Our Big Hairy Audacious Goal

Fantastic ARM Study Day at Wigan on Midwifery Regulation (18th March 2017).  This is what I said in my bit.

We want to set up a new Council for the Regulation of Midwives based on strong values: beginning with the wellbeing of the mother and her family.  We want all mothers to feel supported throughout their maternal pathway and we believe that good quality evidence is at the centre of midwifery practice- for this is what public protection most properly means for maternity.

So my call to you at the end of this day as mothers and midwives of this generation is to set about making this happen for the benefit of the midwives and mothers to come.  It will take work and cunning and more work and political wheeling and dealing and a hell of alot of campaigning but it can be done and we can do it.  And this is what is called a BIG HAIRY AUDACIOUS GOAL.

A BIG HAIRY AUDACIOUS GOAL is based on vision but is not itself a vision – vision is about values such as the stuff I have just said.  A Big Hairy Audacious goal is what you want and what you are determine to achieve.  That all mothers are supported through the maternal pathway is our vision, that the centre of our practice is nurture and good evidence is a value, but  OUR BIG HAIRY AUDACIOUS GOAL – to achieve this vision and these values – is to set up a new Regulatory Council for Midwives.

It is AUDACIOUS: it makes one raise ones eyebrow, it makes others sit up and think, it may keep some of us awake at night wondering how the hell we are going to do it.  It is audacious but it is a concrete outcome and it is achievable so it is a goal.  And it is BIG and HAIRY because ALL Audacious Goals have to be Big and Hairy.  It is more fun that way.

And fun is a big part of this BHAG.  Because it is not much fun being a midwife with a regulatory body that does not have a practicing midwife on it, has a one day a week midwifery advisor to the CEO and does not know the difference between a private midwife and an independent one. It is not fun to lose your practise because your regulatory body can’t be bothered to go through your insurance policy in detail. Fragmentary factory care is not fun!  Coming off a 12 hour shift feeling like you have given your all but not met the needs of the women you have cared for is not fun.  It is not fun to find that supervision, the independent professional support for midwives and mothers has now been seceded in England to the employers – where we are already seeing conflicts of interest come into play.  It is not much fun if you have ever had the misfortune to be hauled infront of the NMC to be tried ( because that is what it is) by judges who do not know or understand your profession – or anything much about maternity.  It is not fun to pay more in regulatory fees than other better paid professions. It is not fun to watch what you hold precious in your profession de-valued so much that it is abolished as has happened with the midwifery code.  It is not right – that is for sure – but it takes all the FUN out of being a midwife.

So our BIG HAIRY AUDACIOUS GOAL is about putting the fun back into our profession.  And so I do suggest that whatever we do whilst achieving this goal, that we ensure that we have FUN whilst achieving it.  Some activists in the Netherlands recently spoke of working with ‘unrealistic optimism’ for the eradication of poverty and injustice.  And that is the attitude we must now have.  In the face of all challenges and setbacks we must work diligently with unrealistic optimism, because that is why we have a BIG HAIRY AUDACIOUS GOAL.

OK so how do we go about achieving our BIG HAIRY AUDACIOUS GOAL? That would be a 2 day course I think so some pointers.  We need a strategy and it needs to be simple and clear.  And then from it we have tasks – things we have to do to take the strategy forward.  A group of us have started working on a strategy and it is simple there are 3 initial key lines (more will emerge and other will fall back).

ONE

We need a research  group – These are our scouts who will find out, what happened last time, what has gone wrong now (digging into papers and minutes), what examples and models are there out there which we could use or partner with etc.  Lots of reading homework for those so inclined. Could do with a lawyer or two as well.  Also some formal meetings and networking work too – they may need to be different people as visiting people is not just about information it is about politics – its not just information we seek but a bond and a political position. We want to get all our ducks in a row all our evidence in place all our arguments formulated, the key people nobbled,before we go in there with our formal proposals

TWO

We need our campaign group to become a movement.  Currently it is small it can be ignored, laughed at and derided – this is currently the outward attitude of the NMC and the Government to the Save Independent Midwifery Campaign and this move against the NMC that has come out of it.  That is fine – they are behaving just as expected.  What we need to do now is make it so big, have so many stake holders in it that it cannot be ignored – this is when we will find the real opposition in and outside midwifery because this is when the fight really begins.

How do we build a movement?  By talking and educating everyone. So we set up meetings, we speak at meetings, we set up study days and conferences. We set up websites, and FB groups blogs and memes (notice the plural – let every flower bloom is my view).  We have meetings with our MPs and our counterparts in other professions.  We talk to consumer groups and parents.  We just talk to everyone who will listen – all the time.  I talk to drunk men coming home on the train from a foot ball match for God’s sake!  Never pass up an opportunity. Yes you become a regulatory bore but make it fun – it is BIG and HAIRY after all – unlike the guy on the train I might add.

Remember Caroline Flint talking about the vow to tell someone everyday about being a midwife and having a homebirth?  Well this is it!  That is how you make a campaign group into a movement – when everyone in the campaign starts telling someone anyone, who crosses their path that they want midwifery to be regulated by midwives and mums, and why. And we have social media which means you don’t even have to go out of your front door to do it.

