Archive for June, 2008

Men! There they are having their ‘male menopause’, poor dears, it must be terrible to have to cope with getting older, increased ear and nasal hair and fatigue. It’s no wonder that they are so dismissive of the female menopause, after all hot flushes are hardly equal to trimming super-long hair within facial cavities.

Yes, I’m feeling miffed. Yesterday I saw my Consultant and asked him if it was usual that women would have an instant menopause following my, non-gynae, operation. He chuckled and said that he had never encountered it before and then proceeded to reassure me that there was no connection. How did he know this? Well, apparently I am older than his wife and she’s had her menopause, he ‘doesn’t think that it caused her any problems, just the odd flush’. I’m lucky, according to this man, no mucking about with missed periods, just stopping, at least I ‘know where I am’.

I was careful not to let him know how disruptive I was finding the little inconveniences surrounding my female menopause, after all he might be having his own major, male menopause. 

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Here we go again, more maternity units scheduled for closure, yet another little side step in the ever more tangled plan that the government has for maternity services. ‘Plan’, did I call it a plan? Sorry, that is misleading, it implies that someone, somewhere has actually thought things through and is now putting forward a researched and structured package and that is something this government has been spectacularly poor in doing. Oh, they are full of ideas and promises, league tables and stars but as regard providing a firm foundation on which to build and maintain these visions they are sadly deficient.

Women and their families are promised 4* facilities, care and abundance of choice. Consultant units, low-risk units, stand alone birth centres and homebirth on demand, whatever the demand the Trusts (aka the staff) will rise to the occasion.  However, now we are hearing that 9 maternity units have already closed, 5 have been downgraded, 15 are threatened with closure and a further 11 are threatened with either closure or downgrading. Why this severe pruning? Well its all down to centralisation and cost-saving. Theoretically these are laudable motives. Centralisation should lead to a consolidation of knowledge, practise and resources, ‘regional super-centres’ , whilst saving money by a reduction in building maintenance and being able to sell off, or convert to other uses, the redundant buildings. Just over a year ago the government published Maternity Matters, a national guarantee, it’s tag line is “choice, access and continuity of care in a safe service”. Well the choice is under the proviso that you are prepared to travel a larger distance; the access will be questionable and the continuity of care will involve a workforce who will, in these times of increased traveling costs, have to travel larger distances to provide the continuity, thus negating a proportion of any cost-saving.

Lo and behold though, there is a plan. Yes, unbeknowns to us mere toilers within the NHS there is a web-site, Healthcareworkforce.nhs.uk, where they have identified the  ‘need for urgent workforce planning principles’ so NWP ( National Workforce Projects) have developed a workforce planning resource pack. Maternity Matters is due to be implemented by 2009, you would imagine that that us ‘on the ground’ would have been briefed in some form concerning the implementation plans/changes, after all they are only 6 months away. However I, and all my colleagues, are strangely ignorant of what our roles will be. I do find this quite concerning as, working within the community, where the government promises provision and continuity of care will be improved I do feel that I should be being prepared for the changes, but I’m not.

As I said, we need good foundations, the staff are the foundations but with lack of consultation, information sharing and cohesion we are weak.

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I’ve just had Jack, Amy and Izzy for 2 days, and I’m shattered! I had forgotten how non-stop 3 little ones can be, especially when the 3 and 4 year olds are starting to demonstrate their independance. Izzy, who’s 17 months, was really no problem, especially as last night she fell asleep whilst I was bathing her, stayed in the land of nod through getting her into night clothes and didn’t wake until disturbed by the other two at 7.15am. Jack and Amy were a different a matter, I was up with them first at daybreak, about 4am, I convinced them to go back to sleep at about 5.30am (they took a lot of convincing) and then they awoke again at 7am. Anyway, as a result of my lack of sleep I have just been slobbing for the last hour in front of the telly and I caught an advertisement for 1st Response, the pregnancy testing kit which can detect pregnancy 5 days before a woman misses her period. We live in a strange old world really. Morning after pills for those who had a quick shag without taking precautions, lets just hope that not using a condom doesn’t result in chlamydia; terminations of pregnancy on demand; embryo research and cloning on the one hand and IVF, ICSI, egg donation, surrogacy, overseas adoptions and life saving surgery on a fetus in the womb on the other.

