NCT – A reply

I received this today from the NCT in response to my communication.

Dear Midwifemuse,

Firstly, I would like to thank you for your e-mail. It’s always really helpful to have feedback in this way.

My name is Jay, and I am the Campaigns Project Officer here at the NCT. As such, it’s very good to be told about the situation for midwives around the country.

We really do acknowledge the work that midwives do – as some of the entries in your blog, and the snapshot you provide show – often under very trying circumstances and without full compliments of staff. The situation you mention, in which two midwives on maternity leave are not being covered, is exactly the sort of situation we are campaigning to prevent. Throughout the country, women are being denied choice of place of birth because of financial constraints on the service. All too often, we are seeing services delivered dependent on budgets, rather than on the needs of women.

 For this reason, we are trying to work with, and put pressure on, the Department of Health and managers throughout the country in order to rectify the disincentives for community midwifery being seen as an option as viable as births in hospitals.

 We hear stories all the time from women who say that they are being actively discouraged from making use of community midwifery, because they can not be guaranteed the service on the day, as a result of staff shortages. Without these choices being realistic and presented to women as such, we will not see the fulfilment of the Government’s choice guarantee.

 We are speaking to the RCM, who are very supportive of this campaign and of the provision of choice. We hope that, by working with them, we will be able to generate a system whereby women have choice and where midwives are not thanklessly working their fingers to the bone. We believe many of the changes necessary for this are related to decision-makers, and should not negatively impact upon midwives themselves.

There are actions that both trusts and midwives can take in order to ensure choice is delivered. Trusts need to make sure that adequate funding and staffing is in place to support midwives in providing choice. Midwives can keep working with women and maternity services to encourage choice and efficient work practices are promoted.

We would also encourage as many people as possible to take action to promote the changes that are needed to bring about choice throughout the UK, not just in England, where the Maternity Matters guarantees apply. The campaign web page – www.nct.org.uk/choice – has information about the campaign, as well as two actions that are quick, easy, and will hopefully be highly effective.

I would also encourage you to join our activist network – NCT Active – as the sorts of views and feedback you have provided are exactly what we like to guide our campaigns and policy.

I apologise for the length of this e-mail, but hope that it explains NCT’s position, and makes clear that we truly have no desire to bring about a situation in which midwives are overworked.

If you have any questions about the campaign, or any wider issues, please do feel free to get in touch with me.

Very best regards,

Jay

I have responded –

Hi Jay,

Thank you for your reply, however the emphasis appears to be on delivering choice in place of birth and the role community midwives play in this. I know that pressure is being put upon government and trusts to improve funding within maternity services to enable the promises made by government to be fulfilled, but trusts are interpreting this as a green light to cease domiciliary visits postnatally and replace them with ‘clinics’. They have been given an open door to introduce this by Maternity Matters – Appendix B; B2

“Reorganisation gives local managers the chance to develop local services that are fit to deliver 21st century care, and in different locations. Antenatal and postnatal care may be provided in community settings such as Sure Start Children’s Centres but care that is more complex may be provided in a hospital within the local network. Reorganisation need not mean closure. It does however offer the option, using the existing infrastructure, to redesign services, which are responsive, flexible and meet the needs of the population, both as a whole and as individuals”

The paragraph which includes ‘to redesign services which are responsive, flexible and meets the needs of the population’ would appear to preclude stopping of postnatal visits but it doesn’t, and it hasn’t. In our area we already operate postnatal clinics at the weekend. How successful are they. Well it depends whether the women you ‘invite’ to attend will co-operate. There are always those who refuse to attend, those who agree but then don’t turn-up and then those who are unable to attend. The result of these non-attendees is that Mondays are now ridiculously busy with community midwives chasing-up, and visiting, those who failed to attend. What will happen when there is no provision for routine postnatal visits? Will the breastfeeding rates fall? Will more babies be re-admitted as ‘failure to thrive’? Will the SID rate rise? Etc.

