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Archive for January, 2011

I know, during all the newspaper coverage regarding the state of the maternity services I have been silent. The truth, I’ve given up hoping that things will change for the better, am so disillusioned and demotivated that I cannot be bothered to rant, report or rue the erosion of a service I entered with passion in my belly and will leave with an extremely sour taste in my mouth. Fingers crossed, one year now until I retire.

In the absence of an urge to blog I have been reading The 19th Wife by David Ebershoff, food for thought in this 600+ page book about The Church of the Latter Day Saints and in particular polygamy or, as the church calls it, celestial marriage. I have many, many thoughts on this practise, I suspect tat my outlook as a female would be quite different to that of a male. However, feeling benevolent toward Joseph Smith, I will say that he hit upon an excellent way to rapidly increase the membership of his church, after all a couple are likely to only manage one child a year, and let’s not forget how high infant mortality was back then so only around 35% would reach their fifth birthday, but if a man takes several wives then the family increases at a rapid rate and the population surges. All the more faithful for the church and all the more power for a community. Brilliant wheeze. The book is one of those set in two time frames, one historical and the other contemporary, I sometimes find this a distraction and spend loads of time flicking back to see where the story had been, or who a character was, I didn’t with this one, which must be a tribute to the author for ensuring appropriate breaks in the narrative.

A few years ago I read ‘Call the Midwife’ by Jennifer Worth, very interesting, especially as my Mother was a district midwife in East London in the late 50’s, the time covered in the book, and I have patchy memories of accompanying her on the back of her bike and waiting in front rooms with a man, and sometimes other children. Then I would hear a baby crying and a red-faced, smiling mother would open the door and call the man out. Anyway, daughter bought the trilogy ‘Tales from a Midwife’ around the other day and having refreshed myself on the first part I am now reading the two new sections. Crikey, if I as a midwife or child-bearing women think things are bad now this book certainly brings us up short, the working day for midwives was long and hard, with terrible conditions but their lot was nothing in comparison to what the women and their families endured. I hear that the BBC have serialised it and that there will be 6 episodes shown sometime this year, can’t wait.

Talking of childbirth/midwifery on TV brings me to ‘One born every minute’, channel 4’s look at the realities of giving birth. This weeks was great, I hardly shouted at the telly at all. The couples shown were brilliant, the births were uplifting and the midwives a credit to the profession. I had stopped watching it last series as I found I was getting so cross with the midwives, and their love of confining women to the bed and strapping monitors on for no apparent reason, that it was increasing my despondency, full marks this week though, nearly made me feel enthusiastic.

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The small print

We are all aware of the wisdom in reading the small print of anything we sign, although I do have to admit that I am sometimes guilty of ‘speed reading’ and not really absorbing the facts but signing anyway. The small print is generally just that, small print, very small print, hardly user friendly and certainly difficult for those of us who have developed long-sightedness and whose arms have not yet lengthened enough to enable us to focus effectively. Tonight, thanks to Hubby’s grumpy old man running commentary about adverts on TV, I realised how clever some companies are with regard to their small print. ‘Santander’s’ latest advert came on and I decided to read the small print they have at the bottom of the screen*, and I couldn’t. I had my new glasses on, was sitting approximately 8 feet from the 32 inch screen and could not do more than identify the odd word of their ‘advisory’ at the bottom of the screen. Small writing, on a moving background and on the screen for too short a time. As a means to provide extra information for prospective customers it is absolutely useless so I can only assume that it is a requirement that the words are broadcast, not that they can be read.

Being me I then became addicted to reading the small print at the bottom of television advertisements, gosh there’s a lot of them and not merely on financial ads. Probiotic drinks; Flora pro-active (no idea what this one says); hand cream and my favourite, at the moment, Sheila’s Wheels. What is it about this car insurance company which has captured my attention? Well one of their advisories states ‘ Discount calculated on price via all other phone numbers’. What? Help, I need a translation. Any offers?

So what does this use of qualifying/explanatory statements say to me? Their use says to me that the advertisement is not giving me the whole story, that in fact the advertisement itself may even be misleading, that I shouldn’t take what they are saying their product provides or produces is not true. It says, ‘Don’t believe the pretty pictures or the eloquent dialogue’. 

