Maternity Experience

Year: 2015

Induction – Cascade – Caesarean Section?

I have great pleasure in introducing a guest blog from Kirsty Sharrock, a.k.a. SouthwarkBelle.  Kirsty is mum to two girls and lives in London. Her other day job involves biological samples, powerful lasers and badly fitting lab coats. When her first child was born in 2009 she became fascinated, and often infuriated, by the amount of misleading information aimed at new parents. Her response was the SouthwarkBelle blog where she tries to make sense of some of the dubious science or at least have a good rant about it.

Thank you so much to Kirsty for writing for us on the topic of Induction of Labour.

Kirsty Sharrock
Kirsty Sharrock – SouthwarkBelle

It’s a well known fact of modern childbirth: Inducing labour sets off a chain of other interventions which often result in an emergency caesarean.

But is this actually true?

Would you be surprised if I said it’s not? I certainly was. The idea goes against so much that I had heard from other women and from midwives, my antenatal teacher and of course the internet.

When I went overdue with my first baby I dreaded being induced. I’d heard nothing but horror stories saying it was entirely awful and unnecessary, it would almost certainly make the birth more painful and complicated and would probably set off a “cascade of interventions” leading, with grim inevitability, to the one thing I was most afraid off – an emergency Caesarean. It would also completely scupper my plans for a natural birth in a midwife led unit. But at the same time I was MASSIVE, it was August, and hot, I was desperate to meet my baby and had had quite enough of being pregnant. So I agreed to book an induction, then did everything I could think of to make that booking unnecessary. In the event I got my wish, sort of.

IMG_9918
41 weeks and feeling massive

So was I right to fear the induction?

It seems the answer to that is no.

A 2014 study showed that being induced doesn’t increase the likelihood of having a caesarean. In fact women who were induced at term or when overdue were 12% LESS likely to have a C section than those who hung on for nature to do her thing. Their babies were also less likely to be stillborn or admitted to the NICU.

But can we believe this study?

We often see piles of scientific “evidence” that contradict each other. One minute coffee causes cancer the next it cures it etc. etc. so how reliable is this publication, given that it goes so strongly against the generally accepted view?

In this case the authors of the paper didn’t set up their own experiment or trial. Instead they did what is known as a meta-analysis. This is important because a meta-analysis is far more reliable than most of the scientific studies that make it into the media. The authors took the data from 157 different trials and did some serious number crunching. Looking not just at the results of those trials but at their weaknesses too. For example, many of the individual trials were pretty small, meaning their results are less reliable than bigger studies. Others were quite old or asked slightly different questions to the rest. But this variation is the whole point of a meta-analysis. By putting it all together it’s possible to overcome many of the errors and biases that inevitably influence the results of individual studies and to find a more reliable consensus.

We rarely get perfect answers in anything associated with biology. For obvious ethical and practical reasons we can’t do loads of enormous, randomly controlled trials to answer questions about human childbirth. So a meta-analysis, although still imperfect, is about as good as it gets.

But how can it be true when it contradicts so many people’s experiences?

This is the really tricky part. These results fly in the face of something many of us have learned to be true: In the experience of many women, midwives, etc. inductions tend to end in C sections. As yet I don’t know of any scientific studies to explain this difference, but if we step away from numbers and statistics for a moment, there are a few, very human, possibilities:

Relying on personal experiences is tricky. We’re all inclined to notice and trust things that confirm our existing beliefs. That’s just human nature, and it happens to everyone (I’ve known a few, usually logical, scientists get carried away over flimsy results that fit their current theory). In this case perhaps midwives and doctors who expect inductions to end in c sections are just a little more likely to remember the ones that do. Those births may also stick in the mind more than the less eventful, straight forward ones.

A similar thing can also happen with women’s own experiences. Even with everything seemingly perfect, births don’t always go to plan. Difficult births happen and sometimes they happen after an induction. If a woman has heard many times that inductions cause c sections, then it’s only natural to assume the induction was to blame if she does end up in theatre. Maybe that was the cause, but there is no way to be completely sure that the same things wouldn’t have happened with a spontaneous labour.

There is also the risk of self-fulfilling prophecies. It’s possible that some women are ending up in theatre just a little earlier than they need to because they, or those caring for them, suspected it was inevitable. Perhaps most importantly, there is the issue of fear. It is thought that fear can be a big cause of problems in childbirth. If a women is induced, and terrified of the procedure and what she’s been told it will lead to, then it could be the fear itself which causes the problems.


So should every woman be induced at full term?

What this study doesn’t do is prove that all women should be induced the second they hit 40 weeks.

There are many reasons why a woman may decide to delay or refuse an induction. I went into labour naturally but still ended up having some of the interventions that can be used in an induction and I found them pretty unpleasant. Every woman and every birth is different and each comes with a unique set of considerations. Meta-analysis and big data sets give us a clearer and more objective view of the big picture but they can’t say what is right or wrong for any individual mother. That choice must be hers and to make it women need good, evidence based information and often help from skilled, knowledgeable, health care professionals.

This paper also doesn’t give us is a very clear picture of just how likely it is that an individual induction will prevent a c section, still birth or NICU admission. What I hope we will see in the future is more user friendly data. Every women will have their own tipping point for where the numbers add up to choosing induction.

P1010492
Looking pretty rough after a labour that started naturally, but still ended in an emergency caesarean

So what now?

Like many pregnant women I was taught to fear induction of labour and the cascade of interventions it would cause. Now it seems that fear was based on a myth. So it’s important that the evidence, challenging though it may feel, gets out to pregnant women and to those giving them advice. Unnecessary fear in childbirth is potentially harmful and certainly unfair. All the more so for those women who feel they have little choice but to be induced for urgent medical reasons.

This study also has implication beyond individual decisions. There is often a binary division of births. On one side the “low risk”, “normal” births that can be handled entirely by midwives and on the other “high risk” births, which are, effectively, everything else. Being induced can push an otherwise low risk woman over that line.

In the hospital where I gave birth this made a big difference. The Midwife led unit didn’t just have lower all round intervention rates, it also housed built in birthing pools and lovely en-suite rooms where mum, dad and baby could recover together after the birth. If I’d been induced I wouldn’t have been allowed on this unit. So, in choosing weather to be induced or not, I wasn’t just weighing up the risks of induction v continued pregnancy. I was also deciding if I should risk higher intervention rates, sacrifice the more welcoming facilities and deny my husband the opportunity to share the first precious hours of his child’s life. Now we have strong evidence that induction can reduce C section rates and in some cases save lives, should it really be the determining factor in where some women can give birth? Or in the standard of care they receive?

For me, spontaneous labour didn’t prevent an emergency C section. Perhaps I’d have stayed out of surgery if I had been induced? I doubt it, although I’ll never know for sure. But I can be glad that when other new mums are overdue, concerned about their baby’s health or just hot, heavy and sick of being pregnant, the myth of induction-cascade-caesarean section will be one less thing to fear.

