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Archive for November, 2008

Family time

In keeping with this as an ‘on-line diary’ this is the time for some updating. Hubby and I have booked our winter holiday, we are off to Tenerife for a week. Last year we did this for the first time, and realised that one week away in the winter was more beneficial to us than two, possibly more, in the summer, plus it’s cheaper. Due to the economic constraints this year we have decided that this is our Christmas pressie to each other, makes it feel less of an extravagance.

Son is incredibly well and has returned to work 3 days a week. There was a slight hiccup last week when he developed an infection, possibly a recurrence, at his wound site but a week of antibiotics appears to have cleared it up. I am so happy, so relieved that I feel as if I beam whenever anyone asks how son is doing, I become a great big smiley face. Son is now talking about having the drop-down surgery, a J-Pouch. Basically where the surgeons pull down his small intestine, form a pouch and then re-attach it to what is left of his rectum. The desired outcome is that son then longer has his stoma and bag, the ileostomy and, other than a few scars on his abdomen appears to be back to normal functioning. Reading up on it reveals that things are no where near that simple. DIL is almost back to normal, her coccyx is not as painful as it was and she appears to be revelling in motherhood. Sitting must be quite a bit more comfortable now as we are babysitting next weekend so they can go and see the James Bond film, I just hope that her Mummy and Daddy will have persuaded her to take a bottle by then as otherwise I can see Nanny and Grandad will be out wandering the streets at night in an effort to convince Evie to sleep. Evie is a real cutie and bestows her smiles on everyone who spends time playing with her, much to the pleasure of her biggest fan, her cousin Amy. We are all still waiting to see what colour the new baby’s eyes will be as our family appears to defy all the inheritance laws as Hubby has brown eyes, I have blue. We have 2 daughters with blue eyes, a son with brown and, so far, all our grandchildren have blue eyes, I thought that brown eyes were dominant.

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The boys (twins, only we don’t refer to them as that) are now both walking, Jamie took off about a month ago but Louis only mastered the skill a week ago. To celebrate their achievement I took them to have their feet measured, and they both have the same size, 4G. I don’t know why I’m surprised as they are still almost identical, we can see differences but strangers are still confused by them. Their sister is growing up so fast, she had her pre-school booster immunisations last week, I gather from daughter that havoc was caused as it was the same room and the nurse as the boys attended for their jabs, hysteria all round. Amy, having by-passed the ‘terrible twos’ has entered into the ‘tiring threes’ with gusto and is constantly trying everyone’s patience with her will and determination. It was possibly inevitable that she would have to demand attention due to having x2 siblings thrust upon her at one time, it must be very disturbing to have your one-to-one life swept aside so abruptly. Alternate Mondays I have her to myself, and she is glorious, hugely entertaining and an absolute pleasure to spend time with. Last weekend we had a family meal to celebrate Evies arrival, Son’s recovery and SIL’s birthday and Amy spent much of the time with DIL and Evie, it turns out that Amy loves babies when there is just one of them!

Jack is now a full-time school boy, and is revelling in it, so much so that he has decided that he should go to school at the weekends. I wonder how long that will last for? As it was their Daddy’s birthday last weekend Izzy and Jack stayed at our house whilst Mummy and Daddy had a party. Izzy is now in a bed so she and Jack shared a bedroom, brilliant arrangement they were absolutely no trouble as when Izzy protested about bedtime Jack just told her to be quiet as he wanted to sleep and that was it, silence until the morning.

I have been a poorly individual the last couple of days, courtesy of the latest tummy bug which is doing the rounds. Much better now though and hopeful that this will protect me through the winter from any other viral attacks.

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I am seriously considering whether I should continue my blog in it present form due to this ‘reminder’ from the NMC.

“The NMC would like to remind nurses and midwives that they are personally accountable for their actions at all times, including how they behave in their personal life”, gosh, it’s almost as if had taken some kind of vow when I qualified. I can actually dismiss that element as irrelevant if they are referring to illegal activities, however they should perhaps of been more explicit as there are many aspects of some peoples personal lives which others may not find professional, or just plain not approve of but they may not affect a persons competency.

