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Hello baby
I was called at 1.30pm yesterday, that third Prostin had done the trick and friend, A, was starting to have regular contractions, as opposed to those viscious 'Prostin Pains' which can hurt like hell but are not labour. When I arrived she was sitting on a birthing ball with the TEN's firmly adhered to her back but was still able to laugh between, and make comments through, her contractions. We had a chat about our plan and decided upon a sit back and wait attitude until 4pm when I would examine her and then go on to rupture her membranes (ARM). In a 'normal' labour I prefer to leave the membranes alone for as long as possible, often I will not break them at all, they provide the baby (and Mum) with a 'buffer' against the contractions and, a personal opinion here, allow the baby a better chance of getting into a good position for the journey out. However, A was being induced, and our hospital policy dictates that an ARM must be performed so our hands were tied. Also, due to the induction and the cholestasis, I would have to continuously monitor baby (CTG) once I had ruptured the membranes. I really dislike using a CTG, it does limit movement and positions to those where a good trace is being recorded, though with the obstetric cholestasis being a complication known to cause distress in babies, and even unexpected stillbirths, I was quite happy to have a mechanical ally on this occasion.
4pm came and I examined A and broke the waters, she had progressed slightly as the cervix was 3cms dilated, but baby's head was still quite high so I asked A to press down on the top of her uterus to encourage baby to move down as the waters escaped and reduce the possibility of the umbilical cord coming down infront of baby, that could be disasterous. Almost immediately the contractions increased in frequency, duration, and judging by A's behaviour, intensity, just what we would hope for if labour is to progress satisfactorily. The gas and air started coming in for some serious use shortly after, and the settings on the TEN's were adjusted to compensate for the changing character of the contractions. At about 6.30 A was sick, often a sign that labour is progressing effectively, so I disconnected the CTG and encouraged her to go off and use the loo, just that additional mobility and change of positions can encourage a reluctant baby to move into a good position and shift labour up a gear. By the time A was back in the room it was obvious that she was giving sly little pushes with the contractions so I got her back using the gas and air and asked her to try and breathe through the contractions, there were no signs that baby was descending and I didn't want her pushing whilst any cervix was still lurking. Eventually she couldn't resist the urge and longer so she just went with her instincts, and at 7.30pm A gave birth to a little boy, Luke. He came out with the cord wrapped really tightly around his neck but as his body followed swiftly it was not a problem. It was when I examined the placenta that I began to thank my guardian angel. On the 20 week scan the placenta had been lying next to the cervix but on a later one they had reported that it was now at the top of the uterus, they were wrong. As a looked at the condition of the placenta and checked that it, and the membranes were all there I noted where the hole was that I started when I broke the waters and baby had increased as he was born, the hole was right next to the placenta. I was so lucky, if it had been an inch lower I would have caught it with the hook we use to break the waters, catastrophic. It did explain why baby stayed so high for long, he had to squeeze past it. Happy outcome though, Mum and baby doing well.
The lift situation I have following took a new turn yesterday evening. Apparently the upstairs wards have now been moved downstairs, quite an achievement given that there are no lifts so everyone, and everything, had to be carried downstairs and taken a good 5 minute walk to a far-flung general ward in the main body of the hospital.
