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Archive for February, 2009

The Change – part 6

 

 

 

menopause_hot_flashes

A burning issue

I would be interested to know if there is an increase in suicide amongst women who are going through the menopause, if there is it really wouldn’t surprise me. Having written that I then did some ‘googling’ and found this article which is discussing the fact that there is a spike in suicides amongst middle-aged women, and apportions some of the blame to menopausal symptoms. I am not actively seeking to end my life but, I do have to admit that there are odd moments when my menopausal symptoms do get the better of me. I know that sounds dramatic, and I don’t mean it to, but I’m being honest in an attempt to convey quite how depressing, life affecting and capable of stripping you of a desire to carry on the menopause can be.

The menopause is one of those things not talked about, unless you are a comedian, or comedienne, men having a ‘lads chat’ about women, or women of a similar age who are going through the menopause. I’m as guilty as the next person. I can remember my Mother-in-Law grabbing my hand and holding it against her forehead to demonstrate how hot and sweaty she was. To my eternal regret my reaction was to snatch my hand away and change the subject. I wish I had told her how hot she felt, sympathised with her and asked her how often and how long those hot flushes were. Instead I just perpetuated the ‘lets not talk about it’ culture, as if there is something distasteful and embarrassing about this normal part of a woman’s life. Now that I am experiencing the same symptoms as she did I would love to be able to talk about them instead of trying to pretend that they are not happening. I would be hugely grateful if, just once, my husband and his friends did not think that it was hilarious when my face becomes flushed and sweat appears on my forehead and chest. I don’t want sympathy, just a small degree of understanding that, however disconcerting it is to them when I start glowing, it is far more embarrassing, and physically uncomfortable, for me.

Just to put things straight, I am not suicidal but there are days when the symptoms of the menopause, especially the hot flushes, are so relentless that life is far from enjoyable. Sleep is not even an escape, as the nights are as disrupted as the days and it is during these episodes that my resilience hits a low, lack of sleep tends to do this to me. It is the totally unpredictable nature of these ‘inner fires’ which makes them so depressing. If you could plan for them, know that the next two days were going to be spent mopping your brow, throwing bed-clothes off and dressing for the summer in the middle of winter, then life would be more enjoyable and the symptoms less something to battle against and more something you could accept.  I can imagine that, for women who don’t have the family responsibilities that I do, or a job which provides them with little satisfaction or an unsupportive partner life must, at times, not seem worth battling on with as no one knows just how long an individuals menopausal symptoms will last, I’ve heard of women who have them for 10 years and more. Now that is depressing.

Pathetic isn’t it? This isn’t a chronic or life-threatening ailment, just the change. Perhaps that is the root of the problem. If my arthritis is flaring up others are understanding. If I were pregnant and affected with morning sickness concessions would be made but here I am beseiged by an unpredictable, uncontrollable event, affecting every aspect of my life and everyone, including me, expects that I should carry on as if nothing untoward is happening.

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Sorrow

So sad to hear about little Ivan dying, my heart goes out to David and Samantha Cameron. I know very little about how poorly their 6 year first-born was, only what I have read in the press. Does his illness make a difference, not really. They have lost a child and their other 2 children have lost their brother.

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Work is manic at the moment. One of our team is off sick with………..chicken pox and another 2 are on annual leave. I have been finishing over an hour late everyday, getting home and then spending another hour making phonecalls and doing all my paperwork.

The couple whose little girl was stillborn were having an especially sad day today as it was today that their baby was ‘due’. The results of the postmortem are expected on Monday, I’m visiting them on Sunday but then I’m off until Friday so I’ve given them my mobile number, just in case they need a chat when they have received the results, if there are any. I know that sounds strange but that’s how it is sometimes, there is no reason found as to why baby did. I suppose that there are different ways to look at a ‘non’ result like that. It could. perhaps should be seen as positive as there was no abnormality found with the placenta or any problem with baby so it would not indicate any reason as to why the next pregnancy should not result in positive outcome. However, a different perspective from the parents point of view may be that it happened for no apparent reason before, why not in subsequent pregnancies? I do know though that, if they go on to have another baby, they will be hugely anxious as they approach and enter the weeks when their first baby stopped moving in the womb.

Last weekend Nanny and Grandad had Jack, Amy and Izzy to stay. I was anticipating bedlam, instead I had a wonderful cuddly time with 3 really angelic (most of the time) grandchildren. On Thursday I took the twins, Jamie and Louis, to a local open farm, it was a messy, glorious affair! I’ve invested in a set of twin reins, they go around my waist and then the boys are attached to me, rather like 2 huskies pulling a sledge, I think we provided an interesting side-show for the other farm visitors.

Jack has, finally, developed chicken-pox. He has taken so long about it that we thought that he may have immunity, we were wrong. His Mummy reported that he had said he was really tired this evening, and then when he had his bath 10 spots were spotted :). When they told him he had the pox he slowly took himself upstairs, got into his bed and announced that he was ‘very poorly’. What a man.

twinrein_011

Not me, or ‘the boys’.