Childbirth is the head-line catching element of the maternity services but antenatal and postnatal care is just as, if not more important, but we are really in the situation here of throwing the baby out with the bath water.

 Yours truly,

Midwifemuse

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An email to the NCT

I read the NCTS’s research, Location, location, location and felt moved to email them. Here it is, will they reply? Will anyone out there stop the pressure and allow maternity services to make CONSIDERED changes rather than perform ill-judged and poorly planned knee-jerk reactions?

As a community midwife I know that your organisation is represented on local MLSC’s so you must appreciate the constraints which many Trusts are placing on local maternity services. In my area we do offer women ‘real choice’, homebirth, MLU or obstetric unit, but in reality it is the midwives who are allowing these choices to be offered by giving of their own time. Government make promises to the public and allocate monies but then tell trusts that they have to make cuts and, even though the maternity service is within budget, cuts are made within that service.
A snapshot. Locally we are now being told that home visits by midwives following birth will be phased out, with women having to attend drop-in clinics. I think this is a backward step and ultimately will have a more adverse impact than women not having choice in place of birth. The community service is about to lose 2 midwives on maternity leave, we have been told that there will be no cover as the trust cannot afford it. As it is I find myself donating over a day a month to cover my workload, and I am not alone. I can now look forward to more work time being unpaid as the team attempt to pick up 2 WTE’s work over the next year.
I read research like ‘Location, location, location’ and my heart sinks as I know there will be more pressure on midwives. Midwives, not managers, not heads of trusts and not government but midwives, on the coal face attempting to fulfill expectations with no support, just more demands.
You can read more of my thoughts on todays midwifery and the mismanagement of the maternity services on http://www.midwifemuse.wordpress.com

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Letter from a student midwife

I received an e-mail this week. NMC, RCM, NHS and Alan Johnson, I hope you all feel ashamed of yourselves. 

Hi, I’m really glad I found your blog. I’m a student midwife (ish) I wish
that someone would have told me beforehand that the midwifery you read about
isn’t the reality.
I think you often get glimpses of the midwifery you’d love to practice but
in reality…its paperwork, targets, interventions (did i mention
interventions?) Its like working on massive a conveyer belt in a factory
whilst jumping through hoops. which are on fire!
I’m on a 6 month break from the course after 2 years because I couldn’t cope
with the impossible situation I was put in and the complete lack of support
thereafter.
I am due to go back early next year, unsure whether I should. I dont see
anything changing now or in the future and its such a shame.
I love midwifery in its true form, so maybe if I can hang in there long
enough Ill get to see it one day, in some part of the world?
being a student feels like being a new mum! but really…’no one tells you
its going to be like this’ 🙂

best wishes,

disheartened student!

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Quick listings & links

People are contacting me via the link at the top, and I’m not sure what to do in some of the cases. I would love to advertise but, although I’d love some money, I want to have some integrity so I’m not going to put things in my toolbar thingy but I will post some of them if I think they will be of interest to readers.

Here goes then, in no particular order:-

• From We Are Social – We have just launched a campaign called Open Up ( you can read more about it
  here: http://www.openupnow.org/) Its basic aim is to change the way MPs and
  Parliament operate and make the current system more democratic and open to
  the public (especially in light of the recent MPs’ expenses scandal.)

 

• Childs i was founded by former Big Brother producer, Lucy Buck, and already
  has support from celebrities such as Life on Mars star, Philip Glenister.
  The foundation has introduced a ‘Buy a Brick’ online donation scheme,
  whereby the public can donate a virtual brick to help build homes for the
  abandoned babies. This helps people to understand how their donations are
  being spent and makes their generous giving much more tangible.The charity has also developed the ‘Child Abandonment Project’ to help mothers at risk of abandoning their babies, providing transitional homes and care and ensuring that every child grows up in a loving family. Childs i already has videos and blogs to communicate with supporters along with a Twitter feed. This helps to show people what a difference their support is making and impact it has on the people’s lives involved. For further information please visit http://www.childsifoundation.org/.

