Archive for the ‘Midwife’ Category

Dear Mr Cameron

I know that you, your government, the country, need to cut spending. I would know that because my wage packet has already been adversely affected, I accept that and don’t believe that public sector workers should be immune from ‘cuts’. Please note that I have said ‘public sector workers’, not ‘the public sector’.

I can’t comment with any degree of authority on the majority of publicly funded institutions but ask me about the maternity services and I can go on for hours, if not days, perhaps even weeks, you see I’m an NHS midwife, and have been for many years.

At this point I could make lots of self-invented comparisons between the effects of cost-savings within education, policing, parks etc., and the maternity services but they would be trite and not substantiated so, I shall just go straight to the heart of the matter, if you adversely affect the budget to the maternity services it will cost lives. Lives of Mothers and babies.

Please don’t interrupt me at this point and say ‘there will be no cuts in the NHS’ as that is plainly untrue. You seem to believe that is true but let me tell you now, cuts are being made, huge cuts are being made within the maternity services.

Back to my diatribe. The cuts. I work on the community and in an effort to reduce expenditure staffing at the weekend has been reduced by 50%. How has this been effected? Clinics have been set-up at the maternity unit and postnatal women, even those 5 days following a caesarean section, have to come to us. Inconvenient for them, especially if they have other children, and also, due to an appointment system, not practical for giving breastfeeding support. It’s also pared down to the marrow the on-call system, at a time when your government has stated that it supports a woman’s choice for homebirth. 2 midwives on-call on the Friday night who are scheduled to work Saturday and cover the clinic. They get called out all night and so are not working the Saturday, that leaves 2 midwives who are on-call for the Saturday. See where this is going? Yes, they get called mid-morning and wham, bam, no midwives. Homebirths are not the only occurence which can show how stupid, short-sighted and negligent the staffing is at weekends, wish they were but thanks to budgetary constraints community, on-call midwives are also called in to cover the consultant unit and the stand-alone birth unit. Yes, due to the cost-savings ‘bank’ staff are no longer ‘allowed’ to be used to cover absence or staffing shortfalls so on-call midwives are summoned to fill in the gaps. Yes, midwives who have already worked a full day are then called in to work all night. The truly amazing thing is that they have been called out because the hospital midwives can’t cope as it is busy so they are entering a stressful working environment when they are already tired. Do you believe that is safe?

Safety. Let’s consider some recent news items about the maternity services.

April 4th 2011 – In The Independent and also discussed in many other places ‘British maternity wards in crisis’ Infant mortality spirals at 14 NHS Trusts.  ‘The safety of maternity care in Britain’s hospitals is under the gravest threat from an over-stretched, under-resourced service which is putting mothers and babies in danger, experts have warned.’

April 4th 2011 – In News West Midlands. ’35 of 45 Infant Deaths Were Avoidable’  The babies’ deaths would have been avoidable if there had been additional staff members and also increased standards of care. The report by the West Midlands Perinatal Institute explained that the maternity service was stretched and short of staff.’

April 1st 2011 – Mail onlineMidwife shortage is causing Caesareans’

April 6th 2011 – Access Legal from Shoosmiths  ‘Patients and their babies are being put at risk due to midwife shortages’  This article discusses the tragic deaths of Mrs Ali and her baby at  Queen’s Hospital in Romford and includes – ‘similarly catastrophic errors can arise, not because midwives don’t aim to provide their patients with proper care, but because they simply lack the time and resources to be able to do so because services are overstretched and/or because they lack the appropriate training.’

What do you think Mr Cameron, are you happy with the care being provided by the maternity services? Do you really believe that they are not being adversely affected by a funding deficit? How about the rumours of over 200 midwives in Birmingham being forced to reapply for their jobs in an effort to save money by downgrading them. What do you think that will do for for retention?

At this point I will insert a quote from the Royal College of Midwives in an article discussing the perinatal deaths in the West Midlands –

‘The general impression was that the only way this could be explained was that this was an overstretched and understaffed service trying to do the best it can’ and ‘Many midwives are being pushed to reduce the amount of time they spend with women…….If midwives do not have sufficient time to assess and support women things including identification of risk factors can get missed. Women also may feel that they have an issue they want to discuss, but do not want to bother the midwife because they can see how busy they are. This is wrong and potentially disastrous.’

I sympathise with the position the government, and the country, finds themselves in now, I appreciate that savings have to be made. With regard to the maternity services though you have to be honest. Either you stand up and admit to the public that the quality of care is being adversely affected by budgetary constraints or you effectively ring-fence the budget for their maternity services and ensure that those services are not subjected to, what are in reality, ‘cuts’.