“What may be considered to be letting off steam about a situation at work can potentially be read by someone who may take offence at the content of a posting.” Who may that someone be? The Secretary of State for Health; a Trust Chairperson; a unit manager perhaps.

 “Nurses and midwives could be putting their registration at risk if posting inappropriate comments about colleagues or patients or posting any material that could be considered explicit.”  Explicit? In what way. Full frontal nudity perhaps or do they mean failing to maintain confidentiality?

I am really in quite a quandary here. I started my first blog when I was first entering into the new experience of being a grandmother, with emphasis on how it impacted on me as a midwife. I soon discovered that people are very interested in midwifery, pregnancy and birth so began including entries about different aspects of my working life, in part to share but also to educate ( how presumptuous!). Now I am concerned that I may be on a collision course with my regulatory body, I may be considered to be ‘inappropriate’. I would really welcome some advise here, any supervisors out there who would care to comment, PLEASE do.

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7-dwarfs-of-menopause

 

Just when I thought everything was under control off it all goes again. I ended up deciding not to take the Clonidine, the side-effects appeared to negate any possible benefit and it seemed as if my decision had been the right one as ALL my symptoms disappeared completely. I had been feeling very pleased with myself, I had made the transition into being postmenopausal without too much trauma, silly me, I hadn’t read the small print, a woman is not postmenopausal until she has been menses free for a year.

There I was sleeping really well, even my restless legs had calmed down. I didn’t have to worry about what I wore, I could dress for the weather and not for the possibility of having to to shed layers of clothing. I was feeling quite positive and then it happened, the tingling started, the temperature rose and the sweating began. I dismissed it, after all I did have the latest virus which was doing the rounds. I awoke during the night, hot and hotter. A nasty headache came, and stayed. I dosed myself up with paracetamol, to no avail. My clothes stopped feeling loose, I couldn’t sleep on my front because my breasts were so sore and a period started.

I feel like I’m laying some cruel version of snakes and ladders, I had climbed that huge ladder which sits in the middle of the board, moved calmly along a few spaces and then, with that final throw of the dice, I find myself sliding right back down again into that maelstrom which is the menopause.

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800px-pinocchio_3akPinocchio

The woman’s perspective

I am a 40 year-old woman who was born and, until 7 years ago, lived in a country where healthcare provision is provided by private companies and where midwives generally only work under the supervision of a doctor. I have a high-powered job in the city and feel that I should not be expected to take time off work to suit the NHS.  I already have one child who was born in this country, I was extremely unhappy with the care arrangements during that pregnancy and had issues with the midwife attached to my G.P’s surgery. Prior to my current pregnancy I suffered 4 miscarriages and was referred, under the NHS, to a specialist unit. However, I felt that the consultant was unsympathetic to my situation, was unnecessarily blunt about my weight and did not give me the time I deserved. I therefore stopped seeing this consultant and paid for private care from a different gynaecologist, I conceived spontaneously, confirmed with a private scan and this pregnancy has since continued without incident.

My first encounter with a midwife was at my G.P’s surgery. It was on one of the 3 days when I work from home and I attended with my 4 year-old. The midwife kept me waiting for half an hour, my child was bored and grumpy by the time we were called in and then the midwife said that she had not received any details about me, and anyway my first appointment should be at my home. I was, understandably, extremely annoyed and told the midwife that I wasn’t sure why I was seeing her anyway, and that I’m not sure what midwives are for. She wanted to arrange another meeting, this time at my home. All the options she could offer were inconvenient and so eventually she told me that her job-share was working that weekend and she would see if that midwife would visit. She wouldn’t give me a time but would ask her job-share to phone me that evening, if she was in. I found all this very trying, she had kept me waiting with a young child and now was unable to provide me with a definite appointment. When I expressed my irritation she attempted to tell me that it wasn’t her fault, the G.P hadn’t informed her of my pregnancy so prior arrangements couldn’t have been made and she only works 8.30 to 4.30 so I would need to take time off work in future for any appointments! Anyway, her job-share did phone me that evening and we arranged that she would come around in 2 days time, Saturday, and complete my booking.

The booking went very well. At least the other midwife appeared to have pre-organised herself and I felt far happier about going on my 2 week holiday the next day.

