Neighbourhood Midwives' Mothers Fund: guest post by Annie Francis

I first met Annie Francis many years ago....and realised almost immediately that she was a woman of incredible substance: a wonderful midwife who was passionate about her work, about childbearing women having the best care possible, and who was willing to stand up for what she believed in. Since then, Annie and I have shared the same spaces, striving to maximise opportunities for all women to have a positive birth experience. Recently Annie invited me to become part of her exciting new venture, and of course I accepted. What an honour. I asked Annie if she would write a guest post for my blog, explaining more about this exciting news, and to tell us a little more about  and her plans for the future. 

Hi Annie! Thank you so much for agreeing to write this post, when I know how incredibly busy you are. Can you tell me a little bit more about Neighbourhood Midwives (NM), and about the new Mother's Fund? 

Annie Francis CEO Neihbourhood midwives

'Hi Sheena....I'll try! I've never done this before, so here goes....

Here at NM we have a simple organisational purpose:….to become an exemplar of a way of delivering midwifery care.

For every decision we make and every action we undertake we ask the question… does this serve our purpose? It is an incredibly powerful way of ensuring that we remain focused on our goal, but also helps when discussing difficult issues - it’s easier to have honest and open conversations when you can keep the shared vision in mind. This week has seen the four of us - all midwives ourselves - who set up Neighbourhood Midwives make a real and significant shift in our understanding of the practical ‘how’ we try and make our purpose and our vision a lived reality.

It has come about through our reading of a book – ‘Reinventing Organisations’ by Frederic Laloux and the case study of Buurtzorg, (which means neighbourhood care), a self managing, Dutch nursing organisation based in the community. Everything we have read about Buurtzorg has chimed with what we are trying to achieve with NM and so, as advocates of active learning, we wasted no time in getting in touch with Jos de Blok the founder, to see if we could go over to meet him and the result is a ferry booked and a trip planned for mid April…'

This sounds really interesting! I am in Holland at the moment, and will make some enquiries. Annie, what would you say to those who suggest that NM is another example of the privatisation of the NHS?

'Firstly, it is important to remember that the NHS has always used private contractors. GPs, dentists,  pharmacists and opticians are almost all privately owned. There have always been private providers of various services in mental health. The private sector is involved  throughout the NHS providing IT systems, drugs, buildings etc. Most Foundation Trusts use the income from private services to subsidise their NHS work so it is a much more complex picture than is often portrayed.

One anxiety often expressed is about private profit going to the shareholders but as an employee owned, social enterprise, any surplus made within Neighbourhood  Midwives will not be siphoned off as dividends for external shareholders, but reinvested into the organisation to improve our service and the welfare of our employees. Our constitution has been written to reflect this position and, should we ever be faced with a hostile takeover, we also have it written into our Articles that any profit from that forced sale would go to a suitable women's charity, not to any individual.

As independent businesses, GPs have a contract with the NHS to supply their services  - we would be no different and would be paid the current tarrif for maternity care, no more and no less - just as any other provider giving care under the NHS banner. 

The third sector - social enterprises, co-operatives and charities have always had an important role in providing services to the NHS and there are some important benefits attached - smaller, lean and flexible they can more easily target 'hard to reach' groups and can in fact often provide care much more effectively and efficiently than a large and unwieldy bureaucratised system.  They have an important role in increasing choice for women/ patients and breaking up the monopoly which can lead to lack of innovation and complacency on the part of the sole provider.

With the correct safeguards in place, my belief is that increased third sector involvement from small, community based providers such as NM can only be a good thing and, with the emphasis on improving outcomes as well as needing to save money, it is time to give us the opportunity to demonstrate what we can do'. 

Thanks for clarifying. Would you like to tell us a little about your new initiative?

'Yes! Last week we had the first meeting of the fabulous trustees of our new charity – the Neighbourhood Midwives’ Mothers Fund. The reason we have taken the decision to start a charity is simple, it helps us meet our purpose. Having successfully launched our private service in July 2013 we have been busy building our track record as the first step towards being ultimately commissioned by the NHS. We know that isn’t going to happen overnight though and, through the Maternal Health Alliance’ campaign, Everyones’ Business, we are increasingly aware of the critical lack of perinatal mental health provision in the UK.  

Even where this service is provided, the reality is that most areas are unable to offer it through a caseloading and continuity of midwife model. As a social enterprise, always looking to fulfil our social aims and knowing that there is considerable evidence that this type of care can make the difference for women struggling with such issues, we have come up with an additional step along the road to our first NHS contract – to register as a charity, called the Neighbourhood Midwives’ Mothers Fund.

We envisage that it will work in a similar way to the Macmillan & Marie Curie model but with a dedicated midwife providing individualised, holistic midwifery care for each woman referred, who can also act as her advocate and co-ordinate her care with the appropriate NHS/multi-disciplinary teams according to individual need… We are really excited by the possibilities and now we get to have lots of fun doing the fundraising!

So far we have three Trustees, selected for their expertise and dedication to to the cause. These are Cathy Stoddart, Emma Mortoo, and you Sheena!' 

Thank you again Annie, what a privilege this is for me. I'm excited to get going now, and to help you to support families most in need. For me, I think this could be a blueprint for other areas, and a catalyst for change for the whole country and beyond. 

Lastly Annie,  I believe you have been selected to be part of the national maternity review team, brought together by NHS England! 

'Yes, I was delighted and honoured to received an invitation to be on the panel. We were already aware that the Five Year Forward View has some very helpful comments about future models of care in maternity:

'To ensure maternity services develop in a safe, responsive and efficient manner, in addition to other actions underway – including increasing midwife numbers - we will:

·       Commission a review of future models for maternity units, to report by next summer, which will make recommendations on how best to sustain and develop maternity units across the NHS. 

·        Ensure that tariff-based NHS funding supports the choices women make, rather than constraining them.

·       As a result, make it easier for groups of midwives to set up their own NHS-funded midwifery service.  

And so, with the indefatigible Baroness Cumberlege at the helm, I’m really looking forward to contributing my thoughts, knowledge and experience to help make this review a genuine opportunity to explore some new options and different ways of working… the evidence is out there, we just need to be prepared to think outside of the box and, in the words of Goethe:

‘Knowing is not enough; we must apply. Willing is not enough; we must do’

I am delighted that you are part of the panel Annie, and I know my friends and colleagues are too. We want this review to be the lever for change to enable improvements in the way we deliver maternity services in England, and beyond. Please let us know how we can help you! 

There are several ways to connect with Annie, and Neighbourhood Midwives:

Website: neighbourhoodmidwives.org.uk

Twitter:  @neighbourhoodmw

Facebook: www.facebook.com/nbrhoodmidwives

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.

Screen Shot 2015-01-23 at 15.58.27

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.

Men, Love & Birth: 'being present'

This book, Men, Love & Birth is out this Spring, and is eagerly awaited by many of us! Here I've actually interviewed the author-midwife extraordinaire, Mark Harris! Hope you enjoy it...please leave comments for Mark at the end of the post...

Hi Mark! We’ve never met in real life; I’ve only read about you, and your brilliant reputation as a midwife and speaker. We've connected via Twitter, and when you told me that you were writing a book, I was delighted for you. What a privilege to interview you for my blog site...thanks for agreeing! And this is the first time I've used audio, so I really welcome your input-let's see!

[These are the questions I proposed to Mark, and he recorded himself answering them...see the clip below]

Can you introduce yourself, and tell us about what you do?

I know that you are a father and grandfather. Does this influence your work at all?

Denis Walsh once told me that after he studied feminism, he change his opinion slightly on male midwives. What are your thoughts on male midwifery? It would be great to have your perspective.

Do you feel that fathers engage with you differently, being the same sex? Also, during your work, do you get any feedback from how dads about their experiences of the birth of their baby?

Mark, what are your thoughts about the publication of the new NICE intrapartum care guidance, in relation to recommendations on place of birth?

What are the three highlights of your health service career Mark ?

I know that you are currently writing a book, and that it’s due to be published early next year! Wow. How exciting. Can you tell us a little bit about it? 

http://youtu.be/R04alDJ9fao

And lastly, if you could change one thing, anything, in maternity services, what would it be?

'If I could change one thing is maternity service I'd want the ratio of midwives to match the population of women giving birth to be one to one.

The role of 'being with' women as support of and pointer to her inner power to birth amazingly takes attention and 'un rushed' time, waiting, watching connecting to the emerging family she is being privileged to meet.

It's very challenging to offer this type of care to more than one woman at a time, regardless of how complex or not their needs area....'

Wow. Thank you so much Mark for the insight into your thoughts on your career, midwifery, 'being present', men and birth, and feminism! I feel like I know you already, and so look forward to meeting you this year.

Good luck with your book!

You can follow Mark on Twitter @Birthing4Blokes

Feeling the power & tasting the satisfaction: a circle full of water

In the early 1990’s I was lucky enough to be a community midwife, supporting women to have home births. When one of the women I was caring for, Helen, told me she was planning a water birth at home, I was both excited and fearful. You see I had never seen a waterbirth, let alone facilitate one, and so off I went to speak to my supervisor of midwives. With support and adequate education I felt more confident when Helen went into labour, and with a trusted colleague I helped as Helen’s baby was born calmly into warm water, in the candle lit living room of his parent’s home. This photograph was taken sometime after the birth, after I checked to see if any stitches were needed! Happy, happy, memories for all of us….

Several years later when I was working in the same organisation, but in the obstetric unit as a senior midwife, I became aware of midwives feeling unable to facilitate water birth on the main delivery suite, as the pool was being used for storage! In addition to that, one particular midwife who didn’t approve of this mode of birth, was creating barriers for other midwives to use the pool, which was causing distress. After giving them support, several enthusiastic and passionate midwives (Joanne and Katriona leading) went on to develop their skills in the use of water for labour and birth, organising study days and developing flexible guidance. There was significant change after this, and water became an option for labouring women using our service. Today, women using East Lancashire Hospitals maternity service have 9 water-pools to choose from, women are actively encouraged to use them, and the water birth rate is 15% in the overall service, and 40% in birth centres!

So why I am telling you all this? Well, last year the fabulous Milli Hill put out a call for waterbirth stories, via social media channels. Milli was editing a book, and wanted positive experiences of waterbirth to be shared to help and inspire others. I contacted staff at the same maternity unit mentioned above, and shared the request with local mothers too, via our Facebook page. Two individuals responded, and I have mentioned them below!

I’m in Australia at the moment, and after the exciting and much awaited publication of Milli’s book ‘Waterbirth: stories to inspire and inform’ this month, Milli offered to send me a copy to review! I read the book from cover to cover in a couple of hours, and I loved it. Apart from feeling totally in awe of the women who shared their positive tales, I learnt lots.

This title of this blog post Feeling the power & tasting the satisfaction: a circle full of water is taken from Milli's introductory chapter and epilogue, and the last sentence of ‘Lisa's story’ (Lisa Hassan Scott page 25). This book gripped me from the beginning; it is full of stories of the power of birthing women, of personal emotions, and of relationships between birth partners, parents, and health professionals.

After a short but revealing and well written introduction to the book, Milli tells two of her own birth stories. This helps to put the reader in the picture from the beginning, and brings perspective as to why Milli decided to produce the book. It’s the first time we read the word ROAR, music to my ears, and used several times in other birth stories too!

I loved the inspiring quotes at beginning of each chapter…I’ll definitely use them in my work.

The stories are varied, from around the world, and include accounts of personal water births from researchers, siblings, doctors, stay home mums, dads, midwives, birth activists, and doulas. Some of the births were in hospital or birth centres, and some at home. Midwives who featured in the stories included those that are independent (private) and others working for the NHS, and whilst some mothers experienced barriers to their choices from staff, most stories are complementary of the empowering approach of their care-givers. Confirming my own experience and knowledge, it was the attitude of maternity care staff that seemed to have the greatest impact on a positive birth experience. An example of this was when a mother had a breech vaginal birth after a previous Caesarean section (VBAC) at home, and after her baby had been born the emergency services were called, and both mother and baby were transferred to hospital. Jenn found the whole experience enormously empowering and positive... and excited to do it again (Page 61)! It seems from her words that the way Jenn was treated, and her choices facilitated, that made the difference.

Many mothers used the term 'sacred space' to describe the protective element of the birth pool. I found this enlightening as I had only thought about the other more commonly described benefits that water brings to a laboring women; ability to move, warmth, natural element, pain relief, and body weight disappearing. These too were highlighted by the authors of the chapters, but the circular structure of the pool, and being almost ‘untouchable’ to others seemed to have an impact on reducing fear. Some of the stories included accounts of a previous traumatic birth, and the space and structure of the pool seemed to give them the power to have the birth they wanted second or third time round.

Some of the mothers used hypnosis in addition to the water, and one used the shower instead of a pool, and another a standard bath, which worked perfectly for them. I read stories of breech water birth, twin water birth, and water birth after three previous Caesarean sections. Another interesting observation I made was that several of the babies where born in their ‘caul’, which means the membrane sac around the baby in utero was still intact and protecting the baby throughout the birth process. A sure sign of minimal intervention.

For me, there was personal satisfaction and humble pride in holding this book in my hands, and reading the two stories from our local maternity service, where I used to work. Both babies had been born in Blackburn Birth Centre, an establishment I helped to develop in 209-2010. One of the mothers, Rachel Barber, mentioned the fact that a student doctor had been present. Now isn’t that the way forward?

Whilst all the stories are inspiring and reassuring, Diane Garland's lovely account of a mother getting in the water-pool with her young frightened daughter made my heart sing. However, Diane was baffled when the young mum texted and Facebook-ed her friends following the birth, and states that she doesn’t understand ‘young people’s fascination with social media!’

I would like to tell Diane I’m not that young!

So Milli, thank you so much for editing this amazing little book. I will be recommending it to all my friends, colleagues, pregnant family members, student midwives (a MUST read), midwives and doctors. What a gem. I hope it becomes part of the suggested toolkit for women and their partners to believe in birth as a natural social event, instead of a medical illness. Bravo!

Follow @waterbirthbook on Twitter!

Reflecting on 2014, and the social media party....

Sat in the sun today, on the last day of 2014 feels wonderful...the Australian climate, especially here in Victoria, is comforting. I'm thinking constantly about and missing my family in UK and Europe, where the snow is falling or the frost biting...especially because it's the festive season. And in a few days we will see our son Tom for first time in 2 years, now that's something to be excited about!

It's been an incredibly interesting year.

We've travelled lots, spent precious time with our family and friends (although sometimes not enough), and met so many new lovely folks. The thing that's really helped me to stay in touch, connect and re-connect, is social media. I can't believe the power it has to bring people together, support, offer opportunites....

Here are some of the highlights:

At the beginning of 2014 my midwife daughter Anna Byrom and I wrote an article about social media for MIDIRS...you can access it here. It was our first article together, and quite symbolic. The article highlights all the benefits of using social media, and some of the pitfalls...and includes this diagram of myths and fears of social media, and offers some solutions, so I won't repeat these here!

After being invited to help with the social media activity at the ICM Congress in Prague in June, I encouraged midwives to join Twitter and become Twitter Buddies to help others to benefit from the enormous benefits it brings. We had 115 midwives, future midwives, doulas, obstetricians joining in from around the world...and from that others were encouraged too. One of those midwives, Deidre Munro, has become quite a phenomena in the tweeting midwifery world...she established the #globalvillagemidwives concept which is gaining momentum by supporting student midwives and midwives, and increasing social capital. And Deirdre keeps us all updated on the latest evidence on maternity matters which is invaluable #EBP.

I have been privileged to help the wonderful charity Best Beginnings with their amazing new Baby Buddy App, by testing it and disseminating the benefits .

