Feeds:
Posts
Comments

Archive for the ‘Midwife’ Category

Experienced midwife required

The BBC is looking for an experienced midwife to feature in a one-hour documentary.

The midwife selected will travel to Liberia to work alongside West African midwives. They will also be staying with their mentor’s family, to gain a picture of life outside the workplace.

The BBC are looking for midwives who are ‘good at expressing an opinion, who are up for a challenge and who aren’t afraid to open their eyes to some very different ways of living and working’.

If you are interested, please email: fiona.walmsley@bbc.co.uk or Tel: 020 8008 5794.

If only I were less of a homebody, and more of an adventurer, I would be on the phone now. Excuses, excuses but who would look after the grandchildren, and I bet that they would want me to have lots and lots of vaccinations and there are creepy, crawlies, but what an opportunity.

Read Full Post »

I’m going to have a new grandchild, all being well, some time in June. I’m being non-committal about dates as there is some disagreement between scan dates and EDD by first day of last period. This situation is not unusual, the majority of my women will arrive at clinic following their dating/nuchal scan with a date a due date a few days earlier or later than the one arrived at by naegel’s rule. There in lies the first dilemma, the scan date is 3 weeks later than calculated using an obstetric calculator. At this point I generally discuss longer cycles with the parents, I started out doing this but was cut off at the pass by son pointing out to me that all the measurements were indicating a fetus whose size was above the top line. We waited for the 20 week scan, same story, big baby estimated as being due 3 weeks later than DIL’s dates. Due to DIL’s low BMI there was another scan at 28 weeks  just in case baby was not growing well. No worries there though as baby was once again on the top line. I’m a little piggy caught in the middle. I know that scans are generally accepted as being more accurate than LMP, however they can be wrong and it’s not surprising really as the measurements used are so small initially that a slight malpositioning of the probe could make days of difference. I’m torn because of several little things,their first baby, Evie, was 12 days late and only came because of induction and even then had to be helped out with the ventouse, dislocating her Mummy’s coccyx on the way.  I rationalise the lateness of Evie by factoring in that DIL was stressed due to son’s illness so her hormones were not behaving optimally for  labour to start spontaneously. Perhaps that wasn’t the cause though, was it because baby was too large for DIL? Now supposing that this baby is also late. DIL’s dates indicate a due date of 5th June, 2 weeks over would mean induction round about 17th to 19th June but the scan says that baby is due on 25th June and allowing DIL to go 12 days over would mean the pregnancy could be 5 weeks over. From another perspective, if the scan dates are correct then this baby is big, very big, will DIL be able to get it out? 2 days I did an antenatal examination, all well until I palpated. Baby feels ‘a good size’ and, at 32 weeks, is measuring in at 34 weeks.

This feels like deja vu. Amy’s Mummy had a large bump with her. I referred her in with polyhydramnios and a large baby at 32 weeks. I was right, but that didn’t stop the consultant allowing daughter to go 10 days over and to end up with an emergency caesarean for failure to progress in labour with a 9lb 12oz baby.  I’ve highlighted the discrepancies between dates, scans and size in the notes, had a word in clinic sister’s ear and eagerly await the consultants thoughts next week.

Read Full Post »

Yes, it’s true, I’m actively searching for a job. It would be excellent if it were midwifery related but, having applied for 2 and not even being short-listed, I’m becoming far less conservative in the roles that I could be lured to apply for. The posts I coveted were non-clinical, research and teaching, but the persons shortlisting were obvious totally unaware what an amazing resource I would be and never even gave me the opportunity to plead in person, their loss. No it wasn’t, it was my loss, I desired those jobs and not just for the change of emphasis but as the escape route they would provide from the hell which is NHS midwifery. Okay, so this sounds incredibly melodramatic, ‘hell’, personal hell is a more accurate description, but that is precisely how I currently view my professional life. I am so, so sad to feel like this as just a few years ago I was known to declare that ‘if I won the lottery I wouldn’t give up work as I loved my job so much’. There has been a complete turn around in my attitude,  I recently informed my manager that I would never have believed that the last few years of my working life would be the unhappiest.