THREE

The technical organiser in me says we will need to constitute a proper organisation at some point – just because this is going to be too big for any small group to hold.  Also we need buy in, leadership and input from a wide cross section of people.  An organisation will keep things relatively orderly when and where it matters which is when we approach funders, ministers, professional bodies and so on and so forth.  Don’t get me wrong the nature of movements is that there will be a happy and at times unhappy chaos.  But at the steely core there has to be a strong structure that can hold things together.  This will take a bit of time and effort but is not hard to do, but running this organisation will take over the lives of the people involved as the ARM has taken over the lives of some of the people involved and as Aquabirths took over my life.  But the group who do this will be making a difference and contributing a big chunk to the BIG HAIRY AUDACIOUS GOAL.

Now the next level down from the big strategy above is the detail – and I certainly aint boring you with that at this time of day!  Join the campaign group choose which bit of the strategy you want to go for and linking in with others get on with it is what I say. Except for one thing: One detail you could all help the campaign with TODAY, is to write a letter of support for a new regulatory body for midwifery.  We need letters of support – hundreds of them – so we must start now.  With you.  Like at school, I need you to write a short letter stating your support for new regulation for midwifery and why.  It does not have to be long – two paragraphs will do – one saying what you want and the other saying why.  Sign off with your role and position – eg Midwife and mother, Big cheese midwife, professor midwife with big hat, Baroness Nobody and mother etc etc  you get the idea anyway.  We can bank these and collect many more for when we need to demonstrate that there is a seriously big mandate for change.  Email to me for now: ruth@aquabirths.co.uk or message me:  ruth Aquabirths Weston – my colleagues who support me selling pools will go mad as they wade through  all the emails.  But hey  – the price of success.

Yes and the price of Success.  This BHAG/Project cannot and must not rest on the shoulders of one person or even of a small few.  And this is a warning to my lovely ARM colleagues here and also to myself.  This is a massive project – it could take years if the movement stays small and we get no money.  So we have to build structures into our movement that ensure that as one falls there is another to take her place.  Not because we are all going to drop off the peg but because we are all ordinary folk here – we have jobs, we have children, we have aging parents we have life in all its fullness.  We will all need to deal with stuff other than Midwifery Regulation and so to box clever we need to ensure that the whole thing rolls on without one particular person having to be there.

This is so important to the achievement of this goal and why constitution of an organisation is part of the initial strategy.  One suffragette who was also a mother and a mill worker said – ‘We fight with one hand tied behind our back because seldom has a cause been won between dinner and tea!’  The suffrage movement – and it became a movement with several organisations within it – was forced to organise in this way to achieve its BHAG.  And these are the women on whose shoulders we stand today.

If you need to learn some lessons on changing constitutions then go and read up on the suffrage movement, we have all their barriers: a profession dominated by another professions, a patriarchal culture still in existence within and outside maternity, our room for manoeuvre limited by our place in society and the expectations and decisions of others.  Do not underestimate the subtle and pernicious ways this affects us and our opponents in the achievement of our goal.  I am not saying this to get you down but to be realistic.  For instance one of the points made at our formative meeting was that midwives are so overworked and crushed by their working conditions they won’t want to know or do anything.  Yep that is so true – and has been true for other movements for change like suffrage – but it is a challenge to be overcome not an eternal barrier – so we must seek out fun ways to meet that challenge in our colleagues. In Peace and Justice circles it is called ‘empowerment’..

And just like this job isn’t just for one person or one group of people, so we cannot do everything at once and won’t achieve everything at once – so we must be focussed.  As a group and as individuals we must recognise what we can do now – choose our priorities and do those few things we can do, the next step will enable us to do more, and so will more people, but ultimately it is choosing our priorities doing what we can do and not worrying about what we cannot.  Really and truly this is how big changes happen.

Remember the cycling team success for the Olympics? – they decided their focus was to be fixing the small things that got in the way of achieving their BHAG and in fixing the small things by degrees they arrived at their BHAG and gold medals.

I remember learning my lesson as a University chaplain many years ago.  My senior colleague told me – there is so much work to be done here, you can only see 10% of it, and of that you can only do 2%.  You have to learn to live with this fact and not try to do everything but do your 2% well.  And he was right – do what you can well and don’t worry about the rest.  This still enabled me to run a national campaign on student poverty, it still enabled me to set up and facilitate a student housing group, that achieved a cross professions task group with council and university reps that ultimately set in place policies that are still in place today keeping students safe.  And I bailed out half way through to have a baby and then was made redundant. But I had facilitated the change from a campaign group to a movement and it did not need me anymore to make the change actually happen.

I despair when people give up on the small thing they could do because it won’t change anything – because I know and so do other change-makers that it is doing the small things everyday that changes EVERYTHING.  If everyone here does the small things they can do – I am telling you we will be well on our way.

Okay, so my time is up and we need to recap to remember.  What is a new regulatory body for midwifery?  A BIG HAIRY AUDACIOUS GOAL – it is big and hairy because it is fun, and it is big and audacious because it is a mighty challenge but it is a GOAL because it is achievable.  And we can and will achieve it.

