As we reach the middle of #FlamingJune I have been thinking about the week I’ve had. To be honest it has pushed my multitasking abilities to the limit: I have had a number of big events to attend or speak at, as well as the day job of being a divisional director at Kingston and a clinician seeing and caring for women – and this is before I even consider my husband and daughters.
Amongst all this I sometime wonder if #MatExp is really having an impact, or have I just got carried away.
It has been a tricky week for others too. The more people know about #MatExp and what we are trying to do the better, but this comes with pressure and also criticism.
It is hard to understand that this is an organic grassroots project with a direction and mind of its own. No one is ‘in charge’ and it is richer for it.
This was brought home to me at the London Maternity Strategic Clinical Network event held on Wednesday. The five pilot sites who had held a #MatExp ‘Whose Shoes’ workshop presented the action they had taken as a result and I was overwhelmed by the diversity of actions taken and the determination with which people had followed through in a multitude of ways.
Devolved leadership and true collaboration with women has been our hallmark from the beginning but I was bowled over to actually witness the results of all the actions gathered together in one place and to recognise how powerful the outcome of the workshops was.
At the same event we launched our ‘Maternity Experience’ film. It was a tense moment, it is so difficult when you are knee-deep in a project to step back and see it afresh and I wasn’t sure how others would find it. I so desperately wanted it to to be true to the workshops and #MatExp conversations we have had over the months.
Fortunately on the whole it seems to have rung true and be a success, which I hope will power more thinking and questioning on a daily basis of ‘why do we do it this way, what could we do instead?’
Rounding off my week I have had the small matter of conversations with the leadership of the Royal College of Obstetricians and Gynaecologists (RCOG) about how they could help, and a flying visit by Helen Bevan to Kingston on Thursday when she said ‘there was lots going on #MatExp yesterday, I got tweeted your film about 15 times!’.
It’s a roller coaster ride but I wouldn’t have it any other way. Each time I have a doubt something happens that reaffirms that however small , changes are actually happening. Just yesterday a midwife at Kingston told me her pledge from our October workshop will be completed next week. She has stuck with it through barriers and blocks and seen it to completion and that desire for action, that is what #MatExp is all about!
It’s nearly a week since lighting the fuse and setting off #FlamingJune with a bang. We launched our website and we are starting to see that ripple of action as a result as well as trying to draw on existing events and plans that we knew were happening in June.
It is getting people’s attention – perfect, just as we hoped! We are being quoted and used as an example, as a change platform, a campaign it’s awesome!
But in some ways we are victims of our own success we are just that bit too innovative and cutting edge so it is hard for people to understand just what we are.
We are not an organisation, we are not employed to do this, we have no funding, we have no rules or structure.
We are quite simply people. People who are like minded, people with initiative, people who see the need for change and want to enable it to happen by bring ideas together and encouraging action.
Some of us it is true are NHS employees however this work is not in our job description we are doing this in our spare time round busy day jobs and home life. Many of us are juggling this with other jobs, small children, home commitments, life… the thing that unites us is a passion and an energy to keep improving maternity services.
So if I were to define us, we are an ever growing fluid and flexible movement of people who want to enable change and improvement in maternity services.
There are no rights or wrongs, no one needs permission to join in, we are leading by default because we happened to step forward.
There is plenty more space for people to step in to help. The key message is to value and respect all views; encourage airing problems to find solutions and we will endeavour to help and support those who can and want to jump on board as best we can.
We have a lot of exciting days to come in June & beyond. Bring it on!
June is our month of ACTION for the #MatExp campaign! All actions big and small are welcome and very valued.
Actions don’t need to be huge or onerous. They could be something you’re already doing. For example, my action focuses on bereavement support for parents who have lost a baby. It is an extension of my blog, and the work I am already doing as part of Hugo’s Legacy.
Your action could be as straightforward as telling everyone you know about #MatExp, and encouraging them to get involved.
If you’re a health professional, it could be something as simple as making sure you always say #hellomynameis. Or, your action could be doing something differently based on feedback from a woman in one of the #MatExp social media channels.
It doesn’t really matter what your action is. Your action should just be something that is relevant to YOU. It should also be something that feels manageable and achievable.
We all have busy lives. Like with any change, to be sustainable it needs to be part of your life, not in addition to it.
You may have seen some comments from folk saying they want to do more, and that’s brilliant. But please remember that is pressure they are putting on THEMSELVES. We think it would be brilliant if everyone made an action, but there is no pressure from us.
There is also no pressure to do the action during June. #MatExp has already achieved so much, and generated so much activity since its official launch at NHS Change Day in March 2015, we have designated want to maintain the momentum. Dependent on your chosen action, it might be something you will do every day, or it might be something it is difficult to put into action for some time yet. Throwing a few clichés around, Rome wasn’t built in a day, and remember how you eat an elephant: in small chunks!
#MatExp is a grassroots movement – that is, it’s led by us all. No one is ‘in charge’ as such. That means you don’t need to ask anyone for permission to do an action (caveat: dependent on your action, of course: you might want to get permission from someone in your organisation if your action involves something like moving a ward!).
Do share with the #MatExp community what your actions are, or about the actions you’re thinking of making, though. That’s not just because we’re a nosey bunch: by sharing our thoughts, we can collaborate by contributing different ideas from our own experiences and expertise. By doing that we can help each other out, and potentially make an even greater impact.
We have seen from our discussions on Twitter and in the Facebook group that discussions around actions create all sorts of lightbulb and penny drop moments.