Emotional wreck
I've gardened today, that's how I always try and sort out inner turmoils. I berate the yellowing geraniums, harangue the overblown roses and visciously prune the forsythia. Bizzie Lizzies are ripped from their baskets, lobelia torn from containers and all the while I replay the scenario of yesterdays meeting with my manager and supervisor of midwives. It didn't go well, I allowed myself to lower my guard and ended up a snivelling wretch. In a nutshell, I am scoring nil points when it comes to communication and I am failing to adhere to my Code of Conduct. Everyone has issues with me, the fact that if I perform a routine antenatal examination on a friend, at my home, my home and the equipment should first have been inspected by a supervisor. I should use my own equipment, even though the woman is under the care of the trust I work for, as it is tantamount to theft if I use theirs???? It's not enough that I write in her notes, which she carrys with her all the time, I must also inform her G.P of the results of the examination. I was stupid enough at this moment to mention that I thought midwives were autonomous practitioners, deep sighs and exchanges of looks, 'you see, lack of communication'. This went on and on, to cap it all I was told that the rest of the team have a problem with me. 'Why? What problem do they have?' No details available, nothing they were able to quote. So I asked if they could find out for me so I could do something about whatever it is I'm doing. That's not appropriate apparently, I have to find out myself. It was at this point that my emotions got the better of me, I was so frustrated. I have always felt that I muddled along well with most people and so to be told that basically all your colleagues have an issue with you, but not to be told why, was like trying to wrestle with fog, an impossible situation. Daughters pregnancy was also discussed, they feel I would not be able to make sound decisions or act appropriately, I DON'T WANT TO BE THE FIRST MIDWIFE. Not good enough, cos I'm her Mother I might get there first and be the first midwife. They were playing 'bad cop, bad cop', both firing sentances at me, I attempted to defend myself by giving them an example of how I can act professionally toward the care I give my daughter, that was shot down in flames, coercion. I think I gave in to the tears at this point, and once released they would not stop. I kept apologising for the fact that they had reduced me to tears, that they had torn my professionalism to shreds, that they had allowed me to attend this meeting without any support. After an hour I was released, to carry on with my visits. First I had to go into the office and make a couple of phonecalls to patients. One of the midwives who has 'issues' with me was in there, I waited until we were alone and then explained that I had heard she had a few problems with me and could she just tell me what they were so I could address them. She looked at me, in the eyes, and told me that she liked me, she hadn't got a problem with me.
I give up. I surrender. 3 years and counting, then I can take early retirement. Only four years ago I declared that if I won the lottery I would still work because I love my job, where has that midwife gone?
Warning signs.
Is anyone else seeing messages on their sidebar? Mine tell be that 'I am not authorised to view this page' and that I 'might not have credentials', what's that about?
Much happier bunny today. Support from 20six, friends and colleagues has lifted my self-esteem from the depths it was plumbing Friday and Saturday. That is how egocentric I am, tell me I am dodging the system and I remain relatively buoyant, tell me people don't like me (have issues) and I sink into depression. I am a 'people person', I value my ability to communicate effectively, so to have that questioned cuts too deeply.
The other weak spot they hit was my loyalty to friends and family. My Hubby and Children have always come first, I would do anything for them, so to be put in a postion where I have to refuse my daughters request, regarding her birth plans, causes me immense heartache.
Have been reading NHS Blog Doc, he's discussing, in his own bombastic way, the Governments incentives to get us to eat more healthily. What do you think?
G.Ps are doing it for themselves
Interesting new idea from the government, devolve operations to G.P surgeries. This will be good, it will really just be an extension of the situation existing at present, you have to virtually go onto a waiting list to see the G.P, now there will be real waiting lists.
I would imagine that this is going to cost a fair amount to implement; extra training for the G.P's, after all a surgeon has to undergo several years training, and fellowship exams to once again revert to the title of 'Mr' or 'Miss'; extra facilities within the surgery to accomodate an operating theatre style room, plus all the equipment and instruments., a recovery room, plus the staff to cover that and the theatre, oh yes, and an anaesthetist. Hmm, our hospitals often have theatres not being used due to lack of staff/funding, why not use those?
There seemed to be concerns that there were not enough G.P's in training, has this changed suddenly? How are the G.P's going to slot the odd operation list into their day, particularly when the chaps in our area can't even seem to find the time to perform routine examinations on newborns? Perhaps therein lies the answer, got an infection, pharmacists will have consultation booths where they can have a quick look at you and prescribe antibiotics, that's possibly 20% of you average family Drs day freed up. There are already 'triage' nurses, why not extend their role more, surely they could decide if someone was depressed, dish out a bit of TLC and a few Happy pills.
Gone are the days when the Doc had a bible on his desk to bash a lump in your wrist, traditional fix for a ganglion, soon he could be whipping out his scalpel to fix that annoying hernia, got tonsilitis, no problem, lets scoop them out, only take a minute.
Until recently we had cottage hospitals, they seem to fit the bill of 'locally accessible healthcare', why can't we reopen them? Oh yes, forgot, they've been sold off, apparently they wern't cost effective. Now lets all add up how much it cost to decide to close them, now add the cost of bringing in the proposed devolution of not so minor surgery to the G.P's, plus the cost of the trials, and all the consultations necessary for anyone to come to a decision about anything within the Health Service.
