Tales of Midwifery - The Truth

Women's Rights

2009-02-07T22:02:00.002Z

Style Police wrote on November 4th 2008 that midwives are 'transient in women's lives'. How I would beg to differ with that statement. Not only do I remember all the midwives that cared for me through 3 pregnancies, labours and during very stormy post-natal times but I remember their faces and names as clearly as if it was yesterday. In real time it is now nearly 40 years since I had my first baby and those midwives were certainly not transient to me or my babies.

How sad it is that we now are educating and delivering a work force of midwives who have no concept of professionalism and vocation. To be a midwife - with woman, is totally that and we are not looking after tins of biscuits on a production line as much as it may feel like this at times. No, we are providing a service and that does mean some sacrifice along the way and if as a midwife you are doing this as a 'professional' then you will certainly not be transient in women's lives - quite the opposite in fact. To become a professional and remain one, requires some degree of discipline and high standards - after all - midwives are dealing with real lives and not some reality show. To sustain this high standard requires constant updating and a life time of continuing professional development.

How can this be achieved safely and to standards required of the NMC (2004) for example, if when midwives go on maternity leave themslves don't return for over a year and do not attend the mandatory study days (which are supposed to be 10 in total) whilst they are on leave? And when they finally do return to the work place on very reduced hours (some only 1 day a week) how are they supposed to maintain their safety and high standard of care for the women that they look after on these very reduced hours and lack of professional study?

In these highly litigatious times, Trusts seriously need to consider the safety of allowing this kind of practice to continue. I certainly would not wish to be cared for by midwives who had been out of the professional arena for so long with no updating that is required by all midwives who declare themselves 'Fit to Practice' when clearly they are not. (NMC Midwives Rules and Standards).

2008-11-23T13:03:00.003Z

Jessica's Story

In 2004, Jessica Palmer tragically died of Puerperal fever (Childbed Fever). This overwhelming infection is caused by Streptococcus A bacteria and used to be a contributing factor in deaths of women after they had given birth. This infection was previoulsy found to be linked to poor hand hygiene and was rife in the beginning part of the last century and at the end of the previous century.

It seems so unnecessary in this day and age of technology and advanced knowledge that a young woman with 2 small children can die so tragically just because the signs and symptoms of this infection were never acted upon until it was too late. Consequently, many midwifery units have now developed an Early Warning Score form for midwives and doctors to fill in and act upon.
These forms will go a long way in preventing such a tragedy occurring again.

Jessica, died from multi-organ failure 6 days after giving birth normally. The details of this can be read on the web site set up in memory of her. Please take a moment to visit this and complete the questionairre by following the link http://www.jessicastrust.org.uk/awareness-survey/

Diary of a working midwife

2008-10-20T21:01:00.001Z

Monday 20th October – Diary of a working midwife.

Any names or reference to events the details are changed to protect client confidentiality.

Its 5.30 am and only another three hours until the day staff come on duty. It has been a long night shift – 12 hours to be precise with only 30 minutes for a quick cup of tea and catch up on note writing before the next women needs attention in labour. A quick glance out of the frosted windows of the labour ward tell me that it is still dark and I can hear the wind and rain rattling the windows but all is warm and cosy and for the moment, quiet on the delivery suite.

Suddenly, the much longed for peace and quiet is shattered. There is an ear piercing cry like someone being attacked as a woman arrives in a wheel-chair at the door. She is obviously in advanced labour so she is wheeled straight into a delivery room. Her partner is asked to help myself and a colleague move her onto a bed so we can quickly assess the situation and the health of the baby and as we do so quickly gather a history about the woman, whether she has had any previous pregnancies, if so, how many, and any medical or obstetric problems. Whilst this is taking place, the woman is screaming and throwing herself about in pain and great distress. Her observations need to be taken and the baby’s heartbeat needs to be listened to. It also has to be ascertained that the baby is a term baby and that the woman is not about to birth a pre-term baby. In this first two to three minutes or so a great rapport and relationship has to be built up between not only midwife and woman but midwife and partner. They both have to be able to feel absolute trust and security with your skills and way of interacting with them. This is vital to ensure that a safe, happy outcome ensues and that what ever happens they are made to feel involved and part of the process.

Anyway, it is very quickly evident that the baby is term but it is breech (bottom first). This is classed as an obstetric emergency in out unit so the obstetric team has to be called for the birth. The woman is very frightened but she is quickly calmed and reassured by the skilful counselling of my colleague. Meanwhile, I put out a ‘crash call’ for the obstetric team who are in the room within seconds. All the equipment is assembled. The doctor makes a decision. This is the woman’s second baby, the baby’s birth is imminent. No time for c.section or theatre (thank goodness) but the team is outside the door in case. My colleague wants to deliver the baby with the doctor’s guidance (midwives in this unit do not have much experience of breech delivery so feel safer and happier with the doctor present). Nb this will be a topic of discussion over the next few weeks. Three minutes later baby is safely delivered, so is the placenta and all is well.

It’s amazing – after only being on the delivery suite fifteen minutes, the woman and her partner have become parents again and all is well. Baby is alert and crying, he is the one making the noise now, not the woman!! However, after another five minutes piece reigns again, baby Sam is on the breast and feeding contentedly.

6.30 am – still another 2 hours to go – plenty of time for a cuppa. Oh no there goes the bell again and the phone and the door. All in a days/nights work.

2008-10-19T11:51:00.000Z

WANTED – URGENTLY

4000 MIDWIVES BY THE YEAR 2010!!

In response to a survey by Net mums, who found that a quarter of women had not been able to attend ante-natal classes because there simply were not any, the Government has promised it will deliver 4000 midwives by the year 2010.

This is a plea to anyone out there who feels they would be able to take up the challenge of becoming a midwife then please get in touch with either someone who is a midwife, contact your local university who provides education for midwife training or read this blog.

Over the next few months (work load permitting), I will endeavour to provide a diary of the daily working life of a midwife and just exactly what the work is like.

Being a midwife is not only a privilege but it is a profession that is extremely rewarding. I can guarantee that being a midwife is never boring. Every working day is different – as you will see from my diary to follow.

Free Birthing

2008-07-27T20:07:00.001Z

There has been a lot of publicity recently about this latest craze of women giving birth alone and unattended by either a midwife or a registered medical practitioner. In Britain, this legally falls into a grey area. It is against the law to give birth attended by anyone other than a midwife or doctor so by the very fact that most women have either a partner or friend with then who could be deemed as assisting the birth, they are in fact, breaking the law.

All this aside, it is also a very dangerous and foolhardy practice. Ok, I have read lovely accounts of how the baby just slipped from its mother and went on the breast and all was lovely and wonderful. But, in reality, giving birth is fraught with all kinds of dangers and problems and it is only because of the very skilled attendance and intervention from highly skilled midwives that prevents the maternal and neo-natal mortality rates being as high in this country as they are in Namibia for example.

In the third world and developing countries, women ‘free birth’ because they have no choice and they unfortunately die in large numbers as do their babies. These women would give anything to be able to access the level of care women in this country not only take for granted, but criticise. Women in this country have it all but still demand more, wanting a ‘birth experience’ that only exists in ‘fairy tales’. Birth is an experience in itself, but it is painful, frightening and can be above all lonely – why would any woman in their right minds want to do it on their own?

Only this week, a young woman gave birth on her own in a hotel in Spain – the baby died and she is being charge with infanticide. Of course we do not know the details of this sad case but I hope it does not prove to be one of another free birthing episode.