 

• It’d be intriguing to know if bloggers and their readers out there were driven to their laptops by stress,
  or if it saved them from some awful fate! We’d love to hear your thoughts. www.powderroomgraffiti.com

 

• In November, Next will be launching a competition to find two new 4-7 year
  olds to model in the Next Directory. The winners will be signed to highly
  respected agency Urban Angels, win a shopping spree at Next and appear in a
  spring Red magazine supplement. The competition will launch in Facebook on
  4th November when parents and guardians can upload photographs at
  www.facebook.com/nextonline.

I love the Next one, they have even invited me to the launch. Unfortunately I have Amy that day and she has declined the opportunity to catch a train to London and have a fun day. Killjoy.

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Choose and Book – Confusion and Bluster

So, having been unable to choose and book it all came back to the good old ‘they give you, or not’ , appointments system. That fell apart when they appointment offered, at a weeks notice, was for a Saturday when I was already booked on to an advanced life support study day. That was back at the beginning of September and as I have heard nothing from the London Teaching Hospital I phoned them today. Bearing in mind that the whole process has been going on since the beginning of July I had thought that apologies may be offered, I am such a numbskull and obviously inhabit an entirely different dimension to this sector of the NHS as no regrets were voiced, in fact the appointments clerk I spoke to was quite tetchy with me for presenting them with a problem. Yes, I am a problem since they have, in error, wiped me off their waiting list. The clerk admitted that they had made a mistake and then spoke to her line-manager whilst keeping me on hold for 10 minutes. This numbskull believed that when the clerk came back on the line it would be with the offer of an urgent appointment. I was worrying about if I would be able to make it, supposing that it were for a day when I was working, or I had the boys, or I was doing a school run or, worse of all, if it was during half-term when I’ve got Amy. I need not have troubled myself as I was told that  ‘ My line manager’s gut feeling is that you will have to go back to your G.P and ask for another referral to be done’. AAAAAAAH!!!!! Unfortunately I was less than happy with this solution to their mistake, and the appointments clerk was less than happy with my unhappiness. Her line manager is going to call me back, probably, at some time and tell me if his ‘gut feeling’ was right.

This whole saga has now turned into farce. A letter will be written and an explanation demanded, the system has got to be tightened up or entirely re-thought.

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Unfair

Very busy at work at the moment, I blame it on the New Year celebrations!  The rumours are still keeping everyone on their toes, brows are furrowed, tongues are wagging and knees are trembling, whilst ears are flapping and teeth are gritted We should enter the World Gurning Competition.

Yesterday I ‘booked’ a young couple who have just gone onto the social housing waiting list. I was discussing the process with them and we got onto the topic of the list of available properties which the housing association publishes. I’ve had quite a number of families who have been going through this process so was passing on some tips about the necessity of acting the minute the list comes through the post when K explained that it had changed, it’s on-line now. I looked around their bedsit and noted the lack of a computer. ‘What happens if you don’t have internet access?’ I wondered. K said that she had told the housing officer that she didn’t have a computer, let alone a printer to hard-copy the list. The reply? You can access the site free at the library. Brilliant. How fair is that. Not at all if you work. K and her husband work, at the time that the list of properties is put on-line they will be earning a living. By the time that they can get to the library it will be too late as all other property seekers will have already expressed their interest to housing. This a wrong approach. All those who have a computer, and or who don’t work have an advantage over this couple who do work but still have limited finances.

The house next door to us is scheduled to be demolished, and a new one constructed. The next few weeks are going to be really interesting. The house is built entirely of asbestos sheets, even the roof is asbestos tiles and the house sits on the boundary. So far the developer has not asked us for access via our land, which they will definitely require but they have informed us that the demolition will start a week on Monday, half-term week. Wonderful, I’ve got the week off but there will be no lie ins for me as there will be plenty of machinery clanking and workmen exchanging pleasantries.

