NORMAL BIRTH - evidence and facts

"Yellow journalism is is a type of journalism that presents little or no legitimate well-researched news and instead uses eye-catching headlines to sell more newspapers'' 

I would usually add screen grabs of the offending news articles HERE, but I am not. They are sickeningly inaccurate and offensive. 

But this post is referring to recent ludicrous press claims in several newspapers, of a non-existant 'cult of normal birth' by midwives, and that mothers and babies are suffering because of it. These stories are fear-mongering untruths, aimed at damaging a profession, and limiting women's autonomy and choice. And, they are adding to the fear amongst pregnant women, that already prevails. 

Shame on you all.

Professor Soo Downe OBE, midwife and internationally recognised expert in the field of childbirth, presents the

EVIDENCE AND FACTS

1.       There is no evidence whatsoever that a ‘cult of normal birth’ exists: indeed, less than half of women in the UK who could have a normal birth do so (40% as opposed to 80%), and nearly  double the World Health Orgnaisation (WHO) recommended rate of 15% of Caesarean section (CS) are being done (over 26%) at a time when the whole world accepts that CS rates are too high, and that high rates risk harm to mothers and babies.

2.       The Morecambe Bay Report seems to be the sole source for all this reporting. This described the situation in one hospital (not a midwife led unit) in one Trust in one part of the country some years ago. Dr Kirkup, who  authored  the report,  has reiterated that there were five areas of failure found – the issue of normal birth was only one of them. He has emphasised that all five areas were equally important in their potential contribution to adverse outcomes. While the report was very important in highlighting the range of problems that were occurring at Morecambe Bay at the time, and that could have been occurring elsewhere in the country,  extrapolating from this that a 'cult of normal birth' exists, and that it is the sole and direct factor responsible for the death/morbidity of thousands of babies across the country, is scandalously bad journalism

3.       There is no evidence that there is an increase in incidences of perinatal asphyxia in the UK.

4.       There is no evidence that normal birth per se (any more than any other mode of birth)  is associated with baby deaths or damage.

5.       The evidence we do have, from reviews of good quality  randomised controlled trials, is that, if women have continuity of midwife led care, they are less likely to lose their babies (from early pregnancy to the early postnatal period, including birth), 24% less likely to have babies born prematurely, AND more likely to have a normal birth. WHO and many other responsible agencies around the world accept this evidence. 

6.       Indeed, WHO is currently working on a guideline to reduce unnecessary CS

7.       The current press coverage in the UK seriously risks damaging mothers and babies in the future if, as consequence, normal births fall and CS  or instrumental vaginal birth climb

8.       In the United States of America, which has one of the highest rates of intervention and one of the most expensive maternity systems in the world, maternal and infant mortality are one of the highest among the group of the worlds richest countries

 

9.       It is also unacceptable that our Secretary of State for Health, who is supposed to be concerned with reducing baby loss, has not challenged these deeply flawed claims, on the basis of the harm it may do to future mothers and their babies.

Given all this evidence, it is astonishing that the press are reporting the complete opposite. They should seriously consider if they are breaking their own press code of ethics, that states that they must adhere to the following:

Seek truth and report it

Minimise harm

Act independently

Be accountable and transparent

All of these ethical principles seem to have been violated in the elements of the recent reporting that link normal birth as a systemic problem, and as the (only) factor in adverse outcomes in mothers and babies.

It is clear that there are still some areas of poor practice which need to be addressed, but the outputs of recent quality assessments show that the majority of maternity care is excellent, including good collegiate relationships between midwives supporting women to have normal births, and obstetricians providing technical interventions where these are needed . Addressing poor quality care should not be at the cost of reducing this excellence.

Professor Soo Downe OBE

DON'T JUDGE ME: I was a victim.

Image:   www.slate.com

Image:  www.slate.com

Dear midwife, do you understand the power of your words?

We met last week, you said that the woman with a controlling husband was stupid for staying with him: I hope that this piece makes you stop and think, and learn and change.

Firstly, who are you, defender of women’s rights and autonomy, advocate, care giver, change maker, worker, midwife, to pass judgement and to call a woman stupid? As I sat across from you, did you think that I was stupid too? I am a third-year student midwife and I presented the paper I had just had published in a journal to a group of qualified midwives: did I not fit the profile of victim of domestic abuse?

I am not stupid

I am not stupid: I am bold, fearless, courageous, loving, loyal, fiercely intelligent. I fled from a controlling and manipulative husband, packing my life and my children into my battered car in less than an hour. After years of unhappiness, months of convincing myself to just hold out a little longer, of ‘safe words’ I knew to use if I had to call my dad and get him to race the 8 miles from his house to mine, it all came down to one abusive phone call too many. It was a choice that was not taken lightly. Do you understand that you made me feel judged, spineless, cowardly, ridiculous, weak, for staying so long?

‘Stupid’ suggests that she knows what he’s like and that she has a choice. That I knew, that I had a choice. Theoretically there is a choice: stay or go. In reality, is there somewhere to go, money, support, safety?

Photo: Pinterest 

Photo: Pinterest 

Do you know what it’s like to live with someone who controls you? Apparently, it isn’t normal for your husband to make all the decisions, to shout at you as soon as he gets home from work, to drink every night, to ignore you, to use sex as a weapon, to check your messages, to track your phone, to scour your phone bill, to follow you, to go through your handbag, to set all your passwords to his name, to read every single reflection you’ve ever written and every scrap of paper you put in the bin. Who knew it wasn’t normal for the man you love to drive you halfway to a family celebration and then refuse to go any further and turn around and go home, to accompany you to your best friend’s wedding and force you to leave after the speeches for no other reason than he didn’t want to stay.

Who was I to say that it wasn’t acceptable to live with a man who told me that my family hated me, that the only reason my dad offered to pay for my wedding was because he wanted to make up for the fact that he had never loved me. I must be stupid for not realising that he was calling my parents behind my back and telling them I was mental. It wasn’t OK for him to hurl abuse at me until I’d end up curled in a ball on the floor sobbing, at which point he would change completely, insisting he hadn’t meant to upset me and that he loved me. It wasn’t OK for him to spend months threatening to tell people that I was an unfit mother if I left him, for me to stand in a supermarket and beg him to love me when I was pregnant with our children. None of it was OK, and none of it was my fault. I understand that, my head knows that he was the one to blame, but he’s conniving and clever and cowardly. He’s inside my head, and has eroded my sense of self-worth. I’ve been left wondering why I would deserve to be loved, and those thoughts spill over into all my relationships: colleagues, friends, women I care for, why would I be good enough?

You have not walked a mile in my shoes

You do not know me, you have not walked a mile in my shoes, you did not barricade yourself in the home office and sleep with a knife under your pillow because you were scared of the man who vowed to love you and protect you. At least I hope that you do not know how it feels, and I hope you don’t have children or friends who will know the loneliness and pain of living in an abusive relationship. I hope you don’t have a son or daughter who will turn up on your doorstep unannounced one day because he or she is scared. I also hope that if that happens, you listen and hear. I hope you don’t tell your child to suck it up because they made their bed, and that you don’t tell them that they’ll never cope without him.

To be honest, I was not stupid, I was afraid. I was afraid of being alone, of coping with my children, of losing my children. He convinced me I was useless, redundant, insane. I felt as though I had lost my mind, and I wanted to die. By the end of our relationship, after nearly a decade of him, I thought the only way out was if I died. I had hit rock bottom and had lost control of my life, and he kept making it worse.

