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.
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.
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.
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:
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.
As more and more people join the fabulous #MatExp community, they may not know the origins of #MatExp, co-founded by Florence Wilcock and Gill Phillips in 2014.
People may not realise that we published the original Whose Shoes? scenarios and poems at the beginning of 2015, before maternity hit the national spotlight and the national maternity review was announced.
The resources were used at all the national maternity review listening events and helped enrich and shape the conversations that led to ‘Better Births’.
People ask for ‘evidence’ of what #MatExp Whose Shoes? has achieved…
And so we bring you our #MatExp 12 Days of Christmas, published in the lead up to Christmas 2018, summarising some of the biggest achievements and outcomes to date. We have helped serve as catalysts. The big achievements have only happened because fantastic people have come together and found that individually we can all make a difference, but TOGETHER we can ‘be the change’.
Each of these ‘things that #MatExp brought us’ has a story behind it; sometimes a big one. Who knows, one day we might get round to writing THAT book. But in the meantime, this is all we have time for. So if you want to know more, please join #MatExp. And most importantly, keep adding to the story. These small or large individual contributions are how positive change will keep happening.
Remember those heart values – all of us working together to improve maternity care. Thank you!
Flo Wilcock and Gill Phillips
#MindNBody And, new for 2019, our #MindNBody campaign – using new crowdsourced Whose Shoes? scenarios and poems to spark crucial conversations around perinatal mental health. A holistic approach, looking to improve the experiences of women and families, including prevention and early intervention. The resources were launched at the Royal College of Obstetricians and Gynaecologists in December 2018 and a diverse mix of people involved in the project made a two minute video for the days of Advent, which are compiled into a single film here:
In December 2018, we were proud to launch our new #MindNBody Whose Shoes? resources – the third in our series of major #MatExp projects to improve maternity care and help people to focus on a holistic ‘Mind N Body’ approach to maternity experience.
The whole thing is crowdsourced, with scenarios and poems contributed about a very large wide range of issues, and from all perspectives.
At the last minute, we got the idea to crowdsource videos from some of the people who’d been involved, as a #MindNBodyAdvent series. Take a look at the hashtag on Twitter . It was very organic and came together better than I dared hope , with lots of fantastic people volunteering to join in .
Here we have collected them into a single video and I hope they give you a feel of the depth and variety of the project.
The new resources are currently going out to over 50 NHS trusts and we hope will support conversations to improve experiences of women and families everywhere .
A Happy New Year to all – hoping 2019 will be another year of positive, action-focused #MatExp change and looking forward to working with everyone to get the most out of the brand new material.
I had an idea for #NHS #FabChange70. I decided I would collect 70 different things that have happened as a result of #MatExp #WhoseShoes and share one a day until the official start date for the #FabChange70 on 17 October.
@MrWhoseShoes rolled his eyes. He knows that these things are in danger of taking over my life (and therefore our lives!) So I promised to keep it simple.
Ideally, I could perhaps have done something sophisticated, crowdsourced the best 70 ideas (there are plenty to choose from!), got different contributors to write a blog, or otherwise tell their story, every day for 70 days… 70 days is a long time and I really don’t have the time.
Apologies in advance if I do not include something important, as I’m bound to miss lots of good stuff! If there is anything you are desperate for me to be include, please get in touch and we can build it in.
So let’s keep it simple. Let’s have some fun. 70 fab #MatExp things And here’s the first one…
And what could be better to start with than #StopNCelebrate? Like most of our best stuff, this was a spontaneous idea that came from one of our #MatExp #WhoseShoes workshops. So the aim is: 70 things that come to mind that give you a flavour of the sorts of stuff we get up to through – culminating in a Steller story that pulls it all together. Steller stories only allowed 75 pages. Therefore only one page per idea. That has to be simple! Wish me luck!
Here is the story of the workshop that led to #StopNCelebrate.
And here is the story of how #StopNCelebrate caught fire! Well done … WARWICK HOSPITAL!!
