Maternity Experience

Florence Wilcock

The Obs Pod

So here it is! I am so excited to support Florence Wilcock, a.k.a. #FabObs Flo to launch her innovative podcast: ‘The Obs Pod’.

Ever since Flo first phoned me, back in 2014, asking ‘if Whose Shoes would work in maternity services’, I have been impressed by her person-centred approach, her ability to challenge the status quo and push boundaries and to work WITH women and families. She lives and breathes her powerful ‘Wrong is wrong …’ mantra.

The Obs Pod’ will appeal to everyone who has an interest in maternity services. Everyone will be able to take something away from each episode, due to Flo’s wide-ranging experience, gentle reflective style and ground-breaking practice.

Gill Phillips, Creator of Whose Shoes? and co-founder, with Flo, of the #MatExp social movement

As a young Mum who was totally blown away by the inspirational obstetricians who delivered my baby nearly two years ago, I am excited to start following ‘The Obs Pod’. The first episode was fantastic; so interesting and captivating. I am sure the podcast will be hugely popular with pregnant women and maternity staff alike, along with so many other people who will find it fascinating to gain an insight into the thoughts and experiences of someone who shares the beauty and intimacy of pregnancy and birth as part of their working life.

Jenny Thirlwall, young Mum and member of #MatExp community,
West Midlands

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One of the things I have enjoyed the most over the last five years of #MatExp is the opportunity to get creative. From being ‘just’ an obstetrician, I have branched out and added: writer, poet, facilitator, film maker, speaker, campaigner to name just a few new skills.

Gill encouraged me to write a blog. I promised my husband it would be just the one, resulting in a nickname now from Gill ‘One blog Flo’. as I have lost count now of how many I have actually written after dipping my toe in the water.

I’ve enjoyed making Steller stories after a quick demo on a train journey, particularly our #MatExpAdvent series and my Nobody’s Patient monthly project reports. I have made videos, my contribution to our series for #MindNBody launch being one of my favourites, reading my poem ‘Reassured’. All this is alongside my day job and I find these creative outlets re-energise me, develop me and feedback into my day to day working in maternity care.

In December, I was lucky enough to meet Natalie Silverman @FertilityPoddy at RCOG women’s network meeting in Manchester. https://www.thefertilitypodcast.com/ She talked enthusiastically about podcasting. She made it sound both interesting and achievable. Something that wasn’t too challenging but that might reach a different audience. She was inspiring and willing to offer advice. I went home enthused.

I spent the next couple of months thinking and exploring, I decided I have things I would like to share. Adam Kay’s book ‘This is going to hurt’ has been a runaway success, but I want to voice a different perspective of the maternity world. One that would be accessible to women and staff alike. One that might ignite change and action as well as entertain. So, I have rolled up my sleeves, listened to a podcast series on making a podcast, taught myself the lingo, attempted the editing and technical bits and loved every minute.

So here goes, I am launching my next adventure:
The Obs Pod.
I hope you enjoy listening as much as I am enjoying making it!

Flo

Here are the episodes so far and new ones will automatically be added:

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#MatExp heart values & Covid19

A blog post from #MatExp co-founder Florence Wilcock

We are living in extraordinary times. Hardly any of us have ever faced the likes of this before. We all react to the stress and anxiety in different ways as we make huge adjustments to our daily life.

I want to reassure women, we’ve got your back. Each person in maternity services is working hard to try and keep mothers and babies safe. We need to care for women with all the normal medical conditions, complications, anxieties and social situations. Then we must multiply that by two to think of how we would manage all the same problems if the woman had Covid19. Then we must add in what if she is in isolation, what if her partner or her child has it? Then we must add to the equation: staff being ill, in isolation or unable to work due to pregnancy or a medical condition.

We have new procedures for almost everything; protective equipment is not a trivial affair, we must learn how to don and doff correctly to protect ourselves and the women we care for. We need distinct levels of protection for different circumstances. We have turned our rota on its head; some of us have been deployed to other wards and areas. We now have the rota, the backup rota and the back up back up rota, all to be certain we will have the people you need to care for you. We have national and local guidance changing almost daily. We are fortunate that the RCOG & RCM are updating guidance frequently – this is helpful for us & the women we serve. https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/covid-19-virus-infection-and-pregnancy/

So when we have to make difficult choices that we never imagined would be needed, please be tolerant. We have to plan for every situation meticulously, not only within our own service but within the health economy as a whole and we have to take decisions at an accelerated rate, the likes of which I have never experienced. We bear in mind not only the impact on individual women and the maternity population but also the surrounding community.

