Maternity Experience

#MatExp Survey – The Results Are In!

29 May 2015 by Helen Calvert / The #MatExp Journey / Comments Off

As you will have seen, I have been sharing maternity experiences on this blog from women I know. Some good, some bad, some unacceptable. But all anonymous. And it occurred to me that this was somewhat unfair on the birth professionals working to support pregnant women, many of whom I have become friends with on Twitter. So I thought it would be good to be able to share the other side of the story, the thoughts and views of the birth professionals, who have also been afforded the luxury of anonymity. Thus the #MatExp survey was born!

As with everything I do, I JFDI it one evening (thank you for that phrase Florence Wilcock!) and popped it up on Twitter. To my great delight, I have had 150 responses from midwives, student midwives, independent midwives, doulas, obstetricians, anaesthetists, antenatal teachers and other birth professionals. Thank you to everyone who has taken part, your input is much appreciated.

This is the split of respondents:

We also had responses from a neonatal registrar, a perinatal psychiatrist, three midwifery lecturers / educators, a research midwife, two hypnobirthing instructors, an anaesthetist and three antenatal teachers. Many are new to their profession, many have been supporting women for one, two or three decades, and one respondent has been a birth professional for 43 years.

The first thing I wanted to know was “What is the best thing about your job?” The vast majority of respondents talked about the women they work with and being able to support them as being the best part of their role. One student midwife caught the general mood with the comment “Supporting women and being there for them no matter what.” Responses included:

“Witnessing the women I support find their strength and power. Witnessing the love between the couple and the birth of a new little family.” (Doula)

“Being a part of a woman and family’s journey into parenthood.” (Independent Midwife)

“Being part of the transformation of woman to mother” (NHS Midwife)

“Supporting and empowering women, whatever the outcome of their pregnancy” (Obstetrician)

“Making a difference to women. To be present & witness to most beautiful time in life” (Student Midwife)

“Seeing women empowered and birth partners knowing their role and both having calm births” (Hypnobirthing Instructor)

“Privileged to be part of the miracle” (Obstetrician)

Unsurprisingly, the independent midwives found that being able to offer continuity of care and build a relationship with the women they support to be one of the best parts of their job. Many of the obstetricians felt that the best part of their role was “averting danger”, “saving lives”, “helping women to have as healthy a pregnancy and birth as possible”, but also “working with women caring for them at such a life changing moment in their lives” and “being able to reduce anxiety with appropriate explanation”. A fair few of the doulas talked about “witnessing the women I support find their strength and power” and “empowering women”. One explained that the best part of her job is voluntary work “with vulnerable women – asylum seekers, poverty, isolation – who may not otherwise feel worthy of advocacy”.

The word “support” comes up a lot in the responses of NHS midwives, and wonderful comments such as “Making a special time, simply awesome!!!”, “Having the honour and privilege of being a part of a very special time in people’s lives” and “working with the women through an amazing experience”. The student midwives made similar comments, but I particularly liked these two responses:

“The list is endless, but one that currently stands out is being able to turn it around when a woman is panicking in labour and giving them confidence in their own body to give birth! Saying a few words of reassurance and visibly seeing the change is incredible.”

“Supporting women on their journey whatever their circumstances or choices and feeling a sense of fullfillment when you know you’ve made a difference to someone’s pregnancy/birth.”

So from these inspiring comments from people who clearly adore their jobs, we move on to the question “What is the biggest challenge currently facing your profession?” Overwhelmingly the response was NOT ENOUGH MIDWIVES! My recent blog post explores the experience from a woman’s point of view when a unit is short staffed. This really is the biggest challenge as far as these respondents are concerned. Closely followed by fear – “The fear of litigation and professional accountability. The wake of the kirkup report savages midwives and their portrayal is unfair. We may all be tarred with the same brush. Normality is under attack again.” For midwives, morale is also a concern – “we are CONSTANTLY being told what we are doing wrong. Such a culture of fear.”

For obstetricians the challenges are different. Comments included:

“Letting the lawyers decide what information we say and letting them take an additional cut. When the press report a 5.2 million payout the lawyers award themselves a further 6 figure payout.”

“More and more ‘high risk’ women embarking on pregnancies.”

“Too much focus on everything EXCEPT caring for patients!”

“Unnecessary obstetric intervention”

For doulas, they are struggling with a lack of awareness of their role and “dispelling the myth that only the wealthy can afford us”. Lack of awareness from families – “People understanding what support we can provide and the value of it” – and from medical professionals – “Being misunderstood – doulas work alongside NOT in place of HCP”. Some respondents even felt that there is resistance to doulas amongst the medical community.

Where student midwives are concerned, the biggest challenges include:

“Feeling left alone and overwhelmed when its busy because my mentors are rushed off their feet.”

“Bullying… NHS culture”

“Working with midwives who don’t use up to date evidence such a optimal cord clamping”

“Guidelines that seem to have very little evidence base.”

“Bad attitudes, both to those in our care and to each other!”

The over-medicalisation of birth was also mentioned by many respondents.

So what can birth professionals do to meet these challenges? The #MatExp campaign is all about action, and everyone being able to make a difference. Respondents were asked “What do you feel you personally can do to face that challenge?”

Whilst some said “not a lot”, “not sure” and “nothing”, most felt that they had ways to meet the challenges they faced. Answers included the simple “keep on caring”, “keep going” and “raise awareness”. Others said:

“By empowering women to have a voice and question these [hospital procedures]. Also, working together with OBs and MWs to also understand their point of view and what challenges they face. So we can all change this together.” (Doula)

“With 3 colleagues I have set up a social enterprise to provide a caseload midwifery service through NHS commissioning at tariff – the battle is to get it accepted by those who resist changing the status quo” (Independent Midwife)

“Keep going, keep trying to provide compassionate, excellent, evidence-based care, serve the women in my care as best as I can doing my best every shift” (NHS Midwife)

“Not resign myself to that’s how things have to be, think about ways to improve and make suggestions, continue to make every contact with women as positive as possible” (NHS Midwife)

“Show by example how important it is to respect and listen to a woman at all stages of antenatal, labour and postnatal care.” (Doula)

“Ensure that I act within my own values despite others in my environment, find support and positivity from like minded individuals. I love Twitter for that!” (Student Midwife)

“Train our midwives to the highest level to avoid litigation. Test their knowledge to ensure they’ve learned from the training. Keep on asking for more staff and bigger units. Never give up!!” (NHS Midwife)

“Trying to individualise care and support women’s choices Positive birth” (Obstetrician)

“I need to remember I’m a student and should be supernumerary. I need to speak up more to make sure I’m learning each day rather than doing what I know or making beds.” (Student Midwife)

“Continue to practise in the best interests of women rather than defensively and vote against abolition of supervision” (NHS Midwife)

“Try as far as possible to support ‘normal birth’, educate women about the risks of high BMI pregnancies etc.” (Obstetrician)

“Be prepared with an abundance of solid evidence” (Student Midwife)

“Keep my heart strong, separate the bigger picture from the day to day interactions of care, do mindfulness, be compassionate to self, inspire trust in women’s bodies” (Student Midwife)

On a personal note, I particularly like the doula who is determined to be “rigorously evidence-based, and relentlessly compassionate.”

I was keen to see how many of the respondents were aware of the #MatExp Campaign. Many would be of course as the survey started out being publicised to people I knew on Twitter, many of whom I have linked up with due to #MatExp. It gradually worked its way out of that community though, and by the time the survey closed the split was as follows:

The orange line is “I have heard of it but don’t know a lot about it”.

I then outlined the aims of #MatExp as they appear on the NHS Change Day website

The next question was “What do you feel you can do to support these aims?” Many respondents felt that renewed or continued work with their MSLC (Maternity Services Liaison Committee) was the answer. Others simply want to “spread the word” and “let mums know”. Other comments included:

“I encourage women to speak up about things they’re not happy with. Raise it at a higher level if you have to, use the SoM or similar. Empower women so they don’t feel intimidated by professionals telling them what they are and are not ‘allowed’ to do.” (Doula)

“Ensure patient feedback is received acknowledged and acted upon. Continue daily ward visits” (NHS Midwife)

“Support AIMS [Association for Improvements in the Maternity Services]” (Independent Midwife)

“Keep banging the drum for parity of esteem for maternal mental health” (Perinatal Psychiatrist)

“Keep raising awareness on Facebook, hold antenatal classes, tell all the women I come across everything is in their power – try to banish the word ‘allow'” (NHS Midwife)

“Probably the friends and family questionnaires would help and I can make sure these are handed out.” (Student Midwife)

“As a researcher I can help to make maternity service user views more visible and I am also doing a lot of work around ways to increase opportunities for service users to get involved in research/maternity service improvement activities. I am also very interested in the idea of co-creation in research (so working alongside service users and frontline staff to develop, do and use research). Part of the work I am involved with at the moment involves empowering pregnant women and midwives to use research evidence more effectively.” (Research Midwife)

“I’m an increasing Twitter user. Social media seems to be the way forward” (NHS Midwife)

The next question looked at the specific areas that the #MatExp campaign covers, including the area for which I am one of the champions: “Life with a new baby”. The full list is:

Skin-to-skin – see Jenny Clarke’s video

Optimal cord clamping – meet Amanda, optimal cord clamping champion

How does lithotomy feel as a woman in labour – read about obstetrician Florence Wilcock’s NHS Change Day lithotomy challenge

Language used towards pregnant women (e.g. “failed induction”, “poor maternal effort”) – this area is championed for the campaign by Leigh Kendall

Life with a new baby – including perinatal mental health and breastfeeding. Read about Rosey PND&Me and also the blog post that Emma Sasaru and I put together on supporting breastfeeding.