Image: South China Morning Post http://www.scmp.com/news/hong-kong/article/2049285/hong-kong-losing-battle-against-domestic-violence

Image: South China Morning Post http://www.scmp.com/news/hong-kong/article/2049285/hong-kong-losing-battle-against-domestic-violence

To anybody who has cared for and will care for women in abusive relationships, you cannot imagine the damage that occurs. He never hit me, but he demoralised me and took great pleasure in telling me how awful I was. On our wedding day, which is four years ago tomorrow, he looked me up and down and sneered ‘that dress is very you’, swiftly followed by ‘I thought you’d have worn more make up’. Not surprisingly, he got insanely drunk and did not utter one word to me after we said our vows. I knew. I knew I shouldn’t be marrying him, but I loved him so much and I wanted to prove that I was good enough for him, that I deserved his love. I was also in over my head and couldn’t think of how to get out.

I’m not sure I can do justice to how that relationship made me feel. I have come out of my marriage bearing battle scars that run deep, and I doubt that I will ever trust anyone again, at least not for a very long time. I will not invite people into my life unless I am sure they don’t just want to hate me and punish me: friends and family are kept at bay because I don’t want pity or misunderstanding, or to get hurt. Some of the friends that I thought were my friends have broken my heart, others who I tried to keep out have called my bluff, got through the armour and are here to stay.

It's not over...

The thing is, it’s not over. We have two glorious children together, I am civil to him for their sake, I can pretend to be friends with him so that the little people in my life do not have to suffer any more. He still controls me. I am going to have to fight to get any money out of our joint-owned property, he chops and changes his mind, he decides when he is working so he can control me. He attempts to manipulate the children, telling them to be brave and count down the days until they are next together. The truth is that they make a fuss when he drops them off because he is making a fuss, they are small and do not deserve to be caught in the crossfire of his games. He wants to be in charge and does not understand why this can’t happen all the time. He isn’t sad that he’s lost my love, he’s sad that I made the decision to stop loving him because that meant he lost a bit of his control over me. I nearly drove myself off the road one day and hoped that people would think it was an accident. Enough was enough. I heard a specialist midwife talk about domestic abuse in a lecture at university and realised that she was describing my life, my marriage. That sowed the seed of doubt, and realisation soon followed. One of my children looked at me one day and said “I don’t want you to die mummy”, and I would have done it, I would have left my kids to get myself out, I nearly walked away and left them. “I don’t want you to die mummy” made me realise that I am important to them, that I matter. I matter!

I had moved all my important documents to a friend’s house weeks before I decided to go, mainly because I was afraid that he would take my children away from me. When I left, I packed everything I could carry and squeezed it into my car, I lived out of bin bags at my dad’s house for a month. I was grateful to him, but I felt in the way and lost, although the relief of not having to yield to my husband was immense. I chose things for a new flat without asking permission or feeling bad, or being made to feel bad. My children and I spent the summer exploring our new home and the surrounding beaches, we spent a week on holiday in Cornwall and we barely stopped laughing. We walked and laughed and cried and adjusted. I was strong and brave and courageous for my children, the hardest part seems to be now. My wedding anniversary, mother’s day, his birthday, my birthday all fall within a ten day period, and it has been tough, although I do not know why. This year I had no expectations of him and therefore was not disappointed. I didn’t cry this year, on any of those days. Last year I cried on each of those days. Progress.

I need to thank the women who picked me up

I have written this anonymously, but I need to thank the women who picked me up and stuck me back together again. The one who emailed me late at night to check that I had returned safely from the marriage counsellor I had been forced to attend, the ones who had the courage to say I couldn’t go home as they didn’t think I was safe, the ones who scooped me up, the ones who kept me going, the ones who treated me as though nothing had happened so I could feel normal, even if only for one shift, the one who invited me into her home and cooked for me, the ones who called my bluff on my standard response of ‘I’m fine’, those who continue to challenge and push me, who realise that an abusive relationship doesn’t define me. To the woman who asked whether my children were clean, dressed, fed and loved, and if they were then that was enough for today. To the friend who insinuated herself into my life without me even realising it, thank you for persevering with me, I couldn’t imagine my life without you in it. To the women who have met my glorious girls, and have smiled at them, given them a word of kindness, to the women who inspire me each and every day with their strength, courage, kindness, laughter, and love.

To my lecturers and mentors, there are literally not enough words to express the depth of my gratitude to you. Thank you for your kindness, support, honesty, compassion and understanding, thank you for giving me the tools to save myself, thank you for having the courage to ask difficult questions. Thank you to the group of feisty and fearless midwives and student midwives who stand shoulder to shoulder with me, who share my successes and hug me when I break. Thank you for sticking me back together piece by piece and for making me feel as though I matter.

To the midwife who prompted this reflection, thank you for your crass comment as it made me stop and think. I hope you have glimpsed inside my life, but you can never know the reality, as I can never know the reality of yours or anybody else’s life. Please think before you offer an opinion next time, please show some compassion, for your colleagues as well as the people you care for. Domestic abuse isn’t always evidenced by a black eye or bodily bruises, you don’t know who is going home to an unhappy relationship, who is being controlled, bullied, raped, beaten, degraded, humiliated, downtrodden. You don’t know who isn’t safe just by looking at them, you don’t know which woman, colleague, student, needs you to ask that question about what their life is like when they step in through the front door. You don’t know whose home has become a prison, and whose partner their jailor. Always ask the difficult questions, and never judge. Please be kind, because here is the thing about being in an abusive relationship, it is just so secretive and lonely.

When midwives are broken - what can we do?

 
 

It’s always a great pleasure to visit universities and meet enthusiastic student midwives. I also have the priviledge of speaking to scores of midwives at conferences and events. Social media is another way I connect with maternity workers, and I read blogs written by midwives about their work both in and out of the NHS. There are many heart soaring moments when I read about innovation, kindness, compassion and women centredness. But I am always alert to messages of distress, and when I hear accounts such as the one below, my heart well and truly sinks. I have written about the overwhelming and increasing pressures of being an NHS midwife, and midwifery manager, before.

I have chosen to share this midwife’s plight for many reasons. Firstly because she asked me to, and because her words represent the feelings of all the others who write to me almost on a weekly basis. And of course I want to add to the lobbying for much needed change in maternity services; how can midwives care and nurture others when they feel stressed, burnt out, and unable to do their work?  The situation is intolerable, and needs action. By using a pseudonym below, I am protecting a midwife’s identity. But many midwives speak out reveal their names, when they don’t feel able to continue. Others reach out to tabloids annonymously to highlight their distress, and recently the mother of a midwife contacted the press. In 2015, the RCM revealed that 50% of midwives in England were stressed

Julie is a newly qualified midwife, and like so many others, the NHS is in danger of loosing her.

It's with much sadness and desperation, that at only four months into my midwifery career, I am going off sick for the first time with stress/burnout. Working conditions, despite generally very good support from colleagues and amazing support from my SOM, are untenable. I am completely heartbroken at my inability to give the kind of quality care women deserve due to staffing issues and chronic overworking. And this is despite my unit having some of the highest levels of positive feedback in the country. The price to be paid for this appears to be the health and wellbeing of all staff (particularly midwives and registrars). I'm sharing this with you as you have all been so supportive of my transition to life as a newly qualified midwife. And I believe it is an outrage that four months of work as a midwife is enough to break me, someone who has sought every strategy possible to engage in maintaining resilience (yoga, meditation, peer support, Twitter, reflecting, conferences, self-care, etc), whose passion and love for midwifery is so strong and who has made it their life's work to reach the point of qualification. I have thought about leaving midwifery. In fact, I have thought it almost daily for the past three months. I had no idea working clinically as a midwife would be so distressing. The most profound problem is that there is no time. No time to create meaningful relationships, to properly support people in their journeys, to hold space, to be tender. I have done my very best every shift and believe I have given everything I could have to the families I have been with but that is not the same as it being as good as they deserve.