Kirsty Sharrock / SouthwarkBelle

2015

Kirsty MatExp pals
Kirsty with #MatExp pals Leigh, Louise and Jen

A version of this blog first appeared on the SouthwarkBelle website: http://www.southwarkbelle.blogspot.co.uk/2014/09/induction-cascade-caesarean-section.html

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BECAUSE OF YOU I DIDN’T GIVE UP: +ve #MatExp

Welcome to the start of ‘A Catalogue of Maternity Experiences’. Rachel @enduringdelight from This Woman’s Work Blog gets us started with her positive maternity experiences and how they inspired her. We hope this motivates you to share your story too.

Read “An Important Catalogue of Your Maternity Experiences” to find out more about this #MatExp action, and submit your story.

Rachel's Positve MatExp story

I am by no means as eloquent when writing as some of the other members of the #MatExp community, but after seeing this tweet from the inspirational Sheena Byrom and following a suggestion from the lovely Helen Calvert I felt it really important to write this post.  As Fab Obs Flo once told me, outside of my comfort zone is where the magic happens (thanks Flo!).

“I’ve learned that people will forget what you said, forget what you did, but people will never forget how you made them feel.” – Maya Angelou

This quote pretty much sums up the story of our children’s births.  I will never forget how the people who cared for us made me feel and how they changed my life.

Rachel at teaI’m Rachel, mama to (almost) 7 year old boy/girl twins and our youngest little boy who is 3½ years old.  I’m also now an NHS Breastfeeding Peer Supporter, MSLC Vice Chair and birth junkie with a particular interest in improving birth experiences for families and the relationship between attachment and neuroscience.

I can’t even remember how I stumbled across #MatExp , but it is an amazing movement; it excites me to know that there are many other people out there as passionate as I am about supporting families to have the maternity experience they crave.  For a long time I thought that my passion for positive birth and all of the issues surrounding it might just be a bit odd!! I don’t contribute to #MatExp as much as many or as much as I would like, but it is a privilege to be part of that community and so I am very grateful to some of #MatExp’s lovely ladies for encouraging me to persevere with writing this when I was struggling.

If you follow #MatExp you will know that, sadly, for a lot of the amazing people contributing to this grass roots movement inadequate care or a negative experience was their catalyst for getting involved.  For me the complete opposite is true, but sometimes that makes things difficult for me because in certain circumstances it’s really hard to talk about having had positive birth experiences as I feel like somehow people may interpret that as me being critical of theirs.

A positive birth experience for me was always going to be a physiological one, but I am not militant about it and I don’t believe that’s what everybody should have.  Moreover I believe that a birth that deviates from a woman’s ideal can still be positive if that woman is consulted, supported and given options rather than dictated to.

Having beautiful birth experiences and successful breastfeeding journeys are what drove me to become involved in movements like #MatExp and peer support.  I’m all too aware that sadly not everybody is as blessed as I am to have had experiences like mine, but I really feel like they should be.  It shouldn’t be a lottery that thankfully I won.  Every woman should be listened to, respected and involved every step of the way in her own and her baby’s care.

“Do the best you can until you know better and when you know better, do better.” –Maya Angelou

My maternity experiences were very different, but positive in their own right.  In hindsight there are things I would change if I could go back and there are things that weren’t ideal and that health care professionals should and could have dealt with differently, but that doesn’t make them a negative experience.  In fact the only reason I know that there are some things I would change and things that could have been done better is because of all of the things I have learned since, but if my birth experiences hadn’t been positive to begin with I wouldn’t have been propelled into the world of positive birth and maternity experience and so would have been none the wiser.  

The birth of our twins involved an induction at 38 weeks and 4 days gestation.   I see so many negative things written about induction that it is important to me to write about this.  I’m not writing about the process of induction and how good/bad this is for women and their babies.  What I want to write about is the fact that, if you have knowledgeable and respectful people caring for you it can be a positive birth experience even if it is not your ideal.  I am so grateful to the midwife who cared for us when our twins were born.  To be honest I think she was the catalyst for my passion for birth and the person who gave me the confidence to decide on a home birth for our youngest son.

Rachel Twins Positive Maternity Experience

I’d had a very straightforward multiple pregnancy and so despite being classed as “high risk” (a label I despise) I hadn’t needed much care at the hospital other than routine appointments and so was quite nervous about how I would gel with midwives caring for me when the time came for our babies to be born in hospital.  I need not have worried; as soon as Carmen walked in the room she came across as so knowledgeable and this gave me complete faith in her from the outset.  It was clear that she had every confidence in my body’s ability to do its job which in turn gave me that very same confidence.  After all, if she thought I could do it then why wouldn’t I?  

Something that particularly stays in my mind is her supporting my decision to not have an epidural. I had never wanted one, but the anaesthetist was fairly insistent on me having one almost as soon as the drip was in my arm and I think I would have given in were it not for Carmen; instead when she could see the conversation was becoming too much for me she delicately stepped in and dealt with it whilst remaining respectful and professional towards her colleague. I remember feeling so grateful to her for that and so relieved to not have to fight for what I wanted.  

“Drinking tea intelligently.” –Tricia Anderson

Our twins were born about 8½ hours after my syntocinon drip was started.  I remember Carmen talking me through each stage of the induction; she read my birth plan and made sure that I didn’t remain on the bed and that I got breaks from the CTG trace, she got a rocking chair to allow me to be more upright and off the bed, dimmed the lights and left us to it as much as possible, but without ever being more than a stone’s throw away.  She really did drink tea intelligently!!  Even when she was drinking tea for real on her break I was her priority and she came back when I begged for her to.

Three years later I found myself excitedly planning a homebirth for our third child in our teeny terrace house. There were a couple of little administrative hiccups, but each midwife I came into contact with was positive and enthusiastic about our plans which made me feel really confident about our decision.  

Rachel with newborn Positive MatExp

When the day came for our little boy’s birth I was blessed to have the support of another intelligent tea drinker; familiarizing herself with my birth preferences and facilitating them; Lorraine was a quiet, reassuring and confident companion and exactly what I needed.  Although she hadn’t been my named midwife I had met her at a routine appointment and as soon as she arrived at our home on my son’s birthday I remembered how enthusiastic she had been about my plans for a homebirth when I had seen her all of those weeks before so I immediately felt calmed by her presence.

It was a very straightforward, if a little speedy, birth and with the aid of a tens machine, some hypnotherapy and a little gas and air our son was born in water less then two hours after Lorraine arrived and probably only about 20 minutes after the arrival of the second midwife. They stayed with us for a couple of hours or so after the birth; helping my husband to tidy up and ensuring we got breastfeeding off to a good start, being attentive, but respectful of what was an important time for us.

