Archive for March, 2009




This last week has been one of those where perpetual motion would not be a bad description. Lots happening –

  • Work very busy, and full of poor examples of ‘team’ working. Midwives are normal human beings and, especially at times of stress, will behave like school kids. All it takes is for 2 people to have a minor misunderstanding, not solve it by talking, and soon others are dragged in, as they are affected by others actions. Presently I have managed to remain on the periphery, a midwife from another team asked me today if I was wearing body armour! Just about sums up the working environment at the moment.
  • Jack and Izzy’s Mummy has been under the weather recently so I took them off her hands on Sunday so she could sleep. I was a very, very naughty Nanny and took them out for the most unhealthy meal……..ever. Hamburgers and chips, chocolate milkshake, pancakes, ice-cream, chocolate sauce, sprinkles and flakes and, just for good measure, the waitress gave them each a lolly for eating all their lunch. We then went to the park and ran off as much of the excess sugar we could. On our return their Mummy felt a little better but then that night her head ‘exploded’. She phoned NHS direct, her partner had to take the phone from her as she couldn’t speak properly. They told him to contact the on-call docs, who just told him to take her to A&E if her breathing was affected. I can only think they were anticipating an embolism of some description. By the morning her face was numb, she was still unable to form words and sitting up caused an escalation of her headache. She visited her G.P who took her blood pressure and pulse, tried to The G.P put the headache down to a continued problem from the whiplash sustained back in September.
  • Hubby went off for a golfing weekend, I pottered. Sorted out earrings, cleaned jewellery, moved my leaf-store, reduced my wardrobe, and recycled it via the local charity shops. Caught up, again, with all my stats, tidied out my car and checked my on-call bag, then went out for a meal with all the other golf-widows.
  • Set up my new printer/scanner/copier.
  • Son’s ileostomy blocked on Sunday night so he, DIL and Evie all came to us on Monday. He went to bed, we went out for a walk and on the way bought a carpet washer! Then Amy came around, her Mummy had offered her a visit to the local, open farm but Amy declined ‘ I don’t want to go to the farm, or the zoo, I’m going to my Nanny’s’, so she did. We painted the ornamental cat as he was showing signs of weather damage, rather than black he was grey and green. He has been reclining by the pond for several years now, I like to think he was a deterrent to the heron but since said heron took all my fish last week his scare abilities were obviously failing, or the heron has become wise to his immobility.

Gosh, now I’ve written it down it really doesn’t seem that busy, but it seemed it at the time then, just to make my day my elderly washing machine declined to rotate this evening. Hubby, who is not an engineer, and definitely NOT a washing machine engineer decided that he could fix it, wrong, so, so wrong. It may have helped if he even knew how to switch it on, let alone know where in different programmes the machine should agitate. Via the grapevine my ex-BIL heard of the demise of my washing-machine and he e-mailed me with an offer too good to gracefully decline. If I wasn’t married, and he wasn’t about to tie the knot I would propose, he has rescued me and my computer on numerous occasions and now he has solved my laundry issue. God bless the man.

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Parking at hospitals is a bone of contention or everyone, staff and patients alike. Within the Trust I work for staff have parking permits, which they have to pay for but, having a permit does not guarantee a parking place, something which seems totally unacceptable to me. In my little world if I pay for something, in advance, then I should have it. I have another issue with this, I have no choice about taking my car to work, it is a condition of my job that I use a car, in fact I can’t do my job without a car. So I am a maverick, I haven’t got a permit. I used to have one, they were free but we did have to pay a deposit, I still have the receipt and have never presented it for remuneration. Twice I have been given a parking ticket, both times were when I had a permit but I had not parked in a staff area as there were no spaces. On both occasions I remonstrated with the parking commandant attendant and neither time did I hear anything more. Today I came across this little gem about a midwife who has been issued with a parking fine at her place of work, the fine is £80. She has appealed, unsuccessfully and now her case is being supported by the local, prospective parliamentary candidate. I read the article, feeling very sorry for this midwife, interested to hear that there are parking spaces just for midwives, lucky them, we don’t even have that luxury. Anyway, back to the article, or more specifically the comments. I’m going to reproduce one of them in full as it is wonderful and really think that the content should be known by anyone who has to pay the exorbitant parking fees charged by many NHS Trusts –

There is no such thing as a “parking fine” on private land and it is a matter of contract the so called “parking tickets” issued are nothing more than “invoices” for breach of contract. The contract is implied by the signs. Without going into law of contract any of these private invoices can be legally contested and won. The company concerned is out for one thing to make money the hospital gets a very small percentage of this money. Whilst I pay when I park in the hospital I know for a fact I do not have to as I do not enter into a legally binding contract. The only cases in Court that these people have won is when the person does not turn up. I am willing to fight and win for this midwife and I will. Having done the same now a few times. It’s about time that the hospital and others are brought to book over what are actually illegal practices and threats. http://forums.pepipoo.com/ has a vast amount of information on this very subject. No private company can issue a “fine” under common law alone, the only thing that can apply is breach of contract when a contract is legally formed. However the Judge in every case that has got this far has ruled against these private parking companies as the amount charged is well above the damages done for breach of contract, if a contract is legally made. But whilst the DVLA is making money out of these people and also the income generated nothing will be done.