On the advice of my supervisor of midwives I'm going to my GP tomorrow to get signed off for two weeks. In this time I will be reviewing my finances to see how I can reduce my clinical hours as a midwife. As someone with a disability who already works 34.5 hours I don't know how I will survive financially. I may look for another part time job to make up the shortfall. My (retired) mother has spoken of giving me a monthly allowance. All this to enable me to practice midwifery. I am angry. I am angry for myself but I am angrier for the people we serve, that working conditions for midwives are so far from adequate and sustainable that they are unable to provide the care they deserve.

If you have any ideas as to how to come back to the vocation I truly love and an identity that shapes who I am, in a way that is healthy and productive then I would be so grateful. And if you can, in any way, publicly share what I have told you (anonymously, as I fear being open may negatively impact me) then I beg of you to please do so. Tell everybody what is happening. That conditions are now so bad they are beyond normal newly qualified midwife transition. That we are experiencing burnout in months. My unit is struggling to retain even the most committed staff. We are demoralised. Not by the wonderful women and families, not by our colleagues, but by the inability to provide truly compassionate, individualised, safe, holistic care and support. The 'workload' is relentless and the only thing left to give is ourselves. And I am broken.

Please share my story if you can.

In response to my supportive email to her, Julie later wrote:

It's reassuring to know I'm not the only one struggling! I really feel that the public deserve to know the real state of affairs. There seems to be an expectation for midwives to be virtuous and perfect (a mother-type complex?), able to carry all burdens without complaint, ever grateful for the 'privilege' and 'joy' of the job. That is not to say midwifery work is without these elements but I do not feel 'privileged' on most shifts! The stress is too great to even appreciate the beauty and wonder that exist. I live with a fellow (non-disabled) NQM, who is on the verge of breakdown too and she has had two two-week long absences from work from physical illnesses she attributes to internalised stress. Again, this is within a four month period of working clinically. I just wanted to let you know as it does affect my ability to earn extra income by managing the potential work-load of another part-time job in order to facilitate reduced clinical hours as a midwife and thus it makes me intensely financially vulnerable (I am 30, live independently with a housemate and all the associated costs). This on top of the stress of working in a busy, high risk obstetric unit with chronic understaffing, demoralised midwives and unmanageable workloads is just horrible. However, to temper this I would like to add that the labour ward co-ordinators, my incredible SOM and colleagues are doing their very best on a daily basis to support me and everyone else, however there is nothing they can do about the staffing and workload issues which underpin everything.

Thank you for taking time out to listen to me. I feel heard and understood which is so lovely in these trying times.

‘...if I'd known the realities I think I would have pursued doula-ing. It's a shame as midwifery is such a beautiful paradigm in its own right but enacting it authentically in the UK, particularly in a hospital setting, seems almost impossible’

If you have any ideas as to how to come back to the vocation I truly love and an identity that shapes who I am, in a way that is healthy and productive then I would be so grateful. And if you can, in any way, publicly share what I have told you (anonymously, as I fear being open may negatively impact me) then I beg of you to please do so. Tell everybody what is happening. That conditions are now so bad they are beyond normal NQM transition. That we are experiencing burnout in months. My unit is struggling to retain even the most committed staff. We are demoralised. Not by the wonderful women and families, not by our colleagues, but by the inability to provide truly compassionate, individualised, safe, holistic care and support. The 'workload' is relentless and the only thing left to give is ourselves. And I am broken. Please share my story if you can.

So what’s the solution? I offer some suggestions. Please comment below and add yours

Strategic

  • WE ARE SHORT OF MIDWIVES, especially in England. The RCM’s calculation is that England needs 2,600 more midwives.
  • The proposed NHS savings of £22bn by 2020 isn’t going to happen unless we work in different ways, and become more innovative and dexterous.
  • The Better Births report tells us this too, and provides some solutions to improving the working lives of maternity care workers, by supporting the development of new models of care, increasing choice of place of birth, and proposing the exploration of no fault compensation.

Organisational

Heads of midwifery, consultant midwives and leaders do you:

  • Meet regularly with your staff, seek opinion on pressures within your services, then lobby for change using quantitative and qualitative data, and benchmarking tools such as BirthRate Plus?
  • Establish schedule of meeting with student midwives and newly qualified midwives? Their views will reflect the culture of your services.
  • Know if your service offers women the full choice offer of place of birth, which gives midwives the opportunity to experience and use their full range of midwifery skills?
  • Monitor your services’ continuity of midwifery care (r) levels, which evidence tells us improves outcomes and experience for mothers, and increases midwives job satisfaction? 
  • Carry in-depth analysis of sickness episodes/levels?
  • Obtain regular feedback from service users via MSLCs or other forums, and frequent audit of views?
  • Work closely with RCM and other union reps to seek opinion on working conditions and job satisfaction, and to share knowledge of your service?

Rewarding staff and showing appreciation, such as organising a celebration event where staff nominate peers is a great way of lifting morale, and increasing motivation.

Individual

  • Look after yourself. You are your greatest asset, and listening to your body and mind then acting on signs of stress are crucial.
  • Talk to someone you admire and trust, and ask for their guidance. This may be your supervisor of midwives, or a member of your team.
  • Stay close to your positive role models.  
  • Exercise regularly, and eat well. Use relaxation aid such as Elly Copp’s The Relaxed Midwife - A meditation aid to pause, rest and recharge and Maggie Howell's Midwives Companion
  • Join the Royal College of Midwives, and meet with your local representative
  • Network with wider groups, such as closed Facebook groups, and seek positive support from others via social media sites such as Twitter. 
  • Read this Hannah Dahlen paper which highlights the importance of identifying real and manufactured fear.
  • Read Chapter 17 in The Roar Behind the Silence entitled Caring for Ourselves: the key to resilience by Hunter and Warren.

The Roar Behind the Silence: why kindness, compassion and respect matter in maternity care – has many examples and ideas for change in maternity care, for all levels.

It doesn’t have to be like this. Carmel McCalmont is an Associate Director of Nursing and Midwifery, and co-wrote a chapter for ROAR, about supporting student midwives in practice. She said:

We try to carry on the work we do with our student midwives into the NQM phase. I personally visit each clinical area every morning and talk to all staff. It is important to learn the names of new  before they start working, to say ‘Hello’ and call them by name from day one. I speak to them during preceptorship at their formal programme, and advise them that I have an open door as do the matrons. It is vital to check their well being to empower and support them.

If we have an incident involving a NQM we try to wrap our arms around them to support, reassure and guide because we really can't afford to loose these amazing midwives who are the future of midwifery.

Carmel's contact details:

carmel.mccalmont@uhcw.nhs.uk

Twitter: @UHCW_Midwife

The pressure must stop - a young midwife's first ROAR

Yesterday a man came to me livid with frustration 'this is not good enough' he told me 'my daughter has been waiting hours to be seen' He went on to tell me 'it isn't you. It isn't the other midwives, the care has been impeccable but the situation just isn't good enough.

