Women's Rights

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).

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

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.

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

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

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

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?