This concept is hotly under debated at the moment and whereas I can understand where women are coming from when they decide to go it alone, I wonder if it is truly because midwives have become so callous and uncaring that women would rather birth alone than have one in attendance – I find this hard to believe and wonder what other motives lie beneath this latest craze.

Celebrity Mums versus the NHS

2008-07-08T20:17:00.000Z

Once again, a celebrity mum has voiced her disgust at the care she has received in the hands of the NHS for her post natal care. Myleene Klass gave birth in a private maternity wing at the Paddington Hospital and then was discharged to the care of the NHS for her post-natal care. Why? Surely, if she was able to pay for private care in the Lindo Wing, why not carry on and pay for her post natal care as well?

Myleene describes feeling outraged at her care from the NHS because no-one came to visit for 6 days – this I find hard to believe even in these over-stretched times of NHS care. Perhaps someone did call and Myleene and partner did not hear the door bell for what ever reason. Midwives are required by law (NMC 2004) to visit women post-natally for up to six weeks in the post-natal period which is the time after the delivery of the baby and placenta. Most NHS Trusts have robust guidelines and policies that make it very clear that all women are visited after their discharge from hospital the next day. Perhaps the Lindo Wing did not ensure that the discharge details were made available to the appropriate midwife?

In this article Myleene said that she used a pseudonym whilst in labour because “she just wanted to be treated like everyone else”. What exactly does she mean by this? Where I practice, we look after a fair number of ‘celebrities’ but you know what? They are treated like everyone else and they don’t use a false name or pay for their care which is superb and most of all safe, efficient and ensures continuity of care.

Poor Myleene – you know, the majority of women who have had a baby feel weepy, sleep deprived, out of control, tired and irritable, but most of them just get on with it and have a life of sheer drudgery with no glamorous modelling careers to take their minds off it either.

So come on. Stop pretending that you care about what other women are going through and stop using your very normal pregnancy and post natal period to advertise your new range of baby clothes and modelling career.

Compared to the majority of women you are in a very privileged position. NB – especially compared to women in the third world and developing countries where 1 in 7 women die in childbirth (here the rate is I in 280.000). Please do not exploit this privileged position to slag off the NHS system which provides a very high standard of care at all times against all odds.

60 Years of the NHS

2008-07-04T13:05:00.004Z

This year the NHS celebrates 60 years of care from 'cradle to the grave' for all. This care is by all intents and purpose FREE to all who use the service apart from contributions that we all make via National Insurance Payments but still cheap at at half the price! (as they say). What a vision Bevin must have had when he first set up the health care system, fondly known as the NHS ill health service.

During it's 60 years there have been dramatic changes and reforms, some for the better, some not, but I could not help but be a little incensed by Alan Johnson's latest ploy to make all health professionals work even harder than they do already. His latest idea is to reward nurses/midwives who smile and show compassion the most by creating some kind of competition between wards and departments. The idea being that whoever earns the most points gets some kind of bonus!! What a ludicrous idea and how condescending. Firstly, it smacks of sheer male arrogance and carries with it just a little hint of portraying the nurses/midwives who are predominately a female work force as just 'silly women' and the only skill they might have is to 'smile and be compassionate. What about doctors? or are they too sophisticated and too busy doing the real work of making diagnosises and wielding surgical knives to be able to smile and be compassionate?

Anyway, surely, being compassionate is part of being a health professional? and as for the 'smiley' bit - well - I agree that as midwives/nurses/doctors etc. then a friendly, warm open face is to be advised but I am not sure I would want a midwife just smiling at me through out the throes of a long painful, labour for example or if I had just been told that my unborn baby had some horrific defect that would make compatibility with life impossible. No, I would much prefer to be on the receiving end of the care of a midwife/nurse who was highly skilled in clinical aspects. Surely, this is what midwives/nurses should be rewarded for? our high level of knowledge and clinical expertise achieved after many years of education at degree level and then of course our experience and all the wealth of information this brings.

Come on Alan Johnson - find out what happens in the real world of the NHS and really help us make a difference, not just pay lip service to yet another idea which is not really new - is it?

Women's Rights?

2008-05-26T16:49:00.002Z

Have recently been reading an interesting article in the guardian about women’s rights not to be questioned about their childcare arrangements or plans for future pregnancies when applying for a job (It has been illegal since 1975 to ask this question of women).
Whilst I wholeheartedly support this, I do think that the whole question of ‘Family Friendly Hours’ and the rights of pregnant women have totally made the world of nurse midwifery and maternity a crazy place to work in. A busy maternity unit has to supply safe, effective midwifery care 24 hours a day, 7 days a week, every week of the year without break in any shape or form. The work force is traditionally predominately female and the age of the work force is mainly of child-bearing age.

Where I work at the moment there is always at least 10 midwives pregnant or on maternity leave at any given period in time. These midwives always return from maternity leave on very reduced hours and usually demand to work set hours. There is never any cover available for them whilst they are on maternity leave so you can imagine this leaves a very depleted work force.

This impacts very heavily on the work-force left to keep the place going and it usually falls very heavily on the shoulders of the older, senior full time midwives who have their own set of problems at home i.e. looking after elderly parents/husbands/partners etc. These midwives never ask for leave or time off to fulfil these demands and often leave at the end of a busy shift to start another shift at home.

Is this equitable? If women really want to have equal rights then surely the men should be involved more in the care of the babies and have time off from work as well to enable the woman to come back to work earlier than a year. And, are the women who are having a year off from a ‘with woman environment’ really being supportive of the profession that they profess to belong to and what about their colleagues? Are they being fair and equitable to them by insisting on having as much time off as possible and then coming back on reduced hours? I don’t think so and trying to manage a service that provides care for a 24 hour period is a total nightmare with continually reduced dwindling resources.

I never thought I would find myself thinking this but I wish sometimes that we could just employ midwives that had completed their families or had no intention of having one in the interest of providing a truly first class maternity service for women.

Hungry mother and baby

2008-05-26T16:19:00.002Z

Independant Midwives

2008-02-29T21:39:00.000Z

Independent Midwives

Well, the Government has done it again. Alan Johnson has made a futile and quite frankly condescending and insulting attempt in order to tempt midwives back into the profession by offering them £1500, plus the same amount in childcare, training days and travel.

What a joke and how sad that women feel that they have to resort to the care from Independent Midwives in order to receive the kind of that they want and are entitled to (Pelling, Daily Telegraph). But the sad reality is that the system is NOT providing the high level of skilled midwifery care that women have a right to.

They have this right because, pregnancy and child birth are fundamentally, normal, life changing events and if managed correctly, sensitively and safely, then women and babies should emerge from this journey relatively unscathed and hopefully as healthy as they were before the pregnancy (unless, of course there is any underlying previous medical or obstetric problem).

Pregnancy and childbirth is the pivot on which the future health of the nation and future generations hang. Surely, it would be better house-keeping for want of a better word, for the government to spend extra money on resources now and prevent billions in litigation costs and costs related to morbidity acquired during the pregnancy process?

The irony of all this is, is the fact that Independent midwives as ‘lovely’ and caring as they may be, will soon be in the same position as NHS midwives – overstretched and unsupported and thus begins the vicious circle all over again.

Happy New Year

2008-01-21T21:44:00.000Z

Well it is a New Year and it has been an extremely busy Christmas and New Year in the maternity unit where I work with the birth of many babies. Fortunately, for all these women, there was a happy outcome with the safe arrival of lovely healthy babies and without adverse complications for the women. So what,? I can hear some of you say or perhaps, ooh how lovely and so on and so forth.