When a woman comes into hospital, she will be greeted with care and compassion and kindness. We know this is a challenging time to birth a baby and become a parent. We may be wearing masks and gloves, but we are there behind them with hearts and minds to do the very best we can. We are fighting to protect the things we know are important. We are encouraging you to come for your scans and appointments that are essential and adapting to contact you by phone when less important to see you in person.

We are one of the few parts of the organisation maintaining a degree of normal outpatient care. Pregnancy and birth can’t be put on hold. Many of us have set up specific Covid pregnancy helplines to answer your questions and are working hard with local Maternity Voices Partnerships to give women the information they need.

We know for some, life at home is increasingly difficult. School, childcare, work has all been thrown in the air let alone worries about other family members, food supplies and money. As NHS Maternity workers, we are giving all that we can give. When we talked at work about the NHS #ClapForCarers, most of us missed it. We were too tired, working or busy feeding our families. Yesterday in my clinic, a few women ‘gave back’. Just a simple ‘how are you?’, or ’thank you for being here’ is enough. We don’t need you to clap us, we just need you with us, together to get through this.

Graphic by Anna Geyer from New Possibilities

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Co-production taster at the RCOG, using ‘Whose Shoes?’

A blog post from #MatExp co-founder Florence Wilcock

When I started thinking about women’s experience of maternity care five years ago, some of my colleagues were rather dubious; ‘safety first’ was their view: why would I bother about the ‘fluff’ of personalisation? Experience can sometimes be seen as a midwifery issue rather than relevant to doctors.  I wrote a blog to try and dispel this idea http://matexp.org.uk/birth-trauma/safety-experience-or-both/ .

In contrast, I have had wonderful support from RCOG, almost from the beginning  first meeting with then President David Richmond in 2015.

David Richmond running a patient experience breakout session at the launch of ‘Better Births’ at the Oval – Sarah Winfield says Whose Shoes works! And who is out???
Flo’s first #MatExp visit to RCOG to meet with David Richmond and tell him about #MatExp Whose Shoes coproduction work. A symbolic little (shoe) step along the way.

RCOG firmly believe in the ethos of  working with women collaboratively and making sure women’s views are front and centre of everything we do in the profession. Despite this I have worried that the O&G doctors who attend our workshops or hear me speak are those that already practice in this way, ‘preaching to the converted’ one might say.  I have wondered how to bring #MatExp and co production to a wider audience and start to influence our more sceptical colleagues. I have long thought the best way would be to get on the agenda of one of the RCOG mandatory training courses.

The annual ‘Management of the Labour ward’ course seemed like a great starting point so with the help of Louise Page, BICS president and Alison Wright & Kate Brian of RCOG women’s network, I managed to get agreement to run a Whose Shoes co-production session one evening in May. All the best #MatExp sessions are collaborative, so I drafted in a few friends from National Maternity Voices as well as fellow obstetric consultants who are actively using  co production.

It was also brilliant to be joined by Nicola from Positive About Down Syndrome (PADS.) My aims were very simple, I wanted to give people a taste of co-production, challenge their assumptions and encourage them to link with their Maternity Voices Partnership or other parents’ groups and take the idea of co-production back to their workplace. I gave a brief introduction and invited people to play Whose Shoes, facilitated by my willing volunteers.

Setting up the room ready for our Whose Shoes? co-production session

Running as an additional session at the end of a long day, it wasn’t surprising that we had a relatively small number attend our session, with 24 completing feedback forms. The feedback we had was incredibly positive.

Not only did 75% of attendees say the session had impacted on the way they will work with women and families in the future but in addition the majority of attendees had no previous experience of co-production so we definitely reached a new audience. 

42% said they would have liked the session to be longer or included as part of the main conference programme.

I am really hoping that the success of the session means  that this is just the start. The new curriculum seems like a brilliant opportunity with much more focus on the softer skills of communication and treating women holistically rather than seeing them as a medical condition or operative procedures to tick off in a log book.