*Not because I would ever use this new manifestation of Abbey, as my experiences with them on behalf of my daughter have always been absolutely horrendous.

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Looking at the mothering, pregnancy, childbirth forums reveals a fair number of members posting the question ‘I’ve got my first visit with the midwife, what will happen?’. I’m going to answer that now, sort of. My slight hesitation is due to the vagaries of how care is provided, everywhere has slight, in some cases major, differences but the interchange of information between the midwife and the pregnant woman will remain the same.

Differences –

  • In some areas the midwife will be the first port of call
  • In other areas the G.P will be the first contact regarding the pregnancy
  • The ”booking’ may be done at home, at the G.P’s, in a Childrens Centre or at the hospital
  • Weirdly, some hospitals have group booking sessions. No idea how this works, confidentiality and all that, most bookings are the midwife, the woman and any other person she consents to have present

Remember that you are entitled to paid time off work for all appointments associated with your pregnancy.

So, you and the midwife have arranged to meet, you are between 8 – 12 weeks pregnant, expect to spend at least 45 minutes on this meeting. You may have been provided with a pack containing booklets and leaflets prior to the meeting, make sure that you have read them as they may provide you with important information about local maternity units, screening tests, diet etc. The pack may also have a blank copy of your maternity notes, if it does then you can make a start filling them in with your name and other personal details. Having read through the information make a note of any questions you want answers to and also any concerns you may have.

Right, so you meet the midwife. She will have lots of questions for you; your previous medical history; about any previous pregnancies; your close family’s medical history regarding diabetes, high blood pressure, miscarriages, stillbirths and also baby’s born with hereditary conditions, abnormalities some of this will also be about baby’s father. Other questions will be about work, alcohol, smoking, recreational drug use, ethnic origin, contact with Social Services and, obscurely, highest educational qualification. At some point screening for Downs Syndrome will be mentioned. The midwife will ensure that you understand all about the tests available and how to access them if you want the screening.  Some areas arrange these for you and some will provide you with the necessary numbers to call. Screening should be available to all on the NHS, you should not have to pay. The midwife will also explain about the blood tests we feel are necessary during pregnancy, she may ask if she can take the blood at this time. There will also be a discussion about where you would like to have your baby, what facilities are offered and the possibility of using a birth unit or having a home birth.

Having listened to your health and social  history the midwife will assess how your care will be provided, whether at this time you fall into the group classed by the hospital as low-risk or whether you need to be seen by an obstetrician. Whichever group you fall into, by the time the midwife leaves you should know the plan for your care and where and when you need to be seen during your pregnancy. At this early time it is difficult to be exact, the midwife can only guesstimate to within 2-3 week windows when the scans will be, and who knows when the consultant appointment will be if you need to see them but she will write down the weeks of pregnancy when you need to be receiving antenatal care and how the appointments are made for these. Information will also be given about the local provision for parentcraft/antenatal classes and contact details given for accessing them. You will also be given the contact details for your midwife and/or her team plus all the local maternity unit numbers.Other topics will include your employment rights during pregnancy, diet, exercise, domestic violence and smoking cessation, you will also receive your form which entitles you to free prescriptions during the pregnancy and until baby is 1 year old. Data protection will be highlighted and the fact it has been discussed will be recorded. I do not discuss labour at this point if it is the first baby but I do cover it following attendance at parentcraft classes and as the end of pregnancy approaches but some midwives may talk about it at this time.

The midwife may test your urine at this time and in some areas a urine specimen will be sent off to be screened for underlying infection. Your blood pressure will also be recorded, along with your weight and height and your BMI calculated. Listening to baby’s heart? Highly unlikely before 12 weeks as baby is still very small and is hidden down below the pubic bone.

By the end of this you may well be suffering from information overload but don’t worry as the midwife will have written everything down in your notes and/or left you leaflets about different topics so you can recap at your leisure!

Here is a link to the NICE Guidelines on Antenatal Care which provide the basis on which your care will be organised.

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