If the midwife has not paid then you can get her to contact me I will supply the information and template letters for her. This is no legal loophole private parking issues which are not regulated are out of control.

Regards John Stanton.

Yeah!!!! Please, please pass this info on to at least 5 others and tell them to pass it on. It’s not just the staff parking issue, it’s also those who have relatives seriously ill in hospital, many for days and weeks and for those undergoing treatment, like chemotherapy, where they have to attend daily for several hours. It’s intolerable that they should have to pay massive parking charges.

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Good Day

Oh how I wish that everyday could be like today. The weather has been mild and dry and I have been able to spend all day in my garden. My spirits are high and I feel that I have spent the day being super, super productive. I’ve raked the grass, drastically pruned various shrubs, de-weeded the flower beds, ensured that the fencing around the pond is strong enough to withstand the twin’s attention and entertained 5 grandchildren, 2 daughters, 1 mother, 1 step-father and one extremely pleasant man from Aus, no idea who he was! I think that he is a distant relation to step-father, I felt very sorry for him as he has been staying with Mum, who is totally bonkers. Not bonkers in a jovial, amusing way but quite outspoken, overbearing and insulting to those unfortunate enough to pass within commenting distance. Anyway, whoever Aus man was he was treated to my Mother conducting a guided tour of our house, poor man must have incredibly embarrassed, but he coped terribly well, making all the right noises about how lovely my house and garden are and expressing disbelief at me having 6 grandchildren. It was shortly after this that 5 of them came flooding in, some through the front door, others via the back gate, all squealing and then just standing, silently staring at this exotic, sun-glass toting male who was commandeering Nanny’s attention. Izzy broke the spell by announcing that she needed a poo, and that Nanny had to take her to the toilet. Aus man left shortly afterwards.

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Labour coming?

Oh Lordy, lordy I’ve just read this article, and I really wish that I hadn’t, it is about childbirth as an orgasmic experience. For the record, I have known 1 woman who told me that she had experienced orgasm at the moment of birth, this was 32 years ago, she had just had her 2nd baby, and I was 7 months pregnant, I thought that she was just trying to make me believe that birth was nothing to fear. As a midwife, at countless births, I have known women be silent, groan, shout, swear and scream, expressing their birth experience in many different ways but I have never suspected that any one of them were in the throws of ecstasy.

I’m going to speak here as a midwife.  ‘A romantic atmosphere is important’, a contributer to the documentary Orgasmic Birth, says. Well, he has my argeement there in that research has shown that a relaxed environment, low-lighting, soft music, contributes to labour progressing well but passionate kissing, what is the midwife supposed to do, hum to herself whilst lookng at her feet? I know that it’s not about what makes me feel comfortable, but how many couples are going to feel relaxed about displaying intimate behaviour in front of strangers? The concerns I have are about women’s expectations. Pregnant women read a lot about labour and many set themselves objectives about how it will proceed, how they will behave and then have this ideal of how they will feel afterwards. If they see this documentary, or read associated articles they may believe that if all goes well they may well experience a climax during labour. Some will be disappointed when this doesn’t happen, others may well go into childbirth with even more of a fear of ‘losing control’ (a common theme when discussing women’s concerns about labour), and a horror that they may behave sexually during the birth and obviously have an orgasm. For some women childbirth is degrading, they feel they are losing their dignity and hate the intimate nature of the examinations which are undertaken. They enter labour ‘uptight, anticipating ‘violations’, vaginal examinations, on a regular basis by complete strangers, is this documentary going to make these examinations appear sexual and more like a violation? I feel that this documentary may cause women to feel more unease about childbirth than eagerly anticipate it.

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Spare time

Did I mention a wedding we were going to? I can’t remember. If I did it would have been because of Hubby’s reaction to the dress that I had purchased for the occasion. Nice little ‘frock’ (the name Hubby uses to describe any apparel combining a top and skirt), or so I thought,  from Next, calf length, 3/4 sleeves, black and cream in colour, tasteful. Not as far as my dearly beloved was concerned. ‘It’s horrible, you look awful in it’. Now he never, ever comments on what I’m wearing, unless prompted, so for him to voice an opinion shocked me and ensured that my new dress would never leave my wardrobe, except to be returned to the shop.  By being extremely judicious with time planning I managed to fit in another trip to the shops and bought myself another dress, but this time plus jacket and shoes, that cheered me up!

