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Danielle edwards <danni@terrawebMy pregnancy went without a hitch. I had no morning sickness or nausea or any other symptoms to trouble me. As a result I was completely calm and relaxed throughout. I went overdue, and at 41+6 was taken into hospital to be induced. I was hooked up to a monitor that indicated I was having contractions, although I couldn’t feel them. I was sent home shortly after being monitored as Labour Ward was too full and they had no space for me. I was told to come back to the next day. When I arrived the next morning they did an internal examination and discovered I was 2cm dilated, so the pessary they had intended to use would not work. The midwife then gave me a membrane sweep to try to speed things up. Throughout the night the contractions started getting more frequent and I could actually feel them now, although they still were not painful, just a nuisance. When checked on the next morning I still hadn’t dilated any further, they now had a space for me in the Labour Ward and I was taken down to have my waters broken. The midwife was nice and informed me of what she was going to do, although she seemed to be easily distracted by things like the T.V or the birth next door, which had now become a competition between me and the girl next door, to see who would deliver first. My waters were broken at approx. 10am and the contractions started to come harder and more frequently. Although I still wasn’t finding them painful, just uncomfortable, the midwife told me I should be using the Gas & Air that was available. Having never been in this situation before I simply did as I was told! I stopped using it shortly after, however, as it was making me vomit. I also found that if I relaxed my body when the contraction came they would pass by, without really bothering me. At approx. 3.55pm all Hell broke loose. I was in severe pain and was pushing. I had absolutely no control over this at all. It had come on so suddenly and was so painful I was terrified. I remember thinking ‘How haven’t I passed out yet?! People in car crashes pass out because they are in so much pain. How am I still conscious?’ I immediately asked for an epidural but was told it was too late now. I was then told by the midwife that my baby’s heartbeat had slowed dramatically. They called in a consultant. He said he wanted to deliver the baby ASAP, by ventouse. He told me I could carry on with the labour naturally and see how it progresses, but he wouldn’t really be comfortable with it. I was in so much pain I just wanted the baby out. So I agreed. When the consultant had got into position, he told me to ‘keep the noise down’. He then told me to stop pushing as I was tearing. I had no control over the pushing, I couldn’t stop. My daughter, Jenna was finally delivered and checked over while we waited for the placenta to be delivered. Despite being given an injection to speed up the process, it still took 15mins to come away. I had a lot of blood stored up behind it and haemorrhaged when it came away. We had specified that my partner, who was present throughout, would like to cut the cord. But due to the commotion of the birth, they forgot and he didn’t get the chance. The consultant gave me an anaesthetic and set to work on the stitches I needed. I told him that I could feel them pulling and that it hurt. He simply looked at me and said ‘nonsense’. Then as he went further down, I suddenly felt him push one of the stitches through, I shouted out in pain and told him that ‘I definitely felt that’, he replied with ‘Well, of course you did. I didn’t put any anaesthetic down there.’ I asked him why not, but he just looked at me. He then told me to ‘stop complaining’ and that ‘I would have been finished by now if it wasn’t for you’. I just sat there speechless. The paediatrician was stood at the end of the bed, just watching. As he hadn’t said anything, I asked him if the baby was ok. He said ‘Yes, she’s fine’ then he left the room. When the stitches were finished everyone wondered off. My baby was handed to me and the midwife asked if I would like any tea. I just asked for some ice. As she was leaving she turned round and said ‘I’ll be right back. Another midwife is having a leaving party and I just want to go and say goodbye.’ 30 mins later an auxiliary nurse wandered in and apologised as she wasn’t aware anyone was in the room. She asked if I would like anything. Again I just asked for ice. 15 mins after that another midwife came in to get a piece of equipment, again showing surprise that we were there. She came over and asked if I had tried to feed Jenna yet. I told her ‘No. I didn’t know if I was supposed to or not.’ She told us that our midwife had gone off duty half an hour ago. So she showed me how to breastfeed. After a 15min or so feed, I was taken to a bath, where I was left with my partner and Jenna. I remember feeling sick and weak. I didn’t really feel any cleaner as I was passing clots in the water. After the bath I was taken to the maternity ward and was told I would have to stay in overnight. I was given a course of antibiotics as they had detected an infection in my urine when I went to the loo just before they broke my waters. First thing the next morning I told them I wanted to go home. They said they would make sure this was ok, a short while later a midwife came over and told me they had just found out I lost a lot of blood during the birth and should have been put on a drip, but it was too late now. So they gave me iron tablets and I was allowed home. I had suffered from depression for a few years prior to becoming pregnant. I was brought up to believe that other people have their own problems so no one is going to be interested to hear what my problems are. I was told I should keep these to myself. So I’ve never been comfortable telling people how I feel or have counselling. So I never told anyone I was depressed beforehand. After the birth of Jenna I took a severe down turn and my Health visitor noticed. So 6 months after the birth I was diagnosed with PND, my health visitor told me she would set up counselling sessions for me, but it would have to be with a different health visitor as she was transferring to another practice. At the same time my doc put me on Prozac. I stopped taking them after 6 months. Although things seemed easier to cope with, the trauma and feelings towards the birth were still there. I never heard from any health visitor about the counselling. When I took Jenna to one of her check ups, I mentioned it to them. They apologised, saying they knew nothing about it, and I must’ve slipped through the gap. They offered to arrange some sessions with me, but I told them not to bother. I didn’t see the point any more. For a year I was adamant I would never have another child. Although before I was pregnant I had always wanted more than one. My maternal instinct proved stronger though, especially when my partner’s sister had a baby. So I am now pregnant again, due 15th August 2005. I’m terrified. I don’t remember a thing about the first year of Jenna’s life. What she ate, when she first crawled, how I coped at night with her. I’ve totally lost the memories. It’s like I wasn’t even there. I don’t want it to be like that again. I have been transferred to another hospital, at my request. I have also asked for an elective c-section. The consultant I saw at 20 weeks didn’t really give me a chance to explain why I felt a c-section would be best for me, or to put my case across. He launched straight into his pros & cons speech, and told me to come back at 36 weeks to see if I’ve ‘changed my mind’. I have to admit I do feel like I brushed off. I have booked an appointment to see my GP about my depression. I know as soon as I get in there I’m gonna clam up and not be able to say how I’m really feeling. Writing things down is always better than actually saying something to someone’s face! I’ve felt this way for so long, I can’t remember what it was like before.
CLINICAL PRACTICE GUIDELINE FOR THE MANAGEMENT OF CATARACT AMONG ADULTS Philippine Academy of Ophthalmology Family Medicine Research Group-Department of Family and Community Medicine University of the Philippines - Philippine General Hospital, Manila SUMMARY OF RECOMMENDATIONS DEFINITION Recommendation 1 In medical practice, cataract is defined as any opacity of