Off I just went on a little deviation, what I really wanted to muse upon was the effect of these early pregnancy tests. It’s known that many pregnancies, up to 10% for women in their 20’s and up to 50% for those over 40, will end in miscarriage, the majority of which will be before 12 weeks of pregnancy. However, I was contemplating whether these figures would be higher with the advent of these early, early tests and I came across this “But the actual rate of miscarriage is even higher since many women have very early miscarriages without ever realizing that they are pregnant. One study that followed women’s hormone levels every day in order to detect very early pregnancy found a total pregnancy loss rate of 31 percent.” I think this is really sad on the whole. I meet a significant number of women who have experienced a miscarriage, a few are philosophical about it, but the majority are hugely affected by losing a baby. For those who miscarry after 8 weeks they have lost a ‘fetus’, or foetus as some would prefer, those who discover a pregnancy at 14 days, as these pregnancy tests allow women to do, may start to bleed a few days later and in reality they will have lost a blastocyte, but to them they will have lost their baby and this grief is the aspect that troubles me.

I would envisage that the majority of women using these tests will be those hoping to conceive, I know that it is important that women are aware that they are pregnant as early as possile so that they can alter their life-style, if necessary. But to be honest, if they were planning a pregnancy they should have taken steps to reduce the risks caused by smoking, drinking, diet and medication, prescribed or otherwise, prior to the conception, not leave it until an embryo is already developing.

The whole fertility, pregnancy, childbirth scenario is becoming so high-tec, it may give the impression that it is controllable, and it really isn’t.

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Jealousy is a terrible thing, and I am sooo jealous. I have been away staying with my ex-jobshare, at her newly built cottage, in a picturesque part of the West Country and visiting the birth unit she is now working ‘bank’ at. How wonderful to have a ‘chocolate box’ cottage, complete with a stream running through the front garden. The joy of going to the shops and walking along the sea-front to get there. The luxury of being able to pick and choose when to work, and when you do go to work being able to provide the care you dream of being able to provide, within an environment the women describe as being like a high class hotel.

Then we drove home, 3 1/2 hours. On the way I phoned son to see how they were getting on as they were having Jack and Izzy whilst their Mummy and Daddy went to watch MotoGP. Daughter-in-law had gone for a lie down whilst Son cooked dinner, Jack had asked if he could go and snooze with her, so they were asleep together. Izzy was ‘helping’ her Uncle to prepare dinner and demanding frequent kisses and I realised then that nothing could ever replace the closeness of our family and the priceless rewards of it and I would lose that if we moved away.

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The Change – Part 3

Well I toddled off to discuss my menopausal symptoms with the G.P and came out armed with a prescription for Clonidine. I’ve just looked this drug up and feel that my doc may not have taken in what I was troubled by, i.e the dizziness and fainting as the info states that ‘Clonidine may cause dizziness or drowsiness. If you experience dizziness or drowsiness, avoid these activities. Use caution when rising from a sitting or lying position, especially first thing in the morning. You may become dizzy while taking clonidine and you may fall and injure yourself if you get up quickly.’ It’s also a trifle worrying that it says to use caution when driving, I’m a community midwife, driving is part of the job! Perhaps doc thinks that if he stops the hot flushes then the swoons will also go, I’m not too sure that I want to test it. Clonidine works by lowering blood pressure, mine is always in my boots, round 90/50, in fact when I had my op they couldn’t even find it, they only knew I was okay because they couldn’t stop me talking, if it goes much lower I will be unable to stand up without passing out. I shall mull this over a little more.

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Call myself a midwife and it’s taken me all day to write about the new law permitting women to breastfeed in public places, well I’ve been busy with Amy and the twins, and anyway I was incredulous that such a law had to be passed. On my wanderings around the web I came across this site which has a page about attitudes and practices in other countries concerning breastfeeding in public, should we really have to worry about this, why have some people got such a problem with it? I feel that it mainly stems from those I regard as the ‘upfront brigade’, those determined to advertise the fact that they are breastfeeding by ensuring that they display as much lactating breast tissue as possible in the most central. public area available. Breastfeeding in public, or rather breastfeeding when baby wants a feed, in a comfortable place, without having to resort to public lavatories or thick undergrowth, does not require everyone in the vicinity  being unable to ignore it, it is not something to be ashamed of but equally it is not something that demands undue attention seeking. I know that this may seem rather ‘prudish’ perhaps but I do believe that some consideration should be given to those members of the public who find a woman exposing a breast in the middle of Bluewater embarrassing. They are not disapproving of breastfeeding, they may just have been bought up at a time, or in a society where  the exhibition of the more usually covered parts of the female anatomy is unknown. There is nothing new about breastfeeding in public, when my babies were still reliant upon me for their nutritional needs I would often end up feeding in public places, but I doubt that anyone around was aware what I was doing, unless they studied me, and I never had any disapproving look or comment. Equally my daughters would both feed their babes when out and about, except the twins. Their Mummy was reluctant to do this, as she found that when breastfeeding two babies at the same time it was impossible to be discreet, and she really did not want to display herself so obviously in public.

