Emma Sasaru

Putting the Heart into Matexp – Heart Values

31 August 2015 by Emma Sasaru / Continuity of Care, Environment and Facilities, Informed Choice, Language, The #MatExp Journey / 2 Comments

A while ago we decided to pick six words that we felt really summarised Matexp. As with the healthcare six C’s, we very much wanted our values to reflect what we feel is important to a good maternity experience both for families and staff. So with this in mind, the six values we chose were;

Choice

Kindness

Language

Respect

Dignity

Compassion

We set about asking everyone on facebook and twitter what each of the values meant to them.

Choice

Our first word was choice and we knew when it comes to maternity experiences is so important to families. So what did everyone say about choice?

“Choice to me means having the same services and facilities available to all women. Birth experiences shouldn’t be a postcode lottery.”

“Choice to me means being presented with the correct information so you can make an informed decision. An informed decision is an empowered one.”

“Choice means to me, that all women whether low risk or high risk have access to the same facilities & are given the opportunity to make an informed decision to choose how & where they birth without judgement or pressure even if it is not medically advised.”

“Choice to me means that we give families accurate, unbiased info so they can make a informed choice that is right for them. Then support them in that choice.

“Listen, really listen to women and let them pour out their heart and get to know what they need to make their birth what is right for them.”

“Choice is about being given all the information you need to make a decision in an unbiased, non-pressurised way.”

“Choice is being told the benefits and risks associated with each option. Choice is being told the benefits and risks with your alternative options (it’s very rare that there is no alternative option).
Choice is being told what happens if you simply do nothing. Choice is knowing how decisions made now will effect your future, I.e.surgery can have implications on future pregnancies. Choice is being able to consider all the information in relation to your own individual situation/ beliefs/ personal history, allowing time for you to make a rational decision. Choice is having balanced open informative discussions feeling that your decisions are supported and not judged. There is no ‘we are just going to’ or ‘we will’, choice is the individual making the decisions.”

We were reminded of nice guidelines for discussing risks and benefits and also CHOICE top tips for maternity care providers.

Another really interesting point was raised about choice,

“In some circumstances there are no choices, and support needs to be given to those mothers who have had their choices limited or removed.”

Sometimes we may have no choice, in that due to circumstances beyond our control we may have to give birth or accept a situation that is far from the choice we would have made or choices have to be made for the wellbeing of mother and/or baby.

“Following my daughter’s death I have questioned the decisions we made many times wondering if a different choice may have meant she’d lived. In my subsequent pregnancies the feeling of responsibility to make the right choice has at times overwhelmed me and made me very anxious. In lots of ways I’d have preferred to have just been told what was going to happen.”

It was also raised that choice means accepting the consequences of the choices we make, both as staff and as families. Sometimes this can mean impossible questions that may never be answered.

“Sometimes we are given the illusion of choice. How information is presented is so important. Manipulated or coerced compliance can be made to look like choice. Yet, within maternity services, it’s hard to challenge this. Some caregivers reveal their own opinions in how they phrase information – about whether induction, or cs, or epidurals have risks, for example. This sometimes is presented differently to data about home birth, or vbac, or physiological third stage.”

What did become clear was choice must be Clear, unbiased, informed and not an ‘illusion’. That families didn’t want those responsible for their care to manipulate information or data to coerce a choice that they felt was right. Instead information given should allow for families to make choices that were right for them.

Yes when it came to choice, it was evident how important this was to a good maternity experience.

Kindness

Next we chose kindness. While many things matter during birth, simple acts of kindness can leave lasting impressions and mean so much.

“True kindness is something you give without expectation of any kind of return, not even a thank you. It’s instinctive and comes from the heart and will always benefit another heart. You don’t have to touch, smell, see or hear it but it can awaken your senses and light up your soul. It’s something that both the giver and receiver benefit from.”

“Kindness to me also includes understanding- even if you don’t make sense or or thoughts are irrational. It’s such a confusing time, someone being kind and saying ‘it’s ok I understand’ means the world.”

“Kindness is SO important. I have met many kind midwives and each time a small gesture has been performed it has meant so much. I will never forget the midwife who made me a cup of tea in the small hours after Luka was born. I was literally (emotionally and physically) broken and her kindness fixed me up enough to carry on.”

“In order to be truly kind one needs the time to be kind. How many people are in such a hurry during their day, under too much pressure or thinking of the next job, to afford true kindness? Kindness means kind words but it also means listening, accepting & acting on the kind thoughts. If you see a person in distress, true kindness is actively easing that distress both verbally and practically.”

“Kindness should be in everything we do. We should treat all women with kindness because it’s the small things that matter too. Even the most difficult, hard and situation can be made a little easier when we are shown kindness. People remember kindness and if we truly seek to show kindness it will affect how we care for women. I believe it should be one of our inner values that we keep and not allow the culture to eat away. It costs nothing and yet can have the biggest effects.”

“Kindness is being empathetic and showing the person that you understand how the person is feeling and showing that you care and that you understand.”

“A quick Google search says “Kindness: the quality of being friendly, generous and considerate.” Generous is an important one. To be kind, in my opinion, means to give of yourself, to do something that takes a bit of extra effort. To deliver a home cooked meal to a family with a new baby is kind. To offer to take baby for a buggy walk whilst mum has a nap is kind. To make a busy parent a cup of tea is kind. To be generous with your time and your abilities is kind. As for “considerate”, this is the one where language is important. Consider what language you are using and the impact that can have on a person. Speak with kindness, aim to boost a family’s confidence and pride rather than to leave them confused or with feelings of inadequacy. Consider how you would wish to be treated in the same situation. Consider what you know of the family and the impact those things might have on their experience.”

So kindness was a valued part of maternity care and many expressed that kindness had made a real difference to them, however small the act.

It was also raised that it is important to also show kindness to those who care for women.

“As families we must not forget that there are times for us to be kind. To be friendly or at least polite. To drop off a box of chocolates on the ward to say thank you. To donate some items to the hospital. To raise money for units that have cared for our children. If we have been fortunate enough to receive kindness we should remember to pass it back or pass it on.”

Yes Kindness in words and deeds really does make for a good Maternity experience for all.

Language

Language is something that is discussed a lot in Matexp, and something that is very important to so many. Language has the power to build up, encourage and empower or to tear down, increase doubts and intensify fear. The words we use can leave lasting impressions.

“Language sets the tone for every experience. What is said, translates into what we hear and that affects how we feel. Being told I was 2-3cm and could go home if I wanted to it was ok. But what I heard was, I’m a failure, I’m not progressing, I’m wasting everyone’s time. It didn’t matter what was said to alleviate those worries, they were now engrained. Also, the word normal is a horrible word and should be replaced with various other descriptive words that can resonate more with the mother. Language is communication, understanding and respect.”

