29 Jul 2015

Results 2015

I genuinely didn't think I would care about my results. I thought I'd either have just given birth or be extraordinarily pregnant, and Thu beyond such minor concerns.
I was wrong. Our gorgeous boy was born at the beginning of July, and results were released a week later. I got to the point of obsessively checking for them within a few days of release. It suddenly felt important to have succeeded after successfully delivering my baby.

And I did.
In biology (SDK125), I gained a pass 2. Considering I was immensely pregnant when I took the exam, I am really proud of this. But, ultimately, I only needed a pass, as it doesn't contribute to my final classification.
So, I was absolutely fucking ecstatic to gain a DISTINCTION in public health (K311).

I have one module left, and start K319 (Adulthood, Ageing and the Lifecourse) in October. It will be the first time I've just done one module in several years. I figure that's the way to compensate for a tiny, breastfeeding baby and his two brothers stealing all my time.
It feels strange to be coming to the end. But I already madly miss studying, so bring it on.

6 Jul 2015

Birth Story - Alex, 2015

Gestation:39w 5d
Site: Hospital
First Stage: 1hr 35min active labour
Transition: One contraction's worth
Second Stage: 10 minutes
Third Stage: 20 minutes
Tearing: Mainly external second degree tear
Weight: 8lb 10oz

As some of you know, I had been quite terrified of going into labour with this baby. My history of short labours and PPH (post-partum haemorrhage) plus generalised anxiety genuinely made me fear we would both die if I went into labour with nobody around to help. I think my body knew that, because despite two weeks of prelabour, nothing kicked off properly until the older boys had gone to their dad's and Tom was home from work.
Early on Friday evening, I started to get a burning cervical pain. I'd been getting a lot of pressure for a few days, but this was really uncomfortable and specific, so I could barely sit. I rang the hospital and they said it was more likely to be thrush or a UTI than imminent or silent labour, but considering my history, to come in to be checked. I didn't really think it could be labour because he wasn't due til the 6th, and other people have their babies early, not me!
Off we went, and had to wait for HOURS to be seen because they had several emergencies - Friday night is party night in delivery. I had a normal CTG. The obstetrician thought it was probably a UTI as I had a lot of leuks and protein in my wee, but my cervix was still thick, and 2-3cm dilated, as it had been for the previous two weeks. I got some antibiotics and left, starving and tired at 11pm. When we left, I didn't want to get out of the car. I had a strong urge to be safe at home, so Tom took me back and went into town to try and find some food. When he rang to tell me he couldn't get anything, I started to cry, which is rather unlike me. He went to McDs and then came home, knocked on the door for me to let him in and as I stood, my waters went CATASTROPHICALLY. It was a veritable DELUGE. I must have lost two pints in the first gush. I managed to get the door open, and then started giggling for joy. I rang the hospital who were sceptical about my need to be admitted immediately until I told them that my consultant had told me to insist on it. I couldn't eat because I knew I was likely to be sick in labour, and leaked about the house while Tom ate his burger.
My waters broke (the first time) at 12:10am.We got to hospital around 1, were seen around 1:30am in triage. I had some fierce backache, but no real contractions. I'd wodged a huge towel between my legs to try and catch the river, and the midwife asked if I hadn't got any pads. My waters had already soaked through two pairs of trousers and pads, I thought a towel might be more dignified...
I went on the monitor, and had a couple of painful contractions. On VE, I was 2cm stretching to 5, and admitted on the basis of previous precipitate labours. I wasn't in much pain, and was still quite joyful at the prospect of incoming child.
I was moved into a delivery suite around 2am, and nothing much was happening aside from the BIBLICAL STORM outside. If you missed it, shame on you - chain lightning, forked lightning, drunks outside A+E stumbling around in the rain. Gorgeous. Ahem. I was cannulated in case of PPH, and had some bloods done. I was then monitored for bloody ages. Alex's heart rate was ALL OVER the place. He was decelerating and accelerating and generally being very worrying, but because I wasn't technically in established labour, they were happy to wait and see if he settled down when labour settled in. I spent most of the next three hours alternating between being monitored and jigging about the room in soggy trousers, trying to get labour going. My waters didn't stop breaking until around 6am, and there were pints and pints of it. I can't believe how much there was. Me and Tom both kept nodding off, although I was getting one contraction every 15 minutes. They prepped my syntocin drip ready for afterwards. I explained that my cervix did not dilate as they're supposed to, but I only actually had two VEs from when my waters broke, which was great.
At 5:15am, I had another VE which was 4cm, stretching to 7 or 8cm, but this still didn't put me in officially established territory.  Nonetheless, the VE got me going, to about one every four minutes. Annoyingly, I had to stay on the CTG throughout because he was still decelerating. I had the same midwife with me (Nina) throughout, and she only left for breaks (in which case someone else came in) or to get someone else to check his trace. This surprised me - I thought I'd be left to get on with it, and I did find it a bit inhibiting to begin with. Once I got going, there could have been a circus in there and I wouldn't have noticed.
The contractions lengthened and got a lot more painful. I was starting to get quite vocal during them, and hallucinating between them as I did in strong labour before, and my official labour start time was 5:55am. However, Nina kept telling other midwives I wasn't established, presumably so they didn't panic about the CTG. It didn't feel like my other labours because I had to be lying down - it made me feel rather detached, and although they were more widely spaced than if I'd been mobile, they were also more difficult to cope with because I couldn't use my body position to cope. Also, the CTG was registering my thunderously vicious contractions as 30-40, instead of 100, which made me wonder if I was actually progressing at all.