We achieve it by having fun and having a strategy.  Our strategy is simple 123. 1 Build a movement – and the key action today is to tell everyone and any one – and all of us can do this, 2. Do our homework and get all our ducks in a row before heading down the M6 to march on Westminster, 3 make sure we have an organisational structure that will keep order and ensure no one person or persons becomes critical to the achievement of our GOAL

We know that we are human that we are women with LIFE and responsibilities but we know that other women before us have faced the challenge of change-making in the midst of life and faced greater discrimination that we do.  So we will be focussed and do what we can well, we will be focussed boxing clever with our priorities, we will be patient because this could take a long time, but we will be confident that change can happen – because this is our  BHAG and we are working stolidly to achieve it.

And today’s actions by this group are: 1. to write a letter of support for this big hairy audacious goal, 2. to make a personal vow to tell someone each day about this by whatever social means, and 3. to think about setting up a public or private meeting and inviting one or two of us to talk about it so we can grow our campaign through the maternity communities of our land.

No big deal then!  Small steps and Big Hairy Audacious Goal – I am looking forward to the fun – and I hope you are too!

Bornstroppy’s new blog and site

Ruth Weston has moved her blog to http://bornstroppy.com/

More than simple blog site is needed now! All the posts from this site are already there as well as a few new posts waiting for you.

This old blog site will stay here for the time being but if you’re a subscriber, please take a look at the new site and re-subscribe there.  On the right, at the top, there is a place to re-subscribe.  Thanks.

Ruth.

What you can do to save midwifery as an independent profession in the UK.

By Ruth Weston and Emma Ashworth

Independent Midwives are in the NMC firing line, and most of the campaigning that you might see is about this. However, the NMC (Nursing and Midwifery Council), which made this decision, did so without a practicing midwife on the board, and the ramifications of the decision affects every midwife in the UK.

For instance, the NMC have stated, “A registered midwife can only attend a woman during a birth if she has appropriate indemnity cover. The midwife cannot avoid this legal requirement by attending the birth in a ‘non-midwife’ capacity… The only exception to this is when a midwife attends a birth in a personal capacity to support a family member or close friend for whom they have not previously provided midwifery services”. “Services” includes emotional and physical support, meaning that midwives are being banned from attending the births of their grandchildren, or their own babies in the case of male or lesbian midwives if they’ve so much as listened in, or supported their partner through morning sickness.

The NMC is removing the midwifery committee, which advises the NMC on midwifery matters. Its replacement will have no budget and delegatory powers and it is unclear who will be on it and what its role will be within the NMC. As the NMC – the NURSING and Midwifery Council – has overwhelming numbers of nurses compared to midwives, and the way it is now being set up means midwives will be regulated by a completely different professional – one geared to nursing sick people rather than caring for healthy women -without their own voice being heard at all.

There is a huge risk that this will toll the death knell to midwifery as an independent and autonomous profession. becoming subsumed into the nursing profession as another branch of nursing.  This is certainly the way the NMC and the Government legislation is treating midwifery at present and would mean Midwives would lose the status of being THE professional experts in the normal maternal pathway and key care provider. This is not inevitable but as a profession and as parents we must rise up and clearly and strongly oppose  the removal of the midwifery code, the midwifery committee and lack of representation for mothers and midwives at the NMC. The profession has never been in more jeopardy, and never has the care of women and their babies been so much at risk since the formation of the profession of midwifery.  It falls to us to do something about it..

What can I do?
1) There have been several petitions. The writer of this one admits that if it had been less rushed it would be better worded, however, if we want Parliament to take note of the voices of women, midwives and their families then this is a good petition to start the ball rolling, so please do support it. https://petition.parliament.uk/petitions/178561

2) Share your story of how midwives have helped and supported you. What impact will the lack of access to IMs have on you?  Share on:

Facebook, Save Independent Midwifery page: https://www.facebook.com/groups/443681876022589/

Send to Birthplace Matters who is preparing stories and letters to the NMC through  birthplacematters at yahoo.co.uk

Send them to the saveourmidwvies.co.uk website.

Don’t forget to include permission to share.

3) Tweet!  Use the #savethemidwife hashtag with your messages about how this affects you. You can  tag Jackie Smith of the NMC using @JackieSmith_nmc, and BBC Watchdog (@BBCWatchdog)

4) Write to your MP. The website saveourmidwives.co.uk has important template letters which answer the cut-and-paste responses that most MPs are sending. Find your MP here: http://www.parliament.uk/mps-lords-and-offices/mps/

5) Join IMUK, the Independent Midwives’ professional body, as a supporting member. It only costs £20: http://www.imuk.org.uk/professionals/join-imuk/

6) Make a complaint to the NMC. E-mail complaints@nmc-uk.org. They have less than 20 working days to respond. It is important to mention that it’s a formal complaint to ensure that you go straight to Stage 2 of their complaints process. If you don’t like the reply, simply respond back, say you’re not satisfied, why, and then appeal the complaint response, escalating to Stage 3.

7) Many women and Midwives across the UK are using their passion, creativity and skills to support independent midwives and to challenge midwifery regulation to do its work better.  Do what you can with the people you can, and watch this space as more developments are in the pipeline.  Thank you!