Informed Choice – see this example of risk being explained in a user accessible way

Respondents were asked to rank these areas in order of importance and the results were:

A couple of respondents had (very fair) specific comments on the above question, namely “our unit is already changing skin to skin and delayed cord clamping, hence their low ranking, otherwise I would have placed them higher, my next project is to reduce the use of lithotomy” (Obstetrician) and “it is impossible to rate these in order. In general they each impact on each other, by improving informed choice you are creating a healthier postnatal environment etc. so rankings don’t mean that skin to skin is the least important” (NHS Midwife).

The response to the next question was fairly definite!

Finally, I asked “If you could change one thing about maternity care in the UK what would it be?” Staffing levels were mentioned again by a lot of respondents, as was caseloading / one to one care. Many of the answers were also indicative of the tensions between different birth professions and professionals:

“For more medical staff to witness natural birth.” (Doula)

“Doctors and midwives respecting each other” (NHS Midwife)

“Obstetricians” (NHS Midwife)

“If we loved and treated our colleagues better, collaborated and supported each other, we’d be a happier, more efficient more compassionate and passionate workforce- and this would filter through to the women we support” (NHS Midwife)

“Reduce obgyn lead care.” (Doula)

“NCT didn’t have such a negative influence on women. No one failed because they didn’t have a vaginal birth. A lot of what is taught is inaccurate and based on personal opinion which is not informed choice.” (NHS Midwife)

“Slow down the relentless overuse of induction…encourage/ optimise midwife led care home birth and birth centres and caseloading model of care.” (Student Midwife)

“Don’t always go and try to enforce your procedures. Listen to women. Use of language for the purpose of influencing a labouring woman into accepting the best thing for hospital such as I witnessed: ” This baby has had enough” is very detrimental, and to say the least, manipulative.” (Doula)

“I would offer a single additional session to antenatal classes/NCT classes etc about the reasons for medical interventions in labour and the risks and benefits. It is unbelievable that in an age of information, when women have spent time with midwives and NCT instructors, we still regularly see birth plans that say “don’t want forceps unless necessary”! It immediately disadvantages obstetricians and puts them on the back foot, as we not only are seen as “the bad guys” for forcing these interventions on women, but often have a matter of minutes to explain the risks and benefits in an urgent situation, which is frankly laughable. Obstetric trainees should be involved in antenatal education; just a single group session on the what, when and why of CTGs, forceps, FBS and Caesarean would I think remove a lot of the fear from women and help those for whom labour does not progress smoothly to feel more empowered and informed.” (Obstetrician)

“More trust in women to make the right choices for themselves. Less bullying and misinformation.” (Independent Midwife)

“Obs and midwifery attitudes to each other.” (Anaesthetist)

I would also like to highlight this heartfelt plea from an NHS Midwife: “I don’t even know where to start… Let’s be compassionate again – let’s treat EVERY woman like our sister. Even the smelly, rude, unpleasant ones. Let’s try.”

Along with a number of #MatExp participants on Twitter, I have been saying that respect and compassion are two vital elements of a positive birth experience, regardless of vaginal birth, c-section, place of birth and so on. This comment from a doula certainly chimes with my personal view on what could change in UK maternity care: “I’d like it to be less of a lottery, some professionals are kind, supportive, informed, happy to discuss options with women. Some are not. On the same wards, in the same hospitals too. I’d like the good experiences that many have to be normal for all. The feedback I get is this comes down to how the woman is treated rather than the final outcome of the birth experience.”

The full results of the survey have been passed to Florence Wilcock, #FabObs of the #MatExp campaign.

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#MatExp at 36+2 – dangerously understaffed

29 May 2015 by Helen Calvert / Birth Trauma, Environment and Facilities, Postnatal Care / Comments Off

One final blog post in this initial round of #MatExp feedback from my Facebook group. Once again, this story is told in the mum’s own words….

“I had a very straightforward pregnancy and was expecting to to go overdue (I was born 14 days late).

My waters broke at 36 + 2 with absolutely no warning, I’d had some indigestion earlier in the day but that had gone by the evening and I was out for dinner with my partner, his Grandad and his Grandad’s friends. We live in Manchester and the meal was in Wakefield, my waters going was very obvious and completely mortifying but luckily I was wearing black jeans and restaurant floor was pretty dark. We called Pinderfields Hospital (a couple of miles from the restaurant) who said to come in as my waters had gone before 37 weeks. I got to the hospital at about 9.30pm and I was hooked up to a monitor for 2 hours which confirmed that the baby’s heartbeat was fine. They were clearly very busy but at about midnight I was examined and they also confirmed that I was not in labour, I wasn’t having any pain at this stage. They said that because I was early I would have to be induced within 24 hours if it didn’t happen naturally or I could go back to Manchester where they have a different policy and they’d let me go to 37 weeks (not sure this was true). They said they couldn’t advise us to move to Manchester but they didn’t think it would be a problem. I felt pretty confident as I wasn’t having any contractions and I’d been reassured by the monitoring. I was also worried about the baby being small and so I was keen to go to 37 weeks if possible. All my notes, stuff for hospital etc was all in Manchester.

St Mary's Hospital, Manchester — St Mary’s Hospital, Manchester

We decided to leave and waited 2 hours for a discharge letter (during this time we drove to a nearby garage for water and haribo) eventually they said they’d call St Mary’s instead and we left, the journey only took about 40 minutes and we got to St. Mary’s at 3.30am. I’d started to feel pains in the car and by the time we arrived at St Mary’s these were 3-4 mins apart. They weren’t strong and seemed quite bearable but I had no idea whether they were ‘proper’ contractions. I told them this when we arrived and they were quite dismissive, they said someone would talk to me about pain relief after a doctor had seen me and I couldn’t do anything before seeing a doctor as I was now high risk.

I was then told to wait in a small, hot triage room and my partner was sent home (an hour round trip) for my notes. Over the next three hours nurses came in periodically (never the same one twice) and I was put on a monitor for a while. I asked if I could moved to a room with a pool (as in my vague birth plan) but we were told we couldn’t have one, then I asked for a normal bath or shower but I was told I couldn’t have anything until a doctor had seen me. It felt like I was left for a really, really long time. I didn’t have anything practical with me (other than my kindle) and was still in my jeans and boots. Contractions were getting more frequent, I kept sending my partner out to see if someone could come and either no one was there or they told him no one was free, a nurse eventually gave me two paracetamol.

Finally, three hours after we arrived I told him that he had to make someone come, I still didn’t know whether I was properly in labour and I wasn’t sure I would be able to cope with the pain. I felt like I needed the loo but it was a huge effort to make it down the corridor to the patient toilets. I was starting to think that I was in labour, but if not I definitely wanted all the pain relief available! I’d had about 20 minutes of quite serious pain and I had heard stories of people being in labour for days. Finally, at about 7 am a doctor arrived to examine me and told me I was fully dilated (which was a huge relief) and then it all happened really fast.

I was rushed round to the birthing suite where there were two midwives, they hooked me up to gas and air but then said I couldn’t have it as I had to push. I was flat on my back and in quite an uncomfortable position, I felt like it was too late to move and no one asked if I wanted to, even though I was staring at a ‘natural birth positions’ poster all the way through. The pushing was quite painful but much easier to cope with as I knew it would be nearly over. I heard a loud pop and (I think) I cracked a rib. That was the most painful bit. The pushing stage was very short and in 15 minutes the baby was out. I had a second degree tear but didn’t feel it at all at the time. As I was pushing the midwife told me that I was going to tear which I didn’t find particularly helpful.

They put the baby straight on me and it was amazing, I felt much less tearful than I had expected as I think I was in shock. After about 5 minutes we looked and saw that she was a girl (we didn’t know beforehand). To our relief, she was obviously not tiny even though she was early and when she was weighed we were told that she was 7lb 5oz. I think I had an injection and the placenta was out very soon afterwards, I wasn’t paying much attention. The next few hours were brilliant but then I did start to get sore, they were still waiting for a doctor to sew me up and in the end it wasn’t done until 4 hours after the birth. I had gas and air while the local anaesthetic was going in.

The stiches felt fine until the local anaesthetic wore off and then the pain was unbelievable, far worse than any part of the labour, I fainted and then lost a lot of blood. I was given paracetamol (again) without being examined and told, quite patronisingly, that I could expect it to hurt for a while. I tried to explain that it was too much pain to cope with but probably wasn’t very coherent. At this point my partner had baby (with no real clue what to do) and was trying to get someone to help as I kept fainting. I didn’t want to take her as I was so shaky I was worried I’d fall off the bed. Eventually, after a couple of hours a midwife looked at my stitches and said that there was a haematoma the size of her fist (nice) which was pushing out all the stitches. They said this would have to be drained and my stitches redone but by that time I didn’t care, I was just so happy that they were going to do something about the pain. I was told that I could have an epidural (finally!) for the procedure. I was supposed to be waiting for a slot in theatre but another midwife came in to borrow some equipment and noticed that I had lost a lot more blood. She went to get someone who was looking after me and then they said I would have to have a general anaesthetic because of the blood loss. I was rushed round to theatre where I was knocked out. They sorted out the stitches and gave me a blood transfusion.

I came round a few hours later and spent the first night on the high dependancy unit. This was (comparatively) brilliant as I had my own room and a nurse there most of the time. I had drips in both hands and my ribs and stitches were very, very painful so it was fantastic to have someone help lift my daughter out of the cot. Unfortunately after that we were taken to the ward and that was just awful.

