the middle of decorating the cake at the moment, when finished I shall take a photo so then everyone can have a chuckle, I’m just taking a break as I am not a domestic goddess and I’m struggling not to lose my temper. Hubby is keeping out of my way, he still has vivid memories of an episode involving a fairy castle cake. I had spent hours making this cake, compete with turrets, and was not happy with my efforts. Poor man made the mistake of coming in from work and reassuring me by saying ‘ It’s not that bad’. I flipped. The cake was balanced on a kitchen stool, I raised a leg, caught the base of the cake board and my glorious creation flew upwards and then landed with a splat on the floor. I rushed past his gob-smacked figure, grabbing my car keys on the way, leapt into my little mini and drove off into the rush hour traffic. When I returned an hour later he had stuck it all back together, securing the turrets with cocktail sticks, I laughed…….until I cried. There will be no repeats of that behaviour, I don’t have a mini anymore!

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