midwife's muse

Comparisons

Yesterday one of my women failed to attend her clinic appointment, annoying as it wasted an appointment and all the more so as she is a Doctor in the Health Service, but these things happen. When I had finished my days work I returned to the unit to check up on one of my women, Kim, who had her baby on Monday, This is a complicated case, her children had previously been on the child protection register but this had ceased a year ago when she had stopped using heroin. When she became pregnant again my colleague wrote to social services requesting advice from them, they replied that they had no interest in the family and would not be involved. I was then contacted by the Health Visitor and G.P saying that they believed she was 'using' again. When I saw Kim I asked her about this, she admitted that she had been using again, but only whilst a relative who was an addict was staying and had now stopped. Then information came, she was on a Methadone programme, that on a recent test she had shown positive for cocaine and cannabis. Kim was now missing antenatal appointments, my Manager was informed, contact Social Services again was her advice, person who knew the family was on a course, there was no one else who I could talk to. All this was put in her notes. Then the Health Visitor contacted me again, the partner was dealing, she had contacted Social Services, not interested. Well, now we have a baby who was born 5 weeks early but seemed to have no withdrawl symptoms. The staff in the hospital contacted Social Services as they were sure Kim was still using illegal drugs, same old, same old, not interested. Anyway, Kim was discharged from hospital yesterday evening and we shall be acting as watchdogs, fingers crossed.

Back to my non-attending lady, visting Kim I looked on the board that has all the patients names, and there was my non-attender, that answered that question, she wasn't at clinic because she was in hospital. Before I went in to see her I looked at her notes, forewarned is forearmed, and they told an interesting story of someone who didn't want to be in hospital. Her records were full of notes she had left on her bed explaining where she had gone, and there were several instances where Registrars and Consultants had come to examine her and she had gone off somewhere, often to her office. She was in hospital with a Grade 3 Placenta Praevia, a potentially life threatening condition, for her and baby. I went had chatted to her, she was about to go home on weekend leave. I was bomdarded by questions concerning how the Consultant was managing her case. Next to her bed were a couple of obstetric reference books and a sheaf of research, she had been reading up about her condition. The gereral jist seemed to be that she didn't want to go home, she didn't feel the consultant was being cautious enough, there was more but everything ended up with her not being happy about the management. I remained as on the fence as I could but told her I would try and have a chat with the consultant. Off I went, had a chat with the midwife who was caring for her, as I suspected she was driving them all batty and then found the consultant who was discussing this lady with the senior obstetrician. I told him what had been conveyed to me, he was flabbergasted, she had been pushing him to be allowed home. Knowing her previous history, and how she had distorted facts, I warned him, he seemed at his wits end. Careful, precise record-keeping is a must in this case.

Last night I was called in to the unit as they were over-run with difficult cases. I took over the care of a young girl, 30 weeks pregnant, and....Grade 4 placenta praevia. . She has been in hospital now for 4 weeks, she does everything she can to follow advice, so different to my woman, but has had several bleeds, the one last night a large bleed, but baby is still fine, it's really just a case now of timing the CS right to give baby the best chance but getting there before a devastating bleed happens.

2.12.06 19:28