Rachel with family

The midwifery team’s apparent confidence from the outset in the decision we had made to have our son at home as well as Lorraine’s confidence in her own ability as a midwife and my body’s ability to deliver our baby served to make me more determined to support other women and help them to achieve a birth experience that they were happy with.  This is how I came to become involved in our local MSLC just a few months later; I wanted so much to make a difference.

It goes without saying that when mistakes are made we need to learn from them and make sure that those mistakes never ever happen again; I’ve worked for solicitors on birth injury cases and am all too aware of the devastation that can result from human error.

In addition though it is vitally important that we learn from the positive.

There are many midwives (and other healthcare professionals) who are wonderful at their jobs and passionate about the care they provide.  These people have life changing positive impacts on families every single day and I feel so strongly about the fact that best practice should be shared and celebrated so that it can be replicated by others and that’s what I wanted to do today and to achieve in writing this. I wanted to share my positive experiences and celebrate the midwives who made a difference to me and to my family; I will forever be eternally grateful to you.

“We are like a snowflake; all different in our own beautiful way.” – Unknown

Most of the world faith traditions have stories of the birth of special people. There are signs accompanying the birth. Stars, wise men and phenomena announcing the arrival on earth of someone wonderful. Perhaps these stories are signs of what we should celebrate with each birth. The birth of every single child and every new parent is special.

As we welcome these little ones into our world let us think deeply. What physical environment is most fitting? What psychological and emotional factors should be named and made present? What people and attitudes will build that loving cradle of experience to welcome the newest member of the human race – our race? Every child and every mother are unique – like every snowflake.

Maternity experience is about creating the best for the newest.

I am fortunate that my experiences have been positive. Let’s always put women, children, families at the centre of our care and create experiences that reflect how special birth is.  

Rachel xx

(The content of this post is my story, but a special thank you to John Walsh not only for taking the time to proof read and make some suggestions as to the finer detail, but also for his encouragement. You can read more of John’s wonderful musings here.)

~ How has your maternity experience influenced you? ~

Look out for @HeartMummy Helen’s story next month.

You can submit your story too; see the second paragraph for more information.

Like what you’ve read? Share far and wide 🙂

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It is time to talk about the ‘perinatal’ aspect of Perinatal Mental Health (PMH): the ‘missing link’ in the national campaign

I am delighted to be able to publish today a guest blog for the #MatExp campaign from Mr Raja Gangopadhyay.  Raja is a Consultant Obstetrician and Gynaecologist with special area of clinical interest in Perinatal Mental Health (PMH) from West Hertfordshire Hospitals NHS Trust. He is a member of the Royal College of Obstetrician and Gynaecologist (RCOG).

Raj capture

I would like to take this opportunity to share my views on why I feel so strongly about the role of the Maternity Services in Perinatal Mental Health (PMH).

Perinatal Mental Health (PMH) has two important components in its terminology: ‘Perinatal’ (period during pregnancy, delivery and post delivery) and ‘Mental Health’. Therefore the care of mums in the Maternity Services during this vital period is of utmost importance in PMH: it should be a no-brainer.

But sadly, PMH is the only one area of Maternal Health where I do not see a strong voice of the Maternity Services in the national campaign.

This has remained ‘Cinderella’ within Maternity Units in spite of the glaring facts:

  • PMH is still one of the leading causes of maternal death in the UK.

  • This is one of the most prevalent conditions mums suffer from during their pregnancy and postpartum period (at least 10% of mums suffering from this).

I strongly believe that without robust ‘perinatal’ care, women would continue to suffer and die from PMH illnesses, no matter how much we spend to expand specialist Mother and Baby Units (MBUs).

Therefore this is the time when we must recognise this important area and raise awareness.

I am trying to address this issue through my campaign on social media and as the Royal College of Obstetrician and Gynaecologist’s (RCOG) Representative to the Maternal Mental Health Alliance (MMHA).

What do I mean by PMH ‘within’ Maternity Services?

Suffering and deaths from PMH illnesses are often preventable if appropriate measures are taken during pregnancy and in the immediate postpartum period.

A prevalent health condition like PMH must be managed with the same readiness as managing other medical conditions in pregnancy such as diabetes, high blood pressure (pre-eclampsia) or heart disease.

The only way to ensure that the women with PMH are appropriately cared for according to the NICE guideline (2014) is to have:

  • A dedicated PMH team within every Maternity Service:

A Consultant Obstetrician, Specialist Midwife, a Perinatal Psychiatrist, a Specialist Psychiatry Nurse and a Paediatrician should jointly lead this service locally. The service should be easily accessible to the mums.

  • A dedicated Obstetric-Psychiatry Antenatal clinic

  • Communication with Community Team:

This Maternity Service should have clear links with GP, Health Visitor (HV), community MH Team, Liaison Psychiatry services, Mental Health Crisis Team, Children and Young People services, Peer Support groups and other charitable organisations.

  • Robust Care Pathway:

There should be a clear pathway for risk assessment (at the booking visit and at every consultation), early identification and treatment. There also should be provision of a multi-professional team meeting on a regular basis.

  • Dedicated specialist service and support:

For conditions such as PTSD / birth trauma, fear of pregnancy and child birth (‘tocophobia’), bereavement and support for mums and dads whose babies are admitted to NICU.

  • Pre-pregnancy advice service:

It is important to have specialist advice and support for women (with PMH illness/ traumatic experience in previous pregnancy) who are considering pregnancy.

  • Patient involvement : ‘Patients first and foremost’

PMH is an area where patients’ opinion must be considered in developing local care pathways. Services must be evaluated on a regular basis based on patient experience.

I firmly believe that all the health conditions should be treated in the same way with professional expertise and kindness and without any prejudice. I am not sure why we still classify health conditions into ‘physical’ and ‘mental’ when there is often an overlap.

Psychological care in pregnancy, delivery and beyond…

It is unfortunate that psychological care has remained a very neglected part within Maternity Services. The reason given for this is ‘the staff are too busy’.

However pregnancy is probably a period of life where psychological support from the HCPs is needed the most.

It is especially important when mums could potentially have severe stress during pregnancy and the postpartum period due to the following factors:

  • Previous history of miscarriage, ectopic pregnancy, IVF, traumatic childbirth.

  • Any other family member or friend has had complicated childbirth experience.

  • Sudden life event such as breakdown in family relation/divorce, loss of employment, bereavement in the family or loved one, relocation/migration and domestic violence.

  • Sexual abuse in childhood or pregnancy as a result of sexual violence.

  • Associated pregnancy complications (for example premature rupture of membrane, high blood pressure, diabetes, concerns on baby’s growth or SPD).

PMH is not only PND and Puerperal Psychosis (PP)…

Many believe that PMH is a term equivalent to the care of Postnatal Depression (PND) and PP.