Important insights by Florence Wilcock, consultant obstetrician at Kingston Hospital and co-founder of #MatExp, as we celebrate the 70th birthday of the NHS today,
5 July 2018.
One cannot open a newspaper, listen to the radio or turn on the TV without a reminder that today the NHS turns 70. For many of us this means that we have no recollection of not having had health care free at the point of use, so perhaps we sometimes take it for granted. The sentiment of being able to do what I feel is right for my patients regardless of cost and without personal gain has always been of central importance to my desire to practice medicine. As we approach the celebrations I’ve been feeling a little despondent, it’s hard to shout and cheer when dealing simultaneously with unprecedented scrutiny of quality and finance and a level of bureaucratic oversight can feel stifling.
Therefore as the NHS turns 70 & I celebrate having worked in the NHS for 25yr here are a few of my positive reflections on NHS maternity care.
The NHS trained me; don’t forget that not only does the NHS treat and care for patients, it provides clinical training for the many doctors , midwives and associated healthcare professionals of the future. The babies born when I was training as a medical student would now be 26yrs old; if I hadn’t witnessed and helped at those births I would not have been inspired to be an obstetrician helping and caring for women now.
Over the years the NHS has also contributed to specialist training of many overseas doctors some of whom now practice here, but many of whom return home and benefit women and families across the globe.
Although British I was born in Brussels and my parents tell the story of arriving at the hospital with my mother in the late stages of labour and my father having to confirm his ability to pay before they started to look after her. I cannot imagine looking after someone in these circumstances. I have seen maternity bills on Twitter reaching $20000 from the USA and have talked to people when I travel abroad about their difficulties in affording basic antenatal and intrapartum care; in this country we do not give this a thought.
We have first rate neonatal care so that babies born prematurely have the best chance of survival, I know mothers in other countries who have not been so lucky, our babies do not die through lack of equipment such as an incubator or ventilator.
When we celebrate all those babies born in the NHS over 70 years, we must not devalue those of us who were not. Many excellent work colleagues and families using maternity service were not born here but do contribute to and deserve the excellent maternity care that the NHS can provide.
Although the NHS can sometimes seem a huge faceless organisation cited as wasteful and cumbersome, I know it is full of the most dedicated, hard working people and that day in day out these people are trying to make a difference as best they can in challenging circumstances.
During my work in Maternity experience #MatExp I have found many like-minded maternity health professionals whowant to work in genuine partnership with women and families and being open and honest about our limitations and co-producing solutions.
So as we celebrate the NHS 70th birthday, let us try and build a foundation for the next 70 years of maternity care that we can be proud of.
For one of my final year modules we were asked to create an informative resource for a professional audience on a current relevant topic of maternity; the topic I chose was Dignity and Respect.
In February 2018 The World Health Organization developed new recommendations for a positive childbirth experience for women, they incorporated the importance of dignity and respect, as well as reinforcing the importance of the experience for women going through the maternity services and not just having a healthy baby.
I created a training pack incorporating a video, based on true stories, and a presentation with reflective questions and discussion points. The intention of my resource is to remind healthcare professionals of the importance of their role within the maternity services, to ensure women-centered care, that human rights are met and women have a positive experience.
I have a confession to make. Lovely Claire wrote this blog AGES ago. But it was when I caring for my lovely Mum during her final weeks and giving it proper attention and publishing it has only just hit the top of the ‘to do’ pile.
Anyway, Claire attended a Whose Shoes? workshop organised by Lewisham and Greenwich NHS Trust which was innovative because it was especially for student midwives. They are doing a lot of very interesting work using the WhoseShoes? approach – look out for smoking cessation. Claire put a lovely comment on Twitter so I invited her to write about it. You can read her article below (Gill Phillips – @WhoseShoes)
We do like a good event @LG_NHS I went to the student whose shoes and it was very informative and powerful
If you’re in healthcare, you will soon come to realise that everyone has a story, from the cleaner right up to the head clinician. These stories are shared and told frequently, often over the desk or in the small hours of the morning whilst sharing a cup of tea in a quiet moment. As a midwife, the art of storytelling becomes intrinsic to the profession, it is how we communicate and empathise with one another. Speaking of the highs and lows with each other, and forging bonds over the shared commonalities we face.