I know. I agree. I have shed too many tears over a career I could not love more because there is nothing I can do. What he didn't know was that heartbreakingly this is a daily occurrence in my life as a midwife. What he didn't know was that actually yesterday was a rare Saturday off for me yet I had come into work so that my amazing colleagues could have a break from their 13 hour shift. A break they won't be paid for whether they take it or not, but that they physically need as human beings. I had come into the unit so that women like his daughter could be seen. So that our unit could be open to women who needed our skills as midwives, doctors, health care professionals. Women who were in labour. Women who's babies weren't moving much. Women who were concerned about their own wellbeing. 

5 maternity units in the North West of England have been closed over the weekend. These women need our care. We are literally being worked to the ground. I am watching amazing midwives leave a profession they love because the workload and stress is too high. 

Today is a rare Sunday off for me. But I will be spending it supporting our rights as workers. The NHS is run on good will. But there is only so much we can take. We joke at work that midwives don't need to eat. To rehydrate. To empty our bladders. To sleep. Let us look after ourselves so that we can look after our women. Our future generation of children. 

Earlier this year, our country voted for a government that said no to more midwives. The Conservative party have demonstrated five years of austerity, falling living standards, pay freezes and huge cuts to public services. They have threatened to make cuts to our night shift and weekend enhancements. Over the past 4 years I have missed Christmas days. New Years days. Family's birthdays. Countless nights out. I had a good education and did very well at school. I am 22. I have held the hands of women through the most emotional times of their lives. I have dressed angels we have had to say goodbye too. I have supported women to make decisions that empower them. I have been scared myself. Tired, stressed, emotional every day. Yet I am not and will not be paid well like my friends who have chosen business careers. I am not offered pay rises for my efforts or successes. I don't care because I get something more valuable than that from what I do. I love what I do. I'm passionate about what I do that's why I do it. But I do care that we are the ones who are being threatened with further cuts. Further strain.

So today I stand with doctors, midwives, nurses, teachers, firemen and many other amazing people to spread awareness of a situation that has gone too far. To share information that the general public are oblivious to because as midwives, we will not let these women be failed. I am regularly met by stunned responses from women and their partners to the situation they watch me working under. But today I say no. Enough is enough. 

I have shed too many tears over a career I love. Missed too many meal breaks. Not physically been able to care for too many women the way I wanted to. Spent too many days off in work. Lost too much sleep over the stress I am under. Watched more of my colleagues than I could count (myself included) be signed off work with stress in the early years of their career. Watched too many good midwives leave careers they love. This is not humane. Please let's end this. Protect your NHS. Your children's future. You're education system. The core foundations of Great Britain. 

I have recently learned the world is a selfish place. But I have also learned that there are a lot of very good people in it. The NHS is run on good will and because of this we have been pushed too far. 

 

Let's change this.

 

This post was written on Facebook, by midwife Hayley Huntoon. We need to make change happen to enable young midwives to ensure mothers and babies are safe #ENOUGH

 

England needs more midwives: but legal services are fine

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I was interviewed on Radio 5 Live yesterday, in relation to the news coverage of the National Audit Office revelations of maternity care.  The report confirmed the fact that England IS short of midwives, and revealed that the NHS spends nearly £700 on clinical negligence cover for each live birth in England. I wonder how many times audits and reports will confirm what we midwives have known and shouted about for years, and how long the message will continue to fall on deaf ears.

The Royal College of Midwives,  National Childbirth Trust, AIMS,  Women’s Institute and other organisations have campaigned long and hard for more midwives, needed urgently for the rising birth rate and increasing complexity in caring for mothers and babies. But there is something else going on here. The financial implications of England’s current negligence insurance scheme (Clinical Negligence Schemes for Trusts) mentioned above are bad enough, but associated processes also significantly increases the workload of maternity care staff, and adds to the growing culture of fear in maternity services.

In an attempt to increase safety through implementing standards of compliance, activity related to the scheme potentially increases risk by putting extra pressure of individual members of staff. ‘Tick box’ activity, extra form filling, and duplication of records add to the human cost and potential for mistakes. In many organisations midwives are taken out of generic posts to work as ‘risk midwives’ or governance leads. Usually these midwives are highly competent clinically, and their absence in the clinical area is missed-adding to the risk.

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However, an important impact of our legal system is related to practitioner's fear of recrimination, and fear of litigation. Defensive practice or ‘covering your back’ ‘just in case’ is a recognised symptom of fear of litigation-and subsequent over treatment increases the risk of iatrogenic harm.  The increased and often duplicated recording of information becomes the focus of ‘care’, as practitioners complete patient records which are audited for insurance purposes. What the carer writes becomes more important than what she/he does, and women and families increasingly experience this distraction negatively.

The medical negligence solicitor who took part in the radio programme with me yesterday, said midwives and doctors need to increase their skills, and he suggested that England’s medical negligence processes were the envy of the world. I have a different opinion. Ensuring safety through appropriate skills is crucial, and whilst mistakes will happen, there is no excuse and we should continually aim to learn from mistakes,  and work on improving services. Along with others, I believe improvements will only come if NHS workers are sufficient in number to have time to care, and that they are supported and nurtured enough to feel safe themselves. Where fear prevails and defensive practice in normal, women and families will continue to suffer. Radical but carefully planned changes are needed. Malpractice claims are rising, and there is little evidence that safety is improving, despite the laborious and bureaucratic systems and process imposed in the name of such. Our negligence claims insurance schemes aren’t working, and midwives are on their knees. Even though politician Dan Poulter is an obstetrician by profession, his responses to the NAO report reveal limited insight into the detail underpinning the facts that matter. We’ve said it before many times. If we don’t get it right for mothers and babies at the beginning of life, the impact can last a lifetime.

Childbirth has far reaching public health implications. This specilist medical negligence solicitor reveals the fact that many of the claims she sees are the result of pressures within the maternity systems, and calls for more resources to be invested.  Maybe it’s time to revisit a no-fault compensation scheme, the attempt in 2003 was never taken forward. Scotland has pursued this in light of the success in other countries.

Whatever we do, we can’t continue in the same vein. I would love to know your thoughts.

What Twitter did, and what student midwives say!

twitter1
twitter1

It's been a while since I started using Twitter. It was my daughter, @acbmidwife who first stirred my interest. I don't know how it all happened, but now most of my days involve 'tweeting' or 'chirping', and the result is I am increasingly connected with like minded folks across the globe.  Not only am I in touch with inspirational leaders from nursing and midwifery,  but NHS CEO's such as Lisa Rodrigues @LisaSaysThis  and Mark Newbold @drmarknewbold always have great information to share. I communicate with local GPs, and Stuart Berry @StuartBerry1 is one of them. Stuart and I have never met, but we have some similar interest and can promote each others' work through Twitter channels. Amazing. Interestingly, Stuart posted this  about the use of Twitter this morning. Great stuff!

There isn't a week goes by when I'm not contacted by individuals asking me for help and support, or inviting me to speak at study days an other events. I am particularly happy with this, as it helps me to share expertise gained by working in the NHS for 35 years.

Last week was a particularly busy week, and almost everything that I did was either initiated or organised via Twitter! I happened to be in London, for some 'away time' with the Trustees of the Iolanthe Midwifery Trust on Saturday...and then the fun started.

