Panorama. Disappointing, once again fairly toothless. Terrible shortcomings revealed, some real problems, women being forgotten about down long corridors, units being too full to take labouring women, appalling staff shortages. Interpretation of events from an 'esteemed' Midwifery professor who, on occasions, didn't seem to know her arse from her elbow. For example, much was made of the undercover reporter holding the pick-up in position whilst a CTG (cardiotocograph) was in progress. There is really no problem with that, she was not being asked to initiate the monitoring, she was just being a human belt to hold it in position and ensure a good tracing. My issue with this was a) A CTG machine should not be used as a 'babysitter' because staff are busy. They always are though, I do it, we all do it. It is poor practice, just supposing that 2 minutes after the midwife leaves the room, with the monitor functioning, there really is a problem with baby, it won't be discovered for 20 plus minutes. Terrible, there you are, assessing if a baby has a problem, it has but you are not there to call for the help which would potentially ensure it was born alive and healthy. If a baby is being monitored it is presumably for a reason. In the eventuality that the baby was compromised, and there was an investigation which culminated in a negligence case the lawyers would have an absolute field day b) A student discontinuing the monitoring, helpful, yes, but safe practice, no, for much the same reasons as point a). There were so many points in the documentary that leapt out as requiring more probing by Jeremy Vine that I could carry on for pages, I just felt sad that a good opportunity was lost.
The twins had their cardiac scans on Friday and were pronounced, "text book babies". Hurrah. I had tried beforehand to alert daughter and SIL as to how important this scan was, if I hadn't succeeded then the place itself had managed to impress upon them how serious the results could be. Daughter related how when they arrived the building had appeared really modern and welcoming but that as soon as they walked in there were couples sitting together, some distraught, some just silent and suddenly the enormity of what they could be told that morning hit them full in the face. They were lucky, Van and Lorry are growing perfectly so far.
Friday was the day of my birthday/Christmas treat, off we went to the Sound of Music. Connie was playing Maria, although that was just the icing on the musical, I just really enjoyed the whole evening. Before we went to the Palladium we had a meal in Carnaby Street, that was a journey back to my youth. When I should have been hard at work in school I could be found touring London with my friend with Carnaby Street and Battersea Funfair being two of our favourite destinations.
We stayed up in London overnight, disappointing hotel, The Kensington Park, allegedly 4-star, I'm assuming they grade themselves or it is only assessed every 10 years because there is no way that it should achieve 4 stars with it's current accommodation and service. Anyway, went to Tate Modern on Saturday. Amazing facility, plus it's free. The majority of modern art is lost on me though, I'm one of the boring old traditionalists who pronounce that 'I could do that'. Hubby has decided that many of the artists are like him, they want to be artists and enjoy painting or sculpting, but they really have no talent. However, they carry on anyway, no one has the heart to tell them they are rubbish and some group somewhere has an 'emperors new clothes' thing going on and no one will admit that the work is stupid. I enjoyed the experience though!
Now for a little, salutary tale -
A married couple in their early 60s were out celebrating their 35th wedding anniversary in a quiet, romantic little restaurant. Suddenly, a tiny yet beautiful fairy appeared on their table and said;
"For being such an exemplary married couple and for being faithful to each other for all this time, I will grant you each a wish."
"Oh, I want to travel around the world with my darling husband" said the wife. The fairy waved her magic wand and - poof! - two tickets for the Queen Mary II appeared in her hands.
Then it was the husband's turn. He thought for a moment and said: "Well, this is all very romantic, but an opportunity like this will never come again. I'm sorry my love, but my wish is to have a wife 30 years younger than me. " The wife, and the fairy, were deeply disappointed, but a wish is a wish.............so the fairy waved her magic wand and - poof! - the husband became 92 years old.
The moral of the story: Men who are ungrateful bastards should remember that fairies are female.
Multiplicity
Twin to Twin, what could the results be? Well here they tell the story of one of them (the link was kindly given to me by 'Della'), and below is a picture from the article.
Yes, they are identical twins!
Expecting?
