Category: Discharge from hospital

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Lifting the lid – my life as a midwife PART ONE 

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This blog has a few aims and I’d like to set them down before anyone panics about what’s going to be said

  • To try and encourage other midwives why it’s ok to bend the system – but only if it benefits the woman and her family
  • To inspire others to be different and think outside the box 📦
  • I’m telling my journey and not only what led me into midwifery but what keeps me there
  • I want to show the media that midwives do care about women
  • There will be no breaches of confidentiality
  • The blog is of my thoughts and feelings

My life as a midwife began in 1982. I was a student nurse and on placement on a maternity unit learning about midwifery. I was sent into a room to watch a forceps birth – this was not in an operating theatre where complex forceps births take place nowadays but in a simple birth room – I can’t recall anything apart from the woman screaming and the way the forceps were used – it marked me for life so I don’t know how the woman progressed from it . I put off any thoughts of having my own children because of the way this woman seemed to suffer. Back then I was learning about life in the NHS , how to become a patients advocate , running my dad’s newsagents , continuing with my student nurse course which was run by the nursing school attached to the hospital . I was in shock afterwards and decided then I would never be a midwife . 

Fast forwards to the birth of my beautiful daughter in 1989 . I was admitted at 0.5cm dilatation and refused permission to go home because that’s how it was then – I was given a cervical sweep without being asked or consented for it and felt violated after the event asking the midwife “what did you just do to me ?” .

“I swept and stretched your cervix , you’ll labour now” was the reply – I didn’t know what to say and I was in pain but I accepted it and just felt lost .

I did eventually give birth 22 hours after my admission and struggled with the pushing part – the consultant was called in and I recall him shouting at me how to push and threatening me with forceps if I didn’t push harder . I gave birth on my back , semi – recumbent – no-one encouraged or suggested a change of position . I was GIVEN an episiotomy without consent and cannot recall any conversation about why this was DONE to me . More or less straight after my birth I was left alone with my daughter she was in skin to skin contact with me . This wasn’t because I knew about the benefits of skin to skin contact at all , but because I just didn’t want to let Jane  go – my mums death when I was just 18 years old had impacted on me massively and I saw something in my daughter Jane’s face that reminded me of my darling mum , I was so emotional I couldn’t put Jane down – despite being encouraged to .

After the birth I developed bladder problems so had to be kept in for 5 days . I recall feelings of loneliness , sadness , especially when my partner and visitors left . There were strict visiting times in those days , no rule bending , no partners staying overnight allowed .

Once home I felt more relaxed but my partner was only given one day off work . I had no one, both my sisters were in high profile jobs and both my parents had died when I was younger . A friend came for a few hours a day and tucked me into bed with Jane , I slept whilst she tidied up , cooked and was there for me , I didn’t know what had hit me .

My community midwife Jean Duerden was amazing , I felt unwell had terrible perineal pain and couldn’t walk far – I accepted this as normal – I was a medical ward sister – I knew nothing about babies and / or petineums . My speciality was caring for men and women with medical conditions – a world apart .

My community midwife Jean realised something was wrong and I was quickly fast tracked and diagnosed with a perineal haematoma – my sutures were subcuticular and very difficult to release so I had to persevere with analgesia and antibiotics .

The visits from Jean my community midwife were the highlight of my days – she would bring a student midwife with her and we would talk about how I was feeling , the importance of rest and nutrition and emotional support . Jean also gave me brilliant Breastfeeding advice . One day I blurted out to Jean about my birth experience and she was amazing . I felt from my moments with Jean that she inspired me to become a midwife . Although my labour experience wasn’t great , my postnatal care was so different .

Almost three years later I started my midwifery training and I have to say despite the ups and downs , staff shortages , media portrayal of midwives , the difficulties I’ve gone through in my career I love being a midwife . My own experiences have shaped me and taught me to listen , act and trust women .

When I started my midwifery there were no computers – we wrote everything and risk management was very low key . I recall the Fire Officer teaching my group that the most important thing was to keep corridors clear and know which extinguisher to use in the event of a fire . This has stayed with me through my career and I get very upset when I see corridors with obstacles , I make it my mission to clear them .

I kept a diary and was so thankful to form a life long friendship on my course with another nurse called April . My tutor Anne Ivill suggested that we would get on and we are still good friends to this day . April went to work on neonatal unit as soon as she qualified and is now a health visitor working with children who have congenital illnesses and special needs . We don’t see each other as much as we should but when we do it’s like we’ve never been apart .