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On Monday  morning I met with the wonderful Alison Baum from Best Beginnings, to see how I could help her with the amazing new smartphone app for new parents. This all came about when I retweeted a short film about the app, and Alison asked to see me. I visited Alison's office and we didn't pause for breath for two hours. Lots of ideas and plans...including a small package to be sent to the Duchess of Cambridge! Take a look at this film to learn more about the Bump Buddy app....

https://vimeo.com/65375471

I then scurried to St Pancras to meet Murray Chick (yes that's his real name). Murray is the owner and brainchild of Britain's Nurses, and I LOVE the site. Again, this opportunity was made via Twitter, I found the site there, and made some enquiries. Incredibly easy, and so effective! Previous to this meeting, and through Twitter, @Britainsnurses picked up two of my blogs to share with nurses for International Nurses Day! Sorry about that @gbutcher17!

The day after I went to Kings College London again to meet a group of wonderfully enthusiastic and very smily  positive student midwives, organised via Twitter following a lovely invite by student midwife Natalie Buschman @Birthsandmore. It wasn't the first time Natalie and I connected and made a plan via Twitter; she also took up the challenge to do the Prudential Ride London, in aid of the  Iolanthe Midwifery Trust, after seeing me advertise the opportunity on Twitter! Great work Natalie! If you want to sponsor Natalie, and thereby support the Iolanthe Midwifery Trust, you can do so here!

After being with the students I ran round the corner to enjoy lunch with three formidably inspirational women: Maggie Howell @MaggieHowell from Natal Hypnotherapy , Independent Midwife extraordinaire Pam Wild @Pamoneuk  and journalist Beverley Turner @BeverleyTurner . What a treat. Again...lot's to chat about and plan in limited time...and it all started with Twitter!

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And then a couple of weeks ago Dean Beaumont @DaddyNatal from Daddy Natal, invited me to review his book...'The Expectant Dad's Handbook' on Twitter. We exchanged contact details through the direct message function, and voila! The book plopped through my letterbox and was avidly devoured within a few days. The book, by the way, is spot on. Sensible and sensitive...with great advice for all Dads-to be. I will be writing a review Dean!

I have the feeling that my Twitter support of StudentMidwife.Net went some way to their decision to invite me to be their Patron. Whoop! What a privilege and an opportunity. Also, through Twitter I saw an chance to be involved with @WeNurses, by running regular @WeMidwives chats...which has been a steep learning curve! This has really given a new voice to Midwifery.

And then there's the fabulous Doulas. I 'met' many of them through Twitter, and we connect so regularly I feel like I know some of them well, even though I have never seen them in person.  There are too many Doula friends to mention here, but you know who you are! (I'll probably cause offence if I miss anyone out!). Through Twitter, I have come to know and appreciate your valuable contribution to childbirth.

And of course this isn't just all about me. I couldn't ask many, but these two student midwives have had opportunities too, through using Twitter:

Student Midwife @Li33ieBee said -'Via Twitter I have had articles proofread by experts and been sent hard to find research papers'.

Sarah Tuke @sazzletastic told me- I have become a more compassionate 'put hands on' midwife after reading quotes from Sheila Kitzinger at a conference to put hands on to reassure to increase oxytocin. It works! Wouldn't have known about what she said without tweeting from that conference as I couldn't make it :)

HOW GOOD IS THAT?

But there aren't many midwives using Twitter, and there are still a considerable number of individuals and organisations that are fearful of using social media.  I know that several health professionals have lost their jobs or places at University, due to inappropriate postings. But this is a pity. There's lots of guidance out there, and with common sense you really can avoid the pitfalls.

SoMe
SoMe

Need help?

Check out the Nursing and Midwifery Council guidance on the use of social media 

The NHS Social Media site has lots of useful tips

Guidance for NHS Caremakers is useful for all health care professionals

Here are some great folks to follow or connect with:

Sarah Stewart- Midwife Educator and Professional Development Officer with Australian College of Midwives @SarahStewart (and quite a whizz with social media matters)

Jacque Gerrard -Director for England Royal College of Midwives @jacquegerrard

Mark Newbold -Chief Executive of Heart of Birmingham FT @drmarknewbold

Anne Cooper -Nurse working in informatics interested in leadership @anniecoops

Teresa Chinn-Nurse and social media specialist @AgencyNurse

And if you are unsure about what Twitter is, and why or how it would be useful to you, @pam007nelmes is a social media expert, AND she believes kindness is magic which for me, is the best. Pam is worth following as she has lots of tips! Here is one of Pam's presentations-Social Media for Nurses Oct 2012

For me, Twitter brings fabulous worthwhile interactions with others, the sharing of current and interesting news or information, and unique and exciting opportunities. And every now and then, there'll be a gem that pops up, such as Molly Case's inspirational poem, read by her at the RCN Congress 2013.

http://www.youtube.com/watch?v=XOCda6OiYpg

So, last night I asked several student midwives who are already engaged with Twitter, what benefits they felt it brought them...and here are a few of their 'tweet responses' back to me!

@dawn_t12 -'Twitter for me is invaluable as a student. It keeps me updated on news/new research/study days, but more than that it's another form of support. I love that through twitter I've made friends with people at different unis in different towns and we help each other through the bad days and celebrate the good. It's just sad some students & midwives are missing out on this world!'

@Beetrooter- 'Twitter brings fellowship with ppl passionate about midwifery from across the world & across spectrum of professional roles. Its my inspiration for learning, gives evidence to inform my practice, rolemodels for me to aspire. Instant access to womens' experience jubilant/ anguish. Twitter is conversations. It's life squished beautifully into 140 characters'.

@Birthsandmore -'great way to broaden mind, horizon and tweet with like minded people you otherwise would not have met. t lifts my spirit to read and hear from so many passionate people, especially after a tough day 'at the office'!

@Josie_jo_F-'from a v.small Uni, twitter gives me a chance to find out what happens in other trusts, have contact with other SMs, learn from MWs, lecturers&other inspirational ppl I'd never meet in my isolated neck o'the woods.glad to have found this community'

@sazzletastic-People on twitter have been an amazing support to me throughout my 3rd yr studying giving me encouragement and reassurance to keep going and have confidence in my knowledge and abilities. Having access to organisations and big names in the field that actually reply to you is brilliant! I've learnt so much via twitter, I only wish I'd had it for the first 2yrs of study too!

So, come on midwives and student midwives....Twitter has so much to offer. Facebook keeps you in touch with friends, but Twitter helps you find those you would never have met, who hold the potential to open up a new world for you! As student midwife Hana Ruth Abel  

@Hana_Studentmid

so eloquently puts it:

'

Twitter is the thread that binds me across the globe, weaving me into the fabric of international midwifery & making me a piece of the puzzle that builds up a global voice, I am an equal part of that voice. Ever changing and pushing myself to grow with a community of individuals who share my philosophy and question practice. Twitter shines a light on every end of the spectrum. United we stand on our virtual platform- Speaking up and stepping forward, one tweet at a time'. 

Wow Hana!

Social Media Posting Guide

Inspirational students and the need for more midwives

Image I have just finished facilitating the @WeMidwives twitter chat, which runs every two weeks, under the domain of @WeNurses.

Tonight the debate centred around the shortage of midwives in the UK, and the impact this has on mothers and babies. The participants in the chat were raring to go. Interestingly but not surprising the majority of tweeters were student midwives, and they carefully and articulately described the situation in today's NHS maternity services. I believe that the content of the chat found here is a true reflection of things, as I hear from my colleagues around the country on a daily basis.