“Language is about reducing the distance between provider and parents and creating a collaborative ‘us’ rather than ‘them’. It’s as much about listening as talking, and it’s about choosing words that come from kindness, even if we can’t avoid the risk that they’re not always received that way.”

“It’s not just the words themselves (although these are important!) but also how it’s delivered. Positive phrasing is important we need to ban certain phrases IMO! A big cultural shift around certain stock phrases is needed. It’s about having a two-sided conversation/discussion in relation to decision making ultimately with the individual involved making the decision with all the facts available, I.e. looking directly at a person when talking, hello my name is campaign, doing admin once individual left room rather than spending lots of time looking at screen or doing paperwork etc.”

“For me language and the way we use language can convey so much. It should always be used in a kind way mindful of the person and their situation. Listening is so important as is thinking about the words we use. Our language should convey that we care, are interested, want the best for that person and that we are genuine. It shouldn’t be harsh or critical or brash.”

“If you can’t say anything nice, don’t say anything at all. Don’t fill silence with platitudes. Judgement is implied in so many statements unwittingly uttered when they fall on the ears of person who is suffering / has suffered a trauma. Instead hold a hand, mop a brow, smile, rub a shoulder but be so careful. It’s easy to say “well you are mum now you’ll put your baby first…” wh
en a new mum admits she feels awful, it’s said without malice, as a statement of fact as you see it BUT to the traumatised mummy it can say something different. To me it said “selfish mum, thinking about yourself, crap mum can’t do it” and so I hid how bad I felt and went home with retained placenta and developed sepsis. Think before you speak.”

“Words need to: be positive, encouraging, soothe, be honest, kind, compassionate, open, have empathy, be professional, clear and simple and always respectful.

Words without:
Attitude
Contempt
Judgement or jargon
Chat ‘with you’ not ‘to you or above you’
Words should not be dismissive or exclusive
Words of kindness always…Words are but leaves, deeds are the fruit.”

“The words we use provide the framework for our thinking. I can tell by the words you use what you think and therefore feel about me. Language is about communicating. We need to develop and agree a shared language to do this well. I don’t really care what your “correct terminology” is unless we have established what it means to us in this relationship. If you are not sure what words to use let’s talk about it. It’s a great way of building trust.”

“Language for me is one aspect of communication and facilitation and if we use it with the aim to facilitate then we are on the right track- this means personalising for atmosphere, experience, individual on a moment by moment level. And we must match the language with all other aspects of communication otherwise it is hard for women to trust in us as the words we use seem at odds with body language etc. Language should be used to empower, inform, educate, provide choice in a non judgemental safe, exploratory non defensive manner. That is the ideal. Consent, not coerce, create chances for inclusion in the care relation ship and take care in the words we choose- as said above we all take things in different ways, but if we are authentic in what we say then that’s a good start.”

Two words in particular that came out as needing to be thrown into room 101 and these were;

“Failure“ and “incompetent”

Language is a very important Heart Value. We need to think about the words we use, but also the way those words are used. Language can greatly affect birth because words are so powerful.

Respect

We would think that respect would be an obvious part of a maternity experience, but sadly many women and staff say they feel it is lacking.

“To me respect means an absence of any type of prejudice. It means getting to know the individual, not treating everyone the same. Acknowledging the family’s history, experience and their knowledge and understanding without making assumptions. Respecting the mother’s decisions as much as her body.”

“Respect is valuing people and listening to/valuing their opinions even if they differ from yours. Finding a way to use these collaboratively when making plans. This respect should go both ways too, no point looking for respect if you’re not giving it.”

R … Respect
E … Every one’s
S… Sensitive soul
P… We are just people
E…Eager to do our best
C… Careful how you say things
T … Two way communication needs kindness & respect.

“Due regard to the feelings or rights of others is where respect really hits in #MatExp. We must give due regard to the feelings and rights of families, whatever our personal views or experiences.”

“Avoid harm or interfering with” – another crucial one. Sometimes these feel mutually exclusive in some areas of #MatExp – can we avoid interfering with mothers and babies but still avoid harm? If in doubt, we go back to respecting the feelings or rights of others. And of course we have to consider whether the baby has rights as well.”

“Respect is valuing the person’s point of view and valuing them as a person. What they want, what they feel and this should be discussed with the woman. Actually to define respect is not that easy. I was thinking how the medical profession has commanded respect and still does and it is very aligned to value.’

“Based on my personal experience, respect is knowing and understanding that this is MY body, MY pregnancy and MY baby NOT yours (health practitioners); hence LISTEN to me, give me OBJECTIVE information to help me to make ‘INFORMED’ decisions and FIGHT/ADVOCATE for my wishes. Don’t give me your opinion if I haven’t asked for it and recognise my birth doesn’t fit round your schedule but the other way. And everything everyone has said so far.”

Respect also encompasses staff and the environment they work and care for women in.

“The first part is the respect I hope all birth professionals command, as they are doing an amazing job.”

“Agree to recognise and abide by”. Do all of the guidelines and protocols in your hospital or birthing centre command respect? Do you respect family’s birth plans? Do families respect your recommendations? Can all of these things be married together? Respect encompasses a huge amount of concepts. We all want it and we’re often slow to give it.”

“It also means respecting each other as staff, working as a team and supporting each other’s roles. Respect also included speaking up when we see wrong attitudes or treatment. It also means the respecting of other view points and realising we can all have different perspectives and that’s ok.”

Respect for women, their families, beliefs, choices and needs MATTERS. Staff too need respect for each other and but also afford respect for the amazing job they are doing.

Dignity

How can we respect a woman’s dignity in birth?

“For me dignity means, allowing me to make decisions without health professional over riding them and making you feel as though you’ve said something wrong.”

“For me respect and dignity come hand in hand. Whatever happens if you have treated me with respect I will be able to preserve my dignity. Labour and birth put you on a very vulnerable place and being respected means whatever procedure or conversation takes place involving very intimate issues, I will feel like I am a human being rather than a problem or hinderance, or worse still, like there is something wrong with me, which is my fault, not a result of the circumstances.”

“Dignity is treating me in a way that doesn’t make me feel I’ve outstayed my welcome on the maternity ward.”

“For me, dignity is about human rights, and human rights are about being treated with respect…a pregnant woman or a woman in labour is entitled to her human rights being respected at all times, and she is entitled to be treated with dignity…there!”

“Recognise that respecting privacy, DIGNITY and autonomy is not an addition to care provision, but an integral part of good care…”

“Being spoken to as a competent adult rather than a naughty child, people introducing themselves before touching me, people remembering I am a person not just a uterus on legs.”

In fact this summed Dignity up perfectly.