We had all, including son, though that his ulcerative colitis was a thing of the past following his total colectomy and ileostomy, this isn’t the case though. What none of us had appreciated was that a short length of bowel is left behind and, obviously now we know, that is still affected by UC. Son doesn’t go into great detail but from the comments he has made it was starting to cause him discomfort, so he is back on medication. Nasty, nasty disease.

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I’m a human being and a midwife BUT I’m not superwoman. However, if I am to provide the care promised by the government, and therefore expected by women and their families, plus complete the piles of paperwork demanded by various different pen-pushers, all within my working hours then I would be capable of being in 2 places at once, capable of remote writing and be able to time travel.

I wrote just a few weeks ago about the problems caused by a homebirth taking two midwives away from an already staff minimised service. There are no allowances made for occasions when midwives are attending a homebirth. The staffing level is maintained at the minimum possible, there is no room for manoeuvre without the whole system being affected adversely. So homebirths are one factor that cannot be predicted day to day, neither are staff absences, sickness etc, or, most importantly what an individuals workload will be. Obviously we know when we have clinics, and give or take an hour we know how long they will last. An initial booking appointment is also a commitment which will already be our diaries, but that can last anything from 45 minutes to an hour and a half, it all depends on how much information giving is required, something which is not predictable. Then there are the scheduled visits, the known postnatal visits, but their length is also an unknown. A Mum and baby with no problems will take about half an hour, but when the midwife arrives at a the home she may find a distressed woman, a breastfeeding problem, an unwell Mum or baby or, my personal irritant, a woman in the bath who spends an age finishing her bath and then drying her hair whilst her partner insists I wait until she is present before I examine the baby, these visits can take up to an hour plus easily. Every morning there are new discharges, totally unpredictable, numbers and locations. Before we can even leave the office the answerphone has to be listened to, messages responded to, calls taken and the work organised and distributed. From this it should be possible to see that a community midwife has a fairly fluid day to day workload.

Today should have been a day which would allow me to catch-up on overdue paperwork, 2 new bookings, a stretch and sweep, 2 new discharge visits, one 2nd visit. The bookings would take approximately 2 hours, plus the 10 miles travelling between them. 2 of the postnatal visits required  me to weigh the baby and do the heel-prick screening test, so they were longer visits, made all the longer as one of the Mums was experiencing breastfeeding difficulties and the other one needed loads of TLC as the woman had suffered an eclamptic fit during the birth. She and baby are both fine now but she and her partner are traumatised by the experience.  The third postnatal visit was to a woman, P, I had seen yesterday, she had a stillborn baby 2 days ago. Ideally she would have been visited by her own midwife, but unfortunately she is on holiday, so we worked out who was able to provide continuity and I was best placed. These visits are horrid, I try very hard not to plan my approach, I just go with the flow, talk if it seems right and listen if the parents want to talk. As a Mum myself I’ve personally experienced many of the upsets, discomforts, fears and joys of the parents I meet, however, thankfully, I have never known the devastation of a stillbirth or neonatal death, I cannot begin to imagine the grief, the emptiness. I tell the parents this, I ask that if my visit is an intrusion that they tell me, that then I will just make sure that physically the woman well, ensure they know how to contact me and arrange to visit in a few days time. I have never had a couple who choose this option, they always want to talk, to go over all the events and show me the photo of their baby. They are sometimes angry, they always cry and there are often questions which I can’t answer. I find it incredibly difficult to leave them, even though part of me is desperate to go, the lump in my throat is painful because I want to cry but another bit of me wants to stay with them and try to make everything better. So, I saw them yesterday, the day after their first baby was born dead. They knew before she was born that she had died. At 38 weeks P had noticed baby was not kicking but she thought that baby was moving around. Then P experienced sharp pain at the top of her uterus, she didn’t think that it was contractions so she went to her G.P who sent her to the hospital, they scanned her and discovered that baby had died, the next day labour was induced. I spent 2 hours with them yesterday,we drank coffee, talked and cuddled and when I left I said I would phone today and if they wanted me to go round I would. I expected that they would tell me they didn’t need me go round today but would see me in a couple of days time, I was wrong, they wanted me to visit today. We talked about the cremation and the service they were planning, they cried and, I cried. I have known this couple for 24 hours now, they have shared their deepest emotions with me, I have been asked to go to the service and I know that I will continue to visit them until after their baby is ‘laid to rest’, I will stay in contact with them for as long as they want.

Today has been long, and a couple of the visits didn’t employ my skills as a midwife just my ability to listen but I know that I have provided all those I saw with the best care that I was able to. However, what on paper appeared to be a day which would allow time for paperwork, ended up being a day when I had no break,  finished an hour late and didn’t get any paperwork done. My thoughts are that everything I did today was important, more important than attempting to quantify, or justify, on paper how I have filled my time. To be blunt, I consider that all the paperwork is a waste of my time, literally my time as I will now spend half of my day off tomorrow catching-up with it.