At 16 weeks I went to see the midwife, she was ill so her clinic was being covered by 2 other midwives. They were useless, when they listened to the baby’s heart they told me that they thought they could hear it, and then went on to suggest that I was not eating sensibly, imbeciles. I was really annoyed with their attitude, they had no consideration of the anxieties I felt due to my previous miscarriages. I had previously opted to have my nuchal scan privately at Fetal Medicine and now, because I was rapidly losing faith in the local maternity service and also the appointment they had given for my anomaly scan was inconvenient, I decided to have my anomaly scan privately as well.

Now, I’m 25 weeks pregnant. I should be seeing my midwife but when I phoned the surgery for an appointment the only ones available were for school picking up time, ridiculous. I contacted my midwife who tried to make me attend before her clinic started, that’s lunchtime, so totally unacceptable. I told her to forget about it. I’m really not bothered about seeing a midwife anyway, I’ll just see my G.P instead.

As a result of all this I have totally lost my faith in the care the NHS can provide and am considering employing a private obstetrician for all my care.

The Midwife’s perspective

I first met B at a busy antenatal clinic. She was decidedly ‘off’ when she came in as I had kept her waiting. I attempted an apology but she wasn’t about to be pacified, and was actually quite insulting about midwives in general, and especially about the midwife involved with her previous pregnancy, vitriolic would not be an understatement. Before seeing her name on my appointment list I had never heard of B so I asked her if she had completed a maternity registration form ( the method by which referrals to midwives are made), she hadn’t as she didn’t have time!! Hence me not contacting her for a home visit, I’m not psychic. After a series of failed alternatives had been offered, all of which were turned down as being inconvenient because of her ‘important’ job, her child, a holiday she had booked or a hair appointment I suggested that my job-share may be able to see her at the weekend. B decided that was acceptable as long as it was at a certain time. I explained that I couldn’t guarantee that as she may already have commitments and, that as today was her day off, I wouldn’t be able to confirm any arrangements until I could phone her that evening. I was subjected, again, to a rant about the NHS, midwives and how we expect people to do what we demand.

That evening I phoned my job-share, described how difficult B was and gave her all the contact details. The next I heard of B was that job-share had visited her at home, when B was 11 weeks pregnant, her booking had been completed and all the necessary blood tests and scans were organised. That was all, until this week when a message was left for me to contact her as she was experiencing difficulties making appointments to see me.

I phoned her and there was immediate hostility from her. She had wanted an appointment to see me that day and when she had phoned to book it the only one available was at school pick-up time. I explained that there was nothing I could offer, except to meet her at the surgery before my clinic started, 1 pm. That was no good apparently as she would be having lunch at that point, neither would an appointment after my clinic finished as it was her child’s tea-time. I then offered to see her a home on Wednesday, also inconvenient as she would be at work. B then suggested that I visit in the evening. I pointed out that I officially finish at 4.30. The response was that my previous suggestion of after clinic would have meant that I would still be working at 5.30, so surely 6.0 pm, when her husband would be at home, was possible. This was when I started to become quite irritated by this woman. It took all my self control not to tell B how unreasonable she was being, especially when she then began to list all her gripes with the NHS. She started with, once again, how pathetic and irritating she had found the midwife in her first pregnancy. She has since discovered that this midwife now works on labour ward, her reaction to this is that if she sees her she will ‘punch her in the face’. Guess she really doesn’t like her! The next targets of her speen were the 2 midwives, actually one midwife and a student, who were not totally positive about hearing the fetal heart and then attempted to advise her about her diet, ‘airheads’. Next she told me that she didn’t even know which hospital she was booked for so had no idea where to go when she was in labour. Unfortunately, as I didn’t book her I couldn’t answer this query so I told her that I would get back to her on this one. In all there was 20 minutes of fault finding, finger pointing and an obstructive attitude. The final decision was that B would see her G.P for the next antenatal appointment. That evening I phoned my job-share, outlined B’s complaints and asked her if she could remember which hospital her booking was for. Job-share was not sure but said that it would be written on the front of B’s handheld notes with all the relevant phone numbers, she still had B’s phone number in her diary so said that she would phone her and sort things out.