Our new book, The Roar Behind the Silence is due to be published in February. Edited by Soo Downe and I, the book explores why kindness, compassion and respect matter in maternity care, and has over 20 chapter authors from around the world. Because of social media, I found and connected with potential contributors-mothers, midwives, doulas and doctors all wanting to help us to try to make a difference. Some of these remarkable individuals are already know in the maternity world, and others are breaking through the 'silence' and have written words of inspiration to highlight issues, support others, and provide ideas for change. I've yet to meet some of them, and I hope 2015 brings us together! We've already been invited to give talks about the book at various events, which is what we hoped for. We really would like the book to be used as a resource for supporting positive change in maternity care. Here's short excerpt from the final chapter....

I have been joined by two fabulous midwives in running WeMidwives, which has been an enormous help. The wonderful Jenny Clarke, known fondly by all as @JennyTheM is our Skin to Skin specialist, and our lovely Caremaker midwife Dawn Stone @HelloMyNameIsDawn  and I are now a team!  @WeMidwives has an ever increasing membership, and helps to positively support student midwives, midwives and all interested or working in maternity care.

Student midwives are our future...and they are certainly making an impact. There is an incredible increase in the number of Midwifery Societies lead by students, and they are unstoppable. Instead of worrying or complaining about the cost of high profile conferences, they organise their own study days...inviting the same speakers from the events they cannot afford to attend. How brilliant is that? I've been privileged to attend many of the days, and have witnessed the passion, determination and courage of our future profession.

Because of Twitter, and meeting the wonderful @KathEvans2, I am helping NHS England to support maternity care workers to provide the best maternity care they can, through learning and sharing good practice. I participated in some filming about the importance of communication; a topic close to my heart.

As an Iolanthe Midwifery Trust trustee, I've set up their first Twitter account @IolantheMidwife. This has been an exciting step forward, and it's so encouraging to see the interactions between student midwife and midwife award winners. Long may it continue.... And lastly, there's my blog...what a privilege to interview Soo Downe, Hannah Dahlen, Toni and Alex from One World Birth, Petra ten Hoope-Bender, Alison Baum CEO of Best Beginnings...quite something! Yesterday I received a report on my blog...here's an excerpt:

The concert hall at the Sydney Opera House holds 2,700 people. This blog was viewed about 47,000 times in 2014. If it were a concert at Sydney Opera House, it would take about 17 sold-out performances for that many people to see it.

Click here to see the complete report.

I love writing my blog...and follow many other blogs too. Do YOU write a blog? Do you have any favourite blogs relating to maternity services to recommend? Please let me know in the comments section below, as I'm planning to publish a list....

So now it's time to plan for 2015

Will you be joining the party on Twitter?

The mother, the midwife and litigation: coming full circle

Professor Soo Downe OBE:

The first time the story below was told, it was as a dramatic performance to the third international UK normal birth research conference in 2006. My intention in asking Kate and Sheena to do this was to highlight the fact that doing normal, out of hospital childbirth may end up exposing mother and midwife to litigation, because this choice is not seen as the standard, ‘safest’ option, despite evidence to the contrary. I was particularly keen for midwives to recognise the need to be courageous in facing this possible outcome. The argument was that facing our fear of litigation may reduce the risk of defensive practice: once the worst has been faced and accepted, there is nothing more to fear.

Kate’s part of the story illustrates the fact that, often, women are caught up in litigation in a way that can be as damaging as the original trauma suffered in unexpectedly pathological childbirth. No-one is a winner in this circumstance. Sheena and Kate show in stark and clear-sighted detail what this experience feels like, and how it is possible to work through it, overcome it, and still maintain faith in normal birth processes, and in mutually respectful relationships.

Mother meets midwife

They met on a winter’s morning in 1994. Kate was a 30 year old woman who had recently returned from four years living the East, working in refugee communities, with her Tibetan husband. Although she had grown up in Lancashire she was living in Swansea, South Wales, working full time in a hostel for homeless people, when she became pregnant with her first child in July 2004.

Sheena was a community midwife with experience of home birth and ten years in a GP maternity home (similar to a birth centre) where there was no medical cover.

For Kate choosing a home birth seemed quite normal: she was born at home, as were her siblings. Her mother is Dutch and so home did not seem so unusual. She had read up on the subject and had direct experience of how things can be in hospital. Kate had been by her younger sister’s side when she was taken for an emergency caesarean, the direct result of over intervention.

For Sheena home birth was the ultimate practice for the use of her midwifery skills.  She had worked in the GP maternity home where there was no technology other than emergency life-saving equipment, and had seen the benefits that brought. More than this, her desire to assist women in their choice was and still is her passion.

Kate had received her antenatal care in another area, where she was booked for a home birth. She wasn’t given GP cover but the midwives were very supportive and discussed the home birth guidance and support with Kate. However Kate lived a house shared with two other men, both smokers, attached to the hostel where she worked. When a friend suggested that Kate move to a more beautiful peaceful area close to where her parents lived, to give birth and stay in the friend’s spare house, Kate wrote to the Head of Midwifery to explore the possibility of transferring the home birth option there.   In the last month of the pregnancy Kate moved up to the Ribble Valley and met Sheena, the midwife who was going to provide her care. Sheena had been asked to care for Kate by her manager, who had read Kate’s letter out during a team meeting.

 Our story

Kate: Sheena and I clicked right from the start. She was so open and respectful, and interested in me as a person. I trusted her and was delighted that she would be with me on this amazing journey into motherhood.

Sheena: I sat on the floor in Kate’s home and she offered me Tibetan tea. Kate told me her story of pregnancy so far, and her desire to birth at home. It was Kate’s first baby and she was so excited. I didn’t meet Cheophel her husband but heard all about him, and felt privileged and happy to be their midwife. I told Kate I would try to be available for the birth by being on call for the three-four weeks necessary.

 Normal procedures were followed. There wasn’t much discussion about the choice of home delivery as the decision had been made in Wales and discussion had taken place there.

Kate: I didn’t think to ask lots of questions about travel time and distances to hospital: I assumed that if the midwives were happy to take me on, and had done the same for other women, it wasn’t an issue

Sheena: I didn’t go into any great detail about distance from hospital etc as I rightly or wrongly assumed Kate knew how far the hospital was. It wasn’t my practice to do so, as I had a worked in a maternity unit for ten years that was quite near to where Kate lived, and transfer hadn’t been a problem. Kate wanted a home birth, she was very healthy and happy, and ready to meet her baby.

Kate called Sheena the morning she went in to labour and she attended shortly afterwards. Kate’s labour was amazing; she was active and alert, calm and serene, and very excited. Cheophel and Lucy (Kate’s friend) were present, and providing wonderful support.

Sheena: I loved caring for Kate. I remember her movements, her smile, the lambs in the fields outside and the loving touches of her birth partners. She was agile, and worked with her labour like a strong, proud woman.

When there was spontaneous rupture of membranes, Sheena performed a vaginal examination to exclude cord prolapse (practice at the time). Kate was standing for the examination, and her cervix was found to be fully dilated. The head however, was still above the ischial spines, and Kate had no desire to push. The second midwife listened to the fetal heart, and there was acute prolonged bradycardia.

The emergency services were called……………

Kate: I had felt strong and centred, but now I started to feel powerless.

I knew things were not going as they should, but there seemed to be nothing I could do about it. I tried to remain calm, to not panic, to breathe deeply. It was my first child, so I had no experience to measure it against. I looked to Sheena for guidance; she my anchor. Time seemed to stretch out and slow down, I recall an incredible sense of clarity but huge waves of fear rising within that..

Sheena: The fetal heart beat was still 60bpm. Immediately my feelings lunged from fear, hope and an urgency to protect. The fear was the strongest sense, and increased with each passing second. I couldn’t do anything. Kate was mobile, so changing her position was a constant thing, and the baby couldn’t be born yet. When the baby’s heart beat increased slightly, hope returned but disappeared as quickly as it came. I knew emergency services had been called so in terms of ‘correct procedure’, all was in order. But it was not. Reality was the person in front of me, Kate, who trusted me implicitly and whom I couldn’t help. I will never forget Kate’s eyes, looking into mine, searching for something that I found so hard to give. I wanted to say; ‘it’s good Kate, you are going to be fine’ but I couldn’t because I wasn’t sure that it was. How could I lie to her. Words that have always come so easy to me during my career were now unsuitable and inappropriate. Neither could I say ‘I am sorry’, as I would have done had fetal death occurred, because the possible outcome couldn’t be spoken about. I had an incredible overwhelming desire to take Kate in my arms and make her safe, or to somehow speed up the birth. But I could neither.

The ambulance arrived 40 mins after the call to the hospital. A local GP was present, but couldn’t assist. The procedure at the time was still the ‘Flying Squad’, where an ambulance was called as an emergency, but it necessitated calling at the hospital to collect the necessary clinicians. The communication between the hospital and ambulance control initiated a response to send one ambulance with obstetrician, midwife, paediatrician and full resuscitation equipment. The room where Kate was small, and yet the paediatrician began to set up the equipment, and the doctor urgently proceeded to examine Kate.

Kate: The house seemed to have been invaded; people upstairs, downstairs, on the stairs, in every room; women and also men that I didn’t know, disembodied voices, glimpses of uniforms. The registrar examined me and didn’t inspire confidence or trust; she seemed authoritarian towards me, but scattered in herself. I looked to Sheena trying to keep the connection, trying to find the direction. My impression was that she had been blocked out by the registrar who had taken over control, and yet didn’t seem in control. It felt as if I had been cut loose, adrift on a sea of emotions I hadn’t been prepared to negotiate.

Sheena: The ambulance was here, and familiar faces. Fetal heart still 60. The doctor was experienced, the midwife a trusted colleague, the paediatrician and his equipment. An examination, questions asked, and a flurry of activity. The doctor wasn’t happy to try to deliver the baby, and asked for Kate’s transfer in. Another ambulance was needed, as Kate and the equipment could not fit in one ambulance. The baby could have been born during the journey. Despair increased and fear intensified. Doctor’s instructions. Confusion and uncertainty. Cheophel looked so afraid, yet I wondered if he really understood the seriousness of the events. How could I make him feel better? I couldn’t speak his language and even if I could, I was unable to say the right thing. I touch his arm but I can’t smile.

Kate asks ‘should I push?’ ‘No’ says the doctor, ‘baby’s position is not good, head too high’. I knew this was so, as I had examined Kate. Kate looks to me not the doctor. Eyes burning into mine. What could I do? Fetal heart still 60 bpm. Despair.

The second ambulance arrived, and transfer began a further 44 minutes later

Sheena: Some relief when 2^nd ambulance arrived but only because something could progress. The fear was still strong, what was to be?

Kate: I started to feel annoyed with everyone else apart from Sheena; I just wanted them to go away and to get back to the birthing we had been dealing with together. I felt that I was no longer present as a person any more; that the whole birthing had been taken out of my hands. I was no longer a woman giving birth to a baby, but a body out of which a baby had to be extracted. I was both acutely aware of myself and at the same time felt entirely disconnected from myself. There was an almost tangible feeling of alienation, which I can only describe as an out of body experience as I observed all of those things happening to me but without my being involved. My body was led down the stairs, my nakedness barely concealed as I stepped out into the spring day on to the street.

The hospital is 12 miles away, and it is peak time. Transfer to hospital began to with the assistance of the blue light. Kate was with Choephel, doctor, Sheena and another midwife who came in 1^st ambulance. The 2^nd ambulance followed with paediatrician and equipment.

Choephel was sat at the bottom of the stretcher that held Kate. Sheena was stood close, trying to listen to the fetal heart. The other midwife recorded the activity. Kate wanted to push during the journey.

Sheena: The journey was so difficult for Kate. Fetal heart still 60. She was desperate and scared, and I could sense such sadness in Choephel who I knew understood the level of urgency. When Kate wanted to push, I could see the baby’s head advancing Lots of black hair. From his position, Cheophel could see too, and looked at me for a solution. As I would normally do, I encouraged Kate to push and to ‘go with her body’. The doctor intervened and told Kate not to push as the hospital was in sight. She (the doctor) didn’t want the baby born at the roadside. Kate found this hard and looked at me for guidance. I felt it appropriate to continue to tell Kate to do as she felt necessary and to push if she wanted to.

Kate: It didn’t help that I was being given conflicting advice-don’t push-push. I felt intense anger (often associated with transition). Who was holding me? How long would I continue freefalling?

Pema was born on April 12^th 1995, a full term baby weighing 7lb 8oz. It was a vaginal birth with an episiotomy.

Kate: She was blue, she seemed big and strong. Cheophel told me that she looked dead and he burst into tears. I was just so relieved that she was out, and alive; that was it, we did it, the baby is born end struggle, I thought. I didn’t realise that the struggle had only just begun.

Sheena: We arrived in hospital and Pema was born immediately. Her condition was poor and she went to NICU. This was the worst experience of my career. In bed that night I thought so much about Kate and Choephel and their sadness and worry. I didn’t sleep much and went through my actions, feeling sure that I had acted appropriately, although I remember wishing I had taken Kate in my car to hospital: an action worthy of instant dismal.

Two supervisors of midwives scrutinised my records and called for me the following day. The meeting was unnerving due to its formality, but my seniors assured me that there were no discrepancies with my care and that my record keeping was good. I visited Kate twice that day, and became part of the grief and concern that enveloped the whole family. Sometimes I wondered if my colleagues felt blame towards me as some didn’t really know the story. I also felt alienated by midwives who believed in 100% hospital birth system, as they said nothing to me. Not much support really.

Kate: I remembered meeting the doctor the next day by chance on the corridor. She enquired after ‘baby’ and then said to me ‘so next time you will be having baby in hospital yes?’ I was too socked to reply, but felt like slapping her.

Kate and Pema came back to their borrowed home after 3 weeks in Intensive Care.

Kate: We had not been in contact with hospital Social Workers. We had not been offered any counselling. We came home with drugs for Pema and a telephone number for SCOPE given by one of the nurses. I remember thinking at the time ‘’ SCOPE, that used to be the Spastics Society- why has he given me that?’’ The words cerebral palsy had not yet been used in connection with my baby. She was so beautiful and precious, our first born child, nearly lost to us. But as she gradually came off the phenobarbitone, a sedative which had kept the seizures under control, she began to scream. She screamed round the clock. She could not be put down even for a second, without hyper extending and screaming. She slept in 5 minutes snatches around and then only if she was being jogged about and bounced vigorously. Thus began a three year round the clock marathon. Our arms grew strong, but our spirits grew weak. We became exhausted. There was no let up. No involvement from Social Services, no respite care, no professional support apart from visits to the consultant for scans and check ups. More drugs were given to help Pema sleep. They were ineffective and that was when the epilepsy kicked in, leading to more drug, prescribed by trial and error.

Over the next year, no-one addressed the emotional side of what we had been through and continued to go through. We were expected to cope. Four lives could very easily have been lost at this point; Choephel tried to take his life, I seriously considered aborting my second child, and then taking my own life; and there were times when we had to leave Pema alone screaming just to prevent ourselves from harming her. We were just so tired. We couldn’t see a way forward. No-one knew how things were for us

Sheena: My work location had changed, but I stayed in touch with Kate and her family. My desperation continued, seeing the distress and despair of this young family. What could I do?

18 months after Pema was born Kate had another baby

Kate: There were medical reasons why I couldn’t go for a home birth this time, even though the system for transfer to hospital had changed. I requested permission for Sheena to be my midwife. I wanted to do it with her by my side again; I wanted it to be a shared experience which could help us both, and it was. I think it was at that point that I reconnected with my own inner strength.

Sheena: It was important for me to be asked by Kate to care for her when she was pregnant with her second child, and it gave me hope and confidence in myself as a midwife.

Some two and half years after Pema’s birth, Kate and her family were at a charity event for disabled children. A solicitor who was a personal friend of Jane the charity founder, was speaking at the event on the litigation process. After the talk Jane introduced me to the solicitor, told him the bare bones of Pema’s birth and suggested that he take a look at Pema’s birth circumstances to see whether he felt that there was any negligence on the part of the NHS Trust.