My little girl hadn’t been able to breastfeed as she had a tongue tie, this was recognised straight away but we didn’t see the same midwife twice and they kept saying that she might manage it anyway. Because she was early she was being cup fed formula as they were monitoring something (possibly blood sugar) and my milk hadn’t come in. I ended up staying in for 5 nights trying to establish feeding but baby just wasn’t interested and when she did latch on she couldn’t suck. We were told she had to be either breastfeeding successfully or bottle feeding, we couldn’t go home cup feeding. I was so exhausted after 4 nights on the ward that we just decided to bottle feed her to get out of hospital.

The time in hospital seems like such a blur as I was just so tired, my partner, mum etc all helped as much as they could during the day but I was still left alone from 8pm until 10am every night with almost no support. Sometimes there was a midwife around to help during the night but often not and with painful ribs/stitches I did feel like I needed help. Baby didn’t settle unless she was on me (which I knew was totally normal) and I fell asleep like that several times. Being back home was amazing, I was finally able to sleep for more than 20 minutes and I was able to enjoy my baby.

The midwives that looked after me were all lovely but they were dangerously understaffed, I rarely saw the same one twice and I think this caused problems afterwards, I had to explain about Anna’s tongue tie every time someone tried to help with feeding and almost everyone mentioned that residual pain relief from labour was probably causing her feeding problems without bothering to look and see that I hadn’t had any.

Being on the ward with no support was dangerous, I would never have fallen asleep with my baby on me in such a precarious position at home because I could have had her in the bed with me and I would have had support, or someone to take her so I could nap for 20 minutes. 14 hours is too long to have to look after a newborn with no help and in unfamiliar surroundings. Allowing partners to stay overnight would have changed the whole experience for me, even having a shorter period with no partners/visitors (e.g 12-6am) would have been so much better, 6 hours is manageable.

I’m very aware that I was incredibly lucky to have an ‘easy’ birth (and my daughter is heathy and wonderful) but I’m still so angry about how I was treated, I think a lot if the fear and difficulty I had was purely due to the treatment in hospital and not the birth process at all – so unnecessary.”

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#MatExp – Caught in the Middle

29 May 2015 by Helen Calvert / Continuity of Care, Environment and Facilities, Pregnancy Complications / Comments Off

I am very grateful to yet another member of my Facebook group for providing me with her maternity experience to share with you. In her own words…..

“My antenatal experiences with my NHS midwife and one consultant led to me transferring to the One-to-One Midwifery Service from about 30 weeks into my second pregnancy. The main issues I had with the NHS were:

The cold and distant manner of the midwife

The total lack of concern or questioning when I declined the breastfeeding DVD (as a natural term breastfeeder with my older son, with intention to tandem feed, I felt I didn’t need it – the midwife simply moved on to the next item and made no attempt to find out why I didn’t take the DVD. I found this shocking.)

At a consultant appointment the consultant informed me that she had booked me in for an induction on my due date, due to my maternal age. No discussion. told her that that would not be happening.

I had my heart set on a MLU, natural water birth, and I raised the issue of booking an induction without discussion or my consent issue with my MW. Her response was that I will do as the consultant decides. At this point I referred myself to One-to-One.

Final point – one slightly raised blood pressure reading triggered off me being designated a high risk pregnancy, so I would have found myself on the consultant led side of things to give birth. Another big driver to move service. My BP was fine throughout the remainder of my pregnancy (with the help of Labetelol).

The whole experience was very ‘tick boxey’, with little or no consideration of the overall picture i.e. my health and fitness, my wishes, previous birth etc. I was very disappointed by the apparent lack of breastfeeding promotion.

So I had my second baby by natural home water birth, with the support of One-to-One Midwives. I ended up in hospital for ten days postnatally with HELLP Syndrome. One issue arising there was the strained relationship, and lack of joined up care provision, between the NHS staff and One-to-One. Before transferring myself to One-to-One, I had heard from a fellow NCT Refresher class Mum, that she had had a bad experience in this regard also.

I was transferred via ambulance to Arrowe Park Hospital following the birth of my daughter in April 2014, with what turned out to be HELLP Syndrome. My daughter came with me. We were in for a total of ten nights.

Although I was a patient, my daughter was not. This became a problem when she needed to have her 72 hour check. In the initial stages, my partner was doing the communicating with my One-to-One midwife; and she told us that my baby would have to be taken to an alternative venue for the check by noon on the Saturday. I was in no fit state to add to the discussion, being quite poorly and ‘not with it’.

Ostensibly One-to-One staff were not allowed on the hospital premises to carry out the check; NHS staff could not do it as my daughter was not a patient. I did become involved in the discussions when Saturday morning arrived, my partner was trying to arrange child care for our older child (not easy as we have no family close by), and it dawned on me that my newborn baby was about to be taken away from me. Breastfeeding aside, that would be traumatic for all involved – baby, me and Dad!

Bearing in mind that the main issue for me was dangerously high blood pressure at that point, I was drawn into having direct telephone conversations with One-to-One, and quite heated talks with NHS staff – who made out that there was absolutely no way One-to-One could come into the hospital to do the checks – no insurance I think was the issue from memory? As my baby was not a patient then they definitely could not perform the check – to do so would generate a second NHS number for her, which I was told would have the potential to cause us problems when trying to register her birth. The systems would not be able to cope with it. We felt that systems were taking priority over the well-being of our newborn baby.

In the end a One-to-One midwife did come into the hospital to do the check. There was an uncomfortable atmosphere between the two sets of staff.

On a side note, my daughter was diagnosed with a mild tongue tie and a referral supposedly made. In fact no appointment ever came through. Fortunately the tongue tie was never an issue.

My One-to-One midwife came to see me in hospital on a number of occasions; each time I picked up on tension between the parties.

Apart from the stress around my daughter’s check, I have to say that the majority of the care I received on the labour ward was fantastic. Apart from one incident where I suffered a huge loss of dignity and lack of respect or concern for my personal space and being. In fact I felt totally humiliated. It happened on my final night at Arrowe Park (so day ten of my stay); I was rushed down from the maternity ward to the labour ward as my blood pressure was so high. I was given intravenous drugs to bring it down; it would have been a trip to the cardiac unit if this had not worked. I needed the toilet – and not just a wee. I was told I had to remain on the bed and my request to use a commode was refused. So I had to use a pot under the sheets. Except the sheet was inadequate and I knew that I wasn’t covered up. So I tried to throw my dressing gown over my knees. People were coming and going in and out of the room. I had a sudden moment of realisation of the total indignity of the situation – people could well have been able to see me trying to have a poo, knees up in the air, largely uncovered. I cried. I just wanted to go home, with my baby.”

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#MatExp – A Midwife’s View

29 May 2015 by Helen Calvert / Informed Choice, Postnatal Care / Comments Off

As promised in my first MatExp feedback post, I have more stories to share with you. Today I have pleasure in sharing the maternity experience of a mum with a different perspective on the care she received, as she has worked as a midwife. In her own words:

“There was nothing truly awful to say about my care, I was just a bit disappointed. I couldn’t take my old consultant hat off so kept thinking about the improvements that were needed and where would I start?! I’ll try and outline the issues as I saw them as briefly as my general verbosity will allow!

Good points first! All 5 midwives I met antenatally and the 2 postnatally were very nice and cheery. The appointments ran pretty much on time and the postnatal visits happened when they said. The antenatal classes were really good. Pitched at just the right level and even my husband enjoyed them. Although there wasn’t much time for socialising, the midwife orchestrated a no pressure way for us to swap contact details and as a result I have made a really good friend. They told me about the Cherubs group, which was good. The handover to the health visitors seemed pretty smooth. Oh yes – this is the best one! My experience of giving birth at the Wythenshawe midwife led unit was fantastic. Every aspect was exactly what we needed and we felt cared for and very special, which is difficult to achieve in a busy unit like that.

Ok, now the not so good! At my booking it was presumed I was ‘low-risk’ (which I am, but the midwife would not have known that). All of the information about care etc was given prior to finding out if that care was going to be appropriate for me or not. I was only asked about ‘me’ at the end and this was a very tick-box exercise. Don’t get me wrong, I know from experience how tough it is to do a booking visit in an hour (or even an hour and a half), but it is possible to individualise the discussion and make the woman feel that this is about the service fitting around her needs rather than her just fitting into the service. Despite the presumption about my low risk status I was not told about my birth place options. The midwife said ‘so you’ll be coming to Macclesfield, right?’ And ticked the place of birth discussion box! Home birth was barely mentioned and the option of using the local midwife led unit was not mentioned at all at any of my appointments, including my longer birth planning appointment. I found out (through Google) about the Wythenshawe MLU at 39 weeks (as I was new to the area I didn’t know where hospitals were and what provision they had).

Thankfully Wythenshawe were excellent – booked me in the next day, gave me a tour of the unit and I had an excellent experience of intrapartum care there.

In general, the information provision was poor. Despite quite long ‘chats’ about topics like the weather, the midwife’s daughter’s pram choices, new granddaughter, for example, little time was spent on birth planning info, breastfeeding info etc. so I don’t think this was a ‘time’ issue. There were no discussions, I was just told how things would be. For example, “we won’t let you go past 41+5 weeks”, “we will induce you”, etc. It made me very worried for women who are not aware of the concept of informed choice, or who are aware but are too polite / nervous / grateful to ask what their options are. I am aware that some of this could have been down to the fact I was a midwife. But actually I don’t think the 2 midwives I told remembered this (I could tell from the way one of them briefly explained Vitamin K to me), so I’m fairly sure I saw an accurate picture of the care most women get.