The next hour or so is a total blur. I had to stay on the bed. Tom was there the whole time, but I had my eyes shut through most of it. I got onto all fours, so I could let gravity do its thing, while staying on the CTG. Then I asked to go to the toilet, for a wee, because I was feeling pushy and I badly wanted to stand up for a minute. Going for a wee was an agony of blood and pain. Nina gave me some dextrose tablets (I hadn't eaten since Friday lunch) and I got back onto all fours, leaning into the back of the bed. She rubbed my back, while Tom held my hands. I remember telling Tom it was nearly time. A midwife came in to review the trace and organise shift handover, and said I was going to be referred to the coordinator for a caesarean, because of his heartrate (this wasn't actually discussed with me or stated explicitly, but I know the drill). I hit transition around then, and my legs started shaking uncontrollably, I felt sick and I told Tom he wasn't allowed to go and I wanted to go home and I couldn't do it anymore.
Then I began to push, so Nina got between my legs to monitor him, and just let me get on with it. I tell you now, giving birth without people telling you if you're allowed, or what to do is the best bloody way! Two other midwives  came in then to take over the shift from Nina (who had already told me she wanted to stay until he was born) and were quite surprised to find me pushing since they'd been told I was 4cm and not established. I felt like it was very much my party - nobody told me what to do.  It didn't take long at all, only ten minutes. I started screaming that it burned when he crowned, but otherwise I tried to be quiet and just pushed. I managed to mostly pant his head out and his shoulders took a bit longer to be born than I was expecting, but then out he came! He was a bit wrapped in cord, but I had my back to them so I'm not sure how bad it was.
I had him at 7:41am, four minutes before Nina's shift finished! I went a bit "Oooh, I had a baby", because it didn't really feel real. They helped me get onto my back and I started to haemorrhage immediately. They gave him to me and I haemorrhaged some more, so they plugged my syntocin in quickly. I lost about 500ml, so not as bad as last time. Alex was quite bluey purple and still properly covered in vernix. He took a while to go pink, but his Apgars were fine.
Then came the placenta. Even with the syntocin and syntometrine injection, it took a while. It was a bit tangled up in membranes and my body did not want to push it out. They got it out in one piece after about twenty minutes, while I was feeding the baby.
Then, bloody horrible stitching. I didn't tear too badly this time (2nd degree, mostly exterior) but being examined by a student with shaky hands was deeply unpleasant. However, when they'd finished and gave me the best tea and toast in the world, I was much improved.
They weighed and checked Alex. He is 8lb 10oz, so a little smaller than we expected but not much. His head circ is only 36cm, which is MUCH smaller than I expected, and quite a relief.
We sat around waiting to go. My drip took 3.5 hours to get through and they wouldn't uncannulate me until it was time to go in case I suddenly had a haemorrhage again. He passed his hearing test first time, which surprised me because he had such a soggy labour. The paediatrician (who I'm sure I went to school with) didn't come round til gone 2pm. Alex is all normal. Then my midwives started to discharge me, got halfway through and called to an emergency, and then we sat for an hour waiting for someone to finish it off. He pooed all over the discharging midwife. We finally left around 5pm, by which time I was heartily sick of hospital having been there (with a break) for almost 24hrs.