My point is that I have recently been reading graphic accounts of child birth and pregnancy outcomes in the third world and developing countries and have been trying to make sense of the great inequity there is between our world and theirs. Of course, we all know that pregnancy and childbirth is just the tip of the ice berg of the problems and it would be naïve to suggest anything other than this.

I have had a lot of response to my posts that I wrote before Christmas about choice and pain relief and I have had an excellent response to these from all kinds of people with all kinds of experience and I thank you all for taking the time and trouble to write a response. It has been extremely interesting to read them all and I am sorry but I cannot possibly reply to you individually.

Choice and control for women are the basis of the central themes which are the main drivers for developing maternity services in the western, developed world. It is interesting to compare this with the drivers in the third world or developing countries where their main objectives are to reduce maternal and neo-natal mortality and morbidity

Sometimes. I feel we have maybe lost sight of just what providing a safe maternity service involves and just how much we take for granted. Do Women in the Gambia or Sierra Leone or any of the other African countries have a choice about where they have their babies or what kind of pain relief they are going to have? If they are lucky, they will have their babies without too much fuss with other women attending them using their remedies and ways of delivering a baby or they may find themselves, in labour, with terrible complications having to walk anything from 50 to 100 miles to access the nearest hospital. By then, sadly, it may be too late for either woman or baby or both.

Yes, we can moan and complain about our NHS system but against all odds, it provides a gold standard of care to the majority of women and the best thing of all is that not only can women choose where they have their baby and what pain relief they want but the outcome is 99.9% positive, with a live mother and a live healthy baby – which of course – is the aim.

Happy New Year!!

Choice and Childbirth

2007-11-10T22:00:00.000Z

It saddened me recently to read an article in a professional midwifery journal which was written by a woman who had recently given birth in a private hospital in London. In this article the woman described her journey of care in the private sector. The article is centred solely on the wondrous care that the ‘doctor’ (obstetrician) gave this woman and her partner and I quote:
“Choosing the right consultant was critical to a happy and calm pregnancy”!

Excuse me, but I was led to believe that choosing the right ‘midwife’ was critical to a happy and calm pregnancy? Midwife meaning being with woman – obstetrician – this word is derived from the Latin word obsterix meaning ‘standing before’.

Yes, that is surely what private obstetricians do with great ease and charm – stand before and hold their hands out for a very fat, lucrative pay cheque which they spend laughing their heads off at the silliness of these women who fall prey to their seductive charms of claiming to ‘always being there’ and ‘yes of course I will cancel my holiday to make sure I am there for the delivery of your baby!’

There is something slightly obscene about the private male obstetrician who seduces these vulnerable women by promising to ‘always be there’ whatever the time of day or night, always at their beck and call – almost like a marriage or a relationship. Are these women really choosing private care for the right reasons? Does this love and care that is lavished on them by a male at a vulnerable time in their lives make up for a big gap in their own relationship? Do the women think that the male obstetrician is superior to the female midwife? Does this smack of patriarchal forces still at work in a society when we are supposed to have moved on from this?

Back to the article in question - the midwives were only mentioned briefly right at the end of the article and their care was only in the post-natal period. I know that the NHS struggles to provide maternity care given it provides a ‘gold standard’ of care on peanuts but at least it is still true to the midwifery profession and against all odds tries to support it and enable its growth.

Yes, women have a right to a choice where they have their babies and how they receive their ante-natal care but the question is are the women who pay privately for it ‘being short changed’ in that the only care they receive from a midwife is at the end when they have had their babies?

Immigration - the true cost

2007-10-24T15:46:00.000Z

There is a plethora of discussion about the financial impact that the high level of immigrants to this country from Eastern European Countries has on this country. We all know the arguments well – yes some of them contribute more in tax, earn more are more highly skilled but balanced against this is the fact that there has been no financial allowance made for the extra demands on the all the public services including the NHS. Because the migrant population is mainly young, they are deemed to be fit and healthy but this has had a huge impact on the already overstretched maternity services in this country. For example, an interpreter is needed for every woman accessing maternity care – this does not come cheap and is around £80 -£100 per hour. This is for all the care from the ante-natal, period, intra-natal and post-natal period. It does not take a mathematician to work out that this is a huge amount of money. However, this is not the issue – these women are entitled to and should receive the high level of excellent midwifery/maternity care that all women in this country receive.

The issue is that recently, there has been nothing but complaints from these Eastern European Women about the care that they received in England. I cannot cite them all but one woman in particular thought her care in labor was appalling because she did not have a doctor deliver her baby and she did not have an episiotomy to deliver the baby – she sustained a very small laceration that needed no suturing what-so-ever and had healed by day 7!! The actual care that this woman received in labor was very low tech, with no intervention, no continual monitoring and resulted in a water birth (which is what the woman had requested on her birth plan)! The question I have is – what is the problem? Why are these women complaining? All the ones that have complained have absolutely no justification whatsoever. All complaints have been thoroughly investigated and the women have had exemplary ante-natal care with an interpreter present, the same in labour and the same post-natally with much more support at home that they would have in their own countries. Britain is the only country that still does post-natal visiting at home!
Another point worth flagging up – is as one woman told me – in labour, in Poland, no pain relief is offered or allowed in labor at all!!

So, what is going on? Will this level of complaints increase? Are they really at the receiving end of terrible care or are they just jumping on to the band wagon of the ‘claim culture’ that we have bred in Britain?

What ever the issue is, midwives need to be alerted to it and quickly put a halt to it. What concerns me is that the fact the women from other countries don’t seem to understand that midwives are professionals in their own right and are on an equal standing with obstetricians and doctors – perhaps it is just a misunderstanding and this can be easily remedied in the parent craft education. If it is not, then immigration might have a big part to play on the midwives role and change it and if we are not careful, midwives might find themselves working as obstetric nurses.

More thoughts on labour

2007-09-05T20:38:00.001Z

Thank you all for your interesting thoughts about pain relief in labour. It is a vast subject and one that generates much thought and discussion. I can vividly remember my own experiences of labour (three times) although I cannot begin to describe the pain, I can remember the moment of giving birth and the feelings that evoked. I actually did have Pethidine and entonox for all 3 labours and thank goodness for that! There is no way I could have gone through labour without anything as I had long labours with all my children and in those days (20 odd years ago and counting) there was not much choice. In fact, the whole attitude, and this was from the midwives as well, was that you ‘put up’ and ‘shut up’. You were very much left to just get on with it. Labour and birth was a process and a ‘job of work’ to be got on with and there was no room for discussion and debate.

How very different to now when women are given all the information they need and their progress in labour is discussed all the way through both with the woman and her partner. This, of course, is how it should be. Giving birth used to be a very lonely process not so long ago. Even your partner could not be there let alone a friend or birth companion.

Interestingly, there has been quite a debate recently about the presence of male partners in the delivery room suggesting that the outcome of labour does not always result in a vaginal delivery when a male partner is around and some birth gurus have even gone on to suggest that there may be a link between the soaring caesarean section rate and the presence of a male partner. This is because, the male partner tries to rationalise the birth process and keeps trying to talk to his partner which interrupts the natural flow of the birth hormones. This is just one theory, there are many more.

It would be interesting to hear your views, thoughts and experiences.

