Feeling special (1979)

a child in a hospital Ward for the mentally handicapped a tragedy that's difficult to accept difficult for two reasons first mental handicap is the result of irreversible brain damage damage sustained through no fault of the child's and second although it's not always easy to be absolutely sure what causes handicaps like these the evidence is overwhelming from studies done abroad that the vast majority are not caused by genetic problems but quite simply because these children were born too small and too soon 70% of all babies who die in the first four weeks of Life are of low birth weight and we know that for every baby who dies two survive handicapped often severely for life it doesn't have to be that way the prevention of prematurity isn't a simple matter but it's made infinite more difficult if an atrisk pregnancy is not identified early in fact according to a booklet issued by the Department of Health the infant death rate is nearly five times higher in the children of mothers who are late in Booking that is making arrangements for caring pregnancy than among those who are early care before birth or anti-natal care as it's called aims at detecting and preventing problems that could lead to death disease or handicap in either the mother or her unborn child specifically antinal care aims to identify possible genetic and chromosomal disorders that could produce handicaps such as mongolism and spinabifida certain infectious illnesses present in the mother at the time of conception can affect the health of her unborn child and these can be identified and cured diabetes high blood pressure and a condition called The Recess Factor must be identified early in pregnancy as these conditions can result in death or damage to the unborn baby it's important to identify mothers who've had problems during a previous pregnancy for instance mothers who may have had a premature baby or mothers who had previous deliveries by cesarian section during pregnancy alcohol smoking and taking drugs can affect the development of the unborn child at this stage health education and advice about nutrition are crucial and it's here at the hospital anti-natal clinic that mothers can best protect themselves against the risk of their babies dying or being born handicapped the problem in Britain is that not enough mothers get to these clinics and many of those who do don't get there early enough in fact 30% of women in Britain have not received any antinal Care by the 16th week of pregnancy in other countries the figure for late booking is only 5% one of the reasons why we have a much higher infant death rate than most other Advanced Nations cdale Area Health Authority comprising Halifax and the surrounding towns and Villages had until recently one of the highest infant mortality rates in Britain which may seem surprising as Halifax boasts a brand new maternity unit and an anti-natal Clinic with all the most up-to-date screening methods but by plowing all its resources into this unit the area health authority overlooked one basic problem with dozens of small towns Villages and hous Estates strung out around the valley surrounding Halifax getting to the unit has its problems any pregnant woman has to get to the Halifax General Hospital for all the medical services which she requires for anyone without a car it's a two bus journey in many cases I suspect more than two buses and for someone who's working or for someone who's got other small children still at home this is a real trudge um and I don't think this has been taken into consider ation it's not been taken seriously enough if you regard the most important thing during pregnancy as the health of the mother and the child then I would have thought the authority has a responsibility to make it as easy as possible for the mother and child to receive that care and I don't think you can achieve that by setting up one Central administrative area to which everyone is required to go it just doesn't work I there's two different problems there's getting people to the clinic in the first place which I I agree is very difficult in some circumstances but then is what happens once you've got the person at the clinic to ensure that they keep on attending regularly I got the impression that the nursing staff and M wives and auxiliaries who form a very important part of this service were under tremendous pressure lot of the time they were overworked they were very worried that if they didn't produce the patients if they kept the doctors waiting at all that they would be in trouble and this obviously created a lot of strain and pressure on people and when people are under stress they're not at their most responsive they're not concerned about making sure every woman feels that she's being treated with care and interest I remember one occasion I've been waiting for a very long time it's very hot you get very drowsy all of a sudden things started to happen names were being called my name was called you react as quickly as you can but when you're eight months pregnant movement is a bit difficult and you have to gather up your belongings come on hurry up is is the reaction you get which isn't exactly calculated to make you feel special or even it's not the way you expect to be treated in any other contact with any other public agency it there is very much an attitude that a pregnant woman is is someone to be patronized by both women and men that you are not quite responsible for your own actions and that um you're not due the common courtesies you're not supposed to ask any questions that's the point you you you're laid there looking at the picture and you're thinking well I wonder what they're doing and what are they finding out and is everything all right but you don't get it told you don't get