Huge thanks to the fab(!) ‘FAB NHS Stuff’ team for setting up a dedicated ‘Whose Shoes’ collection to collate and share some of the FAB stuff that we do, including many #MatExp examples.
The collection is growing! Have a browse – you are bound to find lots of easily transferable ideas that will work for you, not least in our various booklets of case studies.
I am a big fan of the Obs Pod. It is such a wonderfully simple and yet creative idea. Florence Wilcock, a highly experienced consultant obstetrician, muses and reflects each week on different aspects of maternity care. I don’t think anyone has done this before … and certainly not in Flo’s unique style.
The Obs Pod has become a phenomenal resource. I think it is time for it to be shared very widely on all the main maternity websites. Or perhaps it is too radical, too real ?
Many of the podcasts include really practical information and insights that many pregnant women, new parents and families would benefit from greatly. Other parts will appeal more to healthcare professionals or students looking at career paths – there is something for everyone.
In typical #MatExp style, Flo’s many friends and followers are being drawn in to help.
I wanted to create a more visual way to search by topic and theme and enable people also to dip into Flo’s many blogs and videos, so I made this new Padlet, themed in line with the key categories of the Ockenden review, a bit like a mini website. I was thinking about how best to collate the ‘zesty bits’, which pick out the weekly action points but was beaten to it by Deepa Santosh, leaping forward with a plan to create infographics. How amazing would that be!
That is the nature of the #MatExp community – energy draws in more of the same and people find themselves going the extra mile, innovating to amplify each other’s stories.
Images by New Possibilities
As the creator of Whose Shoes, my interest in the Obs Pod is more to understand the world of the NHS, its behind-the-scenes ebbs and flows, the targets, the politics.
So when I saw the title of this weeks episode – ‘Merry-go-round’, I got excited. I thought this was going to be a trip behind the scenes, a look back-stage, so to speak. I was not disappointed. In fact I think this episode takes the podcast series to new heights. It is bold, it is real – it is a tour de force, skilfully combining the voice of experience, observing constant movement that doesn’t necessarily go anywhere, with the joy and potential offered by a constant flow of fresh-faced innovators. I expected it to be challenging; I certainly didn’t expect it to include older monkeys sitting in the trees throwing poo at the upstart younger monkeys below. What a brilliant analogy. 😂
So here are my reflections on the merry-go-round episode and how it resonates with my work:
Reinventing the wheel is a time-honoured tradition, particularly in public services.
As an even older monkey than Flo, and having spent many years working in local government, the image I have regularly seen is more of a concertina. The love of endless reorganisation. Structures moving from national to regional to local and back again, several times. Departments merging and then dividing again. Playing a merry tune possibly, but achieving very little.
The image I often have in my mind about the development of Whose Shoes has Merry-go round elements, but is rather more optimistic. It looks like this:
Things go round in circles but simultaneously build.
Seeds are scattered but often seem to fall on stony ground; they lie dormant but then might be gathered up in the breeze and germinate elsewhere: a different project. Flo refers to this with regard to our ‘Nobody’s Patient’ project. It has been frustrating to see how much support there was for our initial work but then, apart from a few rare exceptions such as the extraordinary work in Liverpool, very little effort to use the resources, even though they are now available in at about 80 NHS trusts. Obviously Covid hasn’t helped any of this, but I am talking pre-Covid. It is as if it is ‘Nobody‘s Project’: consigned to the ’too difficult’ box because it actually requires work between departments and organisations, rather than just sitting neatly within one sphere of command.
I have become a philosophical monkey and generally don’t throw too much poo. I sometimes get ranty, but hopefully not too often because then people switch off – I think they are more likely to be listening when you are generally positive and then … go ballistic from time to time.
Change takes time. Culture change in particular takes time. The most powerful #MatExp Whose Shoes concept is our ‘lemon lightbulbs’ – our belief that people come to their own realisation, they ‘get’ it; and then this influences their behaviour from that day onwards, not just being told something on a training course .
External things can influence to a point, certainly we can create the conditions for lemon lightbulbs to happen. But it is when people see for themselves what needs to change, and hearts and minds are engaged, that real change happens.
Impatient people like Florence, like Helen Calvert, like Joanne Minford who just grab change by the horns and run with it, are the unusual ones; they are very special leaders who drive us all. I am so proud and privileged to work with such amazing people.
