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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.
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!
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.
Unfulfilling
Have just returned from the Primary Care conference in Birmingham and rather than filling me with renewed vigour to face the challenge of midwifery in a rapidly changing environment it has succeeded in making me even more demoralised. Midwife after midwife voiced how they felt unable to carry out their role as they believed it should be and the exultation's of speakers as to how the profession could improve if we pushed for it often fell on such dampened spirits that any fire in them was soon extinguished. I'm not sure how life can be breathed back now, so many changes, too much paperwork, women's high expectations, litigation and frequent attacks from lay people, I allude here to a couple of NCT 'midwife bashers', have left too many of us wondering why we are battling to be midwives. As the midwife in the Panorama documentary said, as she packed to emigrate, 'it's not the job I trained to do.'
I did enjoy the interaction, the exhibition was profitable for me, not just due to the number of pens I obtained, but also because I was given two leads regarding jobs, one in the pharmaceutical industry and the other with an educational facility. Later I shall update my CV, send it off and wait and see.
Tomorrow the family are descending, en-masse, on Brands Hatch to watch SIL race, probably his last one as his funds are running out. The weather looks as if it will be horrid but we have been offered a corporate box so us softy girls can at least keep warm whilst the men patrol the track and pits.
Amy and her Mummy came round this morning and we had a good talk about tentative plans for when Van and Lorry put in an appearance. On Wednesday she has a consultant appointment and another scan, I'm hoping that she will be given a date for her section, weeks away yet but it will give me time to request the fortnight off work. She also questioned me about what to do if something happens whilst she is at work, difficult to answer really as there as so many scenarios, so the best advice I could offer was if it seems non-urgent get someone to drive you to the hospital you are booked at but if it seems urgent then call an ambulance and they will take you to the nearest, most appropriate one. That is the nub of the question really, what 'something' is she thinking of? For the first time today she voiced her fear of the twins arriving really early. I think this is possibly due to the rate at which her bump is growing, day by day it is increasing, and so she is now sure that she will have them before the 36weeks planned by the consultant. Already she is experiencing breathlessness, it is uncomfortable for her to bend forward as it feels tender at the top of her bump, and getting to sleep is difficult as, which ever side she lies on, one of the babies objects and starts to kick madly. Whilst we were on the subject of prem birth I broached the shortage of NICU cots and the chance that the babies could end up in different units, luckily she had already appreciated that because of her sister's threatened prem birth with Izzy and the treat of a journey to Bristol. Once she gets to 28 weeks I will begin to feel much more positive and every day past that milestone will be a blessing.
I see whilst I was away in Brum that NHS blog doctor has been scribing about free-birthers and independant midwives, interesting entry causing much debate about the right of the unborn baby. If only I had a laptop then I would have picked up on it earlier and commented.
If anyone is interested in the Independant Midwives lack of insurance debate then please look here my favourite G.P has given this blog a mention in his BritMed weekly awards, I love a good mud-slinging fest.
Growing up
Amy was 2 years old yesterday and reached a real milestone, she went the whole day without having one episode of wet knickers. This is great news as she has been using here potty all the time, as long as she hasn't got any knickers on, put a pair of draws on her, even her Dora the Explorer ones, and they are wet within half an hour. Yesterday though Nanny decided that cover-up was the order of the day, and it worked, hurrah, chocolate stars all round! All the praising that goes on when she uses the potty is having a knock-on effect, today Amy told me that I was a good girl for using the toilet before we went out shopping, she didn't reward me with any chocolate though.
Her Mummy saw the Consultant again today, and had another scan, all is well. Each twin weighs just under a pound, average for their gestation, and there is no sign of TTTS. Another appointment in two weeks and then, if all is still going so well, no more scans for 4 weeks. We will miss seeing Van and Lorry on such a regular basis but since they are still undecided about if scans are detrimental to unborn babies it will be good to cut down on the frequency of the voyeuristic invasions of their domain.
SIL raced at Brands Hatch on Sunday, in all that rain, and what a scary experience that was. I don't know how he felt, other than he was acting as if he had been wired up to the mains, but I found it frightening watching him zoom round the wet track at breakneck speed, especially when he approached the standing water where 5 riders came off and ended up being blue-lighted to hospital. Anyway, he got 2 thirds so he was a happy bunny, next race in 2 weeks. I shall not be a spectator, the nerves won't take it.