Thoughts on pain relief (reply to Michal)

2007-09-03T20:57:00.000Z

Thank you for your comments on pain relief in labour. You raise many points. All of them are valid and ones that are raised on a daily basis and by most women that I encounter. I am not really sure what you are trying to say, but it would appear that you disagree with epidurals for pain relief in labour. This is a totally different analgesia that is administered to women in labour and it is a medical procedure that involves the skill of an anaesthetist. Because the drugs used in the epidural have the potential to lower the woman’s blood pressure rapidly, there is the need to administer intravenous fluids to counter the side effects of the low blood pressure. If the woman’s blood pressure falls rapidly, then the baby in utero (fetus) drops its heart rate (bradycardia). This is usually transient and recovers very quickly to normal. Incidentally, the fetus has no actual rights of its own until expelled from the womb (Jones and Jenkins 2002. The Law and the Midwife). So you could argue that the woman’s right to a pain free and stress less labour takes precedence over the fetus. Many studies and research have proven that if the women is pain free and not suffering from great surges of adrenalin that are a natural response to the pain impulses, then the fetus will be less stressed and more able to cope with the arduous and dangerous journey of labour.

On your other points re ARM, induction/augmentation etc. these are although related to labour separate points and as such need to be addressed on a different post. If you are trying to say, that ARM and augmentation are linked in some way to epidural analgesia for labour, then yes, there is strong research and evidence to prove that if a woman has an epidural for pain relief then there follows a cascade of intervention. The epidural can sometimes and I stress sometimes, slow the progress of labour hence the need for a hormone infusion of Oxytocinon. This increases the levels of adrenaline and thus a cycle of intervention takes place which can lead to an increase in the need for an instrumental or c.section for delivery. But, there is also other evidence that suggests that this would have occurred anyway and that being in severe pain and frightened by the pain could cause this cycle of intervention.

Finally, if the women you know are not being informed of the risks of pain relief or any procedures that are carried out on them whilst in hospital, then, the hospital is breaching its policy of informed consent and belongs in the ‘dark ages’ where that culture used to exist many, many years ago. I suggest that you do some research and find out just exactly how many maternity units are practising in this barbaric way – I can assure you that everywhere I have practised in the last 20 years, I have never encountered this approach to women centred care. All women have a right to the facts. Not only about pain relief but all aspects of their care whilst pregnant and beyond.

What would you suggest is the best form of pain relief for women in labour?

Thoughts on Pain Relief in Labour

2007-09-02T19:51:00.000Z

Hi everyone out there – midwives, women and new or about to be, mothers. Have been away on a course as well as working hard in the maternity unit where I work. I have recently been reflecting on how men and male partners with women in labour can have such a domineering, controlling and negative effect on women in labour.

For example, on numerous occasions, too many to remember, I have witnessed men demanding that their women in labour do not have pain relief of any kind because it might ‘harm the baby’ or ‘make the baby drowsy’.

I have a few questions to ask of these men.

Firstly: Would they undergo an operation, procedure or dental filling or extraction of any kind without pain relief?

Secondly: Do they seriously think that health professionals, namely midwives, would administer anything that is going to ‘harm the baby’ or ‘make the baby drowsy?’

Thirdly: and this is not a question: men take note: labour is excruciatingly painful. It is number 10 on a pain scale of 1 – 10 and is on a par with a heart attack or renal colic (when a kidney stone is stuck in one of the urethras or ureters that come from the bladder). It is relentless and can go on for many hours, sometimes in excess of 12 hours or more. Perhaps you men out there can recall how you scream for pain relief and take to your beds with a simple cold, toothache, headache etc.?

Yes, labour is a natural physiological process that women are able to withstand and endure and you know what? They usually do it a hell of a lot better without you guys dictating how, what and when they will have (or not) pain relief. If you really, truly want to be supportive to your partner, just be there. Sit down when she tells you, stand up when she tells you and most of all – shut up and let nature take its course, which it will, because, guess what – yes, you guessed it – nature is bigger and better than all of us and the miracle that occurs daily will happen without you interfering and trying to call the shots.

Most of all, please, please don’t deny your partner pain relief because of some misguided concept that you might have read or been told about by some people who have no knowledge whatsoever of the true side effects of pain relief that has been used for many, many years without any detriment whatsoever.

Time out

2007-06-15T20:44:00.002Z

Will not be able to write a blog for little while as I am going on holiday for a few weeks. But before I go, I must pass comment on two issues that have been in the Guardian recently.

One- A report has suggested that maternity care may be put at risk by allowing Health Care Assistants to carry out midwifery functions. This is totally untrue. Health Care Assistants do just that – they assist and very good at it they are as well. They are taught how to help women with breast feeding, bathing and generally care for the baby. On the delivery suite, they help with all manner of things from helping in theatre, washing women, making the much maligned cup of tea, cleaning and stocking up the ward. Would you like a midwife to do all these things whilst you were left unattended in labour? I think not. No, the report was not strictly true. Health care assistants are a very valued part of the team and in no way will they ever be able to carry out midwifery functions, unless of course, they undertake a period of nurse midwife education and quality!!

Two – Zoe Williams writes a very compelling article on why she will not be giving up alcohol or soft cheese whilst she is pregnant. After my initial indignation at what I assumed was going to be a very irresponsible argument, I found myself agreeing with some of her arguments. Especially the fact that she felt all advice was given in a very condescending manner without any reference to research or evidence based reasons for avoiding soft cheese, wine, liver, cats etc.

However, I would remind pregnant women that their immunity is suppressed whilst pregnant leaving them much more susceptible to infections and disease so it is best to limit these risks by avoiding any factor that will render them ill. Such as eating soft cheese, unwashed salad, bought sandwiches, handling cat litter – all these increase the risk of stomach infections, listeria (a flu like illness which has devastating consequences) and toxoplasmosis which if passed on to the fetus can cause a stillbirth. Alcohol in any great quantity is equally as lethal not only in terms of fetal development but makes the pregnant woman more susceptible to accidents and prone to viral infections.

Pregnancy is only a short time in the grand scheme of things – surely it is worth a few sacrifices to ensure the good health not only of oneself but the unborn baby as well.

2007-05-18T16:33:00.000Z

Have just returned from another busy shift where I personally had the privilege of delivering 2
lovely babies (not to the same woman, I hasten to add, although that has been known to happen i.e. Twins)!! It was a very busy shift with too many women and not enough midwives to go round so there I was, in between delivering babies, trying to co-ordinate the labour ward and look for midwives that could have been borrowed from another area when one of the managers strolls on to the ward enquiring if ‘everything was all right and under control’? To which I replied in the negative saying that more staff were needed and that no-one would be having breaks again and certainly would not be able to leave on time (I actually worked that day from 7am til 18.00 when I should have finished at 15.00 – and without a break of any kind. My poor bladder and stomach – no wonder I have so many problems with them these days. One is overfilled and the other is never filled and when it is it cannot cope with what’s put in it.

Anyway, back to the story in question. The only response that I got from the manager was – well, the unit was quiet yesterday and we have to have so many deliveries a day or the unit will be closed!! Yes, yes, we know all that, but it still does not help the situation at the time which is frankly dangerous and could be courting an accident waiting to happen. Women need midwives and they need and deserve midwives that are fresh and able to meet their needs in order to ensure a healthy outcome of the labour and birth. When are managers going to stop just ‘fire fighting’ and look ‘out of the box’, as they are continually spouting to us to do on the shop floor? And ensure that in spite of a tight budget, that there are enough midwives on any shift to give the levels of care that are specified by government and needed so desperately by the women?

