Maternity Experience

The #MatExp Journey

Women’s Voices in #MatExp – your Obstetrician

I was asked to do a talk to student midwives at Salford University last month on the topic of “Women’s Voices” in maternity care.  As part of my presentation I included the voices of the midwives who work in maternity care, and a reminder that there are many other women for whom maternity care is their professional, as well as perhaps their personal, experience.  “Women’s Voices” in maternity care should cover the midwives, obstetricians, health visitors, doulas who care for us, as well as the women giving birth.

So I decided to start a series of blog posts on “Women’s Voices in #MatExp” from the point of view of those working in maternity, and this is the fifth of those. This is Ruth-Anna Macqueen’s experience as an obstetrician in training, and it includes an introduction and follow up comments from #MatExp founder Florence Wilcock.  Thank you so much to Ruth-Anna for agreeing to write for us.  You can read the other blogs in the series here:

Your Midwife

Your Doula

Your Breastfeeding Supporter

Your Sonographer

And yes, I will be doing a “Men’s Voices in #MatExp” series too.  Because this campaign is about all voices.

Helen.x

*********************

Florence Wilcock writes:

Flo

“One of the strengths of #MatExp is to try and hear all voices with respect and understand different perspectives so that we can work together to improve maternity experience.

Obstetricians have been an especially hard group to involve , I have written before about the traditional ‘bad press’ we seem to receive. I included it as a topic in the #matexpadvent Steller series you can read it here  https://steller.co/s/5AduBaxWL6v

I am therefore especially delighted to introduce a brave #FabObs blog, one of a couple that are hopefully coming our way. Some of this may be distressing, some of it may be unpalatable but I ask you to take a deep breath challenge your assumptions & read!  Don’t ‘bash’ the author she is giving you a peek into her world, a world fairly typical of many obstetricians in todays’ NHS . Take this unique opportunity to have sight of what it is like to be in ‘our shoes’ that way we can have the difficult conversations that move us forward.”

*********************

My name is Ruth-Anna, I’m 32 and a Mum of two busy, lively and opinionated little people aged 2.5 and 5. I’m also privileged to work as a doctor in obstetrics and gynaecology. My official title is ST5 doctor, which means I’ve been specialising in obstetrics and gynaecology for 5 ‘years’ (after 6 years at medical school and 2 years of moving around specialities). However it’s actually nearer 6.5 years since I started specialising, because of having time out for having babies, and working part time (I work 35 hours a week and spend two days at home with the kids). At the end of my ST7 ‘year’ of training, all being well, I’ll be able to apply for jobs as a Consultant but right now that feels a long way off!

This is a day in my life… (all events and women are fictionalised, of course)

Ruth-Anna

My alarm is set for 6.45 but the kids usually wake me up first. I get up & dressed, grab some breakfast (if I’m organised enough!) wave goodbye to the kids & husband and jump on my bike. It’s a Saturday so the cycle into work is pleasantly peaceful and I enjoy a bit of headspace. My job is incredibly varied and over the course of a week I could be seeing women in antenatal clinic, gynaecology clinic, on our day assessment unit (walk in for pregnant women with concerns about themselves or their baby), operating in gynaecology theatres, scanning women, looking after women who are inpatients for any gynaecological or pregnancy-related problems, seeing women in A&E with acute gynaecological problems, or covering the Early Pregnancy Assessment Unit.

Today, however, I’m working as the Labour Ward ‘registrar’. I’ll be working with an ‘SHO’ (in newer terminology, this could be an FY2, an ST1 or ST2 doctor), who may or may not be specialising in obstetrics and gynaecology, as well as my Consultant.

I’m in work by 7.45 and change into my scrubs, to head into our handover meeting for a prompt start at 8am. All the midwives, obstetricians and anaethetists for that day on Labour Ward are there. Our night team counterparts inevitably look pretty knackered and relieved to see us.

Some days we take over and there are only one or two women on the Labour Ward but today it’s a busy one. As we talk through the women, one by one, I’m thinking what the risks might be for that woman and baby, predicting and preventing any problems and pre-empting potential issues. Hopefully none of those will happen but our job is largely about predicting problems that never happen, so that we can be prepared for when they do. Even so, a day on Labour Ward is unpredictable and filled with surprises. My current hospital saw around 6000 babies delivered here last year and it serves a fairly ‘high-risk’ population, with above average numbers of women with a high BMI, older mothers, women who may have come into the UK recently, women with multiple pregnancies or concurrent medical problems. We also have women who are transferred in to us from other places where the NICU or SCBU don’t have the facilities to look after the smallest or sickest babies.

Women expected to have totally uneventful labours are normally on our Birth Centre and I won’t generally be involved in their care unless there’s an issue that the midwives ask me to help with. Myself, the Consultant, SHO, the Anaesthetist and the Labour Ward Co-ordinator (Midwife in charge) do a ‘ward round’ of all the other women – to introduce ourselves, find out more about her and how things are progressing, and make a plan, if anything else needs to be done. This morning there are 12 women on Labour Ward. The first woman we see had a Caesarean section overnight and lost a lot of blood. She’s having ‘high dependency unit’ care and is currently having her third unit of blood transfused as she had a very low haemoglobin level due to the blood loss. We assess whether she has had enough blood replaced, whether there are any signs of further bleeding, and whether she needs any further treatment. She’s understandably shell-shocked and we go through the events of the night with her and her husband. Her baby was taken to the NICU and her priority is getting well enough to get into a wheelchair so she can go and see him there.

Next we see a woman who’s tragically had a stillbirth. She attended the day unit at 38 weeks into a normal pregnancy with reduced fetal movements, and it was confirmed the baby had died. Her labour was induced yesterday and she’s spent the night trying to come to terms with what has happened. Understandably she has lots of questions for us, which we do our best to answer. I offer her some medication to suppress her breastmilk production and give her some information to consider about a possible post mortem examination for the baby. We offer her the choice of going home today or staying another day and she will think about it and let her midwife know.

We complete the ward round, seeing a woman with a straightforward labour who is on the Labour Ward only because she has an epidural, a woman who previously had a Caesarean but is in spontaneous labour and all is well, a woman who is being induced for a post-dates pregnancy and a woman who has been admitted in possible preterm labour at 28 weeks.

The next few hours is a whirlwind of emergency buzzers and bleeps. Another woman has been admitted from the day unit – she’s had an uneventful pregnancy so far but at her midwife appointment today at 32 weeks her blood pressure was found to be dangerously high, with protein in her urine. Her midwife suspects she has pre-eclampsia and has sent her in to us. She needs urgent assessment my myself and my anaesthetic colleague, a cannula (drip), bloods taken, and medication to lower her blood pressure. She starts complaining of a headache and when we test her reflexes they are abnormal so we also recommend that she starts another medication (magnesium sulphate) to reduce the risk of having seizures. We need to see how she responds to the treatment but it’s likely we will need to deliver her baby imminently to treat the pre-eclampsia, so we also recommend the first of two doses of steroid to help mature the baby’s lungs. Her midwife calls the Neonatal team to check that our NICU have a cot available for this premature baby. She also asks them to come and speak to the woman to explain what to expect if her baby needs to be born prematurely. I perform a scan under the supervision of my Consultant which shows the baby is small and its fluid is reduced – this is a common effect of pre-eclampsia. We ask her not to eat and drink in case the baby needs delivering imminently (if she needed a general anaesthetic it’s important to have an empty stomach).

I leave my SHO administering the first dose of the magnesium sulphate as the Co-ordinator calls me to see a woman who is in the second stage of labour (fully dilated and pushing) whose baby is showing signs of significant distress. I assess the woman, and the fetal monitoring, and explain that I would recommend an instrumental delivery, to which she agrees. As the baby is already quite low in the birth canal I decide this can be safely achieved in her delivery room, so after giving an injection of local anaesthetic to block the my SHO and I perform a ventouse delivery and her baby is delivered with no complications.