Kate: I went along with it; I felt that it would be quite clear cut.: either it would come out that they had messed up with the transfer to hospital, or it would be shown that everything was done properly. It seemed like a good idea to have someone ‘independent’ look at the facts. I was still very upset about things, used to burst into tears in shops, at meetings, whenever Pema was mentioned really. I suppose I was looking to the solicitor for a form of closure, and for support. But I was very naïve; I had no idea how litigation works, having no previous experience

Sheena: Kate and Choephel told me they had met a solicitor who was going to look into the birth of Pema. They respectfully asked me what I thought about this, and if I had any objections. They were clear they didn’t want to hurt me, and that they were totally happy with the care I gave. Their concern was in relation to the doctor and the transfer to hospital. I felt unclear about the litigation process, and was naive in my belief that as I had given good and appropriate care to Kate and Pema to the best of my knowledge and ability, I had nothing to fear. I gave them my blessing and said I would do anything to help them.

After some years there was a change in the litigation process

Kate: From the initial investigation the solicitor decided that there were strong grounds for a claim as there had been negligence during the transfer to hospital. This did not surprise me .I was asked to write an account of how I came to be giving birth at home and what happened just prior to labour, during labour and something of our life since then. It was very painful but I managed to detach myself from the process enough to write about it. Things took a long time, it was years, before we received any reports from witnesses and expert witnesses. From the expert witness reports there were new allegations which focused on the care of the midwives, which we had never been worried about. We were told that the case would now have to include all these new findings. After the statement which I sent in I was not asked to give my comments on any of the reports that came in; I was told that as Pema’s litigation friend I had a duty to accept the reports of experts I order to seek justice for her. My role in the process became very passive. It seemed to have a life of its own.

Sheena: The Trust’s solicitor emailed me to ask me to call her immediately. New allegations, this time challenging my care. She would send the account, but told me not to worry. I read them with horror when they arrived. My first thought….did Kate believe this? Wasn’t allowed to find out. Did she think I had cared for her inappropriately, without skill and judgment and that I had failed her? She signed to say she did. Oh God this can’t be true.

Anger towards the ‘expert’ midwife who wrote things about my care, that was good and provided with such passion.

Local press, two separate newspapers. Front page news, detailing names and allegations against Sheena. Kate was out of the country and unaware of the events unfolding. The papers were local to the town where Sheena was born and lived most of her life, and where she worked as a community midwife.

Sheena: My colleague had bought the paper on her way into work on a late shift. She brought it straight to me. Horror. It couldn’t really be happening. How can this be allowed when nothing was proven and no case heard? My name, my career, my reputation.   What will the mothers of whom I have cared for over the many years think? I felt sure they would think… ‘lucky escape’ or liken me to Harold Shipman. This may seem ludicrous and far removed from reality. But reality for me. Need to leave my job. My children had comments at school. My neighbours quietly mentioning it to my husband at the bottom of the garden. Pointed fingers.

Kate: We returned from a very difficult but amazing trip to visit my husband’s family in Tibet; he hadn’t been back since leaving as a refugee 17 years earlier. I was pregnant with my 4^th child. We were all ill and exhausted. We were fighting to get adaptations done in the home before my pregnancy advanced much further, so that I wouldn’t have to lift Pema so much. We were waiting for a date for major hip surgery for Pema whose left hip was fully dislocated. She was in constant pain and spent much of the time screaming. And to top it all we were presented with the front page newspaper article. Everyone we knew assumed that we had consented to the article. Everyone we knew assumed that what we were doing was taking Sheena to court. And without any knowledge of the facts everyone assumed that we were wrong.

A petition to the newspapers was circulating, saying that it was wrong to print these unproven accusations about Sheena. We agreed that it was wrong, but felt hurt that the petition didn’t say that it was also wrong to portray us as enemies of Sheena. We were following a legitimate legal process but were being treated as if we were the wrongdoers not the victims.

Comments form mums at schools, insults from people who had formerly supported us. Accusations that we were money grabbers. Support form no-one. Even close friends urged us to drop the case due to the damage it was doing to our family and to Sheena’s

Deep depression for the next few months. Isolation. Hated living in Clitheroe. Wishes for it to all be over, solicitor encouraging us to keep going and soon we would have the financial security to be able to move away

But things didn’t work out that way….

Kate: The Solicitor had only met me one time after that initial meeting. Now he came to visit us with the Barrister. I had made it clear that our concerns did not involve the midwives but of the emergency services. They explained that although negligence had been firmly established with regard to the transfer to hospital, causation had not, because It was difficult to prove that the delays caused by the negligence were the cause of brain damage. The expert witnesses were saying that Pema could have been born sooner, if transfer had been more efficient, but probably not less than 1 hour after the bradycardia. They would be using all the evidence including the evidence against the midwives to support the case, and as Pema’s litigation friend I had a duty to allow them to proceed. There had been an offer of a small out of court settlement which was less than the amount than they would be paying in court costs, so no risk. The solicitor warned me that if we didn’t go to court I would spend the rest of my life wondering what would have happened if we did.

I had just had a baby, I was very open ,quite emotional. I knew that I couldn’t stand up in court and pretend that I believed the midwives had to been to blame even if it was necessary to do so. I also knew that whatever part I played in the proceedings if the case was won on those grounds and not on the grounds of the mess up of the hospital transfer I would spend the rest of my life regretting it.

We telephoned the solicitor a few days later and asked to accept the out of court settlement and withdraw the case. The offer of a settlement was then withdrawn, and it had to go to appeal. Eventually we received an amount of money which has not changed Pema’s life much, except that we could buy her a wheelchair adapted van. We still live in the same place, we can’t afford to move. We still feel isolated, let down by the community. Unsupported. Outsiders. Pema the brave and the beautiful continues to be the epicentre of our lives.

Kate has her own perspective of how this system has failed her:

I believe in the right of a woman to birth in the place she feels is most appropriate for the type of birth experience she wants for her child and herself. The right to have unbiased information to make an informed choice, and support in the choice she makes.

I believe that birthing can be an amazing spiritual experience. I believe that intervention should be available for emergencies but that it should not be the norm, and sensitivity is one of the greatest attributes of a good midwife- when to help, how to support, when to hold back, when to do nothing, letting woman and child lead the way.

Pema’s birth was such a shock; nothing in my life could have prepared me for that experience. But I think that the shock waves which have coloured my whole life since then could have managed better, and I could have had support in integrating the experience, rather than being left with a huge open wound.

I have lived with anger just below the surface for years now. There has been no real closure of the events of the day that Pema was born. I had expected the litigation process to clear things up, and allow me to find the type of resolution that no-one else had allowed. Apart form the legal system no one was looking at Pema’s birth at all, not even from the point of view of how it affected us as a family, or me as a woman. But the legal process made things less clear, muddied the waters and confused me even more. I still had no resolution or closure, just new issues to deal with.

We were abandoned by the services that should have supported us. We were then taken on a desperate journey through the process of litigation which promised a way to escape from some of the problems we had been left with, but which ultimately only added to our problems. I feel that we should never have had to go through that process, and that justice is a game in which you have to play dirty if you want to win. We became pawns in that game, and it took a certain amount of moral courage to get out of it.

Although Sheena and I weren’t allowed to communicate during the whole process.               I felt it important to send cards and letters to reassure Sheena that there was no personal animosity, no change in my feelings for her. Why did we have to be placed on opposite sides of this artificial fence? Discussion of the case with Sheena since it was closed has been the only thing that has really helped me to face what happened and come to terms with it, and start unravelling the threads of anger running through my life.

I was not free to choose the place of birth for my 3^rd and 4^th children, who were born without any intervention or medication and could have been born at home. There were too many issues, and it was clear I was not going to get support. I wasn’t going to do home birth as a battle: I had other battles to fight on Pema’s behalf.

I don’t regret my decision to enter into the process of litigation; what happened at Pema’s birth was swept under the carpet and litigation was the only choice on offer for me to face what happened so that I would be able to close that chapter. I do regret that there is no system in place in this country that can allow a family to honestly and openly request what happened in such circumstances as ours to be looked at, without the need for someone to blame; that there isn’t a supportive way to acknowledge events and their far reaching consequences, even accept shortcomings, provide redress, and enable us all to get on with our lives, integrating the experience however difficult. And while we struggle to support Pema, millions of pounds of public funds have been spent, both on the side of the NHS and through legal aid provided to Pema, most of this going into the private sector of solicitor firms. Would those millions not have been better spent supporting the damaged child?

I have no regrets about withdrawing from the court case; it was the only way for me to remain whole, and in my case I could see that the outcome would constitute neither justice, nor clarification, nor the closure I sought.

I do very much regret that the key players here, Sheena, Sheena’s family, myself; and my family, have had to go through so much heartache, and that my birth damaged daughter does not have what she needs to make the best of her difficult life.

Sheena also has her perspective as a midwife about how the system failed her, and how it should change:

I believe in a woman’s ability to birth her baby, and that unbiased information should be offered to all women to help them choose their birth environment, with appropriate support for ultimate safety. Risks and benefits should include those in hospitals, as well as home.

Pema’s birth taught me that I can’t always make things right, and sometimes, no-one can. It has, however, destroyed part of me that believed and respected British systems, and it has borne in me disgust in the purpose and philosophy of the press.

I didn’t know how to act appropriately following Pema’s birth. Kate was too traumatised to discuss events in detail, and I was unsure of doing so. No discussions between senior medical teams or managers with Kate as to the sequence of events and how things could be better. This has now changed, and there would be dialogue with Kate and her family, and potentially more support.

Once the litigation process began, the destruction started, for me and for Kate. I wasn’t allowed to communicate with her at all, which became harder following the press incidence. I wanted to speak to her and to tell her the allegations were false and that my care was good, but couldn’t.

Since the closure of the case and we have discussed events at length, I feel betrayed by a system that wouldn’t let me care for Kate when she had her third and fourth babies. I would have cared for her at home if Kate desired.

What changes should take place? Sheena and Kate feel:

Sheena: In midwives training, students need to learn about the litigation processes and their effects, without the fear of blame.

Kate: Parents of damaged children need to know about what they could be letting themselves in for entering litigation, and perhaps a solicitor is not the best person to offer that advice.

Sheena: Health services to continue to commit to transparency and openness within their services, and acknowledge failure with an apology if appropriate.

Kate: There needs to be acknowledgment of the events and their emotional impact, the questions that arise-even the ones with uncomfortable or no easy answer. Different aspects will need addressing at different times, but without open acknowledgment this can’t happen. Litigation should not be the only way for this conversation to take place.

Sheena: Parents of babies born damaged or in need of long term care should receive immediate support, without the need for blame.

Kate: The birth of a damaged child should not require parents to turn into fierce warriors continuously fighting for support and services. Litigation should not provide the only way for families to guarantee that their child’s needs will be met.

Sheena: The media should be prohibited by law to publish details of health care professionals, unless they are a proven danger to the public.

It seems that women are loosing out in all of this, and that solicitors are the only ones to gain. And yet, due to our belief in each other and in spite of what has happened, we have travelled a full circle and are firmly back to together again, where we started.

Kate: I trust and respect Sheena as a midwife and friend and given the right circumstances I would have no hesitation in asking her to support me in delivering my baby at home. I would advise my own daughters that given the right circumstances, home is the best place to bring your child into the world.

Sheena:   I still believe in home birth, and supported my daughter in her home birth choice recently. My philosophy is clear that women must do as they feel, and be given unbiased evidence based information to make their choice. Kate and her family are an important part of my life, and I will always feel privileged to be part of theirs.

So what next?

We were almost destroyed by this experience, for very little gain, and although we are back together, the litigation system continues to drive women and midwives apart.

In 2003, the government consulted on a document entitled Making Amends (DoH 2003), which set out proposals for reforming the approach to clinical negligence in the NHS. These ‘redress’ reforms however, have never been implemented.

In 2004/05 422 million was paid out in litigation costs, an example of how costs can run so high is that Kate’s case tool almost 8 years to complete, and her solicitor charged £100 against the case every time a phone cal was made to Kate. We feel that public money needs to be targeted where it is needed as opposed to lining the pockets of the legal profession. New Zealand, Scandinavian countries and France have introduced no fault schemes for medical injury, Virginia and Florida in America are introducing no fault compensation for babies with birth-related neurological injuries. The advantages of these systems are that lawyers are not routinely involved, reducing the amount of costs to legal profession and enabling more efficient targeting of resources.

Kate wanted to tell her story for clarity, to make sense of what happened, to assist in the integration of the experience. She feels it may promote a connection- with other women, midwives and mothers- to encourage them to have courage and to give insights into how the current system is failing women. Sheena feels the same, by telling her story she wants to strengthen professional courage and belief in women and midwives as true partners.

Chapter from Byrom S, Murry K (2009) In: Walsh D, Byrom S Birth Stories for the Soul Quay Books, London

 Reference

Department of Health (2003) Making Amends: A consultation paper setting out proposals for reforming the approach to clinical negligence in the NHS London

Inspiration and technology: Alison Baum blending the two!

I have been observing Alison Baum's phenomenal achievements for many years, and have been captivated by her passion, energy and charisma. Alison is the CEO of the charity Best Beginnings, and there's more about the brilliant work the organisation does in this post. After becoming increasingly involved in Alison's latest project, the Baby Buddy App I wanted to interview her, to find out a little more about the inspiration behind her successes. In particular, I wanted to know more about this app, and why she was driven to make it happen!

Alison, Hi! Can you tell me what the Baby Buddy phone app is?

Baby Buddy is a personal baby expert that guides mums through their pregnancy and the first six months of their baby’s life. It has been designed to help mums give their baby the best start in life and support their health and wellbeing. The app is free to download, and it allows you to create your own personalised avatar (your “Buddy”) and has lots of lovely features, including useful “daily information”, some great videos, a cool goal setting function called “You can do it,” a “What does it mean” feature where you can find out what words means, and a very helpful “Appointments” feature. Baby Buddy focuses on empowering young mothers, as well as increasing their knowledge, improving confidence, enhancing bonding and attachment and reinforcing the importance of accessing health services.

What is the inspiration behind the creation of the app?

Our charity Best Beginnings is all about ending child health inequalities in the UK. This means giving every baby the best possible start in life. Our vision is a future in which all children in the UK enjoy excellent care from the very beginning. My own personal experience has been a major influence on what we are trying to achieve. My first son David was born with a cleft palate as well as breathing and feeding problems. My second son Joshua was also born with a cleft palate and developed viral meningitis at 8 days old. My nephew Joe has a condition called Tuberous Sclerosis, he has multiple and complex healthcare needs, including severe learning difficulties, autism and epilepsy. Sometimes things go wrong, and some health problems are unavoidable, and we all do what we can to make the best of a situation. But as I became more and more aware of the shocking child health inequalities that exist in the UK, I realised some things are avoidable. For example, it’s totally unacceptable that a baby born in Bradford is six times more likely to die in infancy than a baby born in Tunbridge Wells. For the most part these inequalities are avoidable and that is what I decided to focus my energies on. Best Beginnings was set up in 2006 and the Baby Buddy app is an important part of that vision as it is designed to support parents-to-be and new parents in the social, emotional and physical transition to parenthood, and in giving their baby the best start in life. Baby Buddy focuses particularly on engaging young parents, who based on the evidence, are more likely to find the transition to parenthood harder and their babies are more likely to have poorer health outcomes. We as a society have failed to give them information in a way that works for them. Young parents want to give their babies the best possible start and we’ve created this app as a way to help them do just that.

How is it different to all those other parenting apps on the market?

Some apps are offered at a cost but Baby Buddy is free to all. Another important thing is it contains content that can be trusted. Everything in the app has been approved and endorsed by organisations including the Royal College of Midwives and the Royal College of Paediatrics and Child Health. Pregnancy or parenting apps give daily information based on the mother’s pregnancy stage or the baby’s age. No other app straddles pregnancy and birth with content which covers the emotional as well as the physical, which mentions the mother, baby and partner by name which is different content whether or not the mother has a partner and/or is or isn’t breastfeeding, all of which has been endorsed by many key maternal and child health organisations. This means the user gets the right information at the right time. We’ve had a huge amount of input from parents and professionals too. Through this, and with a clear vision of what is possible, we’ve created something that has never been done before. Baby Buddy is unique in its combination of endorsed content, friendly chatty style, its practical and interactive features, and in the ways it is being used. Baby Buddy has also been designed to be used as a tool by healthcare professionals to both support and complement their work. We have been working with local areas to actively embed the app into care pathways.

