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eye, eye
Yesterday I went to my much anticipated study day on setting up as an independent midwife. Hmmm. Really not a lot further forward. It was the practicalities I wanted, as in how much does an oxygen cylinder cost, how do I get blood smples tested etc. They did give us a list of suppliers, so I suppose that it is down to me to do the costings. If I thought that escaping the NHS would reduce my paperwork I was sadly mistaken, documentation seems to be half the answer to evading increased presure from the establishment (supervisors of midwives, NMC) but of course there is the added chore of personal records, as in accounts. Still oodles more musing to do on this one.
As I left the study day Hubby phoned, was I on my way home because he had got a branch in his eye whilst playing golf. I told him that I don't 'do eyes', far to gory, a real yuck factor for me. He assured me that I wouldn't have to excavate his eye but that he did need me to drive him to the hospital as he had an emergency appointment at the eye clinic. I arrived home to find a very sad Hubby, one eye watering copiously and extremely painful. Off we went to the 6.30pm appointment, seen at 7.40pm, not to bad especially as there was a TV in the waiting area, and a 1982 copy of Country Life, wonderful to look at the property prices. Doctor decreed that G.P was right, the cornea is torn, she even drew a little picture and offered to show me, I declined her kind offer. Hubby is now sporting a fetching patch over the afflicted eye, ointment to be applied 4 hourly, I shall have to gird my loins for that one. He returns to the clinic tomorrow, when they will decide if the tear is healing without scarring. We went straight from the hospital for our usual curry, that meant no relaxing beverage for me, golf has a lot to answer for.
Looking ahead
Clinic yesterday was a reminder of how busy our caseload is going to be in January. Bearing in mind that this is just one clinic out of three, to have 9 women who are all 28 weeks pregnant, tells you that the New Year is going to start with a rush, not good timing as daughter is also now 28 weeks so I shall be otherwise engaged at some point. By the time I had reached the fourth pregnant woman I was already running 10 minutes late, everyone was needing their 'bloods' doing and that adds at least an extra 5 minutes to each appointment. Then in comes M, accompanied by toddler, who they took ages to drag from the toys in the waiting room, and Hubby. They are both health care professionals so you would think that they would appreciate that appointments have time constraints. Oh no, they settled in for a cosy chat, another debrief about the last labour, and a protracted discussion about the plans for this one. I know it's understandable, but we go through this every time, plus it is not my decision, it is theirs and the consultants. Just as I thought that I could say goodbye they requested a 'Fitness to Fly' letter. This is one of my irritations with the G.P's I work for, they will supply them, but they charge £15 and also they take a week to produce them, as a result the women come to us, we charge nothing and we do them whilst they are there, but thats an extra 5 minutes.
I'm now running 20 minutes late and I still have 7 women to see. Allowing for blood taking and filling in blood forms and bottles I did pretty well and by the time I got to the 10th woman I was back to 15 minutes behind. In comes H, Doctor H as her record reminded me. I have never met this lady before but her reputation preceeded her. In her last pregnancy she had stuck with us until near the end and then switched to Independent Midwives for a homebirth on a houseboat. The labour had not gone well and eventually she had been transferred into hospital where she had, after some time, had a caesarian section. I was determined not to be influenced by all the stories I heard so treated her as I would any patient I was meeting for the first time. If they have had a baby before I always ask them how things went last time, it gives you a pretty good idea of how they are viewing things this time round. Well, off we went, a tale of woe, disatisfied with previous community midwife, hates 'that f*****g independent midwife', who I know quite well, and has not hit it off with my job-share. However, she told me that as soon as she saw me that she could get along with me, I think it's because we both have an 'in your face' hair colour! Bearing in mind that each appointment lasts 20 minutes I was becoming anxious by the time she had been recounting her woes for 45 minutes, and I still not examined her and she had forgotten her notes. After 55 minutes she went, with a promise that she would see me again as we 'are kindred spirits'. Blow. I can predict what the course of the next few months will be, countless phonecalls, requests for me to visit at home and an overwhelming desire to tell her she is pregnant, not ill.
I was so full of apologies to my last woman about how long she had to wait. Luckily she viewed it as a quiet break, allowing her time to sit and read magazines and getting her an extra hour off work. Would that everyone was like that.
Jack phoned last night from Gran Canaria to ask me to take photos of Guy and the Bangs, sounds like a rock group but is the guy and the fireworks. Today Amy's Mummy and I bought our contributions to the annual firework fest at friends house, this year there's karoke, sister and BIL are coming, yeah, sisters will be doing it for themselves, proclaiming 'we are family' and other such naff offerings.
The bonfire party was excellent last night, coincidentally it was the first one I have ever been able to drink at, strange that! Amy loved the party, definitely not a shy little girl, not keen on the fireworks though, too many loud bangs.