told this I think it gets to a stage where you think well they're so busy and I just don't say anything you don't you think well they haven't got the time so I won't bother asking and you don't you just go and come away and if you've got any worries or any questions they're still unanswered they don't have to sit there and say well Mrs Baker we've done this scan we've found so and so and every everything's all right You' have nothing to worry wor about we'll see you again there's none of that you sort of go in and you're there for a few minutes and you come back out and you know wiser and things are going through your mind and you're thinking well is everything all right is the baby all right is it the right size and everything but you're not all that it's always the cop out with women if women have any criticisms in any area of their lives um they can so often be dismissed as sort of emotional ramblings it's as if you know your emotions aren't a aren't a true guide by which to judge anything I think pregnancy highlights the contradictions of the relationship between um doctors and patients because in fact the woman's not ill and you're in a position to look very clearly at what's happening to you the problems in the antinal clinic at calderdale are mirrored throughout the country for instance the delays at this North London Hospital are so chronic that this sign greets mothers arriving at the CL IC Echoes of British Rail while this film was being made a Consumer's Guide to 300 maternity hospitals was published the 1800 mothers who contributed to the guide said that anti-natal clinics provided the grimmest view of our maternity Services the clinics often seemed like a factory conveyor belt where expectant mothers were processed through machines with very little personal contact of any kind they found it difficult to talk to doctors and seem to be known only by their case notes if the experience is so disappointing and for many mothers almost purposeless perhaps it isn't surprising that 30% of women don't come for antinal care when they should or if they do attend only once I think they go along bouncy and confident and pleased to be pregnant and longing to find out all sorts of things about their baby and their body and themselves and they get to the hospital they see 50 other women also expecting babies um they don't get any personal care nobody can take any real immediate interest in them they feel guilty because they thought they were going to be treated as somebody ever so special and again they turn it inwards on themselves they think oh I was silly of course I'm only one of of 300 that they've seen this month and you queue up for hours I mean the whole visit took about three three hours in fact and you um check in at the desk and then you wait and then you all weighed and then you wait and then you take your urine specimen then you wait and then you have your um bit of medical history taken and then you wait and uh the final humiliation is when you'll put in a Calico dressing gown rather like a sort of 19th century mental institution and you sit in a in a long Corridor holding your clothes in um a metal basket and then they call you in for the internal examination and when I had my internal examination um I was sitting on a bed with two very thin curtains at either side and the consultant and three students who I mean it's a it's a teaching hospital and uh the consultant sort of said always take your dressing gown off so I sat on this bed you know with four strangers completely naked and he uh he said to the the students oh here we have a superb example of a distended breast in early pregnancy these three faces sort of loomed in on on on my breast and I felt so kind of embarrassed by it because not that they haven't got to learn because obviously students students must learn but they weren't learning the right lesson they were learning look at this woman this piece of anatomy instead of um you know look at this patient or look at this this individual and um you know I that struck me as being the sort of thing that a doctor that you knew personally would never have done it is is this contrast that women find most striking because 3/4s of the women in this country receive their antinal Care on a shared care basis care shared between the hospital anti-natal clinic and their own GP see if you can hear pain lot of fat there okay okay yeah so it's it's quite quite clear and regular so Dr McDonald is one of five general practitioners working in a primary healthc care team the Norton Medical Center on the outskirts of Stockton ones looks after 177,000 patients as well as the GPS this team includes a community Midwife a family planning sister a marriage guidance counselor a social worker District nurses and receptionists for women in particular the great advantage in the healthcare team approach is not just the variety of services they can offer Family Planning advice contraception and well baby clinics but that the team is able to adjust to the individual medical and social needs of women and their families this is particularly true of antinal care where the healthcare team recognize that the pregnancies that are at risk are often in fact those mothers who do not come to the clinic because we've got to be prepared to take care down to the people and that we've got to be prepared perhaps to make more home visits um and certainly this applies not just to doctors but to the whole team too um we've got to take care to the houses of these people and in the case of pregnancy almost protect the fetus against the environment that it finds itself in not putting them off by any middle class attitudes trying to get trying to communicate at a level that they can understand and get along with and um perhaps respect as well and that's