Is it easy to use?

Yes, installing the app on to your phone could not be easier and only takes a few minutes. Anyone can access it – mums or dads, health or social care professionals, peer supporters and other charity workers – as long as you have either an Android phone – in which case visit this, or an iPhone – in which case visit this link. Everyone who registers gets access to all the app's features. We ask that people please register as who they really are not as who they are imagining being. We are (as an anonymised dataset) keeping track of who is using Baby Buddy, where in the country users are and (if they complete the in-app questionnaires at 7 and 8 weeks) what they think of it. For example, we are keen to see how many midwives, health-visitors, paediatricians, obstetricians, psychologists etc are using it in different parts of the country. So, tempting as it may be to go in as a 19 year old pregnant woman when you are an interested professional, please register with your real age and profession. Once you are registered you'll end up having exactly the same experience as the 19 year old pregnant women you have in mind when testing the app. The in-app data will help us get the app ever better. We've only released the 1.0 version and this will be a multi-year project informed by in-app and site-based evaluations. Our web page has it all spelled out here. The app itself is very visual, and uses lots of images and video clips. Many mums who have been giving us feedback tell us how much fun it is to use the avatar, which can be customised. There are well over a million different avatar Buddies you can create, each with their unique combination of body shape, skin tone, eye shape and colour, nose, lip shape and colour, outfit and hairstyle, and if the user chooses, virtual earrings, necklace and sunglasses.

Why do mothers need an app when we have so much information on the web available?

Very few young parents with babies are far from their smart phones these days and it makes sense to deliver key messages and support to them in this way. Mums have been telling us that, frankly, they are overwhelmed by the amount of information out there and searching the web for an answer is a minefield when you don’t know if the source can be trusted or not. Baby Buddy has a fantastic Ask Me function that gives them answers to all their questions on pregnancy, birth and parenting, as well as a “what does it mean?” feature. But Baby Buddy does more than give information, it is also highly interactive. This means as well as sending regular messages with timely reminders, daily alerts and video advice, it also enables the parent to set goals, manage health appointments and find local groups and resources via a map. A phone app is a great way to reach out to younger mums, who as a group are among the highest users of smartphones. Younger mums may not always be accessing health services in the same way as older mums, so it provides a way to connect them to a resource that maintains regular contact and alerts.

When will it be ready to install on my phone?

Right now! Version 1.0 is available to install. Visit the web page now to install it. I would actively encourage everyone to download and use it. We are seeking feedback from parents and health and social care professionals ahead of the official launch in mid-November 2014 to make the app even better. When you install it you’ll be asked to give feedback in the app and you can also email us directly. We are particularly keen for multi-disciplinary healthcare professionals to understand its functionality and content, so they can recommend it to the families they support, and use it in appointments. When you register as a user, just choose the options that fit you best.  This way we can separate out feedback from parents and professionals. I really would be delighted to hear any suggestions anyone has for additional content for example new FAQs for the “Ask me” function via: hpapps@bestbeginnings.org.uk. Midwives may even want to rate it and write a review of it on Google Play or iTunes App Store. The more reviews there are for parents-to-be and new parents looking for help, the easier it is for them to decide if Baby Buddy is worth downloading. So if you’re readers, (after using the Baby Buddy app), want to take a few minutes to write a review that would be wonderful.

How are parents going to hear about the app?

Well, there are lots of ways and your readers can play a big part in this, if they wish!

1. Special posters and postcards are available to display in areas where pregnant and new mums visit, and they can be downloaded or ordered free of charge here!  Some areas are putting the leaflets in pregnancy booking appointment letters and other maternity services are working with us to develop ideas on integrating the app into local maternity and children's care pathways.

2. We have a social media campaign building on Twitter using @babybuddyapp @BestBeginnings and @AlisonBaum and we are very keen for you to get involved. We are a growing 'family' and would love you to be part of it! See the video below...

3.  We are planning a press launch on November 19th 2014 - so please do join in the Twitter and Facebook chat, and let us know if you would like your local area to be part of the press launch. Email us at hpapps@bestbeginnings.org.uk

Is the app complete?

No not at all, we are very much at the beginning of a multi-year journey.

We have an abundance of helpful content in the app, but we are constantly looking for more Questions and Answers for the "Ask Me" function and I am always keen for suggestions, all of which have to be endorsed by our team of experts before inclusion. We are also in the process of making more than 100 new films to go into the app which will include everything from young mothers preparing simple healthy meals, to mums at antenatal classes talking about what they get out of them, films about creating wellbeing plans, creating birth plans, films about active labour, about baby communication, spotting a sick child and much much more. We are actively recruiting young pregnant women and young mothers from across the country who are happy to be filmed during their pregnancy and/or their baby's first months. We are also keen to recruit and film mothers with older children who experienced mild, moderate or severe mental health problems to tell their story retrospectively, with the purpose of raising awareness, destigmatising and informing app users about mental health and wellbeing.  For more information please see the dedicated webpage on our website. We'd be delighted to hear from healthcare professionals working with young parents or from parents themselves.

In addition to new content coming on board, we are also adding in new features to Baby Buddy. Within the next few weeks three long-awaited features will go “live”:

Bump Around/Baby Around: this new feature helps users of the Baby Buddy app to find local services and classes based on their locality, using a map. The aim of this feature is to use technology to increase social capital by supporting more young mothers to attend classes and use local services.

Bump Book/Baby Book: this new feature allows users to keep their own private diary with photos, thoughts and reflections. Users can, if they choose, share individual daily entries with friends and family and their wider network). In creating this feature we have created a reflective space within the app to support mind-mindedness and the emotional transition to parenthood. Our aim, in the future, is to create a way for users to easily make a hard-copy version of their Bump or Baby Book if they choose.

Text to voice: that users will be able to tap a button and their Buddy will speak her message to them

Here is a special message from me about how you can play a key role in this project and make a difference to babies' lives in the UK. Thank you!

Here is a special message from me about how you can play a key role in this project and make a difference to babies’ lives in the UK. http://vimeo.com/101627566 Together we can make a difference for future generations. Thank you! PS: If you want to find out more about the dad’s app I mention in my special message click here.

For my Four

Between the moment you were not and you were, I gasped.

The breath was the one before love struck. Like never before.

And into my arms each one of you came, and into my heart and my soul.

None more, nor less. All the very same.

It was then I really understood my own mother.

It’s just how it is.

 We will never walk on equal plains, you and I. Because this love isn’t reciprocal.

Not to be undermined, or misunderstood.

When you feel joy, my heart sings. Your frowns cause a crumble that can’t be controlled.

It’s just how it is.

And that’s why my step is not far from yours, even though I urge you to fly.

 It’s just how it is.

In one moment, I would give all up for you. 

In the end, I ask for nothing, but that you know.

It’s just how it is.

For Anna, James, Tom and Oliva by Sheena Byrom

What I think about birth centres: an interview

Laura Iannuzzi is an Italian midwife, currently studying for a PhD at Nottingham University in England.  After qualifying as a midwife in 2001 Laura has worked in different areas of practice, and since 2004 Laura has been employed by the University Hospital of Careggi, latterly at the Margherita Birth Centre.  Laura's research topic for her study is 'An exploration of midwives' approaches to slow progress of labour in English and Italian birth centres'.

Laura emailed me and asked if she could interview me about my thoughts on birth centres-not for her study, but because she is interested in the relative success of birth centres in England. I agreed of course, as I usually interview others!

Dear Sheena, first of all thank you very much for your availability for this interview. As you know, this is for me a great pleasure and honour; you are indeed largely recognised as an inspirational midwife inside and outside UK. And it is quite intuitive to see why, given your apparent innate ability to communicate the beauty of midwifery, to capture and amplify voices of women and midwives from all over the world, to show that change is actually possible wherever, and to support any initiative aimed to improve midwifery practice, education and research.

We could discuss about many things, but today I would like to talk with you about birth centres and their management, taking the most from your experience. You worked in fact as Head of Midwifery in the East Lancashire Trust where your played a key role in the establishment of the Blackburn Birth Centre, one of the most successful freestanding birth centres in England.

1. As someone might not be familiar with the language and the models, how would you define/describe a birth centre? What are the main features that differentiate a birth centre from other birth settings (e.g. hospital labour ward, maternity houses, home)?

Thank you Laura. What an introduction…I am flattered and grateful, yet as always I am taken aback….

It’s a pleasure to answer your questions!

Birth centres are places where women who have no expected complications can go to give birth, in a calm, non-medical environment, to be cared for by midwives and support workers. There are two types of birth centres, Alongside Birth Centres (AMU) are situated on the same site as an obstetric unit, and Freestanding Birth Centres (FMU) are in a separate building to a hospital, in a community setting. Birth centres should be managed by highly skilled midwives, who carefully monitor women in their care, and encourage and support them to give birth at their own pace, with minimal interference.

In an attempt to describe my thoughts on how birth centres differ to hospital (obstetric unit) birth facilities, I want to tell you about a period of my midwifery career. During the 1980’s I worked for 9 years in a ‘maternity home’, which was the same as a birth centre, except the woman’s GP (family doctor) came to the birth. The maternity home was several miles away from the host hospital, so was ‘freestanding’. Working there taught me how to be a midwife, in the truest sense of the word. I learned from experienced midwives and the women who laboured and gave birth there. There were no electronic fetal monitors, and so I became proficient in using my midwifery skills, my eyes, ears and intuition to give safe, high quality maternity care. I saw women labouring un-interrupted; it became second nature to me to support normal physiological childbirth, and to witness the immeasurable joy and satisfaction of parents as they met their baby for the first time. They did it themselves. We had a progressive manager (Pauline Quinn OBE) who introduced birth mats and birth stools (this was in the early 1980’s)…women rarely used the bed except for resting and sleeping. As I mentioned, this was early in my career, and whilst I had witnessed ‘normal’ birth previously, it was in a hospital setting where women laboured on their backs, on beds that resembled those in an operating theatre. Normal birth mostly happened by chance in the hospital, for example if the woman came in advanced labour or was multiparous, or as a result of the midwife’s strategy to protect the woman from the rigid policies and protocols of active management of labour (O’Driscoll and Meagher 1986). When I returned to the hospital to work after the maternity home closed, I saw that there had been a radical shift in the way women were being cared for. Epidural anaesthesia for pain relief had been introduced, and caring for semi-paralysed labouring women was new for me. I felt like a nurse again, in in a critical care environment. From that time (1990) until now, I have witnessed first hand the increasing medicalisation of childbirth, where pregnancy and birth are pathologised, and risk averse practice dominates. Fear prevails, both from the maternity care workers perspective, and women using the service. Yet maternal and fetal outcomes have not improved during that time, indeed, there is growing concern of potential iatrogenic harm as a result of unnecessary medical intervention (Dahlen et at 2013, Renfrew et al 2014). I must be clear at this stage, that some interventions in childbirth are crucial, and life saving. The task we have in maternity services is identifying those women who really need it, not treating every pregnant woman ‘just in case’.

So birth centres for me provide the space for women to give birth safely and with the least interference, and they act as a catalyst for change.

2. What does it mean that birth centres are midwife-led structures?

It means that midwives, experts of normal physiological childbirth, provide care for childbearing women who don’t have expected complications, in an environment that supports them to labour and birth undisturbed. The midwives should be appropriately skilled, and able to recognise any deviation from the normal and respond and refer appropriately. Safe transfer of care, where collaboration and respect is the prevailing culture within the reciprocal service, is crucial.

3. Why should women and their partners consider a birth centre as place of birth for their baby?

The large study in England (Birthplace) revealed that birth centres are safe for mother and baby, and that giving birth in a non obstetric unit setting significantly and substantially reduces the chance of having an intrapartum caesarean section, instrumental delivery or episiotomy. These are crucial considerations, given the increasing Caesearian section (CS) rate, consequential potential iatrogenic damage, and financial costs. A recent Lancet paper (Renfrew et al 2014) cited a WHO study (Gibbons et al 2012) that estimated 6·2 million unnecessary Caesearean sections were being performed in middle and high-income countries. Avoiding unnecessary intervention in pregnancy and childbirth has been shown to lead to better outcomes for women, they have a quicker recovery and there is improved satisfaction (NCT, RCM, RCOG 2012). Women experiencing a normal birth are more likely to breastfeed, will require less postnatal care and are less likely to visit their doctor with postnatal complications.
Being afraid of childbirth is another important consideration (Ayers 2013), and documented reports of disrespect and abuse add to the picture (Birthrights 2013). However, women giving birth in midwife-led settings report feeling more satisfied with their birth experience, and that their birth positively influenced the way they felt about themselves (Birthrights 2013).

4. Do you think organisations should invest in birth centres? Why?

There is robust evidence that obstetric unit birth is not appropriate for women with low risk pregnancies. If women are more likely to have a normal physiological birth in a birth centre, and normal birth is a public health issue (Sandall 2004), then organisations should provide these settings for women with low risk pregnancies.

In addition, planned birth at home, in a freestanding midwifery unit, or in an alongside midwifery unit generates incremental cost savings compared with planned birth in an obstetric unit (Schroeder 2012). Further, occupancy rates for freestanding midwifery units (30%) were under half that of obstetric units (65%) and much lower than alongside units (57%).

5. As you probably know, while in Italy birth centres are still a rarity (it has been reported around 4-5 in the whole country) in UK there is an increasing presence of these models ( > 100). How would you explain this phenomenon? What factors contributed, in your opinion, to the onset and development of these midwifery models of care in your country?

Intuitively and anecdotally, midwives have always known that out of hospital birth is safe, and more satisfying for mothers, families and midwives. Because of this, midwifery innovators and leaders have striven to establish birth centres, and to promote and support home birth. The difference now is that we have strong, clear evidence to back up the knowledge.

Globally, maternity care workers and politicians are becoming increasingly aware of the human and financial costs associated with the escalating unnecessary intervention in childbirth in high and middle-income countries (Renfrew et al 2014). Because this can be addressed by providing midwife led settings for women to give birth, the draft Intrapartum Care NICE Guidance (2014) is advising low-risk nulliparous and multiparous women to plan to give birth in a midwifery-led unit (freestanding or alongside) as the rate of medical intervention is lower and the outcome for the baby is no different compared with an obstetric unit.

Maternity care leaders also considered midwifery skills. If midwives only work in obstetric led settings, with increasing unnecessary intervention rates, the skill and expertise needed to facilitate normal physiological childbirth become diluted. This compounds the already potentially catastrophic consequences of unnecessary intervention in childbirth (Dahlen 2013).
To demonstrate the reality of this phenomena, here is an exert from a letter recently sent by a student midwife in England, to the Royal College of Midwives (RCM), raising concerns about her lack of exposure to normal childbirth:
[I became very disheartened and concerned about my own experiences. As a student midwife, I completed my second year of training after having witnessed and participated in 52 caesarean sections, 16 instrumental deliveries and very sadly, only 11 normal deliveries. I can vouch for the fact this story is not unique and many students are having a chronic lack of exposure to normality. In fact what the ICM (International Confederation of Midwives) and RCM seemed to call 'normal', to me seemed like a fantasy, not the world in which I was training and learning. I was saddened to realise that I'm now a third year student and have never used intermittent auscultation in practice and have never seen a women give birth off her back].

I believe this is unacceptable.

6. It is a common belief, especially among those who would not advocate for birth centres, that these models are too expensive (and we know that none can ignore the global financial crisis) and provide care just to 'small privileged groups of women' compared to traditional hospital models. What is your opinion and experience about that?

