Frustrating Times! Bad Bad Midwife!

This morning has been one of my most professionally frustrating mornings I have ever had. I must have had these mornings before when I was in fulltime practice and been too tired to notice but since I was doing a morning as a locum midwife I could have screamed.

One of the many roles of the midwife is to believe in and keep pregnancy, labour and birth a 'normal' physiological process which often happens to normal healthy women.

"Midwifery Care takes place in partnership with women. Continuity of midwifery care enhances and protects the normal process of childbirth. "

This a quote from the College of Midwives web site stating the philosophy care behind midwifery.

But, today I have been faced with the most impossible task of keeping things 'normal'. I shall endeavour to explain my frustrations without revealing details which may break confidentiality.
How does a midwife keep it normal when the family insist on searching for the 'abnormal' to the extent that I feel they will fullfil their own prophecy and create their own doom.

After going over aspects for a third time during consultations had to give in and admit defeat. I've had to recommend a referral to the obstetrican even though there is no criteria met for referrals other than the obsessive need to see someone with a white coat. This means a precious appointments, which could be used for someone with a real problem, will be wasted.

So this morning I feel I have failed. I have failed to keep things normal, I have failed to empower someone and their family to believe it all in all I have FAILED!

Teenage Pregnancy 1

I made up this slideshare presentation to discuss antenatal education for young mums.

Teenage Pregnancy 1

View more presentations from Pam H.

Great start to the Day-great email

Police Complaint - just brilliant! This is a genuine complaint to Devon & Cornwall Police Force from an angry member of the publicA true email sent to the force, lengthy but brilliantly written..... --------------

Dear Sir/Madam/Automated telephone answering service,
Having spent the past twenty minutes waiting for someone at Bodmin police station to pick up a telephone, I have decided to abandon the idea - and try e-mailing you instead.Perhaps you would be so kind as to pass this message on to your colleagues in Bodmin, by means of smoke signal, carrier pigeon or Ouija board.As I'm writing this e-mail there are eleven failed medical experiments (I think you call them youths) in St Mary's Crescent, which is just off St Mary's Road in Bodmin.Six of them seem happy enough to play a game which involves kicking a football against an iron gate with the force of a meteorite. This causes an earth shattering CLANG! Which rings throughout the entire building.This game is now in its third week and as I am unsure how the scoring system works, I have no idea if it will end any time soon.The remaining five failed-abortions are happily rummaging through several bags of rubbish and items of furniture that someone has so thoughtfully dumped beside the wheelie bins. One of them has found a saw and is setting about a discarded chair like a beaver on ecstasy pills.I fear that it's only a matter of time before they turn their limited attention to the caravan gas bottle that is lying on its side between the two bins.If they could be relied on to only blow their own arms and legs off then I would happily leave them to it. I would even go so far as to lend them the matches.Unfortunately they are far more likely to blow up half the street with them and I've just finished decorating the kitchen.What I suggest is this - after replying to this e-mail with worthless assurances that the matter is being looked into and will be dealt with, why not leave it until the one night of the year (probably bath night) when there are no mutants around then drive up the street in a Panda car before doing a three point turn and disappearing again. This will of course serve no other purpose than to remind us what policemen actually look like.I trust that when I take a claw hammer to the skull of one of these throwbacks you'll do me the same courtesy of giving me a four month head start before coming to arrest me.I remain your obedient servant???????---------------------------------------------------------------------

Mr ??????,
I have read your e-mail and understand your frustration at the problems caused by youths playing in the area and the problems you have encountered in trying to contact the police.As the Community Beat Officer for your street I would like to extend an offer of discussing the matter fully with you.Should you wish to discuss the matter, please provide contact details (address / telephone number) and when may be suitable.
RegardsPC ???????Community Beat Officer---------------------------------------------------------------------