Probably the most notable thing was an issue with growth measurements. I was measuring slightly under (2cms below my gestation) for 2 consecutive appointments. I hadn’t been that worried until over the next 2 weeks between appointments I felt like I hadn’t grown at all. I said this to the midwife at my 36 week appointment who measured me and said that I measured 36cms so no need to worry. However, she had not actually found my fundus (top of the uterus) and just put her tape measure to my sternum, where my fundus should have been at that gestation. Only, the whole point was that it was not there! It was much lower – 4cms lower, and I had not grown at all in the past 2 weeks, as I suspected. The midwife was a little embarrassed (understandably) when I pointed this out. She flippantly remarked that she could make those measurements anything she wanted to, so they were pointless. After some discussion she referred me to a consultant, who referred me for a scan as she was concerned about the growth. In the end it was all fine, baby was bang on average weight. But that wasn’t the point, a truly compromised baby could have been missed.

I also had a problem with the way they gathered feedback. They were doing the Government’s ‘friends and family test’ and gave out cards for feedback. No problem there. However the midwife handed it to me in an appointment and insisted on me doing it there and then in front of her. So no anonymity and no chance of honest, useful feedback. I refused to do this, but I was accosted by the receptionist at my next appointment and was jokingly told that I was not allowed to leave until I filled it in. This time it was the receptionist watching (not so bad), but it had my initials pre-written on the top of my card. I was honest in my brief feedback, but felt very uncomfortable about it, which I’m sure most women would.

My postnatal care was pretty lacking. On the day after I came home I received a phone call to see how I was and to arrange an appointment on day 3 (actually day 4). This is pretty standard practice now and is a change from all women getting a home visit the day after they get home. I don’t have a problem with this as services need to be individualised and not all women want or need a visit, a phone call will do. But the call was not used to find out if I felt I needed a visit, it was to tell me that there would be no visit until day 4. Then a few clinical questions were fired at me! Again, I was fine, but what if I hadn’t have been? The day 4 visit was a whirlwind. I was still in bed, so my dad let the midwife in and showed her upstairs. By the time I met her in the nursery she had said 3 times that she was “only here to weigh the baby”. She set her stall out early that she would not be staying long! Baby had put on weight, so she said well done and left after quickly asking about my blood loss, whether I’d pooed and giving me the contact phone number. I could tell she was busy (it was a Saturday, skeleton staff and she had visits all over Cheshire), so I didn’t dare ask anything!

So, that’s it! I’m afraid to say that I think this might be pretty typical. It probably says more about the model of care, the resources in the team and the workload than the individual midwives. It’s not easy, but individualised, supportive, positive, evidence-based care can be given in a busy NHS maternity service.

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#MatExp – The Good, The Bad and The Unacceptable

29 May 2015 by Helen Calvert / Environment and Facilities, Language, Pregnancy Complications / Comments Off

When I first came across Florence and Gill and the MatExp Campaign, I knew my group would have a lot of maternity experiences to provide to them. We are always discussing and sharing birth stories, and when I asked them for their feedback it came in abundance. Their stories, from all round the UK, have been passed on to Florence and Gill, and also to Jeanne, midwifery lecturer at Salford University. I have permission to share an initial snapshot with you here, to give you a flavour of the ordinary maternity experiences that are happening around the country and which, for the most part, do not get formally discussed once they are over.

The Good

This was the hardest section to find quotes for. Not, thankfully, because I didn’t have any good birth experiences to work with, but because I was looking for quotations praising the midwives. But when you read a positive birth story the midwives are rarely mentioned. They are there, and their actions are noted, but they do not receive praise for their interventions, because a positive birth story is about the mother: her experience, her actions and her achievement. Rest assured there are plenty of positive stories being shared amongst us, but in terms of positive feedback there is only a little:

“Although I ended up with a c-section after induction, pre eclampsia and gestational diabetes plus a lengthy hospital stay, I only have good things to say about my experience. At all points I felt they were doing the best for me and my baby. I loved the fact that, during my stay in hospital, when midwives asked you how you were feeding they always responded ‘bottle feeding, brilliant’ or ‘breastfeeding, brilliant’ – there was no obvious preference amongst the staff but they were very supportive of either.”

“When I got the epidural I had a lovely midwife waiting with me for the drip to work. I really appreciated her calm, kind attitude – she was so so lovely and I think the fact that it was one to one care made it amazing. I felt so well cared for. When I started to push everyone was SO LOVELY and I felt very in control. It was when they said I needed forceps I started to lose it a bit but they were still lovely even though I was throwing the F-word around a bit by now. I was transferred to theatre and started to get a bit scared, but again my midwife was very reassuring. I had a spinal block which sadly went too high and I started to suffocate. I had to have a GA and I was very frightened but seriously, all praise to the staff, they were so calm and kind. The consultant offered me a debrief appointment and I went to it about twelve weeks later – it helped me process everything. Whilst it wasn’t a great experience I feel the hospital did everything they could to help me and safeguard my emotional health following a scary time.”

“I had excellent care in my second pregnancy with the same midwife all the way through; wonderful home water birth and excellent postnatal care, including breastfeeding support. A great example of how important it is having the same person looking after you and building a relationship.”

The Bad

“While being assessed I gave permission to be examined vaginally on arrival to assess my progress. On finishing the exam the midwife said ‘you’re a good 4-5cm dilated already so I gave you a good stretch whilst I was there to speed it up.’ I had not been asked if I would like a cervical stretch. I did not give my permission for a cervical stretch.”

“Both myself and a friend progressed very quickly once the induction took and struggled to cope with intense pains that came every minute or less. Both of us had dismissive midwives who offered no explanation as to why the pain was so intense and why we could have no painkillers other than paracetamol. We were both told to go to sleep (as if!) and told that if we couldn’t cope now how would we cope when labour was established – which was terrifying! Both of us coped just fine on gas and air.”

“Breastfeeding support was rubbish. My husband showed me how to manually express milk after reading the breastfeeding book. The support workers just shoved my boob in baby’s mouth but I didn’t understand how I was supposed to do it when they weren’t there.”

“…..another midwife was lovely and kind and murmured comforting words as she fixed the belts and monitoring equipment, then left me behind the screen. Bossy midwife then came along and yanked back the screen, announcing that she ‘liked to see her ladies when there are being monitored.’ So I was sat with my jeans so low that my pubic hair was showing, my whole bump exposed, while a couple of women I didn’t know and their partners tried to look anywhere but at me. I had very little shame by that point but this upset me. It felt like punishment.”

“With my 4th baby I was still keen to have a homebirth but requested a growth scan near my due date to monitor baby’s size and check it would be safe [due to previous shoulder dystocia]. This was refused. They ‘didn’t do growth scans’. I could have a homebirth but not a scan. I repeated the request to other midwives but nobody suggested referring me or even seemed to care. I eventually found a midwife who took me seriously and referred me to the consultant. When I eventually got my hospital appointment I saw a registrar who honestly didn’t seem to know what he was doing. He said I couldn’t have a growth scan but refused homebirth in case I had shoulder dystocia again. After another appointment I insisted I saw the actual consultant. The consultant said I couldn’t have a scan but agreed to do a sweep 1 week before my due date. In the end, I asked about a due date induction to reduce the risk of the baby getting too big as I was so frustrated at this point and nervous of baby getting stuck again. They seemed surprised but agreed, so that’s what we did.”

The Unacceptable

Despite the draw of a catchy title, I refused to refer to any of these experiences as “ugly”. A new life entering the world is never ugly. But I feel that “unacceptable” is appropriate for these two experiences, and I hope that you do too:

“My midwife asked, whilst examining me to see how far dilated I was, if I’d like a sweep. I was in agony so I said no. She did it anyway. I screamed and hubby said he had never seen me look so pained before or since. She only said ‘done now’.”

“All going smoothly until I haemorrhaged. I was rushed to delivery and the consultants managed to stem the bleeding, with a review scheduled to decide if theatre was necessary. There was a question mark over retained placenta/products. The placenta was torn and was not confirmed as complete. I had another procedure to stem another heavy bleed with the review still scheduled for later in the day. A junior consultant came and decided that they weren’t going to take me to theatre that day despite still having heavy bleeding. I had not been given any food or drink (other than water) since the previous evening. This was 2pm on Saturday.

After this, I didn’t see a midwife (nor anyone else) for hours. My room had blood covered surgical instruments left on the side plus the swabs etc from the procedures, my catheter came out and I was left in a soaked bed for what seemed like a long time plus the bleeding was still very bad. My buzzer was not answered for long periods of time. I was eventually transferred to a ward at around 8pm. Once on the ward, I continued to bleed and clot heavily. The midwife said this was normal. My obs were low but I didn’t want a blood transfusion unless absolutely necessary. There was no further mention of retained placenta/products and I was allowed home after 3 days.

This resulted in four and a half weeks later being rushed to surgery to have the retained products removed. This was after 3 separate haemorrhages which again the community midwives said just needed monitoring. I was lucky that I didn’t get an infection. The advice in A&E was that I should have called an ambulance.”

I have a lot more #MatExp feedback to share, too much for one blog post. I will put up more soon. For now I will leave you with this illustration of the discussions at a recent Families & Midwives Together Conference I attended at Salford University:

What could have been better about the care you received?

Helen Calvert. 2015

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My #MatExp – two very different experiences!