PMH includes specialised care for women (during pregnancy and one year after the childbirth) with any mental health condition (such as anxiety, depression, bipolar illness, schizophrenia, OCD, eating disorder, and personality disorders).

PMH must include bereavement care (miscarriage, still birth and neonatal death), traumatic birth experience/PTSD, support services for mums and dads whose babies are admitted to NICU and tocophobia (fear of pregnancy and childbirth).

Another important component should be the psychological care of mums and dads throughout the journey of pregnancy, delivery and postpartum period.

PMH, in my view, must be recognised as a separate subspecialty in the training of Obstetricians and Midwives.

Womb

Why is identification in pregnancy and immediate postpartum period so important?

  • Effects of psychological stress in pregnancy:

There are now plenty of research results, which indicate the long-term impact of stress during pregnancy on the brain development of the baby while it is in mum’s womb. Prof Vivette Glover, an eminent Professor of Perinatal Psychology from Imperial College London, explains this: http://www.beginbeforebirth.org/for-schools/films#womb

Therefore timely intervention and adequate support during pregnancy can prevent long-term effects on the child.

  • Care Planning to prevent serious illness:

All pregnant women with risk factors to develop worsening mental health conditions should have a plan of care during delivery and postpartum period.

Confidential Enquiries into Maternal Deaths have repeatedly pointed out that in the majority of cases of deaths from suicide, there is a lack of care planning during pregnancy.

This is only possible through appropriate care within the Maternity Services and multiagency communication.

  • Enjoying the journey of pregnancy:

Experience of pregnancy and birth creates a lasting memory for the mums and dads for the years to come. Therefore this should be an enjoyable experience for the woman and her family to cherish in happiness in the future.

As HCPs our role is to ensure we support and empower women to make informed choices for the safety of her and the baby and most important of all a very positive birth experience.

  • Helping mums to make informed decision regarding medications:

Mums should get proper advice regarding the use of medication in pregnancy and after delivery.

Pregnancy is a short window but an excellent opportunity to address health conditions.

  • Bonding and attachment:

PMH conditions can adversely affect the bonding with the baby and the mum.

‘A stitch in time saves nine’: Prevention of serious PMH illnesses is only possible through good care in Maternity Services.

Guardian capture

Having discussed the importance of the role of Maternity Services in PMH, now let us find out what is happening in the Maternity Units……

A journey of revelations…

I contacted many Maternity Units across the country to find out the provision of PMH services within their Units. What I found was extraordinary.

I raised my concerns in a letter published in The Guardian: http://www.theguardian.com/society/2015/oct/14/perinatal-mental-health-provision-badly-lacking .

I raised this issue with the Maternity Review Team, during my meeting in September (2015).

Although there are examples of good service, the overall structure within the Maternity Units is very poor:

  • Often there is no dedicated Lead Obstetrician and/or Specialist PMH midwife

  • Many Units do not have formal debriefing services (for traumatic birth experience), specialist bereavement midwives and support system for parents with babies admitted to NICU.

  • There are hardly any dedicated services for women with fear of childbirth.

Delving deep into the challenges….

To have a better understanding of the need, I embarked on a journey to meet professionals from all the relevant Royal Colleges (RCOG, RCM, RCPsych, RCGP), Health Visitor organisations, Maternal Mental Health Alliance (MMHA), MPs and All Party Parliamentary Group (APPG), NHS England, CCGs and other national Campaign Groups.

It was revealed that overall there is very little understanding of the vital role of the Maternity Services in PMH.

Thankfully RCM is campaigning for a Specialist Midwife in every Maternity Unit.

But the main barriers are the following:

  • Lack of Mapping of the existing services in PMH within Maternity Units (such as the MMHA map of the available Perinatal Psychiatry services).

  • Lack of a national standard of the service provision within Maternity Units (according to the number of deliveries and complexity of cases).

  • Poor collaborative work among HCPs: as often the Maternity Electronic record system is not accessible to other HCPs and vice versa.

  • Lack of standard Training programme for the Obstetricians and the Midwives.

  • Lack of adequate focus on PMH illnesses in Antenatal Education.

I have concerns that unless these issues are resolved appropriately, we cannot provide the best quality of care for women with PMH illnesses.

With the best of my abilities, I am currently working closely with other national organisations to address these areas.

Maternity HCPs: Please, please do something and don’t wait for things to happen….

Charles Dickens

It is true that funding is necessary to set up specialised PMH services and Mother and Baby Units (MBU). However Maternity Units should not wait for the approval of their business cases.

In my humble opinion, funding is not everything. Our professional values are the most important factors in patient care:

  • Kindness:

Simple measures such as a smile, empathy and a willingness to listen to the concerns of the mums and dads could make a huge difference in patient experience.

  • Communication:

Take every opportunity to explain the situation and ensure that appropriate wording is used during communication.

  • Continuity of care:

Try to ensure continuity whenever possible or communicate adequately with the rest of your team.

  • Local Alliance:

Please try to develop Local Alliances with Community Midwives, Health Visitors, GPs, all available community mental health services, Peer Support groups and children’s services.

This could significantly improve communication among the multi-agency teams in caring for mums with PMH illnesses.

  • Listen to concerns:

Please create opportunities to listen to the concerns of the user group. This may be in the form of promoting your local Maternity Service Liaison Committee (MSLC) or Patient Panels.

If possible, please read the real life stories of the Lived Experiences on the Internet: it would help you to think ‘outside the box’, have a better insight into the PMH illnesses and give you inspiration.

  • Raise awareness:

Arrange patient engagement events, Road shows or Community Events with local CCGs.

Participate in Social Media support, such as #PNDHour (Wednesday 8-9pm) and #BirthTraumaChat (Monday 8-9pm):

This would help to raise awareness, remove stigma and give mums and dads a ray of hope.

  • Arrange training on PMH:

Please ensure all staff are adequately trained in your local Units.

  • Get involved in your Regional PMH network:

Many regions now have regional PMH Networks. This could be an important place for information sharing among the Maternity Units.

  • Please do not forget dads:

There is now good evidence to support that dads can suffer from PTSD/PND. Please take every opportunity to support and communicate with dads.

  • Keep yourself updated:

PMH is a rapidly evolving area; therefore HCPs must keep their knowledge and skills up-to-date through continuous professional development.

If unsure, please seek help and escalate to your senior colleagues: an unsafe advice from a HCP could endanger an invaluable life.

Working together to make a difference…

We ALL need to work together to prevent suffering and death from PMH illnesses.

If you have any suggestions for improving PMH services within Maternity Units, I would be very keen to know (Twitter: @RajaGangopadhyay3).

If you are involved in good projects locally or are aware of any good practice, please share with everyone through #MatExp.

Acknowledgement

I am grateful to #MatExp for giving me this opportunity to write this blog.

I am immensely grateful to all the Lived Experiences for sharing their stories, which have enriched my knowledge on PMH much more than any textbook and journal article.