Needless to say, the manager did not appear once for the rest of the day and in spite of starting her working day at 9.30, she had gone from her office by 16.30. Yes, it would have been really nice if she could have come to make sure everyone got a break and went home on time!! No-one would mind really except, that when it is documented on our time sheets that we worked extra time, then we are accused of trying to cheat the NHS out of time and or money!! What a laugh – I think the NHS is cheating us out of time and money and worse our health!

Pay Rise?

2007-05-08T09:09:00.000Z

Well, we have a pay rise. How very generous of the pay review body to grant us 2.9% and the good news is that we will not be getting it all until the Autumn. In real terms this works out as a PAY CUT not a PAY RISE when the inflation rate is taken into account. What other profession in the world would put up with such patronizing and insulting treatment? It's funny, but the doctors are having a 25% pay rise - now, that's more like it. I wonder why the government thinks it can treat other health professionals so shabbily?
Midwives are health professionals, the same as doctors, with a high degree of autonomy and accoutability that is governed by statute. Our profession deserves and needs a pay rise. Not only because it is necessary to have the extra money to pay the bills but to make us feel that we have some worth - we don't just do the job because we like it and want to do good but because we need to earn money to pay for mortgages etc. and have some kind of life, like, you know, holidays and pleasant things like that.
The question often asked is the one - why are midwives leaving the profession? Simple, not paid enough for the level of responsibility and the amount of hours they work for starters. With this mass exodus from the profession, who is going to look after all the many thousands of pregnant women, women in labour and afterwards if midwives are finally forced to leave the profession simply because they cannot afford to work in it any more? Not the doctors that's for sure - they usually run a mile when presented with a pregnant woman, and as for the GP that will not support one of his women patients who wants a home birth for example, why should they claim the extra fee they receive for giving care to all the pregnant women on their books when they don’t give any of the care?

If midwives continue to leave and are not replaced, then doctors will have to take over their care, conduct all the normal deliveries or women will go without care which could be catastrophic and worse end up delivering their babies on their own (which is against the law, in effect) so they could end up being prosecuted as well!!
Come on government - wake up and pay us what we are worth and on the same level as the doctors before it is too late.

A Society of Want

2007-04-29T15:21:00.000Z

Have just been reading Polly Toynbee’s excellent article in the Guardian today 27th April, 2007 where she has summarized the past 10 years of Tony Blair’s government including all the reforms that have been made in the NHS. All in all there have been some pretty impressive changes made in the NHS system that has evolved since 1948 and has come a long way since its beginning when the mantra then was:
“care for all from the cradle to the grave”.

We must not forget that this service is indeed for all from the ‘cradle to the grave’ and this helps us to remember just where maternity services sit in the grand scheme of things. The changes have overall been to the benefit to the general population and in some ways to the staff with a revamped pay and career structure (not the recent pay rise, by the way, which is a blog for another day).

Interestingly, Toynbee makes reference to the fact that waiting lists times have reduced dramatically and quotes an incident when a patient needing a hip replacement after being told the wait would be three months went off to Germany for private care – the patient’s GP sent her off with a reminder that before 1997 people used to have to wait two years.

Yes, we live in a world now where we want it all and we want it now. This is very much reflected in the world where I work. Women expect to get pregnant straight away and then if they don’t after a few months start demanding IVF. In pregnancy, they want it all, carry on working, carry on being super fit, carry on as if nothing is happening to them. In labour, they want the baby out if after 4 or 5 contractions nothing has happened; they want an epidural (which costs £1500) if the birthing pool is not available; they want a home birth even though it might kill them or the baby; they want a birth experience like its something to be bought and paid for; they want a private room!; they want; they want; they want.

Can’t blame it on the women though. They have been led to believe that maternity services and the service of a midwife is just that – something that can be bought like you would book a holiday or a new car but the fact is, the NHS is not a market place and all the services have an allotted span of money and it has to go round an awful lot of people and women.

So, although there is still a lot left to be desired, all in all, the UK does not fair too badly with the services of the NHS. Let’s just hope that the next Government does not change too many things and try and keep some stability within the maternity services.

More Musings on the state of the Maternity Services in the UK

2007-04-19T15:51:00.003Z

I was not going to write any more thoughts on the sad state of the maternity services in this country for a while. However, after reading a post from a student midwife from America on her excellent site Belly Tales, I felt I had to write a response. Midwife to be from America has just been on her hols here (and I hope she had a good rest ready to finish the rest of her education) where she had been reading all the coverage in the media on the statements issued from Mrs. Hewitt, health secretary. These statements being related to the documents being released stating that by the year 2009 all women would have a named certified nurse midwife and the choice of where they could birth their babies, either at home or in a maternity unit of choice. Yes, as I have spouted before, all very fine ideals and ones that have been muted since 1993 when the then Conservative government launched the concept of Changing Childbirth (DOH 1993). I remember being as excited as Midwife to be from America was at this concept and having only just qualified as a midwife myself was fortunate enough to find myself working in a ‘pilot scheme’ to trial team working. I can remember the joy and pleasure I had at this time of being able to book women at the start of their pregnancy, be with them through all the pregnancy, labour and then carry out the post-natal care. This joy was very short lived however, when after only ironically 9 months, the scheme was disbanded because of acute shortage of midwives in the trust. That was my first wake up call to the state of midwifery in this country. There have been countless other calls since.

As Student Midwife to be from America is or should be aware, Changing Childbirth was often quoted and recognised by its familiar mantra. CHOICE, CONTINUITY AND CONTROL. This was, of course for the woman and not, as many have since suggested, for the midwife, although I have to say, it would be good to have some choice, continuity and control of my working life at times and midwife to be from America will come to realise this herself as time goes by after practising as a qualified midwife for a while.

Anyway, I digress. Midwife to be from America appears to be very excited by Mrs. Hewitt’s proposals and suggests that at last, the maternity services are moving in the right direction in the UK. Her post is full of lots of ideas and thoughts, all very plausible and very well known to all the midwives and women in this country. What midwife to be from America fails to realise or understand is that a) we have been here before and it didn’t work because of the fact that were not enough midwives, not enough money and b) the maternity services in the NHS are part of a huge whole service and monies are allocated for all sorts of services including of course, looking after the very ill and dying and research into ground breaking treatments and operations.

Payment by results means that money is generated for each pregnant woman that uses a NHS Trust service but the money does not even make the maternity unit-it is swallowed up by the trust as a whole. Of course, I am totally committed to raising the importance of women centred, midwifery care and strive to do this on a daily basis but my eyes have been opened to the stark reality of midwifery services in the UK and this time last year, I was not even sure that I had a job in the NHS because of the financial situation in the trust where I work.
The budget had to be slashed dangerously low so that even if the unit was short of midwives because of sickness, then agency and bank were not allowed to be employed. This meant running the maternity unit on dangerously low and unsafe levels of care so if a woman was booked for a home birth, then she could not have one because there were no midwives to be spared to go out to her. This situation has not changed since then and I cannot see it improving in the future and certainly not by 2009. So Midwife to be from America, thanks for your enthusiasm and positive thoughts but we have been here before, 14 years ago in fact. It was lies then and it is certainly lies now. I wish it wasn’t. I wish we could provide a gold standard service but how can you on peanuts or as my dear departed Dad would say, Tram tickets!

Mrs. Hewitt writes again

2007-04-12T20:25:00.000Z

Patricia Hewitt writes today in the Guardian that the Guardians previous claims (April 7th, Birth Care is unattainable) that the NHS has too few midwives to achieve even basic levels of care for women as untrue. Oh, if only that was true! It’s a shame that Mrs. Hewitt is no longer at the age when she could possibly be on the receiving end of maternity care. If she was, then she might be writing a very different kind of response to the one she has just written today. It is very easy to quote facts and figures and percentages – and yes they may be right but the truth is that the maternity services are very badly neglected in terms of funds and resources.

