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Archive for the ‘community midwifery’ Category

For some unknown reason I had imagined that as the years passed I would find myself myself slowing down and having more ‘me’ time. I don’t know where I got that idea from but I was really way off the mark, my life now is full of commitments. When I increased my work hours I knew that my life was going to need to be strictly organised and that I would need to be religious in using a planner to ensure that all my duties slotted into place. What I hadn’t allowed for was Hubby doing his back in so badly that he couldn’t help out when the going got tough, in fact he became yet another commitment. Anyway, so what with juggling 2 jobs; 1 incapacitated husband; household tasks; gardening and 7 grandchildren I have found little time to blog.

Today, today has been declared an ‘I have no intention of doing anything that I don’t want to do’ day. Yes, I will be working on 2 databases but that is my choice, sort of, because if I don’t get on with them I will look a right idiot on Monday when I have to present the results of an audit. They are work but there is not enough time to do them during work hours and staying late at work would not help with the production of these beasties because, if you are seen then people feel they have to interupt you, plus it prompts them to dump more c**p at your door. Strange mentality in the NHS, perhaps everywhere, I don’t know. If I noticed someone having to work late, and over their hours, to complete a job then I would acknowledge that they had too much work. I may not be able to substantially reduce it, but I would definitely not go giving them more to do, where I work the opposite appears to be the case.

Work. The cut-backs continue, the unhappiness of the midwives and the women increases. We have just passed through a huge baby influx and it appears we should be back to normal levels until December when there is another little blip. May/June next year are bumper months which was unfortunate as the booking of these women co-incided with the bumper crop of newborns, making a double whammy for community midwives. I’ve had a couple of exciting call-outs requiring me to accompany women on blue-light transfers. In both cases the women were not in danger but the transfers were in the rush hour so 2’s and blues were used to reduce delay. One woman had rocked up at the wrong place in quite advanced labour and had received no antenatal care at all, was newly arrived from an African country and spoke no English. The other had turned up at a clinic, having taken her own discharge from hospital 2 days previously, and her blood pressure was through the roof. With the first lady I saw very little of the journey as halfway to the obstetric unit she started to make the sounds you associate with pushing so I was kneeling on the floor next to her trying to convince her with body language that she should breathe, breathe. I was also sliding up and down the ambulance as it braked for which I bore the bruises for quite some time, but which did make her laugh between contractions. As I was safely strapped in with the second transfer I had a wonderful view of the ‘Moses’ effect i.e two streams of traffic parting to allow the ambulance through. I also witnessed how stupid some drivers are, one even trying to outrun the ambulance, the paramedic told me that is not unusual. Unbelievable!

Work, job number 2. The job is thought provoking and challenging, however my dealings with HR and payroll have been even more thought-proking and challenging. After 3 months of being relaxed about not being paid, no contract etc. I lost my calm, laid back demenour and went for the throat. I have recollections of uttering such blasphemies as ‘grievance’, ‘union’ and then the ultimate ‘I’m stressed’. It does seem to have worked in that I received lots of back pay 2 weeks ago, I eagerly await the 24th of this month. Who is behind this bungle? A totally US manager, even more US than my other manager, in fact so US that my community manager is now beginning to take on the mantle of the most amazing manager, ever.

Home. Well Hubby had to be carried off the golf course after resurrecting his old back problem. He was in agony and was unable to feel anything down one leg, from his buttock to his little toe. G.P? Anti-inflammatories, this was a phone-call trige because there were no appointments and it wasn’t considered urgent. 4 appointments later, when I dutifully waited outside, and 7 weeks later, I marched into the consulting room with my drop-footed, unable to walk properly husband and waited until the G.P had told my husband it ‘would take time’, and ‘at your age’ (58) whilst staring intently at his computer screen, not even shifting his gaze when husband demonstrated the extent of his ‘dead’ leg, then I waded in. ‘What’s the diagnosis then?’ Still not looking away from the screen the doc responded with ‘Well, it’s possibly the same as he had before’. ‘Sure of that are you? Are you not concerned that previously the symptoms were not as severe but that he did require surgery?’ Oh yes, then I had his attention. A withering look was sent in my direction. ‘We could try physio, but it would possibly be a waste of time’. ‘It may well be a waste of time but now we are at the point where this is having a detremental effect on our lives. My husband has his own business and is unable to work. He can do nothing, not even pick up his grandchildren. So far you have done nothing, not even attempt a definitive diagnosis. I am thinking MRI to rule out a problem which, rather than resolve, could get worse.’ Over to the G.P, ‘Well the wait for an MRI is about 6 weeks and it may be better by then.’ I am surprised that he didn’t push the emergency button at that point because I erupted. A verbatum transcript is impossible, mainly because anger and indignation took over, but the essence was that if they hadn’t waited so ******long already he would now be having his MRI and physio and we would know what we were dealing with and, just because you are only just out of short trousers, don’t regard anyone who has grey hair as too old to spend money on. Now pension ages have been changed everyone else, except NICE and NHS choices, thinks we have at least 10 years of productivity ahead of us, so don’t dare write my husband off. Hubby now has his physio and MRI appointment.

