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Archive for February, 2010

 

Back in the middle of 2009 I was referred by my G.P to a London teaching hospital. After many trials and tribulations I finally saw the consultant, the decision was made to schedule surgery, the exact nature of which would be based upon the results of further scans and tests. I fairly bounced my way home, at last I could look forward to resolution.

I’ve spent the 2 years, since my previous surgery, in discomfort and, by the end of the day, in pain. I’ve put up with it and carried on regardless but increasingly it has been affecting more and more of my day-to-day life. As long as I believed that my op would be only a few weeks away I was prepared to ‘grin an bear it’ but last week my gritty determination crumbled. I had the tests and scans back in December, I had a further appointment last week where. after a 2 hour wait, I was called in. The doc, not the consultant, duly reviewed my scans and told me the plan, fairly simple operation with a reasonable recovery time, yeah! ‘When, when?’ I grinned and, after a brief discussion with the nurses, he told me, ‘ Probably June’.

I slouched home and then spent 10 minutes blubbing. How I wish that the hands of the clock did rotate at a visually disturbing rate, I just want things sorted soon, quickly. In 2 words the doc had made my symptoms escalate from bearable to unbearable. By the evening I’m really tired and extremely uncomfortable, on-calls are now more stressful. It’s not just my usual disinclination to get up in the middle of the night and drive to a previously unknown destination for an unspecified length of time but also a fear that I may not function at 100% when I get there. I mulled the situation over and decided to go and have a chat with the occupational health department. Dream on, what occupational health department, they have been re-branded, Workplace Health. No longer are they there solely for NHS employees, no, workplace health (WPH) are there for NHS, plus they are also providers to the public and businesses. I found this out when I misguidedly phoned them to arrange an appointment, another faux paux as there are no direct referrals, my manager has to refer me. I am now firmly off  into the land of Alice, for years I have inhabited a workplace where, if you had a work-related health query you would chat about it to occy health, you certainly didn’t have to spread word of your personal, health problems around. Right, in Wonderland I have to go to my manager, tell her what ails me and let her decide if I do need to see them. Manager then has to do a referral and then Workplace Health will triage (their word, not mine) me and arrange an appointment accordingly. I’ve done it all, I even made sure that HR were there when I spoke to my manager, I’m really dotting i’s and crossing t’s nowadays, I’m losing faith in people’s motives. HR advised me to phone WPH a week later if I hadn’t heard anything as she felt that I should see them sooner rather than later but I’m generous, I left it 10 days before I phoned them. They cannot find my referral, I have 2 copies, 1 sent by email and the other by snail mail but they haven’t received it in any form, not even by pigeon post. No referral, so no appointment. WPH want a new referral, I’ve sent them one of my copies.

It’s really difficult not to become extremely frustrated by all this paper-trailing, waiting and black holes that referrals disappear into. I can’t believe that I am unlucky enough to have this only happen to me, twice. I don’t expect an instant service, I know that the hands of the clock move slowly within the NHS, but I do expect that once paperwork has been sent that people can at least find it and that when they can’t they at least take ownership of the problem, not turn the poor unfortunate person who has been referred into a human ball being bounced backwards and forwards.

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Reclaiming Birth

A date for those interested in improving maternity services, March 7th.

Reclaiming Birth

What is Reclaiming Birth about?

Reclaiming Birth is a campaign by NCT, AIMS, ARM, IM UK and Albany Mums about the standard of maternity services throughout the UK. We want parents-to-be to have the best opportunity to start family life in the optimum way. Our concerns cover a range of issues:

Many women and their partners are left alone in labour and get little support from overstretched midwives. Parents-to-be often don’t have access to the services and support they need for the birth of their baby to be a safe, positive and life affirming event.

This will only change when there are more midwives, more women being able to birth in free-standing midwifery units (Birth Centres) or at home and more midwives carrying their own caseloads and looking after parents-to-be from conception to birth and postnatally.  Few parents-to-be currently have any of these options.

See you there!

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I’ve had time for musing today and yesterday as I’ve driven between my visits and here’s what I’ve come up with –

  • I really don’t like the drop in clinic. No surprises there. I feel that I’m short-changing the women and that I’m missing out on aspects of the women’s welfare. The clinics are good for the women as they are given an appointment time so they are not left wondering when a midwife will appear at their home, other than that I can’t see a positive for them. For me; I get depressed when I see the long appointment list; it’s difficult to give truly individualised care within an appointment system and in an environment which is alien to both the woman and myself. In most cases the woman is accompanied by her partner/husband and he will come into the room with her, making himself comfy on a chair. This spectator aspect can stultify the midwife and woman relationship, I am not seeing or hearing the real woman, I am receiving the information and impression that the woman wants her husband/partner to receive.

