Postnatal Care Project

Over the past few years there has been an escalation in the erosion of the midwifery care provided at home after birth. I have complained, wrung my hands, and generally played the prophet of doom about the impact this could have but, unfortunately, postnatal care is the easiest way for Trusts to cut staffing costs so the resources for this area have been torn away with relief by struggling maternity services. It is the area less likely to produce litigation, and the area where any successful litigation would probably decide on far smaller awards to the claimant so, in the mind of a budget holder, is the safest area to cut services back to the bone.

I was at a governance meeting a while back where the topic of community postnatal care came-up, and I was surprised to hear a consultant midwife back the reduction in care whilst supporting her approach by mentioning ‘a study in the Netherlands’ which found no difference in outcomes between those who had care at home after birth and those who didn’t. Well, I think I’ve found the study, Costs and effectiveness of community postnatal support workers, and if this was the study then she was in error using it to support the discussion as the visits by midwives were not changed, more and longer visits were provided by maternity support workers. Well, today I learned that there is to be a study conducted initially in Scotland by Sterling University into postnatal care. Am I hopeful it will be a positive thing? Not really as I’m not entirely sure that it will be woman centred. At the moment all I have to go on is the BBC report,and whilst I love ‘Auntie’ I am aware that reporting on this topic, maternity care, is not always accurate so I’m just going on their take on the information. What concerns me is that NICE have already issued their guidance on Postnatal Care, which Trusts have interpreted to mean that care is taken away from the home and provided at clinics and this study are also going to ‘develop a best practice package’… ‘which individual health authorities could then adapt to their needs’, (their needs being to cut costs). I will be interested to read their results but I’m really not going to hold my breath.

My previous musings on this topic include; Letting women and babies down? (2010); The Demise of Community Midwifery – part 2 (2010); What now? (2009); A step backwards (2008); An embarrassment (2007). When reading these offerings prior to linking it was interesting (depressing) to chart the real demise of the postnatal care provision in my area, especially my ’embarrassment’ at the care I was not providing in 2007 when we were still visiting at home. Now we ‘triage’ on the first day home and basically, if the woman answers all the questions on our pro forma correctly, she won’t get to see a midwife until Day 5, and then the likelihood is that it will be at a clinic, one of which is 12 miles away. I’m not embarrassed now, I’m ashamed.

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Time

Time, well it’s just flying at the moment. There’s a lot going on at work, so may machinations, some seemingly innocuous others are rather worrying and are leaving many of us ‘watching our backs’. I have my resignation letter composed and saved and I cannot count the number of times my finger has hovered over PRINT, Hubby is leaping to attention every time the printer goes into action. Tee hee. It is all just a matter of time though.

Jack is now 7 and Amy 6, and both had the same birthday present, a trampoline. I take the blame for this as I acquired one a few months ago and it has been such an amazing hit with all the grandchildren that their parents decided they should have one. I have strict rules in my garden about the trampoline, no bundles, no pushing, no food allowed, there are occasions when Nanny has to turn into a sergeant major but on the whole the children are kept healthily occupied for hours.

From somewhere, and through some movement I have developed ‘tennis elbow’, or lateral epicondylitis. Ouch, ouch, ouch. Nasty condition which catches me out regarding what will elicit an ‘ouch’ and, as a result, what actions I can perform. I can open a car door with no problems but cannot sew. I can get the ironing board out and carry the iron to the board, but I can’t iron (handy that one!). I can chop vegetables but cannot turn the tap on the water butt. On the up-side it is ‘self-limiting’, the down-side is that it can last between 6 months and 2 years. I just hope that time continues to fly.

I was thinking about time today and how we develop our concept of it. I’m not a philosopher, I just heard myself saying ‘You’ve got 10 minutes on the computer Amy’ and so realised that we often give children timings. I will say ‘In a minute’; ‘Give me a couple of minutes’; ‘You’ve got 5 minutes to tidy up’ and other time precise instructions, but they are anything but precise in reality. Do we develop our sense of time from comments like these and, if so, could it account in part for why some people are poor time keepers? Before we learn to tell the time from a clock our concept of time must come from clues given by those who do know about hours and minutes. I had been considering this when daughter came round to collect her off-spring. We sat on the patio having a chat (whilst the children bounced on the trampoline) and after a while she informed them that they had 5 minutes and then they were going home, I waited and timed what would actually happen. In reality it was 20 minutes before they were summoned from their leaping, and then a further 10 minutes before they left to go home. So, having been told that in 5 minutes they would be leaving they really had 6 times that number of minutes, with no correction to the initial instruction. Were they aware that it was more than 5 minutes, or do they now have an erroneous impression of time? Is time a learned concept?

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