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Archive for September, 2009

I’ve debated writing about this, at the moment it is still rumours, pretty strong rumours but it has some pretty hefty mongers instigating the whispering. If there is truth behind the words then the maternity services in one area will be stopping a service which has been provided for decades, that of domiciliary midwifery visits. If one region stops this care then eventually all Trusts will see the savings which can be made and community midwifery as we know it now will disappear.

Apparently a Trust has employed a cost-saving guru who has scoured the services and discovered that community midwives are an expensive item. They drive around the area, visiting new Mums and babies at home and this is obviously not cost effective to an accountants mind, after all, not only do they have to pay the midwife’s travelling time  but also her mileage. To any sensible person it is logical that, rather than the midwife travelling to the patient, the patient should travel to the midwife. This does happen already in some areas over weekends and this has allowed the Trusts to reduce the numbers of midwives working and being paid unsocial hours.

So, the benefits are that a midwife can see double the number of women and doesn’t have to be paid mileage. There are drawbacks, none of which are obviously financial so probably not of interest to an accountant employed to advise a Trust on cost-cutting. Women are now being discharged earlier and earlier from hospital following the birth, even those who have had caesareans now come home on day 2. In the future will they be expected to return the next day to the hospital, often having to travel over 15 miles due to the closure of the smaller maternity units? What about those families who do not have transport, or have other children? There are so many ‘what ifs’, many seemingly trivial but which will impact upon the welfare of mothers and babies.

Links identifying the role of the midwife in postnatal care

NCT

Maternity Matters

Community postnatal care provision in Scotland : the development and evaluation of a template for the provision of woman centred community postnatal care

The Lancet

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Whiskey talking

We’ve been told that there will be redundancies, ‘not clinical’ they hastened to add. No, it will be our clerks, those helpful souls who co-ordinate, organise and generally help pull together all the threads within the megastructure which is the NHS. My first reaction was disappointment for myself, I was hoping that I would be made redundant but then the real blow registered, if a clerk isn’t doing the paperwork who will be? Well, it won’t be the managers, unless the paperwork involves ensuring the issuing of an overwhelming number of memo’s, so I have to assume that the tasks are going to be headed toward clinicians. This has been gradually sinking in throughout the day and I am now resorting to alcohol to soften my musings, as earlier I gave in to misery and contemplated different ways in which I could stop being a hamster on a wheel.

Why am I so depressed? Well…….I had planned to retire next year but unfortunately Hubby’s pension is one of the ones that has virtually disappeared over the past few years so I’m sentenced to continue working for at least another 3 years. Why had I wanted to retire, after all I had wanted to be a midwife since I was 17, I used to love the job. Well……midwifery ain’t what it was. The work has become increasingly stressful, the paperwork has increased 5-fold, the goalposts are being moved every other week and the support and appreciation from managers has vanished. This week has been a normal workload, there is not a bulge in my caseload this month (next month is a different matter), so you would imagine that I could have completed all my work related tasks within my contracted working hours. I couldn’t and I didn’t. On 2 of the days I finished 90 minutes late, that’s 3 hours over, one late day was due to having a student out with me who needed her assessment documents completed, the other was because a colleague had to attend a mandatory study session so I had to pick up her visits. On my day off I then spent 3 hours, in the office, trying to organise care for a woman who had presented at 28 weeks pregnant, unbooked and requesting her care be at a hospital outside our area and also completing a social services referral for the unborn child of another woman who has failed to attend 4 antenatal appointments and whose other children are already considered to be ‘at risk’. Both tasks are too important to leave until my next working day and they have to be done by the named midwife.

Now, if in one week I can succeed in spending 6 hours of my own time on work related tasks, I won’t be paid for extra hours, when I have the present level of clerical support, then how much of my own time, how much of my relaxation time am I going to be donating when these ‘savage cuts’ are implemented?

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breech

There seems to be a positive epidemic of babies wanting to be born bottom first at the moment, and in today’s maternity services that invariably means a caesarean section. There is a procedure which can be offered if the baby is discovered to be breech at 36 weeks, an ECV (external cephalic version). This very much depends upon the hospital she is booked at, her previous obstetric history, medical history and factors affecting this pregnancy and there is quite a variation in success rates, but the average appears to be 50 – 60% if the turning is attempted at 37 weeks.

As the result of an (in)famous study conducted by Hannah the preferred mode of birth for all babes presenting in the breech position is C Section. Prior to, and since the Hannah study several other researchers have concluded that planned caesarean section does not improve outcomes when compared to planned vaginal births for the breech baby when the birth is conducted by a well-trained, EXPERIENCED clinician. This is the crux of the matter, experienced, how does a doctor or midwife gain this experience if all women are being advised, encouraged to opt for a caesarean?

I can empathise with women who decide to take their obstetricians advice as when one of my daughters decided that she wanted a vaginal birth for her baby who as breech I was panic struck, who did I believe could expertly help a bottom-first baby enter the world safely, very few was the answer. I know, and trust, an independent midwife Jane Evans who is experienced in breech births, but when I spoke to the head of midwifery about the possibility of Jane coming into the hospital to deliver baby I was told that the Trust wouldn’t allow it. The consultant that daughter was seeing referred her for an ECV, thank heavens it worked as, although the doctor had offered to be on call for the birth should the ECV fail, I knew that his recent experience of breech births was negligible.