Time to reflect
So who was right in the really sad case of Baby Charlotte? Was anyone 'right', could anyone be right? All I understand now, from the papers, is that a little girl is still living, with a questionable quality of life. Her parents fought and fought for this, they should now be happy, but it has cost them their marriage, and nearly cost her Father his life. Where previously she would occassionally leave hospital for the day to spend it with her family, yesterday, on her third birthday, the little party was at the hospital. To me this is a pyrrhic victory with an appauling cost to all those involved.
Whoops, I did it again
For ages now my monitor has had this ghastly green hue to it. It's been so long in fact that it had started to look okay, it would only be when I left the computer, and everything looked too pink that I began to become concerned that it may alter the tunings of the rods in my eye, or the colour centre of my brain. Anyway my BIL very kindly donated a new monitor to the cause and on Sunday I decided to swap them over. I was really good, I remembered what he said about turning the power off to the monitor before removing and plugging in leads, I even turned the computer off just to be safe, and 'cos I thought that it would sort out its new mate better if they both started from scratch (you can tell I am a computer know nothing). Powered everything up, and there it was, all working nicely, contrast a bit dodgy so tried adjusting that on the monitor, couldn't get it quite how I wanted it so sat and mused. Then I saw it, little icon with a picture of a monitor when I hover my pointy thing over it a little message told me it was 'Intel(R) Extreme Graphics', hmmm that should do the trick, so I clicked, and up came a little options list, 'Display mode', true colour was ticked, high colour wasn't, high colour, that could be the answer, a series of numbers, lets not go for anything too ambitious so I clicked a mid-range one. Blank screen, just sorting itself out, I thought, so I waited. A minute or so later and a blue box appeared ' OUT OF RANGE Computer settings right?' I don't know, what can I click? Panic, there is nothing for me to click, quick, press a key, key pressed, too late my monitor switched off. I tried everything but had no idea what the **** was happening 'cos I had no screen. After an hour switching things off and on I gave in, right have to phone BIL. I am but a simple creature, rubbish with numbers, so I save everything in.............outlook, and I have no screen. My address book was lost in the fire last year so I have no written records, and anyway they have moved since then. My mobile, eureka. Quick scroll, no home number but Sister's mobile, voicemail. I was in despair, where has my Sister's home number gone? Phone Mum, can't, number on computer, phone daughter, she's at work. Hubby by now is whittering on about his computer and how he won't have access to his mail, a few tense words were exchanged. Then an idea flashed before me, strange option I've seen on my mobile, save to SIM memory, I wonder what's in it? Yes, yes a phone number that advertises itself as being my Sister's, click, and there they were, my oh so long-suffering sibling and her Mr Fix-it mate. Quick pressing of F8, VGA mode, and there was my monitor.
Note to self:- Do not press buttons you have no knowledge of, it will only end in tears.
False witness
Today was really difficult. Whilst I was out and about visiting patients labour ward phoned and told me that on of my women was in having a termination of pregnancy at 23 weeks for abnormality, and she would like me to go in and see her. I continued with my visits, all the while dreading seeing this lady, I tend to feel really emotional, in fact I find it quite difficult to keep my emotions under control.
Personally I am anti-abortion but, obviously in my job, I don't/can't reveal my thoughts on the subject, I am there to support parents through an extremely difficult decision, and it is their decision and their lives, in a way I have accepted termination for abnormality.
When I had finished work I went to labour ward and before I went in to see the couple I read her notes to bring myself up to date with all the facts. I read them, and then re-read them, I felt I was missing something, surely there was some report in them that I wasn't seeing. All well on the nuchal scan, then the anomaly scan at 21 weeks, a problem with aa extremity. Referral to a specialist fetal unit, a developmental problem . No syndrome, no other problems, healthy baby, then the form signed to say that the request for a late termination had been granted for fetal abnormality and that 'feticide' had been performed.
How the hell was I supposed to go and commiserate with this couple who had decided to kill their baby because it had a deformity? I did, and I must have done a really good performance because they want to see me again, but I really don't want to see them. I can find no sympathy for them, all I can think of is a fetus that has been killed because it less than perfect. There is no doubt that this baby would have developed into a healthy, active, adult. There was nothing wrong with its brain, its heart, anything, except an extremity. Obviously, we should now consider that anyone who has suffered an accident, which renders an extremity useless, has a zero quality of life and is worthy of euthanasia, Heather McCartney should take note of this acceptable reason to have an abortion.
All the above is a personal reflection. I share it on my blog because I want to rant, and record, my personal abhorrance of the depths I feel society is sinking to.