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.