As a student, I reciprocate midwives’ stories; at points of success and failure there is often a chance to share an anecdote about a similar happening. This helps me to feel like I’m not the only one who has ever got something wrong, or gone about things in a bit of a long winded manner. It’s also how we learn. How often is it that you remember something due to the story accompanying the fact? I already have stories of my own, ones that I’ve shared with fellow students (and ones which I haven’t). Storytelling is important, it allows us to relate to one another as humans and empathise on a level that bare facts are often devoid of. In evidence and research, the lived experience of a human test subject in a drug trial is just as important, if not more so, than the success of a drug itself. What good is success if it comes at the emotional wellbeing of the person you’re trying to help?
It is the art of storytelling that ‘Whose Shoes’ is founded on, the sharing of real life experience that is captured and illustrated. I recently attended a ‘Whose Shoes’ event that was focused on the experience of the Student Midwife. Students from two different sites and universities came together to share their experiences, and listen to those of the families we seek to serve.
The experience was powerful, to sit and listen to a service user’s experience of where they felt listened to was inspiring and an example of what I wish to take forward into my own practice. As we played the board game and snatches of our conversations were transformed into the graphic record, it was interesting to see examples of both good and bad practice that students have witnessed. The unconscious labelling of women and their families, reducing them down to a group of risk factors and where they are along the timeline in terms of intervention. Students feeling invisible, and expected to perform skills which they may not have practiced for a few months due to their rotation through their placement cycle.
The positive aspects of having that extra time to spend with women and their families, of having the safety net of your mentor and university should matters go array. The fear that the job will take over the holistic aims of the profession, that as midwives we become swamped with paperwork and polices, that can cause women to become an afterthought. The reality is that due to chronic understaffing, maternity units and midwife themselves are overworked and busy. A student midwife facing this reality is right to be concerned, however, there are midwives and allied health professionals who want to work to change this.
This is what ‘Whose Shoes’ is about. It is about trying to facilitate change from the ground up. In the right circumstance, being faced with the story of someone’s personal experience within the healthcare system is a powerful tool. You can’t ignore the power of someone having the courage to stand up and say, ‘actually, I felt dehumanised’ or ‘I felt listened to.’ It influences one person who will influence the next, changing ethos and culture one small step at a time.
Thank you Claire and delighted to see that you were BJM Midwifery Student Midwife of the Year.
You are our future – be very proud! Gill
On Monday, to begin #ExpOfCare week, we had an insightful blog from Dr Sarah Winfield reflecting on her experience of taking part in the ‘Lithotomy Challenge’. And today, to end #ExpOfCare week, another #FabObs, Dr Florence Wilcock – the originator of the #LithotomyChallenge and co-founder of #MatExp – tells us all about Caesarean sections and what really happens…
As we come to the end of #ExpOfCare week, I would like to share a blog about Caesarean sections, to demystify the birth that mothers and partners may unexpectedly experience. I originally wrote this blog at the request of Milli Hill & the positive birth movement in October 2016 , subsequently this has been included as a contribution to Milli’s book ‘The Positive Birth Book’ published 16th March 2016.
Why do we need to talk about Caesarean sections?
Unfortunately, sometimes people can be prone to making value judgements about different types of birth. One of the most common examples is vaginal birth = good and Caesarean section = bad. The truth is that in the UK current statistics show 25% of women will give birth by Caesarean section, 10% planned so called ‘elective’ and 15% unplanned ‘emergency’. We can argue these rates back and forth; we can aspire to improve care and change these facts, but for the moment given that 1in 4 women will meet their baby in the operating theatre it is vital that we talk openly about this experience and how it can be a positive, emotional & fulfilling birth for each new family.
Even in an unexpected ‘emergency’ there are still choices to be made. Nice guidance on Caesarean section CG132 section 184.108.40.206 recommends 4 categories of urgency; only category 1, the most urgent suggests delivery within 30mins. Far more common is the ‘emergency’ caesarean category 2, delivery within 75mins of decision making. This gives a woman time to express contingency birth preferences and ensure that even if she did not plan a caesarean birth it remains a calm and positive start for her and her baby. Skin to skin in theatre, optimal cord clamping, birth partner announcing the sex of the baby, choice of music are all possible. I would love to say these are all standard in every hospital but unfortunately that wouldn’t yet be true, however the more women know and ask, the more these will become universally accepted. As I often say ‘Wrong is wrong even if everybody is doing it and right is right even if nobody is doing it’. I wish you all an interesting and positive month discussing Caesarean birth and would like thank Milli for inviting me to contribute & become part of it. If you want to know more about how I am working to try and improve maternity services do check out matexp.org.uk
Caesarean Section a theatre experience & Who is who in the operating theatre?