Flo and I talk about tipping points (the same now applies to her podcast and what will help it truly take off). I have learnt that tipping points come and go. But the underlying spiral keeps building. That is probably a more sustainable model?
Fast forward to 2021. Apparently, learning from Covid, the NHS has embraced coproduction at the highest levels. The corridors of power, no less. Coproduction is now to be the ‘default way of working’. The way we do things around here. I am on the Coproduction Task and Finish group – Flo’s ‘Merry Go Round’ podcast suggests that this is a very optimistic title, but I will try to be a well-behaved monkey and remain optimistic.
However, I do see a fundamental tension between a) wanting to predetermine the outcomes whilst getting people with lived experience to work with you to achieve them and b) genuinely listening and involving people and valuing the ideas equally at every step of the journey, which by definition might lead to a totally unforeseen outcome. It is exciting, it is scary. It takes a leap of faith. And probably more time than a Task and Finish timeframe – we’ll see!
Flo includes a lovely section about her Random Coffee Trial (RCT) meeting with Andrea Gibbons and talks about the power of both formal and informal networking. Networking, for me, is the most underrated QI methodology, but it is catching on.
Things like RCTs would not have happened 10 years ago. Why, when you are so busy, would you randomly meet up with someone that you had never even heard of?
Shock! Horror! Probe! What if you meet .someone who is more senior or more junior than you – the hierarchy in tHe NHS is very strong, so it is good to see our #NoHierarchyJustPeople mantra gaining ground.
In my Whose Shoes work, I will frequently try and link hospitals and teams and ask if they are already connected? The answer can be defensive. Yes, yes they say – but in practice, it is frequently the Heads of Department who are connected. What about the rest of the team?
It is so energising to find an opposite number in another trust who is struggling with the same challenges as you. You can help each other, you might well become friends – it can be fun. Finding our shared humanity is a key theme that runs through all of our work. It cuts through perceived barriers.
I have often felt that some people in the upper echelons of the NHS love Whose Shoes until they hate it. It can be seen as opening a can of worms. It takes a level of confidence and belief to do true coproduction – to uncover the real issues and find out what people think, and then work together to do something about it. Most of the people I work with are passionate leaders; they get this and we make the magic happen together.
Flo gives a really wonderful shoutout in the podcast to my networking skills:
“Gill Phillips @WhoseShoes, who I do so much of my maternity experience work with, is a wonder at networking. she’s absolutely amazing at building connections, introducing people with ideas that may work together, lending things from one area of her work to another and also networking people up and down the country.We’’ve recently done a couple of workshops on Zoom on continuity of care and we have linked various different hospitals and individuals from different hospitals so they can share ideas on what their approach is and try and test out different ideas together and learn and benefit from that experience.”
I genuinely love connecting people, in fact I can’t stop myself. I worry that I can be a bit of a pain – I see people doing amazing things and know that they will be stronger together. I link them in my tweets and smile like a Cheshire cat when they connect, especially if they go on to meet in person. It is important. It can be life-changing.
As Flo says, I am now looking to use the ‘Nobody’s Patient’ resources with new networks of people who are interested in improving the working relationships between maternity and neonatal care. A lot of serendipity is happening, The right people are coming forward, and it feels good. No merry-go-rounds in sight.
Flo’s podcasts always end with zesty bits. Please listen to her top tips this week on how to avoid going round and round in circles.
Networking to learn and share and NOT keep re-inventing the wheel.
Listen to women and families, particularly flagging up the simple things that can so easily be changed.
Final thought: It was lovely to see the photo of Flo enjoying the merry-go-round. It felt very symbolic. Here I am as a young mum, celebrating my daughter‘s first birthday.
What goes around, as they say, comes around. Keep going. 😉
Some really exciting developments with #MatExp Whose Shoes? at the moment.
Bromley MSLC produced a ‘one year on’ report following up on their Whose Shoes? workshop at King’s College hospital using “I said, I did” as a framework to list all the fantastic outcomes that had come from pledges made on the day.
Language continues to be a big issue for women and families, but some great initiatives are now happening. Building on the Whose Shoes? workshops, Leeds and Colchester in particular are working on specific language challenges. I came up with a ‘Negativity Bingo’ and had great fun with my team at the NHS Fab Change Day #DoAthOn event launching #DumptheDaftWords.