I’ve always been quirky and don’t like discipline or rules that restrict creativity, I was the same at school and used to get into trouble for standing up for friends who were unable to stand up for themselves . Once at high school a friend asked me to wait for her after a detention as she was scared of walking home on her own . We were barred from doing such things but I had a plan ! One of the teachers saw me on the corridor and asked what I was doing, I explained that I was waiting for Mr Heathcote to give me extra maths (a total lie).  Mr Heathcote was found and my cover was blown – I had to stay late all week and clean all the desks in T6 (one of our classrooms) . I made those desks so clean and using my anger with myself as energy to get the job done – the relief was that I didn’t get extra maths I suppose ! 😂

So how has my life affected who I am as a midwife and a woman ? The most influential part of my life was growing up in a newsagents shop , talking to people from all walks of life and respecting them all as valued customers . I worked in the shop from a very young age because I mithered my parents to let me . At first I was only “allowed” to sell newspapers or one item sales . The best day was DECIMALISATION DAY . I had learnt a lot at school about this and was determined to help in the shop but my parents said no . I was so upset – then around 7.30 my dad called me into the shop they were struggling – I was to be allowed to help ! I recall elderly people asking me “how much is that in old money ?” And I dutifully exchanged prices bank to pounds , shillings and pence to help them understand . I can recall if I was off school that day or not but if I was in school I still went in as for my parents not to send me I would’ve had to be really unwell .

So I hope you enjoyed part one of my lifting the lid blog – in part two I will be referring to my student diary and how hard it was being the only one on the midwifery cohort with a young child.

To be continued ….,..

Thank you for reading

Love , as always
Jenny x ❤️

Against the odds, Care of the elderly, Change management, Community, Compassion, Courage, Discharge from hospital, Helping others, Hospital, Human kindness, Human rights, Kindness, Learning, Media, NHS, NHS Systems and processes, Patient care, Psychology, Respect, Surgery, Women's health, Women's rights

 The role of L❤️VE in healthcare 

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I recently rewatched    THIS FILM   of Dr Donald Berwick giving the keynote speech in London 2013 to The International Forum on Quality and Safety in Healthcare. This presentation struck a chord with me . 

In the NHS there are many systems and processes which promote working within the confines of guidance and staffing  . However, time and time again there seems to be omissions about how guidance can encompass love . When people love their job and they feel valued within their particular role the result is better health care . It can’t be a coincidence that this is because if you love your job then in effect you love the people you care for .  

When we talk about “love” it’s sometimes misunderstood – actually being human is about loving others .

 I was once in an orthopaedic ward as a patient following an accident and had to have major surgery on my lower leg – a pin and plate and internal fixation , tendon repairs . This operation left me non-weight bearing for 12 weeks . My mobility was severely compromised . In the bed next to me was an elderly woman let’s call her “Sophie”. Each day I’d watch some staff forget to put Sophie’s drink within her reach and this troubled me greatly . I’d ask staff to move her drink closer and I was usually given ‘the look’ i.e “what business is it of yours?” In fact it was totally my business as a human to care about another human . So I made a decision that I’d make Sophie’s hydration my job and also the job of my visitors . Sophie had no visitors , she was confused and didn’t really talk much . I asked my family to bring her a few bottles of sugar free cordial and set about my mission . On a daily basis I hopped to her bed and made her several drinks over the course of the day – usually out of sight of the staff . I began to recognise when she wanted the toilet as she’d shout out , then I’d alert the staff . This went on over about 6 days and with my visitors helping Sophie was soon rehydrated and talking – in fact she was well enough to go back to the nursing home she had been admitted from . 

So what made me do this ? I didn’t know Sophie and I could’ve just focused on my own recovery. In fact Sophie helped me to find the courage to use my crutches (something I was petrified of using) and she took my mind off my own pain and frustration . Much more than this however I saw myself as Sophie in years to come – ‘sat out’ in a chair unable to move or communicate , hoping for the staff to be kind , for the kindness of strangers to aid my recovery or to ease my loneliness in some way . 