What’s the problem? Just about everything I suppose. My joy in my job came from the relationship I formed with the women and their families and the continuity of care I was able to provide. I never wanted to be a hospital midwife and never yearned for the buzz of high-risk cases, I guess that I’m just old-fashioned. Community midwifery is changing, huge reorganisation of the service is underway, home births are in, home visits are out. Experienced, senior midwives within the community are not required, experience for junior midwives within the community is required (it’s also cheaper).

I’m not alone in my disillusion with midwifery. I looked around at all the midwives I trained with and started my professional life with and realised that I am the only one how is still practising as a midwife. Midwives are leaving the profession at a massive rate but this is not just a local phenomenom, it is more widespread and, in some areas, huge. Midwifery is changing, the government has made promises about maternity care without regard as to how they will be funded,  especially at a time when drastic savings are being called for and resources are subject to cutbacks. Managers are attending meetings at an amazing rate, firing off emails to staff inviting them to one-to-ones and then making knee-jerk decisions which astound those on the coal-face, astound and demotivate.

I’m finding my working life excessively stressful, I hate feeling that events are beyond my control and that decisions which directly affect me are being made with absolutely no consultation. Last week several colleagues contacted me with information about dramatic changes which are being planned, changes which will impact directly on them and me. I am receiving titbits which imply that where I work will be changed and that I will no longer be a community midwife but will become the midwife-in-charge on labour ward however no manager has contacted me about these changes. I am in turmoil, cannot sleep, am exhausted with musing upon the upheaval which seems imminent and have an intense desire to just throw in the towel. I’ve tried to speak with my manager, left messages but have not received any response, I am in limbo and looking for a way out.

Read Full Post »

Midwife Muse’s roll call of causative factors so far –

  • PCT’s for with-holding government monies
  • Groups who place the majority of their emphasis on THE BIRTH, and lobby accordingly, putting antenatal and postnatal care on the back burner
  • Trusts for employing too many managers

Fittingly the midwives come last, that’s the usual position we appear to occupy in any planning, so why alter the status quo? Why are we to blame then? Well we will do what we always do when change is foist upon us, we will grumble, get stressed, some of us will even rant, in private but ultimately we will comply. When I used to work in the unit the obstetricians, generally the registrars, would keep coming out with jokes which were always based upon how bolshie midwives are, ‘What’s the difference between a rottweiler and a midwife? A rottweiler eventually lets go.’ That may be true in the one-on-one clinical situation, when we are being an individual woman’s advocate, but as a group, when change is being imposed, our contracts being re-written or some other attack on our ability to provide the care we KNOW that we should provide we capitulate and fail to work together to resist or modify the changes.

My crystal ball is showing me that once again we will moan and have a brief, vaguely supportive interaction with our union, incidentally that won’t get us anywhere (prediction), a couple of us will leave, another couple will retire, half of us will apply for other jobs, perhaps midwifery related but the majority of us will just end up going along with a change we are intensely unhappy with.

Midwives are their own worse enemies. We are already working above our capacities, both within the maternity units and in the community but we don’t ‘work to rule’, we can’t, but we should. The managers are not ignorant of the ridiculous workload and the number of extra, unpaid hours the staff put in, in fact I do believe that the managers join in sometimes, so we are all colluding in the farce which will allow these changes to go through, these changes which will definitely affect the coal-face midwives, the women and babies.

For a profession whose members are portrayed as fierce we are badly misrepresented, we are actually shrinking violets.

Read Full Post »

In Part 1 I identified the PCT’s role in affecting how midwifery care is provided in the community and then, in Part 2, I talked about how I believe that user and pressure groups, focusing their lobbying on the birth, has adversely influenced funding for other areas of maternity care.

Managers, and other higher grades. They are not dissimilar to metal coathangers really, turn your back on them for a while and they have replicated themselves, Southampton have managed a 85% increase in their numbers in 4 years.  Maternity services are not about to be out-shone by the other departments where the number of managers has risen 3 times as fast as the number of nurses.