These are babies who are known to be breech before their mothers go into labour, what about undiagnosed breech? I have a confession to make, I failed to realise that one of my women, W, had a baby lying bottom first. I take some comfort from the fact that the G.P and the hospital registrar and the midwife inducing the labour and the midwife who examined her in labour also failed to discover the correct position. It was found, luckily, when the monitor was failing to detect baby’s heartbeat so they decided to use a fetal scalp electrode, at this point W’s cervix was 6cms dilated and W had been in labour for 4 hours. Although W’s labour had been induced using a prostin pessary her waters had broken by themselves and her labour was not being augmented in any way, and she had only just stared using entonox.  A portable scanner was rushed in, an extended beech was visualised and W was immediately taken to theatre where baby was born by caesarean section. Mum and baby girl are both well but Mum is questioning the decision to get baby out via the ‘sun-roof’. I wouldn’t say anything to her but I wonder if the decision was taken for the right reason. The labour was progressing normally, it wasn’t slow, the contractions were well-co-ordinated and W was coping well with entonox, all positive signs indicating that there were no problems with baby versus W’s pelvis.

This is not unusual, in fact it is almost the norm however far labour has progressed, I have known several babies whose bottoms were visible but were then born by a caesarean section. A little voice inside suggests to me that this may be happening due to clinicians feeling de-skilled with regard to breech births, and who can blame them, if you’ve never seen one how can you have the confidence to support a woman through a vaginal, breech birth?

What’s the answer? I don’t know. We have all been brain-washed into believing that caesarean section is safest for the breech baby courtesy of the Hannah trial and, even though many professional organisations and researchers are now beginning to argue against her conclusions and recommend a more judicious use of the scalpel, I don’t think we will see a rapid increase in obstetricians supporting or encouraging women in having a vaginal birth for their breech baby.

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A year to the day

I can't believe that it has been a year since I last put finger to keypad on Vox. Some things have changed, son and DIL had their baby, a little girl called Evie who was born on Halloween, before this though there was an extremely traumatic time with her Daddy. He had been suffering from ulcerative colitis for about 18 months and then a few weeks before Evie was born he began to have a flare-up. The usual medications failed to bring it under control, the weight dropped off him, over 4 stone in total, he was in and out of hospital for blood transfusions and finally a surgeon phoned him and made him accept that he would die within weeks if he didn't consent to a major bowel operation which would leave him with an ileostomy bag. Thank heavens the op was a success and son is now back to full health.

I still look after the twins, it has got easier! Amy has started 'big' school and loves it. She is at the school that her Mummy went to and I am experiencing deja vu as I do the school runs twice a week, 28 years after I started doing the same school run for her Mummy!

I'm still a midwife, still strugglig with all the bureaucracy, still bemoaning the state of the NHS in general but most specifically the maternity services.

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A picture about Nanny

Picture

Izzy, aged 2 years and 7 months, made a picture for Nanny (me), of all the things I like. Izzy herself is there, just below Po, the Teletubbie.

Dermot is there because during X-Factor on Saturday I commented on how lovely I USED to think he was.

The ‘2’ is because Izzy is 2.

Angelina Ballerina makes an appearance because I studied ballet and, although I am now rather like Dawn French in Vicar of Dibley, I still prance around when the mood takes me!

Tornado’s and (just visible) thunderstorms because I love extreme weather.

I think the dinosaurs are because I have numerous books and plastic models of them and the whole family now have an encyclopaedic knowledge of these extinct creatures due to Jack’s obsession with them.

The rest is fairly self-explanatory. I just wonder if all these images are what come into Izzy’s little brain when Nanny is talked about.

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Microsoft Home Users

I love a bargain, so imagine my joy when I discovered this little gem. Yes, if you’ve clicked the link and read that NHS employees can buy Office 2007 for £8.95, it is true, it is not a scam. Why, why has no one ever told me this before. I couldn’t believe it so I phoned up our computer bods to check with them, well I didn’t check with them, I informed our IT department about it as they were as in the dark as me. Now it is a hassle verifying your NHS email address if you are a busy, community worker but it’s worth it, especially if your home computer has bitten the dust and the new one doesn’t have MS Office pre-loaded. Full of scepticism, after all if this is such a bargain why haven’t my employers informed their employee about this benefit, I opened the email I had forwarded to my home computer from my work one, clicked once, entered my card details, and then downloaded MS Office 2007, it took about 10 minutes in total, and it’s the best bargain I’ve had all year.

download_office_ad

If you’re interested, work for the NHS and have an NHS email address then click  HERE  to start buying.

P.S There are also discounts on other Microsoft products.

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woman%20screaming%202

I’ve grumbled and grouched about Choose and Book and its failure to fulfil my expectations but today I have turned down an appointment they offered me, and I’m gutted. Why have I been so reckless and just thrown away my chance for a consultation? Well, they offered me an appointment which I really couldn’t accept.

Today, Saturday, early afternoon the phone rang and it was the hospital I was referred to telling me that they were running a catch-up clinic next Saturday and that they were offering me an appointment at it. B****r, b****r I can’t go as I’m scheduled to attend a NLS course that day and it would be more than my job’s worth not to attend it. Anything, well almost anything, else and I could/would have cancelled but being given a place on the NLS course is important both to me and my manager. When I told the person on the phone that I couldn’t accept the appointment, and then asked how long I would have to wait for another one, she was pretty non-committal. I’ve blown it, I know I have, I’m back to the bottom of the pile and will have to wait until I’ve retired for another chance at an appointment. Choice? What choice? It really was Hobson’s choice as there was no choice and no alternative was offered. 

I shall still go back to the essence of the Choose and Book concept though, the patient chooses the hospital and then books their appointment, not in my world. In my world the G.P decides on the hospital and then the hospital dispenses the appointment, pretty much how things were before Choose and Book!

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