A cutting comic

One of my favourite comedians is Dara O’Briain. I love his forthright take on issues and his ability to spin off on a fantasy tangent, so imagine my joy when I was watching recently and he began talking about antenatal classes, both NCT and NHS. My ears perked up in rediness for some insightful side-swipes at the presentations he had sat through. It started well, the tone of voice we (some of us) use and the way midwives voice their opinions about doctors being over involved (true). It was during this second observation that my ears pricked up and I started shouting at the TV, something that only usually happens during One Born Every Minute. Mr O’Briain began talking about how the facilitator of the class exhorted the attendees not to let ‘the doctor near them with a knife’, it may have been scissors, or it may have been to cut them, but basically ‘Don’t let a doctor do an episiotomy’. The person went on to say that it was better to tear rather than to be cut, and it was this aspect which Dara went on to disect, using the fact that his wife is a surgeon to support his jocular comments which were ridiculing this attitude.

Tears versus cuts. Research has shown that the use of episiotomy should be restricted, for various reasons, but the one I shall highlight here is healing. As the person presenting Mr and Mrs O’Briain’s classes said, ‘a tear generally heals better than a cut’, this is especially true with muscle. During a caesarean section the surgeons tear the muscle. Why do they perpetrate this violence? If you tear a muscle it generally separates in the direction of the fibres, the fibres can then knit together better following surgery. Move from the abdomen to the perineum and the same logic must apply, with an episiotomy you just cut in a straight line, with a tear it is more likely to follow the fibres, therefore the chances are that it will heal quicker and with less pain. My final thought on this is that an episiotomy ‘may produce a larger wound to heal than would have been produced without intervention‘.

Less pain, better healing and a smaller wound? I know which option I would choose.

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Reduced productivity, I wish

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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Discrimination?

Last night I escaped my confines and went to a colleagues retirement do, analgesia, padding to sit on, plus a couple of glasses of wine and I had an enjoyable couple of hours. Before I started writing I was musing on what to say about this colleague when I realised that I could find myself in trouble for not being PC in my description, she is from the Caribbean and has a much darker skin colour than myself. Do I say ‘black’, ‘brown’, ‘dark skinned’ or ‘of colour’? I really don’t know. Does it matter how I describe a person’s skin colour? When chatting to other ‘white’ people I don’t worry that I may offend by commenting that they are ‘fair’ skinned, ‘sallow’ or ‘olive’. If my darker skinned friends make a comment which involves something along the lines of ‘you white people’ I don’t take offense, this whole debate is really to do with context I suppose. An argument here may be that, as I’m white, I have never been subject to discrimination, but that’s not true as I’m female and apparently we are discriminated against. I’m also a Roman Catholic and we can be discriminated against, never experienced that but I have experienced abuse concerning my faith, inadvertently and by friends who hadn’t realised I am RC. Was I concerned? No. Everyone is entitled to an opinion and it hasn’t affected our friendship.

Dwelling on religion I suddenly remembered something that really wound me up during the week, the Pope’s latest edict  (yes, religion and sex discrimination in one). I  just erupted when his pronouncement regarding the ordination of women came on the news. I actually have no desire to be a priest, I can’t logically see why women can’t be priests but logic aside I assume that there is some tennant within the church’s canon law which preclude it, so live with it. Be a nun if you want to dedicate your life to God and remain a Catholic. No, my argument isn’t with the decision not to ordain women, it’s with the overkill, the real slap down to those women who had harboured a wish. All El Papa had to do was say ‘Look, we have discussed it but it’s a non-starter for these reasons, this, this and this. Sorry and all that but Roman Catholicism just doesn’t allow for women priests’. But no, Ratzinger and his conclave decided to –

1. Discuss the heinous crime of women priests alongside paedophilia
2. Rate female ordination as one of the worst crimes which can be committed within the Church.

Both crimes would be subject to investigation by ‘The Inquisition’, not called that anymore but still the same thing, and whilst sex crimes by priests would lead to de-frocking, but not automatic  referral to outside agencies, attempting to ordain a woman would result in ex-communication and de-frocking  for the ordainer and ex-communication for the would be priest and was a ‘ grave crime against the sacraments’ , which equates it to heresy and desecrating the sacrament. Talk about cracking a nut with a sledgehammer, a woman attempting to serve God is as foul as a priest, in a position of trust, sexually abusing a young child? Sorry Pope Benedict you are so wrong.

I bet that God’s representative on earth, if you’re a rat catcher (Ratzinger, hmm), is not at all happy about the Pope Joan issue being topical again. Crickey, if he can’t tolerate the idea of a woman being a priest he must go into apoplexy at the thought that there might once have been a female Pope.