I have been getting some exciting invitations to speak about building social movements and of course gave #MatExp a big shout out in my talk at the launch of #AHPsIntoAction, they have invited me back for a longer keynote session at their annual conference in June.
More hospitals are coming on board with the Whose Shoes? approach – the energy is particularly strong in London, the West Midlands and the South West regions. It has been great to present on several occasions now with Catherine MacLennan and Emma Jane Sasaru and to see people learning so much from their courageous sharing of their lived experience.
This slideshow requires JavaScript.
Last Friday, 3 Feb 2017, we were invited to present a #MatExp Whose Shoes? session to get some good discussions going as part of a packed event launching #PanStaffsMTP in Stafford. We concentrated specifically on continuity and perinatal mental health. This is the county-wide transformation programme to improve maternity experience in Staffordshire to implement the national ‘Better Births’ vision. This informal film gives you a flavour.
We are proud of the crowdsourced ‘Nobody’s Patient’ project and thank everyone for your fantastic contributions. We now have over 120 new Whose Shoes? scenarios and poems and the new resources will be made available shortly to all the hospitals who were existing customers. Florence Wilcock, Sam Frewin and I are finalising the supporting toolkit and collating the case studies, ahead of our ‘wrap up’ event in March. We are trying to pull together lots of ideas for positive change, with or without a workshop. I hope you are enjoying the regular Steller stories, including Florence’s monthly reports.
Wonderful to see everyone doing such amazing work, speaking all over the place, building networks, spreading the word and generally making great things happen.
“Maternity Service Liaison Committees (MSLCs) provide a means of ensuring the needs of women and professionals are listened to and we saw how effective they could be when properly supported and led.”
“I urge you to play your part in creating the maternity services you want for your family and your community. Voice your opinions, just as you have during this review, and challenge those providing the services to meet your expectations.” (Julia Cumberlege, Chair of the Review Team, 2016)
These quotes really illustrate why MSLCs matter. They sum up why I am so passionate about maintaining and sustaining our wonderful Maternity Services Liaison Committee and helping others maintain theirs.
Because I have seen the difference a dynamic, properly supported, MSLC can make to a hospital Trust. Bromley MSLC, like its counterparts throughout the country, is a mix of individuals including commissioners, service users, midwives, doctors and other professionals coming together to monitor and improve local maternity services. The respect that everyone has for each other is evident in our meetings and some of the lightbulb ideas that arise are extraordinarily exciting. I tend to come away from meetings with my head reeling, but also tremendously grateful that we have this group of extraordinary passionate, dedicated people working and living in our area.
MSLCs were first established in 1984, enabling women to be involved in shaping the maternity care provided for them. The Department of Health suggests there should be an MSLC for each Trust in England and Wales. The Health and Social Care Act of 2012 states that health services at every level need to actively engage with service users:
Participating in planning and making decisions about their care
Enabling effective participation of the public in the commissioning process itself
So that services reflect the needs of local people.
Recommendation 13 from the 2015 Kirkup report into the Morecombe Bay Investigation also highlighted the importance of MSLCs.
MSLCs matter because…..
They are the only multi-disciplinary committee of its kind in maternity, bringing together commissioners, NHS Trust staff AND the women for whom the service is designed. One third of the committee is made up of service users, including a service user rep chair and vice chair.
They are independent NHS working groups that advise on commissioning and service development
They should include service users from all parts of the community, ensuring that all women’s voices are heard.
They promote collaboration and involvement
They plan, oversee and monitor maternity services in a local area and make recommendations for improvements where necessary.
They are one of the few examples in maternity where there is true collaboration between healthcare professionals and service users on equal terms at a local level. This leads to a much greater understanding between both parties of the challenges that are faced and the issues that really matter to local women.
The National Maternity Review also highlights the consensus among health professionals to change things for the better. Nowhere is this more evident than on an MSLC!
MSLCs can achieve amazing things:
They plan…..together with the commissioners, service users have the unique opportunity to help shape the future of the maternity services in the local area. For example, because of user testimonials provided by our MSLC to the clinical executive, a new perinatal mental pathway is being developed in our local area by the CCG, which will greatly benefit thousands of women.