The majority of caesarean sections in the UK will be done under a spinal anaesthetic, that is numb from the nipples downwards. It’s a peculiar feeling as one can feel touch but not pain. It means that women will be awake and aware of people milling around them which can be daunting but it also means they are awake and ready to meet their new baby. Lying on the operating table we tilt women slightly to their left to keep the bump of the baby off the major blood vessels, this prevents dizziness from low blood pressure. If you lie on the operating table in the maternity theatres at my Trust you will look up and find butterflies & cherry blossom on the ceiling, something nice to focus on while you wait for your baby to arrive. I know this is unusual & we are lucky but there is nothing to stop you tucking your favourite picture or photo in your birthing bag so that you have something familiar and relaxing to look at.
It might seem odd that at the start everyone in the theatre will introduce themselves to one another. It isn’t that we have never met but its start of the World Health Organisation (WHO) safety checklist. There is a special checklist just for maternity theatres and it is routine to start by checking simple information such as the woman’s name and date of birth and move onto clinical issues and equipment and it is all aimed at making the experience as safe as possible. So, who are all these people around you and what are their roles, why are there so many people there?
Anaesthetist: At least one sometime two; these are doctors who will administer the anaesthetic ad monitor you closely during the surgery. They will be standing just by your head and often chat to you and reassure you as the operation progresses.
Operating Department Practitioner (ODP): at least one; their role is to assist the anaesthetist, getting & checking the required drugs, drips or equipment, the anaesthetist cannot work without one being present.
Obstetricians: at least two; one will be performing the Caesarean section (the surgeon) the other will be assisting (the assistant) e.g. cutting stiches, holding instruments.
Midwife: At least one; to support the woman and help her with her newborn baby when it arrives
Scrub nurse or midwife: At least one; To check, count all needles, stiches and instruments and to hand them to the surgeon when needed.
Midwifery assistant or runner: This person double checks the swab and instrument count with the scrub midwife or nurse and ‘runs’ to get any additional equipment required as they are not ‘scrubbed up’ so can go in & out of theatre to fetch things.
Paediatrician: asked to attend any ‘emergency’ situation or if there are known concerns about the baby.
So, you see in theatre there is a minimum of seven people caring for any woman all with specific tasks to perform, any complication may result in us calling in extra members of the team.
So back to the woman, she will be on the operating table with her birth partner by her side and the anaesthetist and ODP close at hand. She can often choose the music she would like her baby to be born to. The anaesthetist needs to monitor her heart with sticky labels but these can be put on her back and her gown left loose leaving her chest free and ready for skin to skin with her baby. A sterile drape will be placed over her bump and this is usually used to make a ‘screen’ so that the woman doesn’t see and surgery she doesn’t wish to see however usually we drop this when the baby is ready to be born.
Many hospitals are starting to explore options of optimal cord clamping (waiting to clamp the cord) and passing the baby straight to the mother if the baby is in good condition. These can be done but need to be thought through so as not to contaminate the sterile surgical area, and the surgeon needs to be confident no harm such as excessive bleeding from the womb is happening whilst these things occur. Surgical lights need to be on so the surgeon can see clearly and operate safely but I know one anaesthetist who works in a hospital where the rest of the theatre lights can be dimmed. The mum and new baby can be enjoying skin to skin whilst the rest of the operation proceeds. Weighing and checking babies can be also done at this time but also can be done later on.
Traditionally if we operate with women under a general anaesthetic (asleep) her birth partner has not been in in theatre as their role is to support the woman. Recently on several occasions I have challenged this so that a baby is welcomed to the world with at least one of its family present and awake rather than by a group of strangers caring for the unconscious mother. There are safety considerations to be talked through for this to be successful but it is possible. However, kind and caring staff are, they are no replacement for a birth partner whom the mother has chosen to support her in the intimacy of birth.
