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Archive for May 23rd, 2008

Listening

A Pinard

Salutary day today. Clinic first, not too bad. One of the pregnant women, 39 weeks with her second baby, told me that after she had last seen me baby had done some massive movements, spending one day lying across her womb, a transverse position. When I palpated I really wasn’t sure what I was feeling. It was obvious that baby was in a posterior position, baby’s back to Mum’s back, but was it head down or bum first, breech, I really wasn’t sure. Out came my Pinards, often that will help me solve my dilemma, not today though, wherever I chose to place it I could hear baby’s heartbeat clearly. Obviously a case for a sonographer. After much bargaining with the hospital they gave in and invited her to go straight there. I phoned her tonight to hear the result, head first, cephalic, with the head deeply engaged, explains why I couldn’t feel it!

After clinic I had a couple of routine, 5 day postnatal visits, weigh and PKU, aka the Guthrie, heel-prick or newborn screening test. Then 2 pregnancy booking home visits. The first was a woman who has now moved to another area but wanted me to book her as I had seen her last year when she had an IUD, intra-uterine death, at 34 weeks. After her loss I stayed in touch until after the post-mortem, during all the process she was well supported by the bereavement midwife so I never heard the full results, just that a syndrome was involved. Today we recapped the whole experience again, so very sad but it is important that K and I are able to communicate well. All her hopes and fears through this pregnancy, which is bound to be sometimes beset by doubts however much screening of baby is done, should be shared openly with me.

Next came a booking where I knew that the woman was booked for a CVS, a chorionic villus sampling. There was a healthy, young boy at home with her and, since she was young, I was interested to learn why she was having this invasive form of screening. Her second child, a girl had been born healthy but by 4 months old had started to exhibit physical signs that she was unwell and a genetic abnormality was diagnosed. Over the next year she deteriorated and a bone marrow transplant was tried, with initial success. Unfortunately the little girl died aged 2 years. There were many photos of her, from a healthy newborn to a toddler showing the hair loss, emaciating effects of the drugs used prior to a bone marrow. It was another emotional chat, the Mum discussed all aspects of her daughters life, graphically describing her last few days, I thanked her for sharing her daughter’s story with me and wished her well with the CVS.

So I had visited 2 women who had previously lost babies, both girls due to abnormality, then came my final visit, a newly discharged Mother of 5. Terrible, a disgustingly filthy house. N greeted me with complaints that the house should have been fumigated whilst she was in hospital but ‘ the f*****g social have only done a deep clean. At least it cost the w****rs 3 undred quid’. Good start. No children, no baby, I had been told that there is an ICO on the newborn. Hmmm. Dare I? Here goes. ‘N. Can you tell me about things. Baby, you, the birth. Why you stayed in hospital so long.’ Out it all came. Baby is with foster parents. 1 of the other children is in hospital following an attack by a relative. 2 others are also in temporary care and 1 is being adopted following physical abuse. I sat and listened to a distressing tale of ‘lost’ children, husband in hospital following an assault, inability to care for children and a total lack of understanding why the baby and 2 of the children had been taken away by social services. She is resigned to never having one of the children back but is fighting for the return of the others. She has the services of a barrister and is going to ‘show them social workers what a**e h*les they are and what they can do with their ICO.’ Whilst I was there a friend phoned and she revealed how desperately distressed she was, how she didn’t know how she would cope. By the time I left I was concerned for her mental well-being and was beginning to feel that they were being unfair, I wanted to speak to her social worker, she gave me the number. Once in my car I phoned the social worker, unfortunately she had left for the weekend and wouldn’t be available until Tuesday. The person I spoke to was not really that interested in the information I wanted to share. Next I went to the surgery and spoke to her G.P, I’m not sure what I expected him to do, I just wanted to share my concerns with someone. I returned to the office and ensured that all my concerns were noted and accessible to N’s midwife who is working tomorrow.

Hubby says that I have had an interesting day, I have found today distressing. My final visit has me behaving like a schizophrenic. I am full of a middle-class ire that this woman and her husband leech off the system, off me the taxpayer. They don’t work, have numerous children they are incapable of caring or providing for. Have a house so filthy that it requires deep cleaning which is paid for by the public purse. Then I just see the person sitting there, bereft, desperate to have her children back, children that I’m sure she loves, and I want to help her. I’m so pleased that I’m not a social worker.

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