Tweet using the #MatExp hashtag
Join or start a conversation in the #MatExp Facebook group
If you have a blog, you could write a post about the action you are thinking of making, or have made, and add it to our linky
If you don’t have a blog, you can tell us about your existing or proposed action through this contact form
You can also share your action by taking an action selfie and sharing it on social media. There is a template you can print out on this page.
Here’s my selfie!
Together we are stronger.
There are no right or wrong answers!
Don’t worry if your action seems ‘too small’. No action can be too small. There are no points to be scored, no prizes to be given – and that’s not just because this campaign is run on zero budget – scores are not what #MatExp is about. Making an action that impacts on even one person is amazing, valued, and very worthwhile.
You may have heard of the starfish story:
We hope that makes sense. If you need any guidance or would like to do some brainstorming or have ideas you’d like to share, please do throw it out to the #MatExp community – on Twitter, Facebook, or by looking at some of the ideas on this site. The principle that underpins #MatExp is identifying and sharing best practice across the nation’s maternity services.
There is no false modesty involved when we say we are making it up as we go along – we really are. And that means YOU can help influence the directions #MatExp takes.
It was on 12th May that Leigh Kendall and Helen Calvert thought about starting a Facebook group for the #MatExp campaign. JFDI and all that, the group was started two days later. Three weeks in and we’re at 450 members. You’ve got to love this campaign, nothing happens slowly!
The group is administrated by Emma Jane Sasaru, Helen Calvert,Leigh Kendall and Susanne Remic, and is the Facebook outlet for a campaign that has already gained huge momentum on Twitter. Florence Wilcock, the obstetrician at Kingston Hospital who started the campaign, has always wanted it to be focused on ACTION and this theme is central to the group. Each day a member of the admin team starts a thread on a chosen topic with questions/talking points and a request for actions that families and birth professionals can take to improve maternity experience in this area. We ask that actions are S.M.A.R.T.
Florence and Gill Phillips have a Month of Action planned for June, so we had originally hoped to do a blog post at the start of June detailing the actions put forward so far by the Facebook group and asking that people get involved. The snag is there have been so many fabulous actions put forward already on a number of important topics. The topics are being chosen in alphabetical order as a nod towards the #MatExp ABC that provided so much impetus on Twitter, and we are so far only on “H”– already the actions are numerous and thought provoking.
So we have quickly realised that it might be better for each of the admin team members to do individual blog posts on the topics that they have introduced to the group. These posts will start to come through soon, but for now we still wanted to give you a flavour of the suggestions and we hope that you will join us on Facebook or Twitter (or both) to get involved.
The actions that have been suggested on each of the threads can be divided into two categories:
Immediate – just get up and do it actions that anybody can take, here and now. These tend to be small things but they can still have an impact.
Long-term – group actions that require input and buy-in from different places and will probably require campaigns of their own.
Both are very important to the campaign. There are big issues that need to be addressed in maternity care and the NHS Maternity Review is looking at these right now. We are hoping to work with the review panel and to share our ideas with them. But we also need to remember that simple acts of kindness can change the experience of anyone with whom we come into contact. Sharing a piece of information could send someone down a different path. Signposting to a service could make the difference for that individual. No one needs to sit back and wait for a bandwagon to jump on. We can all of us get up and act today.
So what has been suggested so far? Here is a snapshot of some of the topics we have discussed:
A is for Anxiety
Immediate actions –
Anxious mums to use hypnotherapy techniques in pregnancy
Be honest about your anxieties and find out as much as you can on how to manage them
Midwives please ask mums about their mental health throughout their pregnancy, not just on booking in; anxious mums to look into mindfulness techniques
Long-term actions –
All health visitors need training in identifying and supporting pre and postnatal anxiety
Subsidised doula provision for anxious families
Continuity of care for anxious families
Refer anxiety sufferers to specialist mental health support
B is for Bereavement
Immediate actions –
The most important immediate action can be done by anyone, anywhere, anytime – acknowledge the baby the parents have lost. If you know the baby’s name, use it. If you don’t know the baby’s name, ask. Take the parents’ lead on whether or not they want to talk about their loss. Try not to worry about saying the ‘wrong’ thing. The worst thing you can do is to skirt around the subject, or ignore it completely. To do so insulting and upsetting to bereaved parents.
Long-term actions –
Clear, concise, sensible, and up-to-date information to be provided to bereaved parents when they leave the hospital after the death of their baby. Parents need reassurance about the emotions they are likely to feel, and a few pointers about how to navigate grief, especially during the raw early weeks. The information also needs to clearly state how the parents can access appropriate support as and when they are ready.
Access to counselling support. Too many bereaved parents have had to fight for the counselling and psychological support they need – or have gone without. Some hospitals do offer counselling services: hospitals need to make clear to parents that this is available, and how to access it. Funding issues mean that not every area is able to provide these services, but charities thankfully do exist to fill the gap. Hospital and GP practice staff need to know what support is available locally so they can signpost parents appropriately, or where appropriate make referrals for them. Leaving bereaved parents to source their own support at a time when they are least able to have the tenacity to deal with ‘the system’ is unacceptable.
Training in bereavement care for health professionals. Surprisingly, many don’t receive this as standard practice. The vast majority of health professionals are caring individuals, but a lack of appropriate training means many are unsure about how best to deal with bereavement, which may lead them to saying things that are less than helpful to parents. What is said to parents at this sad time stays with them forever, so the importance of this training cannot be underestimated. This training should be extended to all staff involved with maternity/NNUs (including admin, housekeeping et al) to help prevent unnecessary upsets.
Debrief/support to care for the needs of maternity, obstetric and NNU staff after the death of a baby. These staff are deeply affected by the loss of a baby in their care.
