Skin to skin and the WHO checklist board

Skin to skin after birth can save lives. Have a look at what Jenny Clarke has helped achieve in her trust for theatres

@JennyTheM

The day has arrived – several large cardboard flat packs were delivered to the Women’s Unit Theatre today and I could not wait to open them ALL – lucky for me Nick (a Consultant Anaesthetist) who totally ‘gets’ my passion for skin to skin was there .
“Nick” I said “if those boards don’t have skin to skin on them I’m going to have a huge tantrum and I don’t do tantrums”
“lets get them opened then Jenny” he replied
The first ones were “checkout boards ” which are to ensure that everything is correct prior to the woman leaving theatre –
“let’s try these Jenny ” bear in mind these are huge boards about 2-3 metres by 1.5 metres and very heavy – a theatre nurse joined us to help –
“you and your skin to skin you certainly have a passion for it don’t you ?” Mark (an…

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Bright Friday

Dumbing down the science as much as possible, I will tell you that the “colour” black isn’t a colour at all; it downright refuses to reflect any of the colours that light bounces against it. Rams all the colour into it and keeps it for itself. Greedy black.

So Black Friday is well named, isn’t it really? Judging by recent footage people are rammed into a small space and greedily grab as much as they can carry.

I used to work as a customer service assistant at The Bear Factory (now Build-a-Bear) – yes it was as awesome as it sounds…until it was very, very crowded and people lost sight of the fact that they were getting cross about pricing ON A FOOTBALL KIT FOR A BEAR. In a buzzing crowd, it’s easy to lose perspective, I guess.

Perspective: this is one of my friends from school, bright, enthusiastic, kind – and reached out to me when I was a lonely “keener” weirdo.

Trina Hamblin

Trina on Leavers’ Day 15th May 1998

Trina, yes that’s her real name, yes I know that I said it would only be my name that was real on this blog, but there’s a good reason for her name being here.

At a young age, Trina was fostered into the family I knew as hers. While at school her foster mum sadly died, and she experienced a loss I couldn’t understand or quantify. She was bright and enthusiastic and joined Army Cadets and LOVED it. She left school after her GCSEs and the last time I saw her face-to-face  was about two years after that and she was telling me about what she was studying at college. Telling me about society being any group of people, some really insightful stuff and she was doing well.

That was about fifteen years ago; we’ve chatted on Bookface now and again – but I can safely say we lost touch.

I was shocked to hear a few weeks ago that she’d died rather suddenly; my first thoughts turned to that bastard we all love to hate: Cancer. It made sense, cancer can be quantified, publicly fought, proudly beaten, or agonisingly terminal. It doesn’t discriminate between the old and the young. That’s how my mum died – I could relate to it, if not accept it.

Sadly Trina was fighting a different disease: depression. The killer that walks among us, thriving on silence and misunderstanding. It was an even greater shock to be told that Trina had in fact taken her own life.

I was stunned, what could have happened? I has some selfish thoughts: “Could I have been there for her more?” “If only we hadn’t lost touch” “Maybe I could have been someone she could have talked to.”
They’re selfish thoughts because Trina was surrounded by family and friends who loved her, and being perfectly frank with myself – who the hell do I think I am that could have been there for her instead of her family?!

I attended her funeral on the 5th November and I’m pleased to say that I did *not* sit down. I couldn’t – Canford Crematorium was absolutely packed to the rafters. You might think that off for someone who saw death as a solution, but often people who feel a deep loneliness can do so surrounded by people.

I squeezed in at the back among strangers. My tears fell freely as the person holding the service read out a letter…written by Trina. I won’t disclose what was written, it was directed to the people who had come, but it was heartbreaking to hear words she had written herself having made up her mind. Her birth mother spoke and said much the same, that Trina had seemed to cheer up in her final days, and they guessed afterwards that it was because she knew that she was going to do it.

I hadn’t known Trina in her adult life at all, I don’t know what she faced in that time, or how any of her past pain my have re-surfaced. I regret this; I really regret this.

There will be someone reading this now who has faced depression or may be going through it now, you might be at the end of your tether and feel hopeless, or helpless or that no one cares. This one is for you

a sign

Please call the Samaritans on 08457 90 90 90

To some that might seem crass, but I’m happy to risk that if just one person sees it and thinks “Ok, I wasn’t sure why I was going to read this blog post, but now I see why”, then that’s ok.

