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.