Today Van and Lorry, the babies eldest daughter is incubating, had another scan, this time it was that much looked forward to 20 week, or correctly called, an anomaly scan and I am delighted to record that neither baby appears to have any structural problems. There the little peas in a pod were lying, top to tail, all the easier to aim a good kick at a siblings head. Amy and I sat there, looking wonder at these two little babies waving their perfect minature hands at us. There was one moment as Amy turned her face to me and whispered 'Babies' that I felt an almost overwhelming feeling of happiness, not only do the twins not appear to have any major anatomical problems but there is also no sign of the dreaded twin to twin transfusion syndrome. Both of them are the same size, give or take a couple of millimetres, and the amount of fluid they each have is completely normal. On Friday they will be scanned again, this time at a specialist Fetal Cardiac Unit, to check that they have no subtle, or major, cardiac abnormality as, apparently, twins are more likely to have heart malformations. There will still be a long way to go, but if all is well at this next scan I shall really be celebrating and starting to look forward to being a Grandmother to identical twins.
Tomorrow on BBC's Panorama there is an 'expose' of the problems in the maternity services. One part of me is really looking forward to it, as long as it is a balanced view, but a more cynical side to my nature is already anticipating that it will be as toothless as the ITV programme last year. Why do I suspect this? Well, in The Mail there is an article today which reports on the content of the programme and the only time they mention a Manager it is a Trust Chief Executive. Guess who she blames? The Midwives, and the impression I get is that she gets away with it. Oh well, we'll see.
The pain of the childbirth issue.
I am reproducing this article here, in full, as well as linking to it. It is wonderful to know that good old blighty is not the only country to be experiencing high caesarian rates but it is also refreshing to have someone consider the whole pregnancy, birth experience in relation to fashion, culture and expectations. I feel that pressure is being exerted on women by the media, whether it be in magazines with articles telling them how to have the best childbirth experience, newspapers scaremongering one day about normal birth and how dangerous it is for Mothers and Babies, and calling for homebirths for all the next or the Government weighing in with its plans to increase the number of homebirths, producing little booklets which advise women that they have a choice, and initiatives which they proclaim to the public but omit to say that they are on a wish list and not really available. Which way should a woman go? Protect her reproductive tract and have a caesarian, saving money then on having her 'designer vagina' constructed by a surgeon. Perhaps she should just seek out a birth unit, all low lights, soft music and large baths, certainly that sounds like a lovely option but unfortunately they don't offer epidurals so if it is a birth centre it should be close to the consultant unit and that way, once the aromatherapy and the massage has failed to smother the outrageous contractions, a wonderful anaesthetist can come and site the ultimate in pain blockers and instantly double their odds of requiring an instrumental delivery, if not a caesarian.
Caesarean glut not just about too few midwives
Michelle Hamer
April 30, 2007
Other related coverage
CATHERINE DEVENY The great birthing con is taking choice away
The introduction of one-on-one midwife care alone will not curb Australia's soaring caesarean rate; it hasn't worked in New Zealand and it won't work here.
Catherine Deveny (Opinion, 26/4) wants the Federal Government to support independent midwives as a means of reducing our caesarean rate, which at 30 per cent is double the maximum number of surgical births considered appropriate by the World Health Organisation. (But the WHO figure was set more than 20 years ago, and many argue that it is outdated.)
To support her argument, Deveny cites the introduction of one-on-one midwife care in New Zealand 13 years ago - and the huge maternal shift towards it. What she doesn't mention is that despite the switch to midwife-led care, New Zealand's caesarean rate has continued to rise steadily.
In 2003, 23.1 per cent of New Zealand women underwent a surgical birth; in the same year Australia's rate was 27 per cent. Australia's rate has continued to rise in the past four years and there is no sign that the New Zealand figures have done otherwise.
In Finland, which, as Deveny correctly states, has one of the world's lowest caesarean rates of 16.1 per cent, pregnant women are largely cared for by midwives during their pregnancy, but this is often under the supervision of a specialist, and does not continue during the birth, which is managed by an obstetrician. So something else must be contributing both to Finland's reduced, and Australia's rising, caesarean rate.
Certainly in Scandinavian countries such as Finland, childbirth is seen more as a natural, physiological process, rather than a condition to be managed and controlled. It's no coincidence that the countries with the lowest caesarean rates are also those that most warmly embrace family-friendly work and government policies.