I finally see a woman who has been waiting several hours to progress to the next stage of her induction of labour. We haven’t been able to proceed with things as we would have hoped due to the other situations that have arisen and the effect on available staffing levels. I explain this to her but she’s understandably upset and frustrated, as well as exhausted, and I leave the room feeling pretty downheartened.

It’s 3pm and I suddenly realise I haven’t eaten anything so grab a sandwich and a drink before heading back to see the unwell woman with pre-eclampsia. Her blood pressure still isn’t under control despite high doses of medication and my Consultant decides that we can’t wait any longer and that she will need to have her baby delivered today. At 30 weeks in her first pregnancy, with a growth restricted baby, the team decide that Caesarean will be the quickest and safest way of delivering her baby. She’s shocked – it certainly wasn’t what she was expecting when she headed to her midwife appointment that morning, but her partner has now arrived and she is willing for us to proceed. I talk her through the operation and explain the risks and benefits, before she signs a consent form. The Co-ordinator speaks to the theatre team to prepare everything, as I call my anaesthetic colleagues. Her midwife gives her ‘pre medications’, tight stockings to wear and gets scrubs for her partner to wear.

While with my sick woman I was asked to attend the Birth Centre to check whether a woman who has just delivered has a ‘second degree’ tear (that can be sutured by the midwife in her room) or a ‘third degree’ tear that would need to be sutured in theatre by me. As the anaesthetists perform their anaesthetic for the woman in theatre, I finally make it across to the Birth Centre and thankfully for the woman it’s a second degree tear. I apologise she’s been waiting so long for me – she’s lovely about it but I still feel bad.

I’m bleeped from theatre to say the spinal anaesthetic is working and they are ready for us to start the operation. I do her Caesarean, with my Consultant supervising in view of how sick she is and the fact the baby is premature. Thankfully it is an uneventful procedure and the baby is born in reasonable condition, although he still needs to go to the NICU. His mum comes back to the Labour Ward as she is still unwell and the next 24-48 hours can actually see a deterioration in her condition.

tea phone

We sit down for a quick cup of tea and I feel guilty I haven’t tackled any of the computer-based tasks I have piling up, and the audit I’m trying to finish before my appraisal next month. Still, they’ll have to wait for another day. I check my phone and see 15 messages from home – thankfully it’s nothing urgent; they are just photos from my husband of the family party he and the kids are at today.

The night team start to arrive and I feel relieved. Today I’ll manage to get away pretty much on time, once we’ve finished handover. I need to send some electronic tickets to my Consultant so she can sign to say what she’s witnessed me doing today, for my appraisal. I know that if I don’t do it now I’ll forget. I’m out of the building by 20.45 and head home to wolf down the dinner leftovers. I spend the cycle home thinking about the women and babies I’ve looked after today, hoping all will be well, and wondering what I could have done differently. After 8.5 years as a doctor I’m pretty good at trying to leave all those thoughts behind – at least temporarily – when I put my key in the lock, although I do drop my night colleagues a quick text before bed to ask how the woman with pre-eclampsia is doing. She’s stable and I finally let myself switch off. Tomorrow is one of my days at home with the kids and I’m looking forward to taking my 5 year old to school and my 2 year old to toddler group.

*********************

Florence Wilcock writes:

“When I first read the blog I felt it pretty accurately captured a fairly ‘standard’ day on labour ward for an obstetrician. I recognized it absolutely & have spent many days similar to this over the years. The multitasking, prioirtising, constant juggling of clinical situations is quite typical. Some of it may feel dispassionate and lacking emotion, that doesn’t mean that the author doesn’t feel anything or that she doesn’t treat the women she sees with compassion and care it just means there is an element of self-preservation to enable one to take split second clinical decisions we need maintain an exterior calm. It is also essential so that we are not sobbing halfway through the shift or at the end of the day it enables us to be resilient and get up and do it all again the next day or to care for our own family. Imagine what it would be like if you were trying to do this job pulled from pillar to post how would you feel? This is where working as part of a fantastic multidisciplinary team becomes important, those of us that are lucky have wonderful midwives, nurses, midwifery assistants alongside us. If we are less lucky or those relationships are adversarial that can be very difficult as the support isn’t there. No obstetrician sets out to hurt or upset women or become a barrier they may be under huge pressure, having a bad day, feeling scared of that responsibility, worrying about an exam or appraisal. We are human too.

There is no fluff here , this is obstetrics in reality. There are one or two particular clinical situations that may distress you: such separation of mother and babies is never ideal & making the focus getting a mum to see her baby in NNU sounds so simple but can be harder than it sounds if people don’t work together & make it happen, A bereaved mum seemingly given cursory information and a very short hospital stay after such a life changing event is hard to read but sadly is the current reality , we know this needs improving hugely with better support during and after and a birth environment separate from the main maternity wards. A shocking sudden decision to deliver a baby preterm at 30 weeks. It is hard to write and hard to read and some elements can’t be changed they are clinical reality but amongst that the words we use, the understanding we have of how it might feel both for families and those caring for them there are plenty of things that can be done to improve care.

A mile in my shoes

A few ideas:

Look at #Hugoslegacy #Saytheirname & cards for bereaved parents.

Watch Abigail’s Footsteps’ video ‘The deafening Silence’.

Look at the campaign to have a bereavement suite in every maternity unit started by Ben Gummer MP.

Think about what language you are using in that short time you have to see someone.

Think about the importance of the team to the obstetrician often junior on whose shoulders there is massive responsibility; if you are a midwife or other healthcare professional support them and work with them.

Think about self-care.  What is available to you as a healthcare professional at your Trust, have you had a break, did you eat or drink today?  Looking after yourself is the first step to being able to look after others.”

MatExpblogbadge

Share the Word About MatExp!

Women’s Voices in #MatExp – your Sonographer

I was asked to do a talk to student midwives at Salford University last month on the topic of “Women’s Voices” in maternity care.  As part of my presentation I included the voices of the midwives who work in maternity care, and a reminder that there are many other women for whom maternity care is their professional, as well as perhaps their personal, experience.  “Women’s Voices” in maternity care should cover the midwives, obstetricians, health visitors, doulas who care for us, as well as the women giving birth.

So I decided to start a series of blog posts on “Women’s Voices in #MatExp” from the point of view of those working in maternity, and this is the fourth of those.  Unlike the others, this one is anonymous.  You can read the other blogs in the series here:

Your Midwife

Your Doula

Your Breastfeeding Supporter

And yes, I will be doing a “Men’s Voices in #MatExp” series too.  Because this campaign is about all voices.

Helen.x

*********************

Ultrasound

I have been a sonographer for 13 years, and I’ve asked to be anonymous because I want to be honest, and I don’t think my managers would appreciate every aspect of this.

I’ve worked in a few different NHS trusts over the years, and now work in a small, rural hospital.

I do both pregnancy and non-pregnancy scans, and enjoy the variety in my work. There are more complaints around pregnancy scans, but my overwhelming impression of pregnancy scans is that it can be very hard to meet parents expectations in the NHS.

For routine, screening scans parents generally expect the reassurance that all is well, without necessarily fully considering that the scan findings may be devastating. I have a moment with the notes (hopefully, if the mum remembered them) to quickly obtain a bit of history which may give me an indication that the parents may actually be extremely anxious- but some things aren’t written down, and I struggle to determine the body language differences between anxiety, or that I’m interrupting an argument between the parents, or there is worry about something unrelated to the scan, all while the mum may have a desperately full bladder.

Once the parents are in the room, its usually only a minute or so before the lights are dimmed, if they were ever turned up in the beginning. Myself, and older colleagues have noted how our eyes adjust more slowly to sudden darkness- I used to have no trouble going from bright light to darkness in a scan room, but now I’m older I can’t see very well when the lights go off- not very helpful for the scan, but keeping the room dim all the time adds more barriers to communication.