Dear PC ???????
First of all I would like to thank you for the speedy response to my original e-mail.16 hours and 38 minutes must be a personal record for Bodmin Police Station, and rest assured that I will forward these details to Norris McWhirter for inclusion in his next Guinness book.Secondly I was delighted to hear that our street has its own Community Beat Officer.May I be the first to congratulate you on your covert skills? In the five or so years I have lived in St Mary's Crescent , I have never seen you. Do you hide up a tree or have you gone deep undercover and infiltrated the gang itself? Are you the one with the acne and the moustache on his forehead or the one with a chin like a wash hand basin? It's surely only a matter of time before you are head-hunted by MI5 to look for Osama.Whilst I realise that there may be far more serious crimes taking place in Bodmin, such as smoking in a public place or being Christian without due care and attention, is it too much to ask for a policeman to explain (using words of no more than two syllables at a time) to these twats that they might want to play their strange football game elsewhere.The pitch on Fairpark Road , or the one at Priory Park are both within spitting distance as is the bottom of the Par Dock, the latter being the preferred option especially if the tide is in.Should you wish to discuss these matters further you should feel free to contact me on . If after 25 minutes I have still failed to answer, I'll buy you a large one in the Cat and Fiddle Pub.Regards?????????P.S If you think that this is sarcasm, think yourself lucky that you don't work for the sewerage department with whom I am also in contact !!!

Domestic Goddess! (Me thinks not!)

I have been volunteered to create canapes for a party we are going to tonight. This is the enormous fennel that has been growing in the garden, I have havested it today to create a fennel, pear and Cream cheese dip.

I also created some mini potato cakes last night and I have topped them with the dip mixture.

When I was in the UK I used to look in envy at other doctors wives. We would be invited around to dinner and would be served up meals of perfection which had been slaved over all day yet I always found these things difficult to replicate.

I did slightly get into my stride a bit before I left yet there was one person I could never measure up against. She would create the most perfect meringues which were sandwiched together with freshly whipped cream, she also made perfect bread rolls for a local restaurant she would also whip up fancy dress outfits for the children as well.

Here in New Zealand I have fallen once again by the wayside in my efforts to create great party food because caseloading meant we never actually had anyone around for dinner.

So I have slaved all day and I have created:

Pumpkin Rissotto Balls

Cheesy Pastry sticks

Tomato & Feta Pinwheels

Fennel, Pear & cream cheese dip

Mini Potato cakes topped with Fennel, pear & cream cheese

Mini apple & custard pies

I am now exhausted and looking forward to a glass of wine!

Every picture tells a story

Before Surgery & the last time I allowed picture to be taken

Following 30kg loss

More as I am today nearly 60kg lighter

Size 12 jeans and loving it!

Teen Pregnancy Issue 1

Teen Pregnancy Issue 1

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RCM and RCOG working together why in Australasia are things worse?

"The Royal College of Midwives and the Royal College of Obstetricans and Gynaecologists support home birth for women with uncomplicated pregnancies. There is no reason why home birth should not be offered to women at low risk of complications and it may confer considerable benefits for them and their families. There is ample evidence showing that labouring at home increases a woman's likelihood of a birth that is both satisfying and safe, without implications for her health and that of her baby."

A ground breaking statement which is crucial for the development of the campaign for normal birth in the UK.

It is widely acknowledged that support of medical profession is crticial. More research needs to be produced about the aspects of the woman's body to give birth physiologically. I would like to do more research around the physiology of birth but I would like to do it collaboratively with an obstetrician and a GP. This I would hope would give credibility in the dark deep mysterious world of medicine.

Here in Australasia relationships between the College of GP's, Royal Australian and New Zealand College of Obstetricians and Gynaecologists and Midwives appear to be getting worse with each camp becoming dug in, trenched down and stalemated in their viewpoints.

This is despite the draft Maternity Action Plan and despite the growing body of evidence growing which states that there is increasing rates of intervention in low risk births due to 84% of births occuring on tiertiary units.

