A glimpse of injustice - when caring is a 'crime'.
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It’s been quite a while since I posted here. I’ve been working hard on creating and developing resources for midwives and student midwives with my eldest daughter, Anna - who is also a midwife. More about that later!
So I’m writing a book - a sequel to Catching Babies. Really, I’m writing about my life since leaving the NHS for anyone interested and as a keepsake for my children and their children’s children. I’ve been keeping notes for a couple of years - and with the onslaught of the COVID-19 Pandemic and Lockdown I’ve had the time to really get down to it.
There’s been plenty of opportunity for me to reflect on some of the happy and exciting times and some of the difficulties we’ve faced over the past 9 years, and as I go for walks most days Paul and I try and recall events (for the book). Based on what I had to do for my last book - we categorise them:
Heartwarming occasions
Funny moments
Exciting times
Shared grief - always important
Things that bothered us (though PB doesn’t worry)
Interesting situations we found ourselves in
Travel and incidences
Challenges I’ve or we’ve faced
Oh that last one! Well, I’m still learning how to deal with ‘thinking’ about some of the challenges. When I came to the events I’m telling you about below (which I feel should be included) - I shuddered. Because I’d put them to the back of my mind. That’s how it is sometimes, isn’t it? I’m not a big believer in dwelling on the past and certainly consider myself to be a cup-half-full person, but writing a memoir or biography means you just have to do it. I had a ghost writer for Catching Babies and she absolutely made me go back to the times I thought had gone from my memory forever!
I actually wrote some of this a couple of years ago after speaking at an Association of Radical Midwives (ARM) conference on this traumatic event. It was published in the ARM journal shorty afterwards. So here goes…
‘It’s in the paper, Sheena. Don’t read it.’
My husband Paul came into the bedroom and made this announcement.
I woke up with a jump, and an immediate adrenaline surge of anxiety hit me. Two days previously, I’d received this email:
Dear Sheena,
I am a journalist at the Daily Mail. I am writing a story for tomorrow's newspaper about training at NHS trusts - please could you provide a comment.
The article will say that you gave a lecture at the progressive births conference teaching, amongst others, Derby Teaching Hospitals Trust midwives. In that talk you said: 'We need a solution to increasing intervention. We can't continue as we are.’ You also said: ‘Do we really believe that women's bodies are so faulty that less than 40 per cent will give birth without intervention?'
Later you said: 'Women across the world want straightforward birth.’
You have also given a number of study days at xxxxx Trust with similar pro-natural birth messages. The handout material for those study days say that ‘for most mothers’ natural birth 'is the safest way to give birth' and that NHS staff should ensure ‘normal birth’ should be 'facilitated for all women’. The overall tone is that women should be encouraged to give birth normally.
Parents who have lost babies after, they say, being pushed into a natural birth against their wishes, say the material is 'terrifying' and 'dangerous'.
They say you are a normal birth campaigner, citing your comment: 'protecting normal birth is a midwife’s core function'.
Could you please respond to their comments?
I provided a detailed response (see below), but it was ignored. The journalist chose to ignore my response and publish the allegations anyway.
Paul was awake early and had the read the article on his tablet. When he told me what he was reading, I instantly felt vulnerable, and physically sick.
‘Mum, are you OK?’ The message pinged in on my phone. It was Anna, my eldest daughter who is also a midwife, jumping to my side in support. ‘I’ve seen it. Don’t read it, Mum.’
Months before, I’d been invited to the maternity service in England mentioned above, to help them to reduce their Caesarean section rate; one of the actions they had been charged with, following the mandatory CQC inspection. It was a big decision to accept, as I would need to stay away from home – and my life already full. The maternity service had employed a consultant obstetrician too, to support the team making necessary improvements highlighted in the same review. I was commissioned to work with multidisciplinary teams, and I began by spending time observing the service and speaking to staff. Like the obstetrician, I was paid for the work I did. As I usually provide my services pro-bono and with a background of working in public services, I find it hard to charge a fee for what I do. ‘Hmm, I’m not sure what is reasonable’ I said to the manager wishing to secure my help. ‘I maybe could ask for same amount that I was paid in the last service I worked for?’ So that amount, which I was assured was minimal compared to the visiting obstetrician, was agreed. I thought nothing more of it and worked hard in return. It’s always daunting going into an organisation as an outsider, as a critical but supportive friend. Yet the staff were accepting and kind to me, keen to learn and to explore different ways of working.