B is for Birth Trauma (families)
Immediate actions –
Use of language when discussing birth trauma with families- lots of women have felt their feelings were dismissed, or that they were being ‘silly’. Women also felt that they had failed. Language in notes also very important.
Immediate debrief after a traumatic birth; women felt that they were discharged and sent home without having the chance to talk through events.
Communication- tell women and their families what is happening and why.
Long-term actions –
Birth trauma support groups for women to access after a traumatic birth.
Birth reflections and birth trauma counsellors to be accessed for as long as women and their families need them. Trained counsellors to support, and health visitors to be able to signpost the necessary services too.
Better recognition of PTSD following birth trauma and better support for dads too.
Emotional support for women in subsequent pregnancies.
Ensure that women know how to access appropriate services following birth trauma.
B is for Birth Trauma (midwives)
Immediate actions –
Make sure your colleagues know that they don’t have to “cope” – it’s okay to admit that they have been traumatised by a particular birth experience
Ask if your Trust has guidelines in place for supporting staff after a difficult birth.
Long-term actions –
Stringent debrief sessions put in place for each instrumental birth and any birth that is not straightforward
Tackle trauma that accumulates from seeing the same things again and again – e.g. vaginal exams with inadequate consent, instrumental deliveries without compassion, loss of autonomy and consent.
C is for C-sections
Immediate actions –
Skin to skin in theatre.
Ensure that women are supported in their decision to have a c-section and help them to write a birth plan to feel empowered during surgery. Discussion of gentle c-section options.
Help women to find comfortable positions to breastfeed.
Long-term actions –
Identify reasons for c-sections and look to see where these can be reduced.
Educate women during subsequent pregnancies, ensuring that up to date information is given with regards to VBAC. Ensure access to VBAC clinic is given.
Better patient leaflets with more information on what happens during surgery and what recovery is like.
Debrief from surgeon on how the c-section went and how subsequent pregnancies are likely to be affected.
Better support for women after an emergency c-section.
Provide emotional support and/ or counselling after a c-section for women who require it.
C is for Complications
Immediate actions –
Communication was a common theme in the responses in this thread. Women – especially those who experienced complications around the time of the birth of their baby – wanted professionals to explain what was happening. Not knowing what was happening, and why, added to these women’s anxiety. Women (and their birth partners) need to be told as much as is appropriate at the time what is happening and why, in simple language.
Health professionals need to remember that consent is still vital!
Explain everything – as a health professional, certain things that you consider routine may be daunting or scary to a woman in your care. Make sure you explain everything that is happening, and be patient if they need the information to be repeated – it can often be difficult to take things in when you are in a crisis situation.
Long-term actions –
Information: there is a lot of difference in the quality and content of information pregnant women receive from hospitals and community midwives. It can create confusion, especially combined with the wealth of information available from charities and the internet. While the internet can’t be controlled of course, it would make sense for hospitals nationwide to have consistent leaflets from a central source, with the ability to personalise information as appropriate.
Connected to this point, knowing how much information to tell women about complications is difficult. We want them to know enough so they can recognise symptoms if they appear, but not so much they are stressed and scared. The balance is hard to strike. To compound this, there are women who do not attend antenatal appointments so are unable to receive this information.
For A&E staff to be better aware of pregnancy complications, and to consult maternity/obstetrics staff when needed.
For women to be proactively contacted when pathology (blood/urine etc) tests come back with warning signs, rather than relying on the woman to remember to phone for results.
C is for Continuity of Care
Immediate actions –
Managers to talk to the independent midwives and social enterprise midwives who are knowledgeable in how case-loading can work
Look at the Streatham Valley midwifery team in London for a working model
If a woman is not receiving continuity of care, please ensure as a birth professional that you read her notes thoroughly and write good notes for the next person she sees.
Long-term actions –
We need strong leaders at the helm of Trusts who understand how to lead midwives towards the implementation of continuity of care
June is not going to be dull…! For me personally, this is a big week – I am looking forward to speaking at the NHS Confederation Annual Conference on Wednesday. The session I am involved in, chaired by Dr. Mark Newbold, is about urgent care of older people. The emphasis of my contribution is around prevention, holistic approaches and joined-up systems, ensuring that life is not over-medicalised – the simple things that make life worth living.
@WhoseShoes Not a fan of capitals usually as you know but forgot v imp message DO SOMETHING ABOUT (scandal of) NHS CONTINUING HEALTH CARE.
Mum, known on Twitter as @Gills_Mum, is extremely interested in my talk and threatening to write a blog of her own…
Preparing my presentation brings home yet again the parallels and key themes across all areas of my work. Hardly surprisingly really as we are all people; aspirations, hopes and fears and the desire to have control over our own lives do not suddenly change just because we get older.
Today starts the month with a bang.
Our #MatExp campaign, to improve the maternity experience of women everywhere, goes up a gear.
For anyone who has been twiddling their thumbs and wondering what to do with themselves since the end of the #MatExp alphabet (yes, we know who you are!), you will be delighted to know that June is a month of action!
#MatExp #FlamingJune – we are just waiting for the weather to catch up … although perhaps it is just as well it is a bit cool outside or the energy burning in this remarkable grassroots campaign might just start some forest fires!
Sheena Byrom is an extraordinary woman. As her action for June, she is posting blogs from individuals who have information to offer to the new team set up to conduct a national review of maternity services in England, led by Baroness Julia Cumberlege. We all feel passionately that this new review team needs to engage with the action-focused, inclusive work of what has now become an unstoppable social movement for positive change.
And so it is a huge honour that Sheena invited Florence Wilcock and me, as the initiators of the #MatExp campaign, to write the opening blog and tell everyone what has been happening and why is it so important for these links to be made.