The grandchildren are all well, and growing but of them are growing quite as quickly as grandchild number 8, who is currently nestled in DIL’s womb and scheduled to appear at the beginning of May. Yes, another one. See below for how the others have grown.

 

Well. My update is complete. My databases call. Firework night looms and Christmas lurks.

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Life has recently become extremely hectic and there is now much more juggling with commitments. Family life has been full, June has 2 birthdays and, in our household, that always heralds family meals so we all mustered the other weekend to celebrate Joshua’s 1st birthday (time has flown), his Mummy’s birthday, Father’s Day, son-in-law passing his electricians course (3 years hard graft after a working day at evening college) and me getting a new job. June also appears to be the month when our ‘children’ need a weekend away, so Mum and Dad end up having the grandchildren and not enough sleep.

The new job, well I’m still doing my old one as a community midwife but I have now also taken on another role, within the same Trust, midwifery related but not clinical. I know, I’m always wittering on about wanting to retire so what on earth has possessed me? Two things have prompted this, firstly it is a role that has always really interested me, and secondly, due to the bankers and the politicians I am one of the select group of women who find themselves most disadvantaged by the changes to pensions, state and NHS. I was amazed to be selected for the job as on the day of the interview I had some nasty virus which was causing me to appear grey, subdued and huddled and the interview was at the end of a particularly busy working day. I knew one person on the panel but the other 2 were entirely unknown to me so either the other candidates were totally unacceptable drop-outs with no grasp of the language or the one person I knew bribed the other interviewers!

Community is plodding along, this month has on the whole been quieter postnatally but I have managed to squeeze in 2 homebirths and a birth at the midwife-led unit. One of the homebirths set my adrenaline soaring, all my own fault really as I was being too relaxed, so was the woman in labour, and didn’t phone the 2nd midwife in time, in fact I didn’t phone her at all as my hands were full. I had to ask the woman’s husband to phone her and request she come PDQ, unfortunately it wasn’t PDQ enough as baby arrived 15 minutes before the 2nd midwife, luckily all was well though. There was still a slight frisson when I realised that baby was on her way out and I hadn’t got another pair of hands if needed, all the adverse scenarios started racing through my mind, but then I banished them and I concentrated on welcoming baby into the world.

I wrote all of this yesterday but when I ‘published’ it all that appeared was the title, the body of the text had vanished, for good, and this is the second time that has happened, is anyone else experiencing this?

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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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Life is full, work, grandchildren and a rapidly growing garden are using up lots of time (and energy). My pond, which I made about 15 years ago, appeared to have sprung a slow leak. Fortuitously a friend had decided to get rid of his huge pond, only a year old and constructed before his son started walking, so had a virtually brand new liner which he gave to me at the end of last year. Re-lining a pond, a much bigger job than I had anticipated. Removing all the edging slabs, catching the 2 remaining goldfish and then emptying the pond, by hand, it took days. My glasses kept falling off and into the mud at the bottom, the frogs kept jumping into the pond and then scrambling to get out, so I’d help them, take them down the garden and then 15 minutes later they would hop past me and launch themselves back into the thick sludge. The sludge, buckets full were deposited around the flower beds, Hubby said that it looked as if a cow with a bowel problem had been let loose in the garden, I’ve been assured that it’s good for the plants though. After days of re-levelling, cementing slabs back, re-filling and re-planting I returned the fish, plus three we had been asked to adopt by son, and then realised that they were too visible to the heron so had to net the pond. It’s been good to have the warm weather but it has created an issue with the pond water, it’s turning green, I suspect because the oxygenating plants are not yet established. Should I invest in an aerator?

We have also had Jack’s 7th birthday, I can’t believe that he is 7, it only seems like yesterday that my first grandchild was born and now I find myself escorting him and his friends to the O2 dinosaur exhibition, where he proved himself to be as knowledgeable about ‘terrible lizards’ as the guide escorting us. Obviously there was also the family birthday meal and, thanks to the early summer weather, it was a bbq plus an early outing for the paddling pool. One of life’s conundrums – how come that when you pack the pool up for the winter it has no leaks, but when you get it out the following year it has developed one? Grrrr.

Work is another conundrum. Where is it all going? I don’t know, it just seems particularly grim at the moment and I have a premonition that before too long I will find myself reapplying for my job on a lower pay band, not good news leading up to retirement as it would affect my pension. I am having an interesting debate with the people in control of parking. We have to pay, currently £12 per month to park for half an hour a day, at the hospital where we are based. They are now increasing the fee to £20 per month. I have taken issue about this, pointing out that I have no choice about whether I park at the hospital or not and also the fact that the new rules will mean that we have to park a hundred yards from our office where the gas cylinders and on-call equipment are stored. The response I got has inflamed me even more ‘ if you wish to park on the hospital site’. Hang on there you ignorant bureaucrat, I don’t ‘wish’, I HAVE to, it is one of the conditions of my role that I have a car, that I use that car for my job, I cannot do my job without a car. Plus, why should I, as a job-share, pay the same parking fee as a full timer? Any employment experts out there who might like to weigh in on this one?

