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Last month I reached the grand age of 75, so I am now one of the “vulnerable elderly citizens”  (almost as beloved of politicians as the “hard working families!”)

My first gift was a free TV licence from the government

On the Sunday before my birthday we visited our local stately home with the family and had a splendid cream tea in the Orangerie. (Gracious living at its best)

On the actual day Jennie gave us a birthday party tea, complete with balloons and hats!

Two days later Jennie and I went to see an excellent production of “War Horse” at the Millennium Centre.

When I see 75 written down it looks so old. Inside I still feel 35, still 8st  with all the energy I had then. Sadly I am no longer 8st and though the spirit may be willing the body is not and as for walking miles forget it!

Can it really be 70 years since the little girl with two fair plaits eagerly joined the mixed infants at Bentinck  School? I was the youngest of the family and all the cousins and had been so envious of my brother and cousins when they went to school.

64 years ago that same little girl walked along the boulevard,proudly wearing the scarlet and grey uniform of the grammar school.

56 years ago I started my Nursing training.

52 years ago I visited Norway for the first time and so began about 10 years of sharing my time between England and Norway.

The first babies I delivered will now be over 50, I wonder how they have lived their lives.

48 years ago I had my great adventure on the Bergensfjord.

41 years ago I married JW

35 years ago I had my lovely daughter, Jennie.

Since then the years have just telescoped into one another and Jennie is grown up with a family of her own and my grandchildren are growing up at a rapid rate. I do have one consolation in that my 2 year old granddaughter is a carbon copy of her mother so I have the joy of those early years, (which flew by so rapidly)  all over again.

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The Francis report on the Staffordshire hospital makes disturbing reading and sets
me wondering how nursing could have changed so much since I trained in the 1950s and 1960s.
As an outsider it is difficult to understand how things could have changed so much. I know that today’s nurses work in a very different environment (new drugs, hi-tech equipment, more advanced techniques etc.) from that we enjoyed, but surely the basic ethos of caring should still be there.
I think (as with many professions) that the chain of command has become far too complicated, so that it is much easier to “pass the buck” when things go wrong.
We had a simple, and easy to understand, structure. Matron was at the top and made sure she knew what was happening throughout the hospital. She and her deputy matron visited every ward every day. One day she would take the even numbered wards and the next the odd numbered wards. She went round every patient, and woe betide the nurses if a patient was in a soiled bed or had a genuine complaint.
We had one sister and just one staff nurse on most wards and they alternated their off duty. They were very much in evidence at all times. They went round as soon as they had received the report from the night staff, they did the medicine rounds and served the dinners and many of them rolled up their sleeves and worked on the ward. They somehow managed all this as well as mentoring the student nurses, ordering supplies, arranging the off-duty rotas and writing reports etc. They also accompanied the consultants on their rounds. Visiting times were more regulated then and either the sister or the staff nurse was available for any queries from the relatives.
When I was in hospital a few years ago the only time I ever saw the sister was when the lady in the next bed to me inadvertently pressed the emergency bell and the “crash team” rushed in through the door with all the equipment for resuscitation.
I think successive governments have had ministers with ideological missions, who have added more and more layers of authority, who have taken the authority from the clinical staff. Then in the 1980s Mrs Thatcher and Ken Clarke brought in the idea of “market forces” and put a price on everything and thought that patients would behave like commodities. Sorry MPs but patients are people and people behave differently! Some are textbook cases and “follow the rules” but many others don’t and cannot be put into groups and get all sorts of complications which go far beyond their “price range”
The other scheme in the 1980s was to privatise the domestic service. Before this we had an orderly and a ward maid on each ward. They took great pride in “their” ward and the wards were spotless. One of the orderley’s duties was to clean and refill the water jugs at least twice a day so no one had to drink water from a flower vase! They were accountable to the sister but now no one knows who is going to be doing the domestic work, this has also taken away the satisfaction the old domestic staff could take from looking after “their ward”
We have all seen how this cost cutting exercise was a false economy when the spread of secondary infection caused so much harm.
The reason sisters could manage with one staff nurse was that all the nursing staff, even the lowliest junior, had at least 12 weeks training before they set foot on the ward and most had had considerably more.
We ranged in experience from those just out of the preliminary training school in 3 month sets to those within 3 months of their final exams. There was a new intake of nurses “sets” every 3 months, so, as well as giving us a wealth of experience, the wards were well staffed.
I think one of the best piece of advice I got was, “However dirty, manic or disagreeble the patient may appear this may be part of the illness and you must treat them all with as much compassion as as you would like your own relatives to be treated”. This stood me in good stead when faced with a patient who wet the bed as soon as you had changed it, handed you a present of faeces, or tried to pinch or thump you!”
I have still to be convinced that a university degree is necessary for all nurses, could there not be a different title for those who would be quasi doctors and leave the nurses to do what they are best at, caring, keeping the patient comfortable, fed and hydrated and carrying out the apprpriate nursing procedure efficintly and professionally.
It should be mandatory for politicians, business managers and such individuals to actually work at the business end before they are allowed to make major changes.
As patients we should be more careful when complaining or taking legal action. Of course when there is a valid complaint it should be investigated, but not all patients will recover however dedicated and skillful the medical team, and every time frivolous complaints are made it gives the bureaucrats an excuse to add more paperwork. Very often all the patient wants is a polite and rational explanation. They just want to know that they have had the best care and attention.
Iknow that there are many younger people who will argue against our method of training, but the general consensus among those who trained this way is that we would have more cofidence being nursed by the old style nurses than by the new method. Judging from the presents of chocolates, tights, biscuits etc. left by the majority of patients, I would say that the patients were happy with their treatment.