Sheena is publishing our blog today on her site. But for ease you can also read it below. We are all working together in a very strong collaboration and taking the view that the more different channels we can use to spread the word and involve more and more people, the better!
OUR GUEST BLOG FOR SHEENA BYROM IS REPRODUCED BELOW…
We would like to kick off Sheena’s June blogging series with a strong call for the Maternity Review Team to engage with our fabulous #MatExp grassroots community. We need to build on all the amazing work that has been happening over recent months through this passionate, inclusive group.
Users came forward not only to join the various actions but to initiate and lead them themselves. You can check out the actions here but they cover everything from appropriate language, postnatal support, best practice and experiential learning – including many male obstetricians spending time in the lithotomy position!
Florence is a passionate obstetrician and clinical leader, who was asked by the London Strategic Clinical Network to find ways to improve maternity experience in response to a poor CQC report identifying that six of the seven worst trusts in the country for maternity experience were in London. Florence approached Gill, the creator of Whose Shoes?, to co-produce some challenging Whose Shoes? maternity scenarios and run a series of workshops, getting users and professionals and all other interested parties – NCT, MSLCs, everyone! – to work together as equals and come up with imaginative solutions.
With support from NHS England, five very successful and fully subscribed workshops were held across London.
Queen’s Hospital session in action
The combination of the face-to-face workshops and the social media network have been extraordinary, with lots of overlaps. For example Helen Calvert and Leigh Kendall, two of the mums now helping lead the campaign, came down to London to join the workshops and they also contributed to the #MatExp NHS 6Cs webinar.
The Whose Shoes? workshops, supported by a full leadership and facilitation toolkit kit developed in partnership with the London SCN and NHS, are now planned at other London hospitals and spreading to other parts of the UK, including a session in Guernsey at the end of June.
There is a lot of cross-fertilisation of ideas between localities and between hospitals, with a strong emphasis on building relationships and collaborations. Each workshop culminates in pledges and a local action plan, formulated by the people at the workshop and encapsulated in a powerful graphic record.
Inevitably the themes are similar between the different sessions but with a strong local emphasis and most importantly local ownership, energy and leadership.
It would be easy for the NHS Change Day campaigns to lose momentum after the big day itself, (11 March). #MatExp has done the opposite, continuing to build and bring in new people and actions. #MatExp #now has 110 million Twitter impressions. We have just finished the ‘#MatExp daily alphabet’, a brilliantly simple idea to get people posting each day key issues related to the relevant letter of the alphabet.
This has directly led into the month of action starting today, 1 June!
Helen Calvert set up and ran a survey of health care professionals. She had 150 responses within about 10 days and analysed and reported the results – an extraordinary contribution.
#FabObs Florence Wilcock ensured that her roles as obstetrician and mother blurred a bit more (and took many of her colleagues by surprise) when she did something truly wonderful in terms of making people think, really think about the experience of the women they are caring for. She walked in their shoes, which on this occasion involved taking off her shoes…
It is brilliant that Flo has taken the time and trouble to reflect in such detail and share the learning…
Florence Wilcock writes: For NHS change day I wanted something that made a statement that said “#MatExp has arrived, take notice, we are improving maternity experience, get involved!” I couldn’t quite think of the right action until I saw a twitter exchange with Damian Roland back in December and watched a video where he described his spinal board challenge from NHS Change day, 2014. I had a light bulb moment thinking what would be the maternity equivalent? Lithotomy!
Lithotomy is when we put a woman’s legs up in stirrup; sometimes this can be essential for an assisted birth with forceps or ventouse (suction cup) or if stitching is required. But sometimes we use lithotomy position for normal birth or when stitches are minimal. In our #MatExp Whose Shoes? workshops, my favourite card is one based on Gill Phillips’ Mum (now aged 93) being made to take castor oil, despite telling the midwife it would make her sick. And it did. The card asks what is common practice now that will similarly seem wrong or odd in the future: the unanimous answer given at Kingston was lithotomy.
I started to think about whether we use lithotomy more than we should and wondered what does it feel like? Although I have two daughters, they were both born by emergency Caesarean so I do not have personal experience of lithotomy although I know some of my midwifery and consultant colleagues already do. It seemed the perfect challenge. I chose to do try it for one hour as that is a quite realistic time that a woman might be in that position, sometimes it can be less, but sometimes it can be far longer.
I decided to wear a hospital gown and some running shorts as it didn’t feel quite right to do it in normal clothes. The first thing I learnt was that the hospital gown was stiff and itchy, I couldn’t get it to do up properly without assistance and when I had finally tied it I sat down to discover it felt as if I was being strangled by the neck line so had to loosen it off immediately. I adjusted the back of the bed but found it quite hard to swivel round & reach the buttons to do so. We put on a fetal heart monitor which just felt like a normal waistband, a blood pressure cuff and stuck an IV line on my arm. We also used a doll to give me a bump. I know not all women will have all these attachments but many will. During this time Tom, who was going to follow me with the challenge, commented that I looked anxious from my body language before I had even begun and it was true I felt quite apprehensive with all these people running around being aware I was about to be totally in their power as it were.
We were finally ready for ‘legs up’! The first thing I discovered with a slight shock was that the stirrups were very cold which I hadn’t expected at all. The other observation was that the people started adjusting my legs without asking me. I thought one leg was going to fall off as the stirrup wasn’t tightly fixed enough and I was in a slightly twisted position which I asked them to adjust. Once that was done I felt reasonably comfortable and relaxed. They took my blood pressure with an automated cuff which was surprisingly painful. I decided to have a breech baby and we took a few photos.
