Maternity Experience

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BECAUSE OF YOU I DIDN’T GIVE UP: +ve #MatExp

Welcome to the start of ‘A Catalogue of Maternity Experiences’. Rachel @enduringdelight from This Woman’s Work Blog gets us started with her positive maternity experiences and how they inspired her. We hope this motivates you to share your story too.

Read “An Important Catalogue of Your Maternity Experiences” to find out more about this #MatExp action, and submit your story.

Rachel's Positve MatExp story

I am by no means as eloquent when writing as some of the other members of the #MatExp community, but after seeing this tweet from the inspirational Sheena Byrom and following a suggestion from the lovely Helen Calvert I felt it really important to write this post.  As Fab Obs Flo once told me, outside of my comfort zone is where the magic happens (thanks Flo!).

“I’ve learned that people will forget what you said, forget what you did, but people will never forget how you made them feel.” – Maya Angelou

This quote pretty much sums up the story of our children’s births.  I will never forget how the people who cared for us made me feel and how they changed my life.

Rachel at teaI’m Rachel, mama to (almost) 7 year old boy/girl twins and our youngest little boy who is 3½ years old.  I’m also now an NHS Breastfeeding Peer Supporter, MSLC Vice Chair and birth junkie with a particular interest in improving birth experiences for families and the relationship between attachment and neuroscience.

I can’t even remember how I stumbled across #MatExp , but it is an amazing movement; it excites me to know that there are many other people out there as passionate as I am about supporting families to have the maternity experience they crave.  For a long time I thought that my passion for positive birth and all of the issues surrounding it might just be a bit odd!! I don’t contribute to #MatExp as much as many or as much as I would like, but it is a privilege to be part of that community and so I am very grateful to some of #MatExp’s lovely ladies for encouraging me to persevere with writing this when I was struggling.

If you follow #MatExp you will know that, sadly, for a lot of the amazing people contributing to this grass roots movement inadequate care or a negative experience was their catalyst for getting involved.  For me the complete opposite is true, but sometimes that makes things difficult for me because in certain circumstances it’s really hard to talk about having had positive birth experiences as I feel like somehow people may interpret that as me being critical of theirs.

A positive birth experience for me was always going to be a physiological one, but I am not militant about it and I don’t believe that’s what everybody should have.  Moreover I believe that a birth that deviates from a woman’s ideal can still be positive if that woman is consulted, supported and given options rather than dictated to.

Having beautiful birth experiences and successful breastfeeding journeys are what drove me to become involved in movements like #MatExp and peer support.  I’m all too aware that sadly not everybody is as blessed as I am to have had experiences like mine, but I really feel like they should be.  It shouldn’t be a lottery that thankfully I won.  Every woman should be listened to, respected and involved every step of the way in her own and her baby’s care.

“Do the best you can until you know better and when you know better, do better.” –Maya Angelou

My maternity experiences were very different, but positive in their own right.  In hindsight there are things I would change if I could go back and there are things that weren’t ideal and that health care professionals should and could have dealt with differently, but that doesn’t make them a negative experience.  In fact the only reason I know that there are some things I would change and things that could have been done better is because of all of the things I have learned since, but if my birth experiences hadn’t been positive to begin with I wouldn’t have been propelled into the world of positive birth and maternity experience and so would have been none the wiser.  

The birth of our twins involved an induction at 38 weeks and 4 days gestation.   I see so many negative things written about induction that it is important to me to write about this.  I’m not writing about the process of induction and how good/bad this is for women and their babies.  What I want to write about is the fact that, if you have knowledgeable and respectful people caring for you it can be a positive birth experience even if it is not your ideal.  I am so grateful to the midwife who cared for us when our twins were born.  To be honest I think she was the catalyst for my passion for birth and the person who gave me the confidence to decide on a home birth for our youngest son.

Rachel Twins Positive Maternity Experience

I’d had a very straightforward multiple pregnancy and so despite being classed as “high risk” (a label I despise) I hadn’t needed much care at the hospital other than routine appointments and so was quite nervous about how I would gel with midwives caring for me when the time came for our babies to be born in hospital.  I need not have worried; as soon as Carmen walked in the room she came across as so knowledgeable and this gave me complete faith in her from the outset.  It was clear that she had every confidence in my body’s ability to do its job which in turn gave me that very same confidence.  After all, if she thought I could do it then why wouldn’t I?  

Something that particularly stays in my mind is her supporting my decision to not have an epidural. I had never wanted one, but the anaesthetist was fairly insistent on me having one almost as soon as the drip was in my arm and I think I would have given in were it not for Carmen; instead when she could see the conversation was becoming too much for me she delicately stepped in and dealt with it whilst remaining respectful and professional towards her colleague. I remember feeling so grateful to her for that and so relieved to not have to fight for what I wanted.  

“Drinking tea intelligently.” –Tricia Anderson

Our twins were born about 8½ hours after my syntocinon drip was started.  I remember Carmen talking me through each stage of the induction; she read my birth plan and made sure that I didn’t remain on the bed and that I got breaks from the CTG trace, she got a rocking chair to allow me to be more upright and off the bed, dimmed the lights and left us to it as much as possible, but without ever being more than a stone’s throw away.  She really did drink tea intelligently!!  Even when she was drinking tea for real on her break I was her priority and she came back when I begged for her to.

Three years later I found myself excitedly planning a homebirth for our third child in our teeny terrace house. There were a couple of little administrative hiccups, but each midwife I came into contact with was positive and enthusiastic about our plans which made me feel really confident about our decision.  

Rachel with newborn Positive MatExp

When the day came for our little boy’s birth I was blessed to have the support of another intelligent tea drinker; familiarizing herself with my birth preferences and facilitating them; Lorraine was a quiet, reassuring and confident companion and exactly what I needed.  Although she hadn’t been my named midwife I had met her at a routine appointment and as soon as she arrived at our home on my son’s birthday I remembered how enthusiastic she had been about my plans for a homebirth when I had seen her all of those weeks before so I immediately felt calmed by her presence.

It was a very straightforward, if a little speedy, birth and with the aid of a tens machine, some hypnotherapy and a little gas and air our son was born in water less then two hours after Lorraine arrived and probably only about 20 minutes after the arrival of the second midwife. They stayed with us for a couple of hours or so after the birth; helping my husband to tidy up and ensuring we got breastfeeding off to a good start, being attentive, but respectful of what was an important time for us.

Rachel with family

The midwifery team’s apparent confidence from the outset in the decision we had made to have our son at home as well as Lorraine’s confidence in her own ability as a midwife and my body’s ability to deliver our baby served to make me more determined to support other women and help them to achieve a birth experience that they were happy with.  This is how I came to become involved in our local MSLC just a few months later; I wanted so much to make a difference.

It goes without saying that when mistakes are made we need to learn from them and make sure that those mistakes never ever happen again; I’ve worked for solicitors on birth injury cases and am all too aware of the devastation that can result from human error.