So why the link to Black Friday? Why call it Bright Friday instead? Because for all the TVs, games consoles, electronic bargains that people have clambered over each other to buy, snatch and grab, I’m sure that there are countless others who would crawl over hot coals to grab, snatch and *steal* a few more hours with a lost loved one. THAT is perspective.

Call the people you love, visit the friends you miss, god dammit write a letter to relatives, just reach out and stop missing out on the chances to catch up and show you give a monkeys. There will be new “stuff” every year that we can buy, but some things pass by and are wasted.

I apologise if this has been a depressing post, but when I see how much material stuff seems to matter to people that they will literally trample others, it’s time to get a reality check and consider what is really worth your time and effort.

Allie Brosh is an incredibly talented bloggess, she has a “real life” but her blog  posts about depression are wonderfully open and honest.

Read the first one here.

The second is here

You should read her other stuff too because it’s very funny, click the image for a link to one of her all time funniest posts for a bit of cheeriness!

hopelessbullshit

The Twitter “How-To” Post

Hello again, just a quickie today – not like that, you mucky filth!

If you’ve ever watched Jeremy Kyle, you’ll be aware of the damage that Facebook can do to people’s lives…when they live on it. Well, in some ways it can do the same to your professional life if you’re not wary of how you’re portraying yourself.
If you’ve had a Trust induction yet, or you’ve been to a few, they will tell you in no uncertain terms that you’ll be walking the plank if you act like a plank in the way you use it.
And you woodn’t want that now, would you?
Geddit?
“Woodn’t”?
“plank”?……..

sheesh, tough crowd!

But I’m not talking about BookFace, I’m talking about Twitter here.

Full disclosure: I Bloody Love Twitter

One of the best things about it is that you get linked up very, very quickly to up to the minute ideas and happenings. When conferences are happening and you’re not able to be there, follow the hashtag, you’ll see pictures, quotes, links, all sorts of stuff that you otherwise would have missed out on.

The other incredible thing is that THERE IS NO HIERARCHY on Twitter, you can follow anyone from your friends to speakers and professionals who are leaders of their fields. Cathy Warwick, Lesley Page, Sheena Byrom, Ina May Gaskin – and if you engage, you are already part of the community.

So, not sure where to start? Well you can, ahem, um, you can follow me @Twidmife and see who I follow and go from there, and that will start to suggest other similar people to follow (it’s clever, it knows how to do that!).

Twitter image

If you’d like, I did a 4 minute animated video a few months ago that was specifically for people, like us, who want to use their account professionally.

Hope you like it!

 

Heather x

The right time, the right place…ment

Like the renegade master, I’m back once again – but not with killer beats, no, with tales of placement.

Here’s a little recap of what I’ve been up to over the past 6 weeks while out in placement in antenatal assessment settings.

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How is second year feeling so far? MAN, IT’S LIKE, I KNOW THINGS!

So it’s a step up from first year?: Yes, leaps and bounds – but that only became massively apparent once in placement and the complications we had been learning about were suddenly in front of us with faces, names, and questions.

Questions? WAT?!: Exactly, but it was like that wonderful feeling in the first year when a woman asks you something and you magically know the answer. But it’s not magic, because you learned it with your head and your mind and your brain.

Harder questions though, yeah?: Well, more complicated. All questions are hard if you don’t know the answer, and so yes, there were some hard questions – but being in a placement environment, you’re being taught things as you go, so you learn the answer and can answer the next person. I did this with some twin pregnancies. I sat in with the registrar when she was talking to a couple about their pregnancy, then when the next woman had the same questions, I could answer them before handing over to the registrar for her to come in and talk through everything. Parrot-fashion learning is great for some things, but it’s knowing when to say “I don’t know, but I’ll let them know so that they can talk it through with you.”.

Is it easier learning in the classroom or when you’re out there? I’m a visual learner, and a do-er, but there’s no way I could have learnt half the stuff I’ve learnt without having done the theory first. While you’re there to learn, you still don’t want to look like a fool if you’re asked questions you really should know.

What was the hardest thing?: Getting up very early to do 12 hour shifts.