My thoughts are with all the bereaved families who have lost their loved ones due to this dreadful illness.

Raja Gangopadhyay

2015

 

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Health Visiting & Midwifery – A Partnership

I have great pleasure in sharing with you a guest blog from Health Visiting Lecturer Charlotte Smith and Midwifery Lecturer Neesha Ridley – a great team from UCLan.

Following our wonderfully informative Twitter chat last week, we were asked to contribute to the MatExp blog – what an honour, thank you!

We are writing as a partnership, because this is what we believe health visiting and midwifery should be. To explain, “We” are Neesha and Charlotte, a midwife and health visitor (in that order!) who recently found ourselves united in a number of ways.

First, we are new to our roles as lecturers at the University of Central Lancashire. We enrolled on our teaching course together, thus embarking on our new career journey together – joint working together is enjoyable, time saving, cost effective and efficient, and our shared “newbie” status allows us to express our vulnerabilities and successes openly with each other. (Also, we discover we have a similar sense of humour which is always a bonus!)

Second, our passion for joint working was discovered when Neesha asked Charlotte to come and speak to midwifery students about the role of the health visitor. Neesha had been aware of the importance of MDT working in the childbearing continuum and had organised a succession of guest speakers, designed to give Midwifery students the knowledge and experience of the services they will work alongside in the “real world”. Charlotte leaped at the chance, and went along to the session prepared to outline the role of the health visitor.

What neither of us had been prepared for was the response. Armed with insightful questions and an obvious desire to learn more about their health visiting colleagues, the midwifery students described the need for closer relationships between the two disciplines, and the lack of opportunity in practice to facilitate this.

On feeding this back to the health visiting students, Charlotte had exactly the same response. Why aren’t we being taught with midwives? Why do we not have relationships with our colleagues if we are to work in partnership with them? Why is it that the first time we “properly” meet a midwife is when our training is over? How are we supposed to understand each other’s roles if we learn completely separately?

Our engagement in the Twitter chat around this issue last week confirmed that parents themselves value consistent, seamless support from services in the perinatal period. It also confirmed that at best this experience was inconsistent across the UK.

Just as it is a privilege to be involved in the journey of new parents and the arrival of their baby in the world, so it is equally a privilege to be part of the journey of a new midwife and health visitor into qualification. As we reflected on and evaluated these sessions together, it occurred to us that there were synergies between the two experiences – and it made sense to us that like in every issue in the 1001 critical days, the answer lies in early intervention.

As lecturers, that means introducing the two disciplines in a more facilitative, educational experience during education. In practice, this could be mirrored by a home or clinic joint contact between health visitor, midwife and the family during the antenatal period.

It is well documented that antenatal contacts are significant in improving the health outcomes of women, children and families – we are currently collating the evidence in a paper on exactly this subject. We are very aware that there are organisational and strategic challenges to this proposal, having worked at the coal face for some time and recently, and from listening to our students, and to the views of parents and commissioners. However our third area of unity is this – we have a duty to our professions and to our students, and above all to the children and families who experience our services. We have the privilege of being on a journey with inspirational, committed and dedicated students and we owe it to them to provide the experiences that they identify as facilitating best practice. As a result we are working together not only to influence the curriculum to include structured facilitative relationship building and education between our two professions, but to encourage students to take responsibility for ensuring they maintain this out in the real world.

Not every family would appreciate a joint visit from services – nor might it be economically or organisationally feasible in some cases. But if we educate and practice ourselves as separate, uncommunicative services, families will continue to see us as such. With more conjoined education and more solid relationships from the outset, at least families will have the choice.

Charlotte Smith, RN, HV

Neesha Ridley, RM

TeamWork

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Ready, Set, Go! #MatExpOnTour

Where are you off to this month? Where will you be discussing maternity services? With whom will you be meeting? How will you be travelling?

Following the success of #OxyOct we want to focus on the #MatExp journey in November with #MatExpOnTour. Every connection counts – whether you are speaking at a conference or having a cuppa with a friend. If it involves ideas for improving maternity services then we want to hear about it.

Please tweet us your pics and post updates to our Facebook group of your meetings, conferences, tweet ups and events. Will you and your colleagues be discussing the #MatExp Heart Values? Will you be spreading the word about #MatExp on your travels? Will you and your friends be talking about change over tea and a slice of cake?  As always, everyone counts, all voices matter, all connections matter big or small – we are stronger together.

Let’s get on the road. All aboard!

Tour Bus

P.S. Click here to order #MatExp materials to help you to spread the word!

See where we have been on tour in the map below. Want to add something? Just get in touch.

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#OxyOct BOOM! What have we all made happen?

Leigh Kendall opened this month for #MatExp with a call to action for Oxytocin October. The campaign is always action focused and we are keen to hear from anyone who is doing something to improve maternity experience in the UK, be it something big or something small. Yet we had already put together a number of blog posts with calls to action, back in #FlamingJune. So I decided that my action for this month would be to revisit those blog posts and find out what progress has been made.

Flo Collage

The original blog posts were on these subjects (each subject links to the relevant post):

Having re-shared the posts on Facebook and Twitter I was delighted to see the responses coming in detailing what has changed, what has been started and what is continuing to be done. Take a look!

Perinatal Anxiety

Sarah McMullen of the NCT explained that she invited Emily Slater (MMHA Campaigns Manager) to speak and run a workshop at the NCT national conference – to raise awareness and inspire action. Sarah says that Emily’s plenary talk to 600+ staff, practitioners & volunteers “was incredibly powerful, and we’re meeting to discuss next steps for NCT”. Sarah added “We’ve also submitted two funding applications relating to mental health awareness (thanks to Rosey Wren for support), and have match-funded a PhD studentship with the wonderful Susan Ayres on Birth Trauma, and are supporting another PhD research project on group identity and PTSD”

Midwives on Twitter commented:

Anxiety capture Deirdre

Anxiety capture Jeannine

To read Jeannine and John’s blog post please click here.  “You matter. I care.”

Emotional Wellbeing

Birth Trauma Chat

#MatExp team member Emma Jane Sasaru has been incredibly active over the last few months.  She has launched Unfold Your Wings a place of information and support aiming to raise awareness of Perinatal PTSD, birth trauma, reduce stigma and give sufferers hope.  She has also launched a CoCreation Network community around perinatal mental health.  Emma has then collaborated with #MatExp team member Susanne Remic to bring about a weekly #BirthTraumaChat on Twitter run jointly from Unfold Your Wings and Maternity Matters.

Sue Henry

Also launched this month by West London Mental Health NHS Trust was this fantastic short film about perinatal mental health: https://vimeo.com/143359951 This film has already sparked many useful conversations.