In addition though it is vitally important that we learn from the positive.

There are many midwives (and other healthcare professionals) who are wonderful at their jobs and passionate about the care they provide.  These people have life changing positive impacts on families every single day and I feel so strongly about the fact that best practice should be shared and celebrated so that it can be replicated by others and that’s what I wanted to do today and to achieve in writing this. I wanted to share my positive experiences and celebrate the midwives who made a difference to me and to my family; I will forever be eternally grateful to you.

“We are like a snowflake; all different in our own beautiful way.” – Unknown

Most of the world faith traditions have stories of the birth of special people. There are signs accompanying the birth. Stars, wise men and phenomena announcing the arrival on earth of someone wonderful. Perhaps these stories are signs of what we should celebrate with each birth. The birth of every single child and every new parent is special.

As we welcome these little ones into our world let us think deeply. What physical environment is most fitting? What psychological and emotional factors should be named and made present? What people and attitudes will build that loving cradle of experience to welcome the newest member of the human race – our race? Every child and every mother are unique – like every snowflake.

Maternity experience is about creating the best for the newest.

I am fortunate that my experiences have been positive. Let’s always put women, children, families at the centre of our care and create experiences that reflect how special birth is.  

Rachel xx

(The content of this post is my story, but a special thank you to John Walsh not only for taking the time to proof read and make some suggestions as to the finer detail, but also for his encouragement. You can read more of John’s wonderful musings here.)

~ How has your maternity experience influenced you? ~

Look out for @HeartMummy Helen’s story next month.

You can submit your story too; see the second paragraph for more information.

Like what you’ve read? Share far and wide 🙂

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It is time to talk about the ‘perinatal’ aspect of Perinatal Mental Health (PMH): the ‘missing link’ in the national campaign

I am delighted to be able to publish today a guest blog for the #MatExp campaign from Mr Raja Gangopadhyay.  Raja is a Consultant Obstetrician and Gynaecologist with special area of clinical interest in Perinatal Mental Health (PMH) from West Hertfordshire Hospitals NHS Trust. He is a member of the Royal College of Obstetrician and Gynaecologist (RCOG).

Raj capture

I would like to take this opportunity to share my views on why I feel so strongly about the role of the Maternity Services in Perinatal Mental Health (PMH).

Perinatal Mental Health (PMH) has two important components in its terminology: ‘Perinatal’ (period during pregnancy, delivery and post delivery) and ‘Mental Health’. Therefore the care of mums in the Maternity Services during this vital period is of utmost importance in PMH: it should be a no-brainer.

But sadly, PMH is the only one area of Maternal Health where I do not see a strong voice of the Maternity Services in the national campaign.

This has remained ‘Cinderella’ within Maternity Units in spite of the glaring facts:

  • PMH is still one of the leading causes of maternal death in the UK.

  • This is one of the most prevalent conditions mums suffer from during their pregnancy and postpartum period (at least 10% of mums suffering from this).

I strongly believe that without robust ‘perinatal’ care, women would continue to suffer and die from PMH illnesses, no matter how much we spend to expand specialist Mother and Baby Units (MBUs).

Therefore this is the time when we must recognise this important area and raise awareness.

I am trying to address this issue through my campaign on social media and as the Royal College of Obstetrician and Gynaecologist’s (RCOG) Representative to the Maternal Mental Health Alliance (MMHA).

What do I mean by PMH ‘within’ Maternity Services?

Suffering and deaths from PMH illnesses are often preventable if appropriate measures are taken during pregnancy and in the immediate postpartum period.

A prevalent health condition like PMH must be managed with the same readiness as managing other medical conditions in pregnancy such as diabetes, high blood pressure (pre-eclampsia) or heart disease.

The only way to ensure that the women with PMH are appropriately cared for according to the NICE guideline (2014) is to have:

  • A dedicated PMH team within every Maternity Service:

A Consultant Obstetrician, Specialist Midwife, a Perinatal Psychiatrist, a Specialist Psychiatry Nurse and a Paediatrician should jointly lead this service locally. The service should be easily accessible to the mums.

  • A dedicated Obstetric-Psychiatry Antenatal clinic

  • Communication with Community Team:

This Maternity Service should have clear links with GP, Health Visitor (HV), community MH Team, Liaison Psychiatry services, Mental Health Crisis Team, Children and Young People services, Peer Support groups and other charitable organisations.

  • Robust Care Pathway:

There should be a clear pathway for risk assessment (at the booking visit and at every consultation), early identification and treatment. There also should be provision of a multi-professional team meeting on a regular basis.

  • Dedicated specialist service and support:

For conditions such as PTSD / birth trauma, fear of pregnancy and child birth (‘tocophobia’), bereavement and support for mums and dads whose babies are admitted to NICU.

  • Pre-pregnancy advice service:

It is important to have specialist advice and support for women (with PMH illness/ traumatic experience in previous pregnancy) who are considering pregnancy.

  • Patient involvement : ‘Patients first and foremost’

PMH is an area where patients’ opinion must be considered in developing local care pathways. Services must be evaluated on a regular basis based on patient experience.

I firmly believe that all the health conditions should be treated in the same way with professional expertise and kindness and without any prejudice. I am not sure why we still classify health conditions into ‘physical’ and ‘mental’ when there is often an overlap.

Psychological care in pregnancy, delivery and beyond…

It is unfortunate that psychological care has remained a very neglected part within Maternity Services. The reason given for this is ‘the staff are too busy’.

However pregnancy is probably a period of life where psychological support from the HCPs is needed the most.

It is especially important when mums could potentially have severe stress during pregnancy and the postpartum period due to the following factors:

  • Previous history of miscarriage, ectopic pregnancy, IVF, traumatic childbirth.

  • Any other family member or friend has had complicated childbirth experience.

  • Sudden life event such as breakdown in family relation/divorce, loss of employment, bereavement in the family or loved one, relocation/migration and domestic violence.

  • Sexual abuse in childhood or pregnancy as a result of sexual violence.

  • Associated pregnancy complications (for example premature rupture of membrane, high blood pressure, diabetes, concerns on baby’s growth or SPD).

PMH is not only PND and Puerperal Psychosis (PP)…

Many believe that PMH is a term equivalent to the care of Postnatal Depression (PND) and PP.

PMH includes specialised care for women (during pregnancy and one year after the childbirth) with any mental health condition (such as anxiety, depression, bipolar illness, schizophrenia, OCD, eating disorder, and personality disorders).

PMH must include bereavement care (miscarriage, still birth and neonatal death), traumatic birth experience/PTSD, support services for mums and dads whose babies are admitted to NICU and tocophobia (fear of pregnancy and childbirth).

Another important component should be the psychological care of mums and dads throughout the journey of pregnancy, delivery and postpartum period.

PMH, in my view, must be recognised as a separate subspecialty in the training of Obstetricians and Midwives.

Womb

Why is identification in pregnancy and immediate postpartum period so important?