They oversee……our MSLC is involved in one off projects designed to improve maternity experiences for local women. We have designed information posters, are having an input into a “Welcome to the Ward” postnatal pack and have helped improve the birth environment on the Labour Ward. We also make tours of the wards, bringing a service user perspective and a fresh pair of eyes to the environment.
They monitor……our MSLC gains feedback from women through surveys, questionnaires and Walk the Patch both in the hospital and more recently in children centre health clinics in the community. That feedback is given directly to the lead health professionals of the Trust as well as the commissioners, who listen and act on our recommendations. Those improvements are then fed back to the service users, via social media and other means, so that we close the loop.
This type of work is not just being done by our MSLC. I know of countless other committees which are tirelessly working to improve services in their local area too. Our brilliant vice chair Michelle Quashie is planning a Women’s Voices conference in October and has asked me to present the achievements of our MSLC and others around the country, demonstrating how effective collaborative working can be. I am looking forward to showcasing just what has been and can be achieved then.
At our recent Whose Shoes event pledges were made at the end of the workshop about something that the delegates would do differently as a result of that day. These pledges have formed the workplan for our MSLC for 2016 and we will check to ensure that they have been carried out. MSLCs are true examples of #MatExp in action at a local level.
We were also really pleased to see the importance of MSLCs highlighted on our beautiful graphic courtesy of New Possibilities.
For this blog I asked members of other MSLCs for their thoughts on why MSLCs matter. Responses included:
“MSLCs matter because it is gives all that are passionate about a Women’s Maternity experience a chance to join forces and make their hopes for better birthing world a reality. It enables all members to be involved in ensuring this happens. It allows true collaborative working and keeps service users involved in decisions made about women’s maternity care and that of their family. It’s a safe place where women’s voices are heard, valued and respected. A Women’s experience is its driving force for that reason I am proud to be part of such a dynamic committee.
Initiatives like ‘Walk the Patch’ enable all women’s voices to be heard regarding the maternity care they are receiving. These voices from the community can then be filtered back to senior levels and actions are derived to improve the service as a result. WTP also gives the chance for those HCP that are providing truly women entered care the recognition they deserve.
I joined the MSLC after feeling very let down buy my personal maternity care. I knew I had to help change things for other women. Being part of the MSLC has enabled me to do that from the inside out. The work we have done and the wonderful HPs I have worked with has helped to restore my faith and feel empowered by being part of making change happen for others.
I hope that MSLCs get the recognition and support for the amazing work we are doing across the country. All that give up their time, do so because they are passionate and dedicated. MSLC’s should be mediatory for all trusts. How else can you ensure a woman centred service is given without women voices being heard in order to influence that service?”
Refreshed guidelines from NHS England, due for imminent publication, call for MSLCs to be run, maintained and funded by the CCGs. This is much needed, because in the current economic climate many MSLCs are fighting for modest but essential funding to continue the collaborative work they are doing. In addition, due to the unique nature of these committees it can be difficult for the commissioners to work out a mechanism for funding.
It is against this background, while MSLCs are struggling, that Julia Cumberlege, chair of the National Maternity Review, urges women in her introduction, “play your part…for your family and community … voice your opinions” as quoted at the top of this blog. MSLCs provide an ideal forum for service users to do just that. They are the ‘best practice model’ for shaping the future of our maternity services.
A petition has been started to emphasise the need for MSLCs in all areas. Please consider signing and sharing this petition so that MSLCs can continue the vital collaborative work they are doing at a local level, with volunteers’ expenses paid and commissioners everywhere listening and learning. https://petition.parliament.uk/petitions/121772
If you are not already involved with a local maternity group that feeds into an MSLC – or the MSLC itself, search online to see what you can find out about local provision. Contact your local CCG, your head of midwifery, local Healthwatch, or any pregnancy and parenting groups, such as the NCT and find out what’s happening. You can find out more about MSLCs at https://www.nct.org.uk/professional/mslcs
Leigh Kendall opened this month for #MatExp with a call to action for Oxytocin October. The campaign is always action focused and we are keen to hear from anyone who is doing something to improve maternity experience in the UK, be it something big or something small. Yet we had already put together a number of blog posts with calls to action, back in #FlamingJune. So I decided that my action for this month would be to revisit those blog posts and find out what progress has been made.