Compassion

Last of our Heart Values, but by no means least, is Compassion. Some would argue that compassion alone is the single most important thing we can shown women in a maternity experience, if all care is based on compassion then it will encompass all the other Heart Values.

“To me compassion is seeing a person, realising that they are in need of not just your medical care but your emotional support, kindness and often just to know you actually care. It involves thought, as it can be such little things that make a difference. Think, if this was my daughter or sister how would I want them to be cared for ?”

“Compassion to me is always about time, the extra couple of seconds to smile at someone who looks worried; the couple of minutes to listen to someone who has a question or to ask someone who looks lost on a corridor if they need help; right up to the tasks that take a lot of time.”

Do we see compassion in maternity?

“When I was very sick waiting to have Joseph no one had any time to just sit with me, so the staff got a student midwife to sit and hold my hand. I’ll never forget her kindness. So even if there is no time sometimes there is another way.”

“I was really surprised when I was critically ill. I had a midwife refusing to leave as I was so poorly, she made sure she was my midwife 3 nights in a row. I had so many hugs from so many doctors, midwives, health care assistants I can’t count. I had my 27 weeker in an LNU rather than a Level 3 and they pulled out all stops so we could be cared for close to home.”

“One of my favourite consultants wasn’t even one of mine. Every day he would see me going to Joseph (over ten weeks) and give me a hug and tell me what a lovely mum I was. He was a huge support to me and probably had no idea.”

“For me, it was when one of my consultants told me “your baby *will* be premature”. I started to cry and she put her hand on my arm. It was such a human touch and I was so grateful. But I’m guessing that’s generally not encouraged, whereas for me, it meant so much: it said, I understand and I know this is hard. For me as well, it was when I finally left the hospital and one of my midwives gave me a big hug.”

“It was the array of midwives who looked after me for 10 days talking to me and making me feel almost as if I was just in a second home (ha I was in for 2 weeks which felt like a long time).”

“It was all the consultants who I had come across, always stopping when they saw me to ask how I was and how baby was doing. It was consultants who came to find me the next day to see how I was doing post c sec.I didn’t really expect that, as they must all be very busy people, but they never gave that impression of being in a rush etc.”

“I had so much kindness and compassion when I was in hospital with Joseph, my favourite was the day after Joseph was born, he was ventilated in NICU and I was in my room. I knew I couldn’t see him that day, and had been warned it would be Monday, this was Friday. I quietly crying and the obstetrician reg Charlie came in and said “why are you crying” and I said “I’m fine, I’m hormonal and still very ill and just feeling a bit sorry for myself”. He said “Nonsense, you need to see your baby and I WILL make it happen”. He spent hours organising everything to get me to NICU to see my baby, I will never forget his kindness and him realising that was what I needed, and being prepared to make it happen.”

Can we as families show compassion to staff?

“For staff I believe we should remember the hard work they do and commend them for that. Also be respectful to them. Also compassionate towards each other as a team. Help each other, treat with respect, and value each other’s gifts and abilities. Compassion I truly believe goes a long way when it comes to improving Matexp for all!”

“Immediate thought: always offer your midwife or health visitor a brew when they come to your home, coz they work bloody hard smile emoticon And we know that in the UK tea = compassion.”

“Give thanks and praise where it’s due, people are so quick to complain but never to give thanks. For HCPs, spend 1 moment before each meeting to take a deep breath, rid yourself of other thoughts and allow all focus to be on the couple/Mama you are going to speak with/assist.”

“One of the biggest revelations I’ve had this year, during a fairly turbulent time, is that it is impossible to practice compassion as a HCP towards women day in day out unless you also practice self-compassion.”

“This thread has inspired me. Tonight the children and I are going to bake a big chocolate cake and then tomorrow deliver it to the Labour Ward as a thank you to all the exceptional midwives who work so hard there.”

So those are our six Heart Values. These values are the heart of Matexp, they permeate the actions we make to improve maternity services everywhere.The Values will continue to grow and expand as Matexp does too.

Thank you to everyone who shared their thoughts and ideas with us. We had so many it was impossible to include every single one here, but we hope all the above comments capture the thoughts of women, families and staff.

Matexp is amazing and will make changes for families everywhere. A woman will remember her birth for the rest of her life so lets make sure we do all we can to make her maternity experience one she remembers for all the right reasons, which we can if we remember our Matexp Heart Values. Lets but the heart into Matexp.

Emma Sasaru

Share the Word About MatExp!

#Matexp – Taking action on improving Tongue Tie services.

13 July 2015 by Emma Sasaru / #MatExp Actions, Continuity of Care, Feeding, Informed Choice / 2 Comments

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.

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.

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.

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

Emma Jane Sasaru

@ESasaruNHS

Share the Word About MatExp!

#FlamingJune – #Matexp igniting the flames to improve maternity experiences

29 June 2015 by Emma Sasaru / #MatExp Actions, About MatExp, Baby Loss, Feeding, Informed Choice, Language, The #MatExp Journey / Comments Off

Wow what a month its has been! The whole of June has been #FlamingJune, a month when everyone was asked to share actions big or small to show ways they are going to improve maternity experiences. Everyone whether a mother, a doula, a midwife, blogger or campaigner was invited to post actions on the Matexp facebook page, the twitter hashtag #Matexp or the Matexp website.

What a response! In fact there have been so many actions it is impossible to list them all. But here is a little round up of the general ideas behind the actions.

LISTEN, this was mentioned by so many and shows how important is it that women are listened to, in pregnancy, during birth and afterwards. Many voiced that this simple action alone would have improved their experience and many voiced that listening to women more was their action.

ADVOCATE, for women, for families, by Blogs, campaigns, education classes and working with local maternity liaison service committees many spoke of ways they will seek to support families. Some will be doing so be simply voicing their own experience.

CHOICE, campaign for, raise awareness of, make sure women are aware of and given choices and that their choices are listened to, respected. Some actions involved women simply educating themselves on the choices available to them, while others spoke about raising awareness of options and choices and how to get support.

SUPPORT, for breastfeeding, families with babies in NNU or on paediatric wards, perinatal mental health and for families that have lost their precious babies. Also how healthcare professionals can all work together to make support for families better. There were so many amazing ideas and actions on support and again many voiced how important support is.

Some said that their actions were to become midwives and health visitors and to be on the frontline of supporting women and their families, to change cultures and improve maternity services.

During #FlamingJune we have discussed, tongue ties, infant feeding, baby loss, perinatal wellbeing, birth trauma, medication while breastfeeding, NICU, low birth weight, PND and much more. These were based around the Matexp twitter Alphabet.

This month saw us celebrate fathers day and the importance of dads to families. We saw beautiful pictures on the Matexp facebook page of dads doing skin to skin, holding, playing and loving their families. It was so moving, and truly showed how valuable they are and all partners, to the wellbeing of families.