I have been scanning a number of years, but I only learned a couple of years ago the importance of eye contact in those first seconds of the scan. I think if I’d learned that sooner, I could have easily made more clients feel more welcome. Right at the beginning is when I’m usually checking I’ve got the right patient on the computer screen or paper details, probably staring at a screen, and I expect I really came across rushed or off-hand, before I knew better. I have asked for customer skills training, but the training I have had has been more about dealing with challenging behaviour, and when I asked for training around breaking bad news I ended up on a course which was more about end of life conversations, which was interesting, but geared to spending a lot more time setting the scene for breaking end of life news without interruptions, rather than sonographers specific task of breaking bad news very quickly, with little warning.

Something that comes up time and again, is how rude sonographers are, prodding bellies and saying how fat our clients are. I’m sure a lot of us could gain from some training in customer service, but there is a reason behind the hurtful words. A scan can be uncomfortable- pressing on a full bladder isn’t great at the best of times, but sonographers end up pressing harder on larger tummies trying to see the detail that is required for that scan. We try not to, not only because we don’t intend to hurt our clients, but most sonographers are in physical pain scanning and pressing harder makes it worse. We are our own worst enemies at times though, because we concentrate so hard on what we are looking at on the ultrasound screen. So, brains may not be fully engaged on saying tactful comments, we may not realise how hard we are pressing (I rarely notice the pain I am in until I finish up the scan, and realise I shouldn’t have pressed so hard).

At the end of the scan, the other vital part of our job is communicating the findings, which usually involves giving a copy of the report to the parents in their notes.

We have to explain what limitations there are on the scan- have I seen everything perfectly like the text books? Usually not, and then we have to explain why. I’m not aware of too many people feeling insulted when its baby’s position that is a limitation, but the various ways we say we lost detail because the sound waves were travelling further (which happens if there is a layer of fat in the way) can be perceived as insulting. I know in my trust the midwives try to mention this to larger ladies before they come for any scans, and I feel that being forwarned helps when the sonographers then are repeating something already said. It doesn’t seem too shocking if I’m trying to explain the extra layers around where I’ve been scanning have limited what I can see, if its already been mentioned, hopefully by someone they trust. Sometimes that hasn’t happened, or the parents haven’t taken it on board, and some of us sonographers manage to say things quite badly. Probably in fear of saying it badly, some of us don’t mention it all, and leave it to the midwife to explain the terms on the report, which can be just as upsetting.

Sonographers sometimes across as grumpy, and one possible reason is that we are usually rushed. My day in obstetrics is divided into 15 minute slots- with double slot for first trimester screening and the 20 week anatomy / anomaly scan (different places give it slightly different names), and a bit extra for twins. In that time we really need to allow about 5-7 minutes for trying to document the findings accurately, and producing a copy for the parents to keep in the notes (IT technical issues can easily double this, and are a regular problem where I work now).

Some scans take longer than the allotted time, and sometimes in that short time interval I have to give devastating news, try to be supportive but also find another health care professional to handle the initial grief and arrange what happens next. With no time to reflect I must carry on and scan a lady who might have been kept waiting longer, with a desperately full bladder. I try hard, but part of me is probably still processing the blow I dealt the previous lady, and hoping that while distracted/upset I am doing my job well enough for both clients, and I really hope the lady who has been kept waiting is kind, because I can’t tell her any of this.

The 15 minute break slot I get each list is rarely a break, but just a little leeway so I can try to take a minute or two extra with with each lady I meet without running too late by the end. My lunch break is officially 30 minutes, where I’d love to step outside and enjoy the beautiful grounds my hospital is in, but many days in obstetrics I barely have time to eat in the scan room, before washing my hands and continuing to run late.

I’d love to spend longer, explaining each part of the report, going into the parents particular concerns and signposting them to the appropriate person if I am not the one who can help.

Officially I need to work on my time management. I take too long, I must scan too slow or talk too much. My rescan rate is too high (at the 20 week scan, if we can’t see everything in one visit we are allowed to offer one rescan, which where I worked previously wasn’t ever counted or limited, but now I use that option too freely apparently and I must have less than 10% rescan rate), but that means I must scan for longer to see everything- it is unthinkable that I would say I had seen something when I hadn’t, but I do wonder what will happen when sonographers who aren’t as honest as I am, or feel more pressured than I do, get to this point.

I have been specifically told to talk less to parents before the first trimester screening test, because after a conversation, some mums decided against it. In my old trust we were told, as Band 7 staff in the process and the person about to do the test, that we had to be sure the ladies really wanted it- and check they have heard the potential outcomes including that the diagnostic test, with a risk of miscarriage, may be offered. Where I work now I may ask if they’ve discussed the test with their midwives, have they seen the booklet, but I must not ask enough for me to be confident about the information they have, because their community midwife takes responsibility for this.

Screening tests are an option, not compulsory part of pregnancy. Many women I meet wouldn’t dream of having a pregnancy without a scan, but its not an informed choice if the mum gets in the scan room before she realises the scan is optional-this is something that happened last week.

My personal choices around scans have changed over the years, going from wanting everything going first time around, to having none with my third. I found the anatomy scan with my second child a hugely anxious time, knowing the potential conditions that could be diagnosed, and the huge number of abnormal but unexplained things that might be seen, and of course the range of conditions that a scan would never detect.

A dear friend had a devastating diagnosis at a 20 week scan before my third pregnancy, which meant baby needed delivering at a specialist centre for the best chance of survival, and I was hugely affected by how the family were affected by the diagnosis and the stress throughout the final 20 weeks of pregnancy. Their experience and my attempts to support them made me evaluate exactly what I would gain or lose from scans in my third pregnancy, and, for me, at that time, the decision was not to have scans. The same events affected other people differently, and they tell me they wouldn’t dream of not having a scan after being involved with such a tough experience, which I can completely understand, appreciate and support. I’m not planning more children, but if I did I would have to consider it all very carefully- I don’t know if I would opt for scans or not.

In the first trimester screening scan, sometimes called the NT scan, sonographers are audited in a few different ways. Where I work we have one 30 minute appointment, and if we can’t obtain measurements that meet the national screening committees criteria, then we must offer the quad test. So, we get audited on how many ladies end up being offered the quad. We are audited that our images meet standard criteria. We are audited that our measurements fit a national expected scale- and steps are taken if we don’t meet all these criteria. It isn’t too hard to meet these criteria in a baby that is lying in the perfect position, but the position of baby is one thing outside of our control.

I imagine this scan will be around for a while yet, though I am glad to know non-invasive prenatal screening has been around in private practices a while and hopefully will become more widespread in the NHS in years to come – this blood test is a much more sensitive and specific screening tool, but it is currently quite expensive.

Something else sonographers do that causes conflict is limit the number of people in the scan room, and warn that noisy or disruptive children may need to leave. If there is an accompanying adult then they miss the scan by having to leave with the child, or the scan may be abandoned if the mum is the only adult with unsettled children. I have tried to continue to scan while a child was working very hard to stick their fingers in the fan, run around, screamed constantly, but these are situations where I have to stop before I make a mistake.

It is also very difficult to concentrate when an excited parent/grandparent has someone extra to talk to. The rare time I break the rules and allow someone extra in, I have usually regretted it. I must need further training in being politely assertive to obtain the quite atmosphere I absolutely need to concentrate on seeing all the structures I need – in the given time.

If I scan in silence, I am complained about for being too serious- so I try to keep a light hearted, pleasant line of conversation going while I stare at the screen intently concentrating, looking for potentially life threatening problems with baby. Its a situation perfect for misunderstandings.

Keeping the chatting going is much harder on those days I have a bit of a headache, or my 3 year old has had a bad night, or my 7 year old had a nightmare. I suppose I might call in sick for not being on top form, but the team I work with is so small so I know parents may turn up for long-awaited appointments and be forced to rebook, or my colleagues might try to squash extra scans in an already full list- with all the usual pressures still standing for making it a pleasant scan, not rebooking, etc. And of course, like any business, sickness records are kept and if you take sick time too often, then steps are taken.