We have new next door neighbours, and its the first time we have lived next door to children. It's usually us making all the noise and suddenly it is all down to other people and out of our control. I think we are going to get along fine though, it's the little things that count. Yesterday evening the Mum knocked on the door to say that she thought we had cats and so wanted to warn us that they were going to have a few fireworks, it that sort of thing that makes all the difference.
Today is just going to be a relaxing day, I only have one 'work related' chore to do and that is to plan my breastfeeding workshop for tomorrow, I'm dreading it. I find the whole turning 'breastfeeding into a science' thing at odds with my approach to the concept, plus I'm not convinced as to how effective classes are, for a first time Mum trying to playact breastfeeding with a plastic, immobile dolly is nothing like attempting to breastfeed an extremely active newborn.
Hubby's eye is recovering well, still some difficulty with focusing but other than that it's nearly sorted.
I don't know if anyone out there reads Chippy's blog, but Beachutman left me a message yesterday to request I pass on the news that Chippy has some problems, very sad.
In a previous post I talked about a woman in my caseload who has issues with virtually everyone involved in her care during her last pregnancy. I declined to go over her notes with her as I was unsure about how neutral I could be, but from the 'details' she reported to me I was intrigued, concerned, and downright nosey as to what had happened. Anyway, yesterday I pulled the relevant notes and went through them. It is amazing how different they are from the catalogue of issues she has with the care. I'm so pleased I opted not to debrief her, I would have real problems with reconciling the facts set down in the notes, by several different, unconnected caregivers, with the complaints she has. This is often the case though, and it is a matter of perspective, add the fact that analgesics are involved, relentless contractions and exhaustion and you have a recipe for a resentment aimed at anyone connected with the pregnancy, labour and birth. It is enough though that she has issues from that experience which are colouring her attitude this time. Yes, to me this is a 'nightmare' in which, at present I am innocent, but I know that one wrong look or comment could stir up a hornets nest. I feel as if I'm treading on very thin ice. I just hope we both manage to get happily through the next 14 weeks and she finds it a better experience.
I have just found this site, via Emily. Well worth a read as it illustrates what terrible tragedy can ensue when hospitals are closed due to cutbacks and deliberate staff shortages.
Disenchanted Midwife
Off we go again. For 3 years now my colleague and I have been facilitating the Active Birth classes at our unit. Why? Well a section rate of 26% is not something that any obstetric unit should aspire to and so thoughts turned to how had other units managed to reduce their rates. It turned out it was the simple things that made the difference, the bed not being in the middle of the room, labouring women being encouraged to mobilise, women and partners being shown simple techniques that could assist the womens body in making room for the birth of the baby and, of course, a reduction in epidural rates. Our contribution, commencing the classes. They are very popular, we tried to get other midwives involved, but met brick walls, mainly to do with staff shortages. We enjoyed taking the sessions, the feedback was good, we felt we might be making a difference. As finances were non-existant we provided the birthing balls, devised and had the leaflets printed, paid for, and went on courses, would come in on days off and during annual leave. Today colleague phoned me to say that a sheet of paper had been put in our trays telling us that from January the classes were to stop and thanking us for our input. Full stop, end of story.
It feels like my enjoyment of my job is being eroded bit by bit. The elements of it that gave me fulfilment are being whittled away. I no longer feel that the care we provide to Mothers, at home, following the birth is adequate. Antenatally the number of times we see pregnant women has been cut, what we are supposed to do at these appointments has been modified, we are not encouraged to listen in to the baby, baby's movements are enough! To ensure that we are adhering to these new guidelines our manager will be observing one of our clinics. If someone personally requests that I care for them antenatally I am questioned, if they want me to care for them in labour, well, that seems to be the most terrifying request ever.
This is why I want to become an independent midwife, not to take on the cases where homebirths have been refused as the baby is breech, or there are twins, or some other serious reason why a homebirth is inadvisable but so that I can provide women with the care I know they want, and deserve. I'm not considering offering homebirths, what I want to do is provide an antenatal and postnatal care package. Classes provided to suit the individuals need, antenatal appointments when they are convenient to the women and flexible enough to allow the answering of questions without watching the clock. Sometimes though I start to feel so dejected about everything that I lose motivation, I feel as if I am wading through treacle, all I feel like doing is jacking the whole thing in.
I'm a small cog, a tooth really, in a huge wheel. Anything I do makes so little difference that I might as well give up. Sometimes it feels that whatever you do will be shouted down. A salutary lesson was this amazing response to a nurses blog. Stick your head above the parapet if you dare, your fellow professionals will rip you to pieces
A matter of interpretation
Amy - Poo.
Nanny - Poo, Amy?
Amy - Poo, Nanan.
Nanny - Oh wow, poo. Yes you have done a poo, good girl for telling me. Yeah!
Jack - Amy poo. Poo, poo. Winnie-the-pooh. Amy-the-pooh (Laughs, and laughs, gives himself hiccups)