PMH

Continuity of Care

I was speaking to a commissioner from Cheshire this month about the decision to commission OnetoOne Midwives. The company has this month posted an overview of their caseloading model: http://www.onetoonemidwives.org/_news/caseloading-midwifery-an-ever-evolving-model-of-care

In her talk at a recent National Maternity Review event, Baroness Julie Cumberlege made it very clear that the call for continuity of care is being heard by the review team up and down the country. Neighbourhood Midwives led a discussion at the review’s Birth Tank 2 event, and there were a couple of other discussions where options for continuity were also explored.

Support for Midwives

Poem from banksy midwife @JennytheM:

Midwives JennytheM

Midwife Deirdre Munro celebrated the launch of the new Global Village Midwives website this week. The movement is over a year old and Deirdre explains:

GVM capture

global village midwives

Infant Feeding

Lots of news about infant feeding from passionate individuals and voluntary organisations.  On our #MatExp Facebook group Zoe Woodman explained: “In May we got approval from NCT to run a branch funded feeding support group. Started in June with an NCT bfc attending who is also an IBCLC. We are on 3 boundaries in terms of commissioning services so no local peer to peer style support groups were running within 8miles. The only service is an HV clinic once a week and it’s one on one so you have to wait outside the room to be seen. It’s been on our branch aims at our AMM since I’ve been chair (4yrs!) so finally chuffed to see it in action and I will get to use it myself in January for no3! It’s running twice a month currently but hope we can get funding in the future to run weekly. It’s slowly building in terms of attendance. Feedback so far is great!”

Dorking NCT

Claire Czjakowska’s Breastfeeding Advert is coming together and is looking very exciting – watch this space!  Breastfeeding in Trafford launched its Twitter account this month so please follow for local breastfeeding news.  BfN Portsmouth tweeted:

Bf capture

Midwifery students at the University of Worcester have launched a petition around the questionable practices of infant formula companies – follow the hashtag #WeakenTheFormula for more information.

As if this wasn’t enough, this month has seen the launch of the World Breastfeeding Trend Initiative for the UK.  A committed group of individuals from the major breastfeeding voluntary organisations have come together to measure the country’s performance against the WHO Global Strategy for Infant and Young Child Feeding.  Please visit the website for more information on how this project is structured and the indicators against which the UK will be measured.  The project needs lots of input from families and professionals so please follow @wbtiuk on Twitter and find out how you can help.

WBTI capture

Tongue Tie

Doula Zoe Walsh updated us: “We held a North West tongue-tie workshop in Blackpool. It’s now going on the MSLC agenda for Blackpool so that we can discuss local provision and see if it’s meeting the needs of local families.”  

Breastfeeding and Medications

Friend of DIBM helpline

From a personal point of view, I finally got around to becoming a friend of the Drugs in Breastmilk Helpline this summer.  The helpline is absolutely vital for ensuring that women get the correct information about what medications they can use when breastfeeding.  The service is funded by the Breastfeeding Network and the charity once again asked supporters to do a #TeaBreakChallenge this month to help raise donations.

Teabreak challenge

A wonderful #MatExp collaboration has sprung up this month between Angelique Fox, Sarah Baker and Wendy Jones.  These two #MatExp mums who have never met in person have both volunteered to help Wendy to collect data and raise awareness with regards to drugs in breastmilk, particularly where dentists and podiatrists are concerned.  It was discussed on the #MatExp Facebook group that these two healthcare professions are often cited as not having up to date information about breastfeeding and medications so this collaborative project is aiming to tackle that.

Luisa Lyons, the Infant Feeding Coordinator who wrote our original post on this subject, gave us this fantastic update: “Been a busy couple of months. Infant feeding e-learning training for doctors up and running at my unit and both paeds and obstetricians encouraged to complete it. Great support from our obstetric consultant clinics director too. General paed nurses now doing mandatory infant feeding training every year. Been invited to teach general paed doctors face to face. Three GP’s have done the UNICEF 2 days bf management course with us and now writing bf training for GPs in Norfolk. Included info on bf and medications with scenarios to both student nurses and our midwives at keyworker training now, and incorporating into Mt for all maternity staff. Also off topic slightly am putting in a WHO code game to all the above which has generated lots of awareness with student midwives and maternity staff. Need to join DIBM as a friend which I had forgotten to do, so thanks for the heads up.”

Dads & Partners

Mark Williams, co-founder of Dads Matter UK, wrote this blog post for us for #OxyOct, detailing his work and campaigning: http://matexp.org.uk/matexp-and-me/dads-matter/

Men Love and Birth

Midwife Mark Harris launched his book this month, Men, Love and Birth, “the book about being present at birth that your lover wants you to read”.

A Manchester midwife reported positive outcomes around new rules enabling dads & partners to stay over on her unit:

Dads & Partners Mags

When asked how we can best support Dads & Partners, newly elected NCT president Seana Talbot tweeted:

Dads & Partners Seana

Community Outreach Midwife Wendy Warrington tweeted:

Dads & Partners Wendy

I asked Wendy about the work she does with regards to Dads & Partners and she explained “I talk about attachment and being with their baby, skin-to-skin touch. Antenatal and postnatal depression, and fathers’ role in supporting their partner in pregnancy, birth and beyond and how they can do this. I talk about baby cues and the impact of father’s involvement on child’s future emotional and cognitive development.  I have had excellent feedback from parents and when I see them after the birth they say they felt well prepared for feeling and emotions experienced post birth. They love the fact that I talked about it”

Collaboration between Midwives and Health Visitors

Health visitors on the #MatExp Facebook group told us:

My CPT & I have established 6 weekly meetings with the community midwife and the GP (whose special interest is pregnancy/neonates) to discuss cases”

“We already have that in my team we meet at least once a month with the midwife – it was weekly but we are very busy at the moment (both us and the midwife). She will just knock on our door though and share things – she really came on board with antenatal contacts telling parents to be and signposting those with small children with any worries to us.”

With excellent timing Sharon White, OBE, Professional Officer of the School & Public Health Nurses Association, then tweeted the updated pathway for health visiting and midwifery partnership.

partnership

And as a result of discussing all of this on Twitter, Sheena Byrom has invited me to lead a tweet chat with @WeMidwives and @WeHealthVisitor in November on the subject of midwife and health visitor collaboration.  Watch this space!

Birth Tank

And so much more has been happening in #OxyOct as well! #MatExp was well represented at the NHS Maternity Review’s Birth Tank 2 event in Birmingham – click here for Emma’s round up. I spoke at the launch of the Improving ME maternity review for Wirral, Merseyside, Warrington and West Lancashire – click here for my round up of the morning. Leigh Kendall and Florence Wilcock spread the word at the RCOG Conference on October 16th, and Leigh spoke at the Royal Society of Medicine event on October 20th.

RCOG

Leigh capture

Baby Loss Awareness Week took place this month and many important discussions were had around the subject of grief and loss, something which affects a number of #MatExp campaign members.  Leigh wrote movingly about Standing on the Periphery for #HugosLegacy.