I’m struggling at the moment. Concentrating non-stop, knowing mistakes mean huge potential consequences for families, doing it all against the clock and targets is draining me. By the end of my working week I usually feel too exhausted to cuddle my kids before I crawl into bed, unable to cook or eat tea, straight from work, hoping I can take time out of family life to recover from my week. My head hurts, I keep going faint, but the GP says there’s nothing to worry about. My sickness record is something else to worry about. I can’t cut my hours- I think I could probably cope if I were doing it less. If I could have some time for catching up at the end of my lists, I think I could do a better job.I work with a good team, but the managers don’t seem to get the pressure they are putting on us. But then, I don’t know what pressure they are under. I suspect my manager is struggling, but trying to keep it private. She is taking unpaid leave to try to keep going, but scheduling it has been almost impossible. The needs of the service come first.

MatExpblogbadge

Share the Word About MatExp!

Why Your MSLC Matters

Maternity Service Liaison Committees (MSLCs) provide a means of ensuring the needs of women and professionals are listened to and we saw how effective they could be when properly supported and led.”

National Maternity Review February 2016

“I urge you to play your part in creating the maternity services you want for your family and your community. Voice your opinions, just as you have during this review, and challenge those providing the services to meet your expectations.” (Julia Cumberlege, Chair of the Review Team, 2016)

These quotes really illustrate why MSLCs matter. They sum up why I am so passionate about maintaining and sustaining our wonderful Maternity Services Liaison Committee and helping others maintain theirs.

Print

Because I have seen the difference a dynamic, properly supported, MSLC can make to a hospital Trust. Bromley MSLC, like its counterparts throughout the country, is a mix of individuals including commissioners, service users, midwives, doctors and other professionals coming together to monitor and improve local maternity services. The respect that everyone has for each other is evident in our meetings and some of the lightbulb ideas that arise are extraordinarily exciting. I tend to come away from meetings with my head reeling, but also tremendously grateful that we have this group of extraordinary passionate, dedicated people working and living in our area.

MSLCs were first established in 1984, enabling women to be involved in shaping the maternity care provided for them. The Department of Health suggests there should be an MSLC for each Trust in England and Wales. The Health and Social Care Act of 2012 states that health services at every level need to actively engage with service users:

  • Participating in planning and making decisions about their care
  • Enabling effective participation of the public in the commissioning process itself
  • So that services reflect the needs of local people.

Recommendation 13 from the 2015 Kirkup report into the Morecombe Bay Investigation also highlighted the importance of MSLCs.

MSLCs matter because…..

  • They are the only multi-disciplinary committee of its kind in maternity, bringing together commissioners, NHS Trust staff AND the women for whom the service is designed. One third of the committee is made up of service users, including a service user rep chair and vice chair.
  • They are independent NHS working groups that advise on commissioning and service development
  • They should include service users from all parts of the community, ensuring that all women’s voices are heard.
  • They promote collaboration and involvement
  • They plan, oversee and monitor maternity services in a local area and make recommendations for improvements where necessary.

They are one of the few examples in maternity where there is true collaboration between healthcare professionals and service users on equal terms at a local level. This leads to a much greater understanding between both parties of the challenges that are faced and the issues that really matter to local women.

The National Maternity Review also highlights the consensus among health professionals to change things for the better. Nowhere is this more evident than on an MSLC!

MSLCs1

MSLCs can achieve amazing things:

They plan…..together with the commissioners, service users have the unique opportunity to help shape the future of the maternity services in the local area. For example, because of user testimonials provided by our MSLC to the clinical executive, a new perinatal mental pathway is being developed in our local area by the CCG, which will greatly benefit thousands of women.

They oversee……our MSLC is involved in one off projects designed to improve maternity experiences for local women. We have designed information posters, are having an input into a “Welcome to the Ward” postnatal pack and have helped improve the birth environment on the Labour Ward. We also make tours of the wards, bringing a service user perspective and a fresh pair of eyes to the environment.

They monitor……our MSLC gains feedback from women through surveys, questionnaires and Walk the Patch both in the hospital and more recently in children centre health clinics in the community. That feedback is given directly to the lead health professionals of the Trust as well as the commissioners, who listen and act on our recommendations. Those improvements are then fed back to the service users, via social media and other means, so that we close the loop.

This type of work is not just being done by our MSLC. I know of countless other committees which are tirelessly working to improve services in their local area too. Our brilliant vice chair Michelle Quashie is planning a Women’s Voices conference in October and has asked me to present the achievements of our MSLC and others around the country, demonstrating how effective collaborative working can be. I am looking forward to showcasing just what has been and can be achieved then.

At our recent Whose Shoes event pledges were made at the end of the workshop about something that the delegates would do differently as a result of that day. These pledges have formed the workplan for our MSLC for 2016 and we will check to ensure that they have been carried out. MSLCs are true examples of #MatExp in action at a local level.

MSLCs2

We were also really pleased to see the importance of MSLCs highlighted on our beautiful graphic courtesy of New Possibilities.

For this blog I asked members of other MSLCs for their thoughts on why MSLCs matter. Responses included:

MSLCs4

MSLCs6

MSLCs3

MSLCs5

Catherine Williams has written a lot about the importance of MSLCs in her blog https://birthandbiology.wordpress.com/

And from our MSLC Leaders Facebook group:

MSLCs7

MSLCs8

And this from our vice-chair Michelle Quashie:

“MSLCs matter because it is gives all that are passionate about a Women’s Maternity experience a chance to join forces and make their hopes for better birthing world a reality.  It enables all members to be involved in ensuring this happens. It allows true collaborative working and keeps service users involved in decisions made about women’s maternity care and that of their family. It’s a safe place where women’s voices are heard, valued and respected. A Women’s experience is its driving force for that reason I am proud to be part of such a dynamic committee.

Initiatives like ‘Walk the Patch’ enable all women’s voices to be heard regarding the maternity care they are receiving. These voices from the community can then be filtered back to senior levels and actions are derived to improve the service as a result. WTP also gives the chance for those HCP that are providing truly women entered care the recognition they deserve.

I joined the MSLC after feeling very let down buy my personal maternity care. I knew I had to help change things for other women. Being part of the MSLC has enabled me to do that from the inside out. The work we have done and the wonderful HPs I have worked with has helped to restore my faith and feel empowered by being part of making change happen for others.

I hope that MSLCs get the recognition and support for the amazing work we are doing across the country. All that give up their time, do so because they are passionate and dedicated. MSLC’s should be mediatory for all trusts. How else can you ensure a woman centred service is given without women voices being heard in order to influence that service?”

Refreshed guidelines from NHS England, due for imminent publication, call for MSLCs to be run, maintained and funded by the CCGs. This is much needed, because in the current economic climate many MSLCs are fighting for modest but essential funding to continue the collaborative work they are doing. In addition, due to the unique nature of these committees it can be difficult for the commissioners to work out a mechanism for funding.

It is against this background, while MSLCs are struggling, that Julia Cumberlege, chair of the National Maternity Review, urges women in her introduction, “play your part…for your family and community … voice your opinions” as quoted at the top of this blog. MSLCs provide an ideal forum for service users to do just that. They are the ‘best practice model’ for shaping the future of our maternity services.

A petition has been started to emphasise the need for MSLCs in all areas. Please consider signing and sharing this petition so that MSLCs can continue the vital collaborative work they are doing at a local level, with volunteers’ expenses paid and commissioners everywhere listening and learning. https://petition.parliament.uk/petitions/121772

If you are not already involved with a local maternity group that feeds into an MSLC – or the MSLC itself, search online to see what you can find out about local provision. Contact your local CCG, your head of midwifery, local Healthwatch, or any pregnancy and parenting groups, such as the NCT and find out what’s happening. You can find out more about MSLCs at https://www.nct.org.uk/professional/mslcs

Laura James

Chair, Bromley MSLC

2016

Facebook: http://www.facebook.com/bromleymslc

Twitter: @BromleyMSLC

Share the Word About MatExp!

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.

MatExpblogbadge

 

Share the Word About MatExp!

What Does #MatExp Mean To You?