Following on from the drop-in clinic muse I began to wonder if anyone had followed-up on outcomes for women whose care was provided within clinics compared to those whose care was provided my a ‘named’ midwife, in their own home. This lead me to considering the holistic approach, which named midwifery should favour, and if it is beneficial and gives rise to increased positive outcomes.

  • Yesterday I visited a woman, her husband and 15 month old son to book her care in a new pregnancy. I knew this family through the previous pregnancy so there were many questions I didn’t need to ask, in fact it was less like an ‘interview’ and more like a social catch-up. When I left I was remembering her last pregnancy, all normal, in fact at 36 weeks I booked her for a home birth. Things change though an when I took the home birth bag round a week later I thought S looked puffy. I asked her if she was swollen, she showed me her hands and feet, slightly oedematous, but her face looked different. I asked her husband what he thought, he looked at S and agreed that she was slightly puffy. I took her blood pressure and it was slightly higher than usual, nothing unduly worrying though, a trace of protein in her urine, no headache, flashing lights, everything within acceptable limits, but I was still uneasy. I sent her in to our day assessment unit and within a few hours she was being induced for pre-eclampsia. This disease of pregnancy generally, but not always, shows itself with high blood pressure and lots of protein in the urine, if I had relied solely upon these diagnostic determinants I wouldn’t have suspected PET. I’m not super midwife, I’m just a midwife who knew her patient.

Midwives talk about ‘intuition’ and frequently recount stories like the one I’ve just written down. Examples of when we have been unable to robustly support why we have concerns but feel strongly enough to push for a second opinion or diagnostic tests. I know that if I have a ‘feeling’ about something then I don’t ignore it, I have been proved right too often. It would be interesting to see if community midwives working a named midwife caseload have a higher early detection rate for pregnancy complications or even just better outcomes for pregnancy. I wonder if any research has been conducted on this?

  • Research. Is it beneficial? How, why, when and where does it affect practice? It does if it shows that it improves outcomes. It does if it is shown to be economical. What about if it improves working lives, and here I’m talking midwives, is any research being done on this area? 

‘A happy worker is a productive worker’. Come on midwives, are you happy workers? What woud impove your woking life and the care you can provide, we all know increased numbers would be a huge fillip, but what else? What research could highlight practice which would beneficial to you? Please leave any suggestions in the comments section.

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One of those days

At the weekends we operate a ‘drop-in’ clinic, drop-in, hmm, well that’s wrong for a start as it is a clinic which has a pre-booked, appointment system, it’s held at the local birth centre where 2 community midwives staff it, today was my turn to be one of the midwives. It was depressing looking at the appointment list, 20 women and babies, 1 stretch and sweep, 1 blood pressure check and 1 antenatal examination with a query of oligohydramnios ( low levels of amniotic fluid). The midwife I would be conducting the clinic with announced that she had an appointment at another hospital right in the middle of the busy clinic, I was somewhat stressed at this revelation but luckily a colleague revealed that she not required elsewhere so she could come and lend me a hand. Just over halfway through the clinic the midwife running the birth centre announced that the woman she was caring for in labour required an ambulance transfer to the obstetric unit 15 miles away,and were there any offers to be the escort. Luckily the midwife who had gone off to an appointment arrived back at this time so there were 3 of us to choose from. Ambulances, well-equiped, often life-saving but also great wallowing vehicles so many passengers find that they suffer from a susceptibility to travel sickness therefore volunteers are often quite difficult to find. I thought about it, I’ve never been sick during a transfer, Hubby was playing golf quite close to the obstetric unit and would be finishing about the time I would need rescuing from the unit, the ambulance takes us there but then leaves us to get a taxi back, so I offered to accompany the woman. The ambulance driver asked if we should blue-light and siren, we decided on a calm drive but lights and noise through traffic and half an hour later we arrived at the obstetric unit. Mission accomplished successfully.