When is she going to take her head out of the sand and really look, listen and take on board what every maternity unit and every midwife in England are telling her? There are not enough midwives to fulfil the promise of every woman having a named midwife to look after her by 2009 – in fact, at this rate, there will not be any midwives by the year 2009 because they will either have left the profession, gone on long term sick or died. Yes, the work force is now an ageing population and with no young, bright midwives to carry on the line where will the profession be?

In the past two years, no recently qualified midwives where I work have been given jobs. The senior midwives posts have been reduced. The majority of the midwives work part-time because of either home commitments or they just can’t take the fast and furious pace of working long shifts without a break.

Perhaps Mrs. Hewitt would care to come and work with me for a few days and see for herself just how hard the labour government’s promise is going to be to fulfil – no, on second thoughts- she would not be able to stand the pace – haven’t got time to look after anybody else on a busy shift!

Who Cares for the Carers?

2007-04-11T19:46:00.000Z

Have just been reading the new regulations of the Work and Families Act 2006 that came into force on April 1st. This is a wonderful regulation, that at last recognises that pregnant workers cannot be discriminated against and that certain criteria have to be met in order to make working life for pregnant women tolerable.

Unfortunately, I could not help but feeling ever so slightly cynical that any of these criteria could be successfully implemented in the maternity unit ( or any maternity unit for that matter) where I work. For example, stress levels should be reduced, not a chance on a busy delivery suite or postnatal ward with competing demands. I can just see it now. The pregnant midwife who is 32 weeks pregnant asking for a sit down because she feels stressed or tired – or having a meal break or drink or trip to the toilet. This doesn’t happen for any midwife let alone a pregnant one. The regulations suggest that a risk assessment is carried out to assess for things like night working, heavy lifting, standing for prolonged periods or working with chemicals. All this is can be part of midwife’s daily working life – how can these risks be safely addressed and enable the midwife to carry on with her duties?

Midwives belong to a profession that is heavily involved with caring for others and ensuring the women’s needs are met and then some. The profession cannot even manage sickness and absence compassionately and views every episode of sickness or absence no matter how genuine as people making up stories in order to have time off work! And, worse, bullying people to return to work before they are ready, then guess what, they go off sick again because they catch something else, then before they know where they are, they have had 3 episodes of sickness in a 6 month period – this then results in a disciplinary action being taken out against them – what madness – then people wonder why it is difficult to recruit and retain midwives into the NHS. Why would they want to work until they drop for an employer that treats them in such a Dickensian fashion with not a word of comfort or wishes of a speedy recover or in times of bereavement, a condolence or two. Ah well, I suppose 3 days compassionate leave is a long time to have off to grieve the death of a parent.

I have been on the receiving end of the mad sickness and absence policy having picked up a nasty infection, which my GP assures me I have caught from the hospital and I have been constantly hassled as to when I will be going back to work but no voice of concern has been expressed as to how I am getting on – for all ‘they’ know, I could have some life threatening condition but all ‘they’ are concerned about is me going back to be part of the work force that is severely depleted because of short sightedness on part of the management decisions made last year.

The new regulations for pregnancy suggest that pregnancy should not jeopardise any promotion for women – I sure as hell know that sickness and absence influences managements decisions about promoting midwives even though they may have more than the right skills and attributes for the position. Midwives need the same care and compassion that they give freely to the women they serve if the profession is to flourish and grow.

Lies and More Lies

2007-04-03T20:31:00.000Z

Have been away for a while hence no posting on the site. Whilst away, I have been able to keep up to date with the horror stories about women and maternity problems. More of the same really with article after article both in newspapers and magazines, written by journalists who are women and women who have received care from NHS midwives as opposed to independent midwives. On and on it goes, more of the same, how awful it was, how good it was blah blah blah – but do you know what? Nothing from the midwives or if there was it was very little and either very badly written or very badly expressed verbally.

Take today for instance. The Government have announced that every woman by the end of year 2009 will have a named midwife who will see them through from the beginning of the pregnancy and until after the baby is born. Women will have a choice where they will have their babies – home, hospital or midwife led units. This, apparently, is guaranteed. Funny, the government have been saying this since 1993 when Changing Childbirth was launched and which was heralded as being a revolutionary leap forward in terms of midwifery care for women and a return to the way midwives should be working professionally. Needless to say, this has not come to fruition – why? No money for maternity services and no midwives to run the service.

So, this pledge from the government is more of the same – there’s still no money and there are definitely no midwives. Midwives are qualifying and are not able to get jobs because of cut backs. There are only a few and I mean a few, like possibly 4, midwife led units, home births although encouraged, actually, in a lot of trusts do not happen because there are not enough midwives to be spared out of the maternity unit to attend these births so women have to come into the hospital. As for promising a woman a bed for the night, well that is another empty promise unless she wants to share it with a woman who has just had a hysterectomy or worse some poor woman in her 80’s with dementia. Yes, maternity units have to give up their beds in times of acute shortage to accommodate ill people because in the NHS a bed is a bed is a bed.

What does the midwifery profession do about this? Not a fat lot. No-one is prepared to speak the truth and tell the world what it is really like. Dame Karlene Davies, president of the Royal College of Midwives had an excellent opportunity to tell it like it really was on the BBC news today at lunch time. Instead, she rambled and shuffled and spoke a load of nonsense about Trusts, PCT’s, SHA’s etc.etc. But at no time did she actually say that this promise was in no way or truth, deliverable. She made herself, and worse, the midwifery profession, look like a useless lump of spineless hot air and totally without integrity. Totally unconvincing. Sue MacDonald, also from the RCM did not do a lot better either.

Come on RCM – you are supposed to be leading the profession. Speak up now before it’s too late and stop deluding yourselves and worse the women you are supposed to serving.

Hewitt's pledge to allocate more midwives

2007-03-21T20:59:00.000Z

Yet another depressing article in the Guardian about women’s lonely plight on the delivery suite and another pledge from Mrs. Hewitt to allocate more midwives.

Don’t’ believe it – how can the Government keep on making these empty, condescending promises that belittle a noble profession and a noble society of women who, God forbid, keep getting pregnant and having babies. What must the women be thinking when they read these articles day after day about the rubbish care they will receive when having their babies in hospital It’s enough to make them want to reach for double contraception but hang on a minute, what will happen to the next generation of up and coming young hopefuls to carry on with the human race? Perhaps this is all part of the Blair Government long term plan, that having a baby and giving birth becomes so awful with no midwives in attendance that the human race does not continue.

Sorted – no people, no problems – the Government will have plenty of money then. What will they spend it on I wonder? Not women and midwives – that’s for sure.

Just a word of reassurance for all you pregnant or soon to be pregnant women – in spite of working with reduced midwives and resources, where I work, we go that extra mile to ensure that you are looked after with all the skills and care that we possess, which is a helluva lot.

Please lobby your local MP for more midwives, more birth units and no closures of any kind – before it’s too late.

Happy Mothers Day?