It is desperately sad. The resources are limited and constrained. It seems ludicrous that the NHS has a financial plan that enforces savings on services that potentially cost the NHS more in the long term.

We must keep raising the issue that radical change is needed to ensure care at the very beginning of life is the best it can be.   Midwifery staffing levels are inadequate, and the workload is increasing for many reasons. I recently wrote a post for the  NHS Confederation's blog for NHS Leaders highlighting the need to take stock of the Francis Report's recommendations and to listen to what service users are telling us, before it's too late.  

The students involved in the chat tonight were insightful, sensible and sensitive. They see and feel the pressure, the tension, the joy and the tiredness. They want to change things, and why shouldn't they get the opportunity? They are the future.

And I think we owe it to them to keep pushing for change. I will try, will you?

Childbirth and infant feeding: why the war?

mumandbaby

Image The polarisation of opinion with regard to these topics is growing by the minute…and there is much to debate. For this post my thoughts are focused on childbirth, although both subjects are absolutely interlinked.

My initial response when I read condemnations for those who promote and support normal physiological childbirth or breastfeeding is of sadness and shame. Sadness that there has potentially been some degree of personal distress for the one proclaiming their opinion. Shame that my profession is often part of the ‘problem.’

I see and hear opposing yet valid viewpoints about childbirth on almost a daily basis, mainly via blogs, Facebook and Twitter. We are all entitled to our opinion, and it’s good that there can now be a degree of open debate via social media channels. The problem arises when journalists and high profile individuals sensationalise a particular topic through mass media, basing their opinion on their personal experience. This can be inadvertently damaging, especially when related to childbirth.

Kirstie Allsopp’s response to the recent ‘too posh to push’ coverage in the Telegraph is an example of this. I can fully understand Kirstie’s retaliation to the implications that the Caesarean Section (CS) rate is higher in middle class areas, there may be something personal in that. The fact may have an element of truth, but the reasons for the increasing unnecessary intervention and related CS rates aren’t as simple as this. There are other suggestions for the relentless shift.

As stated in the Telegraph article, and in opposition to what the article headline actually suggests, women choosing to have major surgery instead of giving birth naturally are in the minority, and if there is a request is it usually for a very valid reason, usually associated with unprecedented fear.

Instead, the evidence and debate on the declining normal birth rate points to factors such as increasing maternal age, complexities of pregnancy, increased numbers of multiple pregnancies due to assisted conception, lack of senior doctors to make decisions on birth suite, low midwifery numbers, midwifery skill mix, focus on risk factors, women’s uninformed choices, inappropriate use of clinical ‘guidelines’….the list goes on.

For decades, childbearing women have been marginalised. I witnessed this during the thirty plus years I worked as a midwife, as did (and still do) my midwifery colleagues throughout the UK and beyond. Women’s belief in their ability to birth their babies is declining rapidly as a result of unnecessary medicalisation in maternity care. This was recognised as a growing problem more than thirty years ago, and midwifery organisations such as the Association of Radical Midwives and service user organisations such as the National Childbirth Trust thankfully and successfully campaigned for change.

Whilst practices of unnecessary medical intervention in the childbirth process continues globally, there is a continued and renewed uprising; women, midwives and obstetricians are recognising the potential consequential harm to mother and baby. Childbearing women in particular are the catalyst for change. Instead of remaining afraid, women are forming organisations to support parents to be, such as The Birth I Want, The Positive Birth Movement, One World Birth and Birthrights. Doctors and Midwives are active too. I imagine if Kirstie was having her babies twenty years ago she would been amongst those initial radicals campaigning for change. But with the drive and energy for change comes expectations of parents, and when those expectations aren’t reached for whatever reason, disappointment seems to initiate the need to blame instead of pursuing further change.

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The topic is a complex one. But take a look at the chart here. The Caesarean section rate is increasing, and the normal birth rate decreasing. This alarming fact isn’t matched with improved health for mother and baby, in fact I would suggest it has had the opposite effect.

So, are we wrong to try to influence the way babies are born? I think not. But instead of arguing and blaming others, women, men and families must try to move together. The evidence is stacked high that where birth is as close to nature as possible, where women are cared for respectfully and her caregivers are respected then maternal and child health is at it’s best. Some women need intervention. Both my daughters did, and it was life saving. But we are now in a danger zone where medical advances are replacing nature, and that causes harm and was never meant to be.

So come on. Women are not ‘too posh to push’. They are strong and powerful, and if they are given respectful and supportive maternity care they will flourish as women and as mothers. But they need to know and understand the evidence behind the implications of some of the choices they make, and that others try to make for them. Those providing that information and encouraging them to achieve their goal does not mean they have a ‘luddite obsession’ and they are not the purporters of guilt. Midwives are feeling more desperate for change by the day, and they need women (and their partners) to help them to reverse the trend.

Let’s get together Kirstie, and see what we can do.

Childbirth chart BirthChoiceUK

Photograph copyrighted to SevernJonesPhotography

Why is the birth room being used for mass entertainment?

I don't like this photograph. It actually depicts the worst possible scenario. That is, a labouring mother flat on her back, vulnerable with her legs wide open. The midwives hold the power. As a midwife this is certainly not how I want my profession to be represented.

I imagine that the photo was taken to attract media attention, to draw potential viewers to the BBC TV programme it is associated with...and there will be those who don't notice the image particularly. But there is a message in the pose that has the potential to negatively influence society, and childbearing women. As the documentary programmes have too....ITV's One Born Every Minute, and BBC's The Midwives.

I have to admit that I always avoid watching TV documentaries about maternity services. My decision stems from the fact that I can’t bear to watch poor midwifery or obstetric practice without the ability to influence, and I think the intimate moment of a baby’s birth should take place in a private ‘space’ where the woman feels safe and protected. It certainly isn’t the place for TV cameras, even those that are hidden.

Childbirth is important for humanity, and the ultimate aim of maternity care workers is to ensure women have a positive childbirth experience. When women are in labour the hormones that aid the birth process are heavily influenced by the environment she is in.  Michel Odent, a highly acclaimed French obstetrician gives his expert opinion; one which I fully support after observing childbirth first hand for 35 years. He said:

The best environment I know for an easy birth is when there is nobody around the woman in labor but an experienced midwife or doula – an experienced mother figure who is there, and who can remain silent. Silence is a basic need for a woman in labor. Privacy is another basic need. Michel Odent

So that's a big enough reason not to have cameras in the birth room that broadcast private and intimate moments to millions, with no control over who watches.

And then there's the issue of editing. The producers want to draw viewers in with drama...and the drama is having the desired effect and the viewing is said to be 'compelling'...but what else is happening?

Globally, we are in a situation where women are becoming increasingly afraid of childbirth and unsure of their ability to give birth without medical assistance. There are lots of factors that influence this position, and the media play a huge part.

As a Facebook and Twitter user I have read so many comments in response to the midwifery documentary programmes, from mothers, women, midwives and student midwives. The comments mostly demonstrate the fact that the content of the programmes have stimulated fear. Some midwives, whilst acknowledging the scary and distressing scenes highlighting their colleagues 'under pressure', believe it to be good as it raises the issue of the shortage of midwives nationally. But should this be at the expense of those potentially and actually using maternity services?

Let's read the comments.