I hope I have given you a brief glimpse in to life in a maternity theatre. As an obstetrician, I am privileged to help bring many women and babies together for those special first moments. The emotions are always different for me: sometimes it is a couple I know very well and have bonded with over months or years, sometimes a woman I have only just met who has had to put her absolute trust in me immediately. The theatre atmosphere can range from almost party like jollity to quiet intimacy. Every birth is different; each birth is extremely special just as much as the births that happen in a less clinical environment and each birth will stay with that woman forever.
We are very honoured to begin #ExpOfCare week with a bang, publishing this insightful blog by Dr Sarah Winfield. We have connected with Sarah through the excellent ongoing #MatExp work at Leeds Teaching Hospitals NHS Trust, following the exciting Whose Shoes? workshop last summer. Part of the work in Leeds involves a different #MatExp challenge each month… and January 2017 was ‘lithotomy challenge’ month!
Sarah wrote this a while ago but we held it back to publish here as #ExpOfCare is such an important initiative and one which is central to #MatExp. We are very grateful to Sarah not only for taking the time to do the challenge, but more importantly to reflect so openly on the experience and share with us here…
The #LithotomyChallenge is a term coined by one of my Obstetric colleagues in Kingston, Dr Flo Wilcock, who wanted to put herself in the position of a patient in lithotomy for an hour and to describe the experience. As part of #MatExp and to raise awareness of it’s existence and philosophy, I wanted to do the same. So I did on #NHSDoAthonDay at the start of January 2017. Here is how I got started.
I used to be sceptical about twitter until my tech-loving husband persuaded me to dust the cobwebs off my twitter account @winners352 (set up tentatively a while ago). David is a consultant in Education and assured me that performing CPR on my twitter account would not only be beneficial for my CPD, but would put me in touch with like-minded people, allow me to tweet the odd journal article, and would help me to raise the profile of the unit that I work in. I wasn’t ‘sold’ but I am an optimist and thought that I should give it a go.
So I changed my profile picture, tried to compose a sassy yet professional catch line and I started to browse for people and things that may interest me. Initially I retweeted posts that would not cause any controversy for my digital footprint or reputation as a member of the medical community, but then I worked out that if people put their opinions out there for all to see, then this provokes engagement and discussion. This conversation would then draw others in. Then information begins to flow, more people ‘follow’ and before you know it, there are people from all over the world tapping in to see what this is all about. Amazing. But also slightly scary.
Of course, I appreciate that there are downsides to having a twitter presence, but this is where the world is going now. I recall an article written for the Health Service Journal by Roy Lilley about STPs (Sustainability Transformation Plans). In this article, to paraphrase, he said that STPs are happening and are not going away, so you can be in the cast or the audience. It’s your choice. I think that the same applies to social media and twitter. So, I made the decision to learn more and make it work for me. This was at the beginning of October 2016.
Through twitter I made contact with Gill Phillips (@WhoseShoes) and Flo Wilcock (@FWmaternitykhft) who are the founders of #MatExp, and it turned out that I had actually met one of this duo before!
As well as being a Consultant Obstetrician with an interest in maternal medicine, I am also the Clinical Lead for maternity services for the Yorkshire and the Humber Clinical Network. This role took me to an event at the Kia Oval in London in July 2016 to discuss implementation of ‘Better Births’ (the National Maternity Review) in each network patch. There were a series of workshops and in one I joined in with a discussion about the “Whose Shoes” event that had been held in Leeds earlier in the year. I did not realise it at the time (probably because I was not on twitter at that point!) but Gill Phillips was one of the facilitators of that group. Professor Cathy Warwick and Mr David Richmond were the other facilitators.
While I had not been able to attend the Leeds Whose Shoes event itself, our LTHT strategy midwife, Sarah Bennett, was very much involved. At the event a cartoonist, Tom Bailey, recorded patients’ views and the conversations taking place. These were very thought provoking and I have to admit that one image in particular made me stop and think. It was of a doctor standing at the top of a hill pointing down to a midwife at the bottom of the hill. It was not particularly complimentary to us as doctors.