  • Effects of psychological stress in pregnancy:

There are now plenty of research results, which indicate the long-term impact of stress during pregnancy on the brain development of the baby while it is in mum’s womb. Prof Vivette Glover, an eminent Professor of Perinatal Psychology from Imperial College London, explains this: http://www.beginbeforebirth.org/for-schools/films#womb

Therefore timely intervention and adequate support during pregnancy can prevent long-term effects on the child.

  • Care Planning to prevent serious illness:

All pregnant women with risk factors to develop worsening mental health conditions should have a plan of care during delivery and postpartum period.

Confidential Enquiries into Maternal Deaths have repeatedly pointed out that in the majority of cases of deaths from suicide, there is a lack of care planning during pregnancy.

This is only possible through appropriate care within the Maternity Services and multiagency communication.

  • Enjoying the journey of pregnancy:

Experience of pregnancy and birth creates a lasting memory for the mums and dads for the years to come. Therefore this should be an enjoyable experience for the woman and her family to cherish in happiness in the future.

As HCPs our role is to ensure we support and empower women to make informed choices for the safety of her and the baby and most important of all a very positive birth experience.

  • Helping mums to make informed decision regarding medications:

Mums should get proper advice regarding the use of medication in pregnancy and after delivery.

Pregnancy is a short window but an excellent opportunity to address health conditions.

  • Bonding and attachment:

PMH conditions can adversely affect the bonding with the baby and the mum.

‘A stitch in time saves nine’: Prevention of serious PMH illnesses is only possible through good care in Maternity Services.

Guardian capture

Having discussed the importance of the role of Maternity Services in PMH, now let us find out what is happening in the Maternity Units……

A journey of revelations…

I contacted many Maternity Units across the country to find out the provision of PMH services within their Units. What I found was extraordinary.

I raised my concerns in a letter published in The Guardian: http://www.theguardian.com/society/2015/oct/14/perinatal-mental-health-provision-badly-lacking .

I raised this issue with the Maternity Review Team, during my meeting in September (2015).

Although there are examples of good service, the overall structure within the Maternity Units is very poor:

  • Often there is no dedicated Lead Obstetrician and/or Specialist PMH midwife

  • Many Units do not have formal debriefing services (for traumatic birth experience), specialist bereavement midwives and support system for parents with babies admitted to NICU.

  • There are hardly any dedicated services for women with fear of childbirth.

Delving deep into the challenges….

To have a better understanding of the need, I embarked on a journey to meet professionals from all the relevant Royal Colleges (RCOG, RCM, RCPsych, RCGP), Health Visitor organisations, Maternal Mental Health Alliance (MMHA), MPs and All Party Parliamentary Group (APPG), NHS England, CCGs and other national Campaign Groups.

It was revealed that overall there is very little understanding of the vital role of the Maternity Services in PMH.

Thankfully RCM is campaigning for a Specialist Midwife in every Maternity Unit.

But the main barriers are the following:

  • Lack of Mapping of the existing services in PMH within Maternity Units (such as the MMHA map of the available Perinatal Psychiatry services).

  • Lack of a national standard of the service provision within Maternity Units (according to the number of deliveries and complexity of cases).

  • Poor collaborative work among HCPs: as often the Maternity Electronic record system is not accessible to other HCPs and vice versa.

  • Lack of standard Training programme for the Obstetricians and the Midwives.

  • Lack of adequate focus on PMH illnesses in Antenatal Education.

I have concerns that unless these issues are resolved appropriately, we cannot provide the best quality of care for women with PMH illnesses.

With the best of my abilities, I am currently working closely with other national organisations to address these areas.

Maternity HCPs: Please, please do something and don’t wait for things to happen….

Charles Dickens

It is true that funding is necessary to set up specialised PMH services and Mother and Baby Units (MBU). However Maternity Units should not wait for the approval of their business cases.

In my humble opinion, funding is not everything. Our professional values are the most important factors in patient care:

  • Kindness:

Simple measures such as a smile, empathy and a willingness to listen to the concerns of the mums and dads could make a huge difference in patient experience.

  • Communication:

Take every opportunity to explain the situation and ensure that appropriate wording is used during communication.

  • Continuity of care:

Try to ensure continuity whenever possible or communicate adequately with the rest of your team.

  • Local Alliance:

Please try to develop Local Alliances with Community Midwives, Health Visitors, GPs, all available community mental health services, Peer Support groups and children’s services.

This could significantly improve communication among the multi-agency teams in caring for mums with PMH illnesses.

  • Listen to concerns:

Please create opportunities to listen to the concerns of the user group. This may be in the form of promoting your local Maternity Service Liaison Committee (MSLC) or Patient Panels.

If possible, please read the real life stories of the Lived Experiences on the Internet: it would help you to think ‘outside the box’, have a better insight into the PMH illnesses and give you inspiration.

  • Raise awareness:

Arrange patient engagement events, Road shows or Community Events with local CCGs.

Participate in Social Media support, such as #PNDHour (Wednesday 8-9pm) and #BirthTraumaChat (Monday 8-9pm):

This would help to raise awareness, remove stigma and give mums and dads a ray of hope.

  • Arrange training on PMH:

Please ensure all staff are adequately trained in your local Units.

  • Get involved in your Regional PMH network:

Many regions now have regional PMH Networks. This could be an important place for information sharing among the Maternity Units.

  • Please do not forget dads:

There is now good evidence to support that dads can suffer from PTSD/PND. Please take every opportunity to support and communicate with dads.

  • Keep yourself updated:

PMH is a rapidly evolving area; therefore HCPs must keep their knowledge and skills up-to-date through continuous professional development.

If unsure, please seek help and escalate to your senior colleagues: an unsafe advice from a HCP could endanger an invaluable life.

Working together to make a difference…

We ALL need to work together to prevent suffering and death from PMH illnesses.

If you have any suggestions for improving PMH services within Maternity Units, I would be very keen to know (Twitter: @RajaGangopadhyay3).

If you are involved in good projects locally or are aware of any good practice, please share with everyone through #MatExp.

Acknowledgement

I am grateful to #MatExp for giving me this opportunity to write this blog.

I am immensely grateful to all the Lived Experiences for sharing their stories, which have enriched my knowledge on PMH much more than any textbook and journal article.

My thoughts are with all the bereaved families who have lost their loved ones due to this dreadful illness.

Raja Gangopadhyay

2015

 

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Links Library

A full list of links to articles and blog posts on the #MatExp Focus topics – updated weekly.

Taking #MatExp into 2016

#MatExp In Action – Latest Projects from the Maternity World!