The wedding on Saturday was lovely. Why do I always cry at nuptials, conditioned response perhaps?

Sunday we went to my Sister’s for lunch and, just to prove that she can, she cooked. I could fib here and say that it was terrible, it wasn’t, in fact it was lovely, there was a price to pay though. I seem to have been nominated to host my Mother’s 80th birthday party, blow, blow and thrice blow. My niece was there and was saying how much my blog makes her laugh, especially my menopause entries. See, that’s just what I’m trying to get across, the change is either seen as good material for comedians or something to hide under the carpet, it’s not, not to the woman who’s going through it. Anyway, she insisted on reading one of my ‘The Change’ entries to Hubby, who has never read my blog. At the time  was mortified, it’s one thing writing an on-line diary, divulging thoughts and feelings to a computer screen, it’s another thing entirely hearing someone reading it to your nearest and dearest. I do have to say though that Hubby became quiet afterwards, perhaps it gave him food for thought or, he now thinks that I am totally neurotic and is busy hiding all the knives and paracetamol.

Today has been a lovely day. The tree surgeons came and cut down one of two giant leylandii which were taller than our house, and then reduced the other one to 10ft. Amy came and spent the day with Nanny and Grandad, she was fascinated by the tree surgeons but decided that they aren’t as brave as her Daddy. The weather was glorious so we sent much of the day outside, which was lovely. We gardened, spread some grass seed, watched the frogs in the pond and played with the sand table, just what I needed to unwind.

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I’ve been trying to keep my gift a secret but I can keep it to myself no longer, I am a soothsayer . I don’t have a crystal ball, neither do I read tarot cards but I do interpret omens. I have been observing the omens and I am confident in my prediction that my little realm of community midwifery will fall into total disarray during March.

What are the omens?

  • There is a little ‘bulge’ in the number of babies due during March, I’m not sure why, did we have a warm spell or did England win at something? That means that we are going to be busier, but this alone would not have me wringing my hands and furrowing my brow, there are other elements which are causing me to cry ‘woe, woe and thrice woe.’
  • There are currently 3 community midwives on long-term sick leave.
  • The midwives off-sick are not replaced by ‘bank’. The maternity service have spent too much on ‘bank’ cover for the hospital this year, community haven’t used any, but we have been told we cannot ask for, or expect, help.
  • One of our colleagues is rotating back into the hospital. Her replacement will not be starting her orientation until the post is empty. Orientation takes three weeks, three weeks during which a caseload of 170 women will have to be covered by three other midwives, who each has the same sized caseload already.
  • The covering midwives have each got a weeks annual leave during March.
  • One of those midwives is undertaking a course of study at present, she has one full study day per week.
  • There is a court case coming up which will involve one of the team. She has been instructed that she has to attend briefings and appear as a witness.

Well, I wrote the above at the end of February, and my claims to be able to see into the future were correct. For the past week I have found myself the only midwife on, out of a team of 4, every time I have worked,  covering a large geographical area and combined caseloads of over 700 women. As a result I have been finishing late every day, with a killer headache probably due to low sugar and dehydration since I haven’t had time for a break, and with a desire to cause permanent damage to the midwives on the maternity units for discharging breastfeeding Mothers home without ensuring that the baby is feeding well. At these times I feel an overwhelming urge to tell every Mother who is having feeding problems to give the baby a bottle. Obviously I don’t give this advice I, mentally, take a deep breath and prepare for a long visit. Thank heavens we don’t give people exact times for postnatal visits, otherwise I would be spending all my time on the phone telling people I’m running late. As it is I find myself phoning women I am ‘booking’ to tell them that the leeway I had advised them of, half an hour from the time arranged, is going to be more like an hour and a half. Most are accepting of the fact that midwives find planning work difficult, when you start your day you never know how many visits and how long each will take, but there are those few who cannot comprehend why we are so ‘disorganised’ and insist on re-scheduling to another day, which really doesn’t help the situation and won’t guarantee an on-time visit then either. It would be wonderful if I could organise booking visits on the day I find I the have time to them but that is generally impossible as women work and have lives of their own so are rarely available at short notice. Weekends used to be a good time to schedule bookings, before they cut our numbers back to the bone marrow, now the weekends are as full as the weekdays and every working midwife will be on-call at least day of the weekend, so arranging a booking appointment then runs the risk of being cancelled due to a homebirth. My women and I are in a maze of time and staffing constraints and I want to just bury my head in the sand and hope that when I lift it up again all will be well and I can stop feeling as if the walls are closing in on me.