The job-share’s perspective

I first met B at her home. She struck me as extremely opinionated with a totally unrealistic expectation of the way in which the NHS was able to offer care. I felt that I was diplomatic in how I explained the constraints of the service, sympathetic of her previous poor experiences with the fertility expert and community midwife and very clear about how her care would be arranged. Certainly when I left, an hour and a half later, I felt that she had warmed toward midwives and knew all she needed to know about her care, and how to access it, I was therefore surprised to hear that she didn’t know which hospital she  had chosen for the birth.

When job-share phoned me about B she was ‘spitting nails’. She had felt that B was verbally aggressive, insulting and unreasonable, and was saying that she did not wish to have any further contact with her. Since I had met B, and was the one to blame if her choices were not clear, I said that I would phone her and try to clear the air. Usually when I phone women I identify myself by my first name, on this occasion though I decided to use my official title ‘Sister’, B strikes me as someone who would be impressed by a nomenclature which infers seniority, I was right. Going straight to the point I asked B to look at the front of her notes and tell me what was written there as there was some confusion, immediately she gave me the names of the consultant and the hospital! She then proceeded to say how disappointed she was with her care and how she had no faith in the midwives or the maternity unit, supporting her case with the example of the 2 midwives not hearing the baby’s heart, infection rates at the hospital and the terrible midwife she had first time round. I apologised (through gritted teeth) and was rewarded by B telling me that she had no problem with me and had felt reassured after our first visit but that since then she had been dealt with by ‘idiots’. The situation has been left that I will contact her during the week and we will work out a schedule of visits which suits her and me.

My interpretations, I am ‘job share’. B is manipulating the situation, successfully. The midwife and her student had difficulty auscultating the fetal heart due the fact that B is FAT, hence them giving her advice about diet. The midwife in her first pregnancy was a straight talker who told B that she was overweight and made no concessions to B and her demands.

The question is…….should I make concessions?

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What does a midwife do?

A midwife does far more than just deliver babies. Although a vital part of her role, assisting at the birth is a small part of her overall job and responsibility.

Childbirth in Europe has never been safer and much of this is down to the professionalism and standards of the 21st century midwife.

Typically a midwife will work in partnership with women and their families to give support, care and advice during pregnancy, labour and the postnatal period.

In the UK Midwives work both alone and with a range of other health professionals as best meets the need of the women and families that they care for.

Midwives work in the community and in stand-alone birth centres as well as in hospitals.

Some midwives work within the NHS, others within private health care systems and some have their own businesses on a self-employed basis. NMC 03.03.2008

In the UK they are also subject to regulation in the form of supervision. This takes the form of notifying the NMC yearly of their intention to practise, declaring their fitness to do so and undergoing a yearly interview with their Supervisor of Midwives, SoM. At this event our record-keeping is examined, our updating verified and our Patient Group Directions, PGD’s, reviewed.

For those midwives working within NHS Trusts, whether on a contract or as ‘bank’, there are also mandatory study days. At present I have 3 such days per year, next year there will be 4. These study days cover a range of topics, from ‘obstetric emergencies’ through to ‘equality and diversity’, ‘risk management’ to ‘fire lecture’. It’s very much a case of one size fits all, community or hospital, labour ward or antenatal clinic, manager or preceptor, you’re a midwife so you attend.

Another yearly requirement is the IPR, an appraisal system where our competencies are reviewed using the Knowledge and Skills Framework (KSF), I’ve just undertaken mine, hence this post. I’m pleased to report that I am fulfilling all the criteria for my role, that I require no money to be spent on furthering my knowledge base and that no one has made a complaint about me. When I told my appraiser that I was demotivated, couldn’t wait to retire and was concerned that the low staffing levels were affecting the care we could provide she (a manager) agreed that the situation was appauling and that she was also looking forward to retiring. What an inspiration!

KSF isn’t enough though, there is also the 360° assessment. I just love all this clap-trap, what better way could there be to spend my time? This peer review process is designed to foster individual accountability for professional development and practice, as well as group accountability for overall quality of professional practice” (Toward Clinical Excellence., 2002). I just love all this clap-trap, what better way could there be to spend my time? 