Si, I’ve been busy defending the right of the more reserved in society to not have breastfeeding visuals thrust upon them, when I came across this gem from a really nasty, pr*t, Roshan Doug in Birmingham, “Breastfeeding in public is all wrong”, so apparently, according to Mr Doug are children in restaurants, feminists, by association the husbands and children of women who breastfeed in public and a Greek restaurant near Covent Garden. He recounts that “… a long-skirted Bohemian woman at a near-by table who has decided that, not only is she going to have dinner with her baby on her laps but that she’s going to start breast-feeding whilst sitting at the table.” It was obviously worth noting that she was Bohemian, only her type would do such an outrageous thing as to have dinner with a baby on her laps (!), let alone then breast feed the infant. He goes on to advise the use of baby-sitters, he should really have advised the use of a wet nurse.  “there she was blatantly disregarding us and all the other diners”, would he have rather than she struck up a conversation with them, introduced herself perhaps? “I think it’s appalling that we, as men, should be forced to accept it.” Hang on a minute there Roshan me old misogynist, what’s this ‘as men’ bit, some women may also find it discomforting. He really gives the whole game away though with his “away from preying eyes” demand, surely he means ‘prying’, but even that implies a furtive watching of the boho woman’s actions. I think he was correct to say ‘preying’, obviously a freudian slip, hunting, exerting a baneful or injurious effect, victimising, sounds like Mr Doug has a major attitude problem toward the female sex. The result of his small-minded, egocentric little piece is to change me from empathising with those who are sensitive to breastfeeding in public to advising them to get their heads around it, after all it is what mammary glands are there for.

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The Change – Part 2

The hot flashes persist but they have added a whole new dimension to the amount of embarrassment they can cause, dizziness. To be honest the dizziness itself is just an inconvenience, it only lasts a minute or so, the slightly dissociated from the world aspect is annoying but wears off some 5 minutes after the ‘flash’ finishes but the other day a whole new aspect of the dizziness presented, fainting. Well, I didn’t actually faint but I’m certain that if I hadn’t been able to sit and lean forward for a couple of seconds I would have ended up prostrated in the middle of the high street. Thankfully it hasn’t happened since but I am now careful to seek a ‘place of safety’, a chair, when I feel a flash building. Anyway, as a result of this new aspect resulting from my diminishing hormones I’m off to the docs to discuss HRT. I always swore that I was ‘woman’ enough to get through the menopause without wimping out and resorting to some concoction made from the urine of pregnant mares but I’ve taken the on-line test to see if I should be on HRT and it tells me I should, and we all know that you should believe everything you read on the internet.

What do I know about HRT?


  • Reduces hot flashes & night sweats
  • Alleviates vaginal dryness and urinary sensitivity
  • Improves condition of skin and hair
  • Increases libido


  • ? Increases chances of heart disease
  • Breast disease likelihood is increased
  • Increased blood pressure
  • Weight gain
  • Hair loss
  • Increased facial hair
  • Aggressiveness

Hmm. Sounds all good stuff really but I’ve just found this blog, flashfree, I think I shall study it and find out what else there is on offer, an anti-aging drug would be handy.

On a serious note though, supposing I get a flash and/or dizziness and fainting whilst at a homebirth?

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Fly Past

So there I was planting my fuschias when overhead was the roar of multiple jet engines, I looked up and was surprised to see a formation of RAF jets, Tornados. As I was recovering my composure I heard a distant rumble, more air-power heading my way, I leapt over the flower bed I had been carefully manoevering around, trampling any foliage in my path, and grabbed my camera from the kitchen. I was not to be disappointed huge transport planes thundered overhead, quickly followed by a Nimrod, a couple of tornados and a couple of larger planes I couldn’t identify, then another formation, this time typhoons. It was wonderful, my own personal airshow, finished off with a lone Spitfire. I know, it wasn’t done to lift my spirits, it had started off over London for HRH’s birthday and was heading to do a fly past for a RAF base’s Family Day but they certainly made me a happy little gardener, shame there were no Red Arrows though.

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In previous years I’ve gone up to NEC for the Primary Care Conference but this year I didn’t make it to Conference, instead I went up to NEC for the Gardening World Show yesterday. Monetarily, and professionally, Primary Care is is a better option but, once I had recovered from splashing out £21, the Gardening Show was more enjoyable. The plant displays, especially the fuschias, were spectacular and so tempting that I bought 3 hardys; Ben Jammin, Star Wars and a varigated Procumbus. I’ve always admired twisted hazel and I was lucky enough to nab a red one, apparently it’s going to have red catkins and nuts  should be beautiful. Now all I need is a dry Saturday day-time to plant them and a rainy night to help them settle in. Gardening is still a restrained affair, my op site is still incredibly tender and any out of the ordinary demands on my abdominal muscles end up with me popping voltarol for the next few days but I’m confident that I should get away with planting 4 small shrubs.