I had the privilege of hosting one of the weekly #MatExpHour Twitter chats last night, on the topic of “What Does #MatExp Mean To You?”  We had already received some thoughts on this topic via the #MatExp Facebook group, and I couldn’t wait to hear what answers we had from the gang on Twitter. I was not disappointed.  This campaign that Gill and Flo started has become something more than I think any of us could have imagined.  It is with much delight that I share with you what #MatExp means to those involved.

Those who couldn’t make the chat were keen to get in their thoughts in advance:

Helen Green

Sheena

STARFISH

Emma Jane Sasaru: “To me it embodies what I believe can happen when everyone works together to support families. It means that while many say we cannot improve things we really can. Helen Calvert and I always refer to the starfish story because if we all just make small changes they add up to big change. Always believe you can make a difference because you can.
Personally #MatExp has helped me so much. As many of you know I had PTSD from a terrible birth experience and poor care. #MatExp has given me hope that we can prevent this happening and we can make sure that families are treated with our ‘heart values’. It has helped in my healing, enabled me to meet some amazing people, make changes in my local trust and also further my work to raise awareness around perinatal mental health.
What I love is the passion, the genuine want to improve things for families and the fact that it comes from the heart. Any of you that know Gill and Flo will know this is be true. Thank you everyone and remember you can be the change you want to see.”

Gill Phillips

Gill was worried about the limitations of Twitter when it came to explaining what #MatExp means to her, but started by sharing this article from The Edge.  You don’t have to ask for permission to make change!

Flo

Cathy Brewster: “What I love about #MatExp is the coming together of people from diverse backgrounds. As a parent I have been able to directly talk to midwives, obstetricians, commissioners, researchers, MSLCs etc. about homebirth and have gained unique perspective and insights from them all. And I hope they may have gained something useful from me too. #MatExp certainly made it easy for me to get our homebirth posters out there and it is wonderful to see them being used all over the place. The other thing I love about #MatExp is that it’s a platform for learning. It has opened my eyes to so many new maternity issues that I knew nothing about. So a big thank you from me to #MatExp”

Sue

Flo2

Action

Jeannie

Jude

Surbiton

Susanne

I had shared some wonderful blogs in advance of the chat, this one from Emma Jane Sasaru “Why The Wonderful #MatExp Has Given Me Hope”, and this from Victoria Morgan “Reflecting on #MatExp and the Impact it is Having”.

A bit more from Facebook:

Georgie

Lucy Ruddle: “I found it really useful when I was pregnant, to discuss the choices I had and why certain things were offered / what various hasty discussions with HCPs actually meant etc. So pretty much, a really useful source of good information.

Gill Skene

Anna

Anna2

Bronwen

Gill Stellar

Read Gill’s Stellar story here!

Sarah

Louise

Bronwen2

Surbiton2

Susan Parker: “Even though I haven’t been involved for the longest time, for me it’s about parents being able to share their stories and for HCPs to be able to listen and reflect. It’s about sharing information and collaborating. And at times it’s about having a bit of a debate about a certain topic – which is of course a great thing to listen to a different viewpoint that you may not have considered.
On my radar were things like compassionate care, mental health and a mother’s choice. But my eyes have been opened to way more than that because I hadn’t previously experienced those issues, but I can talk to women who have and learn from them. I feel a blog post coming on (but maybe at some point in the future!) would love to do more with #MatExp.”

heart

Edie

Mandy

Sally

Michelle

Michelle’s wonderful blog post about what the Bromley MSLC #WhoseShoes event meant to her can be found here. And Bromley MSLC had got their thoughts in ahead of time:

Bromley

MSLC

Greenwich

Susanne3

CofC

Lemons

What is is about lemons?!  Find out here.

Flo4

Have you seen Flo’s amazing Lithotomy Challenge? Read about it here. Amazing to see the people who got involved!

Digity

Natalie Finn: “For me it’s knowledge, understanding, support and passion. As an aspiring midwife, I want to extend & broaden my knowledge and there truly is a wealth here. As a mother of 4, I have knowledge of pregnancy/labour/birth, but simply from my perspective and reading others experiences, feedback and action taken interests me immensely. To be a well rounded midwife, I feel I need to see things from all aspects and perspectives, the mothers/families most importantly. Equally my entire maternity experience has been wonderfully positive largely down to having the same wonderful midwife for 6 pregnancies, 2 losses and 4 births over the span of 8 years!! I’m passionate about normalizing birth as a whole as well as home birth, breastfeeding (despite being a reluctant bottle feeding mum!), continuity of care. I also value the level of passion and support shown in this group. No question is too difficult, the cup of #MatExp runs over with understanding and it’s rare to find a community such as this that just so NICE!

Rita2

Gill

Gill2

JFDI

JFDI2

JFDI3

JFDI4

Look what happens when you JFDI! I didn’t ask permission to do the #MatExp Survey!

Michelle2

Jenny

Deirdre

Gill Phillips made this wonderful film which also demonstrates what #MatExp means to her.

At the end of the day it’s all about women and families.

Rita

Because some things never change.

Ur

What does #MatExp mean to you?

cropped-cropped-matexp.jpg

Improvement

TeamWork

MatExpblogbadge

 

 

 

 

 

Share the Word About MatExp!

Women’s Voices in #MatExp – Your Midwife

I was asked to do a talk to student midwives at Salford University last week on the topic of “Women’s Voices” in maternity care.  As part of my presentation I included the voices of the midwives who work in maternity care, and a reminder that there are many other women for whom maternity care is their professional, as well as perhaps their personal, experience.  “Women’s Voices” in maternity care should cover the midwives, obstetricians, health visitors, doulas who care for us, as well as the women giving birth.

So I decided to start a series of blog posts on “Women’s Voices in #MatExp” from the point of view of those working in maternity, and this is the first of those.  This is Dawn Stone’s experience of being a midwife in the NHS.  Thank you so much to Dawn for agreeing to write for us.

And yes, I will be doing a “Men’s Voices in #MatExp” series too.  Because this campaign is about all voices.

Helen.x

*********************

Dawn Stone is a 27 year old midwife living and working in central London. Dawn qualified as a midwife in 2014, and is passionate about improving experiences for students, midwives and women.

Dawn Stone

It’s an insignificant Monday afternoon in SE London to many. It’s beautifully warm, people are rejoicing in beer gardens as they finish work, I hear the giggles and shrieks of laughter from a nearby park as I walk home. It’s an idyllic summers day; and yet somehow it feels cold to me.

I’m on my way to see my GP. I made the appointment last week, but it feels fortuitous to have this lifeline today. Because today, of all the 303 days I’ve been a midwife, it feels way too much to bear. And I need some help.

I’ve been here before. A few months ago the feelings on inadequacy, frustration and disappointment reared their ugly heads and I made the same journey to my GP, begging for help. She, to her credit, was wonderful but the medication she prescribed was not. I went back to work but felt like I was going through the motions. My appetite was reduced, I hadn’t slept a whole night in months, and I constantly had a knot of tension in my stomach whenever I thought about work.

What do I do? I’m a midwife. And it nearly knocked me off my feet completely.

I trained as a midwife in a busy central London hospital, which often felt like a baptism of fire and was definitely not what I was expecting. I was lucky to witness amazing births, incredible women, and unfortunately, at times, disappointing midwives. It seemed as though some had lost the ability to care about the women as well as for them; and so I qualified with a goal. Be the best midwife I can be, and never forget the power and importance of being kind. It sounds so simple when you write it down!

Upon qualifying, I moved to another busy central London hospital, and began working as a bona fide midwife, alongside a group of also newly qualified midwives who would become my lifeline. Together we jumped into this chaotic and intense career, and discovered that being a student midwife does NOT prepare you for being a midwife. Not at all. You have no idea as a student the enormity of every decision you make – that lochia is normal, that baby is not jaundiced, that baby is unwell and needs an urgent review. And on and on it goes; a hundred different decisions, all before lunchtime and all before you’ve had a drink or something to eat. And if you’re lucky, you’re figuring this all out in an environment which is supportive and conducive to learning, where you know you have more experienced midwives to lean on and ask ‘Does it get better?’