This is NOT “Public Protection”

The Nursing and Midwifery Council (NMC’s) decision to stop Independent Midwives (IMs) from practicing is, in their words, for public protection.

IMUK have clearly stated that they feel that their indemnity policy is sufficient. The NMC have stated that they believe it’s not. They also say that they not in a position to state what would be enough. This in no way supports IMUK and in turn this does not support the public who want or need the services of an IM. This is not “public protection”.

But does medical liability insurance protect the public in any way, even if it is “sufficient”, as IMUK believe?

The definition of malpractice, or medial liability insurance (MLI) is a policy which, “protects health care providers against patients who sue them under the claim that they were harmed by the physician’s negligent or intentionally harmful treatment decisions.” (reference: http://www.investopedia.com/terms/m/malpractice-insurance.asp)

There is nothing in that definition which is protecting the public. MLI protects the practitioner. This is not “public protection”.

So, what does MLI actually offer? In the case of IMs, in the unlikely situation that an IM makes an error which causes harm to a mother or baby, the indemnity means that if the parents decide to sue the midwife, the midwife will be able to call upon her policy to pay damages to the parents (after a significant amount of legal wrangling which may take years, and in the meantime the mother or child will receive nothing other than the regular state provided care).

If the injury was not caused by an error by the midwife (or the baby is born with a condition which is unrelated to birth, including some cases of cerebral palsy), the parents will have no recourse from the IM’s indemnity policy and will need to rely on the state provision.

If the state provision is not sufficient for the baby or mother who is damaged by an error, it is not sufficient for those for whom there is no one to “blame”. This is not “public protection”.

In addition to this, there is no evidence at all that MLI changes practice. MLI does not mean that practitioners try harder to not make mistakes, nor that they make fewer mistakes. In other words, the same number of mistakes happen whether or not the practitioner holds insurance. This is not “public protection”.

MLI does not protect the public, so let’s stop pretending that that is what this is about.

Of Priests, Bishops and Midwives

Today I am returned from the service of celebration of the 20th Anniversary of women being ordained at St Asaph Cathedral, Wales. To remind us that we are still radical we had a small picket of people calling upon us to adhere to the scriptures ‘that women should keep silence in churches’. We were there because we had been there 20 years ago when our good friend Kath Southerton was ordained as one of the first women priests in Wales. We took our 2 year old daughter who is photographed in the arms of the presiding Bishop Alwyn.

It is significant for me that we were there 20 years ago and it is significant that I was there today, because this is part of the struggle we face as women to be treated as of equal value with in the world including within our faiths. And misogyny and discrimination remain and most particularly in the two areas of my life I am most passionate about: the maternity system which deals exlusively with women birthing and in the Church whose starting point is God’s love for all regardless of gender and creed and status in life.

Bishop Rachel, first woman Bishop in England gave the sermon. She took as her readings the story of Ruth(!) and the resurrection story of Mary Magdalene in the garden. These were both women, she said, whose context was shaped by the decisions of others.

In the story of Ruth we have a woman whose context is shaped by the decisions beyond her control. A Family of two parents and their sons migrate for work to a neighbouring country. The sons grow up and marry two local girls. This is in a culture where marriages are financial and social contracts where women are commodity as much as people. Tragedy strikes and the Father and sons die leaving the women without the protection of a legally recognised (male) head of household and means of living. Naomi, the mother in law decides to return to her own people where she maybe able to afford some living and protection amongst family and tribes people. Her daughters she releases to return to their families where they would be married off (perhaps as second hand) to another man/family. Ruth looks at the choices she has – shaped by her context and the decisions of others. None of the choices are easy but she chooses to take the risk of going with Naomi, setting aside her own culture and nationality to, in effect, become a daughter of Naomi – her people, her God – taking the risks of an all female household. All ends well for Ruth as with some more courage (and the cunning and audacity of the two women) she marries a wealth relative of Naomi – Boaz – becoming one of the very few women to be named as an ancestor of Jesus in Matthews Gospel. Rachel said that this was a woman taking life changing chances in a context limited by the decisions of others – this is the context of all – men women and children – but very much so for children and women.

Bishop Rachel is the first woman Bishop, but over the last 20-25 years since women were ordained priests in the British Anglican Church there have been many women as clever, as wise as suited to the role of Bishop who have not been ordained due to the ongoing discrimination of the Anglican Church. This will continue to be the case for many years until Women Bishops are the norm. The context of women priests is framed by the decisions of others’, individual women priests face this truth as they follow the path of their vocation.

And so I want to say to my daughters and to my female friends out there. We operate in a context framed by the decisions of others. This can empower us (such as anti discrimination legislation, some maternity laws and the mentoring of women ahead of us) but the decisions can also be limiting – many women I know, myself included have injured ourselves against the glass ceiling – and historically this has often been the case. Our efforts are in the context of a millennia of patriarchy – if we think our steps forward are very small we have to set them in this context – the story of Ruth set in the second millennium BC reminds us of this.

