toircheas/ pregnancy – Page 2 – One of these days…

November 12, 2009November 12, 2009

Information a great antidote to oinking

Unless you have your head stuck in a bucket you will know two things 1. there is currently an outbreak of swine flu (H1N1) in Ireland and 2. I am pregnant. Not maybe of equal importance to you but fact no 2. wins in my book. Mind you if you have your head stuck in a bucket chances are you know all about swine flu already, ye poor aul thing! Photo right owned by merfam (cc)

The second fact puts me firmly me in the at-risk category and I have decided because of the public facing nature of my job that I will get the vaccination.

A couple of weeks ago I had an antenatal appointment in the Coombe where I asked for information about the vaccination. It was the day after Prime Time on RTÉ had focussed on the issue with pre-recorded interviews with at risk patients and other stakeholders and a studio discussion. My midwife told me that the Coombe were advising all pregnant women to get the vaccine but she did not have any further information for me. No leaflets. Nothing. They were also not administering the vaccine and I should ask my GP to do that. Being on combined care (where the hospital and your GP share the antenatal care – a step in the right direction!) that suited me fine as my next appointment in 2 weeks was with the Practice Nurse in my clinic. My GP had actually appeared on the pre-recorded item on Prime Time complaining about the slow reaction of the HSE to this looming health crisis. Therefore I figured I wouldn’t be getting massively impartial advice from the clinic but at least I’d get it sooner rather than later.

When I rang to make my antenatal appointment I asked could I be immunised at the same time and was told no, they had a waiting list. I figured fair enough and was actually reassured by this because it meant there was demand. When I went in on Tuesday for my antenatal appoinment I mentioned this en passant to try and gauge what sort of wait I was looking at. To be honest, I’ve been keeping public appearances to a minimum thinking I would imminently be immunised so it was important to me to know how long this personal policy might have to be kept in place. The nurse immediately told me that I would have to go to a HSE Centre in Ballally. The clinic only had the vaccine with the mercury in it which they were not giving pregnant women but I could get the other non-mercury one from Ballally. I asked her if she had a number; she took out a leaflet which looked like she had printed from somewhere herself, with a list of all the centres and narry a phone number to be had.

Luckily the receptionist had the number so I rang this morning and left my contact details. They got back to me pretty much straight away. When I asked if I could get the non-school going Nipper 2.0 vaccinated at the same time they said no. I explained that I worked full time and would prefer not to have to take time off twice, they still refused. Real caring HSE there, eh? So I said that I would come in anyway and they offered me an appointment next Monday. Coincidentally I have the day off so I said grand. However when I mentioned my address she told me that they were not our centre and I would have to go to Tallaght. I asked her for the number and she said, “We’re a hotline, we don’t give out numbers. You’ll have to look it up.” 2 points for customer focused helpfulness racked up NOT!

So I looked up Tallaght Hospital and rang the general reception because their shocking bad website didn’t have any specific information about their immunization programme. The woman who answered told me that the Education Centre where they were doing the immunizations didn’t have a phone. I said “But how do I make an appointment?” She said on the website swineflu.ie. I, of course, had my browser open in front of me so I asked her where on the website because the expected big obvious Make an Immunization Appointment button wasn’t leaping out at me. She didn’t really respond. I said do I click on “Find a Health Service” she said yes. I said then what and she said, (brace yourself) “I haven’t seen the website. We don’t have internet access.”

My reaction? You need to ask! (After expressing my disbelief I said thanks that I’d work it out. Not before she said “I’ll have to let you go. I don’t have time to discuss it.” Apparently no-one does.)

How on earth are frontline information staff supposed to do their job if they have never even seen the website that they are advising enquirers to access? Are the HSE staff not considered potential consumers of the information on swineflu.ie which incidentally and very confusingly is not in fact a website dedicated to keeping the public and HSE staff informed about the virus; it’s a redirect to a page on hse.ie.

Once you do find the link to book an appointment, there is no clarity that if like me you choose the wrong clinic that they will not give you an appointment at that clinic. No specific areas or zones are mentioned in the information. However as I already knew I was not permitted to go to Ballally thanks to my earlier mistake I picked the correct clinic for my area and was brought to a calendar where I could see the available times and dates and sign myself up for one that suited me. That’s my lovely morning off gone. However at no point was I asked to confirm the district I was in or my postal address so really if it suited me surely I could book into any clinic as long as there was space available. Also while there is a warning that only at-risk patients and pregnant women are being immunised I was not asked to confirm this information when booking. Looking for this confirmation will not stop the committed hypochondriac from booking but it might slow them down.