This month was also #celebratebreastfeeding week. Again we saw amazing pictures and comments of the good support that families have had, but also many posts on the lack of support that so often seems the situation many families face. With many areas finding cuts are being made to breastfeeding support it is a timely reminder of how important it is that feeding support is part of a good maternity experience.

#FlamingJune saw the release of the first, of we hope many, videos on Matexp. Florence, Gill and Sarah in a really moving video shared with us all how and why Matexp started, the whoseshoes workshops and the impact it has had on services.

Also the first Matexp workshop to be held outside of London in Guernsey which is so exciting. Hopefully workshops will start to spread all over the UK and who knows eventually, maybe the whole world.

So as we reach the end of #FlamingJune what now? Well if you haven’t made an action you still can, it doesn’t have to be a big change it can be as simple as thinking about the language we use around a pregnant women or to share our story. If we have made an action, keep going to see it through. Every small change we make as individuals makes a difference. It maybe that your action will be hard to make happen, or will take a long time, but don’t give up because even just changing the maternity experience for one family makes it so worthwhile.

There are more plans ahead for the coming months, so much to look forward to. Thank you for the journey so far, for your actions, thoughts, comments and support. Matexp puts families at the heart, its overall theme is kindness and compassionate care. It is a safe place for everyone to voice their views. So take a look and get involved in making maternity experiences better for everyone.

Emma Jane Sasaru

@ESasaruNHS

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#Matexp – Emotional Wellbeing – what do families really need?

15 June 2015 by Emma Sasaru / #MatExp Actions, About MatExp, Baby Loss, Birth Trauma, Environment and Facilities, Feeding, Postnatal Care, Pregnancy Complications, The #MatExp Journey, Uncategorized / Comments Off

Supporting families – Emotional Wellbeing

#Flamingjune is well under way and there has been so many wonderful conversations taking place on the Matexp facebook group. As part of this months campaign, ACTIONS to improve services have very much been at the forefront with everyone sharing ideas to make sure support given to families is the best it can be.

With this in mind one of the subjects discussed was Emotional Wellbeing. Many shared heartfelt stories, and personal experiences as well as ideas that would have made a difference them and their families.

Matexp asked;

How much do you feel your pregnancy, birth and postnatal care affected your emotional wellbeing?
How do you think we can help prepare women and their partners for the impact that birth and caring for a new baby has on emotional wellbeing ?
What supported or helped you to protect your emotional wellbeing?
What can be done to help health care professionals be able to support families better?

Many commented on how we often under estimate the impact having a new baby has on a family. It was said that ‘adapting from working life to being at home was overwhelming’, ‘that often dads are working long hours and need support too’ and having somewhere to go to talk to others and relax was vital. Emotional support was mentioned as being a “basic need” for families.

One comment noted that ‘real life’ parenting needs to be discussed at antenatal contacts. “We are bombarded with the prefect images of parenthood, I don’t think people are prepared for the realities of parenthood – being totally exhausted but this little person still needs feeding and there is no milk in the fridge so you cant even have a coffee to wake up you”.

Another commented’ ” professionals need to understand the stresses which parents face not just with the birth, but financial, logistical etc”. What suggestions were made that would help? “By looking through the eyes of the patient, and trying to see things from their point of view”. Yes walking in another’s shoes so to speak showing empathy, and understanding helps provide support that protects the emotional wellbeing of families.

Many voiced feeling left alone, isolated and ‘fending for themselves’ after the birth of their babies and how this impacted their emotional wellbeing. Many felt afraid to voice they were struggling with motherhood and kept it to themselves worrying they be dismissed or viewed as ‘failing’.

Others voiced how important good support from health visitors, peer support and support groups was to their emotional wellbeing and not just for mom but dads too. In fact is was mentioned how important it is to ask dads how they are doing too!

Again and again support was mentioned for birth trauma and loss of a baby. Things such as professional counselling to be available as standard and peer support on wards and units. As well as health professionals knowing where to signpost families for support including local charities and national organisations.

One comment read “the single biggest thing would have been to treat us respectfully”. Very sobering.

So what were some of the actions that came out of the discussion to help with emotional wellbeing?

Maternity units to have specially trained staff to care for those that have suffered birth trauma, loss or mental health issues.
To remember that care involves emotional support not just physical.
Peer support for families on wards and in NICU.
Specialist counselling services available as part of post-natal after care and on NICU unit so families do not have to leave their babies.
Antenatal support on ‘real life’ caring for a baby, as well as how to look after their emotional wellbeing.
After birth de-briefs for sharing of experiences both good and bad to help improve care given.
Remember that dads need support too.
Health professionals to be aware of support available to families so they can signpost.
For all staff supporting families to show kindness, compassion and empathy and provide care that is patient-centred meeting individual needs.
Most of all treat families with respect. “letting mums and dads know that being good is good enough – they don’t need to be perfect”.

Emotional wellbeing is important for families, by sharing experiences, listening and working together we can help improve the maternity experience for all.

There is beauty in giving to others

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Emma Jane Sasaru

@ESasaruNHS

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Birth trauma and PTSD – Raising awareness

30 May 2015 by Emma Sasaru / Birth Trauma, Continuity of Care, Environment and Facilities, Language, Postnatal Care, Pregnancy Complications / Comments Off

darkest-passages-the-heart-is-unconquerable-dale-pelzer

When people think about post traumatic stress they often think of a soldier, returning from battle traumatised and battered by the ravages of war and the terrible things seen and experienced.

However PTSD doesn’t only affect those affected in the aftermath of war or a terrible natural disaster or violent act. PTSD can also affect someone in circumstances that should be safe, that should be happy, that should be the start of an amazing journey. For some women the birth of their baby can be traumatic and can be a trigger for PTSD that can severely affect their life. It can affect bonding with their baby, relationships with family and friends, doing everyday activities and physical health. So what is birth trauma and PTSD and how can we help and support women that are suffering?

Firstly what is birth trauma?

‘Birth trauma is in the eye of the beholder’ (Cheryl Beck) and this is true. What is traumatic to one woman may not be traumatic to another woman. Each woman’s experience of birth is unique to her and many things can add to a woman feeling her birth was traumatic. For some it maybe that her birth was a truly scary event, she may had been in an emergency situation where her life and that of her baby was at risk. Maybe her labour was very lengthy and very painful. It may be that a woman’s birth had high levels of medical intervention, such as induction, caesarean section, episiotomy, or other medical issues. It may be that a woman gives birth early and her pre-term baby requires care in NICU. Sadly some women have a birth that results in damage or injury to her baby and some lose their babies at birth.