really one of the basic philosophies of practice is getting care to where it's most needed Community midwives must be sensitive many mothers don't come to antinal care because they're overwhelmed by other problems a sympathetic unauthorised letter from North te to say you haven't been anal it's okay if I come in and examine you that's okay we just have a seat Mrs P just check your blood pressure have you been feeling quite well well I've been all right just me legs are Star as well again look at B one do you not wear any support tights or anything what I'm waiting for a prescription for Mrs Pierce is 27 she'd be classified as a falter and as an atrisk pregnancy in a problem family by implication labels that tend to dismiss her as irresponsible in fact it's her very responsibilities that trap her she has little money and even less support from her husband Mrs Pierce is 7 months pregnant and looking after four young children they always was turn up anal on the 26th week on the need the maternity benefit you can guarantee if they don't come before that they will turn up on 26th week all wanting her benefit um I I us quite naughty I said to them oh you're not do it this way can you you know You' got to come back in a couple of weeks in that way we do get them back a couple of times um but some of them come I'm abolutely desperate for the money you know so you've got to um give them the certificate women desperate for the 25 maternity benefit come to the antinal clinic at 26 weeks the earliest they can qualify for it and medically this is three months too late the medical profession often asserts that if we change the system and increase the maternity Grant problem mothers will have more children but under the present system they're not even being reached now the facts speak for themselves twice as many babies of unskilled workers die in the first month of life than the children of professional workers in other words it's the babies of the poor who die and it doesn't matter where they're born one predominantly middleclass Health area Prides itself on having the lowest infant death rate in the country yet poor people in this area have a worse rate of infant death than most working-class areas of Britain its social considerations not MediCal ones that make the difference the French realized this 5 years ago and introduced a generous maternity grant for a French woman to qualify for her first maternity Grant she must attend her anti-natal clinic by the end of the third month of her pregnancy a month earlier than recommended in this country if she continues to attend the clinic within the specified periods she will have received over £300 in benefits by the time her child's born not surprisingly only 5% of French women do not receive any antinal Care by the 16th week of pregnancy and from an infant death rate 25% above ours 10 years ago it is now 25% below ours in Britain women receive a maternity Grant of 25 and even this is contributory which means in effect that the poor and the unsupported receive nothing precisely those who form the majority of atrisk pregnancies it is here back at the Norton Medical Center that the final Link in this chain of cause and effect is found among the case notes of hundreds of pregnancies stretching back 16 years here over these 16 years the rate of infant death during the first four weeks of life has been less than half the national average and as low as anywhere in the world proof that a policy of positive discrimination in favor of the vulnerable works but the vast majority of vulnerable mothers live in inner city areas where Primary Healthcare teams are a rarity for these mothers contact with the Health Service can be the lockup surgery closed most of the time because the doctor lives miles away and despite such Financial blandishments as this article in the doctor's magazine pulse the gp's interest in maternity care is waning during the last 10 years the entire process of pregnancy and child birth has become increasingly dominated by technology and with 97% of births in this country taking place in hospital GPS lose touch and because they aren't required to keep up to date through retraining their knowledge of maternity care can be 10 to 15 years out of date the community Midwife who used to be the strongest link with these mothers is fast disappearing Health policy has cut their numbers by over a half during the last 10 years so we're back where we started with the initiative firmly with the hospital service and no choice for women yet despite the universally poor standard of care there are a few chinks of light mend Hospital's antinal Clinic wouldn't be regarded as every Health planner's dream yet the staff have made successful efforts to offset these disadvantages by running a flexible appointment system to cut down the waiting about and above all have made the continuity of care each mother seeing her own doctor the overriding priority the team at my end believe that not only has this had an effect on the mother's attitude to antinal care and therefore attendance but that attitudes can also have an effect on the accuracy of the mother's medical history during pregnancy 800 Mrs Evans can you come over let's take your blood pressure please now the clinic that we're able to compare is different from this one in that the waiting time is um very much shorter here the women are aware of which doctor they're going to see and they already know that doctor's attitude this rubs off on to the nurses so that if the nurses outside who are taking the blood pressures find that it's raised they say well why don't you go and have a cup of tea and we'll take it again in 10 minutes and that's what happens and the woman settled down and we find that our inance of raised blood pressure is without any