Two weeks ago I had a lovely birthday.  It began with cards, flowers and presents and then a superb lunch, cooked by Jennie and GG for the extended family where we ranged in age from 8 weeks to 91 years. This reminded me of previous birthdays (of which there have been many :))

When I was a small child, in wartimes, it was usually an extended  family tea. My mother used to hoard any extras to the rations over the weeks before to put on a special spread. Sometimes this had been supplemented by food parcels from my father who was on the North Atlantic convoys. I don’t know how legal this was but he bought food and presents on his shore leave in America. Often he was given extras by the kind family, the Winfields who befriended him in New York. He also seems to have made a friend of the ship’s cook because I remember at least one splendid coconut cake we received. I was lucky to be a summer baby because there were always stawberries and raspberries. No cream or icecream, just top of the milk (in those unhomogenised days), evaporated milk or “mock cream”.

I usually had a new dress for the occasion. This was either one my clever Mum had made or another of those parcels bought in America.

Another time my father bought me a new birthday outfit was for my 16th birthday. Dad came home from work on the Friday and asked if I would walk up to the post office with him. I was wearing an old cotton dress and wearing a rather ancient pair of sandals, but as it was only a walk to the post office, I jumped up and went with him. When we had completed his business he suggested that we walk up the road and look at the shops. I began to feel uneasy when we carried on up the road and into the city centre. In those days a “trip to town” entailed dressing up a bit. My mother always wore a hat and gloves and I at least had a wash and brush up!

He then proceeded into one of the department stores, with me trailing reluctantly behind, and we bought a new dress, jacket and shoes. I think the assistant must have thought I was some urchin he had taken pity on, (but it was a very nice outfit!)

When I reached my teenage years most of my friends were members of the school guide company (99th Nottingham) and several of us had birthdays within 10 days  in July so we sometimes celebrated together. They were a super crowd and now 65 years since we left school  and even though we are very scattered geographically, many of us have kept in touch with each other. Not all of us with everyone but each to a few so between us we convey news between us. Some, sadly, are no longer with us but the only two I haven’t had news of recently are Halina our Polish friend and Chris Bond who I saw briefly when Jennie was a baby, so if anyone has news of them I would love to hear it.

When I was a student nurse I was usually working on my birthday, but we usually had a pyjama party in the Nurses’ Home after work.

On my 21st bithday I was working on the Obstetric ward at the QE in Birmingham. After report I walked onto the ward feeling a bit miserable that this momentous day should be passing without acknowledgement, when the patients started singing “Happy Birthday”  and one of the Midwifery Sisters followed me in carrying an iced cake and suddenly I was inundated with cards and flowers and presents.

In the intervening years I have celebrated my birthday in various parts of the UK and Norway  My last birthday with Dr Alf was celebrated in spectacular fashion at Glyndebourne. It was Dr Alf’s 40th year in General Practice and I was leaving London 1 month later, so he arranged what he called a staff outing on my birthday, which happened to be a Sunday. It felt very strange to be walking out of our flat in evening dress on a Sunday afternoon, but we had a lovely time.

