Thursday, October 26, 2006

Lack Of Food

We had a lot of Muslim staff at our obscure little backwoods hospital, for some unfathomable reason.
Some of them were senior doctors, and the men were, on the whole, charming to all the female staff.
None of the Muslim women wore anything other than Western dress; there was never any sign of a veil.

The Muslim staff all observed Ramadan, and we became used to checking on its date each year, in order not to tempt or offend them into breaking their fast in the daylight hours by inadvertently offering them a cup of coffee after a frantic delivery on Labour Ward. Only once, as a student midwife, did I offer, and I was snapped at quite royally for my pains :-)

I did sometimes wonder, seeing some of the junior staff exhausted from long hours on-call and seeming really quite hypo, how much that combination might be affecting their clinical skills. I certainly would not have wanted them to be operating or performing a forceps delivery on me in those conditions of exhaustion and lack of food, and I do still wonder whether or not proper risk assessment has ever been done of any members of staff who have been deprived of food; whether willingly (as in fasting) or unwillingly (as in simply not having the time to eat) .

It is probably not even possible to raise such questions, given the current political climate in Britain today.

None of us liked to say anything even then, and no-one would dare to now.

We did have a delightful female Hindu registrar, who wore her sari, and was unfailing gentle to everyone, staff and women alike. She was great to work with and her clinical skills were superb.

A lot of our junior SHO grade staff were European, so we really did have quite a mixed bunch of medical staff rotating through the Unit. It was brilliant experience and I learned a huge amount about other cultures.

Wednesday, October 04, 2006

Inequalities In Health

A really interesting in-depth article in The Guardian about the appalling inequalities in Childbirth health care between Sweden and Niger can be found here .

Food for thought:

The chance of dying in childbirth in Sweden is 1:29,800.
In Niger, it is 1:7

It isn`t right and it isn`t fair.

Women in the developing world often suffer horrific childbirth -induced injuries, which are incredibly rare here in the West, which is one of the reasons I support Ethiopiaid, (click on the link to Fistual Hospital ), a charity which in turn helps to fund the wonderful Fistula hospital in Addis Abbaba, where they treat some of the horrific childbirth injuries sustained by the equally unfortunate women of Ethiopia.

Birth In A Park

This is the first birth in a park that I`ve heard of ....

Mother and baby doing well, and well done to the tree surgeons !

I was a little perturbed to find that the emergency services despatchers wanted a postcode in order to send an many people would know the postcode for Richmond Park, for goodness` sake ?

Antenatal Clinic

We were perenially short-staffed in our maternity unit.

We had multiple obstetric consultants, so each one would have their own antenatal clinic session weekly. Antenatal clinic typically involved 30-40 women turning up booked into a 90 minute clinic , which of course always over-ran. Not much fun for the afternoon clinic women relying on public transport to go to pick their little ones up from school.......
If I had £1 for everytime I apologised to these women, as we gave them the option of arranging for one of the community midwives to visit them at home, or rescheduling their appointment ASAP for the earliest possible time in the clinic slot, I would be living in the Bahamas.

A typical clinic involved three doctors : God (AKA The Consultant), the Senior Registrar and the SHO. Midwifery staff were generally Clinic Sister and two other midwives if they were really lucky.

Each pregnant woman needed to have blood pressure measured and a urine sample tested and results documented in their case notes; but if all the clinic staff were in with the doctors, there simply was no one person "outside" the examining rooms to deal with this or answer the phone, chase up missing notes, missing blood tests etc.
Simply too many things to do and not enough pairs of hands. We all spent an awful lot of time zooming back and forth from office to phone to clinical areas and waiting areas to do BP and urinalysis and back again.
I supose it did keep us fit, though !

The doctors were good at doing the "doctor" bit, but not always so good at actually explaining to the woman what they actually *meant*. I used to hate seeing women come out and obviously not have a clue what was meant by the abbreviations written in their Case-notes, which they got to take home and would be discussed with family, friends, neighbours etc. I made a point of "translating" jargon into clear English for all the women I saw at clinic, so when they got home and people asked how they had got on at clinic, they actually KNEW and were able to tell their significant others.

Male medical staff were always chaperoned by midwives, for their own protection. Enough said.

SHO staff generally really *needed* a midwife with them as they began their placements, simply because they weren`t used to the way our unit "did" things , and also because many of them were not yet fully proficient at what they were doing or worse, sometimes didn`t realise that they weren`t proficient.
Their teaching by senior staff was only ever as good as the senior staff member, at the end of the day.....

We were there to make sure nothing got omitted or unnecessarily committed. Most SHO staff were really good, eager to learn as much as we could possibly teach them, and one of the delights was to see them growing in confidence and ability and becoming really excellent obstetric SHOs by the end of their placement.