The original blog posts were on these subjects (each subject links to the relevant post):
Having re-shared the posts on Facebook and Twitter I was delighted to see the responses coming in detailing what has changed, what has been started and what is continuing to be done. Take a look!
Perinatal Anxiety
Sarah McMullen of the NCT explained that she invited Emily Slater (MMHA Campaigns Manager) to speak and run a workshop at the NCT national conference – to raise awareness and inspire action. Sarah says that Emily’s plenary talk to 600+ staff, practitioners & volunteers “was incredibly powerful, and we’re meeting to discuss next steps for NCT”. Sarah added “We’ve also submitted two funding applications relating to mental health awareness (thanks to Rosey Wren for support), and have match-funded a PhD studentship with the wonderful Susan Ayres on Birth Trauma, and are supporting another PhD research project on group identity and PTSD”
Midwives on Twitter commented:
To read Jeannine and John’s blog post please click here. “You matter. I care.”
Emotional Wellbeing
#MatExp team member Emma Jane Sasaru has been incredibly active over the last few months. She has launched Unfold Your Wings a place of information and support aiming to raise awareness of Perinatal PTSD, birth trauma, reduce stigma and give sufferers hope. She has also launched a CoCreation Network community around perinatal mental health. Emma has then collaborated with #MatExp team member Susanne Remic to bring about a weekly #BirthTraumaChat on Twitter run jointly from Unfold Your Wings and Maternity Matters.
Also launched this month by West London Mental Health NHS Trust was this fantastic short film about perinatal mental health: https://vimeo.com/143359951 This film has already sparked many useful conversations.
In her talk at a recent National Maternity Review event, Baroness Julie Cumberlege made it very clear that the call for continuity of care is being heard by the review team up and down the country. Neighbourhood Midwives led a discussion at the review’s Birth Tank 2 event, and there were a couple of other discussions where options for continuity were also explored.
Midwife Deirdre Munro celebrated the launch of the new Global Village Midwives website this week. The movement is over a year old and Deirdre explains:
Infant Feeding
Lots of news about infant feeding from passionate individuals and voluntary organisations. On our #MatExp Facebook group Zoe Woodman explained: “In May we got approval from NCT to run a branch funded feeding support group. Started in June with an NCT bfc attending who is also an IBCLC. We are on 3 boundaries in terms of commissioning services so no local peer to peer style support groups were running within 8miles. The only service is an HV clinic once a week and it’s one on one so you have to wait outside the room to be seen. It’s been on our branch aims at our AMM since I’ve been chair (4yrs!) so finally chuffed to see it in action and I will get to use it myself in January for no3! It’s running twice a month currently but hope we can get funding in the future to run weekly. It’s slowly building in terms of attendance. Feedback so far is great!”
Claire Czjakowska’s Breastfeeding Advert is coming together and is looking very exciting – watch this space! Breastfeeding in Trafford launched its Twitter account this month so please follow for local breastfeeding news. BfN Portsmouth tweeted:
Midwifery students at the University of Worcester have launched a petition around the questionable practices of infant formula companies – follow the hashtag #WeakenTheFormula for more information.
As if this wasn’t enough, this month has seen the launch of the World Breastfeeding Trend Initiative for the UK. A committed group of individuals from the major breastfeeding voluntary organisations have come together to measure the country’s performance against the WHO Global Strategy for Infant and Young Child Feeding. Please visit the website for more information on how this project is structured and the indicators against which the UK will be measured. The project needs lots of input from families and professionals so please follow @wbtiuk on Twitter and find out how you can help.
Tongue Tie
Doula Zoe Walsh updated us: “We held a North West tongue-tie workshop in Blackpool. It’s now going on the MSLC agenda for Blackpool so that we can discuss local provision and see if it’s meeting the needs of local families.”
Breastfeeding and Medications
From a personal point of view, I finally got around to becoming a friend of the Drugs in Breastmilk Helpline this summer. The helpline is absolutely vital for ensuring that women get the correct information about what medications they can use when breastfeeding. The service is funded by the Breastfeeding Network and the charity once again asked supporters to do a #TeaBreakChallenge this month to help raise donations.