And sisters and daughters, if you have worked hard, you are talented and qualified but you don’t achieve what you should, do not blame yourself (as we so often do!), look at the context shaped as it is by the decisions of others. If you seek to bring about change to benefit women – and I think here of the midwives, birth workers, maternity activists and mothers themselves and you fail ( as I have) or your victories are not great and soon eroded, or you burnout ( as I have), then do not blame yourselves, remind yourself that you have been taking life enhancing action, taking life changing risks in a context that is shaped by the decisions of others.

Today we celebrated 20 years for the women who made it to ordination in the Welsh Anglican Church, whilst remembering the many more who worked, campaigned who suffered much and received little in the years before and since. Today we celebrated with the first woman Anglican Bishop of England celebrating in a few days the consecration of the first woman bishop in Wales, commemorating 20 more years of missed opportunities for the gifts and talents of women in Wales.

Today I also remember the many women priests of birth, the midwives and the doulas, who have empowered and enabled women to make their own healthy choices for birth. I celebrate we who have campaigned so women can choose a birth at home, in water, in a midwifery led unit, with a midwife she knows and trusts, to have impartial information and support whatever her decision. Our successes and failure speak of courageous selfless women taking life changing risks in a context shaped by the decision of others. Sisters we do what we can, we do not blame ourselves for what we can’t and we call on our daughters to stand on our shoulders to take the work forward. Amen

Freestanding Midwifery Led Units in Shropshire: at the sharp end of the debate

Notes from ‘Questions at the Shropshire CCG Board meeting’ 13^th December 2016

Those who know me well will understand the commitment of turning out before 8am to drive somewhere (and back) on my own for the first time – I got lost with the help of two SATNAVs today but just managed to slip in on time to the Public Board Meeting of the Shropshire CCG.  I was there because the brilliant Gill George campaigner for the Ludlow Maternity Unit and small hospital had encouraged mothers and others to attend and ask questions:  she wanted a commitment from the CCGs to ensure their contract with the Shropshire and Telford Hospital Trust (SaTH) maintained the freestanding midwifery units (FMU) and all the maternity care they provide to local women in a large county.

The front row was taken by a cluster of Mums with their babes and toddlers – giving a dour meeting a lightness of touch and sense of humour that was much needed.

The first part of the meeting was questions from the public, and the first part of this (clearly planned) were questions from the Mums.  The first Mum stood up saying she represented a small fundraising charity for local midwifery units and all the Mums in the area as there were concerns that the maternity services at the Midwifery Led Units (MLUs) were going to be cut and indeed threatened.  They wanted the Midwifery units to be open 24/7 and offer the postnatal care and breastfeeding support they currently do.  SaTH have announced they will close the MLUs – of which there are three – Ludlow, Bridgnorth and Oswestry – at night, this will also end Postnatal stays and 24 hour breastfeeding support.

Her actual words were that the Units were going to be turned into Birthcentres – clearly implying this was a bad thing.  It is a shame that such a term in this area has become synonymous with cuts to the very services that Birthcentres represent to many of us in other parts of the country.

She described her own ordeal of being transferred by ambulance across Shropshire to hospital but not making it and having to give birth in a layby en route.  She believed that this would happen more often if the services of local MLUs were reduced so women had to travel significantly further during labour.  We know that the least safe place to birth is at the road side.

She described how in just a few days her Save Ludlow Maternity Unit Facebook page had got 1100 members and that there was a successful march in Ludlow on 3 rd December.

She gave 4 reasons for keeping the MLUs:

• Research shows that most women labour during the night (Thank you Alison for that painstaking work over decades!)
• Most Midwives live a significant distance from the MLUs, so there could be delays if women arrive in full labour at the unit before the on-call midwife can make an appearance.  And what if more than one woman births on the same night?
• What would be the impact on breastfeeding rates if the units reduce their care?
• Finally, she described how constant threats to the service and lack of investment in it reduced midwives’ morale.  Good midwives will leave the service was her message.

A second Mum stood and spoke.  She quoted the NICE  Intrapartum Care Guideline reminding the CCG board that planned birth for low risk women in an obstetric unit raised the rate of C-Sections in this group. That MLUs reduced instrumental delivery, raised normal birth rates and so on.

She also described the important role in breastfeeding the MLU in Bridgnorth had provided.  She described how they supported her breastfeeding and she only went home once she was confident.  She had found this invaluable.

Gill George then stood up and asked some incisive questions demonstrating she knew the politics and financial situation in detail.  She along with the Mums asked the board for the same thing:

We want the CCG to commit to funding for continuation of the current rural maternity service and units (Bridgnorth, Ludlow and Oswestry) and to get this written into their contract with the hospital trust – due to be signed by 23rd December. (We also want them to guarantee consultation before they allow any change to the service – but mostly we oppose the cuts!).

I always say that asking the question is more important than the answer you receive.  On this occasion it really was not the case.  The CCG iterated its position that safe good quality maternity services were a priority.  The dire financial position of the Hospital Trust and the CCG was stated but we were told that SaTH had not approached the CCG about reducing or changing its maternity structures. This was a significant point because SaTH have already announced that they are closing the MLUs at night in effect changing the service provision.

The speaker pointed out that there was an issue that women were choosing to birth at Hereford and have their postnatal care at Ludlow – but the tarrif money for the postnatal care had not been retrieved.  I recalled a similar difficulty between Calderdale and Bradford and decade or two ago!