None of us set out to make patients and midwives feel like this but with the language we use, the information we need to get across and our communication skills in general, there was clearly an issue. This made me feel uncomfortable (and perhaps a tad indignant, if I am being honest) and I know that a few of my colleagues felt the same as me.
What happened though was that these images stimulated discussion and debate amongst the maternity staff members. While there might have been levels of disagreement about the images and what they portrayed us to be as medical and midwifery professionals, they were ‘real’ views of and we had to reflect here. Importantly these conversations were a starting point to encourage us to look at how we work on a day-today basis, the language we use with patients and each other, how we conduct ward rounds on the delivery suite and the whole experience for any woman and her family using our maternity service.
In other words, we had a platform from which to share our opinions about the maternity experience of patients in Leeds across both sides of the city.
Leeds is a busy tertiary unit. We have around over 10,000 deliveries a year between Leeds General Infirmary (LGI) and St James’s Hospital (SJUH) and we don’t often get to do sit down with our colleagues, whose opinions we genuinely value, and engage in a dialogue about patient experience. But here we were, and I felt like this was a good start.
I spoke about this experience in positive terms at the Kia event and Gill then made contact with me through twitter a few months later. A fortuitous connection for me and, I hope, for her too. I also ‘met’ Flo through Gill on twitter, and the rest has followed.
So who are Gill and Flo and what is #MatExp?
Gill, the creator of the award-winning Whose Shoes?® concept and tools, has a genuine passion and unsurpassed energy for “looking at issues from different perspectives and getting people to talk together as equals and come up with imaginative solutions”. She is also a mum of three ‘now grown up’ children.
Her website http://nutshellcomms.co.uk/gill-phillips-and-the-origins-of-whose-shoes/ is an inspirational working ode to her warm, inclusive and collaborative style. Gill’s passion for helping others is obvious to see and she takes people with her. This is one of the many reasons why she has been quoted by the Health Service Journal as one of the 50 most influential women of the year.
Florence (Flo) Wilcock is a Consultant Obstetrician at Kingston (and mum of two) and, inspired by Gill’s WhoseShoes concept, was keen to use this to improve maternity services and more. Flo is similarly an inspirational force and counts the RCOG and its former president David Richmond as her supporters, amongst many others. She joined forces with Gill and the #MatExp campaign was born.
The #MatExp website is a vibrant, colourful, positive and proactive resource and I would advise anyone working with women and their families. The best explanation of #MatExp is the one from their website, so in their own words:
“#MatExp is a powerful grassroots campaign using the Whose Shoes?® approach to identify and share best practice across the nation’s maternity services.
Then ensued a flurry of tweets between me, Gill, Flo and other #MatExp supporters and I was overwhelmed by the helpful, collaborative and go-getting approach. They are incredibly supportive to anyone on twitter who shows an interest in improving patient and family experience in maternity services.
As my knowledge grew about #MatExp and I had further twitter conversations with Gill, Flo and others, I read a piece by Flo that she wrote about her taking part in a #Lithotomychallenge. The piece is here and Flo explains:
“For NHS change day I wanted something that made a statement that said “#MatExp has arrived, take notice, we are improving maternity experience, get involved!” I couldn’t quite think of the right action until I saw a twitter exchange with Damian Roland back in December and watched a video where he described his spinal board challenge from NHS Change day, 2014. I had a light bulb moment thinking what would be the maternity equivalent? Lithotomy!”
Taking Flo’s lead and transporting #MatExp to Leeds, I thought that a #LithotomyChallenge would be easy for me to set up and would put me in a patient’s shoes (goodness knows the amount of times in my career that I have put a patient in the lithotomy position for an instrumental delivery, a FBS, a perineal repair..) for a short while. I have two daughters, both born by caesarean section, so I had no experience of this, let alone with contractions, CTG leads, an epidural, a syntocinon drip etc.
I chose Wednesday 11 January 2017 as the morning I would do it. This was #NHSDoAthonDay and it seemed appropriate.