If having a baby is seen as a natural part of life, rather than a scary endeavour that will damage your career and cut you off from mainstream life, then it's likely you'll approach it in a more relaxed manner.
But in countries such as Australia, the baby stakes are high. We're constantly reminded of the cost of bringing up children, and we tend to slot baby-making into a calculated position somewhere after paying off a cavernous house and getting as much travel and experience as possible under our belts. Strange that starting new life is often seen as the ending of so much more.
In this culture it's no wonder the thought of having a baby "the old-fashioned way" is less appealing. Making the decision to have a child in the first place often requires so much agonised consideration and strategic planning that mucking it up at the end is not an option.
And this is the way vaginal birth is increasingly being seen: as a little wild and out of control, messy and unpredictable.
Caesareans are certainly safer for obstetricians; no Australian doctor has ever been sued for performing a caesarean, though many have faced litigation following vaginal births gone awry.
For a society that has elevated technology to a new form of religion that offers a more sanitised, controlled experience of the world, a caesarean is often seen as the "new, improved childbirth".
This month the NSW Government weighed into the debate, trying to reduce the number of medically unnecessary caesareans by ensuring mothers are clearly informed of the risks of such a choice - but research shows that just 5 per cent of Australian women are storming into their obstetricians' rooms and demanding to have their child cut out.
Most mothers set out with the best of intentions for a natural birth, but are often swayed when the "risk" word creeps into prenatal discussions. Multiple birth - ooh risky. Breech - let's get out the scalpel. Previous caesarean - sorry love, no choice. The baby's heart rate is too fast; too slow; too loud - what the hell, let's cut.
We're all scared by the what-ifs of childbirth and have been seduced into the idea that a caesarean will be safer, more predictable and manageable, but major abdominal surgery is not a walk in the park.
Legislative support for midwife care may help, but there are many more conversations about the importance of family, about our shame and blame culture and our intolerance of (perceived) risk before midwife care alone will reduce the caesarean rate.
Michelle Hamer is the author of Delivery by Appointment - caesarean birth today (New Holland) and the mother of four children born by caesarean.
I read this on a day when I also discovered that 'postnatal depression', by the way us midwives are not supposed to call it that anymore, it is depression, pure and simple is at an all time high. I wonder, could there be a link here, are womens expectations of the childbirth experience too high?
Long weekend
Yesterday I was mentioned in dispatches by NHS Blog Doctor, I was surprised, pleasantly so but then I became suspicious, after all my favourite blog doc is not known for his support of 'madwives'. My mention followed a reference to Tom Reynolds and Maternataxis, we had both blogged about ambulances and women requiring transport when in labour. I whole heartedly agree with Random Reality about the misuse of ambulances by women who are just using them as a free taxi service. If, as in my entry about the unplanned homebirth, events progress with unexpected rapidity and the stage is reached when the labouring woman is unable to move, let alone get into a car, then an ambulance and midwife should be summoned PDQ. However, all too often the ambulance service are summoned to transport a woman who really should use her own transport, whether that be in a family car, with friends or in a taxi. Amongst the comments in Tom Reynolds blog were people bemoaning the fact that haven't got their own transport, they have had months in which to arrange a suitable form of transport, being in normal labour is not an emergency, it is an elective event.
I had a phonecall from my job-share partner yesterday to tell me that she had not been at work on Friday, she had instead spent 7 hours in A & E with atrial fibrillation. In the morning she had woken up with chest pain, a superfast heartrate and difficulty breathing. Scary. After the sojourn at the hospital she was discharged with Aspirin and the promise of a follow-up to investigate the cause of her heart misbehaving. She is putting it down to a late cup of coffee with me and stress at work, is this her way of saying I cause heartache?