RCOG world congress in June  again demonstrated firm commitment from the college with lived experience being threaded through the three-day programme,  culminating in a co-produced presentation by Emma Crookes (RCOG women’s network) and myself on the final day.  You can view it here:

RCOG World Congress from Whose Shoes?

I have recently joined RCOG women’s network  as a clinical representative and have been delighted to see the depth and breadth of their work. Women’s voices have become well embedded throughout  RCOG work everything from guidelines to workforce, examinations and genomics. With their help I am hoping this heralds a new era with co-production,  personalisation and informed choice central to the care we provide.

Exciting times!

Florence’s article about #MatExp Whose Shoes? in the RCOG magazine, November, 2015.

Excerpt from RCOG Magazine Nov 2015
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A Shift in Gear

There is a very palpable change in maternity at the moment or at least I think so. A real shift in views and a change of gear. I believe this was in evidence when I was fortunate enough to attend a London Clinical senate forum on 21st April, the first devoted entirely to maternity services. I was honoured to be speaking briefly about #MatExp amongst many illustrious people both speaking and in the audience and I would like to share some personal highlights that both made me think and made me optimistic that there is a change underway.

Baroness Cumberlege started the morning with the National Maternity Review. I have heard her speak before but the concept of personalised care wrapping services around a woman with continuity through the pathway cannot in my view repeated too many times. There are as we know many practical organisational and financial barriers to this at present and the importance of leadership encompassing trustworthiness, competence, reliability and honesty was strongly emphasised.

As co-chairs of the London Maternity Strategic Clinical Network (SCN) the baton passed to Professor Donald Peebles & Donna Ockenden to give an overview of the work undertaken by the SCN in the last 2 years and to introduce some of the work in more detail. Donald set us a challenge to consider how we translate clinical networks that are currently mainly acute provider based into maternity systems with a broader far more integrated approach. Amongst more detailed presentations Jane Sandall presented compelling evidence about the impact of continuity on outcomes & Liz Mc Donald chair of the London Perinatal Mental Health Clinical Network presented both the enormous impact of perinatal mental health and the huge disparity in care across London.

Next we had a panel session with David Richmond (RCOG) and Cathy Warwick (RCM) on their views on the London Quality standards (LQS). These were process based standards e.g. midwifery staffing ratios & consultants’ hours of presence developed 5 years ago to drive improvement, the maternity section being part of a wider piece of work across London health care including emergency care standards. David Richmond spoke of ‘asking what do women want and what makes a difference to them?’ as well as a discussion of the immense workforce challenges facing the specialty. Cathy Warwick spoke of the importance of multidisciplinary culture and gave a lovely cake shop story analogy for women’s choice. If you go into a chocolate cake shop and have a piece of chocolate cake you will say you were satisfied as this was the only choice, however if you had known there was lemon drizzle cake in a shop down the road you may have wanted that and not been pleased with the chocolate cake and annoyed you were not aware of the alternatives. We agreed that the LQS still had purpose in driving improvement but need modification. A discussion flowed on the importance of outcomes rather than process and that we need to move from quantitative to qualitative outcomes. Process can be useful to drive change but should not be the be all and the end all. We talked about the need for different measures for satisfaction as what we currently have is not adequate and the importance of relationship based care.

At one point a question from the audience came as to how women are involved in driving improvement in maternity services across London and what is their role in the implementation of the Maternity Review. The answer was of course that there is far more to do but I was proud that it was also acknowledged that #MatExp both though ‘Whose Shoes’ workshops and virtually is evidence of women starting to drive the change as true collaborators and leaders.

I was the final speaker of the morning and although I was asked if I would like to switch and speak slightly earlier to me this seemed the most appropriate way to finish the meeting. I stood up and spoke to explain: #MatExp Maternity Experience is not the fluff or the afterthought, it is the beginning, the foundation of the future. True multidisciplinary team work and co-production is enshrined in the Health & Social care act, Francis, Kirkup and now the NHS Maternity Review. #MatExp bringing together the grassroots voices of women, families and health care professionals with the energy and enthusiasm for improvement is the future. Join in!