Gill George pressed for rural maternity services to be in the contract signed on 23^rd December and that there would be public consultation before any changes were made.  And what would be the chances of this being signed off on 23^rd?  ‘Optimistic’ came the sad faced reply.

Here I am inserting Gill George’s notes of the answers to her questions at this point which she kindly sent to me on reading this blog:

Q: Will rural maternity services be in next year’s contract with SaTH (the hospital trust)?
A: Yes.
Q: At the current level of service?
A: We’re in discussions with SaTH.
Q: Are you expecting this to be possible?
A: I’m very optimistic.

This was from the Head Honcho of Shropshire Clinical Commissioning Group, in a meeting this morning. It’s possible that we’re getting there. We also got something that came very close to a clear commitment that would be consultation on any ‘substantive change’ to maternity services.

The floor was opened to further public questions – most of which were about cuts to services.  This is clearly a well rehearsed session with the players all knowing each other and their roles.  There is a sense of frustration from the public side as they fight to keep valued health services and exasperation on the board side desperately trying to balance books with one of the lowest budgets per head of population in the country.  There is a massive deficit and the prognosis is £15 million pounds worth of cuts to be found in 2017/18 by the CCG.  There was a short stunned silence at that point: there is no choice was the message we will have to cut valued services – there is no money.

The chair of the board said at one point to the public – you are the electorate you need to elect a Government that provides money for the NHS you want.  This said in a county that returns Conservative MPs and has the lowest financial settlement per head of population.

Finally I stood up and as light relief invited the board and everyone present to the SaTH supported conference – Implementing the National Review in Rural Areas:  Better Births in Shropshire and beyond #SaTHFMU

I mentioned its impressive speaker line up (including Baroness Cumberlege, Prof Dennis Walsh, Cathy Warick and Kathryn Gutteridge).  I left programmes on the table and the response was that someone from the board would probably be there.  Listening to the discussion it could be a good thing.  Here is the link if you want to join us:  https://www.facebook.com/photo.php?fbid=1372545286097059&set=gm.151748551970104&type=3&theater

Meanwhile in the foyer the local reporter was interviewing the Mums about what they said.  No opportunity wasted by these Mums to ensure the survival of their community maternity care.

A CCG with no money, with services costing more than their budget, a Hospital Trust with no money and running at a deficit (as are the majority of hospital trusts in England): the quality of all health services are threatened – A&E waiting times grow, dementia and other care is not getting the investment needed, Maternity care in rural areas threatened.  There are no easy choices here for the CCG Board and I would not be in their shoes for half of all England with no power but to dispense the national Government agenda of cutting heath service costs to this population – dressing it as efficiency does not wash.

In this context it can feel easier to cut low tech low cost services to protect the high cost, high tech, highly qualified services.  But as Alan Brace points out in my blog : Why is it so Difficult to Implement Continuity of Carer, it maybe the low cost services people actually need and it won’t save money to funnel more people into high cost services who only needed a low cost service.  This is the case with Maternity care in special degree – why send healthy young women across a vast county to birth in a high cost obstetric unit when they can more cheaply and safely birth at home or in a midwifery led unit? But if you have made a capital investment in a new Obstetric unit as SaTH has done – it has to be paid for by a higher throughput of women.  Read Belinda Phipps analysis in my blog: One to One Midwifery: How things can Change, of why Trusts may not save money by promoting midwifery led care.  In Austerity NHS, medical-based evidence may come second to a real terms reduction in NHS budget and whoever shouts loudest wins – so shout!

To support those campaigning locally for Shropshire MLUs join the Facebook group : https://www.facebook.com/groups/1219003658173471/

To join in a positive discussion about Freestanding Midwifery Led Units in rural areas and implementing the National Maternity Review for rural populations come to the fantastic Conference Chaired by Baroness Cumberlege 13^th February for just £35 at the Shropshire Conference centre.  More info here: https://www.facebook.com/events/151748521970107/

 

Save the NHS – Waterbirth!

“A woman in birth is at once her most powerful, and her most vulnerable.” Marcie Macari

There are some areas of maternity care which are so valuable, so game changing, that it is remarkable that they are not the default offering for women in labour.  At our most vulnerable time we can be supported to be our most powerful.  Labour and birth in water can transform childbirth, and at the same time it fulfils a vital requirement of our health service: to save money.

Jeremy Hunt continues to force the NHS to make “efficiency” savings, and the NHS has an obligation to provide the best care that it can. Given that waterbirth firmly ticks both of these boxes, it is essential that all trusts ensure that they are providing a sufficient number of birthing pools to be able to offer them to all women who wish to use water.

Tell me more about these cost savings

In summary, water labour and birth compared to land labour and birth reduces the number of interventions or complications that women experience. Some interventions and complications cost the NHS money immediately (such as caesareans, forceps, transfer to the hospital from an out of hospital birth, chemical pain relief) and some also create costs on an ongoing basis due to follow up care (eg caesareans, perineal damage, birth trauma).

