nenatal musings

Well the continuing neonatal care of this baby-yet to be named but I am favouring Harpo after Harpo Marx or Harpic given his birth place continues to have highs and lows. Having established him on breast milk his mother did a runner last night so onto formulae which he promptly aspirated so had a v bad night but a bit better now though still intermittently very cold and unless Karen is there only occasionally fed. We persevere and he is beginning to look around. Not out of the wood yet though. A dreary day screening women for the prolapse team-they all have procidentures and seeing women with normal looking vaginal discharge and infertility which is impossible to investigate-no ovulation testing, no tubal patency tests and no man prepared to produce-so a waste of a consultation. Looking at Hycose but probably far to expensive for here abouts. Found an interesting cause of vaginal bleeding in a 5 year old but failed to get a photograph sadly – that is a vaginal leech…removal by putting lime juice on it! The other excitement today was the old and rusty delivery bed collapsed mid delivery, the head end falling off with rust or metal fatigue or some such. There are some other delivery beds dotted around but we are assured that they are broken but probably not quite broken enough to replace the rusting relic that is the preferred place of delivery. We found an under-stair cupboard full of goodies, which are no being inventoried but include interestingly a series of boxes with new destructive instruments which I have some reservations about letting various semi trained ‘professionals, for want of a better word, loose on. The cupboard also seems to include a tent without tent poles and a stack of chairs and lots of un- opened boxes and-possibly useful too some breast pumps. I am beginning to understand how little ‘aid’ seems to get to the place it is needed.

I seem to be drawing the rather more wearying nights on call, last night spectacularly at 12.30 when all good aid workers should be tucked up in bed after their dinner of uniformly grey and un-appetising beans, I got called to the labour ward. There was a woman in whom labour had been induced at some local health centre with a fully dilated breech presentation, having been fully dilated for some 18 hours or so and with a transit, god knows how of some 2 hours minimum. Both were actually in surprisingly good nick and I am glad I did not go in for heroics as the baby weighed 4 Kg. however it does raise questions about semi trained professionals a. deciding to do inductions in peripheral clinics and b. being unable to decide which way up the baby is – a little knowledge is indeed a dangerous thing. A primip who had been shouting the house down for 4 hours or so was also struggling so, sod it I want to back to bed and bean digestion so that one comes out abdominally too. Happily a woman with lots of stillbirths delivers normally and now has a child.

I have ducked screening for American prolapse doctors today, but met Heidi in despair as she had failed completely to teach a loca,l pelvic floor exercises for her stress incontinence.

Failure of the labour suite kettle means that I have spent a lot of the day ferrying hot water bottles to and from the house to keep ‘Harpo’ warm and trying to supervise his feeds which he seems to be absorbing when he gets them which unless I stand over the staff is not often.
We have no dioralyte left so I set o fto town and have found some lem lem so it will be interesting to see how our young man gets on with a new flavour-curds and whey here we come