Twenty five minutes in we decided it was time to take the bottom of the bed off which we would do for an assisted birth. I felt immediately more precariously positioned and vulnerable like I might fall off of the bed. The midwives put my legs higher and the bed much higher off the ground which was the right position for delivery without causing them back problems. This felt quite odd to be high up in the air or as one midwife put it ‘face to vagina’ so that she could see what she was doing at eye level! I definitely could not have got down from there unaided especially not when contracting and in pain. A midwife walked into the room with the door & curtain open and I realised I could see all the way down the corridor which meant everyone in the corridor could potentially see me. Obviously this was a simulation but it did emphasise to me even more the importance of closing the door & curtain behind you to maintain privacy.
A series of people then came to talk to me. Our chief executive Kate Grimes popped in for a chat and asked if I was willing for a film crew to come in to which I agreed. By this point my bottom (sacrum) was getting pretty sore & I had neck ache. I was feeling fairly uncomfortable. My abdomen felt quite compressed and I thought if I was a woman in labour having to push it would probably make me feel quite nauseous.
I was prepared to be filmed and photographed but it was interesting that a number of people walked in and out to look without talking to me. Helen and the presenter introduced themselves to me but the camera man did not and did a series of sound checks over me and proceeded to film without even speaking to me. I am sure it was an oversight but it gave me an amazing sense of being dehumanised and re-emphasised the importance of #hellomynameis.
In the middle of this Kate Greenstock, our MSLC co-chair arrived. Kate is a doula and came straight to me and asked if I would like a foot massage. Although I thought I was fine, as soon as she asked me I realised actually that I wasn’t fine and here was a person who wasn’t laughing or making a spectacle of me but who actually cared about how I felt. That isn’t to say all the wonderful midwives didn’t but at that moment I felt like Kate and I understood one another and that this was tough and she was ‘on my side’ as it were here to support me.
She gave me a foot massage which was immediately relaxing. I have always understood the importance of support in labour but felt that women could get that from our wonderful midwives and struggled to understand why they wanted a doula too. This experience gave me some inkling of why in some situations a midwife might be focusing on other things and a doula might be able to focus on how the woman is feeling and that alone.
My hour challenge was ticking by and for a short time after the film crew the room emptied out and I was left almost alone. I felt slightly abandoned after such a crowd before and realised if the midwives didn’t come back I was rather stranded in an undignified position. It is not unusual after an assisted delivery for many people to come in and then gradually disappear leaving me as the obstetrician to suture on my own, the midwife popping in and out to get things so in a way this behaviour seemed quite apt.
The midwives returned with a nice plastic baby so that I could have #skintoskin and then my hour was up. The end of the bed was put back in place with the bed rocking as they pushed the parts together and then finally they brought my legs down and it was over.
So what was the impact of me undertaking the lithotomy challenge?
My action has certainly got others thinking and talking. I started tweeting about it in the weeks before change day and challenged a few colleagues. I’m greatly indebted to Professor Jim Thornton who was the first to accept and kicked off a whole week ahead of NHS Change Day.
I know of at least twelve others who have undertaken the challenge and five more who have promised to. The challenges are spread across 10 organisations so I am hoping for a ripple of conversations as a result. Even those that say ‘no’ learn something from asking themselves the question.
An obvious action as a result is for staff to think about trying to avoid lithotomy altogether. There are a multitude of options for positions and care in labour that we can employ. The Better Births initiative is an ideal example of a resource any midwife can access. Environment is also all important: birthing pools, stools, mats, balls are something tangible people can change. Antenatal education and preparation, both NHS and with our partners in the community, is also vital.
For us obstetricians there are certainly situations in which lithotomy is invaluable and necessary however this challenge has definitely made me think about the consequences of the length of time and how to keep it to a minimum as the position became much more uncomfortable after half an hour. Sometime in the pressure of work, helpful midwives get women ready for us in position before we enter the room and I had not given much thought to the impact of additional time or someone new entering the room when you are already in this position. The careful use of sheets or drapes to minimise exposure was also a topic for discussion.
In conclusion my hope with my challenge is that in each Trust conversations will happen that change practice and via networks and social media good practice will spread. I hope it will have the ‘butterfly effect’ where one small change in one place will result in large differences later.
Imagine, a consultant, a midwife, a doula, a support worker, a commissioner, a campaigner and a mother all coming together to help support and improve maternity services for all women and their families.
Wonderful you may say, but will this really ever happen you may wonder? The answer is yes!
#MatExp is a wonderful grassroots campaign using the Whose Shoes?® approach to help identify and help improve our national maternity services. By means of workshops in local hospitals users of maternity services are brought together with others to join conversations about their experiences of maternity care and share what really made a difference to them personally and their experience and talk about ways that care can be improved. These workshops enable health care professionals (in and beyond the NHS) and local communities to listen and work in partnership with women and their families to find ways to improve local and national maternity services. Anyone can take part whether your a maternity service user, partner, community group or NHS staff, from chief executive to volunteer all are welcome to attend and share. Also on twitter using the hashtag #Matexp there are many amazing people sharing personal stories, experiences, achievements and ways they are actively trying to improve care both in there local hospitals but nationally too.
I personally have been involved in a #Matexp campaign for NHS change day. It was action 5 – ‘life with a new baby’ as breastfeeding champion along with the lovely Helen Calvert. Personally for me #Matexp has been really wonderful and something im proud to be part of. After suffering poor care with my first birth and subsequent birth trauma and PTSD, #Matexp has given me hope.
Hope that things can change.
Hope that women will be the centre of maternity care.
Hope that the culture of birth and our maternity services will improve.
Hope that the voices of women will finally be heard.