Yours sincerely

Midwife Muse

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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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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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Midwife wanted

This email arrived in my inbox at work the other day, interesting opportunity for a midwife in the North.

Dear Manuela,

As I explained in our phone conversation earlier I have been commissioned to ghostwrite an uplifting memoir of a modern day midwife for Headline and wondered if you could help me to find a suitable case study whose story I would write on her behalf. The book is to be written in first person narrative and will be uplifting, heart-warming, touching and life-affirming – a real celebration of a modern day heroine.

Ideally the midwife in question would be from the north of England and working in a community. She would be aged between 42 and 53, would have worked as a midwife for at least 15 years and have children of her own. She needs to open, warm and a good storyteller. She will receive payment as the author of the book and will be expected to do PR to promote it. 

My publishers have asked me to come up with a shortlist of suitable midwives for this project and I would be very grateful if there was anyone you could put me in touch with. I’d also be very interested to read the press release about Lindsey Reid.

Many thanks,

Charlotte Ward

Freelance writer

I have a few queries. Why a ghost writer? How much would the midwife be paid? Why the age constraints, especially as that rules me out? Hang on, is that age discrimination ;)? Why the location in the North? Do northerners have more interesting lives and experiences than those from other parts of the UK? Then there is the gender issue, why a female midwife? Male/female, we all do the same job.

Modern day heroine. Tee hee. Read a few parenting websites and you will soon see what the Mums think of midwives, and it’s not as heroines. How exciting though for the chosen sage femme (I just love that french word for a midwife).

She will have to tread carefully though, and I suspect that her every word will be subject to much examination by her Trust. What makes me think that? Well, as an introduction to the forwarded email was an advisory – Any midwife interested in this project should contact their Trust press office to discuss the opportunity. That should be an interesting conversation!

Oh yes, Lindsay Reid is a writer, researcher and midwifery historian.

Well, any midwives reading this who would like the opportunity to become a published authoress should contact Charlotte on charlottefreelance@gmail.com

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Thank you to those who voted/responded to my request for opinions, the results seem to echo the findings by professional surveys in that the majority considered the same midwife throughout labour to be of most importance. To be honest I was expecting that this wouldn’t be the conclusion. From my perspective as a woman giving birth, I couldn’t have cared who was there, as long as s/he attended to my needs, was competant and treated me like a real person and not just another ‘case’. It does throw up dilemmas though, we are supposed to be aiming at ‘one-to-one’ care during labour, but that doesn’t mean same midwife throughout, it just means that one midwife is only caring for one woman at a time. To then move to one-to-one care by the same midwife throughout is really throwing down the gauntlet, not sure how that could work even with a ‘domino’* system. There are days off, annual leave, sickness etc. and then there is the length of labour itself. Anyway, it has certainly left me with more than enough to ruminate on!

* Domino – The midwife who has provided throughout pregnancy then accompanies the woman to hospital and stays with her until after baby is born.

I have been laid low by yet another tooth abcess, according to my dentist it is down to grinding my teeth, something I am doing a great deal of recently. Working, whilst coping with tooth throbbing and jaw and ear aching, plus unable to take the pain-killers I yearned for was difficult but I am eternally grateful to one of our healthcare assistants who appeared at my clinic and helped it run to time by doing all the non-midwifery stuff. There is a box of choccies waiting for her to acknowledge her thoughtfulness toward a flagging colleague.

I have a Google alert set up to notify me of news articles, blogs etc which mention ‘midwife’, it also alerts me to posts on sites like Mumsnet where members have included ‘midwife’ in the title. On occassion I have rsponded to threads, generally to give advice but this week I read a thread which, at first, I was just sad about as the woman was not happy with her midwife. Then I read the replies, and I got really irritated by the tone of some of the respondants. What I should have done was clicked away from it but instead I put fingers to keyboard and fired off a reply (I blame the toothache). They gave as good as they got, the original author amended the title, but the tone was still so unsettling from some that I wish I hadn’t done it. It really makes me realise how little people understand the struggles within the maternity services now and are happy to keep demanding more from an already close to disintegrating system.

Memo to self, don’t read these sites, and if you do think once, think twice before replying.

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I am full of hope, yes me, Mrs Doom and Gloom is being positive. Why is this strange feeling being allowed to grow inside this miserable being? Well, an M.P, David Amess has made a call for more midwives citing an admission from the Prime Minister ‘ that the profession is stretched to breaking point, overworked and demoralised’. Yeah, we might actually be on the agenda now, is that what having all three major party leaders in the child-bearing epoch of their lives will do for the maternity services?