This calendar idea is brilliant (however it is really ugly and if you press F5 it seems to book you in again although so far I have only received one confirmation from SuperSaaS! EDIT: I just received confirmation no. 2. Hmm maybe I will bring Nipper 2.0 with me…) and I just wonder why all health services and practitioners don’t offer and promote similar. However one only needs to look at a few hospital websites to realise that this kind of client empowerment is a long way off.

November 6, 2009November 7, 2009

Heavy mam…

From my weekly Eumom Personal Page

During this period, your baby will become plumper and heavier as stores of white fat are deposited under the skin and as your baby continues to mature and put on weight.

Great. These jeggings (or treggings as they call them in Penneys :)) were a really bad idea then. Let’s just say they’re snug on me. A size bloody 14 too!

Jokes aside I love this service from Eumom. You can choose to receive a weekly update on your baby’s progress by email. It’s very simple but it just reminds me to get my priorities straight! On my first pregnancy my GP recommended Eumom to me and I found their forums, especially the birth clubs to be a great support. I do feel a little mean not using them this time around when I am the very kind of experienced mum who could be helping support the new mums but I honestly just don’t have the time!

October 8, 2009

Bellyboy

I can’t find the posts that I added during my last pregnancy yet (a by product of the transfer from Blogger to WordPress) to do belly comparisons on previous pregnancies but I think this belly compares rather well to mine.

September 6, 2009

The supermarket test

Discussing baby names earlier Himself says, “I dunno, I’ll have to give it the supermarket test.” Me “??!” Himself, “See if I feel like a twat shouting it in the supermarket.”

While on holidays in île d’Oleron last year we overheard a mother calling her (I’m pretty sure step) kids (so not entirely her fault) “Balthazar! Melchior! Julian!” and when discussing names one or other of us might say, “I dunno it’s a bit balthazarmelchior, isn’t it?”

Anyone who knows our family knows that with our pedestrian surname we don’t shy from the more unusual names. However my brothers are not dealing with my childrens’ unusual surname, even he whose daughters have their mother’s name so we have to be far more careful of the Balthazarmelchior syndrome.

September 3, 2009September 3, 2009

No. 7 or Rosie the Cow

I had my first experience of the standard ante-natal care in Dublin yesterday. I nearly avoided it due to a recent change in the hospital’s system (reaction to recent news? Maybe…) that meant that women on the Coombe’s Midwife scheme (like me) are no longer obliged to see a consultant on their second visit. However the midwives were full up so I had to push on with my visit to the Ob/Gyn Specialist. Even though I did not want to, or as far as I could tell, need to.

Photo owned by Dan Phiffer (cc)

I was seventh in line for my consultant and the place was jammers. Post it notes have a lot to answer for in this world. A post it with the mysterious marking “BR 7” was affixed to my chart and I was told room 5 or 6. No explanation was given to me about what I should expect, how I would know when it was my turn. There seemed to be about 5 consultants working. Different midwives would emerge every once in a while and call a name and a number or a name or a number. There didn’t seem to be much logic but I trusted that I would hear either my name or my number. No such luck for the couples whose English wasn’t the mae west or whose names were completely garbled by the staff. When my number was called, up I lept after the woman who called it only to find her there, gone! by the time I had gathered all my stuff. Other women present helpfully pointed me behind a curtained off area where a clatter of midwives did all the standard urine & blood pressure checks first and then proceeded to marvel at my bicycle helmet. “I’m pregnant not disabled”, I said, smiling, “This is my third pregnancy, I think I know what I’m doing.”

While I was waiting again another consultant arrived into his rooms, all-a-fluster. He was an older guy. He went in and out again a couple of times and generally fluted about. I had been there about half an hour and he was only arriving in. I didn’t pay much attention to him until he pops his head out the door and asks the assembled women (and men), “Right who’s first? What system are we using today?” Oooh way to inspire confidence in your patients.

Thankfully he wasn’t the consultant I was visiting. It turned out my consultant wasn’t in room 5 or 6 either. So far, so fail on the instructions, hospital staff. The consultant was very nice, obviously a warm and intelligent woman, but honestly did nothing for me that all the midwives that cared for me in previous pregnancies hadn’t been more than able to do. In fact she did less because the urine and blood pressure tests had been done already. All good and 20 minutes (at most) later off we went.