Now we have come full circle and Jennie is arranging family parties and we are so lucky that we get on well with GG’s family and share with them.

Today the nurses have given a resounding “thumbs down” to Andrew Lansley’s so called reforms. He says that he is listening, but is he hearing?

I feel very sorry for the nurses of today, and am so glad that my nursing career was before politicians and bureaucrats started interfering with a service which ran well until they decided that health care was a business rather than a service.

When I was working in hospital we didn’t have fancy titles, which no one understood, we had Matron in overall control, aided by her deputies. There was a Sister on every ward, which I don’t think they have now, and her deputy was the Staff nurse. All of these were in regular contact with the patients and were easily recognised by their distinctive uniforms.

Obviously all these senior nurses had administrative duties to keep the the hospital running smoothly, but nothing like the mountains of office work that today’s nurses have to cope with. The Matron, or one of her deputies, had time to visit every ward every day, and the Sisters had time to spend on the ward.

The Sister or the Staff nurse, did the medicine rounds, served the meals and supervised and mentored the student nurses, so they knew everything which was happening on the wards, and they knew if patients were not eating or drinking. They were available for patients to ask questions or voice their problems.

I know that today’s nurses are educated to high technical standards now, they do procedures which were formerly done by senior medical students and junior housemen, but has this been at the expense of nursing care? Who has the expertise and time to do the ordinary nursing care now?

When we spent more time on the wards during our training we were there not only as an extra pairs of hands, but we gained confidence in those procedures as we progressed up the ladder towards our final exams. We each had a record of achievements book which had to be filled in by the Sister at the end of each placement.

Sister not only kept the nursing staff and domestic staff under control, but also the patients and their relatives! The relatives accepted that, unless their relative was on the seriously ill list, they should not telephone at other than the given times and they queued up after visiting time to discuss problems with the Sister. I think the general public had more respect for authority then and were able to see that if they interrupted nursing staff at inconvenient times it was their own relatives who were being deprived of the nurses’ time.

Maybe there would be less time spent ticking boxes and form filling if, as a society, we had not become so obsessed with “our rights” and ready to employ the “ambulance chasing” lawyers. This too takes time from caring for patients. It also makes senior staff wary of giving student nurses the opportunity to practise their skills, and in a practical subject you only really become proficient when you actually do the procedure, however thorough the theoretical teaching.

I don’t know when it was decided that health care was to be treated as a marketable commodity rather than a service, but until the 70s the hospitals and the GPs worked together to provide the best service they could and there was no feeling of anyone commissioning any part of the service, or putting a price tag on it. The GPs requested the hospital service they considered necessary and the hospital provided it. When the patient was ready for discharge the GP took over and arranged the domicillary care. It was qute seamless. We didn’t have PCTs or commissioning bodies!

I am not in the profession now and can only judge things by my own experiences as a patient and what I hear or read from those still working in the NHS,  but I hear very few in favour of Andrew Lansley’s reforms other than those with a vested interest in the private sector. The enthusiasm with which the private sector embraces them makes my cynical mind very suspicious!

When we had been at the PTS (preliminary training school) for eight weeks, and had learned the basic bedside nursing techniques, we were taken to the hospital for some ward experience.

When we arrived at the hospital we were sent in twos or threes to the wards. The first sister I met gave me a very rosy picture of how sisters were!  She was a large, bosomy, jolly lady. It was rumoured that she and the two consultants for her ward had all been in the Royal Navy together. I could believe this as they had a rather bawdy sense of humour. It was a busy ward, but efficiently run. The sister was good natured but no “pushover”.  If you did your job to the best of your ability she was sweetness and light, but try to cut corners and the whole hospital would hear her bellow!  She probably sensed our nervousness because she was very kind to us.

She paired us off with either a staff nurse or third year so that we were well supervised  and when the consultant arrived with his entourage of housemen, students and registrars she sent us round too to observe. I thoroughly enjoyed my first morning on the wards.

The sisters then were in complete charge of the wards and were very much in evidence. They managed the nurses and domestic staff, were available for patients’  relatives at visiting time, ordered provisions,drugs, laundry etc. They also did the drug rounds and served the meals from huge heated trolleysand made sure that the student nurses were taught and supervised.

We visited her ward once a week for the three following weeks and then we were given a week off before we started at the hospital full time.

