A doctors' charter

We've had our fair share of contact with doctors the past few years. I certainly feel that what with pregnancies and birth and the care of our children once born, we're quids in when it comes to tax, and that's before we've even accessed the education system. It has led me to think however about what makes a good doctor. And it's rarely their actual medical skills. I was comparing two Consultants the other day, and why it was that I think one is brilliant and the other riles me. Then I realised, the latter one never introduced himself - it fell to me to ask him his name before he poked and prodded my child. Nor did he once use my child's name.

So here is my charter for doctors when dealing with child patients and their parents, for GPs and hospital doctors.

1) Names matter. Introduce yourself and ask what you should call the child. My daughter is never called by her full first name, I am not even sure she knows it. If a doctor wants to make her feel comfortable they need to used the diminutive we all use and they will only find this out by asking, not by glancing at her file. Similarly, my name matters. As I have written before, stop calling me mum.

2) Keep things private. Remember that just because a child is a child doesn't mean they don't also have a right to confidentiality and privacy. Don't start talking to me about their medical history in the corridor or waiting room.

3) Explain. It is easy to assume that just because a young child doesn't understand you there is no point explaining things to them. I believe children understand way more than we often give them credit for, and pick up an awful lot from body language and tone.

4) Be honest. Don't say something won't hurt if it will.

5) Keep listening. Just because I'm neurotic doesn't mean some of my concerns aren't justified. You know when you stop listening to me at my sixth point - well how do you know the seventh point isn't going to be the important one?

6) Ask parents what their worries are. I didn't know how to phrase my questions at one appointment, but the doctor finally managed to get it out of me. What specifically was I worried about, she asked. No one had asked me that before. It freed me to say what was on my mind, in the case the impact of radiation on fertility and cancer, and to be reassured.

7) Remember probability is meaningless to a parent. When you say something has a one in a hundred probability, we hear the one, not the hundred.

8) Talk information. There is no point telling us to steer clear of Google or avoid online forums - we won't. Far better to point us in the direction of the best sources of information.

9) Be human. I have one doctor I have seen a few times who always empathises and tells me his sons had something similar, whatever that may be, I have a hunch, based solely on the fact there is a picture in his office of him and a young girl but none of him and young boys, that his sons are made up wholly for empathetic purposes. Nonetheless I am choosing to believe him. It helps, knowing about your doctor's family, and who it is that they care about.

10) Be nice. My absolute favourite doctor always runs late. And she always apologises profusely. Which makes it okay.

How to make a fuss

At an antenatal appointment this week I was ushered into a room before my main appointment so my urine and blood pressure could be tested. The room, a side room off the waiting room, would be private if only they'd shut the door. And, of course, if they hadn't tried to do my tests in the same room at the same time as they were testing someone else. I made a fuss of course, I am good at that. "It's not our normal practice" they told me. "Then why are you doing it now?" I asked. So they waited, not, I think, because they thought I was being reasonable, but because I was making a fuss. Or as I think of it, making a fuss. The reason? As I explained to them, it's no good for patient confidentiality, mine or the other patient's, if they discover something wrong with one of our tests.

But I have a particular interest in/chip on my shoulder about this issue that stems back to the early weeks of my daughter's life. In the area in which we live, due to high density housing, a large number of immigrants and poverty, all newborns are offered a BCG injection to protect against turberculosis. I was in two minds whether to have this for my daughter, largely because of the associated swelling and scarring and not wanting my beautiful newborn's perfect skin to be sullied in this way, but a belief in herd immunity won out and we duly went to our appointment.

If you are not the kind of person who believes that environment affects behaviour you have probably never been to this particular health centre in Tottenham, North London, where the TB jabs in our area are offered, I used to be a patient at the GP practice there but found it so demoralising I left very quickly. Once I rang over fifty times before getting through to a receptionist. Upon telling the GP I finally saw about this he agreed,saying he'd had the same problem one day when trying to call in sick. Unlike my current GP where you get what you want by being nice to the receptionists, there I found you only got acknowledged by being as arsey as possible.

