It was on 12^th May that Leigh Kendall and Helen Calvert thought about starting a Facebook group for the #MatExp campaign. JFDI and all that, the group was started two days later. Three weeks in and we’re at 450 members. You’ve got to love this campaign, nothing happens slowly!

The group is administrated by Emma Jane Sasaru, Helen Calvert, Leigh Kendall and Susanne Remic, and is the Facebook outlet for a campaign that has already gained huge momentum on Twitter. Florence Wilcock, the obstetrician at Kingston Hospital who started the campaign, has always wanted it to be focused on ACTION and this theme is central to the group. Each day a member of the admin team starts a thread on a chosen topic with questions/talking points and a request for actions that families and birth professionals can take to improve maternity experience in this area. We ask that actions are S.M.A.R.T. 

Florence and Gill Phillips have a Month of Action planned for June, so we had originally hoped to do a blog post at the start of June detailing the actions put forward so far by the Facebook group and asking that people get involved. The snag is there have been so many fabulous actions put forward already on a number of important topics. The topics are being chosen in alphabetical order as a nod towards the #MatExp ABC that provided so much impetus on Twitter, and we are so far only on “H” – already the actions are numerous and thought provoking.

So we have quickly realised that it might be better for each of the admin team members to do individual blog posts on the topics that they have introduced to the group. These posts will start to come through soon, but for now we still wanted to give you a flavour of the suggestions and we hope that you will join us on Facebook or Twitter (or both) to get involved.

ACTION!

The actions that have been suggested on each of the threads can be divided into two categories:

1. Immediate – just get up and do it actions that anybody can take, here and now. These tend to be small things but they can still have an impact.
2. Long-term – group actions that require input and buy-in from different places and will probably require campaigns of their own.

Both are very important to the campaign. There are big issues that need to be addressed in maternity care and the NHS Maternity Review is looking at these right now. We are hoping to work with the review panel and to share our ideas with them. But we also need to remember that simple acts of kindness can change the experience of anyone with whom we come into contact. Sharing a piece of information could send someone down a different path. Signposting to a service could make the difference for that individual. No one needs to sit back and wait for a bandwagon to jump on. We can all of us get up and act today.

So what has been suggested so far? Here is a snapshot of some of the topics we have discussed:

A is for Anxiety

Immediate actions –

• Anxious mums to use hypnotherapy techniques in pregnancy
• Be honest about your anxieties and find out as much as you can on how to manage them
• Midwives please ask mums about their mental health throughout their pregnancy, not just on booking in; anxious mums to look into mindfulness techniques

Long-term actions –

• All health visitors need training in identifying and supporting pre and postnatal anxiety
• Subsidised doula provision for anxious families
• Continuity of care for anxious families
• Refer anxiety sufferers to specialist mental health support

B is for Bereavement

Immediate actions –

• The most important immediate action can be done by anyone, anywhere, anytime – acknowledge the baby the parents have lost. If you know the baby’s name, use it. If you don’t know the baby’s name, ask. Take the parents’ lead on whether or not they want to talk about their loss. Try not to worry about saying the ‘wrong’ thing. The worst thing you can do is to skirt around the subject, or ignore it completely. To do so insulting and upsetting to bereaved parents.

Long-term actions –

• Clear, concise, sensible, and up-to-date information to be provided to bereaved parents when they leave the hospital after the death of their baby. Parents need reassurance about the emotions they are likely to feel, and a few pointers about how to navigate grief, especially during the raw early weeks. The information also needs to clearly state how the parents can access appropriate support as and when they are ready.
• Access to counselling support. Too many bereaved parents have had to fight for the counselling and psychological support they need – or have gone without. Some hospitals do offer counselling services: hospitals need to make clear to parents that this is available, and how to access it. Funding issues mean that not every area is able to provide these services, but charities thankfully do exist to fill the gap. Hospital and GP practice staff need to know what support is available locally so they can signpost parents appropriately, or where appropriate make referrals for them. Leaving bereaved parents to source their own support at a time when they are least able to have the tenacity to deal with ‘the system’ is unacceptable.
• Training in bereavement care for health professionals. Surprisingly, many don’t receive this as standard practice. The vast majority of health professionals are caring individuals, but a lack of appropriate training means many are unsure about how best to deal with bereavement, which may lead them to saying things that are less than helpful to parents. What is said to parents at this sad time stays with them forever, so the importance of this training cannot be underestimated. This training should be extended to all staff involved with maternity/NNUs (including admin, housekeeping et al) to help prevent unnecessary upsets.
• Debrief/support to care for the needs of maternity, obstetric and NNU staff after the death of a baby. These staff are deeply affected by the loss of a baby in their care.

B is for Birth Trauma (families)

Immediate actions –

• Use of language when discussing birth trauma with families- lots of women have felt their feelings were dismissed, or that they were being ‘silly’. Women also felt that they had failed. Language in notes also very important.
• Immediate debrief after a traumatic birth; women felt that they were discharged and sent home without having the chance to talk through events.
• Communication- tell women and their families what is happening and why.

Long-term actions –

• Birth trauma support groups for women to access after a traumatic birth.
• Birth reflections and birth trauma counsellors to be accessed for as long as women and their families need them. Trained counsellors to support, and health visitors to be able to signpost the necessary services too.
• Better recognition of PTSD following birth trauma and better support for dads too.
• Emotional support for women in subsequent pregnancies.
• Ensure that women know how to access appropriate services following birth trauma.