29 May 2015 by Helen Calvert / MatExp and Me / Comments Off

As one of two breastfeeding champions for the NHS Change Day MatExp Campaign, I find myself talking a lot about maternity services. It is strange one for me, as although I speak to mums all the time about their maternity experiences, I actually have very little personal knowledge of giving birth on the NHS. With my first baby, I knew from the start that I wanted a homebirth. I had been following a homebirth email forum since before I got pregnant and had gained the impression that the NHS would make my life as difficult as possible if I decided to give birth that way (especially as a first time mum) so we opted to use an independent midwife. This was totally the right decision for me as I suffer from anxiety and have issues around loss of control so needed continuity of care and to be able to do things my way.

Second time around we couldn’t afford another IM, so we started out with the NHS. We wanted another homebirth and this time I was fairly confident that I could get the birth I wanted, being a lot more knowledgeable and also having already given birth at home. However, a few weeks in to my pregnancy a friend of mine told me about OnetoOne Midwives. Their service was exactly what I was looking for, and I was lucky that in 2013 I was able to self refer to them from Trafford. The lovely OnetoOne team looked after me from then on.

Sadly, when I was 38 weeks pregnant a routine check of baby’s heartbeat revealed an anomaly, and a week of scans and tests later gave us the diagnosis that our baby had Hypoplastic Left Heart Syndrome. Not only was homebirth off the cards but it wasn’t certain we would take our baby home at all. You can read all about our experiences with David here, but in terms of my #MatExp the staff at St Mary’s Hospital in Manchester were fantastic. I had a c-section, and as everyone was focusing on getting David out and into NICU, it was the most medicalised birth you can imagine, but I still felt respected and cared for, with things being explained to me every step of the way. Special mention goes to midwife Della and anaesthetist Andrew Heck who provided the kind of care that makes any maternity experience a positive one.

So going back to that first birth with my gorgeous big boy Edward, let me tell you my birth story as I wrote it back in 2011:

Birth Story – Edward Calvert enters the world

On Monday 31st January I was 42+1 and we were at the hospital for monitoring. We had agreed to be monitored to make sure that baby and I were still healthy, but knew that we didn’t want to book an induction just yet. We had a scan to check on the function of the placenta and then had 30 minutes of monitoring to check on baby’s heart rate, his movements and my pulse. Our lovely Independent Midwife Verena was with me the whole time, and confirmed that the monitoring showed no problems for either of us. We then had to wait to see a young obstetrician who outlined the hospital’s policy for women who had gone past 42 weeks. She confirmed that she would like to book me in to be induced, or failing that she would like me to come in for daily monitoring.

We confirmed that we understood the reasons for her requests but said that we would prefer to come back for monitoring on the Wednesday, and not to book an induction just yet. She respected our choices but due to her being fairly junior requested that we wait whilst she speak to a consultant. A lovely consultant then came to speak to us, and was more than happy to accept our choices once he had confirmed with us that we understood the situation.

That evening I made a concerted effort to relax and get myself into a good mental place to give birth. Having done a sweep that morning, Verena confirmed that everything was ready for me to go into labour – we just needed some contractions! So I lay down on the day bed in the nursery, put the lights down low, asked Phil to come and sit quietly with me and focused on putting myself into my relaxed state as taught by the hypnobirthing CD. Phil sat and read whilst I relaxed for half an hour.

At the end of that time, I asked Phil to get me a glass of water. No sooner had he left the room than I felt a pop and was pretty convinced that my waters had broken. I waited until he came back just in case I had lots of fluid, but when he helped me to stand up I only had enough fluid to soak a small patch into my jeans. I went to the loo and confirmed that the waters were not a bad colour, nor did they appear to contain any meconium. Phil phoned Verena and she said that most women go into labour within 24 hours of their waters breaking, so things should start to get going any time. This was 9:30pm.

At 10:00pm I felt what I was pretty sure was my first contraction, so I made a tentative note of it. I continued doing a jigsaw puzzle downstairs and just noted each contraction as it came, as at this early stage they weren’t painful. They were regular though, coming every 5 minutes from the start, and Phil phoned Verena to let her know what was happening. The contractions became painful fairly shortly, to the point where I had to concentrate through each one. Phil started filling the birth pool just before midnight, as he knew he could keep it warm so thought it best to make sure it was ready. He then phoned Verena at 12:30am to tell her that my contractions were getting stronger and were lasting around 40 seconds. She arrived at our house with Sara (second midwife) at 1:30am, by which time I was feeling a bit nauseous with the contractions and my back was aching. I was standing in the nursery, leaning on the day bed through the contractions, with my wave music on and watching a slide show of photos on the laptop that I had put together in advance to keep me cheerful!

Verena put the TENS machine on for me and that was beneficial although it felt strange to begin with. She checked me over, blood pressure etc. and also had a listen to baby’s heart. All fine, and my contractions were now a bit more spaced out (this often happens when the midwives arrive!) so Verena told me that I was definitely in early labour but that I wasn’t in ‘established’ labour as yet. She and Sara left at 3:00am and said they’d be back in the morning, but obviously we should call them if anything changed or if we needed support.

I spent the rest of the night kneeling on pillows, leaning against our bed and breathing through each contraction – they were now pretty painful and I was using the TENS machine through each one. I was only comfortable kneeling up, I couldn’t lie down at all, so I was dozing between contractions with my head on the bed. Phil got some sleep in the bed beside me, and I remember looking at him snoozing comfortably and being fairly resentful of how cosy he looked! I was sick a couple of times in the night, and Phil woke up to play pass the parcel with various bowls and receptacles! I woke him finally around 6:00am as I was fed up with dealing with the contractions by myself and I needed some support. We tried putting me in the shower to run warm water over my back, and Phil braced his arm against the tiles and I hung onto him during each contraction. Phil then phoned Verena at 7:30am to say that my contractions were every 3-4 minutes apart and were more intense – we definitely needed her to come back! Verena said that I could get into the pool if I felt it would help, and I got in as soon as I could! Was still only comfortable kneeling up so knelt in the pool, leaning over the side, and hanging on to the handles during contractions. I didn’t want to be touched at all whilst contracting, so poor Phil didn’t really feel like he could offer any comfort, but of course he was being fantastic and very encouraging.

Verena and Sara arrived back at 9:00am and put a warm, wet towel across my back to help with the backache. In my labour notes it says that I looked very relaxed but said that I didn’t feel it – I think I looked relaxed coz I was exhausted and was only awake coz I was contracting! Verena had a listen to baby’s heart – thankfully her equipment was waterproof so she could just pop the device into the pool and have a listen between contractions.

At 9:30am Verena told me that I was in or close to transition, i.e. the change between the first stage of labour and the second stage where you can start to get the baby out! I remember being delighted at hearing that, but am surprised reading the notes that it was 9:30am – I would have thought it was later in the morning that she told me that. You lose all sense of time in labour! Verena gave me a homeopathic remedy to help cope with the backache and exhaustion, and they all encouraged me to drink plenty of water. Unfortunately I couldn’t face much food, which was a shame as I desperately needed the energy.

Just before 11:00am I started to feel the urge to push, and got a bit more vocal during my contractions! Phil and Sara had been doing excellent work keeping the pool water warm and the midwives continued to monitor baby, but all this was background to me as my life was all about the contractions. I had a cup of sweet tea as everyone kept encouraging me to get in anything that could give me some energy. Verena has put down in my labour notes that Cleo the cat turned up outside the nursery door at this point to have a concerned yowl, but she wasn’t allowed in the room. I do remember hearing her make her presence felt! It was around this point that I began to push a little during contractions – not a choice, just something my body felt it was time to do. By 11:30am I was getting a strong urge to push with every contraction.

Ten minutes later, Phil lit some candles and Verena noted they were all getting ready to meet baby. I am of course taking all of these timings from my labour notes – I had very little idea of what was going on and certainly no clue of time! It was all about getting through the contractions and resting as much as possible in between. Verena thought a change of position might help with the pushing, so I stood up in the pool supported by Phil. All the signs were good that baby was ready to come, and everyone was encouraging me to push and telling me how well I was doing. I went back to kneeling in the pool and Verena has put in my notes that I was pushing very effectively. I remember it was bloody hard work!

At 12:30pm Verena gave me another homeopathic remedy to help with the pushing and I continued to use all of my efforts. At 12:50pm Verena has made a note to say that when she was listening to baby’s heart “baby trying to kickbox my hand away as if to say go away, I am coming out!!”. I changed position again so that I was lying on my side in the pool, still with my head on the side – change of position suggested by the midwives as all the efforts at pushing were not getting baby “round the u-bend” as they put it! I then tried squatting in the pool, but complained that the contractions were not long enough to give me enough time to push effectively – I was getting in perhaps three good pushes and then the contraction subsided when I felt I could do with just one more push to make it effective! Verena gave me a homeopathic remedy to assist with this (all of these remedies were with my consent of course).

It was becoming clear that a change was needed as we weren’t progressing despite my best efforts at pushing. I therefore got out of the pool just after 1:30pm – this was incredibly hard as moving during a contraction was impossible so it was finding the time between them to get me out and moving! Phil and Verena half carried me into the bathroom and sat me on the loo, as this is a natural place to push and this is often an option used in homebirth. I told them “he is coming” and I think I must have felt him crowning (i.e. the head pushing its way out) at this point. Unfortunately, although the head started to emerge it then retreated back again (not unusual) which was of course discouraging each time it happened as each time I knew I had to get it back again! The midwives moved me onto all fours on the floor of the bathroom and got some towels ready to catch the baby.