Only to have to queue for 10 minutes to hand our file back in and make another appointment. At least cows get to stand in a pleasant field. And the farmer and if required the vet comes to them so as not to interrupt their valubale eating and gestating and mooing work. Of course you can sell a cow and her calf so respect is due to them. Moo.

I was going to leave it at that: a non-plussed account of a visit to a Dublin maternity hospital. But honestly my feelings on this came between me and my sleep early this morning. (That and the urgent need to pee :)) The mind just boggles about the whole system for ante-natal care in Ireland. I have decided that it is a total racket, a money-making scam. I don’t think any individuals are to blame: I think the system is flawed and possibly even corrupt.

The system as it is at the moment means that 100s of women every day have to travel to a central point to have a 20 minute appointment with someone who is over qualified for the average consultation. I do not know how the system works but I presume that the hospital gets paid per woman and obviously they get paid more if that woman visits a consultant. No doubt they get a cut and if a consultant costs say EUR100/ hour and a midwife costs EUR50/hour it doesn’t take a genius to work out why it’s better for the system to force a healthy woman to see a specialist. Please correct me if I’m wrong on these assumptions. I want to understand this system.

Then of course there are also the facilities and their upkeep. The toll that 100 women a day and their partners take on a hospital is no doubt great, no matter how well designed. While I cannot fault the staff that I have met throughout my 3 pregnancies so far, their working conditions, in Holles St., in particular are far from salubrious. Holles St make no secret about this. Naturally it is to the HSE the hospital turn seeking grants to allow them to upgrade their facilities to cater for these 1000s of women a year who are in their care.

But let’s just say for the sake of argument that 50 of those 100 women never had to go to the hospital. What if they were told that from now on all their pregnancy needs would be looked after by a midwife in their community based in the local Health Centre or a local GP’s clinic? What if from now on all these women were told that the highly trained and qualified midwife could refer them to a specialist if specialised care was required? What if these midwives visited the women in their homes, especially in the final trimester, and encouraged them to give birth in their own comfortable surroundings rather than in an uncomfortable, anonymous delivery room?

Who would gain from this arrangement? The women obviously who could arrange to meet their midwife in their home or a local centre. The benefits during labour and childbirth of being in your home or at least a familiar environment with people you know are many. The hospital could retain its facilities and specialists for those who were in actual need. Employers, who are legally obliged to give pregnant women in their employ time off to attend antenatal appointments, would gain as pregnant women would not have to take half a day off work to attend a 20 minute appointment. Who would lose? The hospitals might lose some of the justification for their capital grants and the consultants might find that they have more time to concentrate on what they are really good at and trained for – gynaecology is not just about delivering babies. Surely there are enough women experiencing difficulties even getting pregnant to keep them busy? Heaven forfend there might even be a need for less expensive consultants and more for highly trained midwives for antenatal care! Oh and of course the anaesthethists (sp?) needed to administer epidurals would lose a gig. But of course women need epidurals because childbirth is SO painful. I think that’s a blog post for another day but let me put it like this: When the inventions that most aided women’s liberation are being discussed the washing machine, the pill are mentioned but I have never heard anyone saying the epidural. But like I said another day!

According to the Master’s report for 2008 the Caesarean rate in the National Maternity Hospital was 19.1% in 2008. They concede that this is below the national and international standards. Their corrected perintal mortality for that year was 4.8 per thousand. These figures are indicators (by no means definitive) of the number of pregnancies that might require specialised care before, during or after birth. Granted these figures don’t include data on issues experienced by the women themselves that would require immediate medical care. I’ve heard the horror stories. Show me a pregnant woman who hasn’t heard the horror stories and I’ll show you a Martian.

The most recently published 2007 annual report for the Coombe,(PDF) even with a higher rate of Caesarean, backs up my suggestion that up to 50 women could be moved out of the hospital environment for their antenatal care. Here are the figures for obstetric outcome in 2007:

“Spontaneous vaginal delivery 59.5%
“Forceps 9.5%
“Ventouse 9.2%
“Caesarean Section 22.1%
“Induction 25.9%”

If those 44.6% of women who experienced the ventouse, forceps and induction interventions had been allowed to labour in the comfort of their own home, who knows they may have managed their labours with no intervention. Who knows? They know in Britain where Domino (Domiciliary/ In and out) is the norm. They know in Holles St. and the Rotunda and Wexford General where women can opt for the Domino.