Digital Technology – National Maternity Review

First & Second Trimester Loss Study Day – The Pinks N Blues CIC

GPIFN – GP Infant Feeding Network

Growing Families Conference – Manchester

Homebirth Conference – Manchester

Hospitalbreastfeeding – campaign for better breastfeeding support on paediatrics

Life With Baby, Kent – online peer support for those experiencing postnatal mental health issues

LTHT Maternity Event in Leeds – Leeds #MatExp WhoseShoes workshop

MyBirthMyBody – from Maternity Matters

Open Letter on Breastfeeding – The World Breastfeeding Trends Initiative (WBTi)

Perinatal Mental Health Network

PND&Me – updated website

Showing Thanks – sharing a “thank you” with maternity teams

Tell Me A Good Birth Story

Women’s Voices in #MatExp – blog series

Antenatal Preparation – Expectations vs Reality

Why Are So Many Mums Struggling? – Emma Jane Sasaru

Developing Confident Parents – classes from Vesta Birth and Parenting

Anxiety

Time to Act on Anxiety – #MatExp

The Truth About Hypnobirthing – Suzy Ashworth

How Hypnobirthing is Taking the Fear out of Childbirth – Kirsteen O’Sullivan

Breathing Life – The Power of the Breath – Doula Paris

Fear of Childbirth, or Fear of Medicalisation? – Sara Wickham

Women’s Choices, Expectations & Experiences in Childbirth – Claudia Malacrida

Disenfranchised Grief in Postpartum Women – Rumyana P. Kudeva

Therapy after a Traumatic Pregnancy – Louisa Leaman

Overcome Birth Trauma – Natal Hypnotherapy

Postnatal Recovery – Natal Hypnotherapy

Trauma Releasing Exercises – TRE College

Pregnancy After Loss Support – Facebook page

Baby Loss Study Days – Midwifery & Nursing Online

Managing Symptoms of Birth Trauma

Maternity Matters Peer Support Facebook group

Centrepoint Stress Relief Tool website

Guidance and Help – Campaign for Safer Births

Overcome Birth Trauma website

Birth Trauma Association Facebook group

What do you want people to know about birth trauma?

A health baby is not all that matters – Milli Hill

Birth Trauma and PTSD – Raising Awareness – Emma Jane Sasaru

Birth after Trauma – Alisha’s Birth Story – Emma Jane Sasaru

Promoting Respect and Preventing Mistreatment during Childbirth – BJOG

This is what I want you to know – ghostwritermum

Pregnancy After Birth Trauma

Vaginal Examinations in Labour – Magical Birth

Risk, Safety and Normal Birth – Magical Birth

A Healthy Baby Isn’t All That Matters – Double Crunch

Those Two Blue Lines – ghostwritermummy

Letter Of My Life – ghostwritermummy

Pregnancy After Birth Trauma – ghostwritermummy

What Happens When We Don’t Listen To Women? – ghostwritermummy

Choosing a Caesarean, and Having That Choice Refused – SouthwarkBelle

Pregnancy After Birth Trauma – heartmummy

Body Image

Birth Trauma & Body Image – ghostwritermummy

The Post-Birth Body – ghostwritermummy

The Shape Of A Mother website

Body Image of Mothers – Diana West IBCLC

Breasts, Body Image & Sexuality – Lisa Hassan Scott

007 breasts website

Bare Reality website

Breastfeeding Support On Children’s Wards

#MatExpHour Round Up – heartmummy

HospitalBreastfeeding – heartmummy

Caesarean Birth

A Perfect Caesarean Section, Complete with Skin-to-Skin – Krystal Cleaver

Caesarean Section – Let’s Dispel Some Myths – Our Rach

Caesarean in Focus – Clare Goggin

One Year – Laura Wood

Another Section is not a Solution – Laura Wood

Rachel’s Home VBAC – Gentle Caesarean Birth – Cambridge VBAC Friends

Rachel’s Story of a Gentle Caesarean Birth – Cambridge VBAC Friends

PND and Caesarean Section – Have You Seen That Girl?

The Early Section – Family Fever

The Premature Section – Family Fever

The Crash Section – Family Fever

The Last Section – Family Fever

Ghostwritermum Caesarean Birth posts:

Care Quality Commission Maternity Survey

2015 Survey Results – CQC

Maternity Care Experiences – CQC

Share Your Experience – CQC

Musings on the CQC Survey – Florence Wilcock

Still Some Way To Go – Gill Phillips

My Maternity Care for #YourMaternityCare – Leigh Kendall

#MatExp Lithotomy Challenge – Florence Wilcock & Gill Phillips

Visual Aids for Birthing Positions – Royal College of Midwives

Round up of Twitter Chat – Florence Wilcock

Dads & Partners

Time to Act for Dads & Partners – #MatExp

Dads Matter – Mark Williams

Fathers Reaching Out – Mark Williams

Postnatal Depression in Dads – NCT

Fathers’ Mental Health – Institute of Health Visiting

PND Dads: What You Can Do – Dad Info

Birth Trauma – Dads & Partners – Caesarean In Focus

Being a Birth Partner – The Frog Pyjamas

#MatExp for Deaf Parents

Deaf Nest Conference 2016 – book now!

DeafNest Conference

Deaf Nest Promotional Video

Learn Some Basic Sign Language – Action on Hearing Loss

Why all NHS staff should learn some Basic Sign Language – NHS Change Day

Breastfeeding Support webchat – National Breastfeeding Helpline

Debriefs

What is the Purpose of Debriefing Women in the Postnatal Period? – RCM

Why Hasn’t Birth Debrief Worked Very Well? – Birthing For Blokes

Birth Debrief – Alternative Ways of Supporting Trauma event

Closing The Bones (alternative ways of addressing trauma) – MagicalBirth

Psychological Debriefing is a Waste of Time – The British Journal of Psychiatry

The Importance of the Birth Debrief – Lauren Berrett

9 Words I Wish I Never Heard – Meg Kant

eRedbook

eRedbook – your baby’s digital health record

Use of the word “failure”

I wish I could ban the word “failure” – Emma Jane Sasaru

#MatExpHour Failure to Progress – Mandy Bellenger

Midwives and Health Visitors – collaborative working

Time to Act for Better Collaboration – #MatExp

What Health Visitors Do – The Basics – Jenny Harmer

Health Visiting and Midwifery Partnership Pathway – Public Health England

#MatExp On Tour in Manchester – heartmummy

#WeMidwives Twitter chat summary – WeMidwives

#WeMidwives Twitter chat round up – heartmummy

A health visiting / midwifery partnership from UCLan – Charlotte Smith & Neesha Ridle

Hyperemesis Gravidarum

Pregnancy Sickness Support website

Pregnancy Sickness Support on Facebook

The Unempathic Society – spewingmummy

Spewing Mummy on Facebook

The Stigma of Taking Medications for Sickness in Pregnancy – Caitlin Dean

Neurodevelopmental delay in children exposed in utero to HG – European Journal of Obstetrics & Gynaecology

Familial Aggregation of Hyperemesis Gravidarum – University of Southern California