Seriously?: Yes, but if we’re talking skills, then I would say I get stuck on daft things. Some things I can pick and quickly and run with it. Some things haunt me. I kept getting gravida and parity mixed up, which I knew in first year. It’s such a silly mistake to make too.

Anything else?: Blood bottles and their corresponding envelopes to go to the lab. I never got it wrong because I checked it every time, but I feel like it’s something that should be academic now. I’ll get it.

How about the best thing?: Managing to provide quality care when feeling like I was spinning plates; I’d met the woman week before and she’d been presented with a complication in her pregnancy she wasn’t expecting.

Complications can be expected?: Well yeah, if there’s a history of them in previous pregnancies, of the woman has a pre-existing condition – diabetes for example is pre-existing, whereas gestational diabetes mellitus (GDM) can develop during the pregnancy and say adieu when baby is born.

So how did you identify the care had been ace?: Because I met her in the second part of my placement, we had a familiar chat because we’d met previously and then I was able to do the clinical things knowing she felt at ease with a friendly face. When she was discharged, she popped her head round the door to thank me and said I’d been amazing and made her feel much better.

Nice!: I thought so! Sometimes a long wait can be made ten times more bearable with a cup of tea and a genuine question of “How are you feeling?”

So it can make the difference then, do you think? Having met the woman before?: In a lot of cases, yep it really can – that’s not to say you can’t give exceptional care if you’ve only met the woman for the first time when she’s in the throes of labour, but in antenatal appointments, trust is a big deal and you have to hope for a little so that you can get as much info as possible, but prove you’re willing to earn the rest.

Um, why should you? Can’t you just show it over all the appointments?: Well you don’t always get to see the woman more than once, and sometimes that woman has had a really crappy time with services before and been left feeling betrayed or patronised. My chequered past in customer service and performing arts lets me talk to just about anyone with a certain amount of confidence, but the gift of the gab only gets you so far. You have to under promise and over deliver.

That’s a customer service phrase isn’t it?: Yes

Hate yourself a little bit for using it?: Yeah, it made me a bit sick in my mouth, but through the vom, it’s exactly what I’m trying to say

Fine, explain it: It’s straightforward, a busy antenatal clinic is a bit like speed dating – you only have a short time to show this person that you *do* care, find out how they are feeling, see if anything new has cropped up and help them decide what care they need – if they’re going to call you in my speed dating analogy

Ok, still on board, but the over deliver thing?: Ok, an example here – a woman comes into clinic, you only see her twice before she gives birth as you’re her new midwife. You tell her you’ll come and see her after the birth, but her previous midwife was very busy so often didn’t catch up with her women herself, and someone else would do the postnatal appointments.
“I’ll come and see you after the birth” = under promise.
Checking the maternity system to see when she gives birth and heading to the hospital to see how she is = over deliver

So going the extra mile then?: Well yeah, but midwifery is that every day. Whether people realise it or not, you’re always hoping to be more than you’re expected to be, but over delivering is really making them have that facial expression where they look like you’ve got them all the Christmas presents they never got when they were kids.

Like you’re bringing them a Teddy Ruxpin?: And a Mr Frosty and a Fashion Wheel.

So have you done something like that then?: A couple of times. It actually makes me sad in a way that women are always surprised when you do the good things, because it makes you wonder how low their expectations were.

Well that’s a cheery way of looking at it: Ha ha, yeah fair enough, but having to say “Of course I am, I said I would be” when she says how pleased she is that you’re there does have some echoes of her previous disappointments with things.

All in all a good placement?: Yes. Brilliant, everyone was teaching, I was allowed to be autonomous under guidance which is perfect for the second year, and I never felt that people were too far away if I got an inkling that I might get out of my depth if I went it alone with meeting a woman having looked at her notes before hand. Ideal.

What’s next?: Time at Uni and working on PAL (peer assisted learning) sessions for the first years – December is their placement session and I’m going to RSVP the hell out of them. Admin battling is half the panic over when you head out.

Any other exciting things?: Oh the minor instance that I’ve booked and registered for my elective placement today.

WAT?!: It’s for the next post 😉

FAS: Support vs Blame

Switching from an 8.30 – 4.30 placement to shifts last week, I found myself within earshot of the Jeremy Vine show on Radio 2. I was shouting at the radio as people mansplained the catcalling video that’s still doing the rounds. However, that’s not what this post is about; we’ll leave the objectification of women and how they should be grateful for the attention (*sigh*) to another post, another day.