The Birthplace study mentioned above provides evidence that centre birth is less expensive than obstetric unit birth, taking all aspects of the care of mother and baby into consideration. In East Lancashire in northern England, 30% of women give birth in a birth centre, and those women are from culturally and socially diverse communities. We cannot ignore the evidence we have of potential harm if we do not provide these services; nor the emerging evidence (Dahlen et al 2013). The issue of women using  birth centre facilities if available is an important one. Pathways of care must support women making a decision to give birth in a birth centre, with midwives who work in them providing the information. I know this is one of the reasons why the birth centres at East Lancashire Hospitals mentioned above are so successful. 

7. Given the international problem of the shortage of midwives, denounced by many organisations including the International Confederation of Midwives, it seems important both to lobby for more midwives for women and families, and to use the current resources at their best. In this situation, directors and managers might prefer to 'centralise' midwives in big labour wards rather than encourage their employment in new/different units... Did you come across this kind of debate? Do you think there is a room for birth centres in time of crisis? Why?

Yes, since the 1950/60s there has been the desire to centralize maternity care into hospital in the UK, and more recently reconfigurations of maternity services has seen the amalgamation of smaller maternity services into larger, centralized units. However, national policy drivers (DoH 2007) directed services to offer the choice of midwife led facilities, and the response has been positive with an increase in the number midwife led establishments (see BirthChoice UK chart below).

Other countries such as Catalonia are paying attention to the importance of childbirth as a measure of societal health, and to prioritise midwife led care, and choice (Escuriet & Oritz 2014).

The Birthplace Study is clear that it is less expensive for low risk women to give birth in a birth centre, which included the number of midwives needed to care for them. In fact, given the evidence of increased unnecessary intervention for low risk women giving birth in hospital, there are financial considerations for this. The model of midwifery care in all settings needs to be flexible and responsive to the need of the service, and there is no ‘one size fits all’. However, the general principle that the midwives ‘follow’ the women, i.e. they are able to work in all settings, helps with workforce planning and promotes safety.

8. Always connected to the shortage of midwives, anecdotally, some organisations seem to assume that as midwifery-led units are caring about low-risk women, there is less need for midwives than in obstetric units. What or who establishes the number of midwives needed in a setting? What are the criteria you used or you would suggest to calculate, even within a limited number of midwives, the minimum acceptable staffing especially thinking about birth centres?

I asked the Head of Midwifery, Anita Fleming, from East Lancs Hospitals NHS Trust in England (mentioned above) to help with this question, and her service provides 3 birth centres with 30% of women giving birth in the facilities. Anita said:

[Birthrate Plus (Ball et al 2013) provides guidance for midwifery staffing; it is advantageous to calculate the numbers of midwives needed for your service overall and not necessarily how those midwives are allocated to each area. Professional judgment is essential, and will depend on several things such as number of birth rooms and also on what other activity goes on there, in addition to birth. There needs to be enough staff to provide one to one care in labour and to retain safe numbers if a midwife goes on a transfer.  We have a lot of other activity in our BC’s (checks, clinics, immunisations etc) to make best use of the midwives time when unit quiet; it isn’t appropriate for midwives to be sitting round waiting for women in labour. NICE is currently developing guidance staffing guidance for maternity settings which should be out for consultation in October / November this year, prior to publication of the final guidance in January 2015].

9. What are the current features you think should be reduced and which increased in order to improve maternity care?

I am quite clear about this Laura. I think today’s maternity care systems are focusing so much on preventing risk, that they are blindly increasing it (Dahlen 2014). I believe we should try to reduce the ‘tick box’ culture, which focuses on ‘it’s done’, rather than trying to give individualised care based on building compassionate and trusted relationships both with women in our care, and all members of the maternity team. We are processing women through a strangled system, all the time being reminded to ‘protect ourselves’ against litigation and recrimination. This leads to fear and defensive practice that potentially increases serious harm. Governments and maternity care providers should examine the evidence and respond appropriately, and assess their maternity service on the global Framework for Quality Maternal and Newborn Care [see below] (Renfrew et al 2014). Leaders must also remember that where resources are limited, unnecessary medical intervention is more expensive, and financial costs unsustainable.
What is more important than the birth of a baby?

10. As you know, midwifery-led care and midwifery-led models where midwives work autonomously are highly supported by evidence but may be poorly supported in the reality of daily practice. I have in mind many realities in Italy where brilliant midwives are struggling with a highly-medicalised culture, but this seems to be true also in other more midwife-friendly environments, such as the English one. What are the facilitators and what the barriers to translate evidence?

In believe the key to the success of midwifery led models is for midwives work collaboratively with medical and academic colleagues, and to build trusted relationships. This approach, where possible, reduces the polarisation of models of care, where no-one benefits, least of all the woman and family using maternity services. For this to happen, all parties have to be willing to understand the part that they play in ensuring safe maternity care, and to respect and appreciate each other’s roles and philosophies.

11. Would you like to send a message to all the Italian midwives, especially to the ones that are currently struggling in seeing positive signs for the future of midwifery?

The maternity service where I worked has recently been awarded Maternity Service of the Year, by the Royal College of Midwives. Within the service there are 3 birth centres and an obstetric unit, and 6,500 babies are born each year. It wasn’t always like this. I remember times when we felt desperate-the climate was oppressive and hierarchical, and there was little hope for a positive future. A few of us were strong. We had passion and believed in woman centred care. We engaged academic colleagues who helped us to find and articulate the evidence, and were determined to change. The strength of leadership was changeable, so we tried to lead ourselves, and it worked. This took many years, it didn't happen over-night, and there were many disappointments!

Remember the change needs to start with you-don’t wait for others to do it.

Laura Iannuzzi can be found on Twitter

References (unlinked)

Ayers, S. (2013). Fear of childbirth, postnatal post-traumatic stress disorder and midwifery care. Midwifery 30:2 Feb pg 145-8

Dahlen H (2014) Managing risk, or facilitating safety? International Journal of Childbirth Vol 4, Iss 2

Department of Health (2007) Maternity matters: choice, access and continuity of care in a safe service. DoH London

O'Driscoll K, Meagher D (1986) Active Management 2nd Ed. London: Bailliere Tindall

Sandall J (2004) Normal birth: a public health issue Practising Midwife Jan 7 (1) Pp 4-5

Additional reading:

Coxon K (2013) Freestanding Midwifery Units: local, high quality maternity care RCM publication
https://www.rcm.org.uk/sites/default/files/FMU%20Mythbuster%20-%20Web%20Final.pdf

The Lancet Midwifery Series: by a 'Midwife's Midwife'

At the end of June, and amidst a flurry of excitement and extensive publicity,  the much awaited Lancet Midwifery Series was launched.   The Series, produced by an international group of academics, clinicians, professional midwives, policymakers and advocates for women and children, is the most critical, wide-reaching examination of midwifery ever conducted. The papers systematically summarise the current global picture of maternal and infant health, and provide a framework for policy makers and maternity providers to maximise potential for improvement.  

The Series also highlight key issues on the role of midwifery in the world today, and challenge much of the current thinking and attitudes about it among health professionals and decision makers.

For me, the papers have given us the additional tools to enable and strengthen the drive to lobby for change. The paradox of lack of timely and coordinated life saving interventions in some countries, and over-use of the same interventions in others, needs to end.

Dutch Midwife Petra ten Hoope-Bender , who works as the Director for Reproductive, Maternal, Newborn and Child Health at the Instituto de Cooperación Social INTEGRARE (ICSI) in Barcelona, Spain, co-ordinated The Lancet's Series on Midwifery. I was recently connected to Petra, via Soo Downe, and after reading about her here, felt it would be great to ask her about her role, and about what she hopes her work will achieve.

Hi Petra, thank you for so willingly agreeing to be interviewed for my blog. I know how busy you are! I think many individuals will be very interested to hear about the role you played the development and co-ordination of The Lancet Series on Midwifery, recently published.  Would you introduce yourself please, including a little about your professional background?

I'm a midwife by trade and held an independent midwifery practice in Rotterdam for 12 years before moving into the area of international health. I started as Secretary General of the International Confederation of Midwives in 1998 and later I moved to Geneva to start the Partnership for Maternal, Newborn and Child Health.

Could you explain briefly what the papers are, why and how they were developed?

The idea for a series on midwifery started during the development of the State of the World's Midwifery 2011 report, when the author team realised there were many gaps in evidence about midwifery that urgently needed filling. They approached Zoe Mullan and Richard Horton of The Lancet to find out whether they would be interested in publishing this and received a positive response. There were many topics suggested for inclusion in the series, but after several discussions the content settled down around the four topics we have now. These include an evidence base for quality maternal and newborn care from the perspective of women and newborns that expands the notion of what needs to be provided to how and by whom. It sets out an evidence based definition for midwifery and measures the impact of the lives that can be saved by the midwife working to her full competence and scope of practice. The series also identifies the steps that some countries have successfully taken to deploy midwives and thus reduce their maternal and newborn mortality and finally provides an international policy brief that calls for effective coverage (coverage + quality) of midwifery care and shows how this can contribute to the achievement of international targets and initiatives.

What was the extent of your involvement?

I was the coordinator of the series as well as the lead author on ' The improvement of maternal and newborn health through midwifery'. I was also a co-author on two of the other papers in the series.

If midwives or maternity care workers want to influence political agendas using the series, what advice could you offer them?

The first step would be to lay their maternity services against the Framework for Quality Maternal and Newborn Care to see where the differences are and then identify what the most important issues are in their services that they would like to change.

These can be changes in the midwifery curriculum, or in the way the profession is regulated, but they can also be about service delivery and how the care providers are enabled to provide respectful care that optimises normal processes and strengthens women's capabilities to take care of themselves and their families.

What impact do you hope the papers will have? Has there been any influence so far?

The series has already gathered a lot of support and positive responses. We have started a website called Solution98 where we explain for the general public, what the series means and what they can do to support the provision of such quality services in their health system and facilities. There have already been quite a lot of requests for support and even accreditation of facilities to this new standard of care. What I hope most for the future is that women will understand what we're talking about and start demanding this kind of care for themselves and their families, friends, colleagues. Without the voices of women, the effort to improve maternal and newborn care will remain in the realm of the health care providers and will not be half as effective.

What are your plans for the future Petra? In the near future we're working towards inclusion of the messages and the framework from the series on midwifery, to be taken up and linked with the work on reducing maternal and newborn mortality world wide that is currently being pushed by the UN and its partners in large initiatives such as the Every Newborn Action Plan, Ending Preventable Maternal Mortality and the discussions about the post 2015 sustainable development agenda. But this series is not written for low and middle income countries only. It is as important for high income countries where overmedicalisation threatens normal pregnancy and childbirth and where midwifery is under pressure.

Petra, this work gives us hope for the future, and is a pivotal element of the momentum for radical change. Women and their children will benefit as a result of the recommendations, when they are appreciated and implemented. Women and families, together with midwives and all maternity care workers around the world are thankful for the expertise, time and energy you and your esteemed colleagues have given to addressing the issues that they see, hear, feel and suffer from on a daily basis.

And now we must speak out.

Petra's email address is: petra.tenhoope@integrare.es

Find Petra on Twitter at: @Ptenh

'Keep fear out of the birth room': an interview with Professor Hannah Dahlen

When I first heard Hannah Dahlen speak, it was in Grange-over-Sands, England, at the Normal Birth conference. Hannah gave a talk on the 'Juggernaught of Intervention', describing the potential consequences of unnecessary medical intervention in childbirth,  and  I was hooked. Each of Hannah's words rang true to me, I was, and still am, concerned about the ever increasing focus on 'risk' in maternity services, and the impact this is having on childbearing women and those caring for them.    Since then I have followed Hannah's brilliant work, via academic publications, with enormous interest. After the success of interviewing Prof Soo Downe OBE and Dr Helen Ball, I asked Hannah if she would be willing to participate too. I am thrilled that she said yes! Hello (or G’day!) Hannah! Thank you for agreeing to be interviewed... could you introduce yourself, please?

Hi Sheena, my name is Hannah Dahlen and I have been a midwife for nearly 25 years. I am currently the Professor of Midwifery at the University of Western Sydney, which is in NSW, Australia. I am also a practising midwife and I work with five other lovely midwives (Robyn, Jane, Janine, Emma and Mel) in the largest private group practice in NSW, called Midwives@Sydney and Beyond. I provide continuity of care for women throughout pregnancy, labour and birth and for six weeks following the birth. Around 90% of our women give birth at home. I am also the national media spokesperson for the Australian College of Midwives, which means I can be woken up as early as 5am to tiptoe through political landmines as I try and represent midwives in the best possible light. Once I did a radio interview at 4am and had a very funny time talking to truckies about birth, as apparently they are the only ones awake at that time. I am also on the executive committee of the NSW branch of the Australian College of Midwives and I have held this position for 17 years.

When did you realise you wanted to be a midwife? 

I don’t remember realising that I wanted to be a midwife because I can’t remember ever wanting to be anything else. My mum was a midwife and I grew up Yemen, where I was also born. My earliest memories were being cordoned off in a playpen in the corner of the clinic with a kidney dish and tongue depressor to play with as my mum worked. I also remember being sat on a tin in a backpack so I could see the countryside as mum and dad trekked into the villages to vaccinate people. Because I was so blond and fair skinned and had vivid blue eyes the Yemeni people found me fascinating and my hair was always being pulled to see if it was attached to my head. When I squawked in protest they concluded I must be a wizened up old woman with white hair. But of course there was a moment that I knew without a doubt the kind of midwife I would be when I was 12 years of age. My next door neighbour gave birth to her third child and I helped the local midwife catch the baby. When my neighbour saw it was another girl she turned her head away and said , ‘take it away.’ She feared that her husband would divorce her or take a second wife as she had not produced the much valued son yet. I remember carrying this perfect little girl, which they named Hannah after me, to the window as the dawn was breaking and the minarets began their melodic calls to prayer. I remember as girl on the brink of womanhood feeling both spellbound by the miracle I had witnessed and outraged that girls should have less value than boys. I knew then that you could not be a midwife without fighting for women’s rights and that was when I think the political passion I consider inextricable from the job of midwifery was born. I believe if you are apathetic about women’s rights then you are not cut out to be a midwife and if you are frightened to be political then choose another career.

What does a typical day in your working life look like?

Gosh, I have no typical day, as that sounds too much like the definition of boredom. My life is often very eclectic and unpredictable. I get to work about 9am after putting my youngest daughter on the school bus and then I might be doing several things, such as teaching, undertaking research, going to meetings, answering telephone calls from journalists or the women I care for. I have lots of wonderful PhD, Masters and Honours students who give me such delight, as I love growing the future of our profession, and they are indeed the future. I might end my day with a postnatal or antenatal visit in a woman’s home, and if I get called to a birth it is usually at night. I have only had to get someone to fill in for me once in the past four years of being on call because a woman gave birth when I had a lecture on. Once back home I do what all mothers do: get the dinner on, nag about homework, listen to stories of the day and hopefully collapse on the lounge to watch Call the Midwife with my daughters, or Modern Family, which is another favourite.

I am a great advocate of your work on how the ‘risk agenda’ is influencing maternity care. Can you tell us why this is so important to you?

Fear is ruining birth and we have to stop the fear. When I am asked what I do as a midwife I say my job is to keep fear out of the room. I knit at birth now and work very hard to keep fear at bay in my own practice. I left the hospital system after 20 years of practice because I recognised I had become undone by the fear that was manufactured around me and I was no longer providing women with the best care. Now that I work in private practice and out of the system, supporting women mostly to give birth at home, I have re-found my faith in birth and realise it is not birth that is dangerous, it is us! I love working with midwives on how to put risk in perspective and manage the fear that is so endemic in our maternity systems. We need to make friends with fear and work out when it is protecting us and when it is destroying us. We also need to stop blaming women for their fear as I think the models of care, attitudes and language of health professionals are most to blame. I love watching women give birth without fear now, surrounded by love and trust. Women are so amazing and we are so lucky to share this magic journey with them and their partners and families.

We have a situation where maternity services are focused on risk reduction, and yet outcomes aren’t improving. What do you think the answer is?   