One of my favourite bits of the job was teaching them how to locate the fetal heartbeat using an old-fashioned Pinard stethoscope, rather than *always* using the Doppler. As I often said, one day the batteries will run out on the Doppler, then you are stuffed :-) but I will always have my trusty Pinard AND KNOW HOW TO USE IT!

Locating the fetal heart is not always as easy as you might think, even with a Doppler. I always used my pinard wherever possible after 19 weeks gestation, to keep my own skills honed, but I also *always* used the Doppler briefly for the woman and her companion to hear the baby`s heartbeat too.
We did actually have one locum consultant who felt it was entirely superfluous to use the Doppler if fetal movements were seen/felt on abdominal palpation by the midwifery or medical staff, on the basis of "Well, if it is moving, its heart is obviously beating!"

Added to the workload would be the fact that we were usually also simultaneously running a routine ultrasound scanning clinic at the same time for women at 17-20 weeks gestation, so any problems flagged up by our great ultrasound team would need urgent attention. Equally, any problems identified at clinic would often need a scan to confirm the problem, and the scan staff were brilliant at fitting us into their own hectic schedule of appointments.
Bloods would also have to be drawn for various reasons, and if we were really lucky, we would get a phlebotomist at clinic too.

It would be two hours of frantic activity at clinic, followed by entering all the data into the computer system, and chasing up the women who did not attend, re-scheduling appointments or for persistent defaulters, getting the community midwifery staff to visit them at home to see how they were getting on. We also had to liaise with Social Services for the families with problems to get them as much help and support as possible, as well as providing support for the increasing numbers of pregnant teenagers.

Clinic Sister often used to complain about not having enough staff, and after I had done a few shifts, there, I soon saw her very real point. Having said that, the women on antenatal, postnatal and Labour wards also needed adequate levels of midwifery staff to care for them too.

How on earth is it possible to prioritise whose needs are greater ?
If something crucial is missed at clinic, that woman and her baby could be at risk.
If something is overlooked on a woman admitted with complications to the antenatal ward, they could be at risk.
On Labour ward, good levels of staffing were of paramount importance.
On postnatal ward, if problems were not identified quickly and treated aggressively, mothers and babies could be at risk.

Every area needed more midwifery staff, but the budget was not a bottomless pot of gold, sadly.

Tuesday, October 03, 2006

My Hospital

I trained and worked at a small district general hospital in a socio-economically deprived area of the UK, where health problems were rife.

The original hospital, like so many others, was built in the late Victorian period, on a hill, with quite lovely views over the surrounding areas, until they were all eventually lost in a morass of house and industry building.

It`s still a source of amazement to me how ill folk, or the elderly, were supposed to make their way up a fairly steep hill; when I was pregnant and my colleagues there did my antenatal care, I found it really hard going to walk up from the car-park to the ante-natal clinic.

The original buildings were lovely red-brick, and as the hospital grew and the NHS began, more and more was added on until the hospital became a sprawling mass of concrete and glass blocks and corridors, which was completely baffling to visitors and often to the staff when we had to go to unfamiliar departments......

Maternity was a relatively modern building, lots of glass. A nightmare to clean, no doubt; it was draughty and cold in the winter, when the savage winds whipped and howled around the hillside, and unbearably stuffy and hot in the summer. We had three small mixed antenatal and postnatal wards, a Labour ward with self-contained obstetric theatre and an ante-natal clinic as well as an adjacent Special Care Baby Unit. We couldn`t cope with extremely premature babies, who would have to be transferred to the Big City for care, but we did our best.

My youngest child was one of the last to be born there, surrounded by the loving care of my friends and colleagues, and I have many memories of the time I worked there. Now, under the ravages of Socialist Britain under the Blairs, it is no more - closed, demolished, and the site sold to the highest bidder for redevelopment. I haven`t had the heart to go back and see what they have done to the site.
I prefer to keep my memories intact.

Tuesday, September 26, 2006

Only The Memories Remain.....

The ten years I spent actively working as a midwife were amongst the happiest, most fulfilling and utterly exhausting of my entire life.

There is nothing more amazing than helping a baby to be born, and it is a bitter regret to me that I can no longer work as a midwife due to health problems.

I do have an enormous number of very happy memories to make up for the fact that unless an emergency crops up and I am the only person there to help, I am unlikely ever to deliver a baby again. Sigh.

Monday, September 25, 2006


I saw an awful lot of curious, strange and interesting things whilst I was working as a midwife.
Sometimes all on the same day , LOL.

I hope to post some of them here before they are lost to memory......