Hypnobirthing

The Truth About Hypnobirthing – Suzy Ashworth

Using Hypnobirthing Techniques in Labour – Doula Paris

Hypnobirthing – Sprogcast Episode 10

In the Eye of the Beholder – Emma Jane Sasaru

It Wasn’t My Fault – Keeping It Eclectic

Induction of Labour

Induction – Cascade – Caesarean Section? – SouthwarkBelle

Intrauterine Growth Restriction

An IUGR Story – Child Growth Foundation

IUGR – A Guide for Parents & Patients – Child Growth Foundation

Fetal Growth – Perinatal Institute

Intrauterine Growth Restriction – Patient website

Made to Measure Campaign – MAMA Academy

Made to Measure, A Perfect Fit After All – ghostwritermummy

An IUGR Baby, The Story With A Happy Ending – ghostwritermummy

Maternal Mobility and Malposition in Labour

Pre-Chat Notes – Unlocking Birth

Does Baby’s Position Matter in Labour? – Unlocking Birth

Training – The Breech Birth Network – The Midwife, The Mother and The Breech

Emerging Evidence for Upright Breech Birth – The Midwife, The Mother and The Breech

Application of Assisted Deliveries Ball – CNKI.com

Who Decides The Position For Birth? – Journal of the Australian College of Midwives

spinningbabies website

Help! My Baby is Back to Back – Dr Matthew Prior

Twitter Chat Round-up – Unlocking Birth

Maternity Notes – Access & Language

Accessing your Records – birthrights

Understanding your Notes – Birth Trauma Association

What Does #MatExp Mean To You?

The #MatExp Lithotomy Challenge – Florence Wilcock

#MatExp Survey – The Results Are In! – heartmummy

Why the Wonderful #MatExp has Given me Hope – Emma Jane Sasaru

Reflecting on #MatExp and the Impact it is Having – Victoria Morgan

Putting the Heart into #MatExp – Heart Values – Emma Jane Sasaru

The FUNdamentals of Building a Change Platform – Gill Phillips

This Time Last Year….. – Gill Phillips

Proving That You Don’t Have To Ask For Permission To Make Change – Gill Phillips

WhoseShoes Confirmed That My Shoes Have Climbed A Mountain – Michelle Quashie

No Hierarchy, Just People – Gill Phillips

Twitter Chat Round Up – heartmummy

National Maternity Review Report

National Maternity Review Report – NHS England

Safe Care is Personalised Care – Mary Newburn

Birthrights Responds – Birthrights

Update on NHS Maternity Review – Royal College of Midwives

Positive Birth Movement Responds – Positive Birth Movement

What Can We All Agree On? – Dr Matthew Prior

Cherished Memory – Roy Lilley

A Personal View From A Member Of The Review Team – Annie Francis

What Does Choice Mean? – southwarkbelle

Thoughts on the National Maternity Review – James Titcombe

Night-time Support on the Postnatal Ward

Pre-Twitter Chat Information from Caesarean in Focus

Equal Rights and Staying Overnight – 23weeksocks

The Longest Night of my Life – heartmummy

36+2 Dangerously Understaffed – heartmummy

Time to Act for Dads & Partners – #MatExp

Postnatal Care – My After the Birth Story – SouthwarkBelle

Postnatal Care after CS – A Poem – helenyoungmidwife

The Postnatal Period should not be an Endurance Test – Beyond the Birthing Suite

Twitter Chat Round Up – from Caesarean in Focus

“Normal” Birth

Normal not Normal – Southwark Belle

When Normal Seems To Be The Hardest Word – MatExp

Normal Birth Is Not Always Normal – heartmummy

What is ‘Normal’ Anyway? – Leigh Kendall

Risk, Safety and Normal Birth – Selina Wallis

Peer Support – What Is Helpful?

Birth Trauma Association Facebook Page

PND and Me – host of #PNDHour on Twitter

How a Modern Day Village is Helping me Raise my Child – Maya and the Moon

Pregnancy Complications

Stories from the Heart – congenital heart defect – heartmummy

HELLP Syndrome – Still Processing the Events 10 Months on – Leigh Kendall

An IUGR Baby: And Then It’s All Over – ghostwritermum

Postpartum Hypothyroidism, Pregnancy and Being a Bit of a Divvy – SouthwarkBelle

Pre-Labour Premature Rupture of Membranes (PPROM)

Little Heartbeats website

Till It Happens To You – PPROM Aware Video

We Are Not Alone – Little Heartbeats PPROM Awareness

PPROM Awareness on Facebook

Stillbirth

#MatExpHour Stillbirth Storify

Stillbirth Stories website

MAMA Academy website

The Day The Whole World Went Away – Shoebox of Memories

Wake Up Babies – Shoebox of Memories

It’s Not All Rainbows and Unicorns – Shoebox of Memories

NHS Maternity Review – Our Say – Shoebox of Memories

Taking on Stigma and Taboo – Shoebox of Memories

Saving Babies’ Lives Care Bundle – NHS England

Baby Loss Study Days – Midwifery & Nursing Online

Remember my Baby website

Reduced Movements in Pregnancy – ghostwritermummy

Reduced Foetal Movements – Maternity Care in the Media – Let’s Talk Midwifery

Bereavement Support for Parents – Leigh Kendall

Harrogate Dad

Student Midwives for #MatExp

StudentMidwife.NET website

Thou Shall Not Pass – Alison Brindle (student midwife)

Why Your Voice Matters

When There Are No Words – The Smile Group

Letting My Voice Be Heard – Emma Jane Sasaru

Someone Listened To Me – Ghostwritermum

It’s Complicated – heartmummy

Do Not Silence Me – Emma Jane Sasaru

Gratitude – heartmummy

World Prematurity Day

Thoughts for World Prematurity Day – Leigh Kendall

Twinkle Twinkle Little Star – 23WeekSocks

Navigating the Challenges – NICU – Emma Sasaru

Not Even A Bag Of Sugar blogspot – Kylie Hodges

Social Media and Premature Babies – Kylie Hodges

PTSD – The Hidden Cost of NICU – The Smallest Things

Neonatal Care Services Need Investment Now – The Guardian

Flo WPD

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#OxyOct BOOM! What have we all made happen?

Leigh Kendall opened this month for #MatExp with a call to action for Oxytocin October. The campaign is always action focused and we are keen to hear from anyone who is doing something to improve maternity experience in the UK, be it something big or something small. Yet we had already put together a number of blog posts with calls to action, back in #FlamingJune. So I decided that my action for this month would be to revisit those blog posts and find out what progress has been made.

Flo Collage

The original blog posts were on these subjects (each subject links to the relevant post):

Having re-shared the posts on Facebook and Twitter I was delighted to see the responses coming in detailing what has changed, what has been started and what is continuing to be done. Take a look!

Perinatal Anxiety

Sarah McMullen of the NCT explained that she invited Emily Slater (MMHA Campaigns Manager) to speak and run a workshop at the NCT national conference – to raise awareness and inspire action. Sarah says that Emily’s plenary talk to 600+ staff, practitioners & volunteers “was incredibly powerful, and we’re meeting to discuss next steps for NCT”. Sarah added “We’ve also submitted two funding applications relating to mental health awareness (thanks to Rosey Wren for support), and have match-funded a PhD studentship with the wonderful Susan Ayres on Birth Trauma, and are supporting another PhD research project on group identity and PTSD”

Midwives on Twitter commented:

Anxiety capture Deirdre

Anxiety capture Jeannine

To read Jeannine and John’s blog post please click here.  “You matter. I care.”