When we started full time I got a rude awakening because I was put on a different ward and the sister there was the complete opposite. She was a cold  hearted woman who appeared to dislike student nurses on sight. It was a very busy medical ward, but she made it even harder work than it needed to be. Most of the patients were bedridden, several were incontinent, several needed feeding  and there were i.v. drips and oxygen tents dotted around the ward. She added to our work load by putting everyone on four hourly temperature charts and water balance charts whether they needed it or not. She was quite unreasonable and listened to no excuses. If the night staff didn’t keep  specimens, it was our fault. If the laundry didn’t send back all the laundry, it was our fault. In fact if anything was wrong ,it was our fault!

 It was completely different on her days off when the staff nurses were in charge, the ward was more efficiently run, the mood lightened and even the patients seemed more relaxed. I was tempted to  give up nursing altogether, but my parents encouraged me to wait until I changed wards at the end of three months before I took such a drastic step. They were quite right it was never as bad as that again in my general training and by the time I had a similar sister when I did midwifery, I had hardened up somewhat and coped with it.

Most of the sisters I worked with came somewhere in between the two extremes. I didn’t mind them being strict (well, not much:)) if they were fair.

I think our sanity was saved by us living in the nurses’  homes. We used to meet up with our friends when we came off duty and, over a pot of tea, would air our grievances and comfort one another when we were in trouble. We were all single so had no domestic worries and no household bills to worry about.

When Jennie was small she had a set of books called “A story a day” and I am reminded of these when we hear the news and the coalition government seems to put out a policy a day. I don’t know whether they are trying to get into the Guiness book of records  for the most policies in three months, or whether they are just too excited by getting into government again!

They are churning out policies just like we used to in the 6th form debating society. Some of them are new plans and others seem to paraphrase promises we have heard before.

 Today it was about single sex wards and I heard some woman say that it is difficult to convert the old hospitals to all single sex wards. This puzzled me as, during my time working in NHS hospitals in the 50s and 60s I never worked on a mixed sex ward and some of the hospitals were very old.

At the General Hospital Birmingham, (which was built in the 18c), the sexes were not only on separate wards but at opposite ends of the corridor!

Even in the small cottage hospitals I worked in they didn’t have mixed sex wards so I don’t know when they were introduced. Was it when the accountants took over the management and found that it was more economical to mix the sexes? It sounds like one of the crazy ideas from the business men who took over the running of hospitals and were more interested in “market forces” than patient care and patients became “units” rather than sick people. They doubtless gave a presentation with power points illustrating the advantages of mixed wards.

 I just wish that they would slow down and think through their pronouncements before they make them public, maybe then we would have “joined up” government and would not spend the next 20 years undoing the policies which don’t work.

When I babbled childish  nonsense my Great-Aunt Clara was fond of pointing at my ears and saying, “You have two of those and one of those” (pointing at my mouth), “Use them in the same proportion” i. e. listen twice as much as you speak!

What a pity that some of the MPs had no Great-Aunt Clara.:)

For any retired nurses who are worried by the stories told about nursing care, much of which I think is caused by giving management of hospitals to bureaucrats and accountants, instead of the Matrons and senior Physicians, should read a website  I found and the article in the Nursing Standard  it quotes. It certainly gave me food for thought!

In 1968 I had been drifting around between Norway, Scotland and England. I had held a variety of nursing posts, surgical wards,  medical wards, maternity wards, home nursing both for Marie Curie and a private agency, and, as my present post as night sister at a  private maternity hospital was drawing to a close I was perusing the sits. vac. in the Nursing Mirror when my eye was taken by a small advert. for a practice nurse in West London, which, as an added inducement, offered a small furnished flat with the position.

At that time very few GPs employed practice nurses. Some had district nurses attached to them and some employed nurses as receptionists, but I didn’t know any who did just nursing so I wasn’t sure what to expect when I applied. I went for an interview and met Dr Alf at the surgery on a council estate near Regent’s Canal.

We got along well from the outset and he offered me the job and showed me the flat, which was behind the surgery. He also offered to send his handyman round to redecorate it as  it was a bit shabby.

He had two surgeries, the one on the estate, which had replaced the original surgery damaged by bombs in the war, and another about a mile away by Maida Vale.

He had been in general practice for over 30 years and knew most of the families on the estate and they knew him! They were confident  that, if they had a genuine illness, they were in the best possible hands, but they also knew that he could sniff out a malingerer within a short space of time!