BabyLoss

The RCM has this month launched its State of Maternity Services Report. Emma Jane Sasaru has written a series of three blogs about What Matters in Birth.  Susanne Remic has been raising awareness of IUGR. Michelle Quashie created fantastic word clouds for display in her local maternity unit.  We now have #MatExpHour every Friday created and launched by Louise Parry – click here for her round up of Week 2.  So much going on!

IUGR

I have no doubt there is much much more that I have missed from this round up. There is so much energy and passion in maternity services, and so much desire for change. Whatever it is you are trying to achieve, please join up with #MatExp via Twitter, Facebook or the website and get encouragement and input from like-minded people. Together we are stronger! Feel the Oxytocin flow!

 

Helen Calvert, 2015

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Dads Matter

As part of Oxytocin October (#OxyOct) I have been revisiting the first set of blog posts we put up calling for people to ACT in certain areas of maternity care. One of these was Time to Act for Dads & Partners, which included a mention of Mark Williams‘ work in this area.

Mark Williams is the founder of a new organisation called Dads Matter UK (Perinatal Mental Health for Fathers). He also founded Fathers Reaching Out, Youngness and Independent Mental Health Campaigners.

Father’s Reaching Out was set up in 2011 to raise awareness surrounding the detrimental impact that postnatal depression (PND) has on both fathers and equally families as a whole. Dads Matters UK aims to raise awareness of perinatal mental health, and educate every dad before the birth about birth trauma and PTSD for men.

We are delighted that Mark has written this blog post for #MatExp as part of #OxyOct.

______________________________________________

Mark Williams 4

Depression can hit up to around one in five fathers by the time the child reaches adolescence. In a published report in 2015, it states that at least 10% of fathers will suffer with postnatal depression, which can include the birth itself and up to a year after. Fathers can develop lots of complications in this period, and this can influence their daily lives as well as affect their role within their family unit. It can impact heavily on their relationships, financial stability alongside lifestyle and emotional states. Emotional problems and psychological health needs are crucial elements to postnatal depression in fathers and need to be addressed. Fathers tend to get forgotten at this important and life changing event of having a baby, with mother and child being the centre of care delivery and rightly so, but we must remember there is a father there too. Fathers often get pushed aside which can result in feelings of isolation, anxiety and confusion at a time when they to need help.

Dads Matter

Dads Matter UK is suggesting that the health service needs to develop a process for the screening and detecting of postnatal depression in fathers. As many fathers, the figures suggest, suffer with anxiety post birth of the child. The birth of a new baby can cause problems such as poor sleep, anxiety and stress. This can lead to problems within the relationship and fundamental communication processes within that relationship. After speaking to hundreds of fathers we are primarily concerned with the health of the father and their families. We feel that postnatal depression in fathers is equally significant and requires important consideration when implementing strategies and screening tools for postnatal depression. Fathers suffering with depression can feel increasingly pushed out and unsure of their role within the family thus affecting the bonding and attachment process between father and child.

Screening is important for men, as they are less likely to seek help and support. Particularly, in relation to their health problems. Due to the associated stigma towards mental health and its associated issues, young fathers are even more likely to be at risk and not seek the help they need. Men are often reluctant to admit that they may have an emotional problem or are unlikely to admit to feeling out of control. If this area of health is not addressed adequately this could lead to further breakdowns in the family structure and have long lasting devastating outcomes for our children.

Mark Williams 3

We must remember that fathers can also suffer from PTSD at the birth. Post-traumatic Stress Disorder can occur following a life-threatening event like military combat, natural disasters, terrorist incidents, serious accidents, or violent personal assaults like rape. Most survivors of trauma return to normal given a little time. However, some people have stress reactions that don’t go away on their own, or may even get worse over time. These individuals may develop PTSD.

People who suffer from PTSD often suffer from nightmares, flashbacks, difficulty sleeping, and feeling emotionally numb. These symptoms can significantly impair a person’s daily life. As we know many suffer in silence and let post traumatic stress disorder effect all parts of their daily living. My own nightmares were what if my son had died and the thought of my wife being pregnant in the past did give me so much anxiety that at the time I didn’t know why.

PTSD is marked by clear physical and psychological symptoms. It often has symptoms like depression, substance abuse, problems of memory and cognition, and other physical and mental health problems. The disorder is also associated with difficulties in social or family life, including occupational instability, marital problems, family discord, and difficulties in parenting.

The “invisible wounds” of birth trauma-related PTSD affect not only the father or the family member, but also those around him or her. We must remember it effects everyone and education is needed to prepare the family for what may happen during and after the labour.

We run the risk of letting our fathers down at a time when we need to build strong families and communities for our future generations. Identifying the right support and providing improved health care in relation to Perinatal Mental Health is a top priority, so let’s ensure our health services have the right tools and services available to help and support fathers in relation to their partners’ postnatal depression. When screening fathers we must be mindful to remember that individuals are unique and have developed different styles of coping. It is important to respect the individual, involve them in their care and offer support to them as a person rather than just treat the illness.

Mark Williams, 2015.

What will

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Safety, Experience, or Both?

A blog post from #MatExp co-founder Florence Wilcock.

Flo

There has been much discussion recently about safety within maternity services including a discussion on #MatExp Facebook group. A particular issue that bothers me is the idea that safety and experience might be two separate and mutually exclusive issues and it is this thought that drives me to write today.

Safety is paramount. The purpose of maternity services is to provide safe care through the journey of pregnancy and early newborn life. Every appointment in the NICE pathway is designed to screen for potential problems and ensure they are managed effectively. Every healthcare worker know this is the aim. The 20 week ‘anomaly’ scan might be considered the time to discover the sex of your baby if you wish and to get some photos but the medical purpose is to ensure the baby is growing well, with no abnormalities and to check where the placenta is localised to exclude placenta praevia (low lying placenta) which can cause life threatening bleeding.

But there is more to pregnancy and becoming a parent than safety isn’t there? I am currently reading Atul Gawande ‘Being Mortal’ where he eloquently demonstrates that keeping elderly people ‘safe’ is not enough, there is more to life and living than safety alone. He describes a number of times when giving elderly people purpose such as a plant or animal to look after or more freedom to live the way they wish despite disability it makes a significant difference to their wellbeing. Sometimes this path may deemed ‘less safe’ but for that individual may make all the difference. This comes back to choice. Safety & choice can be tricky ones to combine successfully.