As part of #Matexp I have made contact with some amazing people such a Flo, Gill, Rachel and Helen as well as fantastic midwives such as Jenny and mothers such as Leigh. All are doing amazing things to improve services for women often after personal experiences. Knowing that there are so many people who genuinely want to work to improve services and make care better and who truly value women has helped me heal and also restored my belief in maternity care. It has given me the opportunity to to tell my story and then feel part of improving things to make care given better for others something I am so passionate about. It has also given me confidence to be bold and change things in my own job and NHS trust as I feel supported by some amazing people. Seeing their successes has spurred me on and helped me believe that we can all make a difference.
More importantly #Matexp has given me hope. Hope that one day we will provide a maternity experience that is individualised, respectful, gives dignity and allows for informed choice. That puts a woman, her baby, her family and their needs first. It will mean birth experiences that do not result in trauma but that even under difficult circumstances will make a woman feel loved, protected and supported. Yes I have hope, because finally not only has my voice been heard but the voices of women everywhere will be heard, no matter who they are, what they do, or what choices they made. Why is this so important, because your birth experience stays with with you the good and the bad, it can have a profound effect on you as a family as you start on your journey as parents. All women, babies and families are special and deserving of the best maternity care possible. So join in, get involved and share your stories and your ideas. There’s exciting times a head in #Matexp and together we can make a difference.
As you will have seen, I have been sharing maternity experiences on this blog from women I know. Some good, some bad, some unacceptable. But all anonymous. And it occurred to me that this was somewhat unfair on the birth professionals working to support pregnant women, many of whom I have become friends with on Twitter. So I thought it would be good to be able to share the other side of the story, the thoughts and views of the birth professionals, who have also been afforded the luxury of anonymity. Thus the #MatExp survey was born!
As with everything I do, I JFDI it one evening (thank you for that phrase Florence Wilcock!) and popped it up on Twitter. To my great delight, I have had 150 responses from midwives, student midwives, independent midwives, doulas, obstetricians, anaesthetists, antenatal teachers and other birth professionals. Thank you to everyone who has taken part, your input is much appreciated.
This is the split of respondents:
We also had responses from a neonatal registrar, a perinatal psychiatrist, three midwifery lecturers / educators, a research midwife, two hypnobirthing instructors, an anaesthetist and three antenatal teachers. Many are new to their profession, many have been supporting women for one, two or three decades, and one respondent has been a birth professional for 43 years.
The first thing I wanted to know was “What is the best thing about your job?” The vast majority of respondents talked about the women they work with and being able to support them as being the best part of their role. One student midwife caught the general mood with the comment “Supporting women and being there for them no matter what.” Responses included:
“Witnessing the women I support find their strength and power. Witnessing the love between the couple and the birth of a new little family.” (Doula)
“Being a part of a woman and family’s journey into parenthood.” (Independent Midwife)
“Being part of the transformation of woman to mother” (NHS Midwife)
“Supporting and empowering women, whatever the outcome of their pregnancy” (Obstetrician)
“Making a difference to women. To be present & witness to most beautiful time in life” (Student Midwife)
“Seeing women empowered and birth partners knowing their role and both having calm births” (Hypnobirthing Instructor)
“Privileged to be part of the miracle” (Obstetrician)
Unsurprisingly, the independent midwives found that being able to offer continuity of care and build a relationship with the women they support to be one of the best parts of their job. Many of the obstetricians felt that the best part of their role was “averting danger”, “saving lives”, “helping women to have as healthy a pregnancy and birth as possible”, but also “working with women caring for them at such a life changing moment in their lives” and “being able to reduce anxiety with appropriate explanation”. A fair few of the doulas talked about “witnessing the women I support find their strength and power” and “empowering women”. One explained that the best part of her job is voluntary work “with vulnerable women – asylum seekers, poverty, isolation – who may not otherwise feel worthy of advocacy”.
The word “support” comes up a lot in the responses of NHS midwives, and wonderful comments such as “Making a special time, simply awesome!!!”, “Having the honour and privilege of being a part of a very special time in people’s lives” and “working with the women through an amazing experience”. The student midwives made similar comments, but I particularly liked these two responses:
“The list is endless, but one that currently stands out is being able to turn it around when a woman is panicking in labour and giving them confidence in their own body to give birth! Saying a few words of reassurance and visibly seeing the change is incredible.”
“Supporting women on their journey whatever their circumstances or choices and feeling a sense of fullfillment when you know you’ve made a difference to someone’s pregnancy/birth.”
So from these inspiring comments from people who clearly adore their jobs, we move on to the question “What is the biggest challenge currently facing your profession?” Overwhelmingly the response was NOT ENOUGH MIDWIVES! My recent blog post explores the experience from a woman’s point of view when a unit is short staffed. This really is the biggest challenge as far as these respondents are concerned. Closely followed by fear – “The fear of litigation and professional accountability. The wake of the kirkup report savages midwives and their portrayal is unfair. We may all be tarred with the same brush. Normality is under attack again.” For midwives, morale is also a concern – “we are CONSTANTLY being told what we are doing wrong. Such a culture of fear.”
For obstetricians the challenges are different. Comments included:
“Letting the lawyers decide what information we say and letting them take an additional cut. When the press report a 5.2 million payout the lawyers award themselves a further 6 figure payout.”
“More and more ‘high risk’ women embarking on pregnancies.”
“Too much focus on everything EXCEPT caring for patients!”
“Unnecessary obstetric intervention”
For doulas, they are struggling with a lack of awareness of their role and “dispelling the myth that only the wealthy can afford us”. Lack of awareness from families – “People understanding what support we can provide and the value of it” – and from medical professionals – “Being misunderstood – doulas work alongside NOT in place of HCP”. Some respondents even felt that there is resistance to doulas amongst the medical community.