If you’re unlucky, you’re essentially told to suck it up and keep going. Never mind that you’re awake at 4am going over and over the shift from yesterday, thinking about each woman and baby, and what you handed over – did you forget something? You definitely did. Shut up mind, go to sleep. Except you definitely did forget something because you did a blood sugar on the baby in bed 9 before you left and you forgot to write it down. It was normal, thankfully, but should I ring? No. It’s 4am and it’s your day off. Go back to sleep.

Working on a busy 50 bed AN/PN ward can feel like being on a carousel that’s spinning and spinning; there is no slowing down, only jumping on, and trying to stay upright and facing the right way.

When I arrive for my night shift, I look at my workload and I hope for an okay night. I have a mixture of 2 high risk AN women (for close monitoring of their severe PET), an IOL for post dates and 4 PN mums & babies – all of them are on obs overnight, 1 mum is also on IVABX for sepsis, and my colleague has just handed over that one of the babies hasn’t fed for 6 hours. I take a deep breath, try to quell the tide of worry that’s swirling in my stomach, and do the only thing I can do. I make a plan. I read the notes, I look at the blood results, and I try to prioritise what needs doing and when. I say hello to all 7 women, some of whom I know, and I begin to do what needs to be done.

And I’m sorry if I couldn’t sit with you longer during your breastfeed. I can see your baby is feeding well but as a first time Mum you need some support and guidance as you learn this new skill. I want to sit with you, and gently reassure and reaffirm you as you confidently latch your baby to your breast. But I can’t. Because I have 6 other women, and 3 other babies who need me. So I do what I can, and then ask a maternity support worker to step in, and do what I cannot.

I’m sorry my checking on you and baby felt like a list of questions, one after the other, relentlessly. I know this isn’t the best way to elicit how you feel about this huge shift to parenthood, and I may not ask the question you need me to, and so your niggling worries remain unchecked.

I’m sorry I have to wake you at 2am, and 6am, to check your blood pressure. The medication you’re on to manage it is very good but we need to ensure its effective, and the middle of the night BP is actually one of the most useful. I hate waking people up, and I know you don’t mean to swear at me as you grumble and sigh, before brandishing me your arm, but it still hurts to hear. Thankfully your blood pressure is normal, and I can tiptoe out & leave you to rest.

As I walk past the desk, I see my bottle of water, next to my colleagues. All untouched.

I’m sorry you’re in a mixed bay of women, and you can hear babies crying as your labour is starting, and it’s not dark or quiet as you need it to be. I’m sorry you’re quietly sobbing on the edge of the bed as you try to get through this contraction without making too much noise and waking the sleeping bay. I’m sorry I can’t be with you, talking you through your contractions and helping you to relax and reduce the fear/tension/pain cycle. I know that you need me, but I have obs to do on 2 of the babies in this bay, and I need to check on one of women with raised BP as she’s on the monitor and I hope it’s ok as I had to dash out of the room once it was on. I’m sorry I’m only half with you as I rub your back, as I’m juggling my outstanding jobs in my head. Thankfully, some codeine and a warm baths eases some of your pain, and you spend a few hours soaking in there, feeling much more relaxed.

I’m so relieved.

I’m so relieved that your labour didn’t progress rapidly, and your baby wasn’t born on the ward.

I’m so relieved all of your babies obs were normal, and they didn’t show signs of an infection.

I’m so relieved that the heavy bleeding you complained of turned out to be normal blood loss, and you’re not having a haemorrhage.

I’m so relieved your blood pressure was normal, and you’re not feeling any symptoms of pre eclampsia.

I’m so relieved when you come to me at 4am, as I sit at the desk gratefully drinking a coffee as I relish the middle of the night peace that’s descended, and tell me you latched your baby on yourself & it felt like a good feed.

I’m so relieved. I’m also hungry, and tired, and the water has remained untouched although I have slurped a coffee my colleague made for me.

This shift has been busy, and stressful, and required me to constantly assess, juggle and prioritise. But it’s not extraordinary. It’s a typical shift in a typical London hospital on any given day. The women are grateful, and I leave with a small sense of doing a good job.

Until I return the following night to be told I didn’t do a VTE risk assessment. And the dyad I helped with breastfeeding are now mixed feeding as she felt her baby wasn’t getting enough. And the mum who labour began during the night is still on the ward, awaiting a doctors review to formulate an ongoing plan. And we’re short staffed. And I can feel a headache coming on as I didn’t sleep well, worrying and replaying the previous shift over and over.

With such unrelenting pressure, is it any wonder I’m crying to my GP, telling her how unhappy I am, how tired, how morose? And is it any wonder she doesn’t bat an eyelid when I ask for antidepressants, and a sick note?

*********************

 #MatExp is a campaign about ACTION!  So what can be done?  We have already written about how it is Time to Act for Midwives, but as this recent post on Sheena Byrom’s blog demonstrates, these issues are not isolated and they are not yet being taken seriously.

NHS Maternity Review

Sheena kindly commented on what Dawn had to say:

“Dawn’s reflection of her experience trying to do her work as a midwife is distressing, and tragically, Dawn is by no means alone. I receive regular emails from midwives and student midwives who feel desperate, unable to go on, and ready to leave our profession.

I sincerely hope the National Maternity Review report will kick start the much needed radical reform of maternity services. If we can’t support, care for and nurture maternity workers to provide safe, effective high quality maternity care, we have an unsustainable situation.”

A mile in my shoes

Community Outreach Midwife Wendy Warrington also commented on Dawn’s experiences:

“This could have been written by me and the majority of my midwifery colleagues as accurate, and to be honest been there themselves me included! I came back to work after nearly 3 weeks off and Monday morning I had a knot in my stomach when I turned on my work phone and strolled into the community office. Fortunately all was well, but that was due to in the run up to Christmas ny starting early working at home, finishing late and putting written plans in place. Four women on my caseload delivered and I have high risk caseload due to safeguarding concerns.

In terms of improving the situation there needs to be a shift from the blame and bullying culture that seems to be prevalent within the midwifery profession and the NHS as a whole. Senior management with their expectations bully staff below them and this continues down the pecking order. Midwifery sadly is still very hierarchical. Also the public perception and expectation has shifted from when I first started. There does not seem to be the respect from the public as in days gone by . The “where there’s a blame there’s a claim” culture. Cuts to funding, staff shortages and the media have not helped.

Sadly I am counting down the days until retirement as are many of my colleagues.

So how to improve the situation?  As colleagues we should nurture and support one another, and small pockets of us do. I personally have found my escape using Twitter and Facebook groups. Realising there were others out there who felt and thought like me and had not had the passion snuffed out of them really helped me, and gave me the courage to continue and believe that I can make a difference as a midwife.  But than in itself can cause problems: cyber bullying, we have seen that. The more your profile is raised the more you expose yourself to scrutiny. I was seconded to Project Manager for Early Years agenda for Greater Manchester and the knives were out . I was devastated when my Head of Midwifery said that this was par for the course: try to better yourself and jealousy kicks in.

There are health and well-being initiatives in some trusts which need promoting. While we are there to do our work the public should remember we have children, elderly parents and our own problems like them, and sometimes we can’t leave it at the door as much as we try to, so compassion and understanding comes from both sides. I do not know of any midwife who comes to work to upset, harm or distress any woman or her family.” 

So what do we need to do?  What are you doing? What is happening in your Trust that is helping?  Please share best practice and ideas – we are stronger when we work together.

MatExpblogbadge

 

Share the Word About MatExp!

WhoseShoes Confirmed That My Shoes Have Climbed A Mountain

This post is from Michelle Quashie, and originally appeared on her blog site Strong Since Birth.  Our thanks to Michelle for agreeing for it to be reposted here.

Michelle

The day had finally arrived! After contributing to #MatExp and interacting with many conversations surrounding ‘WhoseShoes’ throughout the year, I was finally going to experience the magic in real life.

Laura, the chair of our MSLC has written a fantastic post that captures the excitement of the day perfectly, you can read it here: When WhoseShoes Came To The PRUH

I was not disappointed, the day was everything I had dreamed of,  but for me it was so much more.