Locally, 10 years ago we had 2 separate maternity units, each unit had 3 managers, including their Head of Midwifery, I’m quoting here from personal experience, but I doubt that my experience is different from many others. Anyway, within 5 years 1 Head of Midwifery had gone, this happened when the 2 separate units came under the umbrella of 1 Trust, but 2 more manager posts and 1 consultant midwife post had been created, so minus 1 but plus 3. When the 2 maternity units later amalgamated into 1 building it was imagined that a manager may lose their job but that didn’t happen, blink twice and there are 11. They don’t all have the title ‘manager’, there are ‘specialist’; ‘consultant’; ‘modern matron’ and ‘head of’ but, basically, they are all managers, I’m not including 9 ‘team leaders’ here as they are a sort of hybrid who manage but are predominately clinically based, unlike the afore mentioned menagerie. So, in summation, over a 5 year period 6 managers have become 11 whilst the number of midwives have increased by 6 therefore 1 more midwife has been employed on the coal face compared to managers. Managers are Band 8, clinical midwives Band 5 and 6. A look at current pay scales shows the difference in wages, bottom Band 5 = £21,000 pa, the same for Band 8 = £38,000 pa, that’s nearly a two for one situation, or scrub the Band 8 and that’s a saving of £38,000 + employers NI and pension contributions, that must take it well over £40,000, nearly what they are saving in mileage costs and stopping weekend/bank holiday working by ALL community midwives.

There, no consultation required. No cutting of domiciliary visits. Just get rid of ONE manager.

Read Full Post »

Maternity funding still not being delivered, British midwives claim

Millions of pounds of government funding intended to improve maternity care is still not reaching front line services, midwives say. Despite a rising birthrate, nearly a fifth of the heads of midwifery said that their budget had been cut, and almost a third had been asked to reduce their budgets. Last year the Government promised £330 million of extra funding for maternity services, but this has not been ring-fenced.

The results, from a survey across Britain by the Royal College of Midwives (RCM), come as the Health Secretary is due to speak at the union’s conference in Manchester. Andy Burnham will today announce a new “Start4life” campaign highlighting the importance of breastfeeding and healthy eating from infancy.

The RCM said that 5,000 more midwives were needed to provide safe and quality care to new mothers. Ann Keen, a health minister, said that it was up to NHS trusts how to invest the additional money. “Where funding is not reaching maternity services I call on Heads of Midwifery to challenge their PCTs,” she said. “We recognise there are concerns around staff morale and attrition rates and we are working with the Royal Colleges and the NHS to address these areas”. From Times Online November 27,2009 & Socialized Medicine

When I first worked on the community we all wore a uniform, when we were instructed to be in ‘mufti’ I was uneasy, I liked the fact that that as soon as a door was opened to me I was identifiable as ‘the midwife’. It’s been nigh on 10 years since I donned my uniform, other than odd days when I have been irritated by edits from above advising us to dress like office workers, so I protest by squeezing into my uniform, after all I’m not an office worker, I need to wear outfits which allow me to drive comfortably, plod across muddy fields, crawl around floors and lean over birthing pools. Do I miss my uniform now? No. That’s the thing about change, at first it’s disturbing but eventually it becomes normality.

There, aren’t I the philosopher, quite rational really. Well that stops now, a change is looming which has me seriously concerned, a change which doesn’t just affect how I dress as a midwife but how I deliver care as a midwife. So, what is the association with the quote from ‘The Times’ and my disquiet? My Trust is one of those affected by the PCT with holding government funding intended for maternity services, and what can be done about it? Nothing apparently, and the result, oh the result is fine and dandy, for the PCT, they keep the money but the providers of maternity services, well they have to make cutbacks. Does that suggest that maternity care will be improved?