Anyway the appointment started badly when everyone there for this injection was asked to fill out a form about their baby including whether they are HIV positive. I understand of course that medical professionals need to know the answer to this, but the forms were being collated on the counter where any other patient walking by could see them. This would not only impinge on my daughter's confidentiality if the answer were yes, but on my own too. On principle I objected.

We were then escorted into a room with another parent and baby. "Are you intending to do both of these children in this room one after the other?" I asked. They said yes. What did I do? That's right, I made a fuss. It wasn't going to happen, I explained, for two reasons. First, I did not want my child, or the other child, to get upset by the post injection screams of the child who went first. But also because it was possible that I, or the other mother, might have medical questions or issues to ask that should be kept confidential. Not just HIV which was clearly on the agenda as a question, but anything else too. "You'll have to wait here in the corridor then," they told me. Which I did. But I was fuming. What they were trying to do as a time saving measure ignored some of the basic tenets of healthcare that we expect our modern health service to offer.

It reminded me, in those early days, that I was not only my own health advocate, but my daughter's, and that just because she was a baby did not mean she didn't also have the right to respect, dignity and privacy as a patient. What's more, that there are times when she will only get that by making a fuss, something I am proving very adept at teaching her.

On being fat and pregnant

It was perhaps a mistake, shortly before the birth of my daughter, to write an article on being fat and pregnant for Easy Living Magazine. Not because I didn't strongly believe the article should be written - it was about the one size fits all approach to fat women when it comes to a failure to conceive and the determination to blame this on weight when weight is only an issue here if it prevents ovulation - but because it meant speaking to experts who were mostly all doom and gloom about pregnant women.

"Fat women who are pregnant," one obstetrician told me, "are much more likely to die in childbirth." "Gulp," I said, "because I'm rather large and 38 weeks pregnant." "I'm sure you'll be fine," she said, unconvincingly.

The thing is, something I don't think non fat people understand, no amount of telling us something is dangerous is going to sate our desire for a baby. I don't know what odds they would have to have given me against my survival to stop me trying for a family but given that in my trying to conceive madness I genuinely felt that I didn't see the point of life without children, I suspect they would have had to be pretty low, and I imagine my husband would have stopped it before me.

Still, I couldn't bring myself to watch 'One Born Every Minute: Fatties' last night as I enter my third trimester with number two, though I recorded it to keep for a moment when I feel particularly vulnerable, when I shall hunker down to watch it with a big bowl of ice cream and a mansize pack of tissues. They didn't call it that, you might cry, and no, they didn't, but they might as well have, as the euphemism of 'One Born Every Minute: Plus Size Mums' is really no better.

I wrote an email to the hospital's head midwife after the birth of my daughter. Stopping short of a formal complaint it offered some friendly advice. Don't make fat women feel shit by sending them to the special fat clinic midwife, it said, if when you get busy you say oh sod it, see a normal midwife today. Either stigmatise us and follow it through with consistency that we actually need someone specially trained to look at us pitifully and ask how much we exercise, or stop bloody stigmatising us.

This time round I'm more confident. "I'll make an appointment for you to see the midwife who specialises in nutrition," my midwife said at my booking in appointment. "No thanks", I replied, "I'm not fat because I'm ignorant, I'm fat because I'm greedy." 'Refused' she duly wrote next to the appointment in my notes.

Nor are fat women allowed to use the birth centre, where women push out babies while sitting on space hoppers with whale music in the background. I don't mind this - I'm an interventionist when it comes to most things, be it world peace or birth - but I know plenty of people who do. On the other hand, I found the idea that I needed a pre birth meeting with the anaesthetist in case I wanted an epidural (I did) a bit insulting. I swear my friend's right that they are just checking you have a spine. Turns out that the same anaestheist looked after me while I had a (non fat related) post birth op for a retained placenta. "Hi", he said, "we've not met before." I wasn't too out of it, or, ahem, spineless, to put him straight.

I'm no evidence denier. I'm sure there are more dangers to fat women in pregnancy and birth than to non fat women. But my guess is the most common danger is to our mental health, when we're treated differently, told to worry and made to feel, ironically, incredibly small.