Get women and midwives out of the hospital. Move back to primary health care, community based models. Give every woman a known midwife and make relationship based care the priority. I often say to my students the largest organ involved in childbirth is the brain not the uterus. If you want the uterus to function well then start working with the brain. Value women and value birth. Base practice on evidence and make health services accountable to the evidence and provide cost effective care. In Australia we have been calling for private obstetricians to make their caesarean rates public so women know when they are cared for by a doctor with a 90% caesarean section rate. In my country I think this would have a big impact on our caesarean section rate which is nearly double in the private sector. Lastly, and most importantly, if women are to trust in themselves and birth then surely those caring for them need to trust in women and birth.

What other areas of maternity care are you interested in?

Just about everything, this is my problem. My mother always said the worst thing you can do with Hannah is make her bored. I can promise you one thing there is nothing about being a midwife that is boring. I say my job is perfect because I combine teaching, research, clinical practice and politics together. I would hate not to believe in what I do and I really, really do believe in the amazing job midwives do. I would love to see my colleagues hold their heads up high and say ‘I have the most amazing job in the world’, after all we usher in the future! I really love history as well, as I am convinced that the past has much to teach us and some really good midwifery practices happened in the past. This is why I chose to undertake a randomised controlled trial looking at the effect of perineal warm packs in second stage for my PhD, as it was branded an ‘old wives tale’ with no evidence to support it. This so called ‘old wives tale’ is now Level 1 evidence. It does give me a thrill that amidst all the ‘machines that go ping’ a midwife can hold her head high as she walks down the corridor with a bowl of steaming water and flannel to give a woman in second stage comfort. I am also very interested in how birth is shaping society and founded the group EPIIC (Epigenetic impact of Childbirth) with Professors Soo Downe (UCLAN) and Holly Powell Kenney (Yale) in 2011. I think this is where we need to really channel our energy in the future. If the way we are born is re-shaping society, which is increasingly looking likely, then we need to urgently get the message out before it is too late.

What are your plans for the future Hannah?

I never think about the future and I never really have. I never thought I would do a PhD - I kind of fell into that. I never thought I would be a professor and that just seemed to happen. I believe in doing what I love and believing in what I do and whatever eventuates usually is a good thing. But most important of all you sleep well at night when you adhere to this philosophy - that is if the phone doesn’t ring to call you to a birth of course. Best of all I can honestly say I have no regrets. Every part of my life, even the sorrows and mistakes have made me who I am and provided me with such valuable lessons.

And lastly, what inspires and motivates you to be proactive what you do?

Women’s rights motivate me and making the world a better place.   None of us should come into this world and leave again without making the world a better place. Until we do right by women and recognise, value and facilitate their amazing role in society then everything we do will be incomplete. The hand that rocks the cradle does rule the world whether the world is willing to acknowledge it or not. When every girl baby is born into the arms of parents who want her as much as they want their sons then we will be on the way to bright and certain future. In many ways I feel today that I am still that 12 year old girl standing by the window in the dawn light gazing at that perfect little girl, spellbound and outraged but always full of hope that we are on the way to a brighter future.

Hannah, thank you SO much for taking time to tell us more about yourself! It's such an honour having your input into my blog….I am thrilled!

You can follow Hannah on Twitter:  @hannahdahlen

And her website: http://www.uws.edu.au/fach/fach/key_people/associate_professor_hannah_dahlen

Photograph by Holly Priddis

How do health professionals use social media?

 

In preparation for an article I am writing for a midwifery journal, I decided to conduct a short survey to ascertain why health care workers use social media in a professional capacity.  The survey ran from 10/4/14 until 27/4/14, and was disseminated via Twitter and Facebook.

321 individuals responded, and the brief results are outlined below. The full article will be published in June edition of MIDIRS as the Hot Topic, authors Sheena Byrom and Anna Byrom

The questions asked were:

1. Do you use social media for professional reasons?

2. Please indicate your profession

3. In what country do you currently reside in?

Respondents were from Australia, Brazil, Canada, England, Ireland, Netherlands, New Zealand, Northern Ireland, Scotland, Spain, Switzerland, USA, UK, Wales.

4. Which social media network do you prefer?

5. How often to you log into social networks?

6. If Facebook is your preferred network, what are the benefits to your professional role?

These included widely used, networking, sharing, support, with a significant amount using private communication through closed groups. Even though the question wasn't asked, several respondents mentioned the fear of  recrimination.

'Posting information to my audience, getting them involved by comments. They get to know me and recommendations come from being known' Participant 2

7. If Twitter is your preferred network, what are the benefits to your professional role?

Benefits included fast responses, more professional than Facebook, access to wide network of individuals and groups,  connecting with other professionals, flattened hierarchy (access to leading professionals), support, sharing, global contacts, easy to use.

'Enables conversation - debate - information and knowledge exchange- encourages active student engagement - modelling professionalism - relationship building and networking' Participant 161

8. Please rank the benefits of your social media use

9. Please give examples of how social media has helped you in your professional role.

The responses further elaborated on the above factors,

'Connecting with health professional who have enabled me to reflect and learn Increasing my professionalism Enabling me to have a voice and communicate my value' Participant 98

'It helped launching CenteringPregnancy in the Netherlands! Connections with obstetrians outside my area. Enlarged my view on midwives, emancipation, women, public health etc' Participant 107

I would like to sincerely thank all those who participated in the survey.

Help to connect more midwives around the world (and be a ‘Twitter Buddy!’)

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19th March 2017

This is an update of a post written three years ago - prior to the ICM in Prague. It was an attempt to connect midwives all around the world - and we're still on the journey! As the next Congress approaches, shall we aim to double the numbers? Let's try! Please read instructions below - and if you want suggestions on who to follow, check out the list on names - all linked. 

With the International Day of the Midwife imminent, and the countdown to the International Confederation of Midwives 30th Triennial Congress (ICM) from 1-5th June, I want to try to engage with midwives around the world, to encourage and support them to connect through Twitter. I started ‘tweeting’ approximately 18 months ago, and I haven’t looked back. Here’s a glimpse of what Twitter does for me.

Nurses and midwives are generally reluctant to use Twitter. Not Facebook, just Twitter. Yet those using it can’t imagine life without it-Twitter has opened so many doors for them, and offered oodles of support. @WeNurses founder and social media expert Teresa Chinn @AgencyNurse is also a registered nurse, and offers thoughts on her blog why nurses and midwives SHOULD engage with Twitter , and some of the reasons why they don’t!  If you are worried about using social media professionally, then listen to this podcast by Dean Royles @NHSE_Dean  CEO of NHS Employers, as he slays some of the myths.

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IF YOU WOULD LIKE TO JOIN TWITTER, JOIN UP HERE. If you are going to ICM in June, and considering using Twitter, please do so BEFORE you leave home. It will be much easier! If you are a health organisation, and you would like to know more about using Facebook or Twitter, check out Social Media toolkit for the NHS. I have facilitated a midwives chat space for 12 months…@WeMidwives (part of @WeNurses) has gone from zero to 3,133 followers, many from around the world. And now it’s time to really try and engage with more! SO….. Would you be a Twitter Buddy? At the ICM I am charged with sharing the event’s highlights through Twitter and other social media platforms, and I will be producing Storify updates each day. I will also be delivering workshops on using social media, but this won’t include ‘how to’. For that, I need 'Twitter Buddies". Twitter Buddy If you are going to ICM in person or joining LIVEonline streaming, or you are planning to tweet during ICM using #ICMLIVE then read on! I am building a team of  midwife and student midwife 'Twitter Buddies' on the recommendation of social media expert @VictoriaBetton.  If you would like to help spread the advantages of Twitter by sharing your skill with least one other person during ICM week (1-5th June), then I'd love you to be part of the project! Here is the simple plan:

1. If you want to be a Twitter Buddy let me know, via Twitter, using #TwitterBuddy. I'll then add your name below!
2. During ICM week connect and sit with an interested midwife colleague, and show her/him how to use Twitter on a 121 basis. Aim for at least one midwife recruit per day!
3. Tweet me the Twitter handles of the new midwife Tweeters, and at the end of the week the results will be collated.
4. The Twitter Buddy who launches the most midwives on a new Twitter journey will be announced the week after the conference!
5. Direct your Twitter recruit to this blog post for encouragement.

ANOTHER REMINDER IF YOU WOULD LIKE TO JOIN TWITTER, JOIN UP HERE.  If you are going to ICM in June, and considering using Twitter, please do so BEFORE you leave home. It will be much easier!  COME AND JOIN IN THE CONVERSATION And HOT OFF THE PRESS, my daughter Anna Byrom and I have written our first article together. It's about social media, so you may find it interesting! Here it is

 CONFIRMED TWITTER BUDDIES!

1. Anna Byrom @acbmidwife  
2. Shawn Walker @SisterShawnRM
3. Simone Valk @sljvalk
4. @linsyrjls
5. @llisa01
6. Jane Morrow @MorrowJane
7. Cassie McNamara @MamaConference
8. Carmel McCalmont @UHCW_Midwife
9. Jenny Clarke @JennyTheM
10. Nalonya vd Laan @nalonya
11. Sarah Johnson @sarahjohnson222
12. Elly Copp @EleanorCopp
13. Tracey Cooper @drtraceyt
14. Amanda Firth @LaughingMrsM
15. Heather Franklin @Twidmife
16. Midwife Supervision @midwiferyWAHT
17. Lola the E-Midwife Lola_emidwife
18. Carolyn Hastie @CarolynHastie
19. Sara Bayes @SaraBayes
20. Alison Brodrick @AliBrodrick
21. Lizzie Bee @Li33ieBee
22. Pam Wild @pamoneuk
23. @Dashing_d_leo
24. Claire Fryer-Croxall @ClaireCroxall
25. Hana Ruth Abel @Hana_Studentmid
26. Ali Searle @alisearle
27. Karen Yates @karenyatesjcu
28. Lyn Ward @linward
29. Nicky @twixynicky1
30. Anita Fleming @AnitaFleming7
31. Lorna @berrybird71
32. Trudy Brock @TrudyBrock1
33. Geraldine Butcher @gbutcher17
34. NHS Midwife @midwife_foz
35. Anjuli Lord @anjulilord
36. Linda Wylie @uwslindawylie
37. Janet Fyle @consideredview
38. Joanne Camac @CamacJoanne  
39. Jane @Midwife2b0514
40. Claire Omand @clarabell080
41. Mary Stewart @midwife_mary
42. Francesca @Francesca343
43. Hannah Bowater @funking-nora
44. Sarah Johnson @sarahjohnson222
45. Kathryn Ashton @KathrynAshton1
46. Birthing Instincts @birthinstincts
47. Dawn Gilkes  @dawnmidwife
48. Debby Gould @DebbyGould
49. Sarah @sarah_pallett
50. Laura Fyall @LauraFyall
51. Tracey Hunter (need link)
52. Alison Taylor (need link)
53. Elsie b @LesleyBland
54. Alison Power @alisonpower31
55. Aku Bidan, Kamu? @BidanBidanku
56. Linda Ball @BallLinn
57. MaggieMoo @MaggieBakesBuns
58. Mhairi @Stmwmhairi
59. Kate @Dottymom
60. Jude @beetrooter
61. Kylie @smileyhudders
62. Lillian Bondo @LillianBondo
63. Mitra Kadarish @mee_tra
64. Annabel Nicholas @annienicholas68
65. Jenny Clarke @JennyTheM
66. Jacque Gerrard @JacqueGRCM
67. Kelly Stadelbaur @KellyStadelbaur
68. Brigid McConville @Brigid_McC
69. Natalie Buschman @Birthsandmore
70. Jayne Case @jaynecase8
71. Sarah Stewart @SarahStewart
72. Beth McRae @outbackmidwife1
73. M. Michel-Schuldt @emma_von_mumm
74. Vanessa Shand @vshand
75. Julie Wray @JuWray
76. Hari Ani @hunnyhunnymuch
77. Soffa Abdillah @soffa_abdillah
78. Fardila Elba @elba_cholia
79. Kerry Spencer @miffymoffit
80. Macavity @elusivesarah
81. Marjolein Gravendeel @MGravendeel
82. Wendy Warrington @wendywarringto1
83. Nicolette Peel @NicolettePeel
84. Hannah Harvey @hannahharv13
85. Helen Young @helenyoungmw
86. Ashleigh @ashleey_latham
87. Linda Bryceland @LyndaBryceland
88. Claire Macdiarmid @Mcdaddymacswife
89. Janie @janiealalawi
90. Sophie @sophieinpariss
91. Leigh @Leighree
92. Laura Williams @Laura4_x
93. NHS Midwife @NHSmidwife
94. Maria Anderson @MariaAnderson17
95. Louise Randall @LouiseAJRandall
96. Mary Ross-Davie @MaryRossDavie
97. Ans Luyben @luybenans
98. Roa @Roretta
99. Inisial Z @zidemanjaya
100. Jupuut @juliaputriutami
101. Berty @me_b3rty
102. Mel @Mel_meilina
103. Qorin @QorinDias
104. Yennita Maharani @nypinyip
105. Michelle Anderson @michellemidirs
106. Cathy Ashwin @CathyAshwin
107. Jane Pilston @janepilston
108. Kookie Salt @kookie31
109. Joanna Lake @JoLake87
110. Hannah Telford @TelfordHannah
111. Mahasiswa Kebidanan @Mahasiswa_Bidan
112. Sisilh @Hilmasilsil
113. Indira A U_tami @indie_utami
114. Ikka Zullianti @ikkazz
115. Nicola Wenlock @wenlock_nicola
116. Charlene Cole @CharleneSTMW
117. Deirdre Munro @DeirdreMunro
118. Sally Goodwin @Sally5881
119. Sam Halliwell @stmwsam01
120. Ellie Baggott @ElzieBag
121. Sami Joyce @sj_studentmiddy
122. Louise Webster @louise_ann_StMw
123. Lindsay Hill @pixhill
124. Clare Morris @Clarsey
125. Lina Duncan @MumbaiMidwife

Obstetric violence and humanized birth in Brazil

Student Midwife Oli Armshaw @olvinda has written another post for my blog. With others, we have been corresponding by email over the past few days, following the horrific revelation below.  

With sadness and horror I read about Adelir Carmen Lemos de Goés, a 29 year old pregnant woman, in Torres, Rio Grande do Sul, Brazil, being forced by the authorities to have a caesarean, on 1 April.

On 31 March, she had a scan and was examined by a doctor, who said she needed an immediate caesarean as she had already had two previous caesareans, the baby was breech and her pregnancy was 42 weeks.

Adelir, saying she would prefer a VBAC (vaginal birth after caesarean) in the hospital -although there was no staff to support her choice, signed a document taking responsibility for her decision and went home to await labour, with her doula, Stephany Hendz. In the middle of the night, when Adelir was already in established labour, armed police and medical personnel arrived in two military police cars and an ambulance, to force her to Hospital Nossa Senhora dos Navegantes, for a caesarean. In the name of risk to the unborn baby, the doctor had asked judge Liniane Maria Mog da Silva, to issue an injunction to bring her in for caesarean section. She was submitted to surgery by force, against her will. Yesterday, the result of her ultrasound scan circulated on Facebook, showing a gestational age of 40 weeks.

Brazil’s major press, including Globo G1, reported the story on 2April, which you can see here and also translated here.   According to Adelir, "Two military police cars came and an ambulance to take us from our house. I was very anxious. I was all but handcuffed," she said, alleging verbal abuse by police.

Here, you can see Adelir speaking about the terrifying experience of police arriving at her house when she was in established labour, contracting every 5 minutes, and being forced to hospital for surgery. You don’t need to understand Portuguese to see how she feels.