The cutbacks, or evisceration, are fairly comprehensive. Our antenatal clinics will be moving out of  G.P surgeries and into Children’s Centres. Actually this is a suggestion within ‘Maternity Matters’ , I was going to put a link here, but fittingly the ‘website was unavailable’ since a quick read would reveal quite how loosely the recommendations (promises) are being implemented, the culling continues further though. Women will only receive a home visit from a midwife the day after they return home with their newborn, after that, well its back to the afore mentioned Children’s Centres. Sorry, I fibbed, not all women will have to travel to these centres, those assessed as requiring more ‘assistance’ will have a home visit. Oh, I forgot to say, no visits on a weekend, no clinics either. We won’t be able to do that, well midwives are expensive at a weekend, so it will be a skeleton service, so skeleton that there will have to be 2 midwives ‘on-call’ for the weekend as, if there is a homebirth, there will not be any midwives left. Incredibly cost-effective really as those 2 ‘on-call’ will only be paid £15 each to put their lives on hold for 24 hours, over a weekend, and be at the Trusts beck and call. Real value for money.

Am I blaming the PCT? Yes, but there are also other culprits, they will be in Part 2.

Read Full Post »

A while ago a reader, Alice, asked what the -3 measurement related to when midwives* describe baby’s position and so, hopefully, I’m just about to explain the concept of assessing descent of the presenting part of baby, generally the presenting part being it’s head. Any midwives etc. reading this may well have apolexy reading my explanations which will be accuate, but not couched in medical terminology, also I have personally illustrated what I’m talking about but I am by no means an artist!

There are two ways that midwives estimate how far down baby’s head has gone. The first is how it’s done in both in pregnancy and during labour and is discovered by abdominal palpation, or having a feel of the woman’s bump. When the midwife concentrates her hands just above the pubic area, and possibly asks the woman to breathe in and then relax as she exhales, the midwife is trying to determine how much of baby’s head she can feel. This may be slightly uncomfortable as the lower part of the uterus, bump, can be a bit tender toward the end of pregnancy. The midwife will then record her findings in terms of fifths. If she can still feel all of baby’s head then she will write 5/5ths palpable (palp), look at my drawings below and the 5 drawings on the left side illustrate the gradual descent into the pelvis as felt abdominally. Basically, the less of the head felt the the lower the number of fifths palpable. Sometimes a midwife will write ‘Engaged’ (eng) rather than a fraction, when this is writen it means that, in her estimation, the widest part of baby’s head has gone through the brim of the pelvis. (In the photo the brim is the top of the inner circle).

Below is a photo of a female pelvis. The angle is such that if this were a real woman the photographer would be standing at the woman’s feet whilst the woman was lying on her back with her bottom tilted upwards.If you look at the inner circle of the pelvis you can see that I have stuck blue stars on little bony protruberances, these little lumps are called the ischial spines, the gap between them is about 10.5- 11 cms, and these are the landmarks that an estimation of descent, or station, of the presenting part is based upon when an internal examination is performed.

 

 

S0, the spines are 0 (nought) in a midwife’s world. When a vaginal examination is performed the midwife will hope to be able to feel these small bony protruberances  and then note where baby’s head is in relation to them. The spines are 0 and whether the head is above or below is expressed in centimetres, minus ( – ) if it is still above, plus ( + ) if below or, if it is level with them, then a midwife will often write ‘at spines’. My drawing shows the gradual descent through the pelvis, sort of!

This is a simplistic explanation of how estimations of descent are conducted and expressed, below are a couple of on-line resources which are well worth reading.

Liverpool University

Pelvic anatomy

* I’ve written ‘midwife’. It could be a G.P or obstetrician.

Read Full Post »

Christmas Day for a midwife

 

7.30am, woke up, not because of excited children but due to my alarm beeping loudly, yes, just like an ordinary working day. Three-quarters of an hour later and I was quietly closing the front door so that I didn’t disturb a sleeping Hubby and, crunching across the icy snow and getting into the car. 

8.30 am and I unlocked the office door. Instead of the usual 4 or 5 midwives in our office there were just two, just 2 with half a dozen mince pies, a tin of chocolates and a box of luxury biscuits. Unfortunately we have no tea or coffee making facilities and the cafe isn’t open at weekends or bank holidays, so the biscuits were left unopened, the mince pies stayed in their container but each of us took a handful of chocs to enjoy whilst driving around. 

