Part of the tipping point: a time to ROAR

Reflecting on the roar....Torquay, Australia

What a month February 2015 has been so far.  We are in Australia on an extended holiday, and as well as enjoying the positive culture and bright skies, I’ve been lucky enough to be part of so many inspiring maternity related conversations, twitter chats, initiatives and book publications. The ‘Tipping Point’ in maternity services, that I often talk about, is ever closer.

From the other side of the world I am excited and encouraged to see the connection of so many like-minded individuals in the UK, ‘meeting’ on Twitter, helping to improve the maternity experience for women and families in England. Initiated by the wonderful Kath Evans, head of patient experience for NHS England,  Gill Phillips, founder of 'Whose Shoes' is working closely with midwives, obstetricians, policy makers, parent organisations, academics and most importantly those using maternity services, to find out what really makes a difference to those using maternity services. Florence Wilcock, #FabObs obstetrician and divisional director at Kingston Hospitals in London, and a member of the London Maternity Strategic Clinical Leadership Group, is helping to lead this much needed initiative. You can read about, follow, and get involved on Twitter here #MatExp. The project is gaining momentum and beginning to influence services in London, and the fact that social media is being used to spread the word, to engage and to influence is adding to the success. It means the potential for exclusion is reduced, and collaboration increased. I can’t wait to get involved in person when I return to England.

I’ve also been privileged to review two fabulous books. The first is Milli Hill’s inspiring book 'Waterbirth: stories to inspire and inform' which is a collection of personal accounts of waterbirth, by mothers, fathers, siblings and maternity care workers and you can read my thoughts about the book here.

I finished reading the review copy of Rebecca Schiller’s new book ‘All That Matters: Women’s Rights in Childbirth’ yesterday, and I was rocked. This superbly crafted and revealing book, written for the Guardian, is a ‘must-read’ for all those providing maternity care, and if we really aim to tip the balance, policy makers, parents to be, teenagers, in fact each member of society would do well to read and act on Rebecca’s words.  Rebecca is a mother of two young children, a writer, doula and birth activist, and she begins by making it clear that her book is about women, yet acknowledges those who support her during childbirth. She also clarifies early on that her book, whilst highlighting many appalling situations around the world, suggests that the problems are usually systemic and cultural, and not the fault of individual practitioners.

As well as detailing the horrors of reality that women experience in  several countries, All That Matters is full of insightful conclusions, which gave me assurance that Rebecca really understands personally and politically, what is happening around childbirth practices globally, and what needs to be done. There are examples of excellence too, where organisations and countries have responded to potentially damaging reproductive care practices and are providing positive approaches to supporting women around conception, pregnancy and childbirth. Connecting ‘childbirth’ as a reflection of societal attitudes, and feminism, really resonated with me…

'As a mirror to society, childbirth, the attitudes to it, practices around it and experiences of women going through it, reflect the progress that has been made in advancing women’s rights'

I could carry on here explaining why you should buy and read All That Matters. I could fill two pages or more. However Maddie Mahon, doula extraordinaire, has written an excellent review of the book here, which represents my opinion and reflections too. Rebecca Schiller’s book is more than timely. It is being released just shortly before our book, The Roar Behind the Silence: why kindness, compassion and respect matter in maternity care.

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This is incredible, as collectively these books hold the potential to inform and influence the ‘tipping point’ by adding to the evidence already available that improving maternity care and respecting women’s rights enhances societal wellbeing.

Claire with baby, and Lynda her midwife and friend

And finally, I want to share this beautiful photograph of Claire having skin to skin with her newborn baby, and her midwife, Lynda Drummond. I worked with Lynda many years ago, and also supported her after a traumatic birth experience. I saw this photo on Facebook, and contacted Claire to ask if I could use it. This is what Claire said:

‘I'm so glad you like this photo, I really do. Through each of my 3 births my midwife has seemed like my angel and I'll never forget the roles that they each played. Although Lynda was at my 3rd birth as a friend to me, she was the one who helped me get the birth I had always wanted, having her there gave me the confidence I needed to believe I could do it, she had me laughing and dancing throughout the labour, she managed to persuade the midwives on duty that I could go in the pool even though my first birth was an emergency section . This photo to me sums up how utterly amazing she is, gentle, caring, supporting, angelic. I hope she knows it.

I've also included a photo of me at 7cm dilated, the big cheesy grin is totally drug free and totally genuine. All down to Ina May and Lynda Drummond......... oh and the cheesy radio station playing Valentines day songs, I think Rod Stuart ‘If you think I'm sexy’ had just been on!’