I think this was probably my easiest birth. It was frustrating being hooked up and immobile for hours, particularly as I'm sure he would have been born sooner if I'd been allowed up and I couldn't really tell how I was progressing because it feels so different from being active in labour. BUT his actual delivery was really good and felt much more natural and easy than the other two and I didn't have quite as bad atony in the third stage as before. I didn't want or need any painkillers, which totally shocked all the midwives, but what's the point for two unbearably hard contractions? That's all it was as well - and they didn't seem to get to the point where they rolled into each other, so I was still getting breaks right up to transition. I was worried before that having him on the consultant led unit would mean a lot of intervention and trying to make my body go by the book, but despite being monitored, the midwife was quite happy for me to get on with it on my own terms.
Alex is beautiful and looks just like his brothers.
I never want to do it again, but I'm so glad it went well.

3 Jul 2015


So, Jeremy Hunt, who will best be remembered as the man who attempted to demolish the NHS (and will probably succeed) has a new idea. He has decreed that the wholesale cost of drugs costing more than £20 should be printed on the prescription label, to tell the person taking those drugs that they are funded by taxpayers.

I used to work in a rural dispensing practice. I absolutely loathed working in the dispensary, and only did during very busy periods, but sometimes I helped unpack the drug order upon which the wholesale cost of drugs is printed. This is the cost your CCG actually pay for the drugs, which you then pay £8.20 per item for, if you pay at all.

Now, in some cases, the price of the drug is less than the prescription cost, so you can bet Jeremy Hunt isn't going to put THAT on your drug box. It would not do for people to know they are paying £8.20 for a drug which has cost less than a quid. They might lose their faith in the prescription charge altogether, and then there would be issues.
However, many drugs cost an absolute fucking fortune. I used to use an asthma drug called Seretide, through an accuhaler (which is a type of inhaler where you don't have to co-ordinate breathing and squeezing). They cost £75 each, wholesale. I often used two a month when my asthma was severe, because I was on double dose. I paid standard prescription cost for it (£6-something back then). My GP recently changed it to the much cheaper Qvar, which is nowhere near as effective, but considering I'm "poorly compliant", it's cheaper for them.
One of my least-favourite jobs when working for the NHS was changing people's drugs, in batches, to something cheaper (usually statins and contraceptives) because the CCG had decided X drug was exactly the same and 5p cheaper, so upsetting hundreds of people's medication routines was worth it. And I could see their point, because that 5p multiplied by a few thousand people per month was a large saving. I hated the impersonality of it.

Now, Jeremy Hunt claims that this new measure will reduce drug wastage. Drug wastage is a HUGE problem for the NHS. If you take your drugs out of the chemist, change your mind and pop back in, those drugs have to be thrown away. They cannot be recycled. They cannot be put back on the shelf. Once they've been signed over to you, they're gone whether you take them or not. Sometimes, an elderly patient would die and their relatives would bring in binbags full of unused medication, hoping we could recycle it. Medication collected month on month, for which they'd paid nothing, never used because they hadn't told the GP they'd stopped taking X four years ago, or they didn't trust the new packaging and weren't sure it was the same drug, or they didn't NEED a fresh bottle of psoriasis shampoo every month, or they weren't sure if they were supposed to take the red tablets with the little white ones. Regular medication reviews may be a pain in the arse if you're on repeat prescriptions, but they're designed to stop this sort of thing happening. I daresay it still does, particularly with older people who live alone and struggle with transport.
But I doubt Jeremy Hunt's measure will make any difference. In fact, if I know elderly, often anxious patients on numerous medications, it's more likely to make them scared to get their medication at all. They don't want to make a fuss. They don't want to cost anyone £80 a month. They don't want any trouble. They'll just leave it. If they only take the pills every other day, that'll help save the NHS money. And that calcium tablet, they only take that once a week anyway, so maybe they don't need it at all?
And you can imagine the damage.