Ways to improve postnatal care #6: Be consistent

When we were in hospital in those very early days, and feeding wasn't working out as planned, I had a flurry of people come to my bedside and try to help me. There were midwives and nursery nurses and breastfeeding counsellors and peer supporters, and they all had different advice. From changing breast to trying a different hold to setting a time limit to letting the baby go for as long as she wished, from squeezing the nipple first to massaging the breast to hand expressing to machine expressing to topping up with formula to not topping up with formula, everyone had a different view. And then the shift would change and I'd see a new lot of midwives and nursery nurses and breastfeeding counsellors and peer supporters all of whom had different views again.

I suspect any single one of them would have worked had their advice been consistent, or had I been able to choose one and have the confidence to follow their advice even when their colleagues were telling me something expressly contradictory. Would it really be so difficult to be consistent, or at least have a plan to enable women to try one thing properly before moving on to the next?

Related posts:
Ways to improve postnatal care #1: Don't call me mum
Ways to improve postnatal care #2: Change the sheets
Ways to improve postnatal care #3: Help us buy the basics
Ways to improve postnatal care #4: Allow partners 24 hour access
Ways to improve postnatal care #5: A debrief for all new mums
Why I love the NHS

Ways to improve postnatal care #4: Allow partners 24 hours access

This applies to labour as well as postnatal care. One of the recurring themes that comes up again and again when women share their birth stories is that their partners were sent home, either when they were in labour and on the ward, having to soldier on alone and in pain, or shortly after delivery. 

Of course our partners need rest, and of course we need rest too, but it would be more helpful for our partners to be able to come and go so that we can manage our time ourselves. That way if the baby will only stop crying between 3am and 5am while being held, or indeed if you will only stop crying by being held, they can be on hand to do this. 

After all, in hospitals it's the nights that go on forever, when overstretched staff take ages to answer the call button, when you need help to get to the loo at 2am and when someone fetching a snack would be most useful. 

Related posts:
Ways to improve postnatal care #1: Don't call me mum
Ways to improve postnatal care #2: Change the sheets
Ways to improve postnatal care #3: Help us buy the basics

Why I love the NHS

Why I love the NHS

I've been writing a series of posts (to be continued) on ways to improve postnatal care in order to make those difficult scary first days with your baby a bit easier, or at least not harder, but it has struck me that I should also write a positive post about the NHS and the care we received. Because most of it was excellent. 

The antenatal appointments checked that the baby and I were safe. Blood tests were taken using clean equipment and results came back quickly. I had choices over pain relief. Pregnancy bleeding led to a trip to casualty and to the early pregnancy unit where both times we were seen quickly, scanned and reassured. My blood pressure was frequently checked. The baby's heartbeat was often listened to. Had I needed to get to hospital in an emergency I knew I would have been able to call an ambulance. We had scans to pick up and monitor any problems. I had my own room to give birth in and was constantly monitored by midwives determined to safely deliver me a healthy baby which they did, and to leave me as unbattered as possible, which they did. Doctors operated on me post birth in a clean operating theatre using strong drugs and great skill. Midwives and doctors looked after my baby when she was sick in the first few days, and looked after me too. The wards were clean. I was given food. The medicines were plentiful. The most up to date technology was used to diagnose my baby and to treat her. And in the days and weeks and months since the birth every time we have needed to see a GP, we have been able to, all
medicines needed have been free and all hospital appointments have been with experts. Wow. 

I have complaints and suggestions for improvement but it's important, I think, not to lose sight that all of this was free at the point of use, available to anyone who needs it and delivered in a clean and safe environment by well trained staff. 

So this is a post to balance out the ones about improving postnatal care and to say how grateful I am to the NHS and all who work for it. How lucky we are to have it. 

Related posts:
Ways to improve postnatal care #1: Don't call me mum
Ways to improve postnatal care #2: Change the sheets
Ways to improve postnatal care #3: Help us buy the basics

Ways to improve postnatal care #4: Allow partners 24 hour access