For other women trauma can result from the way she is looked after by the staff responsible for her care both during the birth of her baby but also postnatally. She may feel a loss of control, dignity and privacy. There may have been a lack of information or a woman may feel she wasn’t listened to and her choices not respected or overlooked. She may feel she had medical procedures done without her consent or without proper explanation or that she was left with no choice. Or maybe unkind, cruel words and actions made her feel vulnerable and exposed.

Some women find birth triggers or adds to previous trauma such as rape or domestic abuse.

Often women who feel traumatised from their birth will feel isolated, other women may not understand why she feels traumatised, after all isn’t childbirth a ‘natural thing’? So a woman can feel guilty and somehow ‘weaker’ than other women for being unable to ‘cope’ with birth . She may feel she should be over the ‘birth’ and often well meaning friends and family will say things such as “at least you are ok and you have a healthy baby”. This only confounds the woman’s feelings and makes her feel more isolated and can damage relationships with partners, family members and friends as a woman feels no one understands and so she withdraws deeper into the trauma. Depending on the nature of the trauma a woman may feel unable to have further medical tests such as smear tests. Sex may also be affected as a woman may fear further pregnancies, or even just the act of physical intimacy itself. Many women who suffer birth trauma may struggle to bond with their baby, others become overly anxious of their babies health and wellbeing and constantly worry about every aspect of caring for their newborn.

For a woman that has lost a baby during birth or whose baby has been injured during birth she may experience overwhelming guilt, she may feel like it is her fault that she somehow failed her baby or that she should somehow have prevented it. She may play over and over again the birth in her head seeking answers or ways she could have changed the outcome.

Feeling like they have no voice, are misunderstood and weak many women will seek to hide their true suffering and ‘carry on’, the weight of trauma bearing down on them crushing hope, light and happiness as they try desperately to cling to normality. Everyday tasks become hard and just coping day to day can feel overwhelming. Their physical health too may suffer, as the effects of trauma ravage them mentally. Lack of sleep, trouble eating and the constant struggle all takes its toll. Flashbacks may take them back to the event reliving moments, even smells and conversations causing great distress and anxiety.

So what is PTSD and how does it differ from postnatal depression?

Often women can be wrongly diagnosed with PND when in reality they have PTSD. While PTSD and PND can overlap as they do have some similar symptoms, they are very different. Its important that a woman receives a correct diagnose so she can have the support, help and therapies she needs. PTSD is the clinical term for a set of normal reactions to a traumatic, scary or bad experience or event. It can occur after a person experiences or witnesses something that was or they perceive to have been life-threatening.

Signs of PTSD include:

Feelings of intense fear, helplessness and/or terror.
The re-experiencing of the event by recurrent intrusive memories, flashbacks and/or nightmares. The individual will usually feel distressed, anxious or panicky when exposed to anything which remind them of the event.
Avoidance of anything that reminds them of the trauma. This can include talking about it, the place where the trauma happened or people that may have been involved in the trauma. (such as hospitals, doctors, healthcare professionals) Even T.V programs or books maybe avoided.
Bad memories and flash backs often result in difficulties with sleeping and concentrating, thus affecting daily activities. Sufferers may also feel angry, irritable and be hyper-vigilant or jumpy, easily startled.
Suffers may suffer panic attacks, depression and anxiety. They may feel detached, alone and have a sense of something bad may happen to them or their loved ones.

It is important to remember that PTSD is beyond the sufferer’s control. It is the mind’s way of trying to make sense of an extremely scary traumatic experience and are not a sign of an individuals ‘weakness’ or inability to cope. The person cannot just ‘get over it’ or ‘pull themselves together’ or ‘move on’. Rather they need help and support to process not only what has happened to them but also the feelings surrounding it.

So what can help a woman who has suffered birth trauma or PTSD?

For partners, family and friends its important to acknowledge what has happened to the women and her feelings surrounding it. Encourage her to talk about her feelings if she is able to. Help her to see you want to try to understand how she is feeling and that you recognise how traumatised she may feel. Reassure her that you are there for her and that you will help in anyway you can. You maybe the only person that she trusts. Encourage, commend show compassion and empathy. Emotional support is invaluable, even if it’s just a listening ear or a hug. Realise that there may be things or activities that she may not yet feel ready to do, be patient and show understanding.

Encourage her to get help, whether it be her GP, health visitor, midwife or a charity such as the Birth Trauma association or Mind. This will not be easy as she may have a fear and distrust of telling anyone how she really feels especially a healthcare professional. Reassure her of your support, maybe offering to attend any appointments with her if she wishes. Asking for help will be hard, and so will the time undergoing any therapies being there for her providing emotional support is so important.

Also, helping with daily activities can mean so much, helping her get much needed rest offering to prepare a meal, or to do some shopping can also be invaluable.

Helping someone with PTSD can be difficult and frustrating.Partners and family can feel lost and confused too. Reading up on PTSD can help you understand it and how it can affect someone that is suffering.

Of course some partners too can feel traumatised and suffer from PTSD after seeing the birth of their baby. It is important they too seek help and support.

What about healthcare professionals?

Its important that any healthcare professional’s when supporting a woman after birth build a relationship built on trust. LISTEN, this is the single most important thing to a woman who is suffering. Listening enables you to truly know what she has been through, how she is feeling and whats important to her and her family. Listening will enable you to know if she is likely to be suffering PTSD or any other perinatal mental health disorder. Listen also to her partner and family, they know her best, if they feel something isn’t right or reach out for your support then be there. Ask for training in order to help you understand the different types of perinatal mental health issues and know the pathways and any local support available to signpost a women to. Be careful of language used and do not minimise her feelings or experience. If you know a woman has had a traumatic birth from postnatal notes etc, ASK, don’t ignore it.

What can a woman who has had birth trauma/PTSD do for herself?

Speak to someone, partner, family, friends, midwife, health visitor, GP. Don’t suffer in silence.
Remember you are not alone, there are others too that have been affected by birth trauma.
Remember you are not to blame.
Look after yourself, make sure you rest and eat a good balanced diet. Do things, activities that help you to relax.
Know your limitations and what you can do both physically and emotionally.
Speak to your hospital about your experience. Some women ask to see their medical notes and discuss exactly what happened to them and why.
Seek help and treatment. There are various treatments for PTSD such as counselling, Eye Movement Desensitization and Reprocessing (EMDR), cognitive behavioural therapy (CBT) and medication.
Find local support groups or support groups on social media (such as birth trauma facebook support page)

Birth trauma is real and so is PTSD, its important that women get the help and support they need to overcome it. The birth of her baby can affect a woman for the rest of her life, it may not be possible to completely prevent birth trauma but what we can do is support women when things do go wrong and make sure that we show them love, compassion, kindness and help even at the darkest times so they believe that it will be possible to bathe in light again. hafiz-quote1

my story of birth trauma

Emma Jane Sasaru

@ESasaruNHS

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What is a ‘Positive’ birth?

