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Archive for the ‘Work’ Category

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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I’ve just finished a run of working days, hell and heaven would be the words to describe them. Heaven were the weekdays, hell was the weekend.

Heaven = Visiting new Mums and babies on their first day home, listening to their birth tales, reassuring them that baby is fine, helping them out with breastfeeding and then going back on day 5 to be greeted with a smiley face and thanks for the advice and help I had given previously. Heaven is also seeing my women at antenatal clinic, listening to their woes and then making them laugh, answering their questions and giving advice. Meeting ‘old’ patients in the waiting room as they queue for babe to have his first jabs and being treated as an old friend, even hugged by some. Heaven is feeling that I must be doing/have done a ‘good’ job, that I have fulfilled my role to those womens satisfaction and/or expectations.

Hell. Hell is the weekend, working with a truly skeleton staff, unable to provide any sort of individualised care, the women are on a conveyor belt and I am an operative. Hell is arriving at the midwives clinic to discover that 2 of the 5 midwives scheduled to be working were out at a homebirth all night so are not working that day, then the phone ringing alerting the 3 remaining midwives that another homebirth is ‘brewing’. Hell is looking at the clinic list and seeing that there are 30 women attending and then reviewing the home visits to discover that 10 women need a visit. Hell is phoning those women who are expecting a home visit to explain that this is an impossibility and ‘inviting’ them in to the clinic to be responded to with ‘this isn’t my problem, it’s yours’. To attempt to reason with the shouting woman at the other end of the phone, tell her that there is a homebirth happening, that unfortunately these take priority, and that there is now only 1 midwife covering all women requiring postnatal care over an area of 400sq miles. To then be replied to, in words containing many expletives, that she is your priority, that your job is to provide her with care where she wants it and that YOU shouldn’t put a homebirth before her (where are the decision makers at times like this?). Heaven is when 1 of the midwives who has been out all night with a homebirth turns up at the clinic and works all day with you, although it must have been hell for her, sleep deprived as she was.

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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’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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Childlike

I’m not a person who enjoys conflict but equally I would rather address a problem than ignore it, until now. When all the rumours about me being moved to work back in on the unit my first inclination was to contact my manager and get the full story, fortunately she didn’t answer her phone and yes, it was ‘fortunately’, as it gave me time to rethink my strategy. I came up with a plan of action which required that I was not in formal consultation until a week ago, timing was all important with regard to when I resigned, which I would do if I was to be moved. So, instead of fronting up to my manager I put my blinkers on, kept my head down, and ignored all the rumours. You know how a child will believe that if they can’t see you, then you can’t see them, well that was me, no tantrums just hands over eyes.

I’m still carrying on with my new policy, and it seems that it may have paid off as my team leader contacted me on Friday to say that I am not being moved. I’m not going to count my chickens yet as I am now firmly of the opinion that you can’t trust a word that managers say to you, but as far as I’m concerned every week that goes by, which sees me still in my role as a community midwife, is a bonus and allowing me to get nearer to the light at the end of the tunnel.

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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.

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At last, at last, I have 13 days off work. I’m not sure if it is a good time to be absent as a major ‘shuffle’ is being hinted at with relocation plans being decided on Monday. Things are dire, and will definitely get worse before they get better. Midwives are leaving at breakneck speed, every week we hear that another colleague has handed her notice in, it’s scary, scary and infectious. Morale is slithering along, unable to drag itself out of it’s rut and, as the whispering and conjecture increases, morale sinks lower, and more midwives hand in their notice, it’s a rapidly progressing, destructive process. I’ve decided to put my blinkers on and not consider the bigger picture, if I broaden my vision it reveals a picture where so many elements are missing that it’s difficult to identify what the original image was, all there is are fragments.

Enough of that. I’ve been gardening, and it’s wonderful. One of my camillia’s is just coming into bloom, the garden is dotted with splashes of colour where little primulas are welcoming the longer days and rising temperatures, the pond is churning with amorous frogs and the red kite which glides over our house is no longer alone, there are two of these magnificent birds circling overhead nowadays. Spring is definitely in the air.

Last weeks homebirth. I was out in the wilds, just about to perform a stretch and sweep, when my phone rang, K was fairly certain that labour had started, 2 weeks after her due date. We had a chat (question and answer session), by the sounds of it things were still early on but as this was K’s second baby I was not going to be too laid back so I told her that I would finish this visit and make my way over to her, I got there within the hour. K was relaxed when I arrived with contractions coming every 5 minutes and lasting just under a minute, I relaxed and made us both a drink. K asked me to examine her so she would know how she was doing and confirm that this was ‘it’. After examining her I was delighted to confirm that this was ‘it’ as the cervix was over 6cms dilated BUT baby’s head was still high so I suggested that a few minutes marching up and down stairs, followed by some rocking on her birthing ball would  be a good idea. Whilst on the ball K munched on toast and honey which her Husband had prepared and before long the contractions were longer, and judging by K’s reaction, more intense. I phoned the unit and asked them to track down the second midwife, no rush but if she could make her way over within the next hour it would be a good idea. That was at 1pm, 5pm the unit phoned and asked what was happening, had we got a baby yet? ‘Umm, well no. I’ll update you within the hour’, even though we are at a homebirth we are still subject to the angst of the obstetric unit! We had a little conflab and K agreed with us that an examination may be a good idea. The examination was slightly disappointing, and confusing. The cervix was 8cms dilated and the baby’s head was still high and way off the cervix and there was something next to the head. I froze, please, not a cord. Gently I investigated, no, not a cord, fingers. There one minute, gone the next. Was it fingers? Could it have been toes? Was this baby in fact a breech? I told K that I was unsure what I was feeling and would she mind if A, the second midwife, checked. A examined and said she was certain that baby was coming head down and said that she couldn’t feel the fingers (or toes). We discussed the situation with K and said that it would be really good if we could a) increase the contractions and b) encourage baby’s head to come down so it was back the stair marching and sitting on the toilet. The unit phoned and were not happy, in fact the consultant said we should transfer K in for augmentation. Unfortunately I had just put the kettle so I still had to make and drink my coffee, then pack my bag up, not forgetting making sure that my notes were up to date! I went to K and her husband and put my cards on the table, I could delay the transfer for a while, I wasn’t concerned, K was fine and baby was happy but things could change at any moment. Nipple stimulation, that may be a help. I left them to it! Twenty minutes later K was violently sick, and her waters broke, within 15 minutes we were seeing the top of baby’s head. Slowly, slowly baby pushed her way out, with her arm across her chest and her hand on her cheek, I had felt fingers and that was why her head stayed high for so long. Weighing in at 8lbs 6ozs she was 2lbs heavier than her sister but with her shock of thick, black hair was the image of her. I got home at 11pm, really hungry but happy to have been able to welcome baby into the world.

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