This does not mean I am belittling safety. As a consultant obstetrician it falls to me to talk to couples when the worst has happened and their baby has died. I also care for women who have had unexpectedly life threatening complications. I know I am with them during probably some of the darkest hours they will ever experience. I cannot pretend to understand how they feel but I do know I have been part of those intimate moments of grief and with some families that has followed through into supporting them sometimes for years. As a hospital we have a robust process of incident reporting and the feedback from a Serious Incident investigation (SI) again will sometimes fall to me. In some cases there is nothing that we think could have been done differently in some cases I have to sit and tell an anguished couple that we have failed them and that maybe things could have been different. It is a devastating thing to do, there is absolutely nothing that can be said that will make the situation better. It feels as if you have personally taken their existing despair and dragged them into an even more unthinkable place and the only thing you can say is ‘sorry’ which feel hopelessly inadequate and trite for such a situation.

So if I could guarantee safety I would in a flash but it is not that simple. Maternity care is delivered by people and unfortunately to err is human. We cannot design a system free of risk because however hard we try the variable of human error gets in the way. We can introduce systems that help minimise the impact of these errors but we can’t eliminate them. My favourite analogy for risk management is James Reason’s model of Swiss cheese. The event only happens when the holes in the ‘cheese’ line up the rest of the time the barriers put in place prevent the error. An example in maternity care might be the introduction of what we call ‘fresh eyes’. A midwife looking after a woman on electronic fetal heart monitoring might misinterpret this or not see the subtle changes over time if she has it in front of her constantly. ‘Fresh eyes’ means another midwife or obstetrician comes and looks at the trace on an hourly basis. This means if unusually the first midwife has made an error there is a system that means it is more likely to be corrected.

The concept of a ‘No Blame’ culture is another example designed to minimise human error. The idea that if one sees or makes an error one should report it without fear so that learning can be gained from it. It may be the learning will be the need for some individual training but equally it might be something totally different. If staff are fearful of consequences then under reporting might be the result and safety gaps may not be identified. Encouraging openness about mistakes and errors is vital but difficult. In maternity it isn’t as if we can just operate our way out of this problem .We know the huge rise in Caesareans sections in the last 30 years has not improved the outcomes for babies but has instead cause maternal health problems. So in maternity as other medical specialties we have to constantly refresh and re-invent what we are doing to try and improve safety. As obstetricians we tread a difficult path trying constantly to call correctly just the right amount of intervention at just the right time.

BirthJourneys

So where does experience fit in I hear you ask? There is abundant published evidence of positive association of patient experience with clinical safety and effectiveness, in other words if your patients (or I prefer users) are having positive experiences then you are running a safer service. It’s hardly surprising if we communicate and explain things to women and their families that we will be more likely to communicate effectively to other members of the multidisciplinary team. If we are open and honest then woman can challenge assumptions and make sure we haven’t missed something critical, a woman knows her own history inside out whereas we might omit a key point. To me one of the most shocking things that was said at our ‘Whose shoes’ #MatExp workshop last year was that women can feel intimidated and unable to ask questions. Trust and understanding between health professionals and those we care for are vital. We cannot possibly hope to improve safety in isolation, experience has to improve too.

There are two specific elements of #MatExp of which I think epitomise the safety -experience overlap. The first is an on-going ever growing constructive conversation between women, families, obstetricians, midwives, health visitors, paediatricians, families and anyone involved in maternity services. Only by tackling the difficult conversations without hierarchy in an equal and respectful way can we improve maternity care. Listening and talking to one another is critical not only as we work with women but in dissolving those barriers and difficulties that sometime exist between different professionals. Flattening of hierarchy, team work and the ability of anyone to challenge is a well-recognised component of a safety culture. We are doing this both locally using the workshops and board game and more broadly via social media and the website.

The second element of #MatExp is that personal sense of responsibility to take action. Own what you are doing and why you are doing it. ‘Wrong is wrong even if everyone is doing it’ that doesn’t mean leave it to someone else. It means that health professionals and women can take action and influence maternity experience up and down the country and through that impact on and improve the safety of maternity care. So in final answer to my question I do not think it is a choice safety or experience I believe the two are fundamentally intertwined. So what will you do to improve #MatExp?

What will

Florence Wilcock, 2015

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#MatExp Flyers and Stickers Are Available!

Want to get out there and spread the word about #MatExp?

20150902_151019

 

Order some flyers and stickers! They’re the ones we used at NHS Expo, as per the image above.

I created the artwork and ordered the flyers and stickers through Instantprint. You can contact them on 0191 2727 327 or email office@instantprint.co.uk, quoting reference number 1708648. They will source the artwork for you and liaise with you to make sure it is what you need. You just need to let them know how many you would like (and of course arrange payment!).

The flyer is A5 size, with this image on one side:

The #MatExp information poster!
The #MatExp information poster!

and the #MatExp logo on the reverse

MatExp logo
MatExp logo

The stickers say…

MatExpblogbadge

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What Will YOU Make Happen for Oxytocin October?

Welcome to Oxytocin October!

What’s that all about, then, I hear you ask?

Well, oxytocin is a powerful hormone often known as the ‘cuddle hormone’ which is greatly stimulated during sex, birth, and breast feeding – all of which are relevant to #MatExp.

You may already know all about oxytocin (especially if you are an obstetrician or midwife, one would hope!) but if you don’t, here’s a brief overview of what the hormone does…

  • It causes cervical dilation and contractions during labour (and it is crucial however and wherever the baby is born)
  • When crossing the placenta, maternal oxytocin reaches the baby’s brain and induces a switch in the action of a neurotransmitter which silences the baby’s brain for the period of delivery and reduces its vulnerability to damage
  • It aids milk production from the mammary glands to the nipple;
  • It plays a central role in sexual arousal, aids orgasm, and there’s speculation the muscle contractions may help the sperm and egg to meet.
  • It has a role in increasing trust and reducing fear – which are inherent in the aims of #MatExp: to enable women (and staff) to the best-possible experience of birth with safe, individualised care as detailed in our Heart Values
  • It can aid bonding within groups and foster positive attitudes.

Isn’t oxytocin incredible?

The point of this brief biology lesson?

Oxytocin, in short, makes things happen. And so can you, because you are incredible too.

For Oxytocin October we would like to ask you what you will do to make something happen to improve maternity experience?

As ever, it doesn’t matter what your action is – big or small, all actions are valued. It doesn’t matter if it’s something you can start doing every day, whether you can start and complete during October, or if it’s a slow-burning action that will take time to come to fruition.

The important thing is to act. JFDI!

If you’d like to tell us about your action, that would be great. You can do that on the Facebook page, on Twitter (#MatExp #OxyOct) or via our contact form. It’s so we can share all the great work that is going on, we can share learning across the country, and measure the impact of our campaign. Remember we’re steering #MatExp, no one is ‘in charge’ so while by all means ask anyone involved for advice you don’t need to ask for permission!

My action will focus on baby loss, because it is also Baby Loss Awareness Month during October, with the awareness day on October 15. My actions will involve activity relating to #HugosLegacy – working to improve support for bereaved parents. I’ll be writing more about that on my own blog.

(I got the bulleted information from Wikipedia – as I say it’s a very brief overview!)

What will

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