Busy day in store. Usually we try to leave Christmas Day free of ‘routine’ visits and only do visits for those who have been discharged from hospital the day before, but the backlog of visits from the couple of  days when the road conditions made some visits too dangerous or impossible meant that we each had 5 visits on the books before we found out about the new discharges. No one wants to be in hospital on Christmas Day so there are always quite a few discharges, and today was no different, so by the time the phone call from the mothership was over I potentially had 11 visits. My colleague and I had a chocolate and then brainstormed, prioritise, that would be the solution. A few phone calls later and 3 women had told me that they didn’t want to see a midwife on Christmas Day and assured me that all was well with them and baby. 

9.30am, I picked up the entonox cylinders and left the office. The main roads are virtually ice and snow free, however the side roads are full of icy, rutted snow and black ice, that was what I encountered arriving at my first visit. Having negotiated the slope and the corners I found a safe place to park, away from any other vehicles and not obstructing anyone’s driveway. As I stood getting my scales and bag out of the boot a BMW started coming toward me, lovely, new 6 series saloon  with an elderly, distinguished looking gentleman behind the wheel. Just as he drew level his car lost traction, there was much wheel-spinning and no forward motion so he ceased trying and proceeded to lower the window nearest to me. He may have looked distinguished, but his language was straight from the gutter . The gist of his discourse was that his driving difficulties were due to him having to drive past my car; that if I didn’t move then he would probably end up bashing my car; that I should drive out of the side road and onto the main road. I wished him a happy Christmas, apologised for having to work and inconvenience him, returned my scales and bag to my boot and drove out of ‘his’ housing estate and parked on the main road. Then I was truly pathetic and had a quick cry. He had difficulty driving up the road, I wish I could see him again and explain to him how much more difficult it was to negotiate 200 yards of rutted, icy snow carrying scales and a heavy bag. Good start to the day. 

My next visit was to the home of the woman’s parents, as arranged, however she was running late so I was asked to ‘return in an hour or so, but not over 2 hours as they would be having christmas dinner then’. For the rest of the day everyone was in, and welcoming, and after 30 miles and 8 visits I pulled onto my drive.

4.30pm  and I’m home. Hubby had cooked the turkey and was just putting the beef in to roast, we are having a christmas ‘buffet’ tomorrow. I phoned all the family and heard how their day had gone, prepared one of the puddings for tomorrow and with ‘The Gruffalo’ recording in the background settled down to baked beans on toast. Who needs turkey and all the trimmings?

Christmas day for a midwife is much the same as any other, the roads may be quieter but there are still breastfeeding issues to try and resolve, newborn screening to undertake and babies to weigh. Unfortunately I’m on call until 8.30am so no relaxation….yet, but tomorrow, whilst everyone else has a year to wait until next Christmas, this midwife will be enjoying her’s with all her family.

Read Full Post »

Slip, sliding away

It’s been a while, but I’m writing again, as much for my sanity as anything else as blogging does appear to have a beneficial effect upon my stress levels. It must be that the ability to let off steam here alleviates the build up of pressure, and there’s certainly a lot of that about at the moment.

The police appear to have completed their investigations into the death of my step-father, the whole process has placed huge strain upon our family, and the next event will be the inquest in January at, or after which, I anticipate my Mother will finally slip over the edge as I don’t think she will be happy with any decision other than to hang, draw and quarter the driver of the reversing car and that ain’t going to happen.

I’m on-call tonight but for the first time ever I am confident that I will not be called. The snow has been so bad, many roads are closed, that the decision has been made that homebirths can not be covered. Generally I would still be on call for the birth centre but as several community are marooned there they will not need to call me in, hurrah, I hate driving in snow.

Amanda Holden’s programme about being a midwife? Love it or hate it? Well, I didn’t hate it. There were some aspects which irritated me but on the whole I felt that it was a positive, if restricted, vignette of a midwife’s role.

The good news is that I’m going to be a Grandmother again in June, that will be seven of the little rug-rats.

HAPPY CHRISTMAS  

Read Full Post »

Protected: A little white lie

This content is password protected. To view it please enter your password below:

Read Full Post »

« Newer Posts - Older Posts »