Let’s back that up with some research.  Looking at caesarean sections, an Italian study in 2014 found that the women in their study who birthed in water had a 94-99% spontaneous vaginal birth rate, in a country where the caesarean birth rate is 38%! A follow on evaluation of Birthplace 2011 showed a reduction in risk of caesarean birth by 20% for first time mothers. The same review also showed that the number of women who were transferred to hospital having planned an out of hospital birth was also significantly reduced for women who laboured in water.

A 2004 observational study over a 9 year period found that waterbirths reduced the risks of perineal tearing, episiotomies and reduces the mother’s blood loss. This leads to NHS cost reductions in follow up care for tears or cuts, and for treatment for anaemia – and leads to a reduction in women coping with new parenthood without being able to sit comfortably (something that we all need to do a lot of as we feed our newborns), and reduces the number of women coping with pathological exhaustion on top of normal postnatal tiredness.

This is just a very small summary of the evidence that is available, because there are hundreds of studies which show the benefits of waterbirth to women, and to the NHS, which we will continue to blog about over the coming months.

Let’s put this into practice!

Aquabirths came about because of my passion for supporting women in birth, and because to be able to ensure that women have access to a pool if she chooses to birth in a hospital or midwife led unit, trusts need to be able to afford the capital cost of installing them. The original investment will be repaid by saving just a couple of women from an unwanted caesarean, and the human cost of an unwanted caesarean is priceless. Aquabirths fitted pools are available from £2900 including plumbing components, and are discounted even further when 2 or more are ordered. They’re manufactured in one piece to make fitting as easy as possible, and Aquabirths will do the installation if required.  The pools are easy to repair in the very unlikely situation that they’re damaged, due to their fibreglass construction rather than plastic, and they also come with an industry-best 10 year warranty.

Ongoing care is made easy and cheap by the fact that the baths are manufactured in one piece, making cleaning and hygiene control quick and effective. All plumbing components are standard parts, so they’re easy to replace if required, although this is very rarely needed, just like it’s almost never the case that you need to replace plumbing in your own home.

In a follow up post I’m going to talk some more about access to birth pools. At the moment, many trusts have a policy which means that many women are not eligible to use them unless they’re classed as “low risk” (a term which I should also cover at some point!). I’ll just leave this post with one final thought. “High risk” women are often denied access to a pool, but told to take a bath, and the same women are denied access to a pool, but instead offered heroin (diamorphine) in labour without being told what they’re being given. It’s time to take another look at labour and birth in water and the benefits of it to women, babies,

…and trust finances.

Aquabirths are running a special offer of a free birth couch (currently £795, normal price £950) with every Canberra, Venus or Heart-shaped Birthing Pool. Use code SB161102  when ordering the Pool.

 

I’ve Had Enough Of Hearing About Jeremy Corbyn.

I don’t re-blog blogs and I don’t want to be party political here.  But this blog is an exception because ultimately it discerns the Corbyn phenomena as a  strong desire for change – he just happened to get in the way of it!  Whatever your political persuasion this blog has a message about making change happen. And that politics and change-making should be about making things better for people – especially the most vulnerable: the sick the young, the very old, the poor, the refugee.  And of course those of us in maternity know how very important change for the benefit of women babies and families is important at this time.

Hold on to your seats for this roller coaster blog!

Right, that’s it, I’ve had enough. I’ve sat on my hands for long enough. I’ve spent months looking at conversations and threads on the internet about Jeremy Corbyn, about ho…

Source: I’ve Had Enough Of Hearing About Jeremy Corbyn.

“In case you sue us”. A discussion on consent.

Guest blog by Emma Ashworth

I had a mole removed yesterday.  Just a simple procedure, done in the GP clinic on a smooth running, efficient weekly service.

Before the doctor went anywhere near me with a scalpel, I was asked to sign a consent form because, of course, even when I ask someone to cut a piece off me, we all need to be very clear about what exactly I have requested, and what they have agreed to do.  I’m quite fussy about consent forms.  I like to know what I’m signing.  I like to read all of the details and to ensure that I clearly understand what is being offered and what the potential risks may be.

Consent forms can often be long and complicated.  This one wasn’t – it was a small piece of text on an A5 sheet of paper and the consent wording was along the lines of, “I agree that I have been fully informed of all of the risks, which may include bleeding, pain and scaring”.  It reminded me of a self-discharge form that I was asked to sign in hospital once.  It stated that, “I have been made fully aware of all of the risks of self-discharging”.  However, the reason that I was self-discharging was that I had been in the hospital for two days without seeing a doctor once, my symptoms had gone and I was clearly low priority, as otherwise I would have already have had a discussion with the doctor, which would have meant that I was, in fact, fully aware of any risks of leaving.  I hadn’t, so I wasn’t.  I declined to sign that form and left anyway.

In AD 579, Emperor Justin II was in need of emergency surgery.  No surgeon would even attempt the procedure because they were too worried about being blamed for it if it went wrong.  Emperor Justin handed the surgeons the scalpel himself to clearly show his request for the surgery, and promised that there would be no retributions if they failed.  In fact, he died, so it’s a good job that they did!  This very early example of consent being gained for the surgeons’ protection rather than the patient’s, is now being repeated time after time in our hospitals and clinics.  The time pressures on clinicians is such that it is extraordinarily difficult for them to walk us through the pros and cons of different options, and so often reduced to the effects of the paternalism endemic throughout history, where the likes of Henri de Mondeville in the late 13^th Century stated, “patients […] should obey their surgeons implicitly in everything appertaining to their cure”, and even the Hippocratic texts which recommend, “concealing most things from the patient, while you are attending to him.”