Emotional Wellbeing

Birth Trauma Chat

#MatExp team member Emma Jane Sasaru has been incredibly active over the last few months.  She has launched Unfold Your Wings a place of information and support aiming to raise awareness of Perinatal PTSD, birth trauma, reduce stigma and give sufferers hope.  She has also launched a CoCreation Network community around perinatal mental health.  Emma has then collaborated with #MatExp team member Susanne Remic to bring about a weekly #BirthTraumaChat on Twitter run jointly from Unfold Your Wings and Maternity Matters.

Sue Henry

Also launched this month by West London Mental Health NHS Trust was this fantastic short film about perinatal mental health: https://vimeo.com/143359951 This film has already sparked many useful conversations.

PMH

Continuity of Care

I was speaking to a commissioner from Cheshire this month about the decision to commission OnetoOne Midwives. The company has this month posted an overview of their caseloading model: http://www.onetoonemidwives.org/_news/caseloading-midwifery-an-ever-evolving-model-of-care

In her talk at a recent National Maternity Review event, Baroness Julie Cumberlege made it very clear that the call for continuity of care is being heard by the review team up and down the country. Neighbourhood Midwives led a discussion at the review’s Birth Tank 2 event, and there were a couple of other discussions where options for continuity were also explored.

Support for Midwives

Poem from banksy midwife @JennytheM:

Midwives JennytheM

Midwife Deirdre Munro celebrated the launch of the new Global Village Midwives website this week. The movement is over a year old and Deirdre explains:

GVM capture

global village midwives

Infant Feeding

Lots of news about infant feeding from passionate individuals and voluntary organisations.  On our #MatExp Facebook group Zoe Woodman explained: “In May we got approval from NCT to run a branch funded feeding support group. Started in June with an NCT bfc attending who is also an IBCLC. We are on 3 boundaries in terms of commissioning services so no local peer to peer style support groups were running within 8miles. The only service is an HV clinic once a week and it’s one on one so you have to wait outside the room to be seen. It’s been on our branch aims at our AMM since I’ve been chair (4yrs!) so finally chuffed to see it in action and I will get to use it myself in January for no3! It’s running twice a month currently but hope we can get funding in the future to run weekly. It’s slowly building in terms of attendance. Feedback so far is great!”

Dorking NCT

Claire Czjakowska’s Breastfeeding Advert is coming together and is looking very exciting – watch this space!  Breastfeeding in Trafford launched its Twitter account this month so please follow for local breastfeeding news.  BfN Portsmouth tweeted:

Bf capture

Midwifery students at the University of Worcester have launched a petition around the questionable practices of infant formula companies – follow the hashtag #WeakenTheFormula for more information.

As if this wasn’t enough, this month has seen the launch of the World Breastfeeding Trend Initiative for the UK.  A committed group of individuals from the major breastfeeding voluntary organisations have come together to measure the country’s performance against the WHO Global Strategy for Infant and Young Child Feeding.  Please visit the website for more information on how this project is structured and the indicators against which the UK will be measured.  The project needs lots of input from families and professionals so please follow @wbtiuk on Twitter and find out how you can help.

WBTI capture

Tongue Tie

Doula Zoe Walsh updated us: “We held a North West tongue-tie workshop in Blackpool. It’s now going on the MSLC agenda for Blackpool so that we can discuss local provision and see if it’s meeting the needs of local families.”  

Breastfeeding and Medications

Friend of DIBM helpline

From a personal point of view, I finally got around to becoming a friend of the Drugs in Breastmilk Helpline this summer.  The helpline is absolutely vital for ensuring that women get the correct information about what medications they can use when breastfeeding.  The service is funded by the Breastfeeding Network and the charity once again asked supporters to do a #TeaBreakChallenge this month to help raise donations.

Teabreak challenge

A wonderful #MatExp collaboration has sprung up this month between Angelique Fox, Sarah Baker and Wendy Jones.  These two #MatExp mums who have never met in person have both volunteered to help Wendy to collect data and raise awareness with regards to drugs in breastmilk, particularly where dentists and podiatrists are concerned.  It was discussed on the #MatExp Facebook group that these two healthcare professions are often cited as not having up to date information about breastfeeding and medications so this collaborative project is aiming to tackle that.

Luisa Lyons, the Infant Feeding Coordinator who wrote our original post on this subject, gave us this fantastic update: “Been a busy couple of months. Infant feeding e-learning training for doctors up and running at my unit and both paeds and obstetricians encouraged to complete it. Great support from our obstetric consultant clinics director too. General paed nurses now doing mandatory infant feeding training every year. Been invited to teach general paed doctors face to face. Three GP’s have done the UNICEF 2 days bf management course with us and now writing bf training for GPs in Norfolk. Included info on bf and medications with scenarios to both student nurses and our midwives at keyworker training now, and incorporating into Mt for all maternity staff. Also off topic slightly am putting in a WHO code game to all the above which has generated lots of awareness with student midwives and maternity staff. Need to join DIBM as a friend which I had forgotten to do, so thanks for the heads up.”

Dads & Partners

Mark Williams, co-founder of Dads Matter UK, wrote this blog post for us for #OxyOct, detailing his work and campaigning: https://matexp.org.uk/matexp-and-me/dads-matter/

Men Love and Birth

Midwife Mark Harris launched his book this month, Men, Love and Birth, “the book about being present at birth that your lover wants you to read”.

A Manchester midwife reported positive outcomes around new rules enabling dads & partners to stay over on her unit:

Dads & Partners Mags

When asked how we can best support Dads & Partners, newly elected NCT president Seana Talbot tweeted:

Dads & Partners Seana

Community Outreach Midwife Wendy Warrington tweeted:

Dads & Partners Wendy

I asked Wendy about the work she does with regards to Dads & Partners and she explained “I talk about attachment and being with their baby, skin-to-skin touch. Antenatal and postnatal depression, and fathers’ role in supporting their partner in pregnancy, birth and beyond and how they can do this. I talk about baby cues and the impact of father’s involvement on child’s future emotional and cognitive development.  I have had excellent feedback from parents and when I see them after the birth they say they felt well prepared for feeling and emotions experienced post birth. They love the fact that I talked about it”

Collaboration between Midwives and Health Visitors

Health visitors on the #MatExp Facebook group told us:

My CPT & I have established 6 weekly meetings with the community midwife and the GP (whose special interest is pregnancy/neonates) to discuss cases”

“We already have that in my team we meet at least once a month with the midwife – it was weekly but we are very busy at the moment (both us and the midwife). She will just knock on our door though and share things – she really came on board with antenatal contacts telling parents to be and signposting those with small children with any worries to us.”