There is an enormous quantity of work ahead to do but it is clear that the work of the London SCN is very much along the right lines in terms of the NHS Maternity Review and the direction of travel. I had never been to a meeting with some many influential people where there was a genuine desire to undertake a wholescale change in maternity services and towards a very much more holistic person centred approach. I left with a real sense of hope and opportunity. On top of this the announcement last week by NHS England of a Maternity Transformation Board make me certain. The future of maternity services is here for the taking so we’d better grab it with both hands. The time to act is now, let’s hope we can do it justice!

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Musings on the 2015 CQC Maternity Survey

Flo

I have been mulling over a few thoughts about the CQC Maternity Services Survey 2015.

With the launch this week of #YourMaternityCare campaign by the Care Quality Commission (CQC) encouraging women to share their maternity experiences now seems as good a time as any to share some of my thinking and importantly ask some questions.

To be clear I am not going to talk scientific methodology, survey design or validity, I am simply going to share some personal ideas as an obstetrician and a member of the #MatExp gang and question if we could use the survey to challenge ourselves in a more creative way.

What sort of impact does this sort of survey have on the care women receive?

The answer to this may depend on how you view the results. It can be examined at a national level looking at care across the country and comparing with previous years to look at trends and themes.

Undoubtedly this survey showed better experiences overall than in previous years and this is good news. An excellent example is the increase in the number of women receiving care before 10 weeks of pregnancy, with a big potential impact on eventual outcome. It is important to take time to give ourselves a collective pat on the back and celebrate those improvements as it can be so easy to focus only on the negatives.

For a great visual overview, take a look at the infographic produced by Picker.

On a regional level the 2013 Maternity survey and the negative results of some London Trusts was actually one of the sparks that led to the London Maternity Strategic Clinical network focusing on ‘Patient experience’. Therefore it directly led to the ‘birth’ of #MatExp and our collaboration with Gill Phillips to produce a maternity version of her Whose Shoes game and development of a workshop toolkit & examples of best practice.

So that’s another positive: the resulting #MatExp change platform and community of people interested in improving maternity experience therefore could be said to be a direct result of the 2013 survey.

We can examine hospital level data and see how a maternity service changes over time, and how women respond on specific questions. This can help us identify a particular area that needs improvement, such as continuity or postnatal care, as well as giving positive feedback about what is working well. It can help us benchmark our services against others locally or nationally. It is undoubtedly a valuable data point even if it has limitations and exclusions however it is only one of many ways we should be looking at feedback.

Most Trusts will have an effective governance system meaning that the results will be reviewed and circulated, an action plan devised and those actions systematically ticked off when completed.

We need to be cautious as it can become all about process and tick boxes if we are not careful, held at management level and a little detached from both those in daily practice and our service users.

I wonder how many Trusts have worked proactively with their Maternity Service Liaison Committee (MSLC), staff and service users since they received their individual 2015 reports to identify what improvements would have the biggest impact for their women and to look at how their survey results correlate with other methods of feedback they use?

Moving on to some specifics now, the very first sentence in the recently published CQC response to the survey results is a shock There are almost 700,000 live births each year in England. Having a baby is the most common reason for a hospital admission.’  

Why is this?

According to the National Tariff benchmark data 65% of women are ‘standard’ i.e. do not have a complicated antenatal period and therefore are ‘healthy’ pregnant women.

Therefore, the first challenge from the results is why are so many of these births happening in hospital. It probably has something to do with the fact that the survey showed 63% of women who have given birth previously were definitely given enough information about where to have their baby, falling to 53% of women giving birth for the first time. This presumably means large numbers of women are not getting adequate information.

I’m not going to recap NICE Intrapartum care 190, but we know it provides evidence that for healthy pregnant women who have had a baby before we should be explaining birth at home or in a midwifery led unit is likely to have less intervention and the same outcome as delivery in a hospital.

Across the survey results first time mothers seem to be getting a worse experience with consistently lower results than women who have given birth previously. Is this because we are doing something different for first time mothers, is this because we should be doing something different or is it simply that the different groups of women have different expectations? Do first time mothers have higher expectations and are then disappointed whereas mothers who have given birth previously have lower expectations as they know what it was like last time?

In amongst some good improvement scores remain worrying minorities. 89% of women said that during their antenatal care they were “always” spoken to in a way they could understand – up by 7 percentage points since 2007 (82%). However, this means that 11% were not “always” spoken in this way.  87% of women reported that they were always treated with dignity and respect during labour and birth compared to 85% in 2013, but what about the 13% that were not? Surely these are the fundamental basics of care and should be true for every single woman. What are we doing about these women? Can we identify who they are, are there specific groups we are not catering for or not understanding what they need?