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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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Christmas Day came and went. Absolutely frenetic, much wrapping paper, steam, yes steam is my major impression of Christmas Day because of all those pots bubbling away, full glass of red wine over my oatmeal coloured carpet and then peace when all the little people were asleep.

Work was busy and foggy with numerous offers of mince pies. I have been desperately trying to ‘book’ a newly pregnant woman, twice we have made appointments and she has phoned minutes before them to cancel, I almost know her phone number off by heart now as I’ve rung her so many times to reschedule but been met by her voicemail. She has left me a message to tell me that she needs to see me before her scan, I KNOW, but when I return the call guess what, voicemail. Hubby is now getting annoyed with it as I am always phoning her, yes on my days off. Get up in the morning, phone. In the car on the way to the DIY store (we are going to decorate and put down a new floor in the shower-room), phone. Cooking dinner, phone. As I was so desperate to speak to the woman I’ve been leaving my work phone on, bad mistake as I keep having to answer it. Swine flu, that is the number 1 topic. Last year I was quite reticent on advising women to have it, I gave them the info and told them to make up their own minds, this year I am swaying toward the ‘it’s probably a good idea’ stance. In my mind I feel somewhat happier about reinforcing the party-line as the vaccine has been around for a year, babies have been born to Mums who had the jab last year, and so far I have not been made aware of any adverse outcomes as a result of it. Next in the things to phone your midwife about is ‘I’ve got a cough, what can I take?’ Now, presumably these coughing ladies will have to go to a pharmacy to purchase the medications I suggest, how about asking the pharmacist? I have recollections of an ad campaign encouraging people to speak to the pharmacist and chemists now have a ‘consulting room’ for that purpose, why ask a midwife when there is a highly trained person who is far better placed to advise?  One of the phone calls was from Children Services asking me if I had seen someone, who I had never heard of, and who there was a meeting about on Thursday. Oh b****r, my heart dropped. After much questioning it turned out that they were giving me the name of her child, who has a different surname to her, my shoulders relaxed. Yes, I knew her, I had seen her, she was ‘co-operating’ with the maternity services but no, I couldn’t come to the meeting as I don’t work that day and, where usually I will attend these meeting if possible on a day off, that is one of the days when I have the boys and they hadn’t given me enough notice to rearrange childcare. Had they got a creche? No. Now I’m consumed with guilt, female thing, but they really should either give more notice or consult with ALL parties on when is a convenient time.

Homebirths are in the news again, apparently doctors are trying to put women off them. Why are the RCM and NCT suddenly getting hot under the collar about this, doctors have always tried to put women off them. When I say ‘doctors’ I actually mean G.P’s, obstetricians, well the ones locally, are supportive as long as the woman fits the criteria for a homebirth, i.e the pregnancy is low-risk. Cathy Warwick, RCM leader, calls for a ‘seismic shift’ in the maternity services and recognises that midwives are unable to offer choice. Sorry, Ms Warwick but we do offer choice around here, and the rest of the service suffers as a result. Yes, we need a shift, seismic or otherwise, but something definitely needs to happen, and soon and not just to enable more women to have a home birth but to allow that to happen without depriving other women of the care they deserve and putting midwives under so much pressure of work that they leave.

So, on this last day of 2010, I wish everyone a wonderful 2011. My resolutions? To carry on with my diet, I have lost over a stone, and lose the 3lbs I have put on over Christmas! To allocate some ‘me time’. 

HAPPY NEW YEAR

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Yep. Sitting here waiting for the phone to ring, I’m on call. On call is really a poor description, ‘in waiting’ would be more appropriate as recently it’s 90% certain I will be answering the phone and driving off somewhere at some point during the night. Last time it was because paramedics were refusing to take a labouring woman in to hospital, even though she was ‘high risk’, because her contractions were too close together! Off I went, in freezing fog, arrived 40 minutes later and discovered that the woman was in early labour. Only problem was that I then had to go in the ambulance with her to the maternity unit, then get back to where my car was, then get home. Nearly 4 hours in the middle of the night, and I’m still not really quite sure why. Then last week it was to the local Birth Centre because they hadn’t got any cover for that night, the week before it was to a homebirth. Once again tonight the Birth Centre has no cover, I wonder what time I’ll be called?

These on calls are starting to stress me out. It seems that as I get older, and perhaps wiser, I dread them and anticipate more problems, mind you, that might have something to do with more women with ‘problems’ booking homebirths. I must be the biggest pessimist as I lie anticipating the phonecall, imagining all the different scenarios I could find myself in, and then, when the electronic ring shrills out my heart leaps into my mouth and virtually flies around the room. That’s the worse bit, the waiting, the trying to get to sleep. Once I’m on the road, in action, and especially once I’ve arrived I’m in the present, no more imagining, or dreading, just a woman to help and support. Yes, things could still not be ‘normal’, but facts are easier to deal with than the imaginings of a sleepless midwife.

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