I have no answer to this only than to call for more research to prove the cost of such interventions to the health budget. Money talks and in this day and age of 'tough times' this is the only aspect that will be understood.

I do get irritated!

"The Good Fight wants bonuses and incentives paid to LMCs who book their client at a private birthing facility or non-tertiary hospital stopped, including a $60 bonus for midwives whose clients do not need to be admitted to hospital."

Can I straighten this out?

This payment we receive for women birthing at home in the first instance covers birthing supplies; we have to pay for pads, waterproof sheeting, disposable goods, sterilizing of equipment, suture supplies basically everything that we may need for birthing at home that we would use at the hospital.
We also pay for Oxygen cylinder hire on a monthly basis for resuscitation, a bag and mask for mum and for baby plus all IV supplies should we need to cannulate.

This payment also covers extra postnatal visits. When someone births in the hospital for the first 48hrs following the birth the woman should have a midwife postnatal check twice a day. Obviously when someone births at home then the midwife has to visit twice a day for the first 48hrs.

It is obscenely offensive to me and my profession to suggest we coerce women into birthing in their home environment because of extra payment.

I am also tired of the argument about midwives getting extra money around the birth because the doctor has to pay the hospital for midwife time. Well I am sorry so they damn well should! They don't provide full on one to one care for the whole of labour, the hospital midwives did it and the doctor visited briefly at set times during the labour and then just came in to catch the baby, suture and walked out to leave the hospital midwives to clean up the mess. I never saw a doctor help and stand with a woman in the shower cleaning her down, I never saw a doctor tired cleaning blood from the floor, I never saw a doctor strip and clean down a bed full of blood and then walk the woman and her baby down to the postnatal room and tuck her in bed. I on the other hand have been in at the start of a 1st time mum induction of labour, done every vaginal examination, given every prostin, listened in every hour to the baby. I have then followed on provided one on one care throughout her labour and birth totalling 27hrs. Do you know that under Section 88 (maternity document) in that time I am only entitled to 20mins of support from hospital midwives? This 20mins is usually used up at the birth due to the fact we did not have resuscitators in the birthing room and just one outside for the three rooms we obviously have to have the hospital midwife in the room then. Which means I have a choice, work 27hrs without a break or have a break but have no second midwife at the birth which is dangerous. After these 27hrs I have to stay legally for a further 2hrs then when I have walked the woman down to her bed a tucked her in I have to strip the birthing room and clean up all blood and dirt.

I have earned every penny of my birth fee and again I resent and am insulted when that payment is questioned as unfair and unbalanced.

As for my business overheads being a lot less than a GP? Well I only have income for 5o women a year my husband has income from 1700 patients a year. His payments come from the government, patients and the PHO. It still cost me $35,000 a year to run my practice as a midwife. Yes this is probably a lot less than what he pays in fact he has a practice manager to take care of all that for him, I had to run my business alone spending easily 3hrs a week on bookwork.

There I am done, my rant is over for tonight and till next time someone gets me going!

My Email to Air NZ CEO Mr Fyfe

Dear Mr Fyfe,

I am a midwife married to a GP and we live in Blenheim. Until my fat busting surgery last year I worked as a case loading midwife in Blenheim, however since my surgery I have been concentrating on gaining a postgraduate masters in Midwifery.

This week I decided to return to a level of work on a casual basis at the Maternity Unit in Wellington as I love working in a very busy, challenging environment but I had begun to dislike the 24hr/7days a week commitment to on call that case loading midwifery brings so I made the decision to work in Wellington. This has meant that this week for the first time I have been separated for 4 days from my husband and two daughters aged 7 and 8.