“We are all one another” 

I never told anyone about this before except my family who were also directly responsible for Sophie’s recovery . You see the truth is we didn’t do it for recognition – we de it because we are human 

Thank you for reading 

With love , Jenny ❤️

Antenatal education, Babies, Birth, Breastfeeding, Caesarean section, Change management, Children, Compassion, Courage, Discharge from hospital, Helping others, Hospital, Human rights, Intra-operative care, Kindness, Labour and birth, Learning, MatExp, Midwife, Midwifery, Midwifery and birth, New parents, Newborn, Newborn attachment, NHS Systems and processes, Obstetrics, Patient care, Postnatal care, Respect, Skin to skin contact, Surgery, Teaching, Women's rights, Young mothers

The Gentle Caesarean – Gentle with what ?

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Last year I was lucky enough to work in a general theatre for a week . I met a wonderful general surgeon and watched him perform bowel surgery . I noticed immediately how gentle and kind he was with the internal tissues and how calm and respectful he was not only towards the patient and his body , but also the staff in the operating theatre. All the staff admired this surgeon – you know when you can just tell ?  

I asked the surgeon afterwards about his technique and he said this

 “I always respect the tissue Jenny- tissues , blood vessels  , muscle and skin are part  of our human make up and being gentle with them means I am showing tissue respect and respect to the patient who is a fellow human . Being a gentle surgeon takes longer but believe me the outcomes are better and I know that there is less trauma , post-op bleeding , infection, pain and therefore happier patients and staff .”

Currently there is a lot in the news and emerging research around “The Gentle caesarean” and I am looking at this from a different angle  (and for those who know me well I don’t do acceptance well – I like to ask things so that others unable to ask might think differently ) so I am questioning what this term “Gentle Caesarean” actually means . Does Gentle Caesarean mean just the moment of birth or should it be right from the decision or choice of the woman to have an operative birth through to arriving home ? 

So for all those who work in the field of midwifery , obstetrics , intra-operative care, surgery , pain management -I would like you to watch a caesarean from start to finish and ask yourself “was that a gentle caesarean from that the moment that the woman arrived in theatre ? Was there gentleness with the woman’s feelings and choices ? Did the obstetrician, scrub midwife and others maintain gentleness towards the internal tissues and the to the baby? Was the transfer to the bed from the operating theatre table gentle ? Was privacy and dignity maintained at all times? 

Just because we have always done something a certain way does not mean that “the way” is always the best . 

I hope I spark someone to change practice and make “The gentle caesarean” standard across the NHS because then it will spread  globally – we must question on a  daily basis what we do and why we do it .
Thank you for reading , please leave feedback and / or share this blog with your colleagues 
With love and midwifery kindness , 

❤️Jenny❤️
Addendum today I am thrilled that The Times journalist Katie Gibbons has written an article about skin to skin contact at Caesarean  CLICK HERE to access or being the rebel that I am here’s a photo 😁

 

Babies, Birth, Care of the elderly, Community, Courage, Discharge from hospital, Discharge planning, Human rights, Kindness, Learning, Newborn, NHS, NHS Systems and processes, Nursing, Patient care, Skin to skin contact, Teaching

Processes within the NHS 

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There is a phrase “going around” that takes the impact of what it’s like to be an elderly person without support and this derogatory term totally dehumanises a very human situation. Talking about humans as processes instead of shouting out loud that caring does not start and begin in a hospital is like saying that once a person reaches 70 nobody really cares about them. The roots of care, compassion and indeed humanity itself  are intertwined into community , family life and neighbourhoods. Love and care begin at birth when the impact of instinctual kindness and love from one’s own mother is portrayed immediately at the moment of arrival by her display of emotions, indescribable craving and total need to hold her newborn child. It is my quest that every midwife, obstetrician and in fact anyone who is privileged to be there when a child is born knows this and thinks about it every second before birth occurs and is instrumental I helping to facilitate it or shout out when it doesn’t seem to be . 

NOW I’d like you to imagine that you are a senior NHS manager questioning your clinical leaders about how to address the problem of  “bed blockers” you are driven and you don’t tolerate excuses . Suddenly fast forward your own life – you are 79 years old and living alone . Your family live just far enough away from you to prevent a daily visit . You are isolated and feel depressed so gradually without any realisation of it , you stop looking after yourself . Your home becomes as uncared for as you are and then you fall . The reason for your fall is that you didn’t like the new slippers your granddaughter bought you for Christmas they were too much like shoes. You therefore continue to wear your old worn ones and on this particular day as you descend your steep unsafe-for-a-79-year-old stairs, your slippers “tread free” soles slip on the edge of a stair – suddenly you’re in flight mode. Your hip dislocates and your femur breaks – time to realise after your operation and recovery in a rehabilitation centre that you can’t get home. Mainly due to the fact that your family are away for a few days in France and social services have deemed your house as unfit for you to move back into . One particular day you are “sat out” in a chair behind some curtains and you overhear a Dr and an occupational therapist talking – your name is used and that familiar term “bed blocker” Is mentioned. The words ring in your ears from when you used to say them about others and now you are one. 