The Telegraph reviewed The Midwives

There is a gruesomeness to childbirth TV that I find partly compelling and mildly horrifying. I understand that births where nothing goes wrong don’t make for exciting enough footage but, as a childless, slightly broody 31 year-old, I found some of the scenes pretty harrowing, and had to watch with my fingers over my eyes. There were complications with almost every birth – is this the BBC’s attempt to keep that soaring birth rate down? If so, it’s certainly worked on me… 

One tweet from a student midwife said that she was scared to go on her next shift following the programme....

Twitter:

'It seems such a shame they always show midwives shouting at women, calling them good girls, or do the 'silent midwives' not want to be on TV…'

Facebook (taken from One Born Every Minute-the truth page)

Susan:

'I watched it last night and couldn't believe the triage midwife with the short blonde hair telling the soon to be mother of 5 that she was definitely not in labour. It was her fifth baby, she knew her own body!! I wanted to shout at the telly. I was so smug when the labouring woman progressed quickly and birthed not long after that. I did not like that midwife's manner at all, and she only seemed to get worse throughout the programme..'

Jane:

'I am 21 weeks pregnant with my third baby, and watched the first programme last night. Honestly, despite having been very lucky both other times, it has left me petrified. Must get a sense of perspective....'

Oh dear. How to demoralise women.

We really need to turn the tide. In addition to #moremidwives we need some positive media....positive stories to raise the bar. What do you think?

P.S. On the contrary, I LOVED Call the Midwife. Quite different.

Photograph 

UK Student Midwives-something to be proud of

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It's a long time ago since I was a student midwife (1970's), we were then known as a pupil midwives. It's even a long time since my daughter was a student midwife...and that does make me feel old! I have worked very closely with so many incredible students throughout my career, and I have instantly recognised the ones who I felt 'had it'- that is, the sensitivity and kindness that makes a difference to childbearing women in their most vulnerable yet special moments of their life.

But during the past year I have been incredibly fortunate to have 'met' hundreds of students from throughout the UK and beyond, in the virtual world. This has been made possible because of two things: writing my midwifery memoir Catching Babies, and using Twitter.

So many student midwives have contacted me and given feedback about my book, and I am touch with dozens on Twitter. I have also been approached by several individual students with requests to talk at their University conferences, and have been humbled and honoured to attend and support them.

So what is it that makes me feel proud? From my experience I feel this new generation of student midwives have not only 'got it', but they have other attributes that really impress me. I have seen a confidence and maturity that enables them to express themselves respectfully, with humility and graciousness. But this assertiveness is not at the cost of kindness and compassion; this is in abundance, along with an enormous passion to make a difference to women and families during the childbirth period.

My belief was further consolidated on the 16th July when several student midwives dressed in 1950's Call the Midwife style uniforms cycled 6 miles through London raising awareness of the desperate need for 5000 more midwives and the petition that the Royal College of Midwives have organised. The event was organised by Rebecca Ashley, and she and her colleagues have demonstrated courage and determination, innovation and leadership and they are still in their first year. We (midwives) are eternally grateful to them.

http://www.youtube.com/watch?v=bqHGuQdUS0U

The more I communicate with, see, hear and chat to our country's student midwives, the more my heart sings. We are incredibly fortunate, and the future health of our nation depends on their ability to say strong, positive and focused.

And these student midwives need midwifery posts when they qualify. HAVE YOU SIGNED THE PETITION? 

Photo of keychain

Home Birth in the Netherlands......back to the future?

Image Attending the second day of the Human Rights in Childbirth Conference  in the Hague on the 2nd June was a revelation, and a remarkable opportunity. I was unable to be part of the first day, as I was travelling by car to the Netherlands for a two week stay to see our brilliant Dutch grandchildren. When I wrote about the conference previously, I didn't think I would be able to attend at all.

It was Hermine Hayes-Klein, an American Lawyer, who developed the idea for a conference with others after researching the politics of birth in the Netherlands and USA following the birth of her two children. Women's right and authority to choose the place of birth for their baby, and to be supported in her choice was the key driver for Hermine.

The first day of the event aimed to bring attention to and focus on the issues surrounding the Ternovszky v. Hungary case. Although I thought I knew a fair deal about the horrific plight of Agnes Gereb, I learnt so much more as I absorbed the text within the conference's detailed publication.

The implications of the Ternovsky case are apparent in other countries other than Hungary, and the holding of the case offers a potential solution globally. Experts from around the world were carefully chosen and they gathered willingly to debate human rights and childbirth and explore a way forward.

Day two was of particular interest to me because of my family link with Holland, and as an advocate of home birth, midwifery and maternity care in the Netherlands has always caught my attention.

It was utterly incredible to be in Den Haag and to listen to the debate surrounding birth in this small country. I found Dr Raymond De Vries's keynote address inspirational, and I couldn't get enough of it. From Dr De Vries and then the panel of experts I heard an array of perspectives about the controversy surrounding the perinatal mortality rate in Holland, how it is higher than other European countries and proposed as one of the factors that is influencing women's decisions on where to give birth. I heard how these statistics are being challenged, and how health professionals are exploring every opportunity to understand the situation.

Another issue raised was the Dutch maternity guideline, Verloskundige IndicatieLijst (VIL) and the restrictions it increasingly imposes on women's choice to birth their baby at home. The introduction of market forces within Dutch health services and changes to how maternity services are funded is also believed to be a factor in the decline in home birth. And some suggest that some women in Holland have different priorities and are preferring to give birth in hospital...although others contest this claim.

I was particularly moved by Rebekka Visser  and  Marjolein Faber's address to the conference, they received standing ovations from the delegates and they gave the impression that they are forces to be reckoned with.

So what did I learn?

1. A country that has been the shining light for birth practice globally for decades is potentially under threat, and that is a travesty. I desperately hope the Netherlands doesn't follow other countries in their quest to improve.

2. I realised that during my career as a midwife in East Lancashire in the UK I experienced something special. Because...

During her address Rebekka Visser said:

To me it's of great importance to really listen to the woman - and to the way she assesses risk for herself. To guarantee absolute trust that she is the one in charge. To provide her with all the information she asks for. To be open about this towards other people.. My dream is to be able to do my work as a midwife in close cooperation with gynecologist and hospital, thus creating a network where women can be respected and supported in their choices.

I was able to provide such care. Obstetricians working closely with midwives to facilitate woman centred care collaboratively meant (and still means) that women do have a choice in home birth, birth centre birth and hospital birth...and their choice is respected and supported even if their individual needs and requests do not 'fit' a guideline.

3. That women in Holland using maternity services now and in the future need to ensure their voice is heard and maintain momentum from the conference. It is crucial.

I feel privileged to have been part of what I consider to be the cusp of a birth revolution. If you would like to learn more  you can visit the conference website and consider subscribing to the webinar.

You may also wish to read comments on Twitter from the two days, and pursue the various links from the posts.

Many thanks to Simone Valk and all the conference organisers for welcoming me on the 2nd.

Other blogs about the Conference:

Rebecca Schiller-The Hackney Doula

Dr Amali Lokugamage 

An identity crisis and nurses uniforms

Image There are obviously some of my ID badges missing from here...I had a student nurse, staff nurse, pupil midwife and staff midwife badge in addition to the ones above. And so many tales to tell whilst wearing each one. I didn't know I had kept them all, but as I make my way through cluttered cupboards as I no longer have to work full time, I am finding lots of gems from the past, such as these. If you want to know more about the stories behind the badges, read my book Catching Babies.