All creatures
I'm all itchy and I keep thinking that I can feel things crawling all over me. Why? An animal lover I had to visit today. On Monday one of my colleagues asked, really nicely, if I would pick-up one of her visits for her and, being the lovely person (!) that I am, I gladly agreed. When I went into the woman's house I had a rueful little chuckle to myself and I knew very quickly why the other midwife had passed the visit over, the house was filthy, smelly and filthy, and noisy. Yes, noisy, smelly and filthy. lovely couple but horrid environment. After I had manoeuvered around the staffordshire bull terrier which was overjoyed to see me, and closed my eyes and prayed when the pit bull stood in front of me, I promise this is the absolute truth, I sat down next to two large tanks, one on top of the other. Out of the corner of my eye I registered movement, bloody whatever's, the top tank had a huge snake in it, heaven knows how long as most of it was curled up and it was only the first three feet that had slid up the front of the glass fronted tank. I tried to act nonchalant but obviously didn't succeed as the husband started reassuring me about how friendly they are. They? Then I saw the second snake in the bottom tank, still large but not quite as impressive as it's tongue flicking friend in the top tank and with bright yellow markings. The guy told me that they are Burmese pythons and the young one is bright yellow and white because it is an albino, apparently it does have pink eyes. I left and promised myself that I would not be returning. Wrong. Today the sly midwife was off as she had been up all night at 2 homebirths and guess who I had to visit, that's it, the threatening creatures people. It was a pleasant reunion with the fearsome dogs and the large reptiles, although one of the snakes had just dirtied it's tank, apparently it smelled, I really couldn't tell as the house has so many noxious odours anyway that one snake poo obviously doesn't make a difference. So, I'm sitting there, dropping blood from the baby's foot onto the card for the Guthrie test when something flits from baby onto my leg. I continued with my blood-letting task whilst trying to ignore the fact that a super-sized flea was sitting on my trouser leg. I looked again, it had gone, gone onto my forearm whilst on the shoulder of the babygro I could see one of its relatives. I finished as quickly as I could, stood outside and shook myself and then started to feel super itchy, and I still do. When I got home I had to explain myself to Hubby as I was stripping off my clothes whilst I entered the house and by the time I had crossed the kitchen I was in a position to put all my clothes into the washing machine. I'm not sure if I should believe him but he thinks that the little bugs I had on me were baby locusts, nymphs, I think I would feel happier if they were, I don't think they bite, do they?
Calling all Midwives and Health Professionals
Any Midwives, or even Doctors out there, who are reading this and have comments to register about the maternity services might like to go to this link to the Kings Fund who are currently collecting evidence for their independent review into the safety of maternity services. The closing date is 30th May. If it weren't for a Google alert I have set up I wouldn't know about this survey/review and I suspect that I am not alone in this.
Now for a 'God help us', hands up in the air, laughing at the extra demands being placed upon us, moment. Whilst midwives, and particularly community midwives are, on a daily basis, having to alter their practice, take on new responsibilities, fight their way through an ever increasing mountain of paperwork and try to provide women with the type of care they are being promised without the resources being in place, this message was relayed to us at a recent team meeting, 'Stop swearing in YOUR cars'. Apparently the university has said that student midwives have complained about the bad language used, whilst driving, by some of the community midwives. It has taken me two days to assimilate this latest edict, at first I thought it was a hoax, but now I realise that Big Brother really is trying to gain more and more of a foothold in my life. Now I've stopped laughing at the picture it paints, a middle-aged woman raging obscenely behind the wheel, I'm full of indignation. If the student objects to the fact that, on occasion, a midwife may comment on another road-users driving skills by the use of an expletive perhaps she/he is too precious to enter the profession. During her working life she is going to encounter many different cultures with very varying opinions on what is acceptable behaviour. Is she going to object whenever a woman a labour uses a word she finds offensive, particularly since most of these words can be heard on any TV channel, any pavement every day. How is she going to deal with the partner who is worried about his partner, finding it difficult to deal with seeing his loved one in pain and, in an effort to express his frustration with not being able to help, aims a swear word at the midwife? I'm not trying to excuse anyone who swears in an ordinary situation, but who hasn't released their frustration at another car driver by the use of some purple prose? During her training the student is in a rarefied position, she has a mountain of studying to complete, but clinically, and responsibly whichever midwife she is working with carries the can for any mistakes she makes, in other words, having a student out with you adds to the stress you are already under. All the students I have had out with me seem to have the most tortured personal lives which they share liberally during our time travelling from one visit to another. I accept this as part of my role as mentor, but it can really 'do your head in' when you are trying to find some obscure address and your passenger is bemoaning their life, answering mobile phone calls from an estranged partner and then bursting into tears. Can, or should, I be blamed for releasing my desire to throw her, and her mobile phone out of MY car, by transferring my irritation verbally to another road user? I am also guilty of uttering the odd expletive between patient appointments at my clinic, it is my way of releasing tension and prevents me from being terse with women who are causing my clinic to run late for no good reason other than their ability to read everything on the web, but apply none of the advice given there to themselves. I shall calm down now and just hope that I don't have a student allocated to me, as I can't promise that I won't let my refined vocabulary slip away and allow myself to shout 'donkey b*******' at the next chelsea tractor that cuts me up.