So no, I’m not superwoman. I’m just one of thousands who daily subsidise the NHS by donating their own time, which allows the understaffing situation to continue, but do recognise what should take priority, and it’s the people, not the paperwork.

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I have received a request from an organisation in America who are running a contest looking for a short, about 4 – 7 minutes, video about an aspect of birth choices which is “factual, informational, educational, inspirational”.

The organisation is Birth Matters and if you would like to find out about the contest, which has a prize of $1,000, click on this link

They state their goal as increasing awareness of the evidence-based choices and options available for childbirth. They hope to ” appeal to and inspire new audiences that may not have previously been exposed to any model of childbirth other than the version we see on television and in movies: dangerous, uncertain, excruciating, and usually in need of extensive and often emergency medical interventions.” Using these videos they believe that they will show ” Birth doesn’t have to be this scary, and people need good information in order to make good choices.”

Unfortunately the competition is aimed at an American audience, shame really I would have loved to contribute! Will it work? Well, with a caesarean section rate there approaching 30%, anything is worth a try.

Perhaps a pressure group here in the UK would like to run a competition along the same lines and with the same aim, after all our CS rate is rapidly approaching that in the USA. The recommendation from the World Health organisation is for a section rate of no more than 10-15%. The NHS Institute for Innovation and Improvement produced a ‘toolkit’ to assist maternity units in reducing the section rate, this doesn’t seem to have worked, perhaps short videos would? I would love to believe this, but sadly I believe that the ‘problem’ of the high CS rate is too multi-facetted for a media vignette to lower the rate by 0ver 10%. Fear of litigation influences clinical decisions, below optimum staffing levels effects both the clinicians, and the labouring womens actions and choices. I could ramble on about other factors like epidurals, unrealistic expectations and ‘control’ issues but these are purely personal, observational conclusions and so have no place in my musings which, although personal, are published on the web.

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Robbery by the Bank

money

I’m a fairly simple being, and as a result do get myself really riled about some subjects purely because I don’t entirely understand the background elements. This may just be one of those situations, and if it is then I am not alone, but what really heartens me is that there are many others who are equally disbelieving, but also more knowledgeable about the subject than I am.

I am beyond riled, I am incandescent with rage and incredulous that any institution, which is only still in existence due to the taxpayer donating £20 million, is considering any type of bonus scheme for it’s employees. How???? Why????  You see, this is a good example of my naivety. I thought that employees only received a bonus if they performed exceptionally well AND if that contributed to the financial success of their employer. Obviously, working for the NHS, I don’t have any personal experience of a bonus culture however, two of my offspring work for employers who do operate a bonus scheme, neither company is failing but both have recognised a need to tighten belts to help them through the recession so their employees are not receiving a bonus, but do still have jobs.

RBS are quoted as saying that part of the bonus may be in the form of company shares, even that has me questioning the ethics, after all ‘we’ now own a majority shareholding, so how come we aren’t receiving the shares, we are just paying out the money.

There is a really good excuse for this paying out huge sums of money to these fat-cat executives according to Peter Mandelson “you’ve got to recruit the best people and keep the best people in place and motivate them.”  Well, they obviously can’t be that good otherwise the financial institutions wouldn’t be in the state they are in now, so that argument doesn’t hold water. If it did though then that flags up an interesting issue, want good doctors, teachers, nurses, etc. then you have to pay them huge salaries, and since we don’t then the assumption must be that they are not any good.

I have put my cards on the table, admitted that I don’t have a huge understanding of this subject, so I would welcome any explanation of why I should not continue to be outraged by this bonus fiasco. Also, why, when the public purse was opened to the banks, didn’t someone tell the recipients that they shouldn’t even think about bonus’ until they had repayed all the monies?

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Caught

Having dripped and sniffed my way through work yesterday, appreciating how dubious new Mums and Dads were about me going near their new baby, I have phoned in sick today. It’s sometimes quite a difficult decision when I have a cold as to whether I should work or not. Minor sniffles I will just carry on, 3 days into a cold I go in but those first two days, especially when accompanied by frequent, protracted sneezes, copious snot and a voice that sounds, and feels, as if I have been swallowing gravel makes me think that I may as well be walking around, ringing a bell and calling out ‘plague’, hardly reassuring to parents of a newborn. Apart from my concern about passing my virus on to patients there is also the fact that I am sharing my bugs with my colleagues, and then I read an article the other day about colds and driving.  Apparently, the advise is now to avoid driving if you have a cold as it may “impair a driver’s mood, concentration, reactions and judgement”. So, not only might I be a risk to my patients and colleagues if I work whilst suffering a nasty cold, I may also be a hazard on the roads!

Actually, my decision to phone in sick was not due to any thought for others, I just really don’t feel very well but do feel the need to justify my decision.

Two weeks ago Amy developed chicken-pox, yesterday Jamie sprouted one blister on his chin, today he still has just the one but Louis is covered in them. Not identical when it comes to the pox then.

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