Did you know  when ambulance crews take patients to accident and emergency that they have to wait and cannot leave their charge until the care is taken over by the hospital team. I know this because last year  I worked with an ambulance team for a day . We were transferring a woman to another hospital & I was the escort midwife – once in another zone the ambulance was recognised on the radar and unable to leave each time a 999 call was made . It was like being in another galaxy unable to return to our own a sort of NHS antithesis to Brigadoon. So if SEVEN ambulance crews arrive at a particular Accident and Emergency department all waiting to handover the care of their patients -SEVEN ambulances are simultaneously  off the road-what’s to be done about this?

A few months ago I realised I was digressing from my ” #skinToSkin” work and asked a friend what I should do . Political issues were starting to interest me more , I felt more aware of care for people living with dementia . I had started reading about how mental  health issues are addressed and pigeon holed. Nick Chinn taught me about silos and I realised that the NHS works in silos. My friends reply was “keep going Jenny – as a NHS Midwife you have a duty to be political so that you can tell others about the day you spent with the ambulance  crew, why skin to skin matters to society and is a public health issue . To be frank I’d be more worried if you said you felt apolitical” 

So my friends let’s keep going and let’s keep championing good care , outing systems that don’t put the patient and/or family at the heart of what we do – one day that “bed blocker” might just be you . 

Thank you for reading please feel free to leave comments – your input helps me to reflect and develop as a midwife , mother and human . 

❤️Jenny ❤️

Being busy as a midwife, Birth, Courage, Discharge from hospital, Kindness, Learning, Midwifery and birth, Newborn, NHS, Patient care, Postnatal care, Skin to skin contact, Teaching, UK Blog Awards 2016, Women's rights

The UK Blog Awards 

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I have entered this years UK Blog Awards in the Health Category to raise the public profile of midwifery in a positive light . 

Compassion is a crucial part of any midwife’s role and I find that blogging helps me to open the window of my midwifery soul through the written word.

It’s crucial that women and families have access to midwifery support now and in the future . Social media is a great way to connect to others and also to learn , inspire and lead. 

You can vote for me BY CLICKING HERE

Thank you for your ongoing support and for reading and sharing my blog . 

With love from Jenny 💛 

 

Babies, Birth, Breastfeeding, Discharge from hospital, Kindness, Learning, Midwifery and birth, New parents, NHS, Postnatal care, Skin to skin contact, Teaching, Women's rights

Transfer from hospital to Community care – planning in maternity services 

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There is so much written about discharge planning for Care of the Elderly / Unscheduled care / patients requiring rehabilitation .

Currently there are extra pressures on maternity services and I have set out my objectives as to why I want to discuss postnatal discharge planning below 

1.To highlight beacons of positivity 

2.To inspire discussion 

3. To make discharge planning an intrinsic part of the admission process 

4. To identity where a same day transfer should not be promoted

5. To make the actual ‘time of discharge’ a governance issue  

6. Share good practice and eliminate bad practice 

7. Raise the profile of effective discharge planning in maternity services 

I have learnt from others and by listening to families how the NHS could streamline the discharge process I’m certain that this would make a positive impact on staff time , families understanding , effective communication , reduce complaints and develop a well rounded understanding of the  discharge process. 

Going home with a newborn is seen as an easy and smooth process so my blog will try to help parents as well as midwives and maternity workers to see that this is not always the case. 

The best time to be discharged home is in the morning , however the pressure on postnatal wards is immense and they have one of the fastest turnovers in the NHS . So often we hear of women and newborn being sent home at ridiculous hours and  HERE is an article about this in Mother and Baby 

So how can we streamline the discharge process ? 

A. Find out if the family have transport home 

B. Start the discharge paperwork by checking address and phone number are correct 

C. Ensure medication to take home is requested as soon as possible 

D. Promote and explain why prolonged skin to skin contact will ensure not only breastfeeding success but also maternal and newborn wellbeing and that continued skin to skin contact is important as well as talking to the newborn and feeling calm (it’s crucial to discuss co-sleeping and I usually direct parents to ISISSLEEP as well as explaining – I’m not going to go into depth about this now, but  I do with parents.  