I think I may be stressed.

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Family time

Today was the family meal in honour of son’s 30th birthday. We have broken with tradition and, rather than having a ‘sit down’ meal, we had a buffet. The problem with the traditional meal is not the fact that there are 8 adults and 6 children, it’s the ages of the children. Amy and Jack, 3 and 4, sit and eat well with the adults but Izzy, 2, and the boys, 18 months, soon get fed-up with the protracted nature of a family meal. Add 4 month old Evie to the mix, she is guaranteed to want feeding as soon as her Mummy sits down, and the whole experience is chaotic and exhausting. I’m not too sure that a buffet was much better, for the adults. The children had a whale of a time. Jack dressed as a pirate, Amy as Belle from Beauty and the Beast and Izzy a pretty, pink fairy raced around creating absolute mayhem. Evie was totally mesmerised by the constant movement and sounds emanating from her cousins and it was lovely to watch her becoming so excited and attempting to vocalise with them, boy has she got a loud voice!
In the midst of all the family pandemonium Jack and Izzy’s Mummy and Daddy made a surprise announcement, Hubby responded by spilling red wine over our oatmeal coloured carpet. Whilst I rushed off to get the salt son dripped white wine onto the spill, our mixed-up approach to stain removal worked, thank heavens, but did rather detract from daughter and SIL’s news.
This last year has been quite a monumental one for son. He got married, became seriously ill, lost over 4 stone in weght, had a major operaton, became a Daddy and put the 4 stone back on. Lets just hope that his 31st year won’t be quite as eventful as hs 30th!

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That well known purveyor of non-sensational news stories, The Daily Mail, has an attention drawing headline today ‘Babies crippled as midwives bungle births’, I started reading with a sense of dread, what is my profession being blamed for now?

The article is about an obstetric emergency, shoulder dystocia, and how it has affected 3 babies. A true shoulder dystocia is an absolutely horrific occurrence, which can lead to the death of a baby. Early on in my midwifery training I met a woman who had just experienced the death of her baby due to shoulder dystocia, I had never heard of this before and I asked the midwife I was working with what it was, her answer chilled me, ‘Every midwife’s nightmare’, she then went on to explain what happens. Basically, the baby’s head is born, but that’s as far as it gets. There is no further progress as the shoulders, generally the anterior, become stuck above the brim of the pelvis. I was terrified, I wanted to find out everything I could about it, why, how, is there anything you can do to avoid it and, most importantly, what can you do if it does happen. I read a huge amount of literature, I found out about the maneuvers recommended, the factors which may lead a midwife to believe a woman may have a large baby and the signs during birth which may indicate that a baby may be having problems sliding it’s shoulders through the pelvic brim.  The video below shows anatomically what happens when shoulder dystocia occurs, and the damage it may wreak on the baby. 

3D Medical Animation: Shoulder Dystocia Birth Injury

There are drills we have to practice on the sequence of events which should happen if we are caring for a women who has a shoulder dystocia, the first element is ‘call for help’. That ‘help’ is not solely another midwife, it is also an obstetric registrar. What happens in practice is, that when the emergency buzzer is pressed, every senior member of staff responds. Did the midwife ‘bungle’ as The Mail says, or did the team fail to respond appropriately? I think the latter, as the article says that the woman had been told that she needed a caesarean section, but that never happened. Instead,  ‘Penelope was at the mercy of an overstretched obstetric team which did not seem to have the skills to deliver the baby without injury’. Whatever happened the woman went through an horrific experience, and her child is left with  a possibly permanent disability, Erb’s palsy.

Back in 1955 W.I.C Morris wrote a description of shoulder dystocia. I read it as a student midwife, and have never forgotten it, the extract below starts from when the baby’s head has been delivered 

‘Time passes. The child’s face becomes suffused. It endeavors unsuccessfully to breathe. Abdominal efforts by the mother and by her attendants produce no advance.

Gentle head traction is equally unavailing. Usually equanimity forsakes the attendants — they push, they pull.

Alarm increases. Eventually, “by greater strength of muscle or by some infernal juggle,” the difficulty appears to be overcome, and the shoulder and trunk of a goodly child are delivered. The pallor of its body contrasts with the plum-colored cyanosis of the face, and the small quantity of freshly expelled meconium about the buttocks.

It dawns upon the attendants that their anxiety was not ill founded, the baby lies limp and voiceless, and only too often remains so despite all efforts at resuscitation.’


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