I have endeavoured to provide a caring, personal midwifery service this week to the women I have come into contact with without showing too much how upset I was at being away from the family. I must say that the service I received on Thursday evening on the flight that left Wellington at 9pm to Blenheim, mirrored the service I had been providing for the previous 4 days.
I arrived at the airport to see that my flight was delayed an hour, no big deal it enabled me to enjoy a couple of peaceful glasses of Pinot Gris. I telephoned home to let them know, my girls were getting anxious as they stayed awake to make the special trip to greet me at the airport. I made my way down to the gate to see that there was another flight for Blenheim about to leave. The flight before mine left and the two glasses of wine were settling nicely in my empty stomach. Imagine my slight horror when after the 1st Blenheim flight left there were two departed notices came up on the board, one next to my flight.
I turned to the people around me to ask which flights they were booked on but all were booked for a Christchurch flight. I began to wonder, had the two glasses of wine led me to missing my name being called? Had I dozed off at the gate under the influence of the wine? I rang home in a panic to have my husband accuse me of deliberately missing the flight and forcing him to struggle as a single parent for an extra night.
I eventually pulled myself together enough to approach the staff, I was relieved to find out it was an error. As the flight was called I was actually approached personally to board which I did think was unusual but as we crossed the tarmac the pilot explained that I had a full choice of seats as I was the only passenger!
We had a great flight!
Now imagine as the only passenger getting off a flight, crossing a dark tarmac to see the excited faces of my two girls jumping up and down excitedly (who by the way had a special bath to smell nice for mum coming home) waving as I walked towards them. They had been anxious in the airport in Blenheim as they were the only people waiting but the Air NZ staff had taken the time to reassure them that their mum was coming home as promised.

I thank your airline Mr Fyfe for continuing to run that flight, my girls thank you and special thanks come from my husband who has managed to complete his surgery after having a better nights’ sleep for me being home.

It would have made a great advert!

Kind regards

Pam Harnden Midwife & Childbirth Educator

Everything begins to catch up!

It has been a hectic two weeks! Arriving back at home now I am beginning to feel the full effects!

So my timetable began:
MONDAY:

Up at 5.30am
Airport: 6.25am
On plane: 6.55am
Off plane: 6:56am
back on plane: 7.40am
In Wellington: 8:10am
Wellington Hospital: 8:30am

The orientation began with the tour of the hospital, which is enormous! There are orange lifts, silver lifts, red lifts each with certain security clearance and one for public use.
I was very impressed with the number of decent coffee shops in the hospital and I loved going to the Wishbone cafe for my lunch breaks.
The day continued with meeting people and filling in paperwork. I also got to learn the correct way to use a neopuff for neonatal resuscitation and how to check all the equipment.
Policies and protocols are very easy to follow with laminated check sheets for emergency situations in each birthing room. The midwifery educators also run mock emergency drills every week which is a fabulous way of getting the practice for emergency situations.
I am very impressed with the support education wise given to the midwifery staff. There are tech skills workshops run every month by the midwifery educators.
Everyone was lovely and very supportive.

The rest of the week has been 7.00 am starts finishing at 15.30. So I was up at 6am having my shower and getting ready for work. The 15.30 finishes have enabled me to have two evenings shopping in Wellington and for this trip I may have overspent just a wee bit!

As I said in the previous post, the most disappointing thing about the trip was my first nights accommodation which turned out to also be a bit of a 'halfway' house and I was pleased I decided to change motel. My worst fears were confirmed when I got a call from the motel manager to apologise for the nights commotion and the police being called.

One of the highlights for me however simple some people may think it is, I managed to get a bus back from the town center to the hospital last night. It was a great opportunity to see parts of the city I hadn't seen before.
I loved meeting up with a friend of mine and having a glass of wine at Astoria, lovely Pinot Gris, I could have happily polished off a bottle of it.

The main advantage of orientation week is being supernumerary, not being in the numbers means that when I answered a call bell I could actually spend some time with whoever I was with. When there is an enormous amount of work to do and just two midwives to do it then things get very busy. This week the unit in Wellington has been full. One morning all the antenatal beds, postnatal beds and the delivery suite were full with an amazing variety of women and cases that all needed expert care.

This is the challenge of working in a Tertiary unit.