Well, if you can't, increased falls, increased stroke, increased heart attacks, increased extremely expensive operations and intensive care therapies, increased inpatients, increased A+E attendance, increased premature death. None of which will particularly save the NHS money. Except the deaths, I suppose.

There is another issue here. If there is one thing I could not loathe more about this toxic fucking government, it's the buzzwords of taxpayer and hardworking families. As a former taxpayer, married to a current taxpayer, in a hardworking family (I assume we're hardworking, I haven't ACTUALLY sent the kids to work down the mine yet, but it's only a matter of time) with fuck all money, I can honestly say that if I get ill, paying for a prescription vs waiting to see if I get better is often a genuine ethical conundrum. I frequently don't bother ordering asthma medication because it costs me almost £17 a month in prescription fees that I don't feel able to justify. It's not a problem at the moment because I have a maternity exemption certificate, but in another year, that'll be gone and I'll be back to poorly managed asthma and recurrent chest infections. Woop. If I was on multiple therapies, the problem would be multiplied. SOME people with life-threatening conditions get their medication free, but not all. And most people who have to pay for their prescriptions ARE taxpayers. This is the sheer bloody idiocy of it.
Taxpayers aren't IMMUNE from illness. Indeed, in the current economic climate, taxpayers are more likely to need antidepressants, anxiolytics and painkillers than usual. Wealth directly correlates to good health, less disability affected years, and longer life expectancy. The poorer you are, the sicker and more disabled you are likely to be (see The Black Report, The Marmot Review for more info) regardless of whether you work enough to pay tax or not.
Not to mention that the elderly, who probably cost the NHS the most in free prescription charges, have been taxpayers. Just as the government like to put pensions in the 'benefits' bracket of government spending, they also put them in the 'workshy' bracket of usefulness. Bloody old people, living too long and costing us money. Let's have a cull.

The money raised by prescription charges helps pay for everyone's medication cost. You might pay £8.20 for your one pound pack of painkillers, but the old lady behind you in the queue has paid nothing for her monthly bag worth £80 or so. And there is a massive deficit, because people live longer thanks to a regime of drugs aimed to hold chronic illness at bay. One day, you will probably need one of those chronic disease drugs, be it aspirin, insulin, a statin, a betablocker, or inhaled steroids. Maybe you're already on them, but begrudge having to pay for it because you'll die without it. Or you begrudge having to pay when you already pay your tax. But National Insurance doesn't just cover medication.
As a five year old, I cut my arm in half, lengthways. The NHS sent an ambulance, X-rayed my arm, cleaned all the glass out, fetched a plastic surgeon in on call to repair tendons and stitch a ligament back together, sewed it back up, gave me two days of inpatient care and then sent me home to recover, with painkillers. The staff, equipment, anaesthetic drugs, bedspace and care were not cheap. Without it, I was unlikely to have died from my injury, (unless it got infected) but I would have lost the use of my right hand, effectively disabling me for life. The NHS has emergencies like that every single SECOND across the country.

Chronic disease causes heart attacks (for which you need intensive care, heart surgery, specialist care, rehabilitation and sometimes intensive care transport), strokes (see previous, but with brain surgery instead of heart), progressive lung disease (home oxygen therapy, home care), and of course, death. The medications used to tackle chronic disease attempts to reduce the need for these expensive interventions. They are ultimately cheaper than inpatient care.Which is also funded by the taxpayer. Perhaps if this measure is a success, we will have balloons at the end of each inpatient bed telling us how much our stay has cost the taxpayer. I mean, I'm due to have a baby any day now, and that'll cost the NHS between £800 and £1000. Perhaps I should go and thank my husband for his taxpaying contributions that will allow a (hopefully) safe birth.

Personally, I think the prescription charge should be reduced, and means tested. If more people paid it, it would be both more profitable even if it were cheaper for individuals. I don't think it's fair that (lifelong taxpayers or not) some very rich people get their medication for free while people scraping the barrel have to choose between food or drugs.

But I don't actually think Jeremy Hunt's new scheme is anything to do with reducing wastage, and the cost of medication to the NHS. If he was that bothered, he'd aim his ire at pharmaceutical companies, who never shy from making money out of the sick. I think this is an early attempt to frighten us into accepting the eventual demise of the NHS, and the use of health insurance.