So I began my task of attempting to influence the culture of the maternity service by facilitating workshops and meetings with ALL members of staff. These sessions were enlightening to me – staff revealed organisational and personal barriers to practice and came up with their own suggestions for improvement. We revisited the basic physiology of labouring women and considered the influences of the environment, rituals and guidelines – and staff attitude. We explored the importance of respecting physiology for ALL births, and paid attention to babies born by Caesarean section or with the help of instruments. After several weeks, the organisation employed a midwife permanently to deliver the strategy, and my task was complete. The output from the events was used to formulate a normal birth strategy - to be considered by the management team.
Several months after I left, to my alarm, I received an email from the Chief Executive Officer of this same organisation advising me that someone had served a Freedom of Information request for the amount of salary I was paid to work with the maternity service. Why?The person making the request was someone who has publicly criticised me on social media for many years. I was shocked. Why would they do this? What was the purpose of knowing this information? I had nothing to hide, but the intimidation, the harassment, made me feel vulnerable. The CEO was responsive and kind, and together we looked at the legal implications surrounding the release of this information. The day after I was informed that the detail of my fee had been revealed and that was when I was contacted by the press as mentioned above. This is the article and you will see that it also includes the fact that I had delivered a talk at a conference on the subject of ‘normal birth’ - my area of interest. The article states:
‘At least two Trusts have allowed Sheena Byrom to give talks to midwives that include pro-natural birth messages, enraging parents who have lost babies after being encouraged towards normal birth’.
Maureen Treadwell, of the Birth Trauma Association, said: ‘There’s this powerful lobby that want to keep the normal birth agenda going. They have to remember it has been responsible for babies dying.’
The outcry, supportive emails, tweets, direct messages and cards received after the publication of the news article, was absolutely overwhelming. Complaints to the Press Commission were made by others, that I couldn’t follow through because of my state of mind. My reaction was dramatic, mainly because I was frustrated with the injustice of it all – once more attacked for supporting maternity services, midwives and mothers in their quest for better birthing practices.
I feel it’s important to share my responses to the young male journalist who contacted me - I presented him with the evidence behind each point (which were, by the way, taken from the tweets of one of the delegates):
'We need a solution to increasing intervention. We can't continue as we are’
This is a global goal, identified by several international organisations– including The Lancet Maternal Health Series and the series on Optimising Caesarean section use.
'Women across the world want straightforward birth.’
A systematic qualitative review of 35 studies in 19 countries by Soo Downe et al in 2018 highlighted this point.
‘Do we really believe that women's bodies are so faulty that less than 40 per cent will give birth without intervention?'
A study in 2016 revealed that less than 40% of babies are born without any medical intervention and NHS Data demonstrates the increasing induction rate. A report in 2019 revealed shocking variations in the induction rates between maternity services (even when controlled for casemix).
Slide by Alison McFarlane, City University London
It is important to note that the International Confederation of Midwives’ scope of midwifery practice is clear – ‘The midwife is recognised as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct births on the midwife’s own responsibility and to provide care for the newborn and the infant. This care includes preventative measures, the promotion of normal birth, the detection of complications in mother and child, the accessing of medical care or other appropriate assistance and the carrying out of emergency measures’ – yet the media and normal birth opponents feel it what I do is a crime, and newsworthy? It is harassment.
We increasingly hear accounts of bullying in midwifery, of intimidation and distress. Midwives are being marginalised in many countries, and unable to make their voice heard. Whilst I am free to practise, to be an activist to influence change, there is an online and very public resistance by some to anything related to normal birth. Whilst I have felt traumatised and unable to provide accuracy, I have learned to cope by continuing to engage positively. My position is clear – I continue to write and speak about the importance of humanised maternity care, of the fundamental importance compassion and respect – and positive birth outcomes for all women. In addition I will continue to raise awareness of the need to respect the physiology of childbirth as part of this agenda, against a backdrop of rising unnecessary medical intervention.
My talk at the ARM conference 2018 gave me the space for my voice to be heard, yet many aren’t afforded that opportunity. I hope that by sharing my story I will encourage others to find the courage to continue despite oppression and conflict. In the end, we can only do the best we can.