B is for Birth Trauma (midwives)

Immediate actions –

• Make sure your colleagues know that they don’t have to “cope” – it’s okay to admit that they have been traumatised by a particular birth experience
• Ask if your Trust has guidelines in place for supporting staff after a difficult birth.

Long-term actions –

• Stringent debrief sessions put in place for each instrumental birth and any birth that is not straightforward
• Tackle trauma that accumulates from seeing the same things again and again – e.g. vaginal exams with inadequate consent, instrumental deliveries without compassion, loss of autonomy and consent.

C is for C-sections

Immediate actions –

• Skin to skin in theatre.
• Ensure that women are supported in their decision to have a c-section and help them to write a birth plan to feel empowered during surgery. Discussion of gentle c-section options.
• Help women to find comfortable positions to breastfeed.

Long-term actions –

• Identify reasons for c-sections and look to see where these can be reduced.
• Educate women during subsequent pregnancies, ensuring that up to date information is given with regards to VBAC. Ensure access to VBAC clinic is given.
• Better patient leaflets with more information on what happens during surgery and what recovery is like.
• Debrief from surgeon on how the c-section went and how subsequent pregnancies are likely to be affected.
• Better support for women after an emergency c-section.
• Provide emotional support and/ or counselling after a c-section for women who require it.

C is for Complications

Immediate actions –

• Communication was a common theme in the responses in this thread. Women – especially those who experienced complications around the time of the birth of their baby – wanted professionals to explain what was happening. Not knowing what was happening, and why, added to these women’s anxiety. Women (and their birth partners) need to be told as much as is appropriate at the time what is happening and why, in simple language.
• Health professionals need to remember that consent is still vital!
• Explain everything – as a health professional, certain things that you consider routine may be daunting or scary to a woman in your care. Make sure you explain everything that is happening, and be patient if they need the information to be repeated – it can often be difficult to take things in when you are in a crisis situation.

Long-term actions –

• Information: there is a lot of difference in the quality and content of information pregnant women receive from hospitals and community midwives. It can create confusion, especially combined with the wealth of information available from charities and the internet. While the internet can’t be controlled of course, it would make sense for hospitals nationwide to have consistent leaflets from a central source, with the ability to personalise information as appropriate.
• Connected to this point, knowing how much information to tell women about complications is difficult. We want them to know enough so they can recognise symptoms if they appear, but not so much they are stressed and scared. The balance is hard to strike. To compound this, there are women who do not attend antenatal appointments so are unable to receive this information.
• For A&E staff to be better aware of pregnancy complications, and to consult maternity/obstetrics staff when needed.
• For women to be proactively contacted when pathology (blood/urine etc) tests come back with warning signs, rather than relying on the woman to remember to phone for results.

C is for Continuity of Care

Immediate actions –

• Managers to talk to the independent midwives and social enterprise midwives who are knowledgeable in how case-loading can work
• Look at the Streatham Valley midwifery team in London for a working model
• If a woman is not receiving continuity of care, please ensure as a birth professional that you read her notes thoroughly and write good notes for the next person she sees.

Long-term actions –

• We need strong leaders at the helm of Trusts who understand how to lead midwives towards the implementation of continuity of care
• Join up with the RCM Better Births Campaign
• We need more midwives
• Look into personalised budgets where the NHS would allocate women funding to choose the service they want.

D is for Dads (and Partners)

Immediate actions –

• Birth professionals please keep Dads and Partners informed during the birth
• If Dads and Partners are not allowed on the ward at specific times please ensure the Bounty rep is not allowed on either
• Recognise that Dads can suffer birth trauma too.

Long-term actions –

• Keep families together, find ways to allow Dads and Partners to stay in hospital
• More paternal leave for fathers of premature babies – 2 weeks at birth and 2 weeks at discharge (the same for sick term babies too).

E is for Emotional Wellbeing

Immediate actions –

• Kindness, dignity and compassionate patient-centred care.
• Accurate information to support informed choice for families.
• Support for traumatic births, families that have a baby on NICU and paediatric wards.
• Good communication between staff, wards and with parents.
• Include partners and realise they need support too.

Long-term actions –

• More support services including peer support groups.
• Healthcare professionals aware of support services and therapies to signpost families to.
• Antenatal education to help parents prepare for parenthood and the impact birth has emotionally.
• Training for midwives and health visitors on all mental health disorders and how to spot/support.
• Specialist perinatal counselling available nationally.
• Continuation of care for families especially if previous trauma or mental health disorders.
• Peer support on NICU units to provide emotional support reduce risks of PTSD.

And before we started the ABC we already had a hot topic that grabbed our participants’ interest:

Tongue Tie

Long-term actions –

• Tongue tie assessment needs to feature in doctor and health visitor training
• Better postnatal care – need skilled assessment of baby, mother and feeding rather than families being sent home ASAP
• Tongue tie assessment to become a part of the newborn checks.

What would you add? What will you do? What have you already done? Come and join the conversation – and join in the ACTION! #MatExp #FlamingJune

Emma, Helen, Leigh & Susanne on behalf of #MatExp.