In the run up to the day, Sarah and I told people what I was going to do through the strategy newsletter, facebook, twitter and word of mouth. People asked why and asked what #MatExp was. There was also an interesting spectrum of opinion about my desire to do the #Lithotomy Challenge, ranging from people thinking that I was ‘patronising’ my patients and colleagues to others congratulating me for taking the initiative to do something different.
On the day of the challenge I put my hospital gown on, strapped the CTG leads to my abdomen and Sarah fixed an IV line to hand with tape and helped me up onto the delivery bed in Room 10 on LGI delivery suite. Then Sarah left to go across the city to St.James’ hospital where the midwives there were waiting for her to set them up with the #Lithotomychallenge too. I was by myself in the room. In lithotomy position.
I felt undignified and vulnerable. I also hoped that nobody would walk through the door, but they did. In groups, in pairs, alone. Mostly midwives. Each time I cringed as the door opened and I realised that the level of the bed meant that my bottom end was at their eye level. I was in leggings and a sheet. I can’t imagine the indignity and embarrassment for a woman of being ‘al fresco’ when someone comes into the room in that situation.
Then I noticed something that I hadn’t before; there was no ‘privacy curtain’ over the door. I now realise that this curtain is a feature of the delivery rooms at St.James’ hospital across the city and in every other maternity unit I can recall having worked in before. Such a simple thing would make a huge difference.
Then the surroundings really began to jump out at me. This room had magnolia walls, a light socket that was hanging off (previously an uplighter), holes and scuffs in the walls and nothing that I would describe as comforting, pleasant or homely. When you sit in a room for over an hour, these details are very obvious. I have been in this room many times during ward rounds, to deliver babies etc. and I had never noticed what an uninspiring and depressing environment it is.
Would I have enjoyed my birth experience in this room? Definitely not. Does it convey an impression of the warmth, skills, knowledge, team spirit and professionalism of the delivery suite staff that I know exists? No it does not. But a woman and her family have this room as the starting point on their personal, special and much anticipated journey to give birth to their precious baby so how is it going to set them up for a positive birth experience? It don’t think it will.
Then something unexpected happened. I felt really cross with this room, if it’s possible to be annoyed with a ‘space’. I know how hard the team work to look after women and their families, so why should the woman and us as the team, with our training, skills, compassion, knowledge and tertiary centre reputation be let down by awful facilities? All women should have a pleasant environment to have their baby. It’s very simple. Some paint, some wall décor, good lighting, promptly repaired faults. The list is not long and is easily addressed. This was the first unexpected result for me of my #Lithotomychallenge and I have to say that it really touched a nerve.
The other unexpected result for me what that when people came in to see me they shared their own birth experiences (good and bad) as I sat there on the bed
with my legs ‘akimbo’. I found this moving because these are people who I have worked with for the last few years, who I chat with when I’m on-call and who I think I know quite well. I heard stories of a fantastic waterbirth, an awful induction, someone struggling to get pregnant plus more. You could say that the ‘barriers’ were down, but I would like to think that me doing this challenge provided an opportunity for people to start conversations with me and each other about their experiences as patients in the maternity service.
My final recollection added some humour to my experience. While I was talking to a group of student midwives (they appeared to be more embarrassed than me), one of our delivery suite domestic staff, who I know quite well, knocked on the door, walked in politely and without ceremony, gave me a glass of water and asked me for the keys to my office so that she could give it a clean while I was tied up! There was no pulling the wool over her eyes. I gave her the key and my thanks.
So, what did I get out of doing the #Lithotomy challenge? There are two things that stand out for me. The first is that I allowed myself to ‘feel’ from a patient’s perspective. I was prepared to give a bit of myself away and open up to the possibility that we may not communicate in a way that enhances a patient experience or consider the importance of the environment that we create to do this. I think that to change culture, the language we use and the way we view the patient experience we need to look closely at our individual practice and challenge our own behaviours and judgements. This is hard and not everyone will want to do this but I have found that doing the #LithotomyChallenge has led me to review my own beliefs and practices as an NHS worker for almost 20 years and this has been like taking a deep breath of fresh air.
