This is really scary, and something I am embarrassed to admit to but, I agree with Blog Docs latest offering, especially as it is something I have blogged about on numerous occasions.
It is 9.30pm and I am sitting here, on a day off, trying to get up to date on a mandatory on-line training package. It should be done during working time, thats a laugh, 'Sorry, I have cancelled clinics this week so I can sit at a computer' the women, and the G.P's, would love that one. Anyway, where am I supposed to do this at work, despite what you read in the press about the NHS and computers we don't have the available computers for us to faff about doing simulations etc. Then there are the times that my day is so full that trying to set aside time to liase between disgruntled pregnant women, managers (who only work 9-3), and Directors of Midwifery would mean that urgent clinical work can't be fitted in, so I end up spending mornings on the telephone when it's really my day off. I am on overload at the moment, complete this audit, conduct another audit, audit these notes, attend this study session, sing the national anthem and do the can-can. No wonder there are staffing issues in the Health Service, we all spend more time sorting through reams of paper and filling in forms than we spend 'interfacing' with the people we are supposed to be caring for.
Then I have the disgruntled pregnant woman. On a woman to woman level I not only see her point of view but I also agree with her, on a professional level I want to shake her and/or bury my head in the sand. Well, not just my head but my whole body really. It doesn't help that she is bombastic and obviously used to getting her own way, quite like me I suppose, and although I remain super-calm during our little tete-a-tetes she has a heated arguement. The problems arose when she decided upon a homebirth but she lives in a different county, within another PCT, served by a Trust and under a different Health Authority. Midwifery Services are an odd financial set-up which is not usually a problem unless you live by a border, it could be any old border, County, PCT whatever, it just potentially means trouble. Back to DPW, I explained that it wasn't that I had an issue with her wanting a homebirth but due to her address I needed to check with my manager if we could attend her at home, or whether she would need to be transferred to the care of the midwives from a different maternity unit. I did this and my manager said that we could not conduct any care in her home. I wrote this in her hospital notes as she was seeing the consultant next, and also conveyed the news to the DPW, not very happy. Next thing I see her for a routine appointment at clinic, she reports that the Consultant has suggested that a hospital birth, with an early discharge, would be favourite but also the consultant said that we should leave a 'delivery pack' with her. What? Why? 'Well, in case I progress quickly and call you'. I, mentally, took a deep breath and explained that as Community Midwives we always carry everything we need for a homebirth and that we don't go leaving that sort of equipment at peoples houses on the off-chance. 'So when I call you you will have everything with you?'. 'Why would you call me, you are going into hospital, and anyway my manager has said that we may not cross the border, and you are over the border.' I was then told that the Consultant had said that we were to cross the border. Under my desk I had clenched fists as I once again attempted to explain that this was not up for negotiation, policy was dictating our course of action. In a attempt to deflect the anger which I felt was directed at me I then hit upon a cunning plan, 'Here's my managers phone number, why don't you give her a ring?' That ploy failed, I was basically told to sort out the mess myself, but that it all had to go her way. I did try, I spoke to my manager, but she had already discussed it with the Director of Maternity Services, and the answer was still 'NO'.
I see DPW's point of view, we have provided her care throughout this pregnancy and she see's no reason to change, she doesn't want to change and, after all, choice is supposed to govern care. However, I see my managers etc perspective that if we set a precident everyone will demand the same and apparently, due to the geography, we receive no funding for DPW. I have a prediction though, DPW will give birth at home, she will leave it too late to get to the hospital, she lives 25 minutes away. Hopefully a midwife and/or ambulance will get there in time, otherwise it will make the papers, she will make sure it does.
Right, back to work.......