With excellent timing Sharon White, OBE, Professional Officer of the School & Public Health Nurses Association, then tweeted the updated pathway for health visiting and midwifery partnership.

partnership

And as a result of discussing all of this on Twitter, Sheena Byrom has invited me to lead a tweet chat with @WeMidwives and @WeHealthVisitor in November on the subject of midwife and health visitor collaboration.  Watch this space!

Birth Tank

And so much more has been happening in #OxyOct as well! #MatExp was well represented at the NHS Maternity Review’s Birth Tank 2 event in Birmingham – click here for Emma’s round up. I spoke at the launch of the Improving ME maternity review for Wirral, Merseyside, Warrington and West Lancashire – click here for my round up of the morning. Leigh Kendall and Florence Wilcock spread the word at the RCOG Conference on October 16th, and Leigh spoke at the Royal Society of Medicine event on October 20th.

RCOG

Leigh capture

Baby Loss Awareness Week took place this month and many important discussions were had around the subject of grief and loss, something which affects a number of #MatExp campaign members.  Leigh wrote movingly about Standing on the Periphery for #HugosLegacy.

BabyLoss

The RCM has this month launched its State of Maternity Services Report. Emma Jane Sasaru has written a series of three blogs about What Matters in Birth.  Susanne Remic has been raising awareness of IUGR. Michelle Quashie created fantastic word clouds for display in her local maternity unit.  We now have #MatExpHour every Friday created and launched by Louise Parry – click here for her round up of Week 2.  So much going on!

IUGR

I have no doubt there is much much more that I have missed from this round up. There is so much energy and passion in maternity services, and so much desire for change. Whatever it is you are trying to achieve, please join up with #MatExp via Twitter, Facebook or the website and get encouragement and input from like-minded people. Together we are stronger! Feel the Oxytocin flow!

 

Helen Calvert, 2015

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#Matexp – Taking action on improving Tongue Tie services.

There have been some fantastic conversations taking place on the #MatExp Facebook group, with lots of ACTION threads being posted to generate discussion. The aim of these discussions is to identify ways that we can ACT to improve maternity experiences. Big, long-term actions that might require system change or a change in culture. And small, immediate actions, that professionals and individuals can take today to improve the maternity experience of those around them.

One of the discussed topics was Tongue Tie’s, the effect they can have on feeding, but also the struggle to access help and support. So what is a tongue tie? How does it affect a mother and her baby? What can we do to ensure families access the support they need?

“Tongue-tie (ankyloglossia) is when the string of tissue under your baby’s tongue called a frenulum, which attaches their tongue to the floor of their mouth, is too short or tight. If your baby has tongue-tie, it can affect the tongues movement, preventing it from moving freely, this can cause problems with feeding, either at the breast or a bottle, speech, and moving on to solid food. Tongue tie can vary in degree, from a mild form in which the tongue’s movement is only slightly impaired, to a severe form in which the tongue is completely fused to the floor of the mouth. Feeding difficulties may arise due to the inability to move the tongue in a normal way and therefore impacting on attachment, sucking, making a seal and removing milk effectively. Many tongue-ties do not require treatment. However, if the condition is causing problems with feeding, surgical division of the frenulum can be recommended and carried out as soon as possible. It is important that families receive support from trained people as not all tongue ties can be clearly seen and each mother and baby will be different.h9991638_003

How does tongue tie affect a mother and baby? If a mother is breastfeeding tongue tie can affect latching to the breast, in fact some babies are completely unable to latch. It can be difficult for the baby to make a good seal on the breast or maintain the latch during a feed. The results can be sore nipples for mom, static or loss of weight in baby due to poor milk transfer, this in turn can affect milk supply and maintaining breastfeeding.  Some babies feed inefficiently for a short periods of time, get fed up, fall off the breast asleep and exhausted, and then wake an hour later as they are still hungry, so that they are feeding almost continuously. Continuing to breastfeed can become almost impossible with the constant feeding, sore nipples and effect on supply. Babies can become exhausted, and so trying to feed becomes more difficult thus affecting the health of the baby.

With bottle-feeding babies, tongue tie makes it difficult to make a good seal around the teat. The suck is inefficient, and the feed can take two to three times longer. As the seal is leaky, babies will often dribble milk in varying amounts, thus not getting a full feed. As the milk leaks out, air can get in and is swallowed. Both breastfeed and bottlefed babies can be very ‘windy’ with the possibility of increased colic and irritability.

So Tongue tie can have massive consequences on both breastfeed and bottlefed babies. For breastfeeding moms it can mean the end of their breastfeeding journey can can affect their emotional wellbeing too.

So the question raised is, how can we support families and improve services for babies with a Tongue tie?

From the discussions on the Matexp facebook page there were three clear areas that were highlighted.

1. Clear pathways of care. Many commented and shared their experiences of lack of support. There seemed great differences in support available from area to area and it was not always clear where or to whom mothers should be referred to for assessment, diagnosis and division of tongue tie. Some commented that perhaps it should be part of the newborn checks for babies, while others discussed the wisdom in waiting a while to see how feeding progressed before doing a division.

Either way, what was clear was the need for all areas to have a simple, clear pathway to help families get the support they need.

  • These pathways should be known by all including breastfeeding support workers, midwives, health visitors, neonatal nurses, paediatric doctors and G.P’s, as well as parents.
  • The pathway should include trained staff to assess, diagnosis and divide tongue ties.
  • That there should be support post division for feeding.
  • Joined up working between private, NHS and voluntary organisations.
  • Actual acknowledgement of the effects of tongue tie, something some parents reported they did not receive.

2. Trained staff . Many of the comments reflected the fact that there seems to be little in the way of trained staff to assess, diagnose and divide tongue tie. Many reported that despite problems they were told feeding was going well and getting checked for tongue tie was difficult. Some reported having to pay privately for both the assessment and treatment, as there was no one trained available in their area.  Others commented on confusion between healthcare professionals regarding the signs of tongue tie and its impact on feeding, some commented that they were told that the tongue tie needed to be cut without any assessment. Also even when tongue was diagnosed many said they faced long waiting lists with no help to support feeding or maintain lactation. In areas where there are no trained NHS staff, there is no where to refer families to and so the only option is private care which has led to often a costly private market which many families are unable to afford.

So what actions were suggested?

  • All areas to have trained NHS staff to assess, diagnose and divide tongue ties.
  • Working together of NHS and private care to support families, provide services, if there is a lack of trained NHS staff.
  • Staff trained on what a tongue tie is and the signs, effects, it can have on feeding.
  • National recognised, agreed method of assessing knowledge, skills and training.
  • Regular weekly clinics to keep waiting times down.

pull-quote-alone

3.  Support. By far the biggest number of comments were about support. Families commented again and again about the lack of support for tongue tie. There was a big discussion regarding definition of roles, appreciation of roles and how this impacts on support given. Many felt they received more support from voluntary support roles than health professionals, but then found that support limited or not not valued. Others said they received no support at all which resulted in loss of breastfeeding relationships. Others said that due to lack of support with breastfeeding, tongue tie became the issue that everyone ‘hung their hat’ on as a magical quick fix but then were left with no post division support and felt left alone to get feeding established. One mum said she ‘wished someone had just listened’ because she knew feeding was not progressing ok.