2007-03-19T20:53:00.000Z

Well, another Mothers Day has been and gone. I actually had the day off for a change so was able to put my feet up and read the papers from beginning to end. What a luxury but not a lot of cheering news to read especially relating to the world of women and midwifery. Once again, women have become victims of being another disadvantaged group with the Government giving notice that all health practitioners will be required to carry professional indemnity insurance. Private midwives have been without this insurance since 2002 when the last company providing this pulled out. Despite this, independent midwives have grown in number and are providing care that women want and in all fairness need – the NHS is unable to provide this kind of care which is totally woman centred and has been proven by research to lead to a higher rate of normal delivery without any intervention. If the Government is unable to let midwives be exempt from this law, then independent midwives will not be able to practise any more which will be a tragic loss to women. The NHS is currently not employing any more midwives due to financial restraints and the maternity services are groaning under the increased work load and are certainly not able to meet the needs of women in a satisfactory way.

The Sunday Times had an equally depressing article on the poor care that women receive in maternity units and women report feeling like ‘pieces of meat on a conveyor belt’ and being looked after (if that is the right word) by ‘uninterested, mechanical, unfeeling midwives’. I suspect and indeed I know, that midwives feel and appear like this because they are treated themselves like ‘pieces of meat on a conveyor belt’ with management breathing down their necks to do more work with less time, less resources and less support. They are also constantly victimised and bullied by the powers that be to make sure that they don’t put a foot wrong and heaven forbid use their own initiative in making decisions about the care for the women they are looking after - after all this is why a midwife trained for 5 hard years to do – become a practitioner in her own right. Now even this is being eroded by the heavily policed risk strategy structures that are in place- yes- to protect the public but it has gone so far now that midwives practise in a climate of fear and litigation which binds them to Trusts policies and procedures and turns them into uninterested, mechanical, unfeeling practitioners who are unable to give midwifery care. Now this ethos is infiltrating into the Independent Midwives life which will prevent them doing the same and stifling women’s choices even more.

This kind of feels like a conspiracy and history repeating itself in that the battle for the control of childbirth still continues with the patriarchal forces at work again and all to the detriment of women and midwives whose position in the work place echoes the position of women in society.

Please sign the E petition on line from Downing Street lobbying the government to stop this nonsense and allow midwives to practise as they should.

Is the World of Midwifery becoming like a Supermarket?

2007-03-17T17:36:00.000Z

Have just read in the Guardian on Wednesday (yes, you must have guessed by now, my favourite newspaper) an article about Lidl – the German supermarket where everything is 70% cheaper. Apparently, there are no stacked shelves, only pallets, pay for trolleys and carrier bags – it has been reported as THE place to shop, not only for its quality but its remarkable prices. But, what about the people who work in Lidl? Staff report leaving in their droves as they cannot stand working back to back shifts. That is finishing at midnight and then having to start at six am the next day – actually this is how I have been working for 20 years and yes it breaks the EU working time directive, but guess what? Yes, that’s right, we have been discussing changing the shift pattern for 20 years and nothing has changed. We also work day and night shifts in the same week and of course we work for anything up to 12 hours without so much as a glass of water, never mind a break or heaven forbid a trip to the toilet!

So what’s this got to do with Lidl? Well, this was only one of the similarities to my work place. The others, the constant pressure Lild staff are under to check out 35-40 items a minute – if they don’t then they face some kind of action from management but they are short staffed anyway to save money so because of the pressure to perform, often mistakes are made and discovered by’ mystery shoppers’, planted to catch unsuspecting staff out.
Midwives too are under constant pressure to see more women, and deliver more babies, (allegedly, payment by results, should mean the money follows the women into the maternity unit, but in reality it doesn’t and is swallowed up by trusts as a whole) and work with less midwives all to save money. Also more paperwork and risk assessment strategies means ticking more boxes to fulfil requirements for insurance purposes – all this takes the midwife away from valuable face to face contact with women and of course, because of the pressure to do more in less time with less resources can equal mistakes, but we are not just talking about supermarket goods – we are talking about women and babies.

The article on Lidl goes on to describe how the constant pressure has led to management becoming totally dehumanised and act inappropriately to situations that need sensitive handling and how the whole work-force works under an atmosphere of suspicion. You know what, this is just how the maternity unit works and in spite of the midwifery managers grand posturing about developing the midwifery profession, the profession still functions from a time gone by when clinicians in the NHS worked in a climate of self sacrifice and fear.

Think I might go and work for Lidl – would feel very at home.

Midwifery Shortages

2007-03-12T21:04:00.000Z

Have just returned from another horrendously busy 12 hours working on the labour ward. As usual, the maternity unit is dangerously understaffed with barely enough midwives to look after the labouring women safely. Numerous pieces of research and evidence based work has been carried out to assess just how many midwives are needed to actually give expert safe care to a woman in labour. This has been assessed and worked out as, funnily enough, one midwife to one woman. This ensures that women are given one to one care which has again been proven by research to contribute to the increased chance of a woman achieving a normal delivery, without intervention and too many pharmacological types of pain relief for labour.

Unfortunately, too many maternity units are running at an all time low in terms of midwives and interestingly the national caesarean section rate is increasing rapidly. I wonder if there is a link somewhere? The Government pays lip service to the fact that women need to one to one care in labour and has even gone to the trouble of producing a very large document to ‘prove it!’ But, midwifery managers are told to keep the numbers of midwives down that they employ and not to hire ‘bank staff’ in times of crisis or at any time for that matter, to save money because otherwise the ‘government’ will have to close the maternity units down because they cost too much money. What a contradiction.

This, unfortunately, could be very costly for some maternity units in the long run. A litigation case that could be proven to be linked to midwifery shortages, for example, could cost millions. Another simple fact is ‘burnout’, low morale; extra demands on an already overstretched service can all lead to a huge increase in sickness levels which in turn leads to extra money being spent and depletion in the work force.

The midwifery profession is a mirror of the junior doctors plight in that midwives now qualifying after 3 or in some cases, 5 years of hard training, are not able to obtain jobs anywhere apart from some supermarket somewhere AND before someone else comments (letters in the Guardian) that just because a doctor or midwife has spent so many years working hard for a profession, it doesn’t mean they should automatically get a job, let me remind that person that let’s hope that in years to come they don’t need the expert help of a doctor or a midwife because there won’t be any. The medical and midwifery profession are unique and a vocation, not just another job.

Oh and another gem of advice, again from the Government (Sunday Times, 11th March, 2007) apparently, all the Nursing Profession need to do improve patient care is “smile”.

The Working Woman

2007-03-07T16:08:00.000Z

(The Guardian, March 2nd, 2007). How incredibly difficult it must have been for her to have to ‘go back to work’ just 13 weeks after the birth of her Babies and work?

Oh dear, poor Gwen Stefani much wanted baby that was born in response to her listening to her biological clock ticking away. Funnily enough, she reports not having enjoyed pregnancy very much and I quote “having something growing in your stomach feels so unnatural” – hello – that’s where babies usually grow and I can assure you it is entirely natural and normal. Poor Gwen also reported feeling fat and having a negative body image, in fact, she felt so bad that halfway through the pregnancy she had to ‘put her feet up’ and retire to her bed for the rest of the pregnancy. I am sure that all the rest of the hard working women in the world that have reached this stage in their pregnancy would have loved to retire to their beds and indulged themselves in telly watching. Not only the extremely hard working midwives that I work with and doctors, female surgeons, dentists to name but a few, but any other women who finds herself pregnant and having to keep going to work to ensure that daily essentials are there, like food, rent, clothes for other children etc.

As for going back to work afterwards – how hard can it be when you have all the help in the world, like a nanny, manager, personal trainer etc.etc? How would Gwen cope, I wonder, within the real world of being a mum and a having a career?