Many of the older ladies used to reminisce about the handsome young doctor who had come as an assistant to the previous doctor in the early thirties and used to do his visits on a bicycle. When the old doctor retired he had taken over the practice and, apart from his time as an army medic during the war had been there ever since, and now did his visits in a Daimler:)

It was a one man practice and we usually had the maximum number of patients (3,500). He employed a receptionist, me and a part time assistant who worked Friday afternoon to Saturday evening as Dr Alf was an orthodox Jew and kept Sabbath and Jewish Holy days. We were a very oecumenical practice. I was Anglican, Jan, the receptionist was Methodist. The first assistant was Hindhu, the second RC and the last one I worked with a Buddhist from Sri Lanka. The estate had many Irish residents, from both sides of the divide, one pub had a collecting box for the IRA and the other a box for the UVF and yet they were surprisingly tolerant of one another and any fights on a Saturday night were unlikely to be over the religious divide.

 We had no guidelines over my duties so we just worked it out as we went along and it seemed to work well. We were much luckier than todays practices in that there was minimal interference either from government or the LHA. We had a package of boomph from Count Hall once a week, mainly new patients notes or requests for the notes of our patients who had moved away. 

Dr Alf did all his own visits, unless he was going out for the evening, and then he used the locum service. Although he was nearly sixty years old he still kept up the enthusiasm he started out with. He had trained at Guy’s and then worked in a 200 bed free hospital in South London which was run by a Matron, a Consultant physician and Consultant surgeon, an almoner  a treasurer and a secretary!  That was the total of management and it ran like clockwork!

He had already decided that he wanted to go into general practice so he studied for, and gained, his MRCP, DPH and DCH and then went to the practice which was to be his life’s work. Every week he spent his half day on Wednesdays at lectures in Hammersmith Hospital and every year he arranged his holidays around medical conferences.

We ran a very comprehensive service, ante natal, post natal, infant welfare as well as all the usual GP services. I also did regular visits to the elderly or long term infirm and reported back to Dr Alf if they needed a follow up visit from him. He gave me a lot of leeway on my duties as he trusted me to know my own limitations and it was one of the most satisfying jobs I ever had.

I learned a lot during my six years there and made lots of friends. At my engagement party (held in the waiting room of the surgery) Dr Alf described himself as my “London Dad”. I only left the job as I had got married and JW  and I had realised that we were unlikely to afford a house in London and had decided to return to my home town of Nottingham.

It was a sad leave taking, especially from Dr Alf and Jan, but we kept in touch for the rest of their lives, and even after Dr Alf died his wife took over the correspondence until her death. They all have a special place in my memory and I am lucky that it was a time when we could do our work as we felt fit without undue interference from bureaucracy.

I heard on the news this week that the government have plans to enable every cancer patient “one to one” nursing care.

Do they mean qualified nursing care or partly trained care assistant care?

I have seen the changes in home care over the decades from the SRN CMB (part 1) District nurse who gave all care ( including personal care) to patients in their own homes,  to the contracted out service now where care assistants with little training call in for 15 minutes before rushing off to their next assignment.

Friends, (qualified District nurses), who did this work often told me about the extra jobs they did when they went to give both nursing and social care, e.g. lighting the fire, bringing in shopping etc.

The District nurse was often a familiar figure in a neighbourhood and worked the same district for many years. In some country districts they also combined nursing, midwifery and health visiting and were known locally as The Nurse, and were greatly respected and often became the unofficial social worker too!

In 1963, while I was waiting to start the midwifery course, I worked for a few months in the Marie Curie Service. This was a service which was run in co-operation with the District nurses. It was run by Superintendent of the D. N., a very competent lady, and the patients were referred by the D.N.s. Marie Curie paid our salary, but it worked like a private nursing agency and we were assigned to one patient and stayed with that patient as long as they stayed in their own homes. The drugs and medical equipment was supplied by the district nursing service.

When I was first offered the job I was a bit dubious, as I thought it would be a very depressing job. I could not have been  more wrong! The patients I had were lovely people and so were their families.

I  had only three patients in my time with them, but they were all cheerful and determined to make the most of the time left to  them. The families were grateful that I was helping to keep the patient as comfortable as possible and were only too happy to co-operate in the care.