30 May 2015 by Emma Sasaru / Birth Trauma, Continuity of Care, Environment and Facilities, Informed Choice, Postnatal Care / Comments Off

The experience of birth will stay with a woman her whole life time

Ask any women her birth story and she will recount it with easy, there is no experience that can compare to bringing a tiny baby into the arms of a loving family. The effects of a birth experience will stay with a woman her whole life , it can effect her subsequent births, her health, her relationships, sometimes for the rest of her life.

So what is a positive birth? What can we do to help women have a positive birth?

As with all things in life choice is very important and this is no different when it comes to birth. Choice is so important for women and should be the foundation of any birth. Women should be aware of their choices and what is available for them. Is there a midwife led unit she can use? Will she be able to have a home birth? What about free birthing? Can she elect to have a cesarean section? These are all things a woman may wish to consider when choosing how to have her baby. Consider how much thought may go into the purchase of a pram. I know couples that have spent months researching and looking at all the different prams available. Shouldn’t we be helping and making sure that just as much thought and research is going into the choices for birth?

What’s also important is accurate evidence based information that will enable a women to make an informed choice. How far from a hospital is she if she chooses a home birth? What are the risks of a cesarean section and the results for future pregnancies? What actually is free birthing? Why has it been recommended to have the baby in a hospital? By good communication and giving accurate information women can be helped to make a informed choice that is right for them and their baby.

So what makes a birth positive?

Think about a day or an event that you enjoyed lately that you view as positive. What made it positive? Maybe it was who was there, or the place you went or what you did. Does a positive event mean that it always goes to plan with everything prefect? No, sometimes even when things don’t go to plan they are still positive. Will everyone have the same view of what is positive and does everyone view the same experiences as positive? Chances are what you find positive someone else wont. So when it comes to birth it is very individual. Every woman has her own view of what a positive birth is.

Picture for a moment a woman, she was desperately looking forward to the birth of her baby, however something went wrong and her beautiful baby was born sleeping. Now she is pregnant again, she is racked with fear, anxiety fills every day as she worries about the safety of her baby. She desires control, needs reassurance of medical staff and the technology they process. For this woman her choice for her birth is a cesarean, her baby delivered, well and alive in a controlled way, at her choosing. As her baby is lifted from her body and she hears the cry of her newborn baby relief, joy and hope fills her heart. This is her positive birth.

Now picture a woman whose previous birth was traumatic an emergency cesarean with much medical interventions. Her recovery was long and feeding was difficult. But this time she wishes to stay at home as long as she can. She wants to trust her body to birth her baby and believe that she can safely bring her little one into the world. She wants calmness and solitude and as little intervention as possible. So she hires a doula that supports her at home till the journey to hospital. Once there in a room thats dark and quiet, with time and the support of her partner she births her baby on all fours into her own hands and she feels at peace. This is her positive birth.

Then there’s the woman that is terrified of birth, of hospitals and doctors. Abused as a child she has trouble trusting people. Yet tears are streaming down her face as she holds her newborn baby, with her is a midwife she trusts and she feels safe in the beautiful room of her local midwife lead unit. Around her are her things that bring her comfort and peace. Her favourite song is playing as the warm waters of birth pool lap around her soothing her tired body. This is her positive birth.

A positive birth will be different for every woman, what matters is what birth means to her. It’s important that a woman’s choice is supported and her wishes understood and as far as possible she is able to have the birth she wishes.

Of course sometimes things don’t go as planned and the birth a woman wants and has planned may not happen. However we can still make sure that it is positive. How?

Firstly communication. Always should a woman know what is happening and why. Explaining what is happening gives the woman confidence and builds trust with those who are caring for her. Understanding the things happening too her will easy anxiety and lessen fear. Don’t forget communication means listening too!

Secondly choice. No matter what is happening the woman still should be given choices. Allowing a woman to have choice even in difficult situations means we give control back to her and her birth.

Thirdly, dignity, respect and compassion feed positivity. Always should a woman feel that she has been treated with dignity by everyone around her. Small things like asking before doing checks and saying please and thank you go a long way. A woman should never be judged or labeled. Respect should be shown her and her choices and her concerns and fears. It maybe that her choices are difficult for us to understand but still they are hers and we must respect them. Never should a woman be spoken to unkindly or her needs ignored.

What about Compassion?

‘Compassion is the emotion that one feels in response to the suffering of others that motivates a desire to help. Compassion is really the act of going out of your way to help physical, spiritual, or emotional hurts or pains of another’

Compassion should move those who support a woman in birth to go out of their way to help her. She is someone’s wife, sister, daughter, she has her own story, feelings, needs, fears, concerns. Care should be individual for each woman taking into account her personality, her background, her current situation. This may sound like an impossible task but is it? Ask yourself if it was you what would you want? More importantly as we said at the outset if the way a woman births stays with her her whole life time then we must do everything we can to make her birth positive. so that she looks back on it and remembers that those around her did everything they could to make her feel loved. images (15)

Emma Jane Sasaru

@ESasaruNHS

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The many faces of birth

30 May 2015 by Emma Sasaru / About MatExp, Continuity of Care, Informed Choice, Language, Postnatal Care / Comments Off

Ive seen lately many discussions on birth and it got me thinking. Birth has many faces and no one situation prevails, it is as individual to each woman, baby and family as a fingerprint. Often things such a ‘risk’, ‘normal’ and ‘natural’ are mentioned along with ‘informed choice’ and ‘statistics’. All this can be banded about and yet is birth really that simple?

Of course the answer is no, birth can be very straight forward but it can also be very complicated and so providing care, support while respecting individual choice can be difficult. What do I mean?

Well I can see there are many faces to birth. Firstly the ‘positive natural’ side of birth that we hear so much about. As I trained as a doula I learnt so much about the human body its ability to birth and ways that a woman can help herself during the stages of labouring. I truly believe that giving birth can be a wonderful, momentous, truly beautiful event during which a woman can, by listening to her body, birth her baby safely anywhere she wishes. In fact women have been doing exactly that for thousands of years. There are many things women find helpful while in the stages of labour such as hypnotherapy, relaxation techniques, massage as well as the right environment and support. Providing information for women and helping them believe in themselves and their bodies is very important. This is often not always the case in antenatal classes where much emphasis can be on pain relief and types of interventions rather than working with your body, by keeping active etc.

However, working with women who have experienced birth trauma I also see that we must be cautious. Why?