I was asked to open the event by sharing my Maternity Experience. I have spoke at several maternity training events in the past but my audience has always been Midwives. I was aware that this was a multi discipline training event and it was to be the first time I would share my story in such detail with Obstetricians and everyone else involved in Maternity. The thought made me feel anxious but I knew how important this opportunity was.

I had planned to stay in control and not let the emotions attached to my experience be displayed in the form of tears. It was so important to me to remain composed and in control.

My heart pounded through the showing of the MatExp film, this film moves me every time. It is so powerful and very thought provoking. Sadly I can resonate with many of the situations displayed in the film. I knew I was about to be discussing some of those memories any minute with all those surrounding me.

My name was called and I made my way to the front with my heart pounding. I decided to be honest and share how I was feeling with the room.

‘Please bare with me, I am feeling very nervous. I’m sure once I start talking I will warm up and I will be fine!’

Automatically I felt more relaxed and felt more able to share my story without the anxiety overruling my thoughts.

Michelle1

It’s amazing how every time I share my experience it comes out slightly different, or I find myself saying things that I hadn’t thought of before? I had missed a couple of important bits out but neither the less I was very happy with the way I had presented and gauging by the feeling of emotion in the room I had touched the hearts of nearly everyone around me. For the first time I was able to keep my tears to myself even though I had noted that tears were shed by many in response. The room fell silent but the atmosphere spoke volumes.

I wasn’t aware of the tweets that were being circulated on social media but looking at them them later along with the emails I had received It confirmed that my talk was a positive part of the day.

Michelle2

“Also a massive well done to Michelle for her heartfelt and emotional story, I could see it touched many people as there were certainly a few tears in the room. That took huge courage to stand there in front of so many people and share such a personal experience and to tell it so well. Huge WELL DONE Michelle.”

We began to play the the game and interesting discussions were had in response to the thought provoking questions that are key to the WhoseShoes success.

Michelle3

Some of the discussions that stick in my mind were:

  1. A woman wanted a home birth but her husband wasn’t convinced. We had discussed that there wasn’t enough support or information given during antenatal care to ensure that the couple felt safe,supported and empowered to fulfil the woman’s birth choice.
  2. Consultant Obstetricians are normally addressed by other members of their team using their title i.e., Sir, Mr, Mrs or Miss as a mark of respect. I may be wrong but it feels hierarchical, unlike the power slogan and barrier breaker behind WhoseShoes and #MatExp ‘No Hierarchy, just ordinary people’.
  3. It was also discussed that consultants were on site until 9 pm, after that they are on call for emergency situations only. Now I understand why during my appointment to discuss my VBAC, the registrar said ‘ I mean, we don’t know when you will go into labour or who will be on duty should you rupture’. I now understand that my birth choices were  influenced by staffing levels at the hospital.
  4. Other key themes were Empathy, Language, supporting and facilitating informed decision making and just how important it was for everyone to be cared for individually based on their individual situation and needs.
  5. Midwives are able to have time to build a relationship with women whereas doctors are often called for the emergency situation and do their best to resolve the medical issue as it arises. This can sometimes make it hard for them to be able to connect with the woman that they are caring for and are not always able to fully appreciate the long lasting effects the experience can have on a woman.

The day was coming to an end and Anna gave us fabulous evaluation of our morning using the comments that came from the discussion at each table. It was fabulous to visualise the discussion using the graphic that Anna had been working on through out the morning.

Michelle4

We each made an individual pledges. Here is my pledge:

“To provide a platform for women to share their Maternity experience.  I would like to ensure that women’s voices are heard as part of training and development.”

Michelle5

I am currently planning a conference called ‘Women’s Voices’. More details will be available soon.

As the morning came to an end and people were leaving someone tapped me on my shoulder. I turned round and my tummy flipped. The face before me took me straight to a place of feeling vulnerable, feeling panicky.

‘Michelle it was me wasn’t it?’

Stood before me was the registrar that I had my consultation for my vba2c with. Unbeknown to my self and the organisers we had shared the morning. I had shared an experience that changed my life but had also been a time that left me feeling scared, vulnerable, isolated and questioning my mental health. The person that was responsible for those feelings was standing here in front of me, for a moment the feelings came flooding back, I battled to keep them contained.

Michelle6

She apologised for the way she had cared for me. She admitted that she had been wrong and has since ensured that she was fully aware of her professional guidance. She was now fully supportive of  women’s choice regarding their birth and ensured me that since having to write a statement in response to my complaint, she is fully aware of the impact of the care she provides a woman.

She actually thanked me for highlighting the error of her ways promising me it had changed her attitudes. I could see that she was overwhelmed with emotion and had spoke to me honestly. She asked if she could hug me and we both held each other for comfort.

I told her that I admired her for taking the time to come a talk to me and for apologising. I also explained that I was aware that she was not entirely to blame for the care I had received and I now understood that her response to me wanting a vaginal birth after two caesareans was due to the cultural belief of the trust she worked in.

It was clear that my birth wishes would not be supported and neither would anyone wanting to support me at that time. I know this because many attempts were made to provide me with the support I needed and no one stepped out of their comfort zone to provide me with the support I needed with regards me birth choices. As a result I had no choice but to transfer my care.

She empathised and promised me that as a result of my experience things were changing.

We said our goodbyes and I was trying very hard to contain my emotion that the meeting had evoked.

A consultant midwife that has walked by my side through this maternity experience and others and who has been a pillar of support to me came to see me. ‘Are you OK Michelle?’

The flood gates open and I broke down. I couldn’t talk at that moment. I was just overwhelmed with emotion. I couldn’t make sense of it at the time but now I think I can.

That meeting with the registrar brought some closure. I admire her ability to acknowledge the error of her ways.

The meeting took me back and reminded me of the scared women I once was sitting in her office, trying to persuade her that I could give birth, pleading with them to allow me. Feeling so horrible when it was highlighted that I had never given birth and they wasn’t sure if I could. I was subjected to a number of negative comments that effected my mental well being and left me questioning my sanity. Comments that left my family feeling unable to support my decisions in fear of my safety. it was a meeting that left me feeling isolated.

Here I sat after coming full circle with the same women but this time I was a different woman. I am a now a woman who has had the most amazing journey and have achieved some incredible things;

I gave birth, not only did I give birth but I bloody rocked that labour ward!

I came back and I told the story, I sang it from the rooftops!

I learnt to believe in me and my abilities.

I joined their MSLC and contributed to so many fantastic improvements within the Maternity service.

I have spoke at training events within maternity with an aim to improve maternity care for women.

I have written and had my views published here and in The Practising Midwife .

I have contributed to #MatExp campaign and connected with some fantastic people as a result.

I have met, received support and been inspired by many fantastic people. too many to mention.

The realisation that my shoes have climbed a mountain has happened!

I received the following email from a Consultant Obstetrician following the Whose Shoes event. It confirmed that this journey has been worth every little step:

“Dear Michelle,

I just wanted to reiterate how touched I was by your story and how impressed I was by the way you delivered it. You will be responsible for improving the practise of every obstetrician in that room today which in the end will improve the care of tens of thousands of women.

If anyone is amazing it is you!”

This is one of many mountains.

I hope to be climbing a mountain near you soon.

 

Michelle Quashie

2016

Share the Word About MatExp!

When WhoseShoes came to the PRUH

Whose Shoes® came to Kings College Hospital this week and wow did we step up to the challenge!

Print

Having observed the Guys and St. Thomas’s event in the summer of 2015, I knew we were in for a treat. I hoped and prayed that our event would generate a similar level of commitment that was felt at Guys, and I was not disappointed.

50 delegates, representing midwives, maternity support workers, doctors, commissioners, service users, receptionists, porters, health visitors and many other areas of maternity, streamed into the Education Centre promptly at 9:30. The day was introduced by Maxine Spencer, director of midwifery, who spoke about the day being a level playing field and that everyone was there as a mother, a wife, a sister, a daughter (or a father or son for the men in the room), irrespective of their profession.