So what does a midwife do? She wades through acronyms virtually every minute of her working day, whether it is listening to the FH, taking a FBC or talking to the ANC you can be sure that she is registered as an RM; has been assessed using KSF and is having trouble finding time for her caseload duties whilst turning 360 and negotiating all this bureaucratic sh1t.

*NMC – Nursing and Midwifery Council

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Day 25

The transformation is amazing. Son may not have regained any weight, despite eating mega amounts of hi-cal, low fibre junk food, but he just looks, and feels, so well. He saw his UC consultant on Tuesday who declared herself pleased with his progress and will not be seeing him for 6 months as Son is no longer her concern since his ulcerative colitis has been chopped out. He does have an appointment to see the surgical team in 2 weeks, I’m not sure if that is just to assess his recovery from the surgery or whether it will also be to discuss if/how/when with regard to the ‘take-down’ surgery. Son and stoma appear to have reached a good working relationship with few of the initial problems with blockages. He is discovering by trial and error which foods to avoid, the list is shrinking daily and which ones cause the fewer issues. His wound infection has almost cleared up entirely and he reports that it causes him virtually no discomfort at all. Certainly he is now practically fully able to do any tasks he sets himself, even mowing their (small) lawn which he did the other day. He has not yet started driving but even that should be possible in another week. We withdrew nearly all the extra running around for them in the middle of the week, I think they were desperate to start being a little family and living their own lives!

DIL is not as free of discomfort as she would like, during the birth her coccyx was displaced, and she is still extremely tender in that area, luckily I still had my wedge cushion from when I fell on my derriere during the snow, and this has been helping slightly with sitting (ouch!!!!). Evie breastfeeds wonderfully, has lost hardly any weight and has, at last, decided that it is possible to sleep in a crib.

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Yesterday started off as an average day in our little office, out of 7 midwives there were 3 working. Within 30 minutes though things were looking rather problematic as there was a homebirth ‘niggling’ and both the on-call midwives were from our office. We spoke to our ‘mothership’, the main community midwives office, and asked them if one of them could attend if required during the day as the homebirth woman was in their area rather than ours. They declined. The problem was that us 3 all had commitments, including a full antenatal clinic, so if the on-calls were needed there was no way the clinic could be covered. Support was sought from our manager, her advise was to wait and see and then cancel the clinic if the homebirth called the midwives. We were all seething, the women don’t appreciate the machinations that go on behind the scenes and will just feel abandoned so I said that if the worse happens we should advise the women to write to the manager about it, as that’s the only way that anything will be done about the staffing levels. The other 2 midwives immediately jumped on me, ‘no we mustn’t do that, we are not allowed to tell the women to complain.’ My colleague then went on to relate how she was disciplined for advising a couple to write a letter of complaint. The reason. Well apparently if a complaint is put in writing they have to respond and be seen to take action. Well blow me down, I thought that was the whole objective of putting in a complaint, whether in writing or verbally, someone taking notice of it!

I have a multitude of issues with all this. If we complain nothing at all gets done, unless we go to occupational health and tell them we are stressed, and you really don’t want to do that as it goes on your record. Most of the time the discord we feel is due to the impact that restraints on the service have on our women and the care we can provide. The women will, obviously, grumble to us about shortcomings, but it is pointless us presenting the issues to managers, as they do nothing, so if that’s the case it is sensible to advise the women to let the managers know how they feel. Now though I’m just supposed to absorb all the discontent, knowing that the women may as well be talking to a brick wall, as I can’t suggest that if they feel strongly they should write in because no one is going to take any notice of me.

Why else am I stunned by the idiocy of the system? Once again it’s the staffing issues. Here we are in a situation where the government is promoting homebirth, where the maternity services (the midwives) are being told to increase the homebirth rate, and all this within a service which already has problems fulfilling routine commitments. Is it so difficult to perceive that increasing the number of homebirths will also require an increase in the number of midwives available and that if this doesn’t happen then other aspects of care will suffer, like antenatal clinics.

Finally, is this a ‘whistleblowing’ by proxy issue? We should be able to highlight problems within the service without censure. We can certainly do that, as long as it’s not in writing. However, give women advise on how to raise issues effectively and you are disciplined. Catch-22 methinks.

The homebirth happened. The clinic was cancelled. One happy new Mummy and baby, 12 unhappy pregnant women.

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