More exciting for me is a Facebook site, The Midwife. I’ve been following her for a while now, often laughing at her take on labour ward life and the midwife/medic relationship but last week, during an interchange about the firemans industrial action, the subject of midwives and their concerns came up. Commentators questioned how we could bring about an improvement in the maternity services via industrial action. Working to rule, striking, marching on parliament and petitions were all mulled over, the pros and cons discussed. Midwives will not strike, it would be just as difficult to work to rule, we may detest the fact that we frequently work hours over our contracted hours without pay but many of us would be unable to actually ‘down tools’ at the end of our shift if there were still women and babies requiring our care. With those options ruled out it looks as if we will protest and seek support via an on-line petition. As yet ‘The Midwife’ and her helper (not a midwife) have not gone live with the petition, and we don’t yet know the content or format, but rest assured, as soon as it is published I shall be linking to it.

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Work is incredibly busy at the moment and it’s all thanks to the snow, apparently. Was it because couples were snowed in and bored, or just because it was so cold, whatever the motivation was it has resulted in a major baby boom. The maternity unit has been bursting at the seams so they have been calling community midwives in to help out. This has had the knock on effect of reducing staffing in community because 2 midwives, who should have been working, have been working for 24 hours. Totally understandable that midwives should be called in but those women who were in hospital having their baby then go home and need visits, but community is short-staffed. The result? Over 5 days I have managed to log an extra 10 hours, and that’s on a phased return after my op. I’m not as hard-done by as one of my colleagues though who finished at 8pm on Friday, bet her women thought that she was never going to arrive and her husband wondered where his other half had got to, she should have finished at 4.30pm.

When a baby boom happens all areas of the service are hit hard. The community midwives feel it first, suddenly an inordinate number of first meetings, the booking, need to be done. Next the ultrasonographers find they are scanning more women, appointments become like hen’s teeth and more have to be slotted in, so it has to function more like a conveyor belt. Hospital staff start increasing clinic lengths to try and fit in all those who need to see an obstetrician during their pregnancy, everyone is beginning to realise that September is going to be a bumper month for babies. The beginning of August sees both hospital and midwife antenatal clinics becoming really, really busy as the women are now being seen every two weeks. Bad timing, school holidays mean that it is the height of the leave taking and there are less bank staff able to work, the maternity services are staff poor. There never was any slack in the system and now the strain is showing.

The end of August, labour ward is getting busier. Hospital tours and study days are cancelled, midwives are needed on the coal face. On-call community midwives are being called into the unit, that’s the first move, then they are being rostered to work in on the unit, their colleagues battle to cover their commitments. Meanwhile, in on the unit the staff there are running, literally, from one labour room to another. Women and their new babies are being moved to the ward as soon as they have given birth as labouring women are queueing for the room. The staff on the ward are desperately trying to help the new Mums and care for those who are unable to care for themselves. A quick discharge is encouraged, beds are at a premium, the paperwork increases. Community starts to receive the discharged women and babies, often the stay in hospital has been so short that breastfeeding hasn’t really started, visits are longer as more help and support is required. The women aren’t just giving birth in the hospital, there are more homebirths to be attended, community is struggling.

Hopefully the situation should start to improve over the next couple of weeks, certainly the managers appear to believe this as the next off-duty hasn’t got community midwives allocated to the unit, it’s the Health Visitors who are now entering the squall, I feel for them.

The managers have sent us letters thanking us for our support and hardwork.  They are also receiving letters. but these communications are complaints about the lack of care and attention. I hope they are blaming the snow and not their staff.

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I’ve learnt from long experience never to take what is said by hierachy at face value, so it is with fingers crossed that I write that the ’emergency’ meeting last week was reassuring. Certainly the head of midwifery acknowledged that community has been bearing the brunt of the staff shortages, that cracks are showing and that complaints have increased. The point was reinforced though that, even when the situation has improved staff-wise, postnatal visits must be kept to a minimum and that all our efforts must concentrate on the booking appointment and the antenatal care. Grrrr, so short-sighted, it is true that postnatal care is now the Cinderella component of maternity care.

There has been lots everywhere about the midwife who was struck off at the beginning of last week, the headlines were eye-catching, Midwife banned for God quip after couple’s newborn baby diedMidwife banned after telling grieving Mother ‘ God knows best’ but that is just what they were, eye-catching, but they were not actually correct as the midwife was struck off for misconduct in that she failed to provide appropriate care, behaved dishonestly with regard to her record keeping etc. This midwife broke numerous rules, breached standards and then attempted to cover her ommisions up, and for this this she deserves to be sanctioned,  but, with regard to he God comment the NMC acknowledge that the words were spoken at an emotional time and were not meant to be deliberately insensitive. This is not the reason she was struck off. Read the full findings on the NMC website.