E. Ask about support at home – visitors who come and help are very valuable and aid recovery and coping . At the same time it’s important that the new family have some time alone in order to gain confidence in being new parents and learning to recognise various cues that their newborn makes .  

F. Go through thoroughly signs and symptoms of illness for mother and baby and mention sepsis – any infection caught early improves the outcome. 

G. Ensure all levels of midwifery staff are competent to discharge women and babies home – in busy times when there are pressures on the service this will facilitate an “all hands on deck” situation 

H. Employ a discharge facilitator who can assist clinical staff to organise the paper trail 

I. Have a generic checklist to refer to primarily so that women and families can see what the process entails and secondly so that staff do not miss any of the steps involved and this will avoid mistakes and maintain communication at all levels .  

J. The first point of contact in regard to any queries should always be the labour ward and / or community midwife . Midwives are responsible for postnatal care up to 6 weeks post birth – I am proud to say that when women present at labour wards they are seen quickly – a walk in centre or a triage service are not equipped to deal with postnatal care – midwives are . 

Explanation, discussion , allowing time and two way communication are all integral to a successful discharge process . I like to tell families that the discharge is in effect a transfer of care to the community midwifery team and also what to expect from the visit. Midwives do not expect families to be up , dressed and ready with the house perfect – they are visiting to see how families  are feeling and coping . To assess if the baby is feeding well and to give support . 

Rushing the process because of pressure has no value and affects communication in a negative manner – it’s so valuable to discuss why discharging takes time at antenatal group and have information on discharge at clinic appointments . 

Ideas such as group work on the postnatal ward to increase questions and save time are being developed in various NHS trusts and discharge guidelines should be updated regularly to match the process. 

Talking about safe regular analgesia and how to take medication will improve recovery , reduce infection , help mobility and be key to reducing venous thromboembolism . Perineal pain is real – it hurts – but in the first day it may not be as bad until the woman arrives home and starts to question her pain threshold . Pain management is part of postnatal care and can make the difference between good recovery and feeling awful for days . 

Perinatal mental health care is gradually improving and it takes skill and experience for midwives to recognise it if the woman is reluctant to disclose . Continuity of carer and knowing ones midwife makes talking about postnatal depression and anxiety easier – but we still have a lot of work to do . HERE The Guardian highlights perinatal anxiety . Post Traumatic Stress Disorder is now a recognised illness caused by trauma around birth – communication and compassion at birth can reduce this and I recently received a letter from a woman telling me that skin to skin contact helped her to cope during an emergency situation – so there’s something to consider .  I am proud to know Emma Sasaru who has PTSD and courageously BLOGS  in order to help other mothers to recognise the signs and how to seek help . 

As the midwife completing the discharge YOUR responsibility is also to ensure the baby is feeding  and that you have observed a feed and given the mother support. Talking about maintaining milk supply and support groups as well as how to recognise that the baby is thriving must be discussed . It’s just as important to explain and know the family understands how to make up milk if the baby is not being breastfed.

 The neonatal examination is not a future prediction of health it just says the baby is fine at the moment it is done . Any signs like continuing sleepiness, a very quiet baby , poor muscle tone and slow weight gain might be indicators  of poor health – mothers usually have an instinct about these things so listen well and get the baby seen by a paediatrician – don’t manage the baby at home without senior input . 

Finally time of discharge is an issue – do families reall want to go home at 23.00 or 3am ? It’s a personal choice but CHOICE it must remain there is no place for sending women and newborns home in the middle of the night – does it happen in any other department? I have never heard of children being sent home in the night or elderly patients so why should we accept it for women or maternity services?  If you have concerns that families are bring sent home at inappropriate times there is action you can take – escalate it to your line manager , fill out an incident form , discuss at your team meeting and raise with your governance lead. Ask other units what they do and be pro-active . 

The main point I want to get across is that discharge from hospital is a complex process . It is much more effective when there is two way communication between midwives / obstetricians and families . Talking about going home must start as soon as the admission process starts. Discharging someone home must be a high quality , thorough , kind and efficient task. It must also be individualised and embody compassionate care . Use your skills in effective discharge and teach them to future midwives – it’s important to share good practice. 

I hope I have raised your interest  in discharge planning . I appreciate and value all feedback and understand there may be some points I have missed . My main aim is to promote thought , discussion and change . 

❤️Thankyou for reading  

Love Jenny ❤️