It was only when I pondered on all the 'midwife' titles did I consider how confused the public must be with the variation in names of staff working in the NHS. And yet I was proud to wear each ID badge, and never gave a thought to the understanding behind the name for those who read it. And then there's all those uniforms! Oh my, it used to be that a nurse's uniform was only worn by nurses, but now the snack machine filler looks like a ward sister....

That aside, I really have mixed views about midwives wearing nurses uniforms. Not averse to having a corporate image (so at least the public can distinguish who is the carer in a hospital situation) I once initiated and managed the move to midwives wearing polo shirts and trousers or skirts, instead of a nurse's attire. The reason being I believe maternity care should be based on a partnership model, with no hierarchies. Once a midwife dons nurse's outfit there is a division, an unspoken 'I am the expert' from the midwife. Now this might not be apparent; the midwife could very well be the most caring and facilitative of woman centred-ness, but the symbol is there. So we wore our navy or green polo shirts with the word 'midwife' blazened above the left breast, and all was well. We had a uniform, but it was less imposing, slightly more informal. There was some rebellion, but eventually it was widely accepted. Until, that is, the porters within the hospital (or was it the maintenance men?) started wearing the same regalia! Well let me tell you that caused a stir. There was anarchy.

Nowadays the midwives are back in nurses uniform. What do you think?

Human Rights and Childbirth: the mother, the baby and the carer

So much attention has been given to this topic in the midwifery world recently, due to the dreadful situation in Hungary with Agnes Gereb. And of course there is much concern about the future of Independent Midwifery in the UK.

Across the water in the Netherlands where my son and grandchildren live, a group of activist are rallying experts to debate the issue of women's choice in place of birth.  The group have organised a unique  conference at the end of the month in the Hague, and a webinar that will be LIVE streamed and available for 30 days following the conference.  This webinar is being offered at a discounted rate if you book via the discount code detailed below. 

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The organisers are a small group of dedicated volunteers and have been working hard to get the conference funded and ready in time.  They are happy to report that the conference is going ahead, although it has been on a shoestring budget.  The line up of panelist is impressive; a team of international voices to help move the subject of human rights in childbirth from theory to reality.   The conference will be a platform to explore the practical aspects of human rights in 21st century healthcare systems, and how those systems can both maximize safety and respect the dignity of the women they support.

For details please visit the website: www.humanrightsinchildbirth.com.

About the Human Rights in Childbirth Webinar: 
This webinar provides a unique opportunity for professionals and parents around the world to be a part of the global discussion on human rights in childbirth.   The Human Rights in Childbirth Conference will be LIVE streamed by a professional team, so you can watch live and join the discussion via twitter.  If you are unable to join live, you will be able to watch the conference panels at your leisure VIA THE WEBINAR for 30 days following the conference, join the ongoing discussion via the Facebook page, and connect with the regional and international networks of professionals capable of protecting women’s fundamental right to authority and support in childbirth.

The organisers want the conference to be accessible for my contacts, and they have negotiated a special price for you to join this important event!

Regular Price: €175 inclusive the pre-conference publication. 
Special Price for Sheena Byrom's community:  €75 pre-conference publication not included.

How to get this special price:

1.    Go to the Registration Form: Registration Page

2.    Fill in the registration form and select the webinar (you will see the regular prices but don’t worry you will get your discount!), in the field “How did you learn about the conference? *” fill in "Catching Babies Discount"

3.    Do not pay by clicking on the PAY PAL directly (then you will pay the regular price). You will receive a confirmation email from our office with the discounted price and you can pay either via PAY PAL or via a bank transfer.  The details for this will be provided in the email confirmation (this is created by a human, it is not an automatic mail, so won't be sent directly).

I think this is an amazing offer; by engaging with this event you will have the potential to influence global change in maternity care, through increased knowledge.

Congratulation to my colleagues in the Netherlands for their hard work and dedication in making this possible.

International Day of the Midwife: University of Central Lancashire!

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The University of Central Lancashire's midwifery department really pushed the boat out the raise funds today for the International Day of the Midwife. The chosen charity is the African Midwives Fund 

Midwifery lecturer, Mercedes Perez-Botella looked every bit the part as she rode around the town rallying potential customers on a very old bike, in true Call the Midwife style!

It was a bit of a rush for me this morning to get to Preston, but after collecting Olivia's home baked ginger biscuits and picking up Anita on route....we arrived heavily laden with cakes and books all ready to go! My daughter Anna is a midwifery lecturer at UCLan and with her colleagues and some student midwives has been planning and working hard to prepare the wares to sell for this important event. Anna's dear friend, the lovely Carys who works as a midwife at Wythenshawe had made chutney, marmalade and jam, all labelled 'made by midwives'. Her mum had knitted some toys, made hearts and other things to sell. A midwife from Preston made some very special handmade cards (I bought six!). I sold signed copies of my book Catching Babies, and the profit went to the charity. We also sold wonderfully crafted recipe books, created by an amazing Scottish midwife, Linda McDonald. I met Linda in Troon, where she explained the MUM's project to me. Basically, Linda has developed three recipe books and the income generated from the sales goes to help develop maternity services in Malawi. Sarah Brown and Davina McCall have written forwards for the books, they are so impressed with Linda's work.

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So we had lots to sell, and everyone worked hard to encourage cake buying! £600 was raised on the stall alone in four hours, and there was lots of discussion from the 'customers' about birth and health....thus raising the profile of the role of the midwife. A sponsored walk when the stall was emptied has raised more much needed money, and donations are still being taken! Congratulations to everyone for such a massive effort. Your time and energy will be someone's improved maternity care. You couldn't ask for more.

Brighton: the English version

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My work as a midwife has brought us once more to the lovely English seaside resort of Brighton. I was here in September last year to give a talk to the midwifery students at Brighton University, and from that was invited to do a workshop on promoting normal birth for the maternity services at Brighton and Sussex University Hospitals.

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Paul and I have happy memories of another Brighton, the one on the East Coast of Australia. It was there that we reunited with our lovely son Tom and his very lovely girlfriend Claire when we visited the Antipodes last September. Tom and Claire were working there and we were thrilled to see them looking so well and happy!

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So this Brighton gave us the opportunity to reunite with another special person. Laura is our beautiful fun loving (and nut cracker thigh-ed!) friend, and she lives here with her outdoor active handsome boyfriend, Gerome. I first met Laura when she was a teenager and she was at the same dance school as Anna. Not only that, Laura was very talented (as Anna was) and we would watch her grace and strength with awe as she worked her magic through movement. Laura works in the dance world still, and does amazing things to engage potentially talented youngsters with the arts, through dance. We were also lucky enough to have Laura as our babysitter, and she was just as talented with our young ones. Laura proudly showed us the best places to go in Brighton, and as we sipped pink tinged wine, ate tapas, and listened to live music we chatted for hours about many things. Great stuff.

So now we make our way to Cathy and Rob’s White Wickets and we say goodbye to Brighton. As we pass through the East Sussex countryside through patchwork fields brightened by the yellow rapeseed blossom contrasting yet complementing the cornflower blue skies, we can’t help thinking about Simon and Caroline at Five. Five is a wonderful contemporary family run hotel that serves guests with a scrumptious organic breakfast at the start of the day. We had a comfortable room with a sea view, and Caroline kindly helped us to store and access our push bikes….

See you soon Brighton! 

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