6480.tmp

Having watched the “In their Shoes” MatExp DVD, during which you could have heard a pin drop, it was then the turn of service user Michelle Quashie to tell us her VBA2C experience. Again, everyone listened with respect and focus and there were tears from a few as she retold her powerful and inspirational story.

D6F6.tmp

After everyone had composed themselves, it was time for the game to begin. Conversations started off fairly hesitantly, but people warmed up and pretty soon it was obvious how powerful this day would be.

On our table discussions ranged from noise on the postnatal wards, to caring for staff and teamwork, how to support women’s feeding choices and the power of language. Everyone spoke in a respectful manner and was very honest and open. Conversations just flowed and, as a facilitator, it was wonderful to see how professionals often spoke from the heart as service users. Proof that birth matters to everyone.

Aldyth

The wonderful Anna Geyer from New Possibilities weaved her magic on the plethora of post-it notes being generated from the discussions and as usual created the most beautiful graphic.

Anna pic

Tweeting was fast and furious during the day, to the point where I thought my Twitter feed was going to explode! Here are just a few of the hundreds of tweets:

Maxine

AnnaGeyer

doulamie 2

doulamie 1

FabImages

AnnaGeyer 2

WhoseShoes

Eventually, after a couple of hours, the discussions were brought to a close and Anna gave us her evaluation of the day, drawing out some of the points that we had raised.

Michelle Quashie

Environment

As chair of Bromley MSLC, I was delighted to see the weight attached to having a strong, powerful MSLC as a voice for service users and professionals alike.

Stronger Voice

Then it was time for the pledges. Each individual was invited to pledge one thing that they would do differently as a result of attending the morning. Spontaneously, everyone clapped and cheered as one pledge from each table was read out. I haven’t had time to go through them all yet, but here are a handful that stood out:

I will try to make every birth special (in theatre especially)”

I will not use the following words: allow, only and let”

To try and make the ward round more personal, friendly and positive and a respectful experience for the woman and her family”

To always ask how the new father is as well as the new mother”

I will facilitate a “good news” newsletter and encourage all staff to submit thank yous and nominate staff for good support”

I will ensure that I always remember to update the woman and relatives on what is going on”

I will make sure that every woman feels had the attention and care she hoped for”

I will always say hello and congratulate all new parents on the ward”

I will continue to facilitate named midwives (and ensure that) a woman sees her named midwife at least 4 times during her pregnancy.”

To provide a platform for women to share their maternity experiences”

What now?

The Bromley MSLC has gathered together all these pledges, which will form our work plan for the next 12 months or so. We intend to monitor and check that they are being implemented. Amazingly, by the time I’d returned home and fired up my computer, one staff member had already emailed her colleagues to initiate the first “good news” newsletter. THAT is MatExp in action!!!

The other email in my inbox when I returned was from a service user who had attended the day. She asked me to share this with other members of the MSLC. She said:

I just wanted to express my thanks and congratulations on your amazing achievement on getting today’s ‘Whose shoes’ event to actually happen and to everyone else who was involved in organising this outstanding event.

What an absolutely amazing experience it was and so refreshing to see such a mix of service users and professionals all come together, to share knowledge and stories and all with the same goal, of making a difference to our maternity services.

I thoroughly enjoyed the morning and could have easily carried on for the rest of the day!!!

As discussed today on my table, people are very quick to complain, but never quick to praise so I thought I would come home and express my feelings and give my praise. 

So thank you and I will see lots of you at the MSLC meeting next week. Really looking forward to seeing what the year ahead holds now we have our pledges to work with!!

I was fairly certain we were in for a special day, but I was overjoyed to feel the tangible buzz and energy created in the room. It was a privilege to witness how something so simple; getting professionals and parents together to talk about improving maternity services in a compassionate, respectful manner, can have such an impact. From the number of comments I’ve had flood into my inbox in the last 24 hours, I think its safe to say that everyone came away feeling fired up and committed to making local maternity services the best they can possibly be. I know it renewed my enthusiasm to do just that.

Oh, and one final thing. I think we raised the stakes of the #MatExp #bakeoff challenge!

bake off 2

Laura James

Chair, Bromley MSLC

2016

Share the Word About MatExp!

2016 Starts Here!

Personally I have had a bit of a Christmas and New Year break, but of course #MatExp never sleeps!  There have been plenty of blogs, new ideas, events planned and meet ups occurring all over the festive period.  We have had new people join the Facebook group, new ideas suggested for #MatExpHour and lots of us are speaking at events around the country in the coming weeks and months.

It seems five minutes since the fantastic #MatExpAdvent initiative came to an end, but here we are on the eleventh day of 2016 and I need to dive back in as otherwise I’ll be left behind!  This wonderful round up from Gill Phillips inspired me this morning to get back on the crazy horse…..

 

Our last #MatExpHour before Christmas, led by the wonderful 23weeksocks, was on the topic of Taking #MatExp Into 2016.  There were some excellent suggestions for actions and initiatives, so let’s take a look and then get cracking!  What would you like to do?

MSLCs

The NCT has developed a new practical guide to running an Maternity Services Liaison Committee (MSLC), “From Good Practice to Trouble Shooting”.  MSLCs are a big part of #MatExp, and there are some exciting WhoseShoes #MatExp MSLC events coming up very soon!

Bromley MSLC

Kings MSLC

Are you already a member of an MSLC?  What has your group got planned for this year?  Is there an MSLC in your area that you can join? Definitely a lot going on around the country – let us know how #MatExp can support your MSLC, joining hands around the country!

BerksMSLC

Rachel

Groups

It was also suggested that #MatExp could work more closely with the fantastic 1001 Critical Days campaign.

1001CriticalDays

1001CriticalDays2

Are you involved with this project?  How can #MatExp best support the campaign, and vice versa?  Do you have some fresh ideas about the conception to age 2 period?  We have many Health Visitors involved in #MatExp and their input here will be invaluable.

The next suggestion was harnessing the power of the next generation of midwives via the country’s Midwifery Societies.  Are you a member of a MidSoc?  How can you collaborate with #MatExp?  Could you host a WhoseShoes event?  Do you have events coming up where #MatExp could be represented?  What is on your agenda for 2016?

MidSoc2

MidSoc

My aim for 2016 is to try to take #MatExp to those not on social media.  How do we engage with healthcare professionals (and parents) who are not on Twitter and Facebook?  Looks like we will have to resort to good old fashioned pen and paper!  Or at least keyboard and printer.  Who in your trust would you like to tell about #MatExp?  Get in touch and help me to spread the message further!

pen and paper

Blog6

The big thing we are all waiting for is the report from the National Maternity Review.  At the Birth Tank 2 event Baroness Cumberlege had hoped that it would be published on 31 December 2015, but unfortunately it is not yet available.  Once it is here we can get stuck in with implementing recommendations at a local level.

Blog1

Blog2

Blog3

And what else have people suggested?  #MatExp is about all voices, everyone getting stuck in doing what they can, when they can, where they can.  A few more ideas to get you inspired:

Blog4

Blog7

Blog8

Blog9

Blog5

Anyone wanting to order #MatExp stickers and other resources can do so here.

What’s your plan?  What is happening in your area?  What needs to be done?  What can be built upon?   Who needs to be involved?  What small things can you do?  What BIG things can you do?  Whatever you are up to remember to tell us on Twitter at hashtag #MatExp, join in on Facebook, comment on this blog post, send us a message by carrier pigeon, write it on the sky…..  The #MatExp train is steaming down the track.  All aboard for 2016!

 

Helen Calvert

@heartmummy

2016

 

Share the Word About MatExp!

Ready, Set, Go! #MatExpOnTour

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

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

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

Let’s get on the road. All aboard!

Tour Bus

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

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

Basic Google Maps Placemarks error: JavaScript and/or CSS files aren't loaded. If you're using do_shortcode() you need to add a filter to your theme first. See the FAQ for details.

Share the Word About MatExp!

1 2 3 4 5