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Last week daughter announced that she was seeing light at the end of the tunnel as far as the boys are concerned, then Friday happened. She was downstairs when sh noticed water coming from around the light fitting in her hall, swiftly followed by an ominous dripping sound in the utility room. She rushed upstairs to discover Louis watching with interest what happens when you’ve blocked the plughole of a sink with loo paper and then turned on the tap. It was all too late though. By the time she had mopped up all the water from the bathroom floor, water was coming out of the light switches and the ceiling plaster downstairs had descended onto the sopping wet hall carpet.  Along with her home lights the light at the end of the tunnel has gone out.

Tomorrow I return to work and the day starts well with a meeting to discuss the staff shortages. Staffing is dire and, according to reports, this is due to an increase in midwifery posts remaining unfilled. I wonder why there is a problem with retention of midwives, I don’t really as I talk to midwives who are leaving and everyone has the same gripe (locally), I don’t do this job to be treated like ****, be unsupported and not provide the care I would like to. When people ask what work I do the majority of people respond with ‘ Oh, what an amazing job, so rewarding’. I used to agree with them, it was rewarding, I did feel appreciated, I was supported and, most importantly, I felt I did a good job. Now? Well now I spend all my time watching my back, if a woman isn’t looking to complain about something, then the Trust is on the lookout for ways to get rid of expensive, experienced midwives. I read articles in the media assuring women that they ‘have a right’, government initiatives lead women to expect that their every wish will be fulfilled, and faceless commentators on sites such as Mumsnet reinforce women’s belief that a midwife’s personal safety* should not be an issue as she ‘has a duty of care’. I feel as if any rights that I may have thought I had have been swept away and left me, as a midwife, extremely vulnerable and, worse of all, I’m not able to provide the routine care that I feel the women and their families deserve.

I think that midwives should take a leaf out of the tube workers book, after all we have a lot in common, both our work involves tubes, they drive through them and I take blood from them, test fluid from them, investigate them and help extract little people from them. There the similarities end. They are taking industrial action as they feel that safety is being compromised due to the reduction in staffing, us midwives, we just leave or carry on covering up the gaps in the service. We are voiceless and ultimately colluders in our own unhappiness.

 ‘Black Dog’ was the phrase Winston Churchill used for his depression. I’m not clinically depressed, just depressed about the current state of the maternity services and knowing that there is worse to come. 

* This demonstrates the measures taken by one Trust to reduce risk for their community midwives. My Trust gives us a training day on personal safety, if they didn’t then they would be at risk of failing in their duty of care as it is recognised as good practice. We all have mobile phones, handy for anyone who wants to contact us but pretty useless if we encounter an unexpected, sudden threat. We do not go out in pairs at night, the first contact is by a lone midwife as sending out 2 midwives is ‘too expensive’.

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There has been a lot in the news recently about a scottish midwife, Anne Duffy who resigned from her job and is now claiming constructive dismissal by her employers. I’ve been interested in the outcome as the decision, it seems to me, will come down to interpretation of the NMC rules.

As yet a decision hasn’t been reached concerning Anne Duffy’s case, so why am I writing about it now?  Well, in the news today was a report about a couple whose baby sadly died as a result of no midwife going out to their home for the birth and the fact that a settlement has been agreed with the Trust.

In Scotland Anne Duffy was the midwife in charge of the maternity unit, which meant that she was the most experienced available midwife, when a call came in that a seriously ill, pregnant woman needed air lifting from an island to the hospital. After a discussion with other staff members she went off in the helicopter, when her actions were discovered she was disciplined and as a result she resigned. Report here.

So, on the one hand we have a case where a midwife attended and was disciplined as a result and  on the other hand, we have a case where a hospital failed to provide a midwife, a baby died, and the Trust have, I assume, admitted fault and made a settlement with the parents.

There are differences here, in one a midwife failed to follow hospital procedure, but fulfilled the professional requirement to provide care, and as a result was disciplined and in the other a hospital failed to provide care and have admitted fault. Can anyone else see the double standard here?

The Huddersfield baby death does bring up the homebirth and midwife staffing issue again though. There must be more to this though as there was already another homebirth underway, there was only one on-call midwife and she was already at the other homebirth so why didn’t the parents come into the hospital?

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