I know that there are far more complex treatments for cancer care now, but good basic nursing care and the right attitude will be little changed. I wonder where all these nurses are coming from? I doubt that nurses will be assigned just one patient at a time and suspect they will be too overladen with patients to do the job as they would like to do it, and will be frustrated by this, instead of getting the satisfaction I felt with my Marie Curie patients in an era when they understood  that nursing was looking after the whole patient, not just performing the medical treatment,and  also supporting the families.

I only see hospital life now from the patients side, so I follow a few “blogs”  posted by the professionals still active in the health service.

One I follow is by a community midwife  who has been in the profession for many years and I can hardly recognise the way the service  is being run now.

I started my training in May 1963. I had enjoyed my year out, but found that I was missing nursing so applied, and was accepted, for the 6 month  training for CMB part one. This would give me the obstetric training I would need if I wanted to practise in some other countries, or, in some hospitals to obtain a sister’s post.

At that time I had no plans to become a practising midwife for which I would have to do another 6 months for CMB part 2. I think there was a scheme for a longer training for those who had not done general training first, but all the midwives and pupils I met were SRNs so I don’t know anything about that scheme.

 There were about 25 of us in the May intake and this was where I met multi-culturism for the first time. The other pupils were from Africa, West Indies, Malaysia, Hong Kong, India and just 5 from the UK!

We started in the schoolroom again and had lectures in great detail on the anatomy of the female pelvis and breast and the foetal skull, the mechanics of labour etc. etc. We also spent every Monday evening having lectures.

During the 6 months we had to observe 10 normal deliveries and do a minimum of 10 deliveries, under the supervision of the midwife assigned as our mentor, and enter them in our case books. The casebooks were sent to the CMB to be assessed at the end of the course. We also had written exams and a viva.

I decided that I liked midwifery, so did part 2.  Passing  this would entitle me to become a certified midwife and practise in my own right.

We did 3 months in hospital (again with more lectures and another 10 deliveries under supervision) and then 3 months on the district.

We were assigned a district midwife each as our mentors for the next three months. Most were working from their own homes but a few of us went to midwives hostels where a group of midwives lived and worked. I went to one in North London which served an area around Archway and The Whittington Hospital. There were four midwives and four pupils. 

In those days there were many more home births, in fact you had to have a reason for a hospital confinement, medical, obstetric or social.

It was very hard work on the district with long hours but I really enjoyed it. We had one clear day off a week and one half day ( it was just my bad luck that this coincided with the evening we had lectures :)) and the rest of the time we were on call 24 hours!

We started the morning work about 8.30 am. We visited all post natal patients for a minimum of 10 days, twice a day for four days and then just once a day if everything was progressing normally. After the post natal visits we did the ante natal  visits to see if the home conditions were suitable for home delivery, or to visit those nearing their due dates to deliver their delivery packs of surgical necessities and to ensure they had everything ready for the delivery.

Once a week we had an ante- natal clinic and once a week post- natal and baby clinic in the afternoons, so we got to know the patients very well and they got to know us, which made it more relaxing  for them when we turned up at 2 am for the labour and birth.

In the evening we did the second visits of the day for the first four days. After that our time was our own, unless of course someone went into labour! Once they were in labour they had either a pupil with them or the midwife and we were both there for the delivery. The GP usually called in , but didn’t stay unless there was a problem. In case of emergency there was a special obstetric ambulance service available within minutes.

We rode around on bicycles and carried our “famous”  black bags on the front and the gas and air machines on the back. Many of the patients went into labour at night, but I never had any reason to fear travelling those streets at night, even the roughest parts, because in those days we never heard about mindless people attacking the emergency services, (the general public would have been more likely to attack anyone molesting us :))

When I heard how the service is now run, and how few  home visits are being proposed,  I could hardly believe it. Of course there are some fortunate women who can have a normal healthy baby and return to normal life very quickly, but there are many who develope  symptoms, be they minor or major, several days later. These can often be dealt with easily if done promptly, but can cause serious problems if left untended.

The physical problems were only one part of post natal visits, we were also able to allay fears, dispel “old wives tales” and establish healthy routines for the babies. 

At the end of the three months we did another written exam and submitted our casebooks of deliveries and a written assessment from our midwife.

After a month of anxious waiting I received the letter informing me that I had satisfied the CMB and was now a State Certified Midwife and entitled to practise in my own right…. providing I fulfilled all the legal requisites and informed all the right authorities!

I think we were lucky to practise at this time when we had so little interference from bureaucrats, no artificial targets and the service was run for the benefit of the patients, not to compete in “market forces”