Perhaps with her next pregnancy, which incidentally she is keen to have (like its some kind of given), she should be mindful of the fact that lying in bed all day when pregnant is not good. Does she not know that this can contribute to an increased chance of deep vein thrombosis? Women are at increased risk of this occurring during and after pregnancy due to the fact that blood composition changes in pregnancy and becomes thicker.

Charlotte Church take note.

Inflation - The Effects of

2007-03-03T17:02:00.000Z

Have just been watching the Money Programme on BBC2 – The Cost of Kids - £180.000. When I last delivered a baby, which was only yesterday, it arrived absolutely free of charge and wrapped only in its perfect skin which had been made by the fusion of its parents genes, which, if I remember my biology correctly, was achieved by them having, well, you know ‘relations’, which is usually the spontaneous act of desire and expression between two people who fancy the pants off each other. This, of course, is usually free and costs absolutely nothing, unless of course you have had to go through IVF to conceive and if you have, then I apologise because I know that this costs more than just money. In fact, all babies and children cost and are about more than just money.

On a practical level, let’s face it. Does a newborn baby really care if its nursery is colour co-ordinated with all the latest furniture and gadgets guaranteed to stimulate and bring on your child on in leaps and bounds to become the next ‘super brain’ or ‘Olympic athlete? Does it really care if its bottom is washed in only the best ‘top and tail set’ costing £100 when a Tupperware bowl at £5 will do exactly the same job? Does it really care if it is dressed in a designer babygro costing £85 only for it to puke on or have a really horrendous nappy on to which the contents of leaks when a Tesco or Boots own at 3 for £7 will do exactly the same job? No, absolutely not.

Do you know what – parents to be should be much more concerned about the long term emotional and physical commitment a baby/child/teenage is rather than the financial one. Parents to be should be much more concerned about how the whole experience from the conception to the birth to the time after will affect their lives together and not just from a financial aspect. Of course, this is important, but all babies need initially is food, warmth, dry clothes, and lots and lots of love and attention.

Watch this space for my top tips for common sense ways of having a baby ‘on the cheap’.
Babies are for life – not just for Christmas!

How far would you go to have your baby?

2007-03-02T17:49:00.000Z

What is it with the Labour Government that everything Big has to be beautiful? Granted, since Tony Blair has been in post, there have been many great improvements in the health service, not to mention a better pay and career structure for its staff but also an attempt to improve quality of care for patients with many more policies, audits, risk management strategies, to name but a few. Along with these vast changes, which incidentally, have happened so rapidly over the last 10 years, that it leaves one’s head reeling, there have been attempts to close smaller maternity units, accident and emergency units and smaller hospitals. When I say smaller maternity units, for example, I mean units that deliver 3000 babies a year, which is hardly small. On a daily basis this equates to approximately 10-12 births, or more in a 24 hour period. A larger maternity unit can deliver up to 8000 babies per year. These units are already stretched to breaking point; imagine them having to absorb another 3000 deliveries on top of this.

The rationale given for closing the smaller units is the always trite answer that the bigger ‘super units’ will offer superior care to the care given in the ‘humble and lowly’ smaller units, that incidentally give a superb range of care from ‘midwifery led care’ to ‘consultant led care’, offering women more choice and a much better chance of ‘knowing their midwife’ and less intervention thus resulting in a much better chance of achieving a ‘normal labour and birth’. Of course, the real reason for the proposed closure of these units is to save money. It has been proposed that some of the deficit funds of the NHS could be reduced by closing the smaller units.

But these smaller units serve a huge population and are often in or near rural areas so that women already have to travel 20 miles or more to access. If these units are closed, then women would have to travel possibly in excess of 40 miles or more which is no joke when in labour or with some serious problem that needs urgent attention. A recent piece of research showed that the presence of these smaller units has prevented 20 or more women from dying in childbirth every year. This image of women having to travel many miles to access maternity care, is all too familiar to developing and third world countries where women there have to travel many miles to get help and where the maternal and neo-natal mortality rate is high.

What can be done to stop this relentless march to close smaller units? Firstly - Midwives – remember that the battle is still about the struggle for the control of childbirth and that patriarchal forces are still at work i.e. the Government and the Medical Profession, which is still predominately male, to control the way women give birth. David Nicholson, Chief Executive for the NHS was confident recently that support would be won from the public for these closures because the doctors would support the proposals. If these closures are allowed to go ahead – then this would be the beginning of the end for the midwifery profession as we know it with vast numbers of midwives becoming technicians assisting on a conveyor belt style of care with all the attending technology and medicalisation of childbirth that this will bring.
Therefore, think very hard and long about why you became midwives in the first place and make your feelings known to local politicians and fight to keep maternity units open. Make sure that you elect managers and supervisors who have vision and courage to challenge the status quo and don’t forget that the position of midwives mirrors the secondary position of women in society.

Secondly - All women, think about what you really want from the maternity services. Do you want to be looked after by midwives who truly care for you and your family holistically and are passionate about providing women centred care which gives you a good chance of achieving a healthy, normal outcome or do you want to have to travel many miles from your home to be looked after by someone who is a ‘birth technician’?

Birth has become an increasingly Kafkaesque with reductions and centralisation of services seen by managers as ‘progress’. Women and Midwives have to fight together to ensure that a safe and wholesome environment is available not too far from home.

Schools and Caesareans?

2007-02-23T21:59:00.000Z

Emerged from four busy shifts on the delivery suite. What happened nine months ago? Was it the World Cup or a power cut or maybe it was the excellent spring weather we experienced in 2006, well whatever it was, it caused a surge in activity in the production of lots of healthy babies being born. Came home to read the paper after one exceptionally busy shift to read that women are “timing their caesareans to win school places”. (The Sunday Times, February 18th 2007). Whatever next? Perhaps they should be timing the conception of the baby to fit in with starting the school year when they are just four years old. i.e. having a baby in August or better still perhaps we could suggest to prospective parents that only so many are allowed to conceive in certain months to spread the load more evenly among maternity units across the country.
Actually, I am surprised that Tony Blair and his government have not suggested this as a way of making maternity services more economic and efficient. If so many babies were allowed to be delivered a month, it would save on money spent on resources, staff and so on and so forth.

Anyway, I digress. Caesarean sections to win school places. This article does not directly state that women are deliberately choosing c.sections to time the arrival of their babies but it does imply that maybe they are. If this is the case, who is giving their support to this decision and are the women fully informed of the risks they are taking in having an unnecessary abdominal operation (because this is what a c.section is). If a c.section is necessary to save the life of the baby or the woman or to prevent a reoccurrence of a previous traumatic delivery then this is fully justified and supported but just to have a c.section so the timing of the birth of a baby can secure a place in an exclusive prep.school is monstrous. Apart from the risks, such as infection, deep vein thrombosis, increased risk of haemorrhage, future health problems in the woman’s later life and an increase in the infertility rate after a c.section, c.section can be a risky business for a baby as well with the fact that the baby’s lungs are not automatically squeezed as they would be during a vaginal birth thus resulting in the baby inhaling fluid on to their lungs and resulting in a possible pneumonia.

The other dilemma with c.sections to secure school places is the one of cost to the NHS which is already groaning under the weight of having to perform necessary life saving surgery and treatments to adults and children with disease. The cost of an unnecessary c.section to the NHS is somewhere in the region of £2000-£3000 as opposed to the cost for a normal vaginal birth which is somewhere in the region of £200-£300. Hopefully, the parents who can afford to send their children to the exclusive prep schools could be persuaded to pay for their elective c.sections, unless, of course, they are already doing so.