 Corylus (Twisted Hazel) Red Admiral

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Last week I wrote an entry entitled Repetition bemoaning the number of times of that I had to enter exactly the same information, on different forms, about the same woman when booking her. I was musing upon the fact that in our electronic age there was not a computer programme, which would allow me with one press of a button to print off all the necessary paperwork. One of the comments I received about the post was from Helen at TheBigOptOut.Org concerning confidentiality and the information about data protection that I give my women. I will admit that initially I was defensive; I felt that I was giving them all the information there was to know, well as much as I knew anyway. Now I know that not only was I sketching a very incomplete outline for them but I also had no idea what was happening to anyone’s, including my own, medical details. I should really have been more savvy, after all it’s not the first time that a government body has allowed personal details to be passed on to other companies. I’m thinking here of DVLA and the way our details, which we have to submit if we wish to be driving legally, are sold to private firms. £15 million is what DVLA have apparently made from allowing car clampers, solicitors etc. to have access to our personal details. Following an outcry about this back in 2005 the government promised to tighten DVLA’s information release practices, however Liberal Democrat M.P Norman Baker obtained figures recently from the Department of Transport and commented that “It’s quite clear that the Government has failed to live up to its promise to stop the inappropriate release of information.”

The situation at present is that all our medical records, hospital and G.P are, if they’re not already they soon will be, being stored electronically. Is that a problem? Well, if you don’t want anyone employed within the NHS to have some degree of access to them, yes it is. You know that receptionist at your G.P’s surgery, the one who lives in the next road, well she will have access to some of your personal information. I’m using the future tense here, in many practices this is already happening, and in some of the practices I have contact with anyone who is able to logon can read ALL about you. I have to admit that this does not overly concern me, after all they are sworn to secrecy when they sign their contracts, it’s not pleasant knowing that someone you see at the school gates may know all your medical complaints but it’s exactly the same when you bump into your G.P at the supermarket, and he rarely sniggers at you whilst whispering to his wife!

So, what does concern me? It’s the way we have no control over who else, what unnamed individuals or companies may be allowed access to, or indeed sent, our medical details. Dr Foster, you have heard of this information giver, well apparently they receive all their info “from data provided by individual trusts and doctors, as well as from the Department of Health.” (BMJ 2002), and what’s more it is given to them in identifiable form. Incidentally, whilst trawling around Dr Foster I found this interesting little contribution from The National Audit Office concerning the “joint venture between the Information Centre and a private sector company Dr Foster LLP” . Staggering to read the monetary details between the Department of Health and The NHS Information Centre’s deal with Dr F  “The Information Centre paid £12 million in cash for a 50 per cent share of the joint venture. This price included an acknowledged strategic premium of between £2.5 million and £4 million, and was higher than their financial advisers’ indicative valuation of the share. The Department also spent more than £1.7 million on professional fees, £50,000 of which was paid to Dr Foster Ltd for advice about the establishment of the Information Centre and a possible relationship with the private sector. The report also raises concerns about the Department’s decision to pay Dr Foster Ltd for advice when it had already entered discussions about a partnership”. Nice money if you can find some government body willing to pay it.

So, now we know how the government sells our details what is there we can do about it? Apparently we can opt-out, well we could if we knew how. The organisation I linked to at the beginning,  The Big Opt Out, have a page which advises on the pro’s and con’s of opting out, and also how to go about it. Remember, it is up to you to make the move, consent is implied.

What do Doctors think about this? NHS Blog Doctor wrote about the issue back in March, he seems to have very little confidence in the Spine’s ability to maintain patient confidentiality  “The British government promised that there would be strict confidentiality of all private medical records uploaded to the NHS Spine. The government lied”.  Dr Rant is far more directive in his approach ” OPT OUT NOW” is his advise. Dr Paul Thornton, in written evidence to The House of Commons Select Committee on Health says “There is a direct conflict between the sharing of information, even among health care professionals, and the protection of patient privacy. Patients divulge information to individuals, perhaps to teams, rarely to institutions and certainly not to the entirety of the National Health Service. The risk to privacy increases in proportion to the number of users of a database.” And boy are there going to be a awful lot of users. (This written evidence is brilliant, well worth reading). According to the Guardian two-thirds of G.P’s are going to boycott the scheme, hardly confidence giving.

The computer world itself is questioning the security of a national database. Martyn Hart, chairman of The National Outsourcing Association, said in Computerworld  “The only place you can make that kind of arrangement work is where there is strict control and governance, like in the army. Not in a health organisation.”

There is no stopping the governments plans for amalgamating all our health records…but….I finish with his from the Guardian article:-

“After a Guardian campaign last year ministers conceded that patients would have the right to stop their medical files being passed from the GP to an NHS data warehouse known as the Spine.

But they said everyone not exercising this veto would be assumed to have given “implied consent”.”

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