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Archive for February 17th, 2009

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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