Don’t even get me started on lithotomy: ‘The proportion of women being in a position of lying with legs in stirrups whilst having a normal vaginal delivery has seen a steady increase over the past few years going from 17% in 2010, to 19% in 2013 and 22% in 2015’. What on earth is this all about? In 2015 I undertook a lithotomy challenge on NHS Change day and you can read about my experience in the blog I subsequently wrote.

Postnatal experience is clearly lagging behind antenatal and labour care with much lower figures sitting in the approx. 50% region on all aspects of care including physical and emotional wellbeing. Collectively we need urgent action to address this? But the need for collective action raises a problem. Within the NHS we now have this terrible dilemma collaboration versus competition.

The CQC Response to the survey results clearly highlights Trust who have performed better or worse than expected in the last two surveys. If we accept that these results are valid and not a difference in expectations or different for other reasons, then as a simple solution we could potentially buddy up good performing Trusts with poor performers.

However, Trusts are individual organisations. The strategic clinical networks and NHS England can influence, but there is no obligation for Trusts to help others. If we work at a good Trust what is the incentive to share what works? Pure altruism goes some way, but when you face difficult budget choices and competing demands collaboration can be an easy casualty, and as health care professionals what responsibility do we have to try and improve quality outside our own immediate practice?

I certainly don’t have all the answers. For me #MatExp is some attempt at trying to improve and discuss many of these issues on a broader scale, ignite a lively conversation about maternity care and to encourage others to think that they can influence positive change however big or small.

Florence Wilcock

2016

If you are interested in joining the conversation or taking action on improving maternity experience in anyway jump in and join us on Twitter (find tweets tagged #MatExp), join our group on Facebook, or send us a message.

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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 Book Club

One of the beauties of #MatExp and our ‘Whose shoes’ maternity workshops is to start to see each other as equals and as people , breaking down assumptions about roles and views. Last week I got into an exchange on Twitter that I believe exemplified this. Catherine @BerksMaternity suggested that those involved in #MatExp might like to read ‘Birth: A History’ by Tina Cassidy. I think she was surprised when replied that I had read it twice over its a brilliant book that my mum gave me. It’s a fascinating history of birth through the ages. In fact it’s there on our Pinterest maternity whose shoes board as I tweeted about it last August. We then started an exchange of other books and a comment about the importance of reading & reflection.

This Twitter exchange made me think about the idea of a #MatExp book group idea. We all share a common interest of improving maternity experience and with it the desire to break down barriers between people so we can work constructively together. There maybe other books that we share a love for, there may be books or extracts that are useful in prompting reflection and thought about how we perceive others. I can immediately think of all sorts of books that influence my thinking that I could share & I’m sure others can too. There are some obvious books to share an comment on those directly about maternity such as Sheena’s @SagefemmeSB wonderful collaborative book ROAR. There are books that fact or fiction that have nothing directly to do with maternity but that influence the way we think. To use a quote from one of my all time favourite books:

All this she must possess,” added Darcy, “and to all this she must yet add something more substantial, in the improvement of her mind by extensive reading.” Mr. Darcy

So I would like to suggest that together we ‘improve our minds’ by sharing some of those books some may be books we recommend are worth reading others may be about sharing the impact they have had on us. To kick us off I will share two.

A Glasgow Manual of Obstetrics Edited by SJ Cameron 1936

I found this in a second hand book shop many years ago & I love to dip in and out of its pages. It has some fascinating diagrams , horrific descriptions of destructive procedures and is like a window into the past. It shows some things never change like the mechanisms of labour and others have changed completely. One of my favourite paragraphs describes not getting out of bed until ten days postnatal and not going outside until week four. This book is the reason why one of my favourite cards in ‘whose shoes’ MatExp workshop asks ‘what do you think we do now that we will look back on and wonder why’ a question promoted by Gill’s mum recounting use of castor oil in her time!