At 1:50pm baby’s head was born – I remember Verena saying “we have eyes, we have a nose, we have a mouth” and I just felt so relieved as I knew his head was finally out and couldn’t go back in again! Verena has noted down that baby was “blowing bubbles” and he looked just like Phil! What I remember very clearly is thinking, okay I have a moment’s respite now before I need to push out his shoulders, and at that point baby decided to have a look around the bathroom. The sensation of him moving his head is indescribable – I think I asked him to stop, or maybe I just thought it, but I didn’t appreciate his enthusiasm at that point!

Three minutes after his head was born the rest of baby emerged – he had his hand up by his face which could explain why pushing him out had been such hard work. He lay on the floor looking up at me, I was on all fours looking down at him and both of us were a little stunned! He needed a bit of a rub with the towels to get him going, and then he cried and was clearly fine and healthy. Verena asked if I wanted to hold him, and I realized that yes I did – it hadn’t occurred to me, I was too stunned!

Baby and I had some skin-to-skin time and the midwives helped me to sit up on the toilet, as I had been kneeling up almost continuously since the night before and my legs were shaking and exhausted. Unfortunately, as I moved to sit up there was a gush of blood – nothing to cause concern, but it did make a pretty effective mess of the bathroom. Thank goodness we were in a room that was easy to clean! Verena took some photos of me and baby, and of Phil with the two of us – these pics will never see the light of day as I look unbelievably awful – but I also look pretty happy!

The cord stopped pulsating but I felt a bit dizzy so they helped me to lie down on some towels and pillows on the landing, still with baby cuddled up with me, and they then tied the cord with our homemade cord ties. Phil cut the cord and said “I declare this baby open” – he was in very high spirits! Sara had made tea and brought up some biscuits so we all had a snack – she hadn’t been able to get in the bathroom as Phil and Verena were in there with me so she missed the actual birth, but could hear it all happening from outside the door! Whilst I had a nibble of something to eat Phil had his first cuddle with baby… and we agreed to call him Edward.

Phil had taken off his T-shirt so he could have skin-to-skin with Edward, and Verena was attending to me as I still needed to birth the placenta. I was contracting slightly and Verena was asking me if I could push out the placenta, but bizarrely I had completely lost the notion of how to push! I just couldn’t work out how to do it! Verena moved me into a couple of different positions again, but by 2:45pm the placenta still hadn’t arrived, so I agreed to the syntometrine injection to encourage the process. Verena gave me the injection and then the placenta arrived about a minute later, so it would have come of its own accord anyway but there you go. I didn’t suffer any nausea with the syntometrine so no harm done.

Verena then helped me to have a quick shower, followed by me being helped into bed – bliss! Verena examined me and said that I had a small tear but that I didn’t need any stitches. By 3:30pm Verena had helped me to latch on Edward for his first feed, whilst lying together in the bed. Very special moment. Phil was making sure everyone had refreshments and they were all encouraging me to have orange juice and things rich in iron due to my blood loss. Verena asked if I wanted to eat a little of the placenta, which I know sounds gross, but I had considered it prior to labour. I agreed as it is a very iron-rich product, and Verena gave me three or four tiny pieces that I washed down with water.

Edward was weighed and checked over – he came in at 8lbs 13oz. Verena and Sara made sure we were all happy and healthy, gave us some advice for the first night, reassured us they would be back tomorrow then they left the house just before 5:00pm. The Calvert family were left together and couldn’t have been happier.

Helen Calvert. 2015.

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In the shoes of … | Florence Wilcock, Divisional Director Specialist Services & Obstetrician, Kingston Hospital FT

29 May 2015 by Gill Phillips / About MatExp, MatExp and Me / 1 Comment

Last week I wrote a blog about how we have built the #MatExp project to improve maternity experience and the campaign was launched on the NHS Change Day site.

Our constantly evolving MatExp story has since been published in NHS #100daysofchange . If you are in any doubt about the difference NHS Change Day makes, take a look at these wonderful stories.

So I am delighted to introduce my J*DI ‘partner in crime’ Florence Wilcock, a.k.a . #FabObs Flo @fwmaternitykhft, who tells her powerful and very human story:

3am the phone rings “There’s a massive obstetric haemorrhage in maternity theatre 2”, I leap out of bed, throw clothes on and get into the car. My mind is racing through causes of haemorrhage, how severe is it? what have the team already done? As I drive into work, I ring to speak to the midwife in charge seeking information and checking off a mental list: pulse, blood pressure, estimated blood loss, blood cross matched, consultant anaesthetist. Brain whirring. By the time I get there, it could be sorted or life threatening, which will it be tonight? Drive carefully, ignore your heart pounding, the adrenaline flowing; don’t be distracted, people are depending on you.

In my role I might be invisible to you if everything is going well and all is normal. You will never meet me, know my face or name, despite my being an essential part of the team and often the lead. One component of my job is to do nothing, to stand back, to not intervene and to teach others how to do likewise. My job is to master the art of being there only at the critical time, to run in and save the day, keep calm whilst doing so and to never get that judgement wrong. An impossible balance of risk vs. choice, art vs. science, clinical outcome vs maternal experience.

My name is Florence. I am an obstetrician.

I’d like to tell you the story of two births.

Birth 1: Twelve days overdue with a first baby, this mother expected a straightforward normal birth. That was what her mother and grandmother had experienced. Her waters broke before labour. The mother was told she had to be induced. She reluctantly went into hospital where she started a hormone drip. She later had an epidural as the midwife kept pressing her to. She had an emergency caesarean after twelve hrs of drip, being only 3cm dilated; it felt the inevitable outcome. The epidural didn’t work, so she had a spinal for the surgery. On the table she felt disconnected, almost like an out of body experience, she felt vulnerable. When the baby was born, she was disinterested and didn’t want to hold her. She was in pain after the surgery but the staff didn’t believe her and told her she had already had the maximum dose of pain killers. She lay rigid and still in pain, watching the clock move slowly until she thought she could reasonably ask again. At home it took months before she could talk about the birth without crying. She had failed.

Birth 2: Same woman, four days overdue planning a VBAC (Vaginal birth after caesarean) contractions started, went to hospital overnight. Next morning, 3cm dilated, offered the birthing pool. Wonderful warm water, giggling with gas and air and the midwives keeping the obstetric team out of the room so they wouldn’t interfere. Sadly after many hours 5cm, so got out of the pool and had an epidural and her husband kept her entertained reading from the newspaper. Later, still 5cm dilated, choices offered, caesarean or hormone drip, joint decision: caesarean now probably safest. A wonderful anaesthetist distracted her with football chat and suddenly a baby daughter was here. Exact same outcome: emergency caesarean, healthy baby girl; exact same hospital: but she felt she’d had her opportunity for a VBAC. She had been listened to, supported, valued, and positively involved in her care.

That mother was me. My name is Florence. I am a mother.

At any social gathering, I inevitably get a blow by blow account of at least one birth story, if not several. A birth experience stays with us forever, we remember it like it was yesterday, it is a pivotal moment in time. I am privileged to witness incredibly special moments and emotional events on a daily basis. Often when I listen to these birth stories, we obstetricians and midwives seem to be portrayed as the villains of the piece, especially the obstetricians. I find this negative stereotype particularly annoying. No doubt there are less empathetic or more obstructive obstetricians as there are imperfect members of any profession, but most will be hard working and diligent and simply trying to do their best for women in their care. From my own personal experience both as an obstetrician and a mother I can see the importance of maternity experience. I often wonder: how have we come to this polarised position? how did maternity staff become the bad guys, upsetting the very women we are trying to care for and what can we do to change this?

How the #MatExp campaign was born

Gill and Flo — Gill Phillips and Florence Wilcock

For this reason I volunteered to lead the London maternity strategic clinical network sub group on ‘patient experience’. London had six of the seven worst performing Trusts in the country in the 2013 CQC Maternity women’s survey; we needed urgent action. In contrast, at Kingston Hospital NHS Foundation Trust where I work, we have had consistently excellent feedback from women in our CQC survey. I thought this was perhaps an opportunity to work out what it was we were doing well; to ‘bottle it’ so that others could copy.
I wanted to find an innovative way to explore the issue and ignite the feeling that experience is everybody’s business including women themselves. I had recently started tweeting (My NHSChangeday 2014 pledge) and stumbled across Gill Phillips @Whoseshoes and the idea for #MatExp workshops was born.

With the support of Kath Evans and a team at NHS England London, Gill and I have collaborated to design a bespoke maternity version of her ‘Whose Shoes?’ board game. We have used real scenarios from users and staff to examine maternity experience from all angles and perspectives.
The aim is to use the workshop as an ‘ignition tool’ to build connections and relationships across the broad maternity community. We want to enable true collaboration, co-design and ongoing conversations to improve maternity user experience.

Poem by Gill Phillips written directly from a 'brainstorm' email Flo sent when we were compiling scenarios, after a middle of the night emergency — Poem by Gill Phillips written directly from a ‘brainstorm’ email Flo sent when we were compiling scenarios, after a middle of the night emergency

We have run 4 of 5 pilots in London, bringing together people from the whole broad maternity community: users and their families, acute and community staff, managers, commissioners and lay organisations. Getting everyone in mixed groups round a board game in a relaxed environment, babies welcome, refreshments on hand, gets the creative sparks flying. It is essential to remember that each person is present in multiple capacities; professionals are also mothers, fathers, sisters, friends and family with their own stories and birth experiences; users often bring knowledge and expertise from other aspects of their lives such as job, culture, education that are invaluable too. Respect and equality are essential ingredients; discussion starts from the assumptions that ‘best can always be better’ and ‘Wrong is wrong even if everyone is doing it, right is right even if no one is doing it’. We have been fortunate to have wonderful graphic facilitation by Anna Geyer @New_Possibiliti which both provides excellent feedback on the day but also a permanent visual record of actions which goes on generating new conversations.