 Pope Joan

Anyway. Lovely evening yesterday. Really sad to see this colleague leave as she was often a ray of sunshine in the frequently dark mood of  our office. When life would get the better of my happy, cheerful personality* she would always take the trouble to offer support and help me shrug off my woes. For the students and ‘new to community midwives’ she would be a strong advocate and a font of knowledge. She has promised that she will come back and do a few hours here and there for us, I truly hope that she does as her retirement has left a huge space which will be extremely difficult to fill.

*Happy, cheerful personality. Yesterday I received a card and pressies from the G.P’s surgery I work with and one of the messages used those words to describe me.  Lovely.

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£1.7 BILLION

Yes, that’s how much the reconfiguration of the NHS will cost THIS time. I heard it last night on Question Time and, if I hadn’t been sitting at the time, I would have fallen over. Hubby was not able to hear much more of the programme as I was well and truly ranting. For God’s sake STOP IT, stop fiddling about and wait for previous changes, initiatives to show a result.

Polly Toynbee in The Guardian was so right when she wrote that ‘polititians have an obsessive, compulsive disorder’ when it comes to reorganising the NHS, it is ‘reorganising virus’ ‘ Polititians are bored by the fiddly stuff – making existing systems work, ironing out the glitches, fixing frontline obstacles for patients. Instead they reach for the big ideological lever…’  I just hope that she has not hit the nail on the head when writing ‘ and this time it might just break the machine’.

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Money talking

I’m in a sulk. I received an ‘invitation’ to register for a conference today, HSJ Maternity Services Conference 2010 , I clicked on the link and was really interested in the agenda, especially as there was much in there which pertained to community midwifery, both the practice and the funding. I checked the date, yes, I would be fit to attend, Tuesday, not ideal as it’s a clinic day but there is enough time for me to rearrange that clinic, so I clicked on the delegate rates. Now, much as I love conferences and know that I would get a great deal from this one, £399 ( £430 with travel etc) is way out of my price range and, for me, a mega amount of money to spend on a ONE day conference so I shall not be attending and I doubt that any other ‘grass roots’ midwives will either. I would hazard a guess that if I cared to attempt a chat with any midwifery managers that day they would be thin on the ground. They will all be there, in London, chummy, chummy, huddling together and nodding wisely as other managers powerpoint away telling them how to impose more paperwork on clinicians whilst reducing patient contact. Sorry, there is the ‘token’ speaker from a users group, the NCT, she will explain how women are unhappy with the care they receive and what the maternity services need to do to improve the situation. The women are unhappy, well I am as well but it ain’t going to get any better, ever. With reduced budgets, increased workloads and increased paperwork there is no way the service can do anything other than reduce and reduce. If you look at the programme it just about says it all, ‘collecting data; analyzing; compliance monitoring; monitoring improvements; engaging the workforce to gather and report timely information; measuring quality’ of yes, there’s a lot of information gathering going on here and who will do it? The midwives. First though there will have to be lots of nice meetings, brain-stormings and oodles of consultations, I should think a few management companies are rubbing their hands at this point anticipating the studies which will be initiated and the revenue these will generate.

I want to be there, I want to be able to hear rationales, I want to debate and comment on change and, more importantly, is it cost-effective and will it improve outcomes? Personally I’m fed-up with having initiatives  thrust upon us from some faceless echelon which magics up ideas and then expects the workforce to implement, audit and document ad nauseum. In a previous post I recorded a days work and compared the time spent on patient contact with other tasks, and now I find that The Nursing Times has discovered that community midwives spend 40% of their time on paperwork and travelling. and they had to conduct research (wonder how much that cost) to come up with that revelation. Well, now its official will someone please take notice and reduce the repetition and the gathering and recording we have to do. Yes, talk about it at the conference but not as to how midwives can record data but as to how systems can be introduced which will cut down on the repetition and free up midiwives to do the job they were trained for.

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The Demise of Community Midwifery- Part 1

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.