While the lack of information sharing nowadays is almost always for entirely different reasons (a lack of time, not desire for control), we do see responses from medical staff when we ask for more information which perhaps many might get huge value from reflecting on. In my experience, impatience is the usual reaction, which again is likely to be because of time constraints, but sometimes there is perhaps a paternalistic throw back. For instance, I was once in a meeting with a consultant who was in discussions with a doula client.  She had plenty to ask after much preparation between us.  After she had gone through a number of her questions, the doctor asked in rather frustrated tones, “You seem to know an awful lot about this. Who have you been talking to?”

My client responded, “Well, my doula”

To which the doctor snapped back, “No, I meant which professionals?”.

So, to go back to my own minor surgery yesterday. I read the consent form and I pointed out that to sign to say that I was fully informed of the potential risks, without them all being laid out, was not full consent. The doctor replied that there was a list, look, right there, and anyway it’s just, he said, so that you won’t sue if there’s any issues.  I explained that I meant that the wording itself implied that there were other risks that weren’t listed – I couldn’t blanket consent to say that I know everything – and, importantly from his perspective, he was unlikely to be protected if, say, he hit a tendon and caused me to lose function in my hand.

The next day I happened to be in the same GP surgery again for a physio appointment. Because my wound had bled quite badly, I asked the receptionist if she would be able to get me a replacement dressing from the nurse.  “Oh no”, she replied, “you’ll have to have an appointment for that”.

“Why?” I asked. “It’s basically like changing a plaster, I can just do it myself”.

“Well,” she responded, “you might sue us if it’s been bleeding so I need to make sure that the nurse sees you to protect ourselves.”

Is this really where we have gone with obtaining consent? I cannot change my own simple dressing because I might sue for some minor bleeding that I’d already signed to say that I understood might happen?.  On the one hand, are health professionals trying to desperately cover themselves with extensive notes, and consent forms which may or may not be adequate, and on the other hand completely unable to give people in their care the time to actually talk things through properly? What does obtaining consent mean? When women in the throes of labour are bullied in caesareans with long speeches about the dangers of continuing with their vaginal birth, and then they are given complex consent forms with risks such as “death” as they’re being wheeled towards the theatre, can we really say that they’re consenting?  And in the end, who, if anyone, is being protected here?

Consent is not as simple as signing a consent form. Food for thought for both health carers and the people in their care.

 

 

NMC Consultation – Respond before 17th June and here’s some help with doing it.

Guest Blog by Rachel Gardner of Forging Families

Dear Friends,

This is the most important thing I have ever written, and I implore you to read it and act upon it by answering these two questions in this government questionnaire.

This is not about labour or conservatives, this is about midwives and women and birth and about saving women’s choice in birth and about saving the midwives who support these changes.

Please get involved and get others involved. The deadline is 17th June. ACT NOW.

THE MOST IMPORTANT QUESTIONNAIRE YOU COULD EVER COMPLETE.

This questionnaire is here:

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/518039/NMC_regulation_consultation_document_A.pdf

It is for professionals and the public but is worded in such a way that most members of the public would not fully understand what is being asked.

There are two questions that you MUST answer. The rest of the questions you can skip but the first two please respond too, and then submit your questionnaire to the government.

Question 1 is:

Do you agree that this additional tier of regulation for midwives should be removed?

This question is referring to the role of Supervisor of Midwives. Supervisor of midwives role is to protect women’s choice, and women’s choice regarding their birth is one the most important things in maternity. Supervisors of Midwives support women choosing birth outside of ‘policy’ or outside of specific guidelines.
Without the role of Supervisor of Midwives the potential is for Trusts to refuse to care for women choosing care outside box guidelines and there will be no protection or support for midwives providing care in these instances.

This would be a catastrophe for maternity care and for women and for choice in birth.

Midwifery supervision brings challenge to Trusts when advocating for the safety of women. This is a healthy level of challenge ensuring Trusts management maintain women’s safety as the focus of their care, enabling women’s choices to be listened to and respected. SoMs also work collaboratively across trusts sharing best practice, completing external investigations and providing “fresh eyes” on midwifery practice. All this has the potential to be lost with the removal of the regulatory function of Supervisors of Midwives.

Do we agree with this happening? No, no no!

Question 2 is:

Do you agree that the current requirement in the NMC’s legislation for a statutory Midwifery Committee should be removed?

Considering the NMC stands for Nursing and Midwifery Council there is poor representation by midwives in the council. If the midwifery Committee is to be removed from the NMC the voice of midwives will become weaker than ever. Someone has to protect the function and role of a midwife or it will be lost forever. Allied health professionals are not just nurses in the same way as midwives are not just nurses. This is like physiotherapists being regulated by radiographers. It just doesn’t make sense. The professions although within health are completely different.

Should we remove midwives from the Nursing and MIDWIFERY Council? No, no, no!