On Friday I babysat Izzy so Daughter could take Jack to the zoo and give him one-to-one time, I was confident all would go smoothly, wrong! It all started off really well, Nanny and Izzy went and did the supermarket shop together and Izzy fell asleep on the way home, unfortunately she woke as soon as we got indoors and that's when the fun started. She was a hungry little girl so Nanny warmed up the bottle, pointless exercise really as tiny tot was not having it. The offending item was pushed away and the crying commenced in earnest. This was no heartbroken sob, this was full blown anger and indignation, a latex teat, even if it was a Nuk, was no substitute for Mummy and was not going to be accepted. We called a truce, nappy-free time was declared, always a good move and cause for giggles and gurgling. Once we were friends again I gave the bottle another try with the same result, I admitted defeat and just spent the rest of the day jiggling around until Daughter arrived home and I could pass Izzy to her favourite milk provider. This week I'm going to buy a new Tommee Tippee bottle and see how that goes, we will solve the dilemma, I hope.
Amy and her parents return from Spain tonight, Hubby is picking them up from the airport but I can't go because all of us, plus their luggage and SIL's golf clubs, won't fit. I'm gutted because I haven't seen for what seems like ages, actually it's a week, and I'm working tomorrow so it will be Tuesday, when I have Amy, before I can see how much Van and Lorry have grown. Daughter has her anomaly scan (20 weeks) on Wednesday and the specialist cardiac scan on Friday, another landmark week.
Homebirth???
I love homebirths, under the right circumstances. I suggest a homebirth as an option to all of my women who a) are considered to have no risk factors (low-risk); b) seem to me to be emotionally, temperamentally a good 'candidate'. Until today I hadn't really acknowledged that I make this judgement call about their emotional 'suitability', perhaps it had never really happened before but then 'Loopy Lou' came into clinic requesting a homebirth. I asked why she was considering a homebirth, I find this a good place to start as from the reply I can usually judge whether this is a well considered choice or them just grabbing hold of political and media hype or 'tree-hugging' stories on homebirth websites. The answer started well, they had attended antenatal classes the previous night where homebirth was mentioned, but then it went a little off, they were making the decision because the hospital was dark when they went there, they had to park, and they had to leave the dog and cats at home. I would see all these points as peripheral to the homebirth choice and certainly not the answer of someone who had really thought about giving birth at home. I continued sounding her out and, just to see if they had thought about everything they would have in the forefront of their minds I asked what they would do with the dog whilst she was giving birth. I explained that dogs may become distressed if their owners are exhibiting signs that they may be in discomfort and could become confused by the odours, particularly blood, which are associated with giving birth. After a momentary pause I received my answer, 'It's alright. Its my husbands dog, I'm not his owner'. There was something not quite right with her whole demeanour, I felt as if I was in a Shakespearean play as she kept making 'asides' to a person who was not in the room and then seemed to be listening to a reply. As we continued chatting I flicked through her notes; minor psychiatric problem in the past; cardiac abnormality at birth, which has since been corrected by surgery. Right, so when is she next going to see the consultant, she's not, whoever booked her considered her low-risk. Now, I'm in a dilemma here. I feel I should ask a Consultant to review her, purely due to her medical history and there is a little voice in my head telling me that this lady is not a good candidate for homebirth. I can advise her that in my personal estimation a homebirth may not be the best option and I have told her I would like her to see the Consultant, but she is now questioning why, in the previous 20 weeks, no other midwife has made that referral. Fair point, why haven't they? Would I have done if she hadn't requested a homebirth? I just don't know, all I know is that I feel uncomfortable with her having baby at home. So I've taken the cowards way out. I've asked my job-share to visit her at home, told her my concerns, admitted I have a strange 'feeling' about this case and said that I will concur with whatever decision she comes to. As it stands though midwives cannot refuse anyone a homebirth, we can advise against it but it is a Health Authority's duty to provide professional care for a woman wishing to have her baby at home. So, if Loopy Lou decides to go ahead with it, all I can do is put on my happy face and go with it. I just wish my gut instinct was not worrying me so much.
Stillbirth rates were is the news this week, they have remained unchanged since the early 90's and unplanned homebirths are mentioned as one of the causes. Do they mean Freebirthing, is that an unplanned homebirth, or a BBA? One is a deliberate decision not to involve professionals, the other a case of events being too rapid to allow professionals to attend. All I know is that any stillbirth is one too many and that any moves to lower the rates should be given huge publicity and support.