The response in Brazil has been mixed: Most Brazilians do not sympathize with Adelir, the outraged birth activists or the ‘crazy feminists’, who support a mother’s right to make her own choices about birth and risk. But there is a strong, groundswell movement for the humanization of birth, fronted by ReHuNa (League for the Humanization of Childbirth), which considers this brutal incident to be an unacceptable breach of human rights, and is demanding that the Justice Department take action to address it. Peaceful protest demonstrations are being staged on 11 April in São Paulo, Rio de Janeiro, Torres, Belem and across the world at all Brazilian embassies. The UK embassy of Brazil is at 16 Cockspur St, London SW1Y 5BL. For more information please visit: weareadelir.blogspot.co.uk

Birth activists have started a petition on Avaaz, which you can sign here, to oppose the infringement on civil liberty, and extreme technical incompetence of doctors and government. They claim the incident not only breaches the Code of Medical Ethics, but goes against basic evidence: “Labour is a safe and appropriate choice for most women who have had one or more previous caesareans” and “pelvic planned vaginal delivery of breech babies may be reasonable under the guidelines of hospital protocols.” (ACOG Bulletin for clinical practice No. 115, 2010). You can read a full translation of the Avaaz petition here.

A formal complaint has been lodged at the Secretariat of Justice and Human Rights of the Presidency of the Republic by Artemis, a Brazilian NGO promoting women's autonomy and the prevention and eradication of all forms of violence against women. Here, you can see their letters on Ligia Moreiras Sena’s blog. @birthrightsorg have responded with this excellent blog on obstetric violence and use of ‘risk’ to legally justify treating women’s bodies “as public objects subject to the whims of the medical profession backed by the coercive power of the state” (Birthrights, 2014). Read also @KathiValeii’s powerful and passionate blog, ‘The war on women just got bloody brutal’ at Birthanarchy.

As Daphne Rattner, president of ReHuNa points out, this incident has occurred in the week that Brazilians are counting fifty years since the military coup d’etat in 1964, making it all the more grimly poignant that armed police were involved in forcing Adelir to hospital for unwanted surgery. It has Brazilians wondering who will be next to be dragged away by police, and if Adelir or her husband, Emerson, had resisted or reacted, would they have been shot?

Thanks to The Iolanthe Midwifery Trust, I’m going to Brazil for an elective midwifery placement at Hopsital Sofia Feldman, a beacon for the humanized model of care in Brazil, and attend the 9^th Normal Labour and Birth Conference. It’s going to be an incredible journey back to Brazil, the country I adore. I anticipate learning a lot from the brilliant midwives there, who are committed to supporting women to birth their babies where, how, with whom, and when they want; and fighting for an end to obstetric violence of all kinds.

“Humanized Birth”, as Elis Almeida puts it so powerfully in her blog Parto Humanizado no SUS, (translated here) “contrary to what most people think, is not background music and/or low light at birth, but a set of actions aimed at a satisfying birth experience, in which the woman and the baby are the protagonists, where attention and care are fully focused on the mother and baby dyad, and not on the doctor and institution”. A bill was passed by the government on 25 September 2013 legislating for humanized conditions at birth, but ‘what’, asks Almeida, ‘is the point of having a law if it is not supported and enforced by existing policies and practices?’

I trust that Adelir’s case will mark a turning point, a pivotal moment in the ongoing fight against obstetric violence, and catalyse lucidity and urgent action to humanize childbirth in Brazil.

Oli Armshaw @olvinda, April 2014 #NOobstetricviolence

Oli Armshaw @olvinda, April 2014

C/S Photo source

Born to Safe Hands: with a few battle cries

Two exceptional midwives from Bolton, in NW England, decided to plan a conference after being inspired whilst attending MAMA conference in 2013. Joanne Camac and Annabel Nicholas wanted to hold an event to celebrate birth centres, and chose the name ‘Born to Safe Hands’  from their family experience/visitors book.  Jo told me 'a lovely family that Annabel and I looked after wrote this and we felt it was just perfect for our conference'.  So they set about inviting potential speakers, collaborators, film makers and researching venues. Last week the conference happened. From the moment I arrived, I knew I was part of something special. The wonderful Oli Armshaw (@Olvinda), a student midwife from the University of the West of England attended (see photo below), and has written a superb reflection of the day.

When Sheena asked me to write a reflection on Friday’s Born to Safe Hands conference, I did what I always do, which is, a) instantly say yes without considering how on earth I’ll lever it in around family/full time placement/exam revision and, b) consult Twitter – and there it was, the whole marvelous day to be relived, one #B2SH tweet at a time!

On 28^th March 2014, 180 midwives, mothers and a few doctors converged on the home of Bolton Wanderers football club for Born to Safe Hands: a conference to celebrate birth centres, beautifully brought to life by Bolton Birth Centre midwives, Joanne Camac and Annabel Nicholas. I’m still buzzing from the vibrantly positive atmosphere and sense of building a community, a living network - not just within the walls of the Reebok stadium conference room, but as far afield as Perth, Rio de Janeiro, Edinburgh, wherever Twitter stretches. The midwifery ecosystem keeps growing, inspiring us to keep up the fight for women’s rights to informed choice and dignity in childbirth, and to keep looking for ways to be ‘with woman’ - for all women, not just those who fit admission criteria.

Certain battle cries stood out from the day:

‘Put on your leadership hat and fight for women!’ Cathy Warwick incited every single midwife to be innovative, imaginative and creative about the woman-centred agenda, do research, challenge practice and use emerging evidence. As we all know, it’s not just the birth rate putting midwifery under pressure, but the complexity of the women we are looking after, and we need to keep this complexity in perspective, as it’s not always a problem. Cathy highlighted the need to adapt our care and policies to the over 40s mothers, who are the most rapidly increasing group, and to learn from each other about keeping the numbers up for birth centres and freestanding midwifery units.

‘Why can’t labour wards look like birth centres?’ Denis Walsh demanded, as he enthused about normalizing birth for older mothers, women with high BMIs and other complexities. He calls for a change in how we assess risk, and to make the point that change can and does happen, told us about the ACOG’s game changing revised active labour thresholds: “Cervical dilation of 6 cm should be considered the threshold for the active phase of most women in labor. Thus, before 6 cm of dilation is achieved, standards of active phase progress should not be applied.” and “A prolonged latent phase (eg, greater than 20 hours in nulliparous women and greater than 14 hours in multiparous women) should not be an indication for cesarean delivery.”

‘It’s the baby’s blood anyway!’ cried obstetrician, David Hutchon confronting the misnomer ‘placental transfusion’. No one can still be in the dark about the benefits of timely cord clamping to prevent neonatal hypovolaemia, though third stage practice is slow to change.

‘Love or fear?’ Soo Downe, made it very simple, binary even: Love or fear. Which one are we working from? Which drives our decisions and actions? I enjoyed her every word about belief and salutogenesis: the fundamental belief that birth is salutogenic – ie seen from a perspective of wellness.

To illustrate the effects of being watched, and the power of belief, Soo showed us this chilling image of Jeremy Bentham’s Panoptican penitentiary (1791). The concept of the design is to allow a single watchman to observe (-opticon) all (pan-) inmates of an institution without them being able to tell whether they are being watched or not. Although it is physically impossible for the single watchman to observe all cells at once, the fact that the inmates cannot know when they are being watched means that all inmates must act as though they are watched at all times, effectively controlling their own behaviour constantly. It reminded me of the main office on delivery suite where 8 women’s CTG traces can be viewed at once on a huge screen – not exactly the ‘private, safe and unobserved’ conditions recommended by Dr Sarah Buckley as the optimum environment for undisturbed, physiological birth.

Sheena Byrom’s whizzy Prezi explored the pitfalls of using guidelines-policies-protocols interchangeably, and linked the importance of supporting women to make autonomous decisions with human rights and the dignity agenda. @SagefemmmeSB is a massive advocate of Twitter, as her ‘I love you Twitter!’ video shows, eulogizing about the potential for getting and giving support; sharing ideas and news; building relationships, communities, networks and social capital; influencing change; starting or engaging in debate about practice. She implores all midwives to adopt Twitter, to respond to evidence and articles, to challenge what’s being said, to question and connect with each other. Bring the birth revolution!

‘Is hospital birth a riskier choice for healthy women and babies?’ It was the first time I’d heard Mary Stewart speak and I loved her ‘coming clean’ as a passionate advocate of homebirth. She tackled the knotty concept of risk, swapping the word risk for chance, when talking about out of obstetric unit (OU) birth and transfers to OU from home. Mary urged us to be responsible when talking to women about place of birth, providing balanced information about planned hospital birth as well as planned home birth.

What I found most stimulating about Born to Safe Hands, was the social bonding, and positive community building of it all, which Lesley Choucri, director of midwifery at Salford University, related to Cooperider’s work on ‘unleashing the positive revolution of conversations’. Thanks to Twitter, the potential reach of the normal birth conversation at Born to Safe Hands stretches way beyond the immediate 180 people present in the room. In fact, Twitter stats  suggested that 123,228 unique users saw #B2SH and the number of impacts was over 2 million, i.e. the potential number of times someone could have seen #B2SH. This is very exciting.

Born to Safe Hands really was a celebration of the inspiring woman-led work going on in birth centres around the country - an antidote to fear and feeling disheartened, that we are losing our grip as birth becomes ever more medicalized, as women become more complex, and less curious and trusting of our bodies. Born to Safe Hands has revived my vigour and clarity about how to develop and nurture the new midwifery and bring to life the benefits of being truly ‘with woman’, for all women - the benefits of which span generations.

Oli Armshaw @olvinda

THANK YOU OLI!

A Storify from the conference is here, and a selection of comments:

‘best study day ever! Thank you – it’s been wonderful’

‘Best conference I’ve been to in years (and I go to a lot!). Well done. Make it annual! Make available on DVD for sale!’

‘Wonderful, wonderful day, loads of evidence and positive stories to take into my practice, thank you so much for organising’

‘Had a fabulous time, brilliant speakers. Feel ready to return fully invigorated’

‘Lovely to her what committed, expert birth centre midwives are doing in Bolton and around the UK’

‘More than exceeded my expectations, totally fantastic day, will look forward to the next one’

‘I came today to be uplifted and inspired as my unit feels very negative and de-motivated. I feel much more confident, have learnt something and feel so inspired and enthusiastic’

So Annabel and Jo, we hope you will start to plan next year's conference soon, and make it a annual event. As Jacque Gerrard said 'This could be the North West's answer to MAMA!'

We are NOT using the evidence: it’s time to change

 

I am posting this on #NHSChangeDay 2014.

I pledge to continue to make the case for change in maternity services, until ears listen.

Recently, my lovely Italian midwife friend who is a Doctoral student in England, told me of her confusion. ‘What I can’t understand’, she began ‘is why practice in maternity services in UK remains unchallenged when you have so many esteemed academics and the some of best research evidence in the world? She made me think.

Last week I was invited to present evidence related to continuity of care and choice in place of birth at one of the Personalised Maternity Care stakeholder events, in Leeds. The events are being held around the country, and are hosted by NHS Health Education England in response to a request from the Permanent Secretary for Health, Dr Dan Poulter. Dr Poulter wants to explore the ambitions for future Maternity Services and what such services might look like by 2022.

You can read info via the tweets here.

So on finding the evidence it became very apparent-we certainly aren’t using it.

Here are my slides.  I decided to share them widely to enable discussion and hopefully receive comments and ideas from readers to help inform the Minister.

Slide 1: There is an abundance of policy, guidance and results of surveys directing maternity services, which is largely being ignored. This is alarming, though not surprising. Yet let us consider: why was the Peel Report (Ministry of Health 1970) directing 100% hospital ‘deliveries’ given urgent attention, and fully implemented WITHOUT  evidence presented or women’s opinions to back it up?

Slide 2: We are not using latest research evidence, and according to the National Audit Office report (NAO) and the Public Accounts Committee report  (PAC) there is no measuring or reporting progress, no data, no assurance of value for money, and huge variations in cost, quality, safety and outcomes. In addition, women and families are reporting dissatisfaction with their care (Birthrights, CQC, Women's Institute), few women are receiving continuity, and choice in pace of birth (NAO, BirthChoice UK). Furthermore, stillbirth rates in England are highest in UK, and litigation costs increasing.

Slide 3: Margaret Hodge MP spells it out for you to read. Maragert chairs the PAC, and her observations are, I believe, a true reflection of maternity services in England today.

Slide 4 and 5: Reality for midwives. Desperation which often leads to leaving the profession, and for those can’t leave, numbness which increases risk of substandard care. There is a link to another post on this blog, where many comments have been made.

Slide 6: The NHS Mandate gives some direction for the future. Named midwife. What does that mean? The NHS England definition is 'a midwife who co-ordinates all the care and delivers some of the care' .   Continuity of care is another misused phrase, but if continuity is good, surely there would be improved responses to ‘mental health concerns’.

Slide 7: Highlights the main references for the research evidence for continuity of care

Slide 8: Reveals some of what this evidence tells us. How can we not take notice?

Slide 9: Did you know that the National Service Framework for children, young people and maternity services was still the current directive for maternity services?  And it states that every woman should be able ‘to choose the most appropriate place and professional during childbirth’

Slide 10, 11 & 12 : The evidence for choice in place of birth has NEVER been so strong as it is now, for women with no or expected complications. These are the key findings of the Birthplace Study but in general it tells us:

-Giving birth is generally very safe

-Midwifery units appear to be safe for the baby and offer benefits for the mother

-For women having a second or subsequent baby, home births and midwifery unit births appear to be safe for the baby and offer benefits for the mother

-For women having a first baby, a planned home birth increases the risk for the baby (this is very small- four more babies in every thousand births had a poor outcome as a result of a planned home birth in first pregnancies).

-Women planning to give birth in a midwifery unit experienced substantially less medical intervention than those in an obstetric unit.

For women having a second or subsequent baby, home births and midwifery unit births appear to be safe for the baby and offer benefits for the mother

 For multiparous women, there were no significant differences in adverse perinatal outcomes

between planned home births or midwifery unit births and planned births in obstetric units.

 For multiparous women, birth in a non‐obstetric unit setting significantly and substantially reduced the odds of having an intrapartum caesarean section, instrumental delivery or episiotomy.

Important points I would like to make here, for those working closely with expectant parents:

Do you mention the above evidence when talking to women about their choices? I expect most will remember to mention the small risk for first time mothers wishing to birth at home. But do you advise women about the potential increased risk of unnecessary  medical intervention?

How do you make evidence accessible for parents? How do you deliver the evidence, do you know what it says? This is a brilliant article on how to share evidence based information. It’s a must read.

Slide 13: Is self-explanatory. Note the decrease in obstetric units (OU) and increase in alongside midwifery led units (MLU). This coincides with the number of amalgamated Trusts, and the aforesaid NSF. There is only a slight increase in the number of freestanding midwifery units (FMU), probably due to closures corresponding with others opening.  The slide informs us that very few women have the full choice guarantee as proposed in the NSF in 2004.

Slide 14: Because of the above, the slide shows that most women (87%) give birth in an OU.

Slide 15: Two recent media articles demonstrating ongoing constraints of providing home birth and birth centre births, yet the evidence is clear that women choosing to birth in these venues are there less to endure unnecessary interventions, and the service is more cost effective.  Does that make sense?

Slide 16: The best estimate of women eligible to have their baby in a non OU setting (low risk) is 50%, although WHO estimate this should be between 70-80%.   Taking 50% of 2012 birth rate (700,000) = 350,000  and deducting 89,000 women who actually had midwife led births in non OU setting, leaves us with the shocking figure of 261,000 women and babies who, according to Birthplace Study, are potentially exposed to unnecessary medical intervention.

This is unacceptable. Yet it remains silent, unspoken, when the small risk of home birth is magnified out of proportion. In addition to the human cost in terms of morbidity, there are financial implications, and pressures on the workforce. So now we have the evidence, and things MUST to change.

Slide 17: Some of the effects of the previous slide, in terms of mode of birth, and maternal feelings. Diagrams taken from the Dignity Survey 2013.

Slide 18: The potential consequences of current maternity service provision.

Slide 19: What Personalised Maternity Care should look like, including flexible use of clinical guidelines, to support women’s choices.

Slide 20: Relevant and important recommendations from the Public Accounts Committee.

