Busy day at the office

The clinic this morning was packed full. The first woman I saw was pregnant with her 2nd child. Her first baby was stillborn at 38 weeks. How on earth am I meant to fulfill all her needs and offer support in a 10 minute slot? She was understandably anxious and my 10 minute allocation went out of the window as we talked about her lost son and her fears for her current pregnancy. We planned that I would offer her more visits and at her home so that she would have the privacy and time to explore all her apprehensions and of course for reassurance that all was well in this pregnancy. The trust won't be happy. "Multips" are only meant to have 7 visits antenatally including all bloods and scans according to the (not so) N.I.C.E guidelines.

All my timings were then up the spout. The third woman who came in with her brood of 3 toddlers starting swearing at me and complaining about waiting for an extra 45 minutes. She stunk of cigarettes but I could tell that now was not the time to be discussing her smoking habits if I wanted to keep my teeth.

10 women later, I had to rush to my first home visit. No time for lunch, luckily I had a banana in the car (the only fruit that doesn't cause me to puke). My first visit was to a woman who had given birth 2 days earlier. She was struggling with breastfeeding and her left nipple was quite cracked and sore. I sat with her a while and watched her feed and we found a position which helped her latch on the baby more comfortably.

The second woman was someone I had concerns about as her blood pressure had been creeping up and she had one plus of protein in her urine when I saw her yesterday. She was 31 weeks pregnant. She hates hospitals and had been planning a homebirth. She sobbed as I told her that she really did need to be admitted after the third BP reading was still 140/90 and her plus of protein wasn't disappearing. We talked about the dangers of pre-eclampsia and that she was outside the realms of normal midwifery and needed obstetric input quite urgently. She eventually agreed to go in.

A couple of routine postnatal visits and then my "cause for concern" family. Wendy (not her real name) lives on the 11th floor of a high rise. The stink of urine in the lift would overpower anyone but in my current state it sent my gag reflex into overdrive. Wendy's flat would be small for a couple but for a family of 6, it is cramped and overcrowded.

Once again I am hit by the smell of stale smoke as she opens the door. Wendy's latest addition is 6 days old. The other 4 children range from 7 down to 2 years. The baby has lost weight. It is normal for babies to lose 10 % of their body weight in the first week of birth but this baby had gone down from 3.7kg to 3kg. Quite a drastic weight loss and worrying. Wendy doesn't like Doctors. She doesn't like hospitals (this baby was a BBA, born before arrival..we are seeing a lot of these in the community). Two of Wendy's children are on the at risk register. The baby needed a paeditricians' expertise. Wendy especially does not like paeditricians!

Eventually I persuaded Wendy that it would be in her best interest as far as child protection orders and the like were concerned, that she attend hospital with her baby. It would look far better from her point of view as a mother, that her concern for her child's weight loss over ruled her desire to keep away from "the system". She lit a fag, sighed a plume of smoke and reluctantly agreed with me. I felt it best not to inform her at that moment that her flat was also my place of work and therefore she was breaking the law by smoking!

On call tonite. We have 4 homebirths due. I hope none of them smoke.

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