Where student midwives are concerned, the biggest challenges include:
“Feeling left alone and overwhelmed when its busy because my mentors are rushed off their feet.”
“Bullying… NHS culture”
“Working with midwives who don’t use up to date evidence such a optimal cord clamping”
“Guidelines that seem to have very little evidence base.”
“Bad attitudes, both to those in our care and to each other!”
The over-medicalisation of birth was also mentioned by many respondents.
So what can birth professionals do to meet these challenges? The #MatExp campaign is all about action, and everyone being able to make a difference. Respondents were asked “What do you feel you personally can do to face that challenge?”
Whilst some said “not a lot”, “not sure” and “nothing”, most felt that they had ways to meet the challenges they faced. Answers included the simple “keep on caring”, “keep going” and “raise awareness”. Others said:
“By empowering women to have a voice and question these [hospital procedures]. Also, working together with OBs and MWs to also understand their point of view and what challenges they face. So we can all change this together.” (Doula)
“With 3 colleagues I have set up a social enterprise to provide a caseload midwifery service through NHS commissioning at tariff – the battle is to get it accepted by those who resist changing the status quo” (Independent Midwife)
“Keep going, keep trying to provide compassionate, excellent, evidence-based care, serve the women in my care as best as I can doing my best every shift” (NHS Midwife)
“Not resign myself to that’s how things have to be, think about ways to improve and make suggestions, continue to make every contact with women as positive as possible” (NHS Midwife)
“Show by example how important it is to respect and listen to a woman at all stages of antenatal, labour and postnatal care.” (Doula)
“Ensure that I act within my own values despite others in my environment, find support and positivity from like minded individuals. I love Twitter for that!” (Student Midwife)
“Train our midwives to the highest level to avoid litigation. Test their knowledge to ensure they’ve learned from the training. Keep on asking for more staff and bigger units. Never give up!!” (NHS Midwife)
“Trying to individualise care and support women’s choices Positive birth” (Obstetrician)
“I need to remember I’m a student and should be supernumerary. I need to speak up more to make sure I’m learning each day rather than doing what I know or making beds.” (Student Midwife)
“Continue to practise in the best interests of women rather than defensively and vote against abolition of supervision” (NHS Midwife)
“Try as far as possible to support ‘normal birth’, educate women about the risks of high BMI pregnancies etc.” (Obstetrician)
“Be prepared with an abundance of solid evidence” (Student Midwife)
“Keep my heart strong, separate the bigger picture from the day to day interactions of care, do mindfulness, be compassionate to self, inspire trust in women’s bodies” (Student Midwife)
On a personal note, I particularly like the doula who is determined to be “rigorously evidence-based, and relentlessly compassionate.”
I was keen to see how many of the respondents were aware of the #MatExp Campaign. Many would be of course as the survey started out being publicised to people I knew on Twitter, many of whom I have linked up with due to #MatExp. It gradually worked its way out of that community though, and by the time the survey closed the split was as follows:
The orange line is “I have heard of it but don’t know a lot about it”.
I then outlined the aims of #MatExp as they appear on the NHS Change Day website
The next question was “What do you feel you can do to support these aims?” Many respondents felt that renewed or continued work with their MSLC (Maternity Services Liaison Committee) was the answer. Others simply want to “spread the word” and “let mums know”. Other comments included:
“I encourage women to speak up about things they’re not happy with. Raise it at a higher level if you have to, use the SoM or similar. Empower women so they don’t feel intimidated by professionals telling them what they are and are not ‘allowed’ to do.” (Doula)
“Ensure patient feedback is received acknowledged and acted upon. Continue daily ward visits” (NHS Midwife)
“Support AIMS [Association for Improvements in the Maternity Services]” (Independent Midwife)
“Keep banging the drum for parity of esteem for maternal mental health” (Perinatal Psychiatrist)
“Keep raising awareness on Facebook, hold antenatal classes, tell all the women I come across everything is in their power – try to banish the word ‘allow'” (NHS Midwife)
“Probably the friends and family questionnaires would help and I can make sure these are handed out.” (Student Midwife)
“As a researcher I can help to make maternity service user views more visible and I am also doing a lot of work around ways to increase opportunities for service users to get involved in research/maternity service improvement activities. I am also very interested in the idea of co-creation in research (so working alongside service users and frontline staff to develop, do and use research). Part of the work I am involved with at the moment involves empowering pregnant women and midwives to use research evidence more effectively.” (Research Midwife)
“I’m an increasing Twitter user. Social media seems to be the way forward” (NHS Midwife)
The next question looked at the specific areas that the #MatExp campaign covers, including the area for which I am one of the champions: “Life with a new baby”. The full list is:
How does lithotomy feel as a woman in labour – read about obstetrician Florence Wilcock’s NHS Change Day lithotomy challenge
Language used towards pregnant women (e.g. “failed induction”, “poor maternal effort”) – this area is championed for the campaign by Leigh Kendall
Life with a new baby – including perinatal mental health and breastfeeding. Read about Rosey PND&Me and also the blog post that Emma Sasaru and I put together on supporting breastfeeding.
Informed Choice – see this example of risk being explained in a user accessible way
Respondents were asked to rank these areas in order of importance and the results were:
A couple of respondents had (very fair) specific comments on the above question, namely “our unit is already changing skin to skin and delayed cord clamping, hence their low ranking, otherwise I would have placed them higher, my next project is to reduce the use of lithotomy” (Obstetrician) and “it is impossible to rate these in order. In general they each impact on each other, by improving informed choice you are creating a healthier postnatal environment etc. so rankings don’t mean that skin to skin is the least important” (NHS Midwife).