The following slides give and example of maternity services in East Lancashire, where I worked for 35 years. I have highlighted these award-winning services to demonstrate how choice and continuity can be achieved. The service is situated in one of the most socially deprived Local Authorities in England, and has undergone a significant reconfiguration in 2013. With 30% of 6,700 births per year in the three birth centres (2 FMUs and 1 AMU), they are maximizing opportunity for women and staff, with excellent results.  The slides demonstrate financial gain from the model of care, and how mothers, midwives and managers feel about the service.  The key factors of success for the model in East Lancashire are:

-Model of care: midwives work in the community AND the birth centre, providing continuity and accurate and positive information sharing about place of birth

-Collaboration: obstetricians, midwives, neonatoligists, service uses, auxiliary staff support each other, and work together to ensure the woman and her family are supported.

-Leadership: the service has strong midwifery leadership at all levels.

The last slide is of my newest granddaughter, Myla. When Myla is of age to have children of her own, I want her to know that the evidence we now have was used well, to give her the best chance ever to have a positive experience and healthy baby.

Please leave your comments. We musn’t give up.

Table: Dodwell and Newburn (2010) 

Reference:

Ministry of Health (1970) Domiciliary Midwifery and Maternity Bed Needs: the Report of the Standing Maternity and Midwifery Advisory Committee (Sub-committee Chairman J. Peel), HMSO, London

Photographs used in slides are owned by Sheena Byrom and East Lancashire Hospitals Trust

We need more midwife Care Makers! Check out what Liverpool students did!

I received an email today from the Royal College of Midwives, asking me to post this wonderful news item on my blog. And I was delighted to, for many reasons.

As I regularly use Twitter and connect with nurses and midwives at all levels, I read about the massive impact the Compassion in Practice strategy is having on the NHS…both at the bedside and on social media. I've been enthused by the role of Care Makers, and have been trying to encourage more midwives to join. So if you are a student midwife, or a midwife, this may encourage you!

Care Makers are health and social care staff (student and qualified) who act as ambassadors for the 6Cs. They are selected for demonstrating a commitment to spreading the word about Compassion in Practice across the NHS. Care Makers create a unique link between national policy and strategy to staff working with patients. The aim is to capture the ‘spirit’ of London 2012, learning from the way Games Makers were recruited, trained and valued and  instilling the spirit of energy and enthusiasm they created.

This January five Liverpool John Moores Midwifery Students represented their University at a Nursing and Midwifery Celebration Event at Liverpool Women's Hospital. These students (pictured above) volunteered as Caremakers at the event, which showcased services at Liverpool Women's Hospital. The day was a huge success, with notable external speakers, stakeholders, staff and service users in attendance. Nursing and Midwifery workforce also got the opportunity to make a commitment to their patients in part of the new strategy at the Women's titled "Our Promise to Patients".

Three of the students also represented the University and Trust as Student Quality Ambassadors - a new role developed in the North West of England for students to champion and highlight good practice and challenge areas needing development in the practice areas of their placements. Student Midwife Ela Yuregir said "Having just started my Midwifery training I am keen to get involved in the sphere of Midwifery both at a local and regional level which is why I chose to become an SQA at The Women's Hospital. Events like this one really inspire me as I can see the staff here are so passionate about the women they care for, and it's great to see the Hospital are so pro-active in acknowledging and improving their great standard of care" Student Clare Bratherton comments on her experience taking part in the "Me Effect" video launched at the event: "I was really proud to be asked by Liverpool Women's hospital to represent LJMU by taking part in  video.  It highlights the impact that every individual has on patient experience and care.  The nursing and midwifery celebration day saw the launch of this and to be present as a Caremaker was a real privilege." Tisian Lysnkey-Wylkie explains how the event highlighted to her the passion that her mentors still have "As a student midwife in the middle of my training it's great to be part of an event and see my mentors keen to engage in the trust they work for, and be proud to work at LWH. That to me shows that they are still motivated and passionate about midwifery and include themselves in progressing to provide better maternity care for our women. I am proud to be a student learning in a trust that is so dedicated to women's health and look forward to the rest of my training here. As an SQA it's part of my role to highlight good practice an developments that benefit those in the NHS, at a time when midwives are under pressure celebration days are needed to show the appreciation that midwives deserve, more events should be done to acknowledge their hard work" The event was a great success overall and the students hope that their roles as both Care Makers and SQAs will inspire current and future JMU Midwifery Students to get involved with their local trusts.

WOW! What incredibly motivated and passionate student midwives…well done to all of you for representing your organisations, the NW of England, and MIDWIFERY! Thank you!

So come on fellow midwives…join the crew! 

EXCLUSIVE INTERVIEW-Toni and Alex changing the world

Toni Harman and her partner Alex became known to me when I saw a short clip of one of their outstanding videos, on a social media channel. This was several years ago, and since then I have stayed in close contact with them, assisting and supporting them whenever I can. To say that they took the birthing world by storm is an understatement. This unique partnership has given birth activists the voice they needed, and their expertise in documentary film making means we now how a powerful medium to share knowledge to more people.

As Toni and Alex have just launched their exciting new campaign MicroBirth, I asked Toni if I could interview her for my blog (and she agreed!)

Hi Toni, thanks for agreeing to answering my questions, hope you have fun! Can you tell us a bit about yourselves in a nutshell?

 Toni: Thanks Sheena for inviting us to do this! 

Alex and I met at London Film School 20 years ago, (back then it was called the London International Film School). After we graduated, we formed a company called Alto Films and started making films together. We made documentaries, short films and even a psychological thriller feature film. Then six years ago, we had a baby. And that changed everything.

We started making films about birth. We made a documentary about doulas called DOULA! then we started looking into the bigger picture of childbirth.

Three years later, we've travelled 35,000 miles and interviewed over 150 world leading experts - amongst them, academics, lawyers, scientists, midwives, obstetricians, psychologists and anthropologists. We've released short videos on our One World Birth website and started building a community of people on Facebook.

In 2012 we released FREEDOM FOR BIRTH, a 60 minute documentary that exposed human rights abuses around the world, particularly highlighting the story of the imprisoned Hungarian midwife Agnes Gereb.

In December 2012, we started looking at possible subjects for our next documentary. We started researching the science around birth and the more we read, the more “levels” we seemed to uncover. It was fascinating but also, deeply troubling. So in the summer of 2013, we started filming, first in the UK and then we flew out to the United States and Canada. What we learned shocked us to the core - we realised this film had the potential to change everything. And so MICROBIRTH was born.

ONE WORLD BIRTH is a now well known name globally, and FREEDOM FOR BIRTH  is a huge success. What impact do you think you and the campaign has had so far ?

Toni: That's very kind of you to say. I think ONE WORLD BIRTH is perhaps well-known in the birth world, but outside the birth world, I don't think many people have heard of it.

Same goes for FREEDOM FOR BIRTH - I am really proud of its “success” in terms of the number of people in the birth world who have seen it, or at least have heard about the film. With the premiere launch, we had over 100,000 people see the film at over 1,000 screenings in 50 countries in 17 languages - all on one day.

 And I'm very proud that the film has played a part in starting to change maternity policies worldwide so that the rights of birthing women are respected. But realistically, outside the birth world, I'm not sure how many of the “mainstream population” have heard about it or know about the issues.

Unfortunately, women's rights in childbirth are still being abused every day all around the world - many expectant women are not being given full informed consent, home birth attended by midwives is not available as a supported choice in many parts of the world and indeed, in the past year, many more midwives have been criminally prosecuted for supporting women giving birth at home. I remain optimistic that change will happen so that all women's choices are fully respected everywhere around the world and I am excited by the potential of the formation of Human Rights in Childbirth and Birthrights as organisations that will help further the cause.

 I am so excited about your new project MICROBIRTH -do tell us about it please, and a something about the inspiration behind it?

 

Toni: MICROBIRTH is our new feature-length documentary asking if medical interventions in childbirth could be damaging the long-term health of our children and have repercussions for the whole of our species.

We wanted to make a film that looks at birth in a whole new way, through the lens of a microscope. This has never been done before and we believe the science the film is revealing is the missing piece of the jigsaw. This could change birth around the world, forever.

The film explores the latest scientific developments in the fields of microbiology, physiology and epigenetics.

Some scientists are starting to question if there is a link between medical interventions in childbirth (specifically use of synthetic oxytocin, antibiotics, C-section and formula feeding) with an increased risk of our children developing non-communicable disease later in life.

Non-communicable diseases include heart disease, asthma and other respiratory diseases, diabetes, autoimmune diseases, some cancers and mental health disorders. They are already at epidemic proportions around the world and are the world's no. 1 killer. But these diseases are on the rise. It is predicted that the cost of non-communicable disease could bankrupt world healthcare systems by the year 2030, an event that could have catastrophic consequences for mankind....

The campaign's 9 minute pitch video features some of the scientists we have filmed and explains a bit of the science of the microbiome. The film also tells more about the event that we've been describing as “global warming for the species”:

What are your plans for this campaign?

Toni: We need to raise $100,000 to complete filming and to get the film seen around the world. So we've launched an Indiegogo campaign to help us raise the funds we need. If we can raise enough money, then we want to film at the Human Microbiome Project in New York, the United Nations, the World Economic Forum and the World Health Organization as well as filming the top people at leading obstetric organisations to hear their view about the potential long-term consequences of medical interventions in childbirth.

The most exciting part of this project is how we want to release the film. Just like we did with FREEDOM FOR BIRTH, we want to have thousands of premiere screenings of MICROBIRTH held all around the world on one single day. We want to create a global simultaneous event with screenings in every community, in every country so that we can grab the attention of the global media and we can grab the attention of decision-makers including our Presidents and Prime Ministers. It sounds ambitious, but we truly believe that if we can do this, especially if we have the the support of strong-minded, strong-willed individuals committed to making change happen.

In terms of what we want this film to achieve, we want to raise awareness that there could be long-term consequences arising from the medicalised way we are giving birth today, both for our children and for our whole species. We want to get everyone talking about this and taking this issue extremely seriously for the future of humanity could be at stake. And we would love to see much more scientific research looking at the potential long-term consequences of medical interventions in childbirth, before it is too late.

 What’s the most important thing you have learnt since beginning this amazing journey of campaigning for better childbirth?

Toni: We've been very fortunate in being able to film interviews with over 150 experts across so many different fields.

But I think there's two pivotal moments in our journey so far.  The first birth I filmed completely changed my world view. It was four years ago and it was a home water birth in the UK with the mother and father supported by a doula and two wonderful midwives (it was the first birth featured in our DOULA! Film). It was a completely physiological labour, birth and 3rd stage with no pharmacological pain relief, not even gas and air.  The labour and birth was the most beautiful, amazing, calm, wonderful, inspiring thing I have ever seen. It was perfect. I saw with my own eyes what birth could be like. I know some women might not want a home birth. And some women might want or need pain relief and other medical interventions. But the beauty of that moment, well, it was simply life-changing.

The second pivotal moment was last summer when we were filming for MICROBIRTH. We filmed a Professor of Immunotoxiciology at Cornell University. He told us exactly why and how interventions in childbirth could be damaging the long-term health of our children with implications for the whole of mankind. We had huge goose-bumps. I still have them now as I remember that moment.

If I had a magic wand, and could grant one wish to ensure all women had a positive birth experience, what would you ask for?

Toni: After we made FREEDOM FOR BIRTH my hope was that every woman on the planet has the best possible birth wherever, however and with whom she chooses to give birth. I hope that all women are fully informed about their birth choices and that these choices are fully respected by every healthcare provider.

But now with MICROBIRTH, I have one more wish. That every expectant mother and healthcare provider is fully informed about the importance of seeding the baby's microbiome with the mother's own bacteria. That even if a mother needs to have a C-section, that she is still fully supported with immediate skin-to-skin contact and with breastfeeding. It sounds a technical, scientific wish, but if this was possible on a planet-wide basis, I believe that this could make a significant difference to the future health of mankind.

And lastly, what drives you both, as a couple, to stay motivated and passionate about your work in this area?

Toni: When we were at film school, we were told to never make a film unless you felt that it had the power to change the world. So every film we make, we honestly do set out to change the world. That's what drives us forward. That's what motivates us. The thought that we can use our skills as filmmakers to make a significant difference to the world.

With MICROBIRTH, we think this could be a game-changer. This could be THE ONE. We feel that this is the most important film we will ever make. But to get it finished and seen around the world for maximum impact, we need everyone's support - not just financially in terms of contributions to our fund-raising campaign, but in sharing links and in spreading awareness, both now and when the finished film is released this September.

Thanks Sheena for asking me to do this. It was fun!

It's 2014. Time to listen, and hear what midwives say

Earlier this month a health correspondent from The Independent contacted me via Twitter to ask me if I would be willing to comment on this article, written the day before.

The piece quoted the words of a very honest and courageous midwife, and I applaud her. I don’t usually like commentaries which could potential cause fear amongst women who use our maternity services…and I am always wary of journalists, for this very reason. However this article is very accurate, and I am sure 80% of midwives would agree with what is written.

I wrote about these issues here.

The RCM are continuously campaigning for more midwives, and although NHS England have published a staffing strategy placing onus on Trusts to ensure safe standards in terms of capacity and capability http://www.england.nhs.uk/2013/11/19/staff-guidance/, there aren’t enough midwives to fill posts. Support staff are crucial, as often midwives are doing non midwifery tasks, but often organisations can't afford them either. We are constantly reminded that there are increased pressures within maternity services due to an increasing birth rate and complexities of those using the service, but external and internal reviews of NHS organisations and departments, and risk management agendas (including processes relating to CNST) are adding to the strain through increased bureaucracy and fear.

It seems some midwives possess professional resilience to pressure and adversity in the workplace, managing to stay positive and motivated despite the increasing demands placed upon them (Hunter and Warren 2013). . One of the themes from this study findings was ‘building resilience’, where participants demonstrated the development of strategies to help themselves and others to cope. So where do student midwives and midwives get the support from, to help them to cope on a daily basis? Do they know whom these ‘resilient midwives’ are, to help them to build coping mechanism for preservation? Sometimes sharing a crisis moment with a work colleague or supervisor of midwives does the trick, and support is there and continues. But there are times when practitioners fail to share feelings for many reasons, including time, confidentiality, and confidence.

I had specific colleagues that I turned to in stressful times or moments of crisis, and I knew the things I could do to help me re-focus and keep things in perspective. In the early 1990s I had read Caroline Flint’s book, ‘Sensitive Midwifery’ (Flint 1991), and I loved and used the suggestions Caroline gave to midwives on self-care. I think they helped me.

I have written a short piece in February's edition of Practising Midwife, about how social media and online resources can help practitioners to stay in touch with like minded individuals and to glean tips to try to stay positive at work. And later this month I have written a @wemidwives chat to share ideas with nurses, midwives and students. Join in if you can!

In the meantime, these were my suggestions to the journalist, about how we can try to help midwives and improve maternity care:

The Government needs to hear and act in terms of resourcing increased midwife numbers. The problem will not go away. Choice, continuity of care and carer and the sustainability of independent midwifery are all crucial issues that need urgent attention, BUT WE NEED MORE MIDWIVES.

For maternity services, there needs to be a shift of focus on wellbeing instead of illness, and kindness and compassion instead of punitive culture where fear and blame prevails. The latter adds extra burden on an already pressured service. Although midwives are leaving due to increased stress at work, there are many who can’t, and they need to be valued and cared for.

We need an invigorated focus on reducing unnecessary medical intervention during childbirth, mainly because there is emerging evidence that the consequences are potentially catastrophic.

What are your thoughts?

Reference:

Flint C (1991) Sensitive Midwifery Butterworth-Heinemann Ltd London

What happened to my blog! Thanks to all readers in 2013

The WordPress.com stats helper monkeys prepared a 2013 annual report for this blog.

Here's an excerpt:

The concert hall at the Sydney Opera House holds 2,700 people. This blog was viewed about 46,000 times in 2013. If it were a concert at Sydney Opera House, it would take about 17 sold-out performances for that many people to see it.

Click here to see the complete report.