A wonderful #MatExp collaboration has sprung up this month between Angelique Fox, Sarah Baker and Wendy Jones. These two #MatExp mums who have never met in person have both volunteered to help Wendy to collect data and raise awareness with regards to drugs in breastmilk, particularly where dentists and podiatrists are concerned. It was discussed on the #MatExp Facebook group that these two healthcare professions are often cited as not having up to date information about breastfeeding and medications so this collaborative project is aiming to tackle that.
Luisa Lyons, the Infant Feeding Coordinator who wrote our original post on this subject, gave us this fantastic update: “Been a busy couple of months. Infant feeding e-learning training for doctors up and running at my unit and both paeds and obstetricians encouraged to complete it. Great support from our obstetric consultant clinicsdirector too. General paed nurses now doing mandatory infant feeding training every year. Been invited to teach general paed doctors face to face. Three GP’s have done the UNICEF 2 days bf management course with us and now writing bf training for GPs in Norfolk. Included info on bf and medications with scenarios to both student nurses and our midwives at keyworker training now, and incorporating into Mt for all maternity staff. Also off topic slightly am putting in a WHO code game to all the above which has generated lots of awareness with student midwives and maternity staff. Need to join DIBM as a friend which I had forgotten to do, so thanks for the heads up.”
Midwife Mark Harris launched his book this month, Men, Love and Birth, “the book about being present at birth that your lover wants you to read”.
A Manchester midwife reported positive outcomes around new rules enabling dads & partners to stay over on her unit:
When asked how we can best support Dads & Partners, newly elected NCT president Seana Talbot tweeted:
Community Outreach Midwife Wendy Warrington tweeted:
I asked Wendy about the work she does with regards to Dads & Partners and she explained “I talk about attachment and being with their baby, skin-to-skin touch. Antenatal and postnatal depression, and fathers’ role in supporting their partner in pregnancy, birth and beyond and how they can do this. I talk about baby cues and the impact of father’s involvement on child’s future emotional and cognitive development. I have had excellent feedback from parents and when I see them after the birth they say they felt well prepared for feeling and emotions experienced post birth. They love the fact that I talked about it”
Collaboration between Midwives and Health Visitors
Health visitors on the #MatExp Facebook group told us:
“My CPT & I have established 6 weekly meetings with the community midwife and the GP (whose special interest is pregnancy/neonates) to discuss cases”
“We already have that in my team we meet at least once a month with the midwife – it was weekly but we are very busy at the moment (both us and the midwife). She will just knock on our door though and share things – she really came on board with antenatal contacts telling parents to be and signposting those with small children with any worries to us.”
With excellent timing Sharon White, OBE, Professional Officer of the School & Public Health Nurses Association, then tweeted the updated pathway for health visiting and midwifery partnership.
And as a result of discussing all of this on Twitter, Sheena Byrom has invited me to lead a tweet chat with @WeMidwives and @WeHealthVisitor in November on the subject of midwife and health visitor collaboration. Watch this space!
And so much more has been happening in #OxyOct as well! #MatExp was well represented at the NHS Maternity Review’s Birth Tank 2 event in Birmingham – click here for Emma’s round up. I spoke at the launch of the Improving ME maternity review for Wirral, Merseyside, Warrington and West Lancashire – click here for my round up of the morning. Leigh Kendall and Florence Wilcock spread the word at the RCOG Conference on October 16th, and Leigh spoke at the Royal Society of Medicine event on October 20th.
Baby Loss Awareness Week took place this month and many important discussions were had around the subject of grief and loss, something which affects a number of #MatExp campaign members. Leigh wrote movingly about Standing on the Periphery for #HugosLegacy.
The RCM has this month launched its State of Maternity Services Report. Emma Jane Sasaru has written a series of three blogs about What Matters in Birth. Susanne Remic has been raising awareness of IUGR. Michelle Quashie created fantastic word clouds for display in her local maternity unit. We now have #MatExpHour every Friday created and launched by Louise Parry – click here for her round up of Week 2. So much going on!
I have no doubt there is much much more that I have missed from this round up. There is so much energy and passion in maternity services, and so much desire for change. Whatever it is you are trying to achieve, please join up with #MatExp via Twitter, Facebook or the website and get encouragement and input from like-minded people. Together we are stronger! Feel the Oxytocin flow!
