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.
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
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!
Here are the episodes so far and new ones will automatically be added:
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 188.8.131.52 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.