Hubby arrived from golf, unfortunately he had a golfing chum with him who we had to drop off before continuing to the birth centre. We had to drive past the top of our road so I asked if we could just pull into our drive so I could run in and get a biscuit, it was 3.45 pm by then, I hadn’t eaten since 7.45 and was ravenous, we then drove the 9 miles to the unit and Hubby dropped me off. I went in, helped with the last appointment, tidied up and went to leave, no car keys. Right, I had them to get in and grab a biscuit. I remembered taking them out of the front door, perhaps I had left them in Hubby’s car. Quick phonecall, no the keys weren’t there. I scoured the birth unit, we all scoured the birth unit, looked in the emergency transfer bag, no car keys. Phoned Hubby again and asked him to drive over with my spare key. By now he was convinced that I had left the keys in the front door and someone had taken them. I wasn’t so sure, I felt sure that I had had them with me when I went back into the birth centre. I was worried though, car keys, house keys, office keys, children’s house keys and Mum’s keys were all on my key ring, massive loss. I needed to pick up the entonox from our office, but it was locked, and I didn’t have the key.  B****r.

One last search and there, peeking out from behind a clinical waste bin, my keys. Yeah! I phoned Hubby, not a happy man as he was nearly back with me. Whoops.

Now I’m sitting here, jumping every time the phone rings as I’m on-call for community and the birth centre, at least it’s stopped snowing though, and I’ve got the entonox.

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E-mail I received today

I am contacting you on behalf of the MHRA (Medicines and Healthcare products
Regulatory Agency), the government agency responsible for ensuring medicines
and medical devices work and are acceptably safe.

I would like to invite you to take part in our online discussion around the
MHRA’s proposal on making information about medicines available online, and
would love to have your voice added to the conversation.

Please take a look at the online dialogue here:
http://www.medinfodiscussion.org/

This will be a big decision for the MHRA and they want as many views as
possible on it – is it a good idea? What difference, if any, would such a
resource make to you? How would you use a resource like this?

You can read, rate and add ideas to the discussion until 8 March 2010,
during which time we hope to hear from as many people as possible, ranging
from health professionals and patients to members of the public.

Would it be possible to disseminate this information on your website and in
any press/newsletter outreach?

Thanks in advance for taking part, and please forward this message widely –
the more people taking part, the richer discussion we will have! Please get
in touch if you require any further information.

Many Thanks

 Jenny Hardy

Delib (Working with MHRA on the discussion.)

Online Opinion Research and Public Consultation

www.delib.co.uk

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Play

Boys in a box

Two weeks ago my 10 month old Vax carpet washer packed up. I phoned the number on the handle, spoke to a lovely man about my problem, exchanged chit-chat about grandchildren and then arranged for my defunct cleaner to be picked up. On Thursday it was returned to me in a large cardboard box, I was happy to have my Vax back, the boys were delighted to have a box to play in, hours of fun.

Today I have been a domestic goddess, well my version anyway. I have made 3 puddings for a family meal tomorrow, a lemon meringue pie, an apple cake and, a new to me recipe, toffee apple crumble. This crumble has apples( obviously), lemon juice, golden syrup, flapjacks and fudge, I think that tomorrow I may be a cursed Nanny, all that sugar!

Work? Well I’m just not thinking about it, it’s too depressing, demotivating, demoralising and many more de- something or others.

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Midwife Muse’s roll call of causative factors so far –

  • PCT’s for with-holding government monies
  • Groups who place the majority of their emphasis on THE BIRTH, and lobby accordingly, putting antenatal and postnatal care on the back burner
  • Trusts for employing too many managers

Fittingly the midwives come last, that’s the usual position we appear to occupy in any planning, so why alter the status quo? Why are we to blame then? Well we will do what we always do when change is foist upon us, we will grumble, get stressed, some of us will even rant, in private but ultimately we will comply. When I used to work in the unit the obstetricians, generally the registrars, would keep coming out with jokes which were always based upon how bolshie midwives are, ‘What’s the difference between a rottweiler and a midwife? A rottweiler eventually lets go.’ That may be true in the one-on-one clinical situation, when we are being an individual woman’s advocate, but as a group, when change is being imposed, our contracts being re-written or some other attack on our ability to provide the care we KNOW that we should provide we capitulate and fail to work together to resist or modify the changes.

My crystal ball is showing me that once again we will moan and have a brief, vaguely supportive interaction with our union, incidentally that won’t get us anywhere (prediction), a couple of us will leave, another couple will retire, half of us will apply for other jobs, perhaps midwifery related but the majority of us will just end up going along with a change we are intensely unhappy with.

Midwives are their own worse enemies. We are already working above our capacities, both within the maternity units and in the community but we don’t ‘work to rule’, we can’t, but we should. The managers are not ignorant of the ridiculous workload and the number of extra, unpaid hours the staff put in, in fact I do believe that the managers join in sometimes, so we are all colluding in the farce which will allow these changes to go through, these changes which will definitely affect the coal-face midwives, the women and babies.

For a profession whose members are portrayed as fierce we are badly misrepresented, we are actually shrinking violets.

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