When birth goes well and is the experience a woman hoped for it is amazing. Many times however I have heard women say that when things have not gone to plan or birth has taken a different journey to the one they had envisioned they have felt like a failure. When her baby comes early, or a labour becomes complicated, when hypnobirthing hasn’t worked or when a women hasn’t been able to give birth vaginally and birth ends in a caesarean she may feel her body has failed her. I have personally heard many women voice that they feel let down, that the reality of birth wasn’t explained to them and that they felt unprepared and almost lulled into a false sense of security believing that their birth would go to plan if they just believed it and nature would do the rest. This however doesn’t always happen, birth sometimes takes a different turn, or a woman may not manage labour like she thought she would. Sometimes there is medical complications or emergencies. When a woman doesn’t have the birth she wanted then comments like ‘whats wrong with me’ or ‘why did I fail’, ‘what what did I do wrong’ or ‘I regret my birth’ often are said. This can then result in the pursuit of the ultimate ideal birth. Or for some women it can result in a feeling of despair and sometimes trauma.

So how do we empower women but also at the same time not give a unrealistic view of birth?

The key here is knowledge that is evidence based but also realistic and takes into account each woman, her wishes, her choices but also her history, previous births and health.

We also must never put one form of birth on a pedestal as the ultimate to be achieved and as a sort of goal or prize to be attained. Why are women that have laboured for hours, attempting to birth vaginally but going on to have caesareans feeling like failures? In fact why is any woman who has had a baby feeling like failure? When did it happen that one way of birth equals success and another failure? I read recently a women asking for support after going on a facebook page where women were discussing the length of their labours and competing with each other on how long they laboured before they accepted any pain relief. The woman in question had suffered a long labour, then a episiotomy, then forceps, then a caesarean because her baby was firmly wedged and in distress. Why was she seeking support? Because she felt a failure for having accepted pain relief during her labour.

I feel like a failure

Women are then often let down after birth, when birth hasn’t gone as planned women are told “you have a healthy baby, thats all that matters” but this is not true. Birth has a profound effect upon a woman and her family, there must be support after. Emotionally it can take time to process birth and with a new baby to care for it can be overwhelming. Expectations abound as does advice. Time spent with a women reflecting on her birth can be invaluable, sometimes there can be so much emphasis on the birth itself that little time is given to thinking about after. Especially where birth has been traumatic is it important that it is acknowledged and support be offered. Reflecting on good experiences is also important as it enables learning what helps and supports a woman and helps improve care given. Its important that women know it is ok to be disappointed with their birth experience but it doesn’t mean that their birth was any less an amazing event.

This brings me on to another side of birth, the medical side and in particular healthcare professionals.

To be fair those that care for women often come in for a lot of criticism. Sometimes this is justified, I myself had very poor care after the birth of my daughter, however many are trying hard under very difficult circumstances to provide care in birth that is kind, compassionate and patient centred. Empowering women can be hard in a hospital environment. Rooms are often bright, clinical areas with lots of equipment with many staff coming and going. Language often used such as ‘failure to progress’ or ‘allowed’ does little to build confidence. Midwife led units while providing the lovely environment for birth and being available for things like water births often have such strict guidelines that few women qualify to use them. Even if women do qualify at the slightest issue they are often transferred to hospital causing anxiety and concern. At a recent support group nearly all the moms there said they had started labouring in a MLU but was transferred over to hospital. They all stated they would not try to use a MLU again as they felt there was no point as they would likely just be transferred over.

What is the reason for this almost ‘over concern’?

Im not a midwife or an obstetrician but I would imagine that being responsible for the safe birth of a baby is a heavy responsibility. No one wants anything to go wrong or a women or her baby to suffer any problems. However birth can be risky and unpredictable and so in the hast to make it as safe as possible it has in many ways become over medicalised. Rather than risk injury or death of a women or her baby doctors or midwives may err on the side of caution preferring to monitor and whisk baby out at any sign of a problem. Having procedures and policies in place makes staff feel safe and processing medical training they may see things from a very different angle to the family they are caring for. Add into this the risk of litigation when things do go wrong and it can be a mix that doesn’t allow for much movement. A woman may make a choice on her birth but if things go wrong doctors and staff may still face questioning and litigation. It may also be hard to accept that a woman is indeed making an informed choice if it seems to go against the very medical guidelines that have been set in place to keep her safe. Because of this much of the ‘natural’ way of birthing has been lost in a sea of trying to make everything ‘safe’ by checks more checks and even more checks. Of course for some this has meant the saving of their life or that of their baby, however for others it has meant they haven’t had the birth experience they wanted.

No one wants anything to go wrong

If a women came to you as a doctor requesting a vaginal birth after multiple complicated pregnancies that had resulted in caesareans likely the answer you would jump to would be to advise against it. Everything you know, have experienced, and trained for, as well as all the polices and guidance around you would be screaming in your head that this was not the best idea for this woman. But what if that was that woman’s desire and choice? What if she felt informed and educated. What if she felt she was aware of the risks?

Which leads onto another face of birth.

How far do we feel women should be able to ‘choose’ how they give birth? When everything is clearly pointing to great risk to her and her baby, or if pursuing that choice could have the potential to cause issues how do we then support a woman in her choice, showing respect and dignity but at the same time mitigate risk? Do we allow a woman to birth as she wishes knowing that it may not be safe for her and her baby?

There may be no clear answer to this and this is where the waters become muddy. It is true that a woman has the choice and control of her own body and baby. But also those caring for her have a responsibility too. Informed choice must truly be that, an informed choice. As women the onus is upon us to make sure that we truly are educating ourselves on birth before making a choice. That includes not only the way to help our bodies birth our babies but also to make sure we are prepared for the situations when that may not be possible. As women we should not try to live up to any ‘ideals’ of what a birth should or shouldn’t be. It is your birth, it is your body, it is your family, does it really matter what anyone else has or hasn’t done? Of course not every woman does this or wishes to do this and is happy to follow the recommendations of her doctor for her care, trusting that they know what is best for her and her baby. Again that must be respected and should not be looked down upon or a woman made to feel guilty because she has chosen to do so. We must also remember that we are then responsible for our choices and so its important that we truly are making a choice that is informed and evidence based.

Likewise those that care for women must be mindful of the woman. Communication is the key. Finding out what her choices are, why she has chosen certain things. Look at a woman as a whole person with her own thoughts, ideas, needs, wants and desires. This is very challenging and may seem impossible. But only by doing so can correct information and support be given that relates to that women and her circumstances. Language is very important as is respecting choice. It can be easy to say ‘but that’s what we have always advised, suggested’, but challenge your knowledge and seek to always learn more and improve care given. Fear of litigation is very real however that fear can lead to being over cautious, leaving no room for choice or movement or consideration of individual requests. Also important is consent. No matter what the situation it is very important that a woman gives consent. Ive lost count of the amount of women who have voiced that they had procedures done to them during birth that they did not consent to but felt they had no choice. Communicating why, and making sure that a woman fully understands and consents to anything done to her cannot be overly stated.