So what actions came forward regarding support?

  • Always listen to the mother, if she feels something isn’t right remember she knows her baby best.
  • Full assessments of feeds by qualified staff to see if feeding is affected by tongue tie.
  • Information and awareness of the signs of tongue tie for HCP’s, and parents.
  • Support with breastfeeding is essential as often support to position and attach baby well can be enough to improve feeding and prevent the need for division.
  • Support for families who bottlefeed on ways to improve feeding pre and post division.
  • Parents need information and support to make an informed choice as to whether to have a tongue tie division.
  • Post division support with breastfeeding and follow up.
  • Help to support lactation, pump loan.
  • Specialist support for premature babies with tongue tie.
  • Appreciation of roles in both the NHS, private and Voluntary sectors. All working together to provide integrated care for families.
  • Clear definition for families and HCP’s on roles, who can do what and who can offer support.

Tongue tie can be a difficult issue that families face, accessing support, finding information and getting lost in the system can leave them feeling frustrated and let down. Of course we all wish we had a magic wand to instantly provide clear pathways, much needed training and support and also weekly clinics that enabled those that needed tongue tie divisions to be seen as soon as possible to lessen its impact. However, while at present support varies from area to area, what can we all do to help make changes to help families?

  • Write to your local MSLC, head of midwifery, head of health visiting, PALS, commissioners or NHS trust and tell them both your struggles to access help but also when you have experienced great support.
  • We can also build on good existing services or use these as a model for setting up services in other areas.
  • If your a HCP and suspect a baby has a tongue tie but are not trained or unsure then signpost or refer the family to someone that is. Find out what is available in your local area.
  • If your a parent that suspects your baby has a tongue tie and isn’t feeding well, seek help and keep on asking! Research tongue tie for yourself so you can make an informed choice and remember is not a quick fix but feeding will take time to settle and adjust after division.
  • As support workers, breastfeeding counsellors, IBCLCs, healthcare professionals and NHS Trusts let us all listen to families and work together to provide them with the care, support and services they need, to give their little ones the best start we can.

familybw1800x1200
Tongue tie support http://tonguetieuk.org/network/ 

Emma Jane Sasaru

@ESasaruNHS

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What does it take to build a change platform? A year ago I had no idea. #MatExp

What does it take to build a change platform?
by Gill Phillips

If you had asked me this question a year ago, I would probably have said that I had no idea. And yet a year later, it seems that that is what we have done. On Friday we were absolutely delighted when Helen Bevan and team included #MatExp as one of the top change platforms in a global webinar.
MatExp - change platform


I was sitting last night contemplating this. Then serendipity struck when Jodi Brown, who had co-hosted the webinar with Helen, posted this tweet:


Jenny's bottle of matexp wineI think a big part of my philosophy is not to try to ‘bottle’ something that is a bit magic – other than in this wonderful #MatExp bottle distilled by Jenny Clarke. 😉 People want to feel part of growing something themselves rather than just taking on a formula dreamt up by others, however successful it may be. It always felt like a let-down on Blue Peter when they said “Here’s one I made earlier” and all the fun of discovery was removed.

Similarly, whilst it felt exciting to read a tweet the other day saying that our Whose Shoes? workshops should be ‘mandatory training’ for all, this goes directly against what I am desperate to achieve, which is to help people, users and healthcare professionals, devise and own their own solutions, working together as equals. It can never be a top-down approach.

Florence Wilcock wrote:
Florence Wilcock wrote:
“A very small pilot….!”

The #MatExp journey has been and continues to be extraordinary. Starting as a planned ‘very small pilot’, it has combined the energy of vibrant workshops with the speed and connectivity of intensive social media.

I started using the #MatExp hashtag back in about September 2014 and registered it with Symplur as a way of monitoring its reach. I had previously done this with #dementiachallengers, so knew this would be be important.

I am somewhat blown away by the fact that #MatExp now has over 144 million Twitter impressions.

It has created a virtuous circle. People tweet photos of the workshops, make positive comments about the experience and take real action. As other people see this and pick up the energy, they too want to get involved; as more people get involved, the workshops get even better. In the jargon ( I am not a fan of jargon) we ‘pull’ people in rather than telling them what they should do.


Bazaar - Helen BevanSome of the slides that Helen Bevan included really struck a chord with me.
I absolutely love the idea of comparing building a change platform to running a bazaar. You cannot see anyone in charge but no doubt someone somewhere has thought to get it started in the first place … and then perhaps would be in a lot of trouble if they tried to stop it!

A bazaar is such a colourful, vibrant and slightly chaotic image – it describes #MatExp perfectly.

As you may know, I am not one for a lot of rules. So here, in an unusual ‘tip of the hat’ to a popular formula, I decided to write a kind of ‘List of 10 things’ – the first 10 things came into my head rather than anything more scientific. The whole thing has been a fantastic team effort – the ‘core’ team from the project as originally envisaged made so much stronger by all the fabulous people who have stepped forward as leaders as the campaign has progressed. I have missed loads of things out, for which apologies, but there is masses of #MatExp stuff on the internet so it is pretty much all available to someone wanting to do their own research…

TEN (or perhaps a few more) THINGS…

The #MatExp month of ACTION begins today. Why women everywhere need the Maternity Review Team to engage!

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.


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.

FlamingJuneToday 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.

So what is #MatExp and how did it come about?

A lot has been written about this already – for example, Florence’s ‘in my shoes blog’.

Florence and Gill made this short video when, due to the phenomenal grassroots energy it had inspired, #MatExp was included as a major campaign in NHS Change Day, 2015.

300- 2 Graphic record from our #MatExp Whose Shoes? workshop, held at Kingston Hospital. New Possibilities are the graphic artists.[/caption]

Inevitably the themes are similar between the different sessions but with a strong local emphasis and most importantly local ownership, energy and leadership.

On Gill’s original blog there are LOADS of scrolling photos at this point showing #MatExp #Whose Shoes workshops and the wider campaign in action – take a look!

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.

We have a vibrant Facebook group (please apply to join – initiated by fab Helen Calvert @heartmummy) and the brand new website (LAUNCHED TODAY! – huge thanks in particular to Leigh Kendall @leighakendall) set up by the #MatExp team of mums who are incredibly focused, working long hours – all as volunteers. We are all absolutely determined to keep working together to improve maternity experience for women everywhere.

Gill Phillips and Florence Wilcock

There will be LOADS of ideas to help you…
So please get involved.

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The #MatExp Lithotomy Challenge

#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…

Lithotomy challenge graphic

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.
Changing times - castor oil2In 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.

Flo 1We 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.

Flo - Helen & camera crewIn 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.

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