The story that struck me was that there is currently an appeal taking place for compensation to be awarded to a child who is suffering the effects of Foetal Alcohol Syndrome (FAS). The high tribunal found that the pregnant mother was not at fault as the nature of the crime alleged couldn’t be a committed against a someone who was classed as “not a person” in terms of the law. You can read it here.
Cases have been successful before, but the rules changed in November 2012, so only cases submitted before that date have paid out (if awarded) since that date. Just this September compensation of £500,000 was awarded to a girl whose mother “drank heavily” during pregnancy.

When alcohol is consumed during pregnancy it has the potential to cause physiological damage to the foetus and later behavioural issues too. Organ development, hormone function and dysmorphic facial features of children have been linked to the impairments presented by alcohol consumption of the mother. There is also the increased possibility that a child will have a lowered concept of consequences of their actions as they grow up and a lack of understanding boundaries making it difficult for them to socialise at their age level. Difficulty in communicating can lead to frustration, and subsequent lashing out both verbally and physically.

Where folic acid is most effective during the first 14 weeks of foetal development, alcohol is most damaging in the first half of that period – a time when a lot of women don’t even know they are pregnant.
The advice given by midwives is “We don’t know what would be classed as a “safe” amount of alcohol, so our advice is to avoid it completely.” avoidance in place of evidence is currently best practice when it comes to drinking. The word “excessive” is used in relation to the amount of alcohol being drunk, but as that’s a subjective term to most it’s not particularly helpful. Nor is it helpful to read or hear of news stories and studies proclaiming that it’s “nothing to worry about” – this creates blurred lines, confusion, and often leads to women having to interpret the recommendations for themselves.

So then, what of this story? It’s asking that women who have babies with FAS are to be prosecuted and the victim (child) to be compensated. I have endless sympathy with all children born with extra struggles and obstacles to be overcome…or insurmountable ones – but will criminalising women really help?

No.

Gosh that was black and white of me, wasn’t it? Yep.

In my personal experience caring for women with both drug and alcohol misuse, trust is a damned precious thing. In many cases, they have been engaging with the health services on and off for a long while for various reasons and may have been let down, reprimanded, or made to feel less than they are worth. When they choose to come to midwives with their pregnancy, the last thing they would want would be to hear about the legal implications of their actions; damnit it’s already difficult enough to sensitively assert the effects of the substances on the life growing inside them, and that’s without looming criminal proceedings.

Negative discriminatory attitudes exist in all walks of life, and I shudder to recall some of the things I have overheard from seemingly disillusioned health professionals. In my humble opinion, if you feel so strongly about a Daily M*il-type comment spinning around your thought process that you have to verbalise it perhaps working with people is not for you.

Honesty from women about what they are consuming is something borne of their trust, and if that has already been taken for granted, abused, and generally disrespected by others, why the hell are they going to give it to me? I have to earn it, and that would be made one hundred times harder if they are thinking that I’m helping with one hand, but writing secret updates for the Crown Prosecution Service over their “intrauterine child abuse” with the other.

Women who are smoking while pregnant are offered rightly support, not condemnation despite the health and behavioural problems this can cause children – including the anti-social disorders linked with FAS. Stop Smoking services are offered, but not compulsory. With women I’ve cared for, I have congratulated their efforts in cutting down on cigarettes, even if they are not at zero. The fact that they have reduced their smoking means they understand the health implications and are actively making an effort (much as the mother in this particular case did) – that should be applauded and encouraged. I can’t imagine they would share anything else with me if they thought they were always going to be met with negativity and reprimands.

I very much hope that there is a measured response to the appeal currently taking place; the suffering of the child in question is to be acknowledged, but if that is through the persecution and subsequent prosecution of their mother – I cannot support it.
When women with problems like alcoholism become pregnant, it is often the only regular contact that they will have with health services and we should be making the most of the opportunity to engage with them for support and help. If they think they will be deemed criminals of sorts we run the risk of them not engaging at all, further endangering their unborn child. I have had the opportunity to work with excellent specialist midwives and doctors so far who uphold the same ideals. Should the ruling for the appeal deem it necessary to wholly hold mothers accountable, the antenatal care will undoubtedly change and I fear this will be to the detriment of mothers, and subsequently their children.