Claire Riding

With our book in mind, I look at Claire’s birth photo and description of her midwife, and I sense the Roar Behind the Silence.

Breastfeeding and Baby Friendly Initiative: a success story

I remember it well. Working as a midwife and supporting women to breastfeed wasn't always plain sailing. As I became more confident and skilful, women were becoming more confused due to conflicting advice. I am sure this is still the case in many areas, but in East Lancashire something happened that influenced things for the better. UNICEF's Baby Friendly Initiative was introduced more than 17 years ago at East Lancashire Hospitals NHS Trust in NW England, breast feeding rates have soared from 27% to 70%, and the BFI accreditation has been awarded and maintained for 15 years! This is no mean feat, given the demographics of the local population and the fact that there has been a huge service merger and reconfiguration. The current infant feeding coordinator, Sue Henry (@suziehenry68), has kindly reflected on this success with a guest post. Thanks Sue!

'East Lancashire Hospitals NHS Trust (ELHT) has been accredited with the Baby Friendly Hospital Initiative (BFHI) award for 15 years this year. The maintenance of this award demonstrates the commitment of this hospital Trust to ensure high standards of care in relation to infant feeding. In December 2012 the Baby Friendly Initiative (BFI) team assessed our unit again to ensure these standards have been maintained. The unit demonstrated at this assessment that standards of care remain high and BFI re-accredited us with this prestigious award. Policy and guidelines are evidence based, all staff are trained appropriately, and mums can expect skilled support and sound information. The unit will be re-assessed in four years.

In the beginning, it was the Head of Midwifery (Pauline Quinn) who ensured that ELHT progressed forward with the BFHI standards. Many significant changes were seen including the end of separation of mums and babies, abolition of routine formula supplementation for breastfed babies, the start of skin to skin contact after birth, and closer working with community colleagues to ensure ongoing support in the community. Infant feeding co-ordinators over the years (Catherine Boyle, Cathie Melvin and Sue Henry) supported staff through this change and ensured that they were abreast of the evidence.

As time went by ELHT saw our audit results improve, staff becoming conversant with the standards, a change of hearts and minds was witnessed, and breastfeeding rates rising from then 27% to now 70%, maximising potential for improvement in public health. Two hospitals (Royal Blackburn and Burnley General) merged to become ELHT – and both hospitals gained full BFHI accreditation before the merge.

The BFHI have updated their standards during this time, and more recently launched revised standards (December 2012). ELHT are now working to ensure these revised standards are embedded in practice. These standards now have a focus not just on infant feeding, but also on relationship building between mum and baby. We know the two intertwine and we feel excited about sharing new knowledge with staff and local women and families.

Reflecting on what the BFHI means to us locally in addition to giving us evidence based standards and rising breastfeeding rates, the BFHI team gives support, encouragement, direction, external audit (quality checks), and importantly belief. A belief that it is possible to change lives, not just by increasing breastfeeding rates but also by enhancing the feeding experience and the closeness felt between a mum and baby. These memories for mothers last forever.  We are increasingly aware of the importance of bonding, confidence building, care for preterm babies in the neonatal unit and brain development. We thank UNICEF BFI for taking us forward so that we can do our best for babies and families.

How have we maintained our BFHI standards for so long?  Staying committed with support from all staff levels, constantly re-auditing standards and making improvements, having a project lead to keep driving agenda forward, believing in breast milk / breastfeeding, believing in informed choice for all mums, and believing in equality – every mum being support in her choice. Choice is very important. Every mums feeding experience is important. These are things we at ELHT respect. 

Grandmother in waiting

I am at home anxiously awaiting the birth of my eldest daughter's second baby. When the little one arrives, we will have 5 grandchildren, and each one caused a tummy twisting turmoil just before they made their appearance. When I gave birth to my four I was confident and happy as I approached labour and was lucky enough to have four positive experiences.

So why am I sat here in a tizzy? I swing from staring at my mobile for messages, to looking at the house phone and wondering whether I should call...and then I walk round the house doing half tasks.

It's hard being a mother to a mother that's labouring in another place, so hard. Please come safely and soon little one.

And then I wonder if my lovely late Mum had the same worries when me and my sisters laboured hard for hours?

That's what I'll do; I'll go to her grave and I'll ask her...

Photograph

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

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 

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. 

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.