At the end of each workshop each attendee is asked to pledge what they as an individual will do differently to improve maternity experience. This brings a personal sense of responsibility for the actions, the outcome is not the sole responsibility of the traditional hierarchical leaders but of us all.

“The resulting actions are already taking us in directions I could never have imagined such as user co-design of maternity notes, improving antenatal information for fathers and starting a midwifery team twitter account.”

Despite believing myself to be already very ‘person centred’, as I work on the project I am finding a succession of small changes spilling into my own everyday practice. I am thinking increasingly carefully about the choice of language I use and the way we behave. No more ‘are you happy with that?’ when explaining a plan but ‘how does that sound to you?’; explaining to women why we have come on a ward round; having a father in theatre when his wife had to have a general anaesthetic so that they didn’t both miss the birth; using the intense listening I have learnt in coaching to understand women’s perspectives in my clinic.

Through social media the #MatExp project has generated interest from women and maternity staff up and down the country. We have held a train-the-facilitator day to look at how to roll out the workshops both in London and more widely. But the conversation has already become much broader than the board game, with people from the maternity community energised to talk about maternity experience and actions they can take. The project appears to be prompting people to speak up, share and act on their ideas. Linking with NHS Change day on 11^th March is a fantastic opportunity to spread the message and get those vital conversations started.

So what can you do?

Here is the link to our #MatExp campaign page. Or you can go straight through to a list of 8 specific actions that we are encouraging people to take.

The beauty of #MatExp is anyone can do anything, however big or small, whoever you are: user, partner, community group or NHS staff. Your action could be one of those simple suggestions listed or could be your own idea. The sky is the limit! Imagine if we designed maternity care from scratch what would it look like? Would it even be called maternity? How about transition to parenthood? Every action we each take, however small, keeps the #MatExp conversation going and makes a small improvement. If we all take action together, we have huge potential to improve maternity services and an experience that has an impact on us all.

[youtube https://www.youtube.com/watch?v=n1Xgv2h-CXQ&w=560&h=315%5D

[youtube https://www.youtube.com/watch?v=P4upEK33_0U&w=560&h=315%5D

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Baby Loss and Communication

29 May 2015 by Leigh Kendall / Baby Loss, Language / Comments Off

Being in a healthcare environment – whether that be a GP’s surgery or a hospital – can be a hugely disempowering experience. You are likely to feel especially disempowered when you receive bad news – your head spinning, struggling to take in usually complex information. Then, more than ever healthcare professionals of all disciplines need to reflect that each patient is an individual, with their own experiences, values, hopes and fears.

Professionals need to be able to listen effectively, which includes reflecting back what a patient has said to check their understanding, and to make sure they understand a patient’s views.

My son Hugo was born 16 weeks prematurely because I had the life-threatening pregnancy conditions HELLP syndrome and pre-eclampsia. My beautiful boy fought so hard, but died in my arms at the age of 35 days.

Everything possible was done to save Hugo’s life. Sadly, he was too small, and too premature.

There were, however, areas of both mine and Hugo’s care that could have been better. These issues were around communication – there were occasions where stresses could have been avoided if there had been better interaction between staff, or if we had been provided with more suitable written information.

I’m proud to be the #MatExp language champion. Effective language and communication underpins so much, and even a few thoughtless words can cause enduring hurt.

A huge thank you is owed to everyone who shared this post asking parents to get in touch about their own communication experiences around baby loss. An even greater debt of gratitude is owed to those who got in touch to share their experiences – good and bad.

It was interesting that the bad experiences reflected what I suspected – they are focused around failing to reflect that each patient is an individual, with their own hopes and dreams. The incidences of good communication are heartening.

I will take the poor first, so we can end on a positive note with the good.

One mother had a medical termination because her baby was diagnosed with a condition that meant they sadly would not live. I was appalled at what the mum had to say:

We were ushered in to see a male consultant. He obviously did not have adequate time to spend with us. Everything he said felt like one more thing he had to tick off his to do list. His comment: “at this point, I have to say that I’m sorry for your loss” was the least genuine and sympathetic expression I have ever heard in my life. He then followed this by referring to our baby, OUR BABY, as the “retained product of conception” and the loss of our baby, THE LOSS, as “the event”. He sickened me!

Another mum said:

…we had decided to have an amnio. We explained this to the Community Midwife (whose first words as we walked in was ‘oh this will be an easy appointment’….how little she knew!) Her response? ‘But how would you feel if you lost it and nothing was wrong’ said in a very judgemental way. As if we had not consider the risks…..I left the appointment gobsmacked she could be so insensitive and was so upset, I sobbed all the way home.

A woman who had a miscarriage said:

He then flippantly answered my questions in a nonsensical fashion. “It would hurt no more than a period” (I found labour easier, was offered pethidine for the pain all whilst being physically sick). “I wouldn’t need to stay the night” (ummm…I did…. “I wouldn’t bleed much” (not true). And my personal favourite: “no, you don’t need any medication now. Go home and just turn up at any point on Friday and we’ll deal with you.” (15 minutes later and in a taxi on our way home I noticed numerous missed calls. As we thought, I had needed to take the first of my tablets and was asked to return to the hospital as soon as possible.)

The two examples around my own experience include when discussing Hugo’s end of life, in my distress I cried how guilty I felt. The consultant said:

All mothers feel guilty.

That may be so – no mother of a premature baby, or a baby that dies for whatever reason is at fault. Knowing that does not diminish our sense of guilt, and that comment felt very dismissive. I wanted to talk about why I felt guilty, and be listened to.

The other example relates to a midwife from my local hospital phoning me the day after Hugo died. In a cheerful voice, she asked how I was. I replied that Hugo had died the previous evening. It was evident she had not heard me, because continuing in that cheerful voice she said “Oh ok, I understand you are at home now, would you like a visit?” Even if Hugo had not died, the tone and content of the call was inappropriate. Hugo would have been 29 weeks at that stage and while the unit that cared for him is excellent, there is no way he would have been home by that stage. It seemed to be a failure of checking the notes properly.

These are all examples of health care staff using jargon, and impersonal medical terminology. I am sure (and hope) these staff did not intend to be impersonal or insensitive. I am sure (and hope) these staff simply failed to put themselves in these women’s shoes, to consider how they were feeling at such a sad and difficult time, and to offer empathy. In the example of the midwife who phoned me, she needed to have used a different tone to the one she would commonly use with the happy events of mums at home with their healthy babies.

Effective communication is something I am passionate about, for the benefit of patients – I have worked in the profession within the NHS for several years.

Thankfully, we do have positive examples of communication to talk about.

The woman who had a miscarriage gave this emotional account:

The ward matron ushered us into her office and apologised profusely. She gave me my tablet and then offered to answer honestly any questions we had. We went over everything again but this time we received compassionate and truthful answers. “Yes, it would hurt lots but you will be offered pain relief”. “You will need to stay the night”. “It will be hard but we will be here to help you get through it”.

In the digital age, most of us will take to Google to explore our diagnosis and prognosis to find out more. Of course, while the internet has many useful, trustworthy sites, there are many that are complete rubbish (this is true of every condition, not just baby loss).

As one mum said about her baby’s diagnosis

Probably the worst thing I did was google the condition when I got home.

I found the same about HELLP syndrome – it is so rare, there is little information about it, and much of what I read was terrifying – not helpful to my emotional recovery.

Patients need to be guided towards trustworthy sites. I was heartened to read that as the result of the involvement of a bereaved mum, one hospital’s website has “information specifically about fetal abnormalities as well as details of the team of people who will be looking after them. When they leave the hospital after diagnosis they are given the website address and the number of a counsellor so they can look at it when the shock has worn off”. The website also has some links to recommended forums.

Happily, I do have examples of better communication of my own to share: consultants (both obstetric and neonatal) listening to me, and patiently answering my questions without patronising being an important one. Vitally, I have found the majority willing to listen to and take on board my feedback, and seek to reflect on their practice and make changes were appropriate.

That is heartening progress, for the benefit of other women during the heartbreaking time of losing a precious baby.

Language matters, always.

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Language Matters!

29 May 2015 by Leigh Kendall / Language, MatExp and Me / Comments Off

A short film by Gill Phillips

Being in any healthcare environment for any reason can feel disempowering for a patient. Effective communication between healthcare professionals and patients can help build trusting relationships, improve patient outcomes and patients’ experiences.

Communication is at the centre of everything, and no more so than in a healthcare environment:

That is why I have chosen my NHS Change Day action for the #MatExp campaign to centre around language.

As part of my action I will:

Continue to raise awareness of the importance and impact of effective communication – verbal and written – through all appropriate channels (including my blog, on social media, engagement workshops, for instance). While healthcare communication is important in any specialty, as a result of my personal experiences my focus is on maternity and neonatal unit environments.
Empower women to feed back about their experiences – positive and negative – to help health care professionals improve patient experience (part of this action includes discussing how to make the process of giving feedback easier, and meaningful).

I have been proud to be involved with the #MatExp campaign for the past few months. #MatExp is a campaign led by healthcare professionals and users alike, aimed at identifying and sharing best practice across the country’s maternity services. If you check out the hashtag on Twitter, you will see it has already been generating lively discussion about what needs to improve.

My passion for appropriate language and effective communication stems from my years of experience as a communications professional in the NHS. This passion was enhanced as a result of my personal experiences as a patient and as a parent in 2014.

