midwife's muse

Break

On Tuesday I am going here for 4 nights and I am really excited. 5 whole days without any demands on my time from anyone, except Hubby, and after the last few weeks that is a really rejuvenating concept.

Work has been very busy, called out every night that I'm on call and because we are so short staffed still having to work the next day is really taking it's toll on every aspect of my being, healthwise and emotions. Even days when I'm not on call something has cropped up and meant that I don't get home until 7.30. Tuesday's 'something' was one of my younger patients who phoned me during the day to say she thought she was in labour, would I go round? This young woman has quite a complex social history and at one point during her pregnancy she was homeless and due to the stress went into premature labour. Things have calmed down now but I was still happy to spread the TLC more thickly. When I visited her she was in labour, but still early on, I stirred things up a bit, and told her that I thought it would be early evening before she would meet baby for the first time, just carry on walking, eating etc. and go in when things had hotted up. As I left I heard her comment to the Grandmother, as another contraction came, ' Oh God, what has she done?'.!

When I returned to the hspital at the end of my day I went to Labour Ward and looked to see if she was there, she was, but what was written on the board indicated that they felt that she was less progressed in labour than I had discovered 6 hours earlier. Being an abject coward, I decided not to to go in and see her, I imagined they would be unhappy and have no confidence in me. Sitting writing some notes and a medical student appeared ' She wants to push', she announced. Looking around no one seemed to be impressed with the news, they were all doing something, so I plucked up my courage, and went in. She was pushing, and was also panicing. After a few minutes I managed to calm her down and encouraged her to breath rather than push with the contractions. I wanted to ensure that she was ready to push, if women in labour push before all the cervix (neck of the womb) has gone it can cause the cervix to swell and cause problems.

Got to go, unexpected visitors, back later.

Right back now, where was I? Oh yes, pushing Mummy. On examination cervix had gone, hurrah, push if you feel like it. Often I don't need to physically exam to know that the cervix is fully dilated (delighted) but with the difference in opinion on my previous findings, and once she had reached hospital, I felt that it would be advisable. Then we had to retrieve her partner, who had gone off in search of nourishment as opinion had been that they were in in for a long haul. He was tracked down just in time, we could just see the top of baby's head by the time he was back. He took one look, then looked up at me and asked if it was okay. I remember the first time I saw the first inches of baby's head and how worried I was that everything was normal, it looks rather like the inside of a walnut, all crinkled up folds of skin, bit like a brain. I assured him it was, then hastely sat him down, he was looking decidedly pale and sweaty! Half an hour after I had entered the room we had a little girl, 7lbs 1oz, Sky. Hugs with everyone, and off I went. Only two hours late home.

When we go into work we only have a vague idea of what could be happening that day. We know if we have a clinic, but we don't know whether it will last for 1,2 or 3 hours, my Friday clinic will often run for 4 hours. If we arranged to 'book' someone we have an allocated time in our diary, I always warn them when I arrange it that it is not unusual for me to run late, but that if it is over half an hour I will phone them and let them know. We then have postnatal visits and the number of these varies from day to day dependant on who has been discharged and whether we need to cover colleagues work if they are sick, attending a homebirth, or on holiday. Then the unexpected happens through the day, a rapid labour leading to an unexpected homebirth, someone needing an urgent visit. On Friday I was touring my 'patch', which has a large area where my mobile has no coverage, and suddenly my voicemail alerted me that I had 10 messages. I can't ignore them, they may be urgent, so I have to pull over and listen to them all. One of them was from a woman who had just found out during a scan that her baby had spina bifida and she was desperate to talk to me, another hour used. Why am I mentioning all this? Well, I've been reading this blog and have been disturbed to learn how little people appreciate the 'juggling' community midwives have to do with their workloads. On a good day it all runs smoothly, even so I never get time for a lunchbreak, but most of the time it is a question of trying desperately to fit it all in. They want evening clinics, actually that would suit me, I hate mornings, but where? Doctors surgeries close at 6pm, or the ones I work in do, Antenatal clinic at the hospital closes at 5pm. Anyway, other professionals I may need to contact during a clinic, scanning departments, physio etc. all finish at 5pm so it would be difficult to deal with situations requiring referral. To be fair I would say that 95% of the women I see are lovely, they are understanding that I am only human, that I do have a life outside midwifery, and that I have 170 pregnant women under my care so sometimes they have to wait, but those other 5% are the ones who make the most noise and cause me most stress trying to see that all their demands are met. I try not to take it personally, I rationalise it and tell myself that it's the shortages and cutbacks that mean we are under-resourced and overstretched, but when I read blogs like Emily's, and particularly one of the comments, I feel really frustrated.  

1.10.06 11:25