As a doctor and a consultant I am familiar with pushing my boundaries professionally and clinically, but can I use any ‘influence’ that I have in a different way? Of course I can be an ‘opinion’, counsel patients, make management plans, perform difficult c-sections, chair regional meetings etc. but working towards improving patient experience may be regarded by some as a ‘fluffy’ goal. Very ‘touchy feely’ and not really hard-hitting or go-getting enough to warrant using precious consultant time in an already busy day where we are here to deliver a service and fulfill the objectives of our job plan/appraisal personal development portfolio. But sometimes it’s not until you experience the ‘other side’ and and allow yourself to ‘feel’, that you realise what needs to change. I now know that I would like to be more proactive in considering the whole patient experience when I am involved in any aspect of a consultation or a procedure.
The décor was the second thing. I have seen many articles and personal commentaries about the effect of surroundings on birth experience, and we already know that the environment during labour and delivery can have a profound effect on how patients ‘experience’ their care. After spending time in a room that has seen better days, I can believe it. Never underestimate the importance of surroundings and this challenge has highlighted that for me. I hope that this piece will result in privacy curtains being put up in each delivery room at LGI. This would make such a difference. But improving the delivery rooms in this unit is going to require funds. I regularly see healthcare workers and patients fundraising for their units and doing the #Lithotomychallenge to spurred me on to do this.
There is one final thing that the challenge has done. By writing this piece I have a voice. I have not asked permission and have not sought the ‘approval’ of anyone. I have just done it and have been supported by most of my colleagues, including Sarah B. I was nervous about doing the #LithotomyChallenge and had a sense of trepidation about what others would think, but I have enjoyed what the experience has brought and have been inspired by Flo and Gill, who have given me a masterclass in wholeheartedly and warmly welcoming others thoughts and diverse opinions. In their eyes no opinion is ‘wrong’ or ‘daft’. If disagreement arises then it is not to be feared or ridiculed. It can be used as the basis of a conversation to challenge the status quo and then move forwards.
“Change will not come if we wait for some other person or some other time. We are the ones we’ve been waiting for. We are the change that we seek” (Barack Obama).
Dr Sarah Winfield Consultant in Obstetrics with Special Interest in Maternal Medicine. Leeds Teaching Hospitals NHS Trust Yorkshire and the Humber Clinical Network Clinical Lead for Maternity Services NHS England Women’s Specialised Services Clinical Reference Group representative for the North of England
Some really exciting developments with #MatExp Whose Shoes? at the moment.
Bromley MSLC produced a ‘one year on’ report following up on their Whose Shoes? workshop at King’s College hospital using “I said, I did” as a framework to list all the fantastic outcomes that had come from pledges made on the day.
Language continues to be a big issue for women and families, but some great initiatives are now happening. Building on the Whose Shoes? workshops, Leeds and Colchester in particular are working on specific language challenges. I came up with a ‘Negativity Bingo’ and had great fun with my team at the NHS Fab Change Day #DoAthOn event launching #DumptheDaftWords.
I have been getting some exciting invitations to speak about building social movements and of course gave #MatExp a big shout out in my talk at the launch of #AHPsIntoAction, they have invited me back for a longer keynote session at their annual conference in June.
Last Friday, 3 Feb 2017, we were invited to present a #MatExp Whose Shoes? session to get some good discussions going as part of a packed event launching #PanStaffsMTP in Stafford. We concentrated specifically on continuity and perinatal mental health. This is the county-wide transformation programme to improve maternity experience in Staffordshire to implement the national ‘Better Births’ vision. This informal film gives you a flavour.
We are proud of the crowdsourced ‘Nobody’s Patient’ project and thank everyone for your fantastic contributions. We now have over 120 new Whose Shoes? scenarios and poems and the new resources will be made available shortly to all the hospitals who were existing customers. Florence Wilcock, Sam Frewin and I are finalising the supporting toolkit and collating the case studies, ahead of our ‘wrap up’ event in March. We are trying to pull together lots of ideas for positive change, with or without a workshop. I hope you are enjoying the regular Steller stories, including Florence’s monthly reports.
Wonderful to see everyone doing such amazing work, speaking all over the place, building networks, spreading the word and generally making great things happen.