For the benefit of those unfamiliar with my story, in February 2014 I was diagnosed with the rare, life-threatening pregnancy conditions HELLP syndrome and pre-eclampsia when I was just 24 weeks along. The only cure is for the baby to be born, and my son Hugo was born 16 weeks early. My beautiful son was too small, and premature and sadly died at the age of 35 days.

Raising awareness of HELLP syndrome was the inspiration for my pledge for last year’s NHS Change Day.

While nothing differently could have been done from a clinical perspective, there were several incidences where our experience could have been less stressful, and additional upset avoided if there had been better communication. That is why I set up Bright in Mind and Spirit (it is what Hugo’s name means), to raise awareness of these issues.

This slide explains more about why language matters, and why healthcare professionals should care about getting it right:

Feedback from many other women on social media and through their own blogs reveals I am not alone in wishing for better communication in my maternity experience. These women had every kind of pregnancy and birth experience you can think of. The one thing we share in common is the impact poor communication and choice of vocabulary by healthcare professionals had on our maternity experience.

Language can have an enduring impact, with things that were said to women when they were giving birth to their babies staying with them many years later.

This slide describes the language we want to ban, and the kind of language we would like to see more of:

Medical jargon can be confusing and bewildering. In addition, some terms may impact a woman’s self-esteem.

Terms like ‘failure to progress’ and ‘incompetent cervix’ might be perfectly proper medical terms, not intended to be personal. But think about it for a moment: these terms describe a woman’s physiology. Women therefore cannot help but take personally such terms. In the context of pregnancy, where expectant mothers want to do everything possible to protect their babies, such words can inadvertently convey a sense of blame, leading the woman to feel she a failure or incompetent, rather than elements of her physiology that are beyond her control.

The words and terms in this column can make a woman feel like she is not in control of her body, her care, or decisions that are made. A bit of a walking womb. Doesn’t sound very nice, does it?

The examples given in the ‘language we want to see more of’ column outlines some simple ways to help a woman feel more in control of her body, an equal partner in her care, and involved in decisions. Sounds much better, doesn’t it?

Healthcare professionals of all disciplines need to reflect that each patient is an individual, with their own experiences, values, hopes and fears.

There is so much discussion around language in maternity services. For instance, women have raised points about choice (some women have little choice about how or where they give birth, for a variety of reasons); risk (which sounds scary – often it means only ‘possibility’); and ‘normal’ birth (the notion that there is a ‘right’ way or place to give birth). The vocabulary we use to describe birth is crucial for helping women feel equal and empowered. It could also help remove the polarisation of views between ‘normal’ birth always being best, interventions always being harmful, and take some of the fear out of the delivery room.

Empowering women to feed back about their experiences is the second part of my action. Healthcare professionals may not always be able to recognise that experience needs to be improved, unless they receive feedback. The problem is, the traditional feedback processes can often be onerous, stressful and result in unsatisfactory results for the complainant.

The NHS complaints process is complex, for many reasons, and can include cases of straightforward feedback to serious incident investigations and everything in between. The whys and wherefores of the complexity of the process is not a topic for this post. However, there are some simple considerations individual providers can implement to help the complainant feel like they have been listened to, been taken seriously and that they matter.

My personal experience of the complaints process from a hospital, a GP practice, and a mental health provider is the opposite. More stress and upset was caused by written responses that were impersonal, formulaic, and failed to acknowledge the impact the experiences had on me. The tone of the letters felt like board reports, and that the response had to be written so it could be added to a chart.

People composing these responses need to take a step back and appreciate that while there are statutory points to be made, facts to be stated, the recipient is a human being with feelings that do not fit into a chart. Think about the language of the letter and how things are phrased to help the complainant feel like they have been listened to, been taken seriously, and that they matter. Where appropriate, also advise the complainant of actions that are being taken as a result so they can be assured taking the effort to give feedback was worth it.

It is difficult to write this post without some reference to the Kirkup Report. There is so much I could write about it, but this post from Birthrights provides a useful insight into the impact that communication had on the care of women and babies at Morecambe Bay – with tragic results.

Improving language and communication will take time, and a shift in culture. In many cases there are no easy answers. However, recent social media discussions (with midwives, obstetricians, professionals from other specialties, as well as other users) about language have been heartening. It is heartening because the discussions between healthcare professionals and users have happened, and on such a public forum. It is heartening to see language being thought of, and the link between communication, outcomes, and patient experience being recognised.

The main point to remember about communication in healthcare is to consider how you would like to be treated yourself. You’re likely to want to be treated with compassion, empathy and respect, aren’t you?

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MatExp and Hugo’s Legacy

28 May 2015 by Leigh Kendall / MatExp and Me / Comments Off

A significant part of Hugo’s legacy includes improving experiences of maternity services for women who have a traumatic birth, and/or whose baby is cared for in a neonatal unit. My particular focus is on making sure language, communication and information is clear and effective at this time, which can be bewildering and upsetting for mums (and dads).

Twitter is a fantastic networking resource, and for the past few months I have been tweeting with a group of health care professionals (HCPs), NHS change agent folk, and other women who, like me, are passionate about helping improve other women’s experience of maternity services.

I was delighted to meet Flo, Gill, Kath, and Carolyn after tweeting for so long. Being able to talk in sentences longer than 140 characters was refreshing! My good friend Michaela was also at the event, and it was lovely to catch up with her.

There are a series of #MatExp events, which seek to get service users and HCPs together to discuss experiences. I went to an event at Queen’s Hospital in Romford, which is part of Barking, Havering and Redbridge University Hospitals NHS Trust.

It is an impressive hospital: the reception airy is airy and colourful. Someone was even playing a grand piano.

The attendees for the event included trust staff from a range of professions and grades, as well as service users. We were sat on round tables: when I introduced myself, I was amazed that someone on my table said they followed me on Twitter. Hugo’s story is getting around!

A comment in the opening speeches about “pregnancy not being an illness” raised my hackles. Yes, for the vast majority of women pregnancy and birth is a natural, wonderful life event. But for some women, pregnancy and birth can be a source of great trauma. Indeed, pregnancy can make a minority of women very ill indeed, as I can attest.

The speech was full of aspiration and positivity, which is understandable in the context of the hospital seeking to become one of the country’s highest-performing maternity services (a few years ago they ranked amongst the worst). However, speakers do need to be mindful of the range of women who are likely to be in the audience. Pregnancy and birth does not always go to plan – there are times when it is unavoidable, it is no one’s fault, and women like me do appreciate this being acknowledged. That’s my soap box moment – it is a point of sensitivity.

Each table played the Whose Shoes game. The game is simple – you roll the dice, move your shoe around the board, and discuss the scenario related to the colour shoe you land on. The scenarios involve getting in the shoes of a mum, or a range of HCPs.

My table’s scenarios generated some interesting discussion. For example, we talked about perception around labouring women being ‘not allowed’ to do certain things. The HCPs said they never knowingly say women are ‘not allowed’ to do anything, which is interesting in terms of perception.

In any healthcare setting, a patient may feel disempowered, and feel like they have to do what they are told. Think of transactional analysis: even if the HCP and patient might have an adult/adult relationship in a social setting, a healthcare environment can transform that relationship to a parent/child relationship.

Think about how parents tend to talk to children. The children are given parameters, boundaries, and if they disobey they may find themselves at the receiving end of a wagging finger or sharp tongue. That’s not fun as a child, and even less so as an adult. It’s a key example for HCPs to consider language – what they say, and how they say it.

Of course, as the table discussed, there are some situations where women are told they shouldn’t do things, and for good reason – for example, directly before or after a Caesarean section. In any such situation, the table agreed, it is vital for the HCP to explain the reasons, as well as any suitable alternative options and what they might mean. The HCP can use active listening (paraphrasing what the woman has said) to check their understanding. That doesn’t take long, costs nothing, and has the benefit of helping the woman (or any patient) feel like an equal partner in decisions about their care.

Equality was the subject of another scenario. The scenario related to the needs of minority ethnic women, but sparked a wider discussion about equity of care. The consensus was that women should not be treated equally. That might sound counter-intuitive, but think about it for a moment: every human being is an individual, with their own individual hopes, dreams, fears and needs. In a maternity setting, you and the woman in the bay next to you might be there for the same reason, but because you are each unique individuals your needs are unlikely to be the same.

For example, I was treated differently in some ways to the other mums when I was in the post-natal ward after giving birth to Hugo. I was grateful for the private side room, meaning I avoided being in a bay with mums who had their babies with them. However, the staff didn’t consider all my needs as a new mum whose baby was being cared for in the neonatal unit: I was left waiting for too long to see the doctor on their rounds, for instance, which meant I missed precious time with my seriously-ill baby.

The event concluded with the key points from each table’s discussions included on a giant piece of paper by a graphic facilitator. You can see some of the points in the photo below. Appropriate care for women like me who have had a traumatic birth and/or whose baby is in a neonatal unit is a focus for me and I would have liked to have seen more on that. However, if there is an overall focus on doing everything possible to meet individual women’s needs, as well as other points of feedback, then this will hopefully improve as part of that.

There was then a challenge to decide what the hospital’s maternity services wanted to be known for. I was relieved the suggestion of ‘a positive birth experience for every woman’ wasn’t accepted, because they would be setting themselves up to fail and more importantly, setting women who don’t have a positive experience (for whatever reason) to feel like they have failed. “Having pride in our delivery of care with excellence” was the chosen slogan. While positive, I am on the fence about it (it is pretty standard) but to be fair it was chosen quickly by mass of people who were at the end of a long day.

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