Birth may have many faces, the woman, her family, those that care for her and other women and their experiences, but what matters is the woman herself. Teamwork, communication, consent and dignity all play a part. Women and staff who care for a women need a good relationship built on trust.

Failure has no place in birth, because no woman fails but only does her best in the circumstances she finds herself in. Birth is not a competition or a race, it isn’t the same journey for any two women in fact for any two babies. Birth is individual, wonderful and breathtaking, sometimes it can be difficult and heartbreaking but, if women are at the centre, if a women are the motive, the passion, the love, then everyone will always strive to make every woman’s birth the best it can be for HER, no matter what that may be, because for every women that will be something different.

As women yes believe in yourself and your body and your ability to birth your baby, but also be prepared that sometimes things don’t go to plan. That doesn’t mean your choices are gone, or that you have failed or that your experience is somehow less than anyone else’s. It just means your birth journey changed but with help, support and care it can still be a beautiful journey.

find-joy-in-the-journey-quote-1

Emma Jane Sasaru

@ESasaruNHS

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Why the wonderful #matexp has given me hope

29 May 2015 by Emma Sasaru / About MatExp, Birth Trauma, Informed Choice, MatExp and Me, The #MatExp Journey / Comments Off

believe-quotes-11

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.
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Emma Jane Sasaru

@ESasaruNHS

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#MatExp and NHS change day – a call to action to support Breastfeeding

29 May 2015 by Emma Sasaru / About MatExp, Feeding, Informed Choice / Comments Off

Helen Calvert and I are the breastfeeding champions for the NHS Change Day #MatExp campaign. What on earth does that mean I hear you ask? It means that we have the privilege of being part of a powerful grassroots campaign using the Whose Shoes?^® approach to identify and share best practice across the nation’s maternity services and look at ways we can improve these services for women and their families. The campaign has already been triggering discussions about what needs to improve to make sure women and their families have the care that is right for them. You can read all about it here: http://changeday.nhs.uk/campaigns/matexp/

There are 8 existing #MatExp Change Day actions, and we are focusing on #MatExp5 – Life With A New Baby, and in particular breastfeeding: http://changeday.nhs.uk/campaigns/matexp/matexp-improving-maternity-experience-just/

Anyone familiar with this blog will know that I suffered birth trauma with my first daughter and I am very passionate about improving maternity and perinatal care for women and their families that is patient centred and supportive of their choices. I work as a breastfeeding peer support worker for the NHS helping families in Neonatal, hospital and community. I also volunteer for the BfN and am a trained Doula. I write my blog to raise awareness of birth trauma and Perinatal mental health, reduce stigma and help others. I am passionate about supporting women in their breastfeeding journey especially those that have had pre-term babies. You can read about my story here http://changeday.nhs.uk/story35/

Helen started the #hospitalbreastfeeding campaign on Twitter following her experiences of breastfeeding her younger son, David, who has a congenital heart defect. This campaign led to the launch of Helen’s website, http://www.heartmummy.co.uk, which has key messages to help medical professionals to understand what’s in it for them when it comes to supporting breastfeeding in wards and departments. It provides much needed information to help healthcare professionals provide support to breastfeeding mom’s especially with sick vulnerable babies. Helen tirelessly campaigns to raise awareness for families with children who have a heart defect and also to support moms in their breastfeeding journey.

So what is it that we would like you to do?

Well, firstly, why not log an action on the NHS Change Day website, where “we give ourselves permission to make the changes we can make, share them, and inspire others”? What’s lovely is this is for anyone. Most of us come into contact with women and babies, so simple things like a simple smile to a new mother or a kind word or deed can make a difference.

If you are working in maternity services or are passionate about supporting women and their families and are going to log an action, do so under the #Matexp campaign. There are a few actions to choose from, why not go for something that will make a change to the breastfeeding experience of UK families? Actions can be as simple as you like, what matters is they are personal to you.

Here are our suggestions, and how to log your action. Your action could be to:

Look outside of the NHS for breastfeeding information to use to support families.[Best beginnings, BfN, UNICEF, ABM, La Leche League, kellymom, Dr Jack Newman etc.]
Always remember that breastfeeding is more likely to be possible than impossible. Just keep this in mind every day and see how it changes your approach to families who want to breastfeed.
Follow the RCN’s guidelines for supporting breastfeeding on paediatric wards: http://www.rcn.org.uk/__data/assets/pdf_file/0017/270161/003544.pdf
Download and share the posters from heartmummy.co.uk – simple messages and guidance explaining how breastfeeding can be a key part of a child’s medical care.
Support all families to make an informed choice by giving accurate evidence based information regarding breastfeeding.
Encourage each other to support a mom whatever her feeding choice.
Help the wards/places we work in to reach out/work towards Unicef baby friendly accreditation. Use the resources they provide and makes sure the culture reflects those standards.
Not to use the term Breast is Best, but seek to normalise breastfeeding as the biological norm.
Always introduce yourself #hellomynameis and explain who you are and your role. Be friendly, give of your time, listen and remember that each is an individual trying hard to do the best for their babies. Smile!
Think about language, what we say matters. Make sure we are not undermining breastfeeding, causing a woman to doubt her ability to care for her baby.

To log your action go to : http://changeday.nhs.uk/campaigns/matexp/ scroll down and click on the light bulb that says action. Then follow the instructions. Put #MatExp5 in the title of your action to link it to our area of the campaign if you would like to, and don’t forget to tweet and share your action once you’ve written it!

Also you can join or set up one of the maternity workshops that are going to be running around the country. These workshops give the opportunity for all, whether staff or service users, to engage, share ideas, and look at ways to improve our maternity services.

What are we hoping to achieve?

When we spoke to women a few core things became clear, they wanted clear consistent advice on breastfeeding, good support in hospital and lots of encouragement and support. They spoke about respect for their choices and not having things forced on them by healthcare professionals and how sometimes all the wanted was for someone to say “well done’.

The standard of care we see in our maternity units needs to improve. To do this we must all work together, staff and service users, men and women. We all want women and families to be supported in their choices and have the best possible care. The maternity experience a woman has can stay with her all her life, as can the support she receives to feed her baby. We owe it to women and their families to make a change. What matters is real people, real families and real lives. Women should be equal partners in their maternity care their voices need to be heard so that the maternity experience meets individual needs. Dignity and respect must govern all we do. Maybe we can only make small changes or pledge small actions, but when they all join up together that means big changes for women, for families, for us all.

Thank you Emma and Helen

Emma’s change day action: http://changeday.nhs.uk/user_action/ive-got-involved-in-the-matexp-actions/

Helens change day action: http://changeday.nhs.uk/user_action/matexp5-encouraging-support-for-breastfeeding-on-childrens-wards/

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