The Hand that First Held Mine by Maggie O’Farrell

I love many of Maggie O’Farrell’s books my favourite is actually ‘The vanishing act of Esme Lennox’ more of which another time. In The hand that first held mine she writes a very powerful description in the first few chapters of a woman’s experience of a massive obstetric haemorrhage and the immediate postnatal period afterwards. It is an incredibly terrifying description both of the events but also her confusion with the well meaning midwife, health visitors etc who come and do her home visits afterwards. I highly recommend dipping into it and have sometimes read excerpts as part of training sessions. 

Books

 So there are two books to get people thinking, I’ve picked at random there are many more I can and will suggest. So calling all #MatExp friends what books do you recommend or what do you get out of them that you could add to the #MatExp book group conversation ?

 

Florence Wilcock
Divisional Director Specialist Services
Kingston Hospital NHS Foundation Trust

 

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#MatExp – Real or Not Real?

As we reach the middle of #FlamingJune I have been thinking about the week I’ve had. To be honest it has pushed my multitasking abilities to the limit: I have had a number of big events to attend or speak at, as well as the day job of being a divisional director at Kingston and a clinician seeing and caring for women – and this is before I even consider my husband and daughters.

Amongst all this I sometime wonder if #MatExp is really having an impact, or have I just got carried away.

It has been a tricky week for others too. The more people know about #MatExp and what we are trying to do the better, but this comes with pressure and also criticism.

It is hard to understand that this is an organic grassroots project with a direction and mind of its own. No one is ‘in charge’ and it is richer for it.

This was brought home to me at the London Maternity Strategic Clinical Network event held on Wednesday. The five pilot sites who had held a #MatExp ‘Whose Shoes’ workshop presented the action they had taken as a result and I was overwhelmed by the diversity of actions taken and the determination with which people had followed through in a multitude of ways.

Devolved leadership and true collaboration with women has been our hallmark from the beginning but I was bowled over to actually witness the results of all the actions gathered together in one place and to recognise how powerful the outcome of the workshops was.

At the same event we launched our ‘Maternity Experience’ film. It was a tense moment, it is so difficult when you are knee-deep in a project to step back and see it afresh and I wasn’t sure how others would find it. I so desperately wanted it to to be true to the workshops and #MatExp conversations we have had over the months.

Fortunately on the whole it seems to have rung true and be a success, which I hope will power more thinking and questioning on a daily basis of ‘why do we do it this way, what could we do instead?’

Rounding off my week I have had the small matter of conversations with the leadership of the Royal College of Obstetricians and Gynaecologists (RCOG) about how they could help, and a flying visit by Helen Bevan to Kingston on Thursday when she said ‘there was lots going on #MatExp yesterday, I got tweeted your film about 15 times!’.

It’s a roller coaster ride but I wouldn’t have it any other way. Each time I have a doubt something happens that reaffirms that however small , changes are actually happening. Just yesterday a midwife at Kingston told me her pledge from our October workshop will be completed next week. She has stuck with it through barriers and blocks and seen it to completion and that desire for action, that is what #MatExp is all about!

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No need for permission to join #Flaming June – JFDI!

It’s nearly a week since lighting the fuse and setting off #FlamingJune with a bang. We launched our website and we are starting to see that ripple of action as a result as well as trying to draw on existing events and plans that we knew were happening in June.

It is getting people’s attention – perfect, just as we hoped! We are being quoted and used as an example, as a change platform, a campaign it’s awesome!

But in some ways we are victims of our own success we are just that bit too innovative and cutting edge so it is hard for people to understand just what we are.

We are not an organisation, we are not employed to do this, we have no funding, we have no rules or structure.

We are quite simply people. People who are like minded, people with initiative, people who see the need for change and want to enable it to happen by bring ideas together and encouraging action.

Some of us it is true are NHS employees however this work is not in our job description we are doing this in our spare time round busy day jobs and home life. Many of us are juggling this with other jobs, small children, home commitments, life… the thing that unites us is a passion and an energy to keep improving maternity services.

So if I were to define us, we are an ever growing fluid and flexible movement of people who want to enable change and improvement in maternity services.

There are no rights or wrongs, no one needs permission to join in, we are leading by default because we happened to step forward.

There is plenty more space for people to step in to help. The key message is to value and respect all views; encourage airing problems to find solutions and we will endeavour to help and support those who can and want to jump on board as best we can.

We have a lot of exciting days to come in June & beyond. Bring it on!

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