There have been some fantastic conversations taking place on the MatExp Facebook group, with lots of ACTION threads being posted to generate discussion. The aim of these discussions is to identify ways that we can ACT to improve maternity experiences. Big, long-term actions that might require system change or a change in culture. And small, immediate actions, that professionals and individuals can take today to improve the maternity experience of those around them.
One of the subjects we started to tackle early on was Birth Trauma. This was an insightful discussion about parental experiences, but it was mentioned that midwives can also be traumatised by their experiences of birth. We started a thread specifically to discuss this issue and for me it got to the heart of some of the problems facing maternity care today.
I was at a user group at Salford University in May where a group of parents discussed the midwifery curriculum with some of the lecturers. We talked about all of the things that parents want – compassionate care, informed consent, skin to skin, optimal cord clamping, breastfeeding support – the usual topics. One of the lecturers commented that they had been teaching all of these things for years, why were the same complaints and comments still coming back from parents?
I really feel that midwives’ experiences and the way that these are dealt with is one of the answers.
A comment that particularly resonated with the group was from a third year student midwife and I would like to share it here in full:
“I agree, that the trauma for me is cumulative. Often a singular ‘traumatic birth’ is easier to process as the necessity for intervention is usually clearer, staff involvement/support is higher and women/families are offered enhanced care/debrief/support. It is the ‘routine’, less critical ‘procedures’ that affect me over time. The ‘heroic’ ARM, the VEs by doctors with inadequate consent, instrumental deliveries without compassion or the ignoring of important birth wishes (OCC for example). It calls into question your very notions of love, kindness and compassion. It hurts personally to see these violations of women, often by doctors. Usually it is not the ‘act’ itself but instead the loss of autonomy and consent that causes me so much pain. I also have noticed, how frequently these things are not noticed by women, because they don’t know it could be any different. And I feel that in that alone ‘we’, the system, have let her down. It took me a very long time to establish why I found the delivery suite so challenging. Now I understand that witnessing, sometimes being part of, repeated human rights violations is of course going to be distressing. It would be to anyone. The fact that this job is integral to my sense of self, identity, world view and beliefs makes the impact even greater. But I do think that without adequate support birthworkers (midwives, doctors, doulas, etc) may become detached or choose to leave the hospital setting to protect themselves. This has been my biggest challenge throughout my training and I know will continue to be as a NQM. I believe all birthworkers need nourishing support to continue to provide compassionate care. I have received this from a community of feminist birthworkers spread across the country but whose shared values inspire, support and encourage me. Having space held for me as a student midwife by fellow birthworkers has taught me more about how to provide loving care than almost anything else.”
A retired midwife commented “I’m old hand in some respects and you basically brushed yourself down and moved forward. The difficulty occurs I think in the future as over time as you find that the coping mechanisms aren’t working as well and you exist with a high level of adrenaline running around your body; it becomes more and more challenging to cope.”
Birth workers discussed crying in the toilets whilst at work, fire-fighting from one emergency situation to another, feeling vulnerable, angry and frustrated. Cutting costs and box ticking were mentioned and a lack of compassion amongst the management system, with policies slowly eroding midwives’ scope of practice.
“As a student, I have found morale amongst midwives one of the hardest things to deal with. The majority dislike their jobs for many reasons (too many to list but management and politics play a huge part) and are unresponsive to students enthusiasm. I have even been told by mentors that they don’t like having student? This obviously has an impact on learning and emotions. When experiencing birth trauma with a midwife that shows no emotion, even after the event, it is hard for a student to deal with and can have a huge impact on students emotional/mental well being. That being said, there are some fantastic mentors. However, students leaving training due to lack of support is unacceptable.”
Immediate, short term actions:
Find out if your Trust has guidelines about supporting families AND staff after difficult births
If anyone has good guidelines from their Trust that they are able to share please let us know
Midwives at all levels to reassure one another that it is acceptable to have difficulties coping with some of the births that they witness, and to talk about coping strategies that they have found helpful.