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Protected: A little white lie

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Choose and Book – Confusion and Bluster

So, having been unable to choose and book it all came back to the good old ‘they give you, or not’ , appointments system. That fell apart when they appointment offered, at a weeks notice, was for a Saturday when I was already booked on to an advanced life support study day. That was back at the beginning of September and as I have heard nothing from the London Teaching Hospital I phoned them today. Bearing in mind that the whole process has been going on since the beginning of July I had thought that apologies may be offered, I am such a numbskull and obviously inhabit an entirely different dimension to this sector of the NHS as no regrets were voiced, in fact the appointments clerk I spoke to was quite tetchy with me for presenting them with a problem. Yes, I am a problem since they have, in error, wiped me off their waiting list. The clerk admitted that they had made a mistake and then spoke to her line-manager whilst keeping me on hold for 10 minutes. This numbskull believed that when the clerk came back on the line it would be with the offer of an urgent appointment. I was worrying about if I would be able to make it, supposing that it were for a day when I was working, or I had the boys, or I was doing a school run or, worse of all, if it was during half-term when I’ve got Amy. I need not have troubled myself as I was told that  ‘ My line manager’s gut feeling is that you will have to go back to your G.P and ask for another referral to be done’. AAAAAAAH!!!!! Unfortunately I was less than happy with this solution to their mistake, and the appointments clerk was less than happy with my unhappiness. Her line manager is going to call me back, probably, at some time and tell me if his ‘gut feeling’ was right.

This whole saga has now turned into farce. A letter will be written and an explanation demanded, the system has got to be tightened up or entirely re-thought.

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Age discrimination

I have been scowled at today, so was my friend. Our grandsons, all aged just 2 were tutted about. Our crime was to go into Starbucks for a coffee and a chat after music makers. The local Starbucks is a large and irregularly shaped establishment, unlike the Costa Coffee, and this is why we chose it, we can go right to the back, around a corner and not disturb other patrons. Brilliant, our little area was empty, as was much of the cafe. The boys were also issued with instructions, no running, no throwing, no touching and stay next to the ‘Nannies’. After a while two middle-aged ladies came and sat about 15 feet away from our menagerie. The boys were doing what toddlers do, being quite noisy, nothing unpleasant, mainly giggling alot because they were playing peep-bo around the chairs within the area we had indicated to them. After a short while my friend caught my eye and indicated I should look over at the 2 women. Well, if looks could kill I would not be writing this. My initial reaction was to ask the boys to quieten down, but since my friend I were able to carry on a conversation without raising our voices I kept quiet. The next thing is that these two good ladies had vacated their seats, whilst shaking their heads at us and tutting at the boys, and moved to a different part of the cafe. At first I felt guilty but then the bolshie part came out. Hang on a minute, we were sitting there first, there were plenty of other tables they could have sat at but they chose to sit there. The boys were not being disruptive, they were not anywhere near them all they were doing was laughing and amusing themselves. At no time did they move anywhere near them, in fact they stayed in a corner with the width of the room, and friend and I, between our clan and the sour-faced old biddies (they were in fact younger than friend and I, but they were sour-faced).

It is ages since friend and I have ventured into a coffee shop, we have deliberately waited until we knew the boys could be controlled without tantrums and tear.  Today was a trial run, a hope that we can start doing social activities again. The boys all behaved brilliantly, friend and I couldn’t have hoped for more from them, but those 2 women have ruined the moment of normality for us.

So, the lesson for today is that if you are a grandmother, with toddlers, do not go anywhere, even late morning, where there may be ladies who coffee as coffee houses are obviously their domain.

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What now?

I’ve debated writing about this, at the moment it is still rumours, pretty strong rumours but it has some pretty hefty mongers instigating the whispering. If there is truth behind the words then the maternity services in one area will be stopping a service which has been provided for decades, that of domiciliary midwifery visits. If one region stops this care then eventually all Trusts will see the savings which can be made and community midwifery as we know it now will disappear.

Apparently a Trust has employed a cost-saving guru who has scoured the services and discovered that community midwives are an expensive item. They drive around the area, visiting new Mums and babies at home and this is obviously not cost effective to an accountants mind, after all, not only do they have to pay the midwife’s travelling time  but also her mileage. To any sensible person it is logical that, rather than the midwife travelling to the patient, the patient should travel to the midwife. This does happen already in some areas over weekends and this has allowed the Trusts to reduce the numbers of midwives working and being paid unsocial hours.

So, the benefits are that a midwife can see double the number of women and doesn’t have to be paid mileage. There are drawbacks, none of which are obviously financial so probably not of interest to an accountant employed to advise a Trust on cost-cutting. Women are now being discharged earlier and earlier from hospital following the birth, even those who have had caesareans now come home on day 2. In the future will they be expected to return the next day to the hospital, often having to travel over 15 miles due to the closure of the smaller maternity units? What about those families who do not have transport, or have other children? There are so many ‘what ifs’, many seemingly trivial but which will impact upon the welfare of mothers and babies.

Links identifying the role of the midwife in postnatal care

NCT

Maternity Matters

Community postnatal care provision in Scotland : the development and evaluation of a template for the provision of woman centred community postnatal care

The Lancet

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