exaggeration at least half of the incidents in our sister Clinic a mile along the road which is run on a totally different lines what I might call Orthodox modern obstetric hospital lines I think too much too much emphasis has been placed on an efficient system rather than on preserving the dignity and the individuality of people seeking hospital care and maternity care this raises the sensitive question of leadership in medicine for if medicine itself is hierarchical by nature it follows that the attitudes and example of whoever runs the department are crucial to how people are treated doctors should share responsibility for decision making with the people they're looking after I believe that particularly as far as technology is concerned that the general public is able to understand practically all of the technology they're able to appreciate the decisions that are involved in that technology and I think they actually want to share in the decision making not everybody does but coming out of that I feel that people should at least be given the choice of taking part in the decision making if the doctor doesn't show them there's a choice they have no opportunity whatsoever and I think actually most people know that there is a choice and would wish to be involved in making it well it's grown nicely the amount of water around it it's quite normal yeah and I can feel its head down here feels quite normal I thought foot was going going to come through the other has it been kicking down there yeah before it was sort of bump bump movements and yeah getting stronger is it wles and rolls something I've seen this particular couple every time and I think that this is the most marvelous situation for a couple he is as much involved with that pregnancy as any man Poss possibly could be can begin to feel it now as a as a baby I'm always being disturbed look look look look are you when it's moving they've been brought together by a particularly stressful period during their pregnancy that's what has enabled this to happen and I think they're a different couple out of that we never thought it's made up for that terrible time of anxiety that's good he actually felt him moved didn't he usually he used to put his hand on me may stop well I think you're going to have a really nice time when the labor starts aren't you I wish it could happen to everybody not the stress but that they could share in this situation because I think there is so much in growing together as the pregnancy grows and the relationship developing out of that that is of tremendous value I'm not anticipating anything any problem I think we've had the problems I hope so anyway hope so I think all well I think that sensitivity to people's emotions is not actually a quality that doctors cultivate in fact most of medical education teaches them to discard that sort of thing whereas I don't believe that's true I believe sharing emotions and reacting emotionally with a person who's seeking one's help is actually beneficial to both parties I think it creates a bond which is extremely close it enables the woman in my case to ask her questions very quickly it enables me to cut through lots of roundabout ways of stating things I feel I can be more truthful and more honest without hurting her every barrier that you put down you find there new territory behind it which brings you closer together which gives the woman a better experience which enables you to do your job better what other questions have you got this week to discuss now what I'm thinking about it um what influences normal life have on still still thinking about what influences normal life has on an unborn baby you know because I read a lot of times books and leaflets about pregnancy and what you should do and how it should be ideal and then I see how my practical life is and I see it isn't that ideal I'm I have much more stress than it is in the leaflet and and I watch how my baby moves and I see if I'm happy my baby moves a lot and if I'm not happy say I have money problems or this this problems my baby doesn't move for two days and then and I'm in Soros nursing well I'm sure those things are important but the fact that you think about it and discuss it also I think means that the baby also must sense that you're caring about that that's important yeah nothing in life is ideal but if we recognize the imperfections and try to make up in other ways as you do because you're thinking about this I think this is what's important yeah that it feels I'm carrying anywhere doesn't matter there are never any things that are irrevocable that can't be undone do you play music to um my own music yeah play my flute to it well nice yeah sure did I hear that of course yeah sure which music is I mean say well it depends what you bring it up to like they they test it with cows or something they give more milk if they un that's correct because you watch television produce more milk so they say anyway no I think those are nice things and you think about your baby and I think uh not in adult terms but but I'm sure the baby is perceiving this what is perceiving me um understanding yeah feels it sure feels it just goes all over feel it yeah mhm I try to be as sorrowful as I can sorrowful yeah do you want why not sorrowful uh um SS yeah Carefree yeah the care and respect the professor huntingford extends to his patients should be the right of every pregnant woman unfortunately it is not for many women pregnancy is rules not rights dictum not Direction care before birth is often unobtainable inaccessible and wholly unattractive many people who have just watched the final sequence in this film will question its relevance a question that reveals how little we value or or even recognize the needs of women and the health of our future Generations for