Read The Roar Behind The Silence (and encourage colleagues and managers to read it) – many of these issues are discussed in the book and action points suggested
Consideration to be given to what will replace supervision of midwives if it is to be dismantled, in terms of who midwives are going to go to for support
“We need a powerhouse of strong and courageous managers, midwives and students who are able to steer midwifery towards kinder more humane care keeping in mind our goal for physically safe and emotionally satisfying outcomes for women.” (midwifery student)
“The emotional investment of midwifery takes its toll”
June is not going to be dull…! For me personally, this is a big week – I am looking forward to speaking at the NHS Confederation Annual Conference on Wednesday. The session I am involved in, chaired by Dr. Mark Newbold, is about urgent care of older people. The emphasis of my contribution is around prevention, holistic approaches and joined-up systems, ensuring that life is not over-medicalised – the simple things that make life worth living.
@WhoseShoes Not a fan of capitals usually as you know but forgot v imp message DO SOMETHING ABOUT (scandal of) NHS CONTINUING HEALTH CARE.
Mum, known on Twitter as @Gills_Mum, is extremely interested in my talk and threatening to write a blog of her own…
Preparing my presentation brings home yet again the parallels and key themes across all areas of my work. Hardly surprisingly really as we are all people; aspirations, hopes and fears and the desire to have control over our own lives do not suddenly change just because we get older.
Today starts the month with a bang.
Our #MatExp campaign, to improve the maternity experience of women everywhere, goes up a gear.
For anyone who has been twiddling their thumbs and wondering what to do with themselves since the end of the #MatExp alphabet (yes, we know who you are!), you will be delighted to know that June is a month of action!
@FWmaternitykhft how does it work?? Really want to get involved in #MatExp 💥
#MatExp #FlamingJune – we are just waiting for the weather to catch up … although perhaps it is just as well it is a bit cool outside or the energy burning in this remarkable grassroots campaign might just start some forest fires!
The Maternity Experience change platform launches! http://t.co/CY9Cq1He1E Sharing great practice across Britain's maternity services #MatExp
Sheena Byrom is an extraordinary woman. As her action for June, she is posting blogs from individuals who have information to offer to the new team set up to conduct a national review of maternity services in England, led by Baroness Julia Cumberlege. We all feel passionately that this new review team needs to engage with the action-focused, inclusive work of what has now become an unstoppable social movement for positive change.
And so it is a huge honour that Sheena invited Florence Wilcock and me, as the initiators of the #MatExp campaign, to write the opening blog and tell everyone what has been happening and why is it so important for these links to be made.
Sheena is publishing our blog today on her site. But for ease you can also read it below. We are all working together in a very strong collaboration and taking the view that the more different channels we can use to spread the word and involve more and more people, the better!
OUR GUEST BLOG FOR SHEENA BYROM IS REPRODUCED BELOW…
We would like to kick off Sheena’s June blogging series with a strong call for the Maternity Review Team to engage with our fabulous #MatExp grassroots community. We need to build on all the amazing work that has been happening over recent months through this passionate, inclusive group.
Graphic record from our #MatExp Whose Shoes? workshop, held at Kingston Hospital. New Possibilities are the graphic artists.[/caption]
Inevitably the themes are similar between the different sessions but with a strong local emphasis and most importantly local ownership, energy and leadership.
On Gill’s original blog there are LOADS of scrolling photos at this point showing #MatExp #Whose Shoes workshops and the wider campaign in action – take a look!
It would be easy for the NHS Change Day campaigns to lose momentum after the big day itself, (11 March). #MatExp has done the opposite, continuing to build and bring in new people and actions. #MatExp #now has 110 million Twitter impressions. We have just finished the ‘#MatExp daily alphabet’, a brilliantly simple idea to get people posting each day key issues related to the relevant letter of the alphabet.
This has directly led into the month of action starting today, 1 June!
Helen Calvert set up and ran a survey of health care professionals. She had 150 responses within about 10 days and analysed and reported the results – an extraordinary contribution.
We have a vibrant Facebook group (please apply to join – initiated by fab Helen Calvert @heartmummy) and the brand new website (LAUNCHED TODAY! – huge thanks in particular to Leigh Kendall @leighakendall) set up by the #MatExp team of mums who are incredibly focused, working long hours – all as volunteers. We are all absolutely determined to keep working together to improve maternity experience for women everywhere.
Gill Phillips and Florence Wilcock
There will be LOADS of ideas to help you…
So please get involved.