The asbestos concerns me. They can’t help but damage it as it is removed, that will release fibres and my home is only 8 feet away, with no barrier between the houses.

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Perfect memory

This is one of those days that will stay with me for ever. We had gone to a little one’s birthday party where the field at the back of their house had just been harvested. Jack and Izzy have a rabbit, Bradley, so freebie hay is great. The picture is of 5 of the grandchildren collecting hay together, Evie wasn’t with us.

Why is it perfect? It was a flash back to my childhood where I spent hours and hours enjoying the freedom to roam in wide open spaces. It conjures up memories of Famous Five and other innocent portrayals of children’s lives and imaginations. It is also a moment captured where the grandchildren were all playing and working together, no arguments or fights, no plastic trains or electronic gizmos, just sun, fresh air and each other.

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Musing on c-sections

At the rate things are going I’m going to have to brush up on post-operative recovery skills, not because I’m going to be working back in the hospital, but because my women are being discharged earlier and earlier post caesarean section. Just a few years ago a 5 day stay was routine, then 4 and now it’s day 2, how long before they walk out of the operating theatre and get straight into the car to come home?

C-section is now viewed as just another option in the childbirth choices. It is that but it’s the just  which is inaccurate, it is a major operation. If you are not squeamish then watch the video and appreciate the invasive nature of this major surgery.

In some cases caesarean section is a life-saving procedure, in many it was defensive practice. Over the past 15 years the C-Section rate has more than doubled BUT there has been no decrease in maternal morbidity or mortality, in fact it may even be stationary with researchers in the USA concluding that caesarean section quadruples a woman’s risk of dying.

How much higher is that risk going to be when leaving the hospital earlier and earlier?

Which poses more risk to women and babies, caesarean section or homebirth?

Don’t even get me started on the possible risks to the baby during and following a c-section for non-medical reasons.

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Age discrimination

I have been scowled at today, so was my friend. Our grandsons, all aged just 2 were tutted about. Our crime was to go into Starbucks for a coffee and a chat after music makers. The local Starbucks is a large and irregularly shaped establishment, unlike the Costa Coffee, and this is why we chose it, we can go right to the back, around a corner and not disturb other patrons. Brilliant, our little area was empty, as was much of the cafe. The boys were also issued with instructions, no running, no throwing, no touching and stay next to the ‘Nannies’. After a while two middle-aged ladies came and sat about 15 feet away from our menagerie. The boys were doing what toddlers do, being quite noisy, nothing unpleasant, mainly giggling alot because they were playing peep-bo around the chairs within the area we had indicated to them. After a short while my friend caught my eye and indicated I should look over at the 2 women. Well, if looks could kill I would not be writing this. My initial reaction was to ask the boys to quieten down, but since my friend I were able to carry on a conversation without raising our voices I kept quiet. The next thing is that these two good ladies had vacated their seats, whilst shaking their heads at us and tutting at the boys, and moved to a different part of the cafe. At first I felt guilty but then the bolshie part came out. Hang on a minute, we were sitting there first, there were plenty of other tables they could have sat at but they chose to sit there. The boys were not being disruptive, they were not anywhere near them all they were doing was laughing and amusing themselves. At no time did they move anywhere near them, in fact they stayed in a corner with the width of the room, and friend and I, between our clan and the sour-faced old biddies (they were in fact younger than friend and I, but they were sour-faced).

It is ages since friend and I have ventured into a coffee shop, we have deliberately waited until we knew the boys could be controlled without tantrums and tear.  Today was a trial run, a hope that we can start doing social activities again. The boys all behaved brilliantly, friend and I couldn’t have hoped for more from them, but those 2 women have ruined the moment of normality for us.

So, the lesson for today is that if you are a grandmother, with toddlers, do not go anywhere, even late morning, where there may be ladies who coffee as coffee houses are obviously their domain.

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