The response to the next question was fairly definite!
Finally, I asked “If you could change one thing about maternity care in the UK what would it be?” Staffing levels were mentioned again by a lot of respondents, as was caseloading / one to one care. Many of the answers were also indicative of the tensions between different birth professions and professionals:
“For more medical staff to witness natural birth.” (Doula)
“Doctors and midwives respecting each other” (NHS Midwife)
“Obstetricians” (NHS Midwife)
“If we loved and treated our colleagues better, collaborated and supported each other, we’d be a happier, more efficient more compassionate and passionate workforce- and this would filter through to the women we support” (NHS Midwife)
“Reduce obgyn lead care.” (Doula)
“NCT didn’t have such a negative influence on women. No one failed because they didn’t have a vaginal birth. A lot of what is taught is inaccurate and based on personal opinion which is not informed choice.” (NHS Midwife)
“Slow down the relentless overuse of induction…encourage/ optimise midwife led care home birth and birth centres and caseloading model of care.” (Student Midwife)
“Don’t always go and try to enforce your procedures. Listen to women. Use of language for the purpose of influencing a labouring woman into accepting the best thing for hospital such as I witnessed: ” This baby has had enough” is very detrimental, and to say the least, manipulative.” (Doula)
“I would offer a single additional session to antenatal classes/NCT classes etc about the reasons for medical interventions in labour and the risks and benefits. It is unbelievable that in an age of information, when women have spent time with midwives and NCT instructors, we still regularly see birth plans that say “don’t want forceps unless necessary”! It immediately disadvantages obstetricians and puts them on the back foot, as we not only are seen as “the bad guys” for forcing these interventions on women, but often have a matter of minutes to explain the risks and benefits in an urgent situation, which is frankly laughable. Obstetric trainees should be involved in antenatal education; just a single group session on the what, when and why of CTGs, forceps, FBS and Caesarean would I think remove a lot of the fear from women and help those for whom labour does not progress smoothly to feel more empowered and informed.” (Obstetrician)
“More trust in women to make the right choices for themselves. Less bullying and misinformation.” (Independent Midwife)
“Obs and midwifery attitudes to each other.” (Anaesthetist)
I would also like to highlight this heartfelt plea from an NHS Midwife: “I don’t even know where to start… Let’s be compassionate again – let’s treat EVERY woman like our sister. Even the smelly, rude, unpleasant ones. Let’s try.”
Along with a number of #MatExp participants on Twitter, I have been saying that respect and compassion are two vital elements of a positive birth experience, regardless of vaginal birth, c-section, place of birth and so on. This comment from a doula certainly chimes with my personal view on what could change in UK maternity care: “I’d like it to be less of a lottery, some professionals are kind, supportive, informed, happy to discuss options with women. Some are not. On the same wards, in the same hospitals too. I’d like the good experiences that many have to be normal for all. The feedback I get is this comes down to how the woman is treated rather than the final outcome of the birth experience.”
The full results of the survey have been passed to Florence Wilcock, #FabObs of the #MatExp campaign.
Have you been following the #MatExp journey? Have you been following the #MatExp ABC?
It has been so exciting and so so full on that I haven’t had time to write a blog about it – and I don’t think anybody else has either! But it has been absolutely compelling, with people waking up early each day to post words that reflect key issues around improving the maternity experience of women, sharing good practice examples, building our inclusive community – and having a lot of fun!
I made a visual story book at the weekend using Steller. I should be able to embed it here but can’t get the code to work so here is the link. It was inspired by a walk in the woods on Saturday and has been very popular. It is published today in the Stellerverse…! (No idea what that means except that I guess people like it!)
I cannot possibly do justice to what has been happening in our #MatExp ABC.
I should have been warned. The very first phone call I had with Florence resulted in us starting a collaboration that has turned into #MatExp. Florence wrote neatly in her ‘little black book of serious ideas’ that she envisaged just ‘a very small pilot’.
Six months on now, we have run 5 Whose Shoes? workshops across London in partnership with the London Strategic Clinical Network and NHS England, and a Train the Facilitator session attended by people from most of the London hospitals and much further afield.
We are now starting to plan equivalent sessions with creative people who ‘get’ the process and are sufficiently open and transparent to embrace it, in other parts of the country. There is a particularly exciting workshop in Guernsey at the end of next month.
So when Florence got that glint in her eye and said she had been thinking about a #MatExp alphabet – one letter a day; Florence leading with one or two words and people invited to join the conversation… I should have had some idea of what was coming!
We have had contributions from so many people. A deluge of tweets every day, and fantastic learning in terms of things that really matter to women, shared with passion and love – or sometimes out of pure frustration.
I have compiled a cross-section of tweets into a Storify, trying to bring in something from all of the main contributors but it has not been easy – please let me know if I have missed you!
The Storify is just a flavour – for the full story, look on the #MatExp hashtag.
#MatExp is a very small pilot. We know that because Florence wrote it in her book so it is evidence-based. So that makes it true… Hmm.
Conversely we struggle to record everything we are actually doing – because we are too busy doing it. #irony
With special thanks to my friend Ken Howard, who happens to live with younger onset dementia and breaks every stereotype in the book, who very kindly designed a logo for us. No meetings, no prolonged agonies, no massive expense (thinking British Airways here)… just a simple request and a quick ‘JFDI’ response, with three different versions. And everyone loves it. Thank you Ken!
Less than